Peri-Imp disease / Maintenance for patients

Question 1

Peri-Imp health

Answer 1

• absence of clinical signs of inflammation
• absence of bleeding/ suppuration on gentle probing
• no increase in PD compared to previous exam (usually 5mm)
• absence of bone loss beyond crestal bone level changes resulting from initial bone remodelling (depends on implant system)

Definition- allows presence of a single bleeding spot around implant

• is there enough keratinised tissue around

Question 2

Peri-imp mucositis

Answer 2

• inflammatory lesion of peri-imp mucosa, in the absence of continuing marginal bone loss
• bleeding on probing
• erythema, swelling and/or suppuration
• increase in probing depth is frequently observed in the presence of peri- implant mucositis due to oedema or a decrease in probing resistance

Question 3

Peri-implantitis

Answer 3

• peri-implant biofilm- associated pathological condition, occurring in tissues around dental implants, and characterized by inflammation in the peri-implant mucosa and subsequent progressive loss of supporting bone
• radiographic bone loss compared with previous examinations

Question 4

Difference of normal tooth vs implant

Answer 4

• can have a PD around Imp even tho its healthy due to lack of PDL

Question 5

Why does this pt gets mucositis?

Answer 5

• big red flag for future implants
• diff to clean due to the pink acrylic in between 2 implants
• refer back to the original dentist who did the procedure

Question 6

Why peri- implantitis?

Answer 6

• prob place the imp too bucally
• not enough buccal bone

Question 7

Answer 7

• use 6 point chart probe
• do not use BPE probe

Question 8

Prevalence of Peri-imp

Answer 8

• 43% have peri-imp mucositis
• 22% with peri-implantitis

Question 9

Factors predisposing peri-implant

Answer 9

• history of severe periodontitis*
• poor plaque control*
• no regular supportive peri-imp care*
• smoking*
• diabetes

Question 10

Local factors causing peri-imp disease

Answer 10

• submucosal cement
• Positioning of implants limiting access to oral hygiene (OH) and maintenance
• absence of peri-implant keratinized mucosa
• occlusal overload
• presence of titanium particles within peri-implant tissues
• bone compression necrosis, overheating, micromotion or biocorrosion

Question 11

Role of GDP

Answer 11

• regular, hollistic care before and after imp
• patient preparation; clinical and emotional
• info about technical aspects and where and who to go see
• referral to an implantologist
• after care and ongoing maintenance

Question 12

Why do they need Imp?

Answer 12

• Congenitally missing teeth
• Tumour resection
• Trauma
• Endodontic failure
• Periodontally related tooth loss
• Behavioural
• Aesthetic

Question 13

Discuss with pt about?

Answer 13

• Are they up for it?
• Do they know what it involves?
• Do you understand some of the surgical complexity e.g might the patient need a sinus lift and what does that mean for them in terms of time, cost and who does the surgery?
• If the drive is chiefly aesthetic? do you understand what things might look like?
• Do they understand what happens after and what the commitment to ongoing care looks like and cost?
• Do they understand the alternatives?

Question 14

Post Placement support

Answer 14

• Oral hygiene around implants; easier to establish good habits before placement
• the referring dentist will take back responsibility for implant monitoring and maintenance

Question 15

Post placement problems

Answer 15

Question 16

Assessing dental imp and restoration

Answer 16

• look for inflammation/ infection
• check OH
• probe around imp and compare probing depth
• Check the restoration for signs of cracks, loosening, cleansability
• take radiograph and check bone levels
• regularity

Question 17

What to look for?

Answer 17

Question 18

Levels of prevention for Peri-imp disease

Answer 18