Peri-Implant Diseases

Question 1

Peri-Implant Health

Answer 1

• No Inflammation
• No BOP
• No Suppuration
• No ⇡ PDs
• No Bone Loss
  
  • only bone remodeling

Question 2

Peri-Implant Mucositis

Answer 2

• BOP
• Suppuration-maybe
• No PD Change
  
  • with or without
• No Bone Loss

Question 3

Peri-Implant Implantitis

Answer 3

• BOP
• Suppuration-maybe
• ⇡ PD
• Bone Loss
• if no previous exam data:
  
  • BOP
  • Suppuration (maybe)
  • PD ≥ 6mm
  • Bone Level ≥ 3mm apical to most coronal intraosseous part of implant

Question 4

Peri-Implant Hard and Soft Tissue Deficiences

Answer 4

• Hard Tissue
  
  • Before Implant Placement
    
    • Systemic Diseases
    • Tooth Loss
    • Trauma
    • Trauma from Tooth Extraction
    • Periodontitis
    • Endo Infection
    • Longitudinal Root Fractures
    • Posterior Maxilla Bone Height
  • After Implant Placement
    
    • Systemic Diseases
    • Healthy Defects
    • Implant Malposition
    • Peri-implantitis
    • Mechanical Overload
    • Soft Tissue Thickness
• Soft Tissue:
  
  • Before Implant placement:
    
    • Systemic Diseases
    • Tooth Loss
    • Periodontal Disease
  • After:
    
    • No Buccal Bone
    • Papilla Height
    • Keratinized Tissue
    • Tooth Migration
    • Life-Long Skeletal Changes

Question 5

Peri-implantitis vs Peri-mucositis: Etiology & Tx

Answer 5

• Mucositis:
  
  • Etiology: Xs Cement (86%)
  • remove XS and GBR
• Implantitis:
  
  • Etiology: Plaque
  • mechanical debridement
    
    • resolves in 3 weeks

Question 6

Clinical Differences b/w healthy periodontal and peri-implant tissues

Answer 6

• No visual differences
• PD:
  
  • Implant > Tooth
• Interproximal Papilla:
  
  • Implant=Shorter

Question 7

What does a peri-implant exam consist of?

Answer 7

• Inflammation:
  
  • visual
  • probing
    
    • BOP
    • PD
    • Mucosal Margin migration
  • Palpation

Question 8

Ailing Implant vs Failing Implant vs Failed Implant

Answer 8

• Ailing:
  
  • No Mobility
  • No Inflammation
  • Radiographic Bone Loss
• Failing Implant:
  
  • No Mobility
  • Inflammation
  • Progressive Bone Loss
• Failed:
  
  • Mobile
  • Non-functional
  • Need to remove

Question 9

CIST

Answer 9

• Cumulative Interceptive Supportive Therapy
• Based one periodic diagnosis
• 4 Treatment Modalities:
  
  • A= Mechanical
  • B= Antiseptic Treatment
  • C: Antibiotic Tx
  • D: Regeneratie or resectie surgery

Question 10

Peri-implant disease: Risk Factors

Answer 10

• Poor Plaque Control
• No Maintenace
• Smoking/Diabetes
• History of Perio

Question 11

What should you do after finishing implant supported prosthesis?

Answer 11

• Baseline:
  
  • radiographs
  • PD
• Radiographs after loading period
  
  • Bone Level Reference after remodeling

Question 12

Patient Plaque Control around Implant

Answer 12

• Methods:
  
  • Floss
  • Sulcular Bass Brushing Technique
    
    • Cleans under mucosa
    • caution with Narrow WKG
  • After osseointegration:
    
    • Interdental Brush
    • Rubber Tip

Question 13

Professional Plaque Control around Implant

Answer 13

• Perio Maintenance:
  
  • 3-4 months if tooth loss due to caries or perio
• Minimal Damage to transmucosal surfaces when removing plaque and calc
  
  • ex: Polished titanium implant collar
• Gold or ceramic surfaces
  
  • use most scalers and curettes w/no damage
  • ex: Plastic, gold coated, stainless steel
• Metal Probe
  
  • no concern→Minimal surface alteration
  • Plastic Probe=Effective
• Rubber Cup & Polishing Paste
  
  • remove biofilm
  • machined and polished surfaces
• Ultrasonic Instruments w/metal tips
  
  • Magnetostrictive or Pizoelectric
    
    • ex: Cavitron
  • Caution→Surface irregularities
    
    • use special tip
• Friendly Materials for Abutment:
  
  • Teflon
  • Titanium
  • Gold
  • Plastic Tips

Question 14

What to evaluate for Implant Prosthesis: At Delivery vs F/u Visits

Answer 14

• Delivery:
  
  • Radiograph=Baseline
  • Complete seating
    
    • Implant Abutment Interface
  • Cement retained
    
    • No XS cement
• F/u Visits
  
  • loose screws or fractures
    
    • Replace:
      
      • Loose screws & toque down
      • worn out retentive parts
        
        • Hader Clips
        • Locator attachment inserts
  • Occlusal guards

Question 15

What are the main peri-implant diseases?

Answer 15

• Health
• Mucositis
• Implantitis
• Hard & Soft Tissue Defiicencies

Question 16

What are the main treatment modalities for peri-implantitis?

Answer 16

• Mechanical Debridement
• Antiseptic Tx
• ANtibiotic Tx
• Regenerative or Resective Sx

Question 17

Why does excess cement cause peri-implantitis?

Answer 17

• Allows bacterize to colonize→ ⇡Inflammation around implant

Question 18

Types of Implant Complications?

Answer 18

• Biologic
• Esthetic
• Mechanical

Question 19

Biologic Implant Complications

Answer 19

• Mucosal Inflammation
• Mucosal Hyperplasia
• Mobility
• BOP
• Suppuration
• ⇡ PD
• BL
• Thread Exposure
• Peri-implant diseases
• Pain

Question 20

Esthetic Implant Complications

Answer 20

• Poor positioning
• Poor Restoration
• Poor Appearance
  
  • inadequate tx planning
• Recession
• Hard & Soft Tissue Deficiency

Question 21

Mechanical Implant Complication

Answer 21

• Screw Loose
• Screw Frature
• Meshwork Fracture
• Ceramic Fracture
• Implant Fracture

Question 22

Prosthetic Design

Answer 22

• Proper Assessment
  
  • crucial for dx and tx plan
  • proper emergence profile
• Innaccurate assessment
  
  • Prosthesis Misfit
    
    • Passive Misfit ⇡Burden on Bone
    • Bacteria Colonize space b/w prosthesis
  • Biocompatabilty
    
    • Zirconia > Metal

Question 23

Excess Cement

Answer 23

• Peri-implantitis (81%)
  
  • Increase:
    
    • Plaque
    • Bleeding index
    • Suppuration
    • Fistula
• Radiographs can’t detect
• Cement Types→ proliferation of bacterial strains
• Impossible to remove all excess when abutment margin≥ 1 mm subg

Question 24

Types of Cement

Answer 24

• Methacrylate
  
  • Bacterial Colonization
• Zinc Oxide Non-Eugenol
  
  • Less host response in vitro

Question 25

What are some techniques to minimize excess cement?

Answer 25

• Teflon Tape
• Venting
• Dual Cord
• Dummy abutment

Question 26

Cemented retained vs Screw Retained Complications

Answer 26

• Cemented Retained
  
  • BIologic complications
    
    • plaque control to prevent
• Screw Retained
  
  • Technique Complication
  • preferred due to:
    
    • retrievability
    • High Biologic compatibility

Question 27

What are some crucial factors for cement retained restorations?

Answer 27

• Implant position
• Abutment selection
• Retention Design
• Margin Position

Question 28

Fracture and Loosening?

Answer 28

• Facilitate Peri-implant disease
  
  • bacteria colonize spaces

Question 29

Lack of Keratinized Mucosa

Answer 29

• Increase:
  
  • Plaque accumulation
  • inflammation
  • recession
  • attachment loss
• Increase Keratinized Tissue w/Tissue Graft
  
  • Reduce Gingival Complications:
    
    • physical compression
    • contact w/ restorative material
    • Biofilm

Question 30

Open Contacts

Answer 30

• Proximal Contact tightness Decreases overtime
  
  • replace restoration
  • Modify restoration
  • restore adjacent tooth
• associated w/peri-implantitis

Question 31

Retrograde implantitis

Answer 31

• Previous RCT on Adjacent teeth
  
  • not curetted well after extraction