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Perio 2 > peri-implantitis and tx > Flashcards

peri-implantitis and tx Flashcards

1
Q

BIOLOGY OF IMPLANT COMPONENTS

A
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2
Q

Epithelial Attachment of implants

A
  • 2mm
  • Long junctional epithelium attached implant
  • Via basal lamina and hemidesmosomes
  • same in both tooth and implant
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3
Q

conn tissue of implant

A
  • Parallel, circular “cuff-like” fiber bundles
  • Seal with a space of a 20nm wide proteoglycan layer
  • 1-1.5mm high
  • CT not directly attached to implant surface
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4
Q

typical supracrestal attatchment of implants

A
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5
Q

Soft Tissue Assessment of implants (compared to teeth)
probing depth? (with force of .25N)
buccal mucosa thickness
papilla height and fill ?

A
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6
Q

Osseointegration vs PDL
mechanoreception

A

No PDL=no mechanoreception

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7
Q

implant vascularity
* limited where?
* sources
* inflamm response

A

same inlfamm response

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8
Q

MD aspect of implant positioning

A
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9
Q

BL aspects of implant position

A

1.8mm buccal bone

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10
Q

apical coronal aspect of implant position

A

3-4 mm for bio width

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11
Q

Peri-implant Diseases and Conditions

A
  • Peri-implant health
  • Peri-implant mucositis
  • Peri-implantitis
  • Peri-implant hard and soft tissue deficiencies
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12
Q

Peri-implant mucositis
Prevalence:

A

79% of patients
50-90% of implants

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13
Q

Peri-implant mucositis
Caused by?
Presence of ?
Reversible?
Precursor of?

A

Caused by plaque accumulation.
Presence of inflammation.
Reversible condition.
Precursor of peri-implantitis

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14
Q

Peri-implantitis
Prevalence:

A

20% of patients
10-56% of implants

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15
Q

Peri-implantitis
Caused by?
Presence of?
Loss of ?
reversible?

A

Caused by plaque accumulation.
Presence of inflammation.
Loss of supporting bone.
Non-reversible condition.

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16
Q

Peri-implant hard and soft tissue deficiencies
Contributing factors:

A

tooth loss, trauma, periodontitis, thin
soft tissue, lack of keratinized mucosa,
implant malposition, etc

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17
Q

pl;aque and host response compariosn btwn teeth and implants

A
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18
Q

microbiom of teeth and implants

A

The microbiome may be different
although the opportunistic
periodontal pathogens can be
identified in peri-implantiti

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19
Q

inflamm response in teeth vs implants and reversal?

A

Stronger inflammatory response was
around implants than teeth; need
longer time to complete reverse
peri-mucositis than gingivitis

20
Q

Peri-implantitis vs periodontitis histo

A

Peri-implantitis contained larger
proportions of neutrophil granulocytes
and osteoclasts than in periodontitis

21
Q

Peri-implantitis risk factors/indicators

A
  • Poor plaque control
  • Lack of regular maintenance
  • Tissue quality: thin phenotype, bonedeficiency
  • Iatrogenic factors: malpositioning, poor design of emergency profile, inadequate abutment/implant seating
  • Excessive cement
  • Occlusal overload
  • Titanium particles: implant corrosion, micromovement
    History of periodontal disease
    Smoking
    DM
    Genetic factors/
    systemic condition
22
Q

peri implantits presentation

A
  • Inflammation: redness, swelling
  • Pain
  • Suppuration
  • Bone loss
23
Q

how does peri implantitis occur

A

susceptiable host with microbial dysbiosis

24
Q

clinical exam of implants

A

Peri-implant tissue
Occlusion and mobility
Plaque, probing depth, BOP, exudates

25
Q

Peri-implant probing Diagnostic Procedures
Variables in peri-implant probing

A

Variables:
- Probe Positioning
- Presence of Inflammation (BoP, Exudates)

Plastic or Metal? DOESNT MATTER

26
Q

Occlusal Evaluation and Mobility of implants

A
27
Q

Successful and stable
osseointegrated implants
mobility?

A

Successful and stable
osseointegrated implants
exhibited NO mobility

28
Q

what could be loosened from occ/mobility?

A
29
Q

Peri-implant tissue examination

A

The impact of the soft tissue phenotype
modification on peri-implant health

30
Q

KERATINIZED TISSUE WIDTH
MUCOSA THICKNESS
INITIAL TISSUE THICKNESS

req for success of implant

A

2mm

31
Q

Radiogrpahic exam
Peri-implant radiolucency
Bone level Assessment

to be considered successful?

A

< 0.2mm bone loss per year after the 1st-year loading
< 2mm bone loss starting after loading

32
Q

TREATMENT MODALITIES

decision tree

A
33
Q

TREATMENT MODALITIES for peri-implantitis

A
34
Q

surgical techniques for peri-implantitis

A

IMPLANTOPLASTY RESECTIVE SURGERY
REGENERATIVE SURGERY:
BONE GRAFT or SOFT TISSUE GRAFT

removal of biofilm and any debris

35
Q

local abx delivery devices

A
  • tetracycline fibers
  • doxy gel
  • minocycline microspheres
36
Q

implant surface decontamination devices

A

air polisher and laser

37
Q

MAINTENANCE OF DENTAL IMPLANTS
* Provide guidelines for?
* Focus on?
* Work as a team?
* Prevent future complications by?

A
  • Provide guidelines for maintaining the long term health of the dental implant
  • Focus on both hard and soft tissue stability around the dental implant
  • Work as a team— patient are co-therapists in the maintenance therapy
  • Prevent future complications by thorough diagnosis and treatment planning
38
Q

WHY of implant maintenance
* Detect?
* Plan corrective interventions
* Important clinical decisions must be reached at?

A
  • Detect early signs of disease
  • Plan corrective interventions
  • Important clinical decisions must be reached at several stages during treatment and maintenance of implant patients
39
Q

HOW of implant maintenance
Establish useful set of clinical parameters to?
components of this?

A

Establish useful set of clinical parameters to evaluate dental implants
Components:
1. Assessment of home care
1. Examination of peri-implant soft tissue
1. Radiographic examination

40
Q

RADIOGRAPH protocols for follow up

A

Examples of varying protocols are:
Initial placement: 3 months, 6 months, 12 months, every 2 years.
Initial placement: 6 months, 12 months, and every 2 years if no pathology present.
Initial placement: every 6 months if pathology present.

41
Q

WHAT of implant maintenance

  • A thorough review of?
  • Deposit removal?
  • Appropriate use of?
  • Reevaluation of?
A
  • A thorough review of oral hygiene reinforcement and modifications
  • Deposit removal from implant/prosthesis surfaces
  • Appropriate use of antibiotics
  • Reevaluation of the present maintenance interval, with modification as dictated by the clinical presentation
42
Q

oral hy mod: IP brushes

A

Interproximal brushes can effectively
penetrate up to 3mm into a gingival
sulcus and may effectively clean a
peri-implant sulcus

43
Q

what tools to avoid with devbridement

A

SCALERS MADE OF STAINLESS STEEL AND ULTRASONIC TIPS CAN ROUGHEN THE IMPLANT SURFACES CREATING SCARRING AND PITTING
use Ti or plastic instead

44
Q

Cumulative Interceptive Supportive Therapy flow chart based on PD
(<3, 4-5, >5)

A
45
Q

WHEN of implant maintenance

  • Maintenance treatment should be customized according to?
  • Patients with history of periodontitis with acceptable self-care:
  • Patients with no systemic or local risk factors:
A
  • Maintenance treatment should be customized according to each patient’s systemic and local risk factors.
  • Patients with history of periodontitis with acceptable self-care: 3-month recare interval
  • Patients with no systemic or local risk factors: 6 month recare interval
46
Q

SUMMARY
* Respect the what when placing
implants?
* Evaluate implants at every?
* Know the implant complications
* Detect early, treat accordingly or
refer/consult early?

A
  • Respect the biology when placing
    implants
  • Evaluate implants at every maintenance appointment
  • Know the implant complications
  • Detect early, treat accordingly or
    refer/consult early
47
Q

critical areas for implant maintenance/ reevaluation

A
  • peri-implat tissue
  • connection of prothesis and implant
  • prothesis
  • bone level

Perio 2 (13 decks)

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