peri-implantitis and tx Flashcards
BIOLOGY OF IMPLANT COMPONENTS
Epithelial Attachment of implants
- 2mm
- Long junctional epithelium attached implant
- Via basal lamina and hemidesmosomes
- same in both tooth and implant
conn tissue of implant
- 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
typical supracrestal attatchment of implants
Soft Tissue Assessment of implants (compared to teeth)
probing depth? (with force of .25N)
buccal mucosa thickness
papilla height and fill ?
Osseointegration vs PDL
mechanoreception
No PDL=no mechanoreception
implant vascularity
* limited where?
* sources
* inflamm response
same inlfamm response
MD aspect of implant positioning
BL aspects of implant position
1.8mm buccal bone
apical coronal aspect of implant position
3-4 mm for bio width
Peri-implant Diseases and Conditions
- Peri-implant health
- Peri-implant mucositis
- Peri-implantitis
- Peri-implant hard and soft tissue deficiencies
Peri-implant mucositis
Prevalence:
79% of patients
50-90% of implants
Peri-implant mucositis
Caused by?
Presence of ?
Reversible?
Precursor of?
Caused by plaque accumulation.
Presence of inflammation.
Reversible condition.
Precursor of peri-implantitis
Peri-implantitis
Prevalence:
20% of patients
10-56% of implants
Peri-implantitis
Caused by?
Presence of?
Loss of ?
reversible?
Caused by plaque accumulation.
Presence of inflammation.
Loss of supporting bone.
Non-reversible condition.
Peri-implant hard and soft tissue deficiencies
Contributing factors:
tooth loss, trauma, periodontitis, thin
soft tissue, lack of keratinized mucosa,
implant malposition, etc
pl;aque and host response compariosn btwn teeth and implants
microbiom of teeth and implants
The microbiome may be different
although the opportunistic
periodontal pathogens can be
identified in peri-implantiti
inflamm response in teeth vs implants and reversal?
Stronger inflammatory response was
around implants than teeth; need
longer time to complete reverse
peri-mucositis than gingivitis
Peri-implantitis vs periodontitis histo
Peri-implantitis contained larger
proportions of neutrophil granulocytes
and osteoclasts than in periodontitis
Peri-implantitis risk factors/indicators
- 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
peri implantits presentation
- Inflammation: redness, swelling
- Pain
- Suppuration
- Bone loss
how does peri implantitis occur
susceptiable host with microbial dysbiosis
clinical exam of implants
Peri-implant tissue
Occlusion and mobility
Plaque, probing depth, BOP, exudates
Peri-implant probing Diagnostic Procedures
Variables in peri-implant probing
Variables:
- Probe Positioning
- Presence of Inflammation (BoP, Exudates)
Plastic or Metal? DOESNT MATTER
Occlusal Evaluation and Mobility of implants
Successful and stable
osseointegrated implants
mobility?
Successful and stable
osseointegrated implants
exhibited NO mobility
what could be loosened from occ/mobility?
Peri-implant tissue examination
The impact of the soft tissue phenotype
modification on peri-implant health
KERATINIZED TISSUE WIDTH
MUCOSA THICKNESS
INITIAL TISSUE THICKNESS
req for success of implant
2mm
Radiogrpahic exam
Peri-implant radiolucency
Bone level Assessment
to be considered successful?
< 0.2mm bone loss per year after the 1st-year loading
< 2mm bone loss starting after loading
TREATMENT MODALITIES
decision tree
TREATMENT MODALITIES for peri-implantitis
surgical techniques for peri-implantitis
IMPLANTOPLASTY RESECTIVE SURGERY
REGENERATIVE SURGERY:
BONE GRAFT or SOFT TISSUE GRAFT
removal of biofilm and any debris
local abx delivery devices
- tetracycline fibers
- doxy gel
- minocycline microspheres
implant surface decontamination devices
air polisher and laser
MAINTENANCE OF DENTAL IMPLANTS
* Provide guidelines for?
* Focus on?
* Work as a team?
* Prevent future complications by?
- 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
WHY of implant maintenance
* Detect?
* Plan corrective interventions
* Important clinical decisions must be reached at?
- Detect early signs of disease
- Plan corrective interventions
- Important clinical decisions must be reached at several stages during treatment and maintenance of implant patients
HOW of implant maintenance
Establish useful set of clinical parameters to?
components of this?
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
RADIOGRAPH protocols for follow up
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.
WHAT of implant maintenance
- A thorough review of?
- Deposit removal?
- Appropriate use of?
- Reevaluation of?
- 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
oral hy mod: IP brushes
Interproximal brushes can effectively
penetrate up to 3mm into a gingival
sulcus and may effectively clean a
peri-implant sulcus
what tools to avoid with devbridement
SCALERS MADE OF STAINLESS STEEL AND ULTRASONIC TIPS CAN ROUGHEN THE IMPLANT SURFACES CREATING SCARRING AND PITTING
use Ti or plastic instead
Cumulative Interceptive Supportive Therapy flow chart based on PD
(<3, 4-5, >5)
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:
- 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
SUMMARY
* Respect the what when placing
implants?
* Evaluate implants at every?
* Know the implant complications
* Detect early, treat accordingly or
refer/consult early?
- Respect the biology when placing
implants - Evaluate implants at every maintenance appointment
- Know the implant complications
- Detect early, treat accordingly or
refer/consult early
critical areas for implant maintenance/ reevaluation
- peri-implat tissue
- connection of prothesis and implant
- prothesis
- bone level
