Peri-Implantitis Diagnosis and Prevention Flashcards
PERI-IMPLANTITIS
“a plaque-associated pathologic condition occurring
in tissue around dental implants, characterized by
inflammation in the peri-implant mucosa and
subsequent progressive loss of supporting bone”
NEW CLASSIFICATION
(4)
Peri-implant health
Peri-implant mucositis
Peri-implantitis
Peri-implant hard and soft tissue deficiencies
Peri-implant health
Absence of erythema, bleeding on
probing, swelling and suppuration.
Peri-implant mucositis
Caused by —
Presence of —.
— condition.
Precursor of —
plaque accumulation.
inflammation
Reversible
peri-implantitis.
Peri-implant mucositis
Prevalence: –% of patients and –% of implants
79
50-90
Peri-implantitis
Caused by —
Presence of —.
Loss of —
— condition
plaque accumulation.
inflammation
supporting bone.
Non-reversible
Peri-implantitis
Prevalence: –% of patients and –% of implants
20
10-56
TOOTH VERSUS IMPLANT: Epithelial Attachment
Similarities with –
Long junctional epithelium attached implant ~
tooth surface
2mm long
via basal lamina and hemidesmosomes
TOOTH VERSUS IMPLANT: Connective Tissue
Similarities to —
Differences with —
fiber bundles:
A space of — wide proteoglycan layer
— rich but cell poor
Supracrestal connective tissue zone —high
tooth surface
tooth surface
Parallel, circular “cuff-like”
20nm
Collagen
~ 1-1.5mm
TOOTH VERSUS IMPLANT: Soft Tissue Assessment
(3)
Probing
Dimensions of the buccal soft tissue
Dimensions of the papilla
Probing force –
0.25N
TOOTH VERSUS IMPLANT: Osseointegration vs PDL (2)
Periodontal mechanoreceptors
Higher stress at the neck of the screw/implant
Implant patients
have less awareness
of occlusal
interferences
Timed occlusal contacts
Teeth opposing teeth:
Implant opposing teeth:
Implant opposing implant:
20 microns
48 microns
64 microns
PDL space ~ –
0.2mm
TOOTH VERSUS IMPLANT: Vascularity
(3)
Vascularity in peri-implant gingival mucosa is limited
Vascularity in connective tissue under sulcular/junctional epithelium is similar
Inflammatory response to plaque is the same way
Periodontal disease vs Peri-implant disease
The microbiome may be different
although the opportunistic
periodontal pathogens can be
identified in — patients.
peri-implantitis
Stronger inflammatory response was
around implants than teeth; need
— time to complete reverse peri-
mucositis than gingivitis
longer
Peri-implantitis contained larger
proportions of (2) than in periodontitis
neutrophil granulocytes
and osteoclasts
Peri-implantitis
risk factors/indicators
(7)
Poor plaque control
Lack of regular
maintenance
Tissue quality: thin
phenotype, bone
deficiency
Iatrogenic factors:
malpositioning, poor
design of emergency
profile, inadequate
abutment/implant
seating
Excessive cement
Occlusal overload
Titanium particles:
implant corrosion,
micromovemen
Peri-implantitis risk
indicators/modifiers
(4)
History of
periodontal disease
Smoking
DM
Genetic factors/
systemic condition
Disease presentation
(4)
Inflammation:
redness, swelling
Pain
Suppuration
Bone loss
CLINICAL EXAMINATION
(4)
Plaque and calculus
Peri-implant tissue
Occlusion and mobility
Probing depth, BOP, exudates
Peri-implant probing
Diagnostic Procedures
Variables in peri-implant probing
- Probe Positioning
- Presence of Inflammation
Plastic or Metal?
Bleeding on Probing
There is a positive correlation between bleeding on
probing and histologic signs of inflammation at
peri-implant sites.
Exudates?
Definitely there’s — inflammation
chronic
Occlusal Evaluation
Occlusal overload: (3)
Loosening of abutment screws
Implant failure
Prosthetic failure
Implant-Protected Occlusion
(3)
- Occlusal contact position
- No occlusal interference
- Timed occlusal contacts
(light contact)
Successful and stable osseointegrated implants
exhibited no —
mobility
Loose crown:
Loose abutment:
Loose implant body: Oh, no….
Take a radiograph
May need to — to evaluate implant body directly
screw or cement has loosened/broken
abutment screw has loosened
remove the crown/bridge
RADIOGRAPH: Assessment
Peri-implant radiolucency
Bone level
Assessment
< — bone loss per year after the 1st-year loading
< — bone loss starting after loading
0.2mm
2mm
Examples of varying protocols are:
Initial placement:
Initial placement: — if no pathology present.
Initial placement: — if pathology present.
3 months, 6 months, 12 months, every 2 years.
6 months, 12 months, and every 2 years
every 6 months
“HEALTHY
IMPLANT”
(5)
No plaque/calculus
No sign of inflammation
Probing depth ≤ 5mm
No mobility
Bone loss < 2mm
HAPPY LIFE
WHY
(3)
Detect early signs of disease
Plan corrective interventions
Important clinical decisions must be reached
at several stages during treatment and
maintenance of implant patients
MAINTENANCE OF DENTAL IMPLANTS
(4)
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
HOW
Establish useful set of clinical parameters to
evaluate dental implants
Components
(3)
Assessment of home care
Examination of peri-implant soft tissue
Radiographic examination
WHAT
(4)
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 HYGIENE MODIFICATION
Interproximal brushes can effectively
penetrate up to — into a gingival
sulcus and may effectively clean a
peri-implant sulcus
3mm
WHEN
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
