Peri-Implantitis Diagnosis and Prevention Flashcards by Pickle Rick

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”

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NEW CLASSIFICATION
(4)

Peri-implant health
Peri-implant mucositis
Peri-implantitis
Peri-implant hard and soft tissue deficiencies

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Peri-implant health

Absence of erythema, bleeding on
probing, swelling and suppuration.

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Peri-implant mucositis
Caused by —
Presence of —.
— condition.
Precursor of —

plaque accumulation.
inflammation
Reversible
peri-implantitis.

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Peri-implant mucositis
Prevalence: –% of patients and –% of implants

79
50-90

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Peri-implantitis
Caused by —
Presence of —.
Loss of —
— condition

plaque accumulation.
inflammation
supporting bone.
Non-reversible

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Peri-implantitis
Prevalence: –% of patients and –% of implants

20
10-56

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TOOTH VERSUS IMPLANT: Epithelial Attachment

Similarities with –
Long junctional epithelium attached implant ~

tooth surface
2mm long
via basal lamina and hemidesmosomes

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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

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TOOTH VERSUS IMPLANT: Soft Tissue Assessment
(3)

Probing
Dimensions of the buccal soft tissue
Dimensions of the papilla

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Probing force –

0.25N

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TOOTH VERSUS IMPLANT: Osseointegration vs PDL (2)

Periodontal mechanoreceptors
Higher stress at the neck of the screw/implant

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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

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PDL space ~ –

0.2mm

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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

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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