perio - peri implant disease

Question 1

2 key reasons for implant failure

Answer 1

1. cement remaining
2. poor placement of implants

Question 2

what constitutes peri implant health

Answer 2

• absence of clinical signs of inflammation
• absence of bleeding / suppuration on gentle probing
• no increase in pocket depth compared to previous examination (no increase up to 5mm)
• absence of bone loss beyond crestal bone level changes resulting from initial bone remodelling
• current definition of peri implant health allows for presence of single bleeding spot around the implant

Question 3

why do implants show deeper pockets

Answer 3

collagen fibres heal parallel instead of perpendicularly
also bony healing of 1-2mm around implant which allows for bigger pocket
? not too sure about this

Question 4

what is peri implant mucositis

Answer 4

inflammatory lesion of peri implant mucosa in absence of continuing marginal bone loss
characterised by -
- bleeding on gentle probing
other signs inc: erythema / swelling / suppuration / increase in probing depth (due to oedema or a decrease in probing resistance)

Question 5

definition of peri implant mucositis

Answer 5

presence of bleeding and / or suppuration on gentle probing with or without increased pocket depth compared to previous examinations
absence of bone loss beyond crestal bone levels changes resulting from initial bone remodelling

Question 6

when looking at radiograph

Answer 6

bone still around treds of implant = no bone loss yet
if in territory of >2mm bone missing this is peri implantitis direction especially if you are seeing pockets of >6mm

Question 7

peri implantitis

Answer 7

inflammation of peri implant mucosa & subsequent progressive loss of supporting bone
- presence of bleeding and / or suppuration on gentle probing
- increased pocket depth compared to previous examination
- presence of bone loss beyond crestal bone level changes resulting from initial bone remodelling

if no previous data available -
- presence of bleeding and / or suppuration on gentle probing
- pockets >6mm
- bone levels >3mm apical to most coronal portion of the intraosseous part of the implant

Question 8

prevalence of peri implant disease

Answer 8

43% patients have peri implant mucositis
22% patients have peri implantitis

Question 9

do you do a BPE

Answer 9

NO
do 6PPC

Question 10

5 factors that predispose to peri implant disease

Answer 10

1. history of severe periodontitis
2. poor plaque control
3. no regular supportive peri implant care
4. smoking
5. diabetes

Question 11

local factors that can cause peri implant disease (6)

Answer 11

1. submucosal cement
2. positioning of implants limiting OH & maintenance
3. absence of peri implant keratinised mucosa
4. occlusal overload
5. presence of titanium particles within peri implant tissues
6. bone compression necrosis, overheating, micromotion or biocorrosion

Question 12

reasons for placing implants

Answer 12

hypodontia
tumour resection
trauma
endo failure
perio related tooth loss
behavioural
aesthetic

Question 13

what to look for clinically

Answer 13

• is occlusal restoration intact
• occlusal contacts
• deep implants
• minimal keratinised tissue
• red, swollen, marginal soft tissue
• presence or absence of plaque on implant & soft tissues
• radiographic signs of bone loss
• long contact points
• very wide emergence profile

Question 14

use of super floss

Answer 14

don’t use superfloss with implants due to microfibres embedding in soft tissue surface & can lead to irritation
interdental brush is better
can send ID brush to lab & request restoration to fit one of these

Question 15

guidelines

Answer 15

SDCEP
BSP
BSP - EFP guidelines