Periodontal Therapy in Implant Patients

Question 1

What is peri-implantitis?

Answer 1

Pathological condition occurring in tissues around dental implants, characterized by inflammation in the peri-implant mucosa and progressive loss of supporting bone

Question 2

What is peri-implant mucositis?

Answer 2

Inflammatory lesion of the soft tissues surrounding a dental implant, without the presence if bone loss.

Question 3

What are the signs of peri-implant mucositis?

Answer 3

BOP
Erythema
Oedema
Pain and tenderness of the gingivae
No radiological signs of crystal bone loss

Linked to inadequate plaque control.

Question 4

What are the signs of peri-implantitis?

Answer 4

Same signs and symptoms of peri-implant mucositis plus radiographic evidence of crestal bone loss.

BOP
Erythema
Oedema
Increased probing depths
Suppuration
Mobility
Progressive loss of bone height on radiographs

Question 5

What bacteria are involved in peri-implant disease?

Answer 5

P. Gingivalis
T.Forsythia
P.Intermedia

Question 6

What factors may affect peri-implant disease?

Answer 6

Poor OH
Smoking
History of perio disease
Poorly controlled diabetes
Impaired host defence
Implant design
Operator placement
Degree of toughness allowing plaque accumulation

Question 7

Would you do a BPE around implants?

Answer 7

No.

Soft tissues are not connected in the same way to an implant surface as those surrounding the teeth- less resistant to probing.

Question 8

How much bone loss is normal for implants?

Answer 8

0.2mm per year.

Question 9

How should you examine the peri-implant tissues?

Answer 9

Oral hygiene

Assess visually the implant site- erythematous, oedematous, any obvious plaque or calculus deposits.

Probing depths, BOP, suppuration present, calculus present.
- using an implant probe.
- pockets should be 3mm but check against baseline depths.

Presence of supramucosal calculus

PA radiograph one year after placement to assess bone levels

Assess patient’s current OH routine and give detailed OHI.

Question 10

What should you do 3 months after implant placement?

Answer 10

Examine the peri-mucosal tissues and take PA radiograph to determine bone levels one healing has occurred.

Question 11

Outline the treatment for peri-implant mucositis.

Answer 11

Check that the restoration is cleansable.

Check for the presence of cement around the restoration.

Explain diagnosis to patient.

Give detailed OHI.
- implant floss and interdental brushes.

Smoking cessation

Supramucosal and submucosal PMPR.

Review 1-2 months.

Question 12

What is the goal of treatment of peri-implant mucositis?

Answer 12

BOP at less than or equal to one site and absence of suppuration 2-3 months after treatment.

Question 13

Describe the treatment for peri-implantitis.

Answer 13

If progressing crestal bone loss is detected, then refer back to clinician who placed the implant
- surgical intervention may be required.

Determine if implant is saveable.
- if it is, then go through same treatment as for peri-implant mucositis.

Question 14

What are the goals of treatment of peri-implantitis?

Answer 14

Probing depths less than or equal to 5mm.

BOP at less than or equal to 1 site on the implant.

Lack of suppuration around implant.

Question 15

What prevention strategies should be employed for peri-implant diseases?

Answer 15

Warn the patient of the risk factors
Smoking cessation advice
Meticulous plaque control and OHI
Contact GP for diabetes control

Question 16

What implant specific oral hygiene measures can be adopted?

Answer 16

Implant floss

Interdental brushes- sized as you would for natural teeth

Powered toothbrushes may be useful for those who struggle with manual dexterity

Single tufted brushes

Question 17

After implant placement, what post-op instructions might be given?

Answer 17

Use chlorhexidine mouthwash/gel after surgery
Soft toothbrush- tailored OHI
Interdental brushes
Superfloss or tape/implant floss
Single tufted brushes
Smoking cessation advice