Treatment Of Periimplantitis

Question 1

*Define the term peri implantitis

Answer 1

a plaque‐associated pathologic condition occurring in the tissue around dental implants, characterised by inflammation in the peri‐implant mucosa and subsequent progressive loss of supporting bone.

Question 2

Peri implantitis is associated with

Answer 2

poor plaque control and with patients with a history of severe periodontitis.

Question 3

The onset of peri‐implantitis may occur

Answer 3

early following implant placement as indicated by radiographic data.

Question 4

Define the term peri implant mucositis

Answer 4

characterized by bleeding on probing and visual signs of inflammation.
While there is strong evidence that peri‐implant mucositis is caused by plaque, there is very limited evidence for non‐plaque induced peri‐implant mucositis.
Peri‐implant mucositis can be reversed with measures aimed at eliminating the plaque.

Question 5

Describe the clinical characteristics of peri implant disease

Answer 5

presence of inflammation in the tissues surrounding the implant and is categorised into two states:
peri-implant mucositis
peri-implantitis

Tissues around the implant head are red, swollen, inflammation and bleeding on probing

Question 6

Describe peri implant health (not on LO)

Answer 6

Clinically, peri‐implant health is characterized by an absence of visual signs of inflammation and bleeding on probing.
Peri‐implant health can exist around implants with normal or reduced bone support. It is not possible to define a range of probing depths compatible with peri‐implant health.

Question 7

Describe the clinical presentation of peri implantitis

Question 8

Peri implantitis in the absence of treatment seems to progress in a

Answer 8

Non linear and accelerating pattern.

Question 9

Peri implantitis may look clinically like…

Answer 9

Tissues look very inflammed
Gross plaque deposits around implants
Implant heads are exposed and can see the threads
Next photo: implant supported crown on the maxillary canine
Photo below: deep periodontal pocket and suppuration.
Radiograph- in health you would see bone around the neck/crest of the implant and all of the threads of the implant should be completely surrounded by alveolar bone.
But can see we have lost about 3/4 of the bone around the implant and quite a lot of the threads of that implant are not surrounded by bone, hence the deep pocket depths. Would be worries that this implant is becoming mobile.

Question 10

*How to diagnose peri implant disease?

Answer 10

1. Probing (measures pathology and disease progression)
2. Radiographs

Question 11

Describe how probing is used to diagnose peri implantitis

Answer 11

Measures pathology and disease progression

Looking at
1. Pocket depth
2. Suppurations
3. Bleeding on probing

Can use a metal probe or a plastic probe (this can be a bit more bendy to get in and around the implants. The probe must go down the long axis of the implant so we can get more accurate readings.
6 point measurement or 4 (2bucallyand 2lingually)

Use a fixed reference point. This could be the margin of the crown or the restoration so that each time we are measuring from the same position.

Question 12

Describe how radiographs are used to diagnose peri implantitis

Answer 12

Interpreting peri implant bone levels - good measure of peri implant health

Paralleling IOPAs are the most useful radiograph to detect crestal changes over time.

When?

Question 13

When do we use radiographs to measure peri implant health?

Answer 13

Recommended to be taken at the time of implant placement, abutment insertion, and prosthesis insertion.
Follow-up radiographs?
If no complications are detected?

Question 14

Follow up radiographs

Answer 14

Are generally taken 6 months after insertion of the restoration, and then annually thereafter.
If no complications are detected?

Question 15

If no complications are detected

Answer 15

radiographically or clinically, then the interval could be lengthened to 2 years.

Question 16

Implant mobility?

Answer 16

indicates complete lack of osseointegration and the implant should be removed.
Mobility is therefore not useful for early diagnosis of peri-implant diseases.

Question 17

Osseointegration is

Answer 17

a direct functional and structural connection between living bone and the surface of a load carrying implant

Question 18

Exam question- how to diagnose for peri implantitis?

Answer 18

Probing using a light force (0.25 N) - not to damage the peri-implant tissues.

Bleeding on probing (BOP) -indicates presence of inflammation in the peri-implant mucosa.

An increase in probing depth over time is associated with –loss of attachment and supporting bone.

Radiographs are required to evaluate supporting bone levels around implants.

Question 19

Describe the risk factors for developing peri implant disease.

Answer 19

Poor oral hygiene

History of periodontitis:
studies (comparing patients with a history of periodontitis with non-periodontitis patients) show an increased risk for peri-implant disease.
Cigarette smoking:

A systematic review reported an association between smoking and peri-implantitis. Studies showed a significant increase in marginal bone loss in smokers compared with non-smokers.

Question 20

Management of peri implant disease-

Answer 20

For both peri implant mucositis and peri implantitis the basis of management is the same:
OHI
But then for active therapy peri implant mucositis needs non surgical therapy but per implantitis needs surgical therapy.
And then both might need modification of prosthesis (to make more it more cleansable)
And then both need maintenance.

Question 21

Non surgical management of peri implant mucositis…

Answer 21

Mechanical techniques such as the use of titanium-coated Gracey curettes, carbon fibre curettes, plastic-coated ultrasonic scalers, or air-powder abrasives

Use of chemicals such as chlorhexidine, citric acid, hydrogen peroxide, tetracycline, or stannous fluoride

Laser-based treatments

Question 22

Surgical management of peri implantitis

Answer 22

Access surgery (an open flap technique)
Resective surgery with or without implant surface modification (implanto-plasty)
Regenerative approach (use of grafting materials with or without membrane)

Question 23

Treatment of peri implantitis

Answer 23

There is currently no long-term evidence that peri-implantitis can be treated in a predictable manner.
It does not seem to be treatable by non-surgical means alone.

It should be treated promptly and surgical intervention is required earlier and more frequently than in a case of periodontitis.

Question 24

Implant maintenance

Answer 24

Patient motivation and oral hygiene

Perio health should be achieved prior to proceeding with implant therapy.

Restorations should be cleansable with well fitting margins.

Question 25

Important points about maintenance post treatment of peri implant disease

Answer 25

Warn px- inflammation and infection around implants.
OHI- important to clean around prosthesis.
Maintenance care at least once a year depending on the patient’s past Hx and susceptibility for periodontitis.
Px who experienced periodontitis are also at higher risk of developing peri-implant diseases. Hence recall interval is shortened to 3–4 months.

During maintenance - use a perio probe to monitor probing depth, bleeding on probing, and possible suppuration.
Intervene with prophylactic measures when mucositis (bleeding) is noted around the implant.
Obtain a radiograph whenever the probing depth around an implant is 6 mm or more.
Maintain optimal OHI post peri-implantitis therapy.