Perio Lecture 7

The implant body is a screw-like object that is threaded on one end and is placed into the bone of the jaw.
The implant body is seated in an osteotomy (a hole that is made in the bone) and is attached to the abutment with a screw.
The abutment is a post that protrudes from the implant body and is inserted into the mouth.
The abutment supports the prosthetic crown or denture.
The peri-implant tissues are the hard and soft tissues that surround the dental implant.
The peri-implant tissues are similar in many ways to the periodontium of a natural tooth, but there are some important differences.
The epithelium adapts to the abutment post, or to the implant itself, creating a biological seal.
The union of the epithelial cells to the abutment or implant surface is very similar to that of the epithelial cells to the natural tooth surface.
The biological seal functions as a barrier between the implant and the oral cavity.
As with a natural tooth, a sulcus lined by sulcular epithelium and junctional epithelium surrounds the abutment or in some cases, the top of the implant body.
The supragingival fibers brace the gingival margin against the tooth and strengthen the attachment of the junctional epithelium to the tooth.
The supragingival fibers insert into the cementum of the tooth.
Peri-implant health is characterized by an absence of erythema, bleeding on probing, swelling, and suppuration.
Clinically, there are no visual differences between healthy peri-implant tissues and healthy periodontal tissues.
Probing depths may be deeper at a healthy implant site compared to a healthy tooth site, but this may be due to the orientation of the connective tissue fibers which offer less tissue resistance to probe penetration.
Healthy Perl-Implant Tissues.
A. Clinical photograph 3 months after the implant body was surgically placed. Note the healthy color. contour, and tone of the peri-implant tissue.
B. One-year clinical photograph. Note there are no visual differences between the healthy appearance of the peri-implant tissues and the healthy periodontal tissues surrounding the adjacent natural teeth.
C. One-year radiographic follow-up. Note the absence of bone loss around both implants. (The implant in the maxillary first premolar position was placed 5 years prior.)
If the etiologic factors are completely eliminated, peri-implant health is maintained.
Peri-implant inflammation is characterized by an increase in the amount of pus, redness, and pain around the implant.
Peri-implant inflammation is the cause of peri-implantitis, which is a serious complication of dental implants.
Peri-implantitis can lead to implant failure and tooth loss.
The key factors that contribute to peri-implant inflammation areunknown.
Peri-implant mucositis is characterized by an increase in the amount of mucus around the implant.
Peri-implant mucositis is the cause of peri-implantitis, which is a serious complication of dental implants.
Peri-implantitis can lead to implant failure and tooth loss.
The key factors that contribute to peri-implant mucositis are unknown.
Peri-implant mucositis is a plaque biofilm-induced inflammation of the soft tissues-with no loss of supporting bone-that is localized in the mucosal tissues surrounding a dental implant.
Peri-implantitis is essentially chronic periodontitis affecting the soft and hard tissues surrounding a functioning osseointegrated dental implant, characterized by a plaque biofilm-induced inflammation in the peri-implant mucosal tissues and progressive loss of supporting alveolar bone.
The onset of peri-implantitis may occur early during follow-up and may progress in a nonlinear and accelerating pattern.
Most of the time, the patient is unaware that they have peri-implantitis until the implant becomes mobile.
If this is observed, the implant should be removed.
The prevalence of peri-implantitis reported in studies ranges from a prevalence of 6.61% to 47%.
According to the 2017 AAP/EFP World Workshop, a diagnosis of peri-implantitis requires:
Visual inspection demonstrating the presence of peri-implant signs of inflammation (red as opposed to pink, swollen tissue as opposed to no swelling, soft as opposed to firm tissue consistency).
Presence of bleeding and/or suppuration upon probing (Note: in the absence of inflammatory changes, a local dot of bleeding resulting from traumatic probing should not be considered as a clinical sign of peri-implant disease.)
Increased probing depths compared to previous measurements.
Progressive bone loss seen by examining the bone levels between two radiographs taken at different time periods (i.e., comparison of radiograph taken at baseline vs. radiograph taken 12 months after cementation of the implant prosthesis).
In the absence of initial radiographs and probing depths (lack of baseline recordings), radiographic evidence of bone level ~3 mm and/or probing depths ~6 mm in conjunction with profuse bleeding represents peri-implantitis.
Hard and Soft Tissue Deficiencies
Following tooth loss, bone resorption naturally takes place.
This will result in hard tissue deficiencies.
To correct the deficiency, hard tissue augmentation must be performed either before implant surgery or simultaneously with implant surgery.
Another common type of deficiency seen with implants is soft tissue recession.
This may be due to mal-positioning of implant or inadequate restoration of the gingival sulcus.
Radiographs should be taken at the time of implant placement and then at 12-month intervals to monitor the progress of the disease.
Peri-implant diseases-peri-implant mucositis and peri-implantitis- share a common primary etiology-bacterial infection.
Risk factors for peri-implant disease include history of Periodontal disease, poor plaque/biofilm control/Lack of regular maintenance therapy, smoking, residual cement, and biomechanical overload.
Signs of a failing implant include the presence of a peri-implant pocket., bleeding after gentle probing, and or suppuration from the pocket.
Treatment for a failing implant includes nonsurgical periodontal instrumentation, the use of antiseptics, local and/or systemic antibiotics, and access flap surgery.
Surgical treatment in which the lost bone is reestablished through bone grafting shows promising results.
Nonsurgical periodontal instrumentation of peri-implantitis lesions with adjunctive local delivery of microencapsulated minocycline or chlorhexidine may be beneficial to patients with peri-implantitis.
The available evidence suggests that subgingival glycine powder air polishing for biofilm removal may reduce clinical signs of peri-implant mucosal inflammation to a greater extent than periodontal instrumentation with plastic curettes combined with adjunctive irrigation with chlorhexidine.
Routine monitoring of dental implants as a part of a comprehensive periodontal examination and maintenance is essential to the early detection and the effective management of peri-implant diseases.