Peri-Implantitis Lecture 10 PDF

Rohit Kunnath Menon ▪ Define peri-implantitis, peri-implant mucositis, and implant failure ▪ Discuss the current evidence on the risk factors for periimplantitis ▪ Discuss the evidence-based treatment options for peri- implantitis ▪ Peri-implant mucositis is a reversible inflammatory lesion...

Rohit Kunnath Menon ▪ Define peri-implantitis, peri-implant mucositis, and implant failure ▪ Discuss the current evidence on the risk factors for periimplantitis ▪ Discuss the evidence-based treatment options for peri- implantitis ▪ Peri-implant mucositis is a reversible inflammatory lesion of the peri‐implant mucosa with the absence of progressive marginal bone loss. ▪ Peri-implantitis is characterized by inflammation of the adjacent circumferential connective tissues and escalating loss of the supporting bone, that, if not recognized and treated, might also lead to implant loss. ▪ Most common complication around dental implants ▪ Primary reason for implant loss ▪ Has a faster, non-linear, and more aggressive progression compared to periodontitis.  Absence of clinical signs of inflammation Absence of bleeding and/or suppuration on gentle probing No increase in probing depth compared to previous examinations Absence of bone loss beyond crestal bone level changes resulting from initial bone remodeling  Bleeding and/or suppuration on gentle probing with or without increased probing depth compared to previous examinations Absence of bone loss as observed on a radiograph (beyond crestal bone level changes resulting from initial bone remodeling)  Presence of bleeding and/or suppuration on gentle probing Probing depths of ≥6 mm; Bone levels ≥3 mm apical of the most coronal portion of the intraosseous part of the implant  Implant presenting ≥ 50% of bone loss Mobile implant, Loss of osseointegration Persistent inflammation described by presence of profuse bleeding and/or suppuration and a radiographically documented continuous bone loss despite treatment. ▪ The microbiota associated with peri- implant mucositis appear to be similar to those associated with peri-implantitis, suggesting that supra-mucosal plaque formation and the development of peri- implant mucositis could potentially be the precursors to peri-implantitis. ▪ Highly suggestive: Periodontitis, Cigarette smoking ▪ Significant factors: Diabetes mellitus, hyperglycemia, lack of prophylaxis, lack of prophylaxis, ongoing or history of periodontal disease, implants located in anterior region, osteoprotegerin gene polymorphism, lack of keratinized mucosal width ▪ Identifying risk factors is essential to develop an individualized treatment plan for each patient  Completion of active periodontal therapy to eliminate the residual pockets In cases of persisting periodontal inflammation (PD ≥ 5 mm, BOP+, PI > 20%,) – re-treatment and periodontal re-evaluation In patients with aggressive periodontitis, a more frequent maintenance program is essential,.  Training of oral healthcare providers, including undergraduate students, to recognize clinical signs of peri-implant pathology. After delivery, advised to probe around dental implants to record clinical measurements and to additionally document dental implants by means of clinical photographs and radiographs Regular diagnostic monitoring of the peri-implant tissues should include assessment of plaque presence (PI), probing depth (PD), extent of bleeding on gentle probing (BoP), and/or suppuration (SUP).  In the presence of clinical signs of disease, an appropriate radiograph is indicated to detect radiographic bone-level changes compared to previous examinations. PD changes should be followed in relation to a marked fixed point. A recall frequency of at least once per year is recommended unless systemic and/or local conditions require more frequent intervals. In cases of peri-implant mucositis – OH reinforcement + mechanical debridement In cases of peri-implantitis – early treatment needed to prevent further progression  Mechanical debridement (using special curettes and/or air-polishing devices) Local application of antiseptics (e.g., sterile saline, CHX, essential oils) Adjunctive antibiotics (local and/or systemic) Laser ▪ Elevation of mucoperiosteal flaps and thorough debridement of granulation tissue around dental implants, followed by implant surface decontamination. ▪ Depending on the defect configuration, either regenerative or resective surgical techniques are indicated ▪ Unfortunately, there is currently no definite consensus on the optimal treatment protocols for peri-implantitis. ▪ Various clinical protocols for treating peri-implantitis have been proposed with various degrees of success. ▪ In conclusion, it is still for clinicians, depending on their clinical experience and expertise (and following certain predetermined guidelines), to determine the proper treatment protocol and its predictability for each patient individually. ▪ Mechanical debridement with adjunctive systemic antibiotics or photodynamic therapy improves clinical outcomes in peri-implantitis ▪ Define peri-implantitis, peri-implant mucositis, and implant failure ▪ Discuss the current evidence on the risk factors for periimplantitis ▪ Discuss the evidence-based treatment options for peri-implantitis