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Peri-implantitis
Definition and
clinical diagnosis
Management
Prevention
Introduction
Oral implants have enjoyed high clinical success rates over the last decade,
with an explosion of numerous surfaces and designs of implants all claiming
to have superior quality over another.
• A systematic review of the incidence of biological and technical complications in implant dentistry reported
in prospective longitudinal studies of the last 5 years. (Berglund T, Person L, Kline B. J Clin Periodontal 2002;
** A long term survey of tooth loss in 600 treated periodontal patients. (Hirschfield L, Wasserman B. J
Periodontal 1978
Introduction
There is a statistically significant higher incidence of peri–implantitis for
implants placed in patients with a history of chronic periodontitis (28.6%)
compared with periodontally healthy individuals (5.8%).* The correlation
between the presence of periodontitis and the development of peri–
implantitis has been supported by a recent systematic review.**
(Zitzmann & Berglundh 2008 Journal of Clinical Periodontology 6'Th European workshop
on Periodontology)
Clinical Diagnosis
• Dental implants:
maintenance, care and
treatment of peri-implant
infection.
Chen S, Darby I. Aust
Dent J 2003; 48(4):212-
220.
Clinical Diagnosis
Microbiology
Numerous animal and human studies have clearly shown that bacterial
plaque which is allowed to build up on implants leads to inflammatory
changes of the adjacent soft tissues.
Gram negative anaerobic rods, spirochaetes and fusiform bacteria were found
in higher proportions at peri-implantitis sites as compared with healthy sites,
which were predominantly composed of coccoid forms.*
The clinical implication is, if traditional periodontal pathogens are found, then
the disease process could be similar to periodontal disease and patients
with a history of chronic periodontitis may be at increased risk of peri-
implantitis. It is suggested, that the microbiology associated with implants
are related to the bacteria already resident in the oral cavity, that is, that the
remaining teeth can act as reservoirs for seeding of bacteria in the peri-
implant tissues.
Microbiology
(1) The disturbance and/or removal of the bacterial biofilm in the peri-
implant pocket
(5) Re-osseointegration
Management
This protocol relies on PPD, BOP and radiographic evidence of bone loss.
As each parameter becomes more severe, more complex treatment is
introduced, with each subsequent treatment incorporating that of the
previous.
2 ) Infection control
Great care should be taken with implant placement so as to avoid damaging
the host bone. The implant must at no time be contaminated in order to
prevent retrograde peri-implantitis.
3 ) Hygienic restoration design
Accessibility
The prosthetic reconstruction must be placed in such way that it is accessible to
hygiene at the periimplant area.
Poor design led to high risk of failure
In cases where aesthetics and hygiene come into conflict, the patient should be
informed about the consequences that restoration with no access to hygiene can
lead to failure.
4 ) Periodic recall visits
References:
Nevertheless, the fact that new bone does fill osseous defects, as documented
by an increase in radiographic bone density, represents a healing process most
likely resulting in further implant stability over time*1.
Clinical Case
Peri-
Implantitis
Protocol
A,B,C,D
Loading
3 Years
Follow up
X-Rays
Review
Take home message
Limited scientific evidence is available to endorse or recommend a specific
modality for treatment and it seems that like periodontal disease, one
regime may be successful in one patient and not another.