Bab 9 Peri-implant health disease

Nama : Tira Nurfaizah

NIM : J035211002
01 Anatomy of the Dental Implant and Surrounding
Peri-Implant Tissues

02 Peri-Implant Health, Diseases, and Conditions

03 Recognition of Peri-Implant Diseases

04 Clinical Monitoring of Peri-Implant Health and Diseases

05 Clinical Guidelines for Maintenance of Patients With

Dental Implants

06 SUMMARY
 01.
Anatomy of the Dental Implant
and
Surrounding Peri-Implant Tissues
 Introduction
A dental implant is a nonbiologic (artificial) device
surgically inserted into the jawbone to replace a
missing tooth or provide support for a prosthetic
denture. Over the past 30 years, research has
validated the success of implant placement as a
feasible option to replace missing teeth in partially or
fully edentulous patients
1. The dental implant system

A. Component of an
implant system

The implant body

The abutment
Surgical Placement of a Dental Implant. A. Edentulous alveolar ridge. B. Initial osteotomy
site established. C and D. Drills of increasing diameters used to prepare the osteotomy site to the size of the
planned implant. E. Implant body seated in the osteotomy. The top of the implant body may be placed slightly
above, level with, or slightly below the crest of the bone. F. Implant body seated in bone with cover screw
attached. At the end of placement surgery, the implant can be covered with gingiva or left exposed to the oral
cavity, as shown here. A healing time of several weeks to months is allowed so that osseointegration can
occur.
 THE PERI-IMPLANT TISSUE

IMPLANT TO EPITHELIAL TISSUE INTERFACE IMPLANT TO BONE INTERFACE

The epithelium adapts to the abutment post, or Osseointegration is the direct contact of the living bone
to the implant itself, creating a biological seal. with the surface of the implant body (with no intervening
The union of the epithelial cells to the abutment periodontal ligament). In other words, an
or implant surface is very similar to that of the osseointegrated implant is functionally ankylosed to
epithelial cells to the natural tooth surface. surrounding bone without the periodontal ligament
(PDL). Osseointegrati.on is the major determinant for
implant success.

IMPLANT TO CONNECTIVE TISSUE INTERFACE

the implant-to-connective tissue interface is significantly different from that of

the connective 'tissue surrounding a natural tooth. The implant surface lacks
cementum, so the gingival fibers and the periodontal ligament cannot insert
into the titanium. surface as they do into the cementum of a natural tooth.
02. Peri-Implant Health,
Diseases, and Conditions

Peri Implant Health Peri Implant Mucositis Peri implantitis

Peri Implant Health
A. 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. Figure 9-9 shows an example of peri-
implant health.
B. 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.
 Peri Implant Mucositis
A. Peri-implant mucositis is reversible if the etiologic factors are
removed. On the other hand, if the etiologic factors are not removed,
peri-implant mucositis may progress to peri-implantitis.
B. Peri-implant mucositis has been reported to occur in about 80% of
subjects and 50% of implant sites, while peri-implantitis has been
reported to occur in 28% to 56% of subjects and 12% to 43% of sites.
The reported prevalence, however, varies widely and change as implant
designs evolve.
C. According to the 2017 AAP/EFP World Workshop, a diagnosis of
peri-implant mucositis requires:
 A. The onset of peri-implantitis may occur early
Peri Implantitis during follow-up and may progress in a nonlinear and
accelerating pattern.
B. Peri-implantitis lesion can be diagnosed by the
detection of radiographic bone loss around the
implant
1. The implant does not become mobile until the final
stages of peri-implantitis. In fact, in most cases, the
patient is unaware that they have peri-implantitis until
the implant becomes mobile.
2. An implant that exhibits mobility is an indication
that it has lost osseointegration. this is observed, the
implant should be removed. Differences in the
prevalence of peri-implantitis have been reported by
a number of research studies.
 A. Following tooth loss, bone resorption
HARD & SOFT narurally takes place. This will result in hard
tissue deficiencies. To correct the
TISSUE deficiency, hard tissue augmentation must
be performed either before implant surgery
DEFICIENCIES or simultaneously with implant surgery.
B. Another common type of deficiency seen
with implants is soft tissue recession. This
may be due to malpositioning of implants,
lack of buccal bone, thin soft tissue, lack of
keratinized tissue, stat:us of attachment of
the adjacent teeth, and surgical trauma.
Figure 9-13 shows an example of a clinical
deficiency in which recession of the gingival
margin results in the implant collar being
clinically visible.
 03. Recognition of peri implant disease
Detection of
failing implant
Etiology Soft tissue indicator, implant
Bacterial Infection mobility, & radiographic sign

Risk Factor Treatment modalities

History of periodontal for failing implant
disease, plaque, smoking, Surgical and non
residual cement, surgical
biomechanical overload
 04. Clinical monitoring of peri implant
health & disease
Probing
• initial probing of the implant
should be done once the final
restoration has been installed.
• Some implant surgeons
recommend that probing
should be avoided until
postoperative healing is
complete, approximately 3
months after abutment
connection.
Bleeding &
Radiographs
suppuration
• Lack of bleeding on gentle • Maintenance of bone levels
probing is useful in predicting around dental implants is an
tissue health around implants. important criterion for
• Elimination of the bleeding on determining treatment success.
probing in peri-implant Radiographic evaluation of bone
height and topography is
mucositis should be
accomplished with improved necessary for the longitudinal
biofilm removal by the clinician monitoring of peri-implant
and the patient. stability
• Increasing probing depth and
bleeding are indicators for the
need to perform an additional
radiographic examination.
 05. Clinical guidelines for maintenance of patient
with dental implant

1. Considerations for
Implant Maintenance

A. Goals of Maintenance
Therapy for Dental B. Patient Provided C. The Dental Implant
Implants Information Maintenance Visit
 2. Guidelines for
Professional Recall and
Maintenance

A. Maintenance Frequency B. Guidelines for Professional C. Special Considerations

Maintenance. for Polishing
 3. Patient Self~ are of Dental Implants

A. Considerations : An individualized self-care routine should be developed for each patient.

B. Care of Fixed Prosthetic Restorations : Dental floss is used to clean a single implant with a
prosthetic crown. The "bulky" contours of the crown may contact the tissue and then dip in"
to meet the abutment at or below the gingival margin.
C. Care of a Removable Prosthesis

An implant-supported removable
prosthesis is similar to a
traditional full denture except that
in the case of implants, it is
attached to the abutments by
devices such as 0-rings, magnets,
or clips
• The patient can remove
the prosthesis to clean it,
the attachment devices, metal bar connects the abutments and is
the abutments, and the used to attach the prosthetic denture in the
remainder of the mouth. mouth. Tufted dental floss or an unfolded
2 x 2 gauze square can be useful in
cleaning underneath the metal bar and
around the abutments
 Chapter Summary
• As dental implant therapy becomes more common, dental hygienists will care
for increasing numbers of patients with implants, and as such, a significantly
higher incidence of peri-implant diseases is inevitable. The primary goals of
treatment for peri- implant diseases are to stop disease progression and
maintain the implant in function with healthy peri-implant tissues. To be able
to accomplish this, the dental hygienist must be able to distinguish between
peri-implant health and peri-implant diseases.
• Frequent professional maintenance is the most important step in the early
detection and management of peri-implant diseases. An important role of the
dental hygienist is to educate patients about the importance of meticulous
self-care and frequent maintenance visits.
• Implant restorations necessitate customized self-care instructions and
devices. Implant maintenance appointments should include monitoring of
plaque biofilm levels, examination of soft tissues, assessment of the
restorative integrity, reinforcement of patient self-care measures, periodontal
instrumentation of implant abutments and prostheses, and radiographic
examination.
Thank you