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Objective

Discuss the effect GBR in management peri-implant bone loss Evident base supporting a decision tree as a guide line

Introduction
When losing teeth
RPD (Removal Partial Denture) FPD (Fixed Partial Denture) ISP (Implant Support Denture)

Increasing of implant placement, but there are many complications

Introduction
International Congress of Oral Implantologist Pisa Consensus Conference report give a definition of
Implant failure: remove or lost Implant complication: deviation of standard tx outcome, and requires further tx
Peri-implantitis (survival rate 89&-95% in 10y reports)

Peri-implantitis
A systemic review of 51 prospective studies reported
0%-14.4% in 5 year follow up

Other reported
11.3%-47.1% in 10-16 years

Biological and mechanical factors

Biological factor
Micro-organism especially periopathic bacterial: P.g, T.f, T.d Smoking Diabetes Others : compression necrosis, infection, overheating of bone during operative

Schwarz peri-implantitis
Class I: intrabonydefect
a: dehiscences defect b: buccal & interproximal defect c: class Ib + lingual defect d: buccal and lingual dehiscence e: circurferential

Class II: suprabony defect

Mechanical factor
Occlusal over loading is considered the primary factor Poor prosthetic design Inadequate number, dimensions Non ideal position

Parafunction habit

Complication of Implant Failure


Effect quality of life
Function Esthetics Time Money Psychological stress

Management of this failure to reosteointegration GBR

Treatment Modalities
Goal is trying to eliminate and restoring lost strutures and function It is divided as periodontal treatment
Non-surgical
Antimicrobial therapy & mechanical debridement

Surgical
Surgical debridement, implantoplasty, dental lasers

Regenerative
GBR

Non-Surgical
Local tetracycline combines with debridement
6% bone filled on x-ray 0.2-0.3mm clinical significant

Evident review an ineffective method in management peri-implantitis

Surface Decontamination
Eliminating etiological factor Several agents use for decontamination found no significant over superior
Saline, Abrasive pumice, Citric acid, CHX, Air power abrasive

Systemic review shows SD improve re-osteointergration


Dental laser and PDT
CO2 reduce amount of S. sanguis and P. gingivalis Nd:YAG=Er:YAG=diode laser

Laser + bone graft + collagen membrane: almost complete bone fill


No long term study report

Surface Decontamination
Implantoplasty: archive smooth surface & plaque adhesion Poor effects:
increase heat, damage adjacent tissue, metallic debris

Diamond bur with water irrigation only 1.5 degree C


No surrounding tissue damage Rubber dam might helpful

Surgical Debridement
Surgical re-entry examination
GBR>Bone graft alone>flap debridement: bone fill

GBR with / without bone graft no significant different GBR still not predictable as a Systemic review reported

Decision Tree

Decision Tree
Management in horizontal defect
APF & implantoplasty

Management in vertical defects


Dependent on patient related (OHI, smoking) Systemic condition(uDM) Defects

Defects
Ochsenbien and Cortellini and Tonetti
1 wall APF 2, 3 wall GBR with non resorbable membrane 3 wall (contained) GBR with resorbable membrane Circumferential defect occlusal evaluation
Release heavy loading

Not ideal implant position remove


hard & soft tissue graft

Others
PASS principle GBR must be done with primary closure
Reduce bacterial/foreign bodies contaminated

OFD and GBR


Debridement + Antibiotic (local / systemic)