Peri-implantitisAn inflammatory reaction, with the loss of

supporting bone in the tissues surrounding a functioning implant .

What Is peri-implantitis? Clinical findings to look for Contributing factors Prevention Treatment

What we need to know

Starts with a less threatening disease called Peri-Implant mucositis.

Peri-implantitis -described as an inflammatory, bacterial driven destruction of the implant-supporting apparatus.

Inflammation -a complex reaction of the body in response to an infectious agent, antigen challenge, or injury.

Accumulation of plaque aggravates the inflammatory reaction over time, resulting in irreversible tissue destruction.

Inflammation visible within 10 to 20 days of plaque

Even during early stages of inflammation,considerable tissue damage occurs

Site-specific infection yielding many features in common with chronic adult periodontitis

Peri-implantitis KRISTEN

• Composed of three parts:

• Titanium implant - fuses with the jawbone

• Abutment - fits over portion of the implant that protrudes from the gum line.

• Crown - created by a restorative dentist and fitted onto abutment for natural appearance.

Implant anatomy KRISTEN

Poor oral hygiene◦ Teeth serve as reservoirs for pathogens

As early as 1 month after implantation, putative periodontal pathogens were detected around the implants of partially edentulous patients

History of periodontitis ◦ Periimplant microbiota resembles that of adult

periodontitis Occlusal overload

◦ Loosening of screws Systemic influences

◦ Diabetes (uncontrolled glucose levels)◦ Osteoporosis (Bisphosphonate drugs)

Contributing Factors

Smoking◦ Higher bleeding scores◦ Deeper pocket depths◦ More signs of inflammation◦ More radiographic bone loss around implants◦ Failure rates

Smokers:11.3%Non-smokers: 4.8%

Chances of developing peri-implantitis are automatically greater if original teeth were lost because of periodontal disease, caries, or recurrent trauma.

Contributing Factors

Prevention is our main purpose as dental hygienists

Regular dental visits

Education

Plaque control procedures◦ Particularly around implants

Mechanical instrumentation of the affected areas possessing surgical flap access should be performed.

Routine radiographs

Prevention

Lack of keratinized tissue around an implant

Bleeding & suppuration upon probing

Mobility

Retention of restorations

Radiographic findings

What to look for

Open flap debridement◦ Alveolar bone and root surfaces of teeth are

exposed for scaling and root planing

Implant detoxification◦ Calcium hydroxide and chlorhexidine gluconate

may provide an antimicrobial action for detoxifying.

◦ Calcium hydroxide should not be left in the surgical site.

Treatment KRISTEN

• Implantic Debrider• Water cooling agent • Cleans down between threads

of visible fixture◦ Rotary motion - designed to

remove deposits from exposed threads of affected implants

Laser therapy◦ Becoming increasingly

common in dentistry◦ Applications in soft tissue

surgery, caries removal, and in treatment of peri-implantitis.

◦ Lasers irradiate the whole surface

A newer approach: KRISTIN

Because dental implants are becoming more in demand, peri-implantitis is becoming more common in individuals.

Peri-implantitis is difficult to treat, therefore early detection and prevention are key.

It is crucial for patients with dental implants to have the professional care and support of a dental team. A hygienist’s goals are to encourage outstanding oral hygiene and to teach the patient which tools to use for homecare as well as to urge the patient to desire a healthy oral environment

Conclusion KRISTEN

Fletcher, P. (2011). Concepts for modern implantology. Dimensions of Dental Hygiene, 9(9), 44,46-48.

Heasman, P., Esmail, Z., & Barclay, C. (2010). Peri-implant disease. Dental Update, (37), 511-516.

Hempton, T. J., Bonacci, F. J., Lancaster, D., & Pechter, J. E. (2011). Implant maintenance. Dimensions of Dental Hygiene, 9(1), 58-61.

Hempton, T. J., Bonnaci, F. J., & Lassonde, M. (2011). Identifying the risks. Dimensions of Dental Hygiene, 9(5), 60-63.

Terracciano-Mortilla, L. D. (2010). Effective implant care. Dimensions of Dental Hygiene, 8(9), 30-32,34.

Petkovic-Curcin, A., Matic, S., Vojvodic, D., Stamatovic, N., & Todorovic, T., (2011). Cytokines in pathogenesis of peri-implantitis. Vojnosaniteski Pregled: Military Medical & Pharmaceutical Journal of Serbia & Montenegro, 68(5), 435-440. doi:10.2298/VSP1105435P 

References

http://www.drchetan.com/dentalpics/dental-instruments/dental-implants/dental-implant-7/

http://www.exodontia.info/files/Dental_Update_2010._Peri-Implant_Diseases.pdf

Picture References KRISTEN

QUESTIONS?