peri implant health and disease - periodontitis

Question 1

what is implant?

Answer 1

used to replace individual teeth or support a fixed bridge or removable denture

Question 2

implant to epithelial surface

Answer 2

creation of biological seal
functions as barrier
between implant and oral cavity
sulcus lined by SE and JE (just like natural tooth)

Question 3

components of the implant

Answer 3

implant body: the root of the implant on the alveolar bone
abutment post: made from titanium, through gingival tissue and support the crown
prosthesis: single crown, bridge or denture

Question 4

implant to connective tissues

Answer 4

significantly different to natural tooth
CT fibres support gingiva against the abutment - orientated parallel or encircling the implant
there are no PDL fibres
keratinised gingival tissue may/may not be present around the implant

Question 5

what is osseointegration?

Answer 5

is the directed contact of bone with the implant surface. determine the success of the implant. but it does not happen over night, around 4 weeks when the new bone form and the implant connected to the bone. it will be success if:
no mobility
absence of inflammation of tissues
no discomfort or pain when functioning
no increase bone loss or radiolucency

Question 6

what are the implant health and conditions?

Answer 6

peri implant health
peri implant mucositis
peri implantitis

Question 7

what is peri implant health?

Answer 7

absence of:
erythema, BOP, swelling and suppuration
probing depth may be deeper at a healthy implant site compare with a health tooth site.

Question 8

what is peri implant mucositis?

Answer 8

plaque biofilm-induced inflammation of the soft tissues with no loss of supporting bone
it is reversible
diagnosis requires: visual signs of inflammations; presence of BOP/suppuration; increase probing depths: absence of bone loss

Question 9

what is peri-implantitis?

Answer 9

plaque biofilm-induced inflammation of the peri-implant mucosal tissues and progressive loss of supporting alveolar bone
diagnosis visual signs of inflammation: the presence of BOP/suppuration; increased PD; progressive bone loss
probing depth more than 6 mm - consider as peri-implantitis

Question 10

what is peri-implant soft and hard tissue deficiencies?

Answer 10

Tissue deficiencies at implant sites are common clinical findings. Their presence may lead to an increase in marginal bone loss, soft-tissue inflammation, and soft-tissue recession. These abnormalities can be corrected by grafting the hard or soft tissues. Hard-tissue defects at implant sites encompass intra-alveolar, dehiscence, fenestration, horizontal ridge, and vertical ridge defects.9 Soft-tissue defects include volume and quality deficiencies, i.e. lack of keratinized tissue.

Question 11

aetiology: bacterial infection

Answer 11

mucositis- plaque/ biofilm is the same as gingivitis
implantitis - overwhelming infection which is same as periodontitis

note; peri mucositis does not always progress to peri implantitis

Question 12

bacterial infection of peri implants

Answer 12

the rate tissue destructions tends to be more rapid in peri implant tissues than in periodontal tissues.
after 3 weeks of undisturbed plaque accumulation; similar response in dento- gingival and implant mucosal units (not much different, very identical)
after 3 months of undisturbed plaque accumulation; inflammatory infiltrate in implant mucosal unit is 3 times greater

Question 13

risk factor for the implants

Answer 13

history of periodontal disease
poor plaque biofilm control - the longer plaque, the more destruction of the tissue
lack of maintenance therapy
smoking - it is advance to quit smoking first before put the implant because there is too much failure
residual cement
biomechanical overload - influence by position, the number of the implant and the patient occlusal

Question 14

clinical monitoring of peri-implant health and disease

Answer 14

probing
assessing clinical attachment levels
assess for bleeding
assess for evidence of suppuration
collect routine radiographic evidence of health/disease

Question 15

diagnosis of peri implant health, peri implant mucositis and peri implantitis

Answer 15

peri-implant health:
- clinical signs of inflammation: absent
- PD; no increase or < 5 mm
- RBL: no changes after initial remodelling (<2mm)
peri-implant mucositis:
- clinical signs of inflammation: localised erythema, swelling, suppuration, bleeding on probing
- PD; increase compared to baseline
- RBL; no changes after initial remodelling (<2mm)
peri-implantitis:
- clinical signs of inflammation: localised erythema, swelling, suppuration, bleeding on probing
-PD: increased or >6mm (if no baseline)
- RBL: increased beyond initial remodelling or >3mm after 1 year in function

Question 16

maintenance of patients with dental implants

Answer 16

recall frequency: first year (3months), subsequent years (3-6 months; risk dependent)
titanium instruments are recommended - need to choose the instruments carefully based on the implants.
patient self-care is critical

Question 17

detection of failing implant

Answer 17

clinical signs;
- soft tissue indicators; pocketing, BOP, suppuration, inflammation
- implant mobility may indicate; lack of osseointegration, loose abutment, loose internal screws, implant fracture, prosthetics failure between components
radiographic signs:
-vertical destruction of the crystal bone
-wedge shaped defects along the implant
-peri-implant radiolucency
treatment modalities:
- non surgical periodontal instrumentation
-use antiseptics
- local/systemic antibiotics
- flap surgery
- available evidence suggest sub gingival air polishing with glycine powder may reduce mucosal inflammation