Ch 19 Peri Implant Health & Diseases

Question 1

Dental implant

Answer 1

-a nonbiological device surgically inserted into the jawbone to replace a missing tooth and/or provide support for a prosthetic denture

Question 2

Implant body

Answer 2

The “root” of the implant that is surgically placed into the living alveolar bone

Question 3

Abutment

Answer 3

-titanium post that attaches to the implant body
-protrudes partially or fully through the gingival tissue
-supports the crown or denture
-biocompatible (not rejected) with the body

Question 4

Peri implant issues

Answer 4

The soft tissue surrounding the dental implant
-similar in many ways to the periodontium of a natural tooth, but there are important differences

Question 5

Implant to epithelial tissue interface

Answer 5

-the epithelium adapts to the titanium abutment post, creating a biological seal
-the biological seal functions as a barrier between the implant and the oral cavity
-the sulcular epithelium surrounds the implant abutment post surgery

Question 6

Implant to connective tissue interface

Answer 6

-significantly different than that of a natural tooth
-implant surface lacks cementum
-gingival fibers and periodontal ligament cannot insert into the titanium surface
-periodontal pathogens can destroy bone faster along a dental implant than a natural tooth

Question 7

Implant to bone interface

Answer 7

-osseointegration is the direct contact of bone with the implant surface
-major requirement for implant success
-osseointegration is successful if no mobility, absence of inflammation of tissues, no discomfort or pain when functioning, no increased bone loss or radiolucency

Question 8

Tissue surrounding a dental implant

Answer 8

-Junctional epithelium: attaches to the implant surface (biologic seal)
-Connective tissue: run parallel to or encircle the implant
-PDL: no periodontal ligament
-Cementum: no cementum
-Alveolar bone: makes direct contact with the implant surface (osseointegration)

Question 9

Peri Implant Health

Answer 9

-characterized by an absence of erythema, bleeding upon probing, swelling, and suppuration
-does not appear clinically different from clinically healthy periodontal tissues
-probing depths may be deeper compared to a healthy tooth site (due to orientation of CT tissue fibers

Question 10

Peri implant disease

Answer 10

Peri implant tissue inflammation
-plaque deposits on implants
-can result in inflammation of soft tissues around the implant
-as disease progresses, partial or total loss of osseointegration occurs

Question 11

2 forms of peri implant disease

Answer 11

-peri implant mucositis: (also known as peri implant gingivitis) plaque-induced gingivitis in tissues surrounding the implant
-peri implantitis- periodontitis in tissues surrounding osseointegrated implant, resulting in bone loss

Question 12

Peri implant mucositis

Answer 12

-also called peri implant gingivitis
-plaque biofilm induced inflammation of the soft tissues
-no loss of supporting bones
-reversible if plaque is removed; if not, may progress to peri implantitis
-occurs in 80% of patients and 50% of implant sites

Question 13

Peri implant mucositis requires close monitoring to notice signs of mucositis. What are signs?

Answer 13

Red tissues
Swelling
bleeding
Increased probing depths may

Question 14

Peri implantitis

Answer 14

-periodontitis affecting soft and hard tissues surrounding a functioning osseointegrated dental implant
-plaque biofilm-induced inflammation
-progressive loss of alveolar bone
-may progress in a nonlinear and accelerating pattern
-prevalence ranges from 6.61-47%

Question 15

Peri implantitis diagnosis requires

Answer 15

-Signs of inflammation
-Presence of bleeding and suppuration upon probing
-increased probing depths
-progressive bone loss as seen on radiographs

Question 16

Peri implantitis begins where?

Answer 16

Begins at the coronal portion of the implant while the apical portion continues to be osseointegrated
-the implant does not become mobile until final stages of diseases
-mobile implants that show signs of loss of osseointegration should be removed

Question 17

Radiographic signs of implant failure

Answer 17

-vertical destruction of crestal bone around implant
-bottom portion of implant remains osseointegrated
-may be wedge shaped defects along implant

Question 18

Peri-implant disease etiology

Answer 18

Both forms share common etiology
-polymicrobial bacterial infection
-biomechanical factors

Question 19

Bacterial infection

Answer 19

-perio disease in both the periodontium in natural teeth and the peri implant tissues of implants progresses in a similar fashion
-both require bacterial plaque biofilm and host inflammatory response
-perimucositis does not always progress to peri implantitis
-rate of destruction is more rapid in peri implant tissues than in a natural dentition

Question 20

Risk factors for implant failure

Answer 20

-history of previous periodontal disease
-poor plaque biofilm control
-smoking
-residual cement
-biomechanical overload

Question 21

Biomechanical overload

Answer 21

-collective forces placed on an implant
-influenced by a number of factors: position of the implant fixture, number of implants supporting prosthesis, occlusal force distribution among implants and remaining teeth
-implants lack the protective structure of periodontal ligaments
-implants are in direct contact with the bone
-forces placed in an implant are transmitted directly to the bone
-it is critical to minimize forces placed on an implant

Question 22

Detection of a failing implant: clinical signs in soft tissue

Answer 22

-peri implant pocket
-bleeding
-suppuration
-possible swelling
-pain usually not present

Question 23

Detection of a failing implant: changes to bone support

Answer 23

-mobility is best indicator of implant failure
-should not be mobile if healthy
-may indicate presence of loose abutment or rupture of cement seal
-severe mobility associated with pain may indicate a fracture of the implant

Question 24

Radiographic signs of failure

Answer 24

-vertical destruction of crestal bone around implant
-bottom portion of implant may remain osseointegrated
-radiolucency indicates bone loss adjacent to implant

Question 25

Treatment modalities for failing implants

Answer 25

-nonsurgical periodontal instrumentation -use of antiseptics -local/systemic antibiotics -flap surgery -available evidence suggest Subgingival air polishing with glycine powder may reduce mucosal inflammation

Question 26

Clinical monitoring of dental implants

Answer 26

Routine monitoring of implants is part of a comprehensive examination and maintenance and is essential to effective management of peri implant disease

Question 27

Important data collecting procedure

Answer 27

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

Question 28

Probing

Answer 28

-initial probing depths collected upon seating of final restoration -probing does not jeopardize longevity of implant -some surgeons may recommend postponing probing until healing is complete (3 months) -use light force with either plastic or metal probe

Question 29

Clinical attachment levels

Answer 29

-must collect baseline data to use as a fixed reference point (initial probing) -probing depths may be a deeper than 1-3mm considered normal for natural teeth -healthy peri-implant sulcus ranges from 1.3-3.8mm -depth is dependent upon thickness of tissue around the abutment

Question 30

Bleeding on probing

Answer 30

-good indicator of current tissue inflammation -lack of bleeding upon gentle probing predicts health -if bleeding is present biofilm removal will reduce inflammation

Question 31

Evidence of suppuration

Answer 31

Can be detected during probing -record by specific area: tooth and surface -can also detect by applying gentle pressure over the implant to see if pus is expressed

Question 32

Radiographs

Answer 32

-vertical bone loss of less than 0.2mm annually following first year of function -baseline radiographs should include day of implant placement, a day of final restoration placement, and day of maintenance visit -examine radiographs day of final restoration placement for presence of remaining cement -radiograph implant at least once a year

Question 33

Maintenance of dental implants

Answer 33

-important for long term success of the implant -similar to a maintenance visit for a patient treated for periodontitis -meticulous patient self care is necessary to prevent peri implant disease

Question 34

Goals for implant maintenance

Answer 34

-maintenance of alveolar bone support -control of inflammation -maintenance of healthy functional implant -maintenance of healthy and functioning periodontium surrounding neighbouring teeth

Question 35

Guidelines for professional recall and maintenance

Answer 35

-intervals determined on an individual basis -3-month interval is usually appropriate for the first year -schedule appointments as frequently as necessary to keep peri implant tissues healthy -more frequent intervals if reduced bone support, inflammation, or host response due to systemic conditions

Question 36

Implant stability evaluation

Answer 36

Implants should not have mobility if they are osseointegrated and healthy -assess mobility as a natural tooth -use instruments with plastic handles if fixture must be touched -radiographic evaluation is indicated for mobile implant

Question 37

Implant mobility indicates

Answer 37

-lack of osseointegration -loose abutment -loose internal screws attaching abutment post to implant fixture -fracture of the implant -prosthetic failure between components

Question 38

Guidelines for professional maintenance

Answer 38

-residue left on implant body is a significant cause of implant failure -implant material is rough to allow for better osseointegration -Subgingival cement/calculus deposits require slender instruments made of compatible metal -titanium instruments are recommended

Question 39

Special considerations for polishing implants

Answer 39

-implants, abutments and components do not require routing polishing -when indicated, rubber cups with no abrasive polishing paste can be used -suprahingival air polishing either glycine powder is safe, effective and biocompatible and gentle on soft tissues

Question 40

Pt self care of dental implants

Answer 40

-meticulous self care is of utmost importance in preventing peri implant implant disease -individualized self care developed for each patient -porcelain, acrylic, or composite tooth fits over abutment -crown covering an implant may be larger in circumference than the abutment post -the bulky surface of the crown contacts the tissue and then “dips in” to meet the post

Question 41

Techniques and device for osc and implants

Answer 41

-standard tb are appropriate -powered tb may also be used -interdental brushed must have protective coating on the twisted wire -tufted dental floss is an ineffective combination of tools for large embrassure spaces -oral irrigators may be used -daily antimicrobial mouth rinse may be beneficial