Prevention and peri-implant maintenance treatment (PIMT) Flashcards
List the post- operative considerations an OHT would need to know after implant placement
- Implant type
- Placement surgical procedure (flapless/flapped surgery)
- Immediate /delayed placement
- Bone grafting/ sinus lifting prior to placement
State the preferable oral hygiene regimen in patients with implants
- Post-operatively: special toothbrush with very soft bristles
- CHx for 2 - 4 weeks or if healing is compromised then 6 weeks (alcohol free)
- EO can be used
- After healing, suggest soft bristle, small head electric toothbrush (helps with older patient lacking dexterity)
List the things an OHT should examine during the 3 week healing check
- Soft tissue colour/condition
- Presence of suppuration, bleeding, exposure of membrane/implant, etc
- Presence of plaque and calculus
Explain why interdental brushes are preferred to floss in patients with implants. Also, state what type of interdental brushes should be recommended
- Floss can fray and leave pieces of itself behind on the implant -> lead to peri- implant mucositis
- Interdental brushes that are plastic coated are the best option
Understand that initial bone remodelling is a normal sequalae to implant surgery, and the level of bone remodelling that is considered healthy, in mm
- The late stage of healing involves the remodelling of bone
- Osteoclasts remove the old bone and in so doing provide a surface on the old bone with the appropriate topography, with which the newly formed bone may bond
- Usually, this should NOT exceed 2 mm. If it is equal to or more than 2mm, it is considered pathologic
- An initial pA is taken as a baseline reading to be compared to in subsequent appointments
Explain what is considered healthy in relation to implants.
Discuss probing depths and reduced bone levels
Characterised by the absence of: • Erythema/ signs of inflammation • Bleeding upon probing • Swelling and or suppuration • Bone loss beyond crestal bone level
- Probing depth: not possible to define a range of probing depth compatible with health. If a baseline measure exists, then there should not be an increase in it
- Peri-implant health can exist around implants with reduced bone support
List the signs of peri-implant mucositis
- Erythema/ signs of inflammation
- Bleeding upon probing
- Swelling and suppuration
- Increase in PPD from baseline measurement
- Reduced tissue resistance
- NO BONE LOSS (only affects mucosa)
List the difference between peri-implant mucositis and peri-implantitis
Peri-implantitis has the same signs as peri- implant mucositis EXCEPT it also involves bone loss and mobility
List the systemic risk factors for implant diseases (4)
- Smoking
- Radiation therapy
- Diabetes mellitus
- History of periodontitis
List the local risk factors for implant diseases
- Oral hygiene
- Lack of compliance with PIMT
- Design of the suprastructure (crown)
- Excess cement (left behind after cementing the crown to abutment)
- Keratinised peri- implant mucosa
- Material/ surface characteristics
Explain how implants should be probed by stating:
• The material of the probe
• The probing force
• When to probe
• The parameters to look for when probing
Material:
• Can use stainless steel or Teflon coated probe
Probing force:
• Probing force should be reduced by half. Force of 0.25N
When to probe:
• Only probe 6- 8 weeks after abutment insertion
Parameters probed: • BOP • PPD • Recession • KTW especially on buccal aspect
If previous examination data of a patient with an implant is unavailable, explain how the OHT should diagnose peri- implantitis. Are probing depths >6mm a good indication?
When previous data is unavailable:
• Presence of BOP and/ or suppuration
• Thread exposure ≥ 3mm apical to the most coronal portion of the intraosseous part of the implant
• Probing depths of ≥6mm are NOT a reliable indicator
Describe the histological characteristics of tissue affected by peri- implantitis in comparison to periodontitis (with a focus on the immune response)
- Lesion sizes in peri- implantitis tend to be larger (more than twice as large)
- The lesion extends apical to the JE
- Periodontitis “self-limiting process” meaning that it has periods of remission and progression. However, peri-implantitis is continuous and progressive
- The bone loss configuration in peri-implantitis is circumferential, unlike periodontitis where there is horizontal and/ or vertical bone loss
Immune response:
• Plasma cells
• Lymphocytes with larger proportion of PMN and macrophages
• Higher infiltrate density
Explain what type of instruments need to be use to remove calculus around implants
- Stainless steel instruments and ultrasonics can cause a lot of damage/ scratches to the implant surface
- For ultrasonics -> use implant specific tips
- Air polishing devices and non-abrasive prophy pastes can be used
- High grade resin proven not to scratch titanium abutment
- Disadvantages: bulky, single use and resin particle retention on the surface (though this is not a major issue)
List the 2 powders that can be used subgingivally to clean implants
Glycine (amino acid):
• Extremely low abrasive
• Pleasant sweet taste (no sugar)
Erythritol (natural sugar substitute):
• Contains 0.3% CHX
• Suitable for patients on low salt diet (no salt)
