Summary of Book Lindh chapter 24

1. Chapter 24: Peri-implant Pathology
Dr Nadiah Alenaizan

3. Healthy peri- implant mucosa

4. Peri- Implant Mucosa
*Tissues are lined with a keratinized oral
epithelium; this is continuous with a thin non-
keratinized sulcular epithelium that faces the
implant.
*In the underlying connective tissue there are
small infiltrates of inflammatory cells(neutrophils,
macrophages, T cells, B cells) .
*Junctional epithelium connects to the dental
implant surface via hemidesmosomoes and basal
lamina.

6. Peri-Implant Complications: A Clinical Guide to Diagnosis and Treatment
By Anastasia Kelekis-Cholakis, Reem Atout, Nader Hamdan, Ioannis Tsourounakis

7. Teeth Dental Implants
periodontal fibers Insert in cementum on the
root surfaces of natural
teeth
Extend parallel to the
surface of the implant or
abutment
Connection Periodontal ligaments Osseointegration
Connective tissue Lower percentage of
collagen fibers
Higher percentage of cells
More vascular
Higher percentage of
collagen fibers
Lower percentage of
fibroblast
Less vascular
Blood supply to
surrounding gingivae
Three different sources
(PDL, interdental bone
,supraperiosteal region )
Two different sources
(supraperiosteal region,few
vesseles from bone )
Biological width JE:0.97-1.14mm
CT: 0.77-1.07mm
BW:2.04-2.91mm
JE:1.88mm
CT: 1.05mm
BW:3.08mm

8. Teeth Dental implants
proprioception Periodontal
mechanoreceptors
Osseoperception
Tactile sensitivity High low
Axial 25-100 μm 3-5μm
Fulcrum when lateral
forces applied
Apical third of the root crestal bone

10. Prevalence of implant
diseases
Has been reported in several
studies ranges from 5-63% *
*Introduction to Understanding the Basics of Teeth vs. Dental Implants: Similarities and
Differences
, Reem Atout1, Nader Hamdan2 and Ioannis Tsourounakis3

11. bacterial species associated
with peri- implant diseases
mainly (Gram –negative
anerobic)
Staphylococcus aureus are
important pathogens in peri-
implantitis
*Introduction to Understanding the Basics of Teeth vs. Dental Implants: Similarities and
Differences
, Reem Atout1, Nader Hamdan2 and Ioannis Tsourounakis3

12. A disease in which the
presence of inflammation is
confined to the mucosa
surrounding dental implant
with no signs of loss of
supporting bone.

13. Reversible inflammatory
process in the soft tissues
surrounding a functioning
implant.

14. 1-signs of redness and
swelling.
2-Bleeding on probing .
Peri-implant mucositis
Clinical features

15. Berglundhbet al.
(1992)
Abrahamsson et al.
(1998)
Ericsson et al. 1992)
Zitzmann et al. (2001)
2- Peri-implant mucositis may or may
not progress to peri-implantitis
1-Plaque accumulation on the
titanium surface and the formation
of a biofilm seem to be essential for
the initiation and progression of
peri-implant mucositis.
Aetiology

16. • peri-implant mucositis when effectively
treated, can be reversed back to health
• So removal of the biofilm from the dental
implant surface is the primary objective when
treating peri-implant mucositis

18. An inflammatory process around dental
implant which includes both soft tissue
inflammation and loss of supporting
bone

19. Infl ammatory process additionally
characterized by loss of peri-implant
bone.

20. Clinical features
• An inflamatory lesion in the peri-implant mucosa
and loss of peri-implant bone.
• Peri-implantitis initially affects the marginal part
of the peri-implant tissues and the implant may
remain stable and in function for varying periods
of time. Implant mobility is therefore not an
essential symptom for peri-implantitis but may
occur in a final stage of disease progression and
indicates complete loss of integration.

21. Most of the researches related to peri- implantitis
suggested that a certain
amount of bone loss (≥1.8 mm compared with the
1-year data) together with the finding of BoP was
required for the diagnosis peri-implantitis

22. Q-Why The rate of progression to the
supporting bone is often faster in peri-
implantitis compared to periodontitis?
A- the periodontal ligament is missing, so
inflammation progresses directly to the bone.

23. Pathogensis
Studies have documented that a biofilm on the implant
surface initiates inflammation in the peri-implant mucosa
(peri-implant mucositis).
This lesion is initially located in the connective tissue
immediately lateral to the barrier epithelium. In the
continued presence of a submarginal biofilm, the lesion in
the marginal mucosa around implants may occasionally
spread in an “apical” direction to involve the hard tissue,
compromise osseointegration, cause varying degrees of
marginal bone loss (peri-implantitis), and eventually the
loss of the implant.

24. An Individualized Approach to Peri-Mucositis Prevention
Oral health professionals well versed in effective diagnostics and prevention strategies can
help patients avoid this precursor to peri-implantitis.
By Christine DeBaz, BA, Lisa Lang, BSDH, DDS, MS, MBA and Leena Palomo, DDS, MSD

25. The End