Periodontitis is a chronic infectious inflammatory disease caused by microbes; however the presence of microbes is not enough for the cause of its complex nature of disease. Inflammation is the prime cause of periodontal disease. It commences with the aggregation of pathogenic microbes that induce the host to stimulate a cascade of inflammatory response reactions which in-turn leads to the destruction of the host tissues itself. There is a complex interplay of innate and adaptive immune responses which fights against the pathogens by direct interaction or by release of certain molecules including cytokines.
Cytokines are cell signalling molecules that aid cell to cell communication in immune responses and stimulate the movement of cells towards sites of inflammation, infection and trauma. Cytokine biology reveals that there are some subsets of cytokines which are pro-inflammatory cytokines which stimulate the inflammatory responses and cause tissue destruction.
A periodontist is expected to have a sound basis of the cytokine profile to understand the pathogenesis of periodontitis and also to discover the new treatment modality of anti-cytokine therapy.
Surgical v/s Non surgical periodontal therapy Achi Joshi
Both surgical and nonsurgical therapy produced improvement in the periodontal health.
Treatment approach was based on the comfort level of the practitioner.
In the late 60’s and continuing into the 70’s and 80’s, many series of longitudinal studies were conducted, aimed to document the immediate and most importantly long term clinical results following several types of periodontal therapy.
Peri-implantitis is a chronic inflammatory disease affecting the bone and gum tissue around implants. As the number of implants being placed increases and subjected to inflammatory and occlusal demands the incidence of problems associated with Peri-implantitis will also increase. It is essential for practitioners to understand the etiology of Peri-implantitis and their role in preventing, treating and maintaining this growing problem.
AGGREGATIBACTER ACTINOMYCETEMCOMITANS is a bacterium with an array of diverse potential virulence characteristics, including multiple immune evasion mechanisms and novel mechanisms for binding to host matrices and invading host cells, any one of which may play a crucial role in the local tissue pathology of Localized aggressive periodontitis.
”Contemporary Biomarkers In Periodontitis”- Guest lecture as a part of Dr NTRUHS Zonal CDE programme at Government Dental College and Hospital, Hyderabad, India on 281/1/2011, SIBAR Institute of Dental Sciences, Guntur, India on 29/12/12 and at Meghna Institute of Dental Sciences, Nizamabad, India on 31/7/2013.
Periodontitis is a chronic infectious inflammatory disease caused by microbes; however the presence of microbes is not enough for the cause of its complex nature of disease. Inflammation is the prime cause of periodontal disease. It commences with the aggregation of pathogenic microbes that induce the host to stimulate a cascade of inflammatory response reactions which in-turn leads to the destruction of the host tissues itself. There is a complex interplay of innate and adaptive immune responses which fights against the pathogens by direct interaction or by release of certain molecules including cytokines.
Cytokines are cell signalling molecules that aid cell to cell communication in immune responses and stimulate the movement of cells towards sites of inflammation, infection and trauma. Cytokine biology reveals that there are some subsets of cytokines which are pro-inflammatory cytokines which stimulate the inflammatory responses and cause tissue destruction.
A periodontist is expected to have a sound basis of the cytokine profile to understand the pathogenesis of periodontitis and also to discover the new treatment modality of anti-cytokine therapy.
Surgical v/s Non surgical periodontal therapy Achi Joshi
Both surgical and nonsurgical therapy produced improvement in the periodontal health.
Treatment approach was based on the comfort level of the practitioner.
In the late 60’s and continuing into the 70’s and 80’s, many series of longitudinal studies were conducted, aimed to document the immediate and most importantly long term clinical results following several types of periodontal therapy.
Peri-implantitis is a chronic inflammatory disease affecting the bone and gum tissue around implants. As the number of implants being placed increases and subjected to inflammatory and occlusal demands the incidence of problems associated with Peri-implantitis will also increase. It is essential for practitioners to understand the etiology of Peri-implantitis and their role in preventing, treating and maintaining this growing problem.
AGGREGATIBACTER ACTINOMYCETEMCOMITANS is a bacterium with an array of diverse potential virulence characteristics, including multiple immune evasion mechanisms and novel mechanisms for binding to host matrices and invading host cells, any one of which may play a crucial role in the local tissue pathology of Localized aggressive periodontitis.
”Contemporary Biomarkers In Periodontitis”- Guest lecture as a part of Dr NTRUHS Zonal CDE programme at Government Dental College and Hospital, Hyderabad, India on 281/1/2011, SIBAR Institute of Dental Sciences, Guntur, India on 29/12/12 and at Meghna Institute of Dental Sciences, Nizamabad, India on 31/7/2013.
Avance de la ponencia del Dr. Ignacio Sanz Sánchez, en el I Simposio SEPA-Dentaid, que se centrará en el tratamiento y prevención de la peri-implantitis.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The contact established without interposition of non bone tissue between normal remodelled bone and on implant entailing a sustained transfer and distribution of load from the implant to and within bone tissue.
This seminar gives the history of osseointegration along with the mechanism of osseointegration, success and failures of osseointegration and the future prospects in osseointegration.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Diagnosis & treatment plan for periimplant desease/ dental implant coursesIndian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
ORTHODONTIC TREATMENT OF AN IMPACTED MAXILLARY CENTRAL INCISOR COMBINED WI...Abu-Hussein Muhamad
Impaction of maxillary permanent incisors is not a frequent case in dental practice, but its treatment is challenging because of these teeth importance to facial esthetics Management by a combination of orthodontics and surgery produces a satisfactory result. The surgical exposure and orthodontic traction of impacted central incisor after surgical exposure of impacted maxillary central incisor teeth is presented in this case report.
Key words: Impacted tooth, Maxillary incisors orthodontics, tooth movement
Periodontal changes in ortho treatment/certified fixed orthodontic courses by...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
Abstract—This study was aimed to present a case report of a case of peripheral ossifying fibroma which is a rare case. This case was a 30 years non smoker male with the chief complaint of growth of gum tissue, moderately large in the mandibular posterior region. On intraoral examination, a peduncalated growth of 17 x 12 x 6 mm on marginal and attached gingiva with respect to tooth number 47 considerably hard in consistency and movable was seen. The lesion was erythmatous having a smooth non ulcerated surface. It was asymptomatic with no sign of pain. Intra oral periapical radiograph was taken which revealed slight erosion of crest of bone which was later confirmed during surgical excision. The possible reason of crestal bone erosion may be constant pressure of the growth. Differential diagnosis of irritation fibroma, pyogenic granuloma and peripheral giant cell granuloma was considered. However, clinical appearance and consistency was of a hard fibrous growth, which therefore led to a provisional diagnosis of peripheral ossifying fibroma or peripheral odontogenic fibroma.
Esthetic Management of Congenitally Missing Lateral Incisors With Single Toot...Abu-Hussein Muhamad
Congenitally missing teeth are frequently presented to the dentist. Interdisciplinary approach may be needed for the proper treatment plan. Several treatment options exist for the replacement of congenitally missing lateral incisors.This case report addresses the fundamental considerations related to replacement of a congenitally missing lateral incisor by a team approach.
Esthetic Management of Congenitally Missing Lateral Incisors With Single Toot...Abu-Hussein Muhamad
Congenitally missing teeth are frequently presented to the dentist. Interdisciplinary approach may be needed for the proper treatment plan. Several treatment options exist for the replacement of congenitally missing lateral incisors.This case report addresses the fundamental considerations related to replacement of a congenitally missing lateral incisor by a team approach.
Erosive cola-based drinks affect the bonding to enamel surface: an in vitro s...AD Dental
Erosive cola-based drinks affect the bonding to enamel surface: an in vitro study
Leslie Caroll CASAS-APAYCO, Vanessa Manzini DREIBI, Ana Carolina HIPÓLITO, Márcia Sirlene Zardin GRAEFF, Daniela RIOS, Ana Carolina MAGALHÃES, Marília Afonso Rabelo BUZALAF, Linda WANG
J Appl Oral Sci. http://dx.doi.org/10.1590/1678-775720130468
Abstract
Objective: This study aimed to assess the impact of in vitro erosion provoked by different cola-based drinks (Coke types), associated or not with toothbrushing, to bonding to enamel. Material and methods: Forty-six bovine enamel specimens were prepared and randomly assigned into seven groups (N=8): C- Control (neither eroded nor abraded), ERO-RC: 3x/1-minute immersion in Regular Coke (RC), ERO-LC: 3x/1-minute immersion in Light Coke (LC), ERO-ZC: 3x/1-minute immersion in Zero Coke (ZC) and three other eroded groups, subsequently abraded for 1-minute toothbrushing (EROAB-RC, EROAB-LC and EROAB-ZC, respectively). After challenges, they were stored overnight in artificial saliva for a total of 24 hours and restored with Adper Single Bond 2/Filtek Z350. Buildup coronal surfaces were cut in 1 mm2-specimens and subjected to a microtensile test. Data were statistically analyzed by two-way ANOVA/Bonferroni tests (a=0.05). Failure modes were assessed by optical microscopy (X40). The Interface of the restorations were observed using Confocal Laser Scanning Microscopy (CLSM). Results: All tested cola-based drinks significantly reduced the bond strength, which was also observed in the analyses of interfaces. Toothbrushing did not have any impact on the bond strength. CLSM showed that except for Zero Coke, all eroded specimens resulted in irregular hybrid layer formation.
Conclusions: All cola-based drinks reduced the bond strength. Different patterns of hybrid layers were obtained revealing their impact, except for ZC.
Comparative study between k-files use from stainless steel or nickel titanium...AD Dental
COMPARATIVE STUDY BETWEEN KERR FILE NEEDLES USE FROM STAINLESS STEEL OR NICKEL TITANIUM ALLOY AND PROTAPER CUTTERS USED IN MANUAL WIDENING OF ROOT CANALS WITH DIFFERENT DEGREES OF CURVATURE
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Etiology, Pathogenesis and treatment of peri implantitis - A Review
1. Periimplantitis
Himanshu Khashu, CS Baiju, Gunjan Gupta, Praful Bali
ABSTRACT
Periimplantitis is an inflammatory process that affects both the hard and soft tissues
around a functional implant and results in marginal bone loss, which may eventually
lead to loss of osseointegration. Bacterial infection is known to play a major role in
the etiology of this disease although there remains some debate as to whether this is
a host susceptibility related or implant surface phenomenon or both. Prevention of
these infections is a major factor when treating patients with implants, particularly, if
they present with a periodontal disease. This article presents the etiology,
pathogenesis and treatment of periimplantitis that has been seen to yield favorable
results.
Keywords: Microbiota, Periimplantitis, Peri-mucositis, Periodontitis, Lasers.
How to cite this article: Khashu H, Baiju CS, Gupta G, Bali P. Periimplantitis. Int J
Oral Implantol Clin Res 2012;3(2):71-76.
Source of support: Nil
Conflict of interest: None declared
INTRODUCTION
Endosseous oral implants have successfully been used during the last decades for
facilitating the replacement of missing teeth in totally or partially edentulous patients.
Although considered a highly successful treatment modality, concerns have been
raised in the literature regarding local infectious conditions in conjunction with oral
implants. Infection around implants has been described and named as
periimplantitis.1
Periimplantitis is defined as an inflammatory reaction with the loss of supporting bone
in the tissues surrounding a functioning implant.2
Periimplantitis denotes an inflammatory reaction affecting the tissues surrounding
2. osseoint.egrated dental implants resulting in loss of supporting bone. Periimplantitis
has also been described as asite-specific infection yielding many features in common
with chronic adult periodontitis.3
Healthy Periodontium around Implants
During the past decade, the demand for dental implants, artificial tooth roots has
grown considerably. Dental implants are used to replace removable partial or full
dentures in edentulous and partially edentulous patients. Implants and implant-
supported prostheses offer greater stability, comfort and esthetics than any other
removable prostheses. Dental implants are titanium fixtures placed into the jaw bone
during surgery. Titanium is the most common biomet:al used in endosseus dental
implants because of its excellent biocompatibility property in physiological
conditions.4
Natural tooth crown / +---Pontic
Gingiva/ f
Pdl fiber holding
gum to tooth .
Fiber holding tooth ----,.1
to bone (periodontal
ligament)
Bone attaches
directly to implant;
called osseolntegration
Fig. 1: Basic comparison model+implant versus tooth
The term osseoint.egration means direct bone contact with an alloplastic metallic
implant. The hard and soft tissues surrounding an osseointegrated implant show
some similarities to the periodontium around natural dentition (Rg. 1).5 The gingiva
around dental implants is called periimplant mucosa, and consists of well-keratinized
oral epithelium, sulrular epithelium and junc:tional epithelium with underlying
connective tissue. Between the implant surface and epithelial c211s are
hernidesmosomes and the basal lamina.6 The most significant difference between
natural teeth and implants is that implants lack the periodontal ligament. The collagen
3. fibers are unattached and parallel to the implant surface rather than in functional
contact from the bone to the cementum. The titanium screw attaches directly to the
alveolar bone, which is in direct and tight contact with the implant surface.
Classification and Pathogenesis of Periimplantitis
Periimplantitis is regarded as an +infection-induced inflammatory process affecting
the tissues around an osseointegrated implant in function, resulting in loss of
supporting bon~.2
Although dental implant therapy has been considered to have an excellent prognosis,
recent reports on the long-term success of implant therapy have presented
surprisingly high prevalence rates of perimucositis and periimplantitis.7
A number of risk factors have been identified, including
{1) poor oral hygiene, {2) a history of periodontitis,
{3) diabetes and (4) smoking.a
Two types of implant failures have been identified and should be considered
separately as follows:
I. An early implant failure due to occlusal overloading corresponds to the inability to
establish osseointegration.9 Occlusal overload increases the risk for microfracbJres at
the implant-bone interface which can result in significant marginal bone loss and
implant failure.10
II. A late implant failure is periimplantitis, a site-specific inflammatory disease with
microorganisms associated in patterns known from the chronic periodontitis of
natural teeth, leading to bone loss and finally to implant failure.11 The microbial
plaque accumulation is considered the most important factor in the pathogenesis of
periimplantitis.12 In the initial stage, plaque accumulation can cause perimucositis, a
reversible inflammation of the soft tissues surrounding functional implants.13 The
adherence of microorganisms to nonshedding biomaterial surfaces and the successful
colonization of these surfaces are principal factors in biomaterial-associated
infections.14 The periimplant microflora is established shortly after implant placement,
and several studies have demonstrated that periodontal pathogens, such as P.
intermedia, can be transmitted from residual teeth to implants.11 Overall, microbiota
4. found in periimplant lesions is similar or at least almost similar to that found in
periodontal lesions.15 Distinct from periodontitis, spirochetes are closely linked to
periimplantitis. Structurally, the periimplant epithelium closely resembles the
junctional epithelium found around natural teeth. The periimplant epithelium
produces inflammatory mediators, and the local host response is biochemically similar
to the response observed in periodontitis.l6
Failing implants affected by periimplantitis are generally characterized by:
• The presence of mobility.
• Progressive marginal bone loss resulting in a typical +crater-like+ bony defect,
while the bottom part of the implant retains perfect osseointegration.
• Signs of infection and inflammation, the infiltration of inflammatory cells,
plasma cells and PMNs, and the ulceration and proliferation of the junctional
epithelium.
International Journal of Oral Implantology and Clinical Research, May-August
2012;3(2):71-76
Himanshu Khashu et al
MICROORGANISMS IN HEALTHY AND DISEASED PERIIMPLANT SITES
Healthy periimplant sites are characterized by high proportions of coccoid cells, a low
ratio of anerobic/aerobic species, a low level of Gram-negative species, and low
detection frequencies of periodontal pathogens.11,17-19 Implants with periimplantitis
reveal a complex microbiota encompassing conventional periodontal pathogens
species, such as Aggregatibacter actinomycetemcomitans, Porphyromonas
gingivalis,Tannerella forsythia, Peptostreptococcus micros, Campylobacter
rectus and Fusobacterium species.11120 Other more unusual oral species, such
as Pseudomonas aeruginosa, Enterobacteriaceae, Candida albicans and Staphylococci
can also be recovered from failing implants.21
DIAGNOSIS OF PERIIMPLANT TISSUE BREAKDOWN
Periimplant Probing
5. To diagnose a compromised implant site, soft tissue measurements using manual or
automated probes have been suggested. Probing the periimplant sulcus with a
straight periodontal probe allows assessment of the following parameters:
• Periimplant probing depth.
• Distance between the soft tissue margin and a reference point on the implant
(measure of soft tissue hyperplasia or recession).
• Bleeding after probing.
• Exudation and suppuration from the periimplant space.
• Successful implants generally allow probe penetration of approximately 3 mm.
• For teeth, a probing force of 0.25 N has been recommended (Lang et al 1991). It
appears reasonable to use the same probing force for determination of bleeding
on probing around implants.
• Probing depth measurements related to fixed landmark on the implant and
examination of the bleeding tendency of the periimplant tissues seem to be well-
suited for the longitudinal monitoring of periimplant stability. Standardized
probes, such as the Audio probe, the TPS probe or the HAWE Click probe, may
be recommended.
Mobility
• Implant mobility is an indication for lack of osseointegration. Even if disease
conditions in the periimplant tissues have progressed relatively far, implants may
still appear immobile due to some remaining direct bone to implant contact.
• Thus, mobility is insensitive in detecting the early stages of periimplant disease.
• The parameter serves to diagnose the final stage of osseodisintegration and may
help to decide that an implant has to be removed.
• For interpretation of low degrees of mobility an electronic device has been
designed to measure the damping characteristics of the periodontium of natural
teeth+periotest.
• Periotest readings were found to be related to characteristic of the mandible, the
periimplant tissue and the length of the abutment.
• The prognostic value of periotest readings for periimplantitis remains to be
determined.
JAYPEE
6. Periimplantitis
Suppuration
• Histologic examinations of periodontal tissues show an infiltration with
neutrophils whenever disease is present.
• High numbers of leukocytes have been shown also with implants that have
increased gingival inflammation.
• Suppuration is associated with disease activity and indicates a need for
antiinfective therapy.
Clinical Indices
• Swelling and redness of the marginal tissues have been reported form
periimplant infections in addition to pocket formation, suppuration and bleeding.
• Recognition of these signs has been considered important in the diagnosis of
periodontal disease.
• Parameters developed for teeth are not strictly applicable to the features of
tissues encountered around implants.
• The bleeding tendency of the marginal periimplant tissues can be assessed using
the modified sulcus index.
• An index for assessing periimplant mucosal tissues based on the gingival index,
but without incorporating the bleeding criterion, has also been proposed.
• Scorings from teeth and implants should be handled and interpreted separately.
• The texture and color of the tissues which are important discriminators between
gingival index scores depend on the normal appearance of the recipient tissues
before implantation and vary due to properties of the implant surface.
• The modified plaque index may be used to assess the amount of plaque on
implants.
Periimplant Radiography
• Vertical bone loss of less than 0.2 mm annually following the implants first year
of service has been proposed as one of the major criteria for success.
• For accurate assessments of bone level changes, longitudinal series of
standardized radiographs are required.
7. • Detection of minute changes of bone level or density requires reproducible
projection geometry for the X-ray beam, provided by an appropriate aiming
device.
• Above-mentioned changes in the range of 0.1 mm are only mathematically
determined and cannot be detected by comparison of two radiographs from a
single implant.
• Radiographic examination cannot be the only parameter to estimate the
performance of implants in the individual patient.
• In absence of clinical signs of infection, it is recommended to take radiographs 1
year after implant installation and every other year thereafter.
Microbiology
• Bacterial culture, DNA probes, polymerase chain reaction, monoclonal antibody
and enzyme assays to monitor the subgingival flora have been proposed to
determine an elevated risk for periodontal disease or periimplantitis.
• Studies indicating the existence of different forms of periimplant disease,
including specific infections and nonbacterial failures illustrate that
microbiological tests may be valuable tools for the differential diagnosis of
periimplantitis and for planning treatment.
Clinical Appearance of Periimplantitis8
Periimplantitis lesions are often asymptomatic and usually detectec:I at routine recall
appointments. Careful probing around teeth and implants should be routine
procedures included at these check-up appointments. The validity of probing around
implants to properly detect periimplant lesions has previously been questioned,
although this dogma needs to be reassessed. Increased clinical probing pocket depth,
often accompanied by bleeding and sometimes suppuration, is an indicator of
pathology in periimplant tissues. A common clinical problem regarding probing at
implants is accessibility (i.e. the design of the bridgework may interfere with the
probing procedure). In this context, it is important to realize that periimplant defects
normally encompass the full cirrumference of the implant; therefore, it may be
sufficient to probe only solitary sites at any given implant when there is obstruction
by the prostheses. Based on the findings of the clinical examination, radiographs of
the selected areas may be proposed. In periimplantitis, a bony defect develops
8. around single or multiple implants. The radiographic appearance is often in the shape
of a saucer or rounded beaker and, as stated earlier, the lesion most often extends
the full circumference of the implant. Periimplant lesions may develop after several
years. In biomedicine, a +safety zon~ of 5 years has often been misinterpreted to
denote safe survival or no further risk for disease progression. In periodontitis, tissue
destruction seems to be a relatively slow process; consequently, a function time
exceeding 5 years for implants may be required to detect destructive periimplantitis
sites. Regular check-up visits and life-long supportive therapy is an absolute necessity
for the implant patient.
International Journal of Oral Implantology and Clinical Research, May-August
2012;3(2):71-76
Himanshu Khashu et al
TREATMENT OF PERIIMPLANTITIS
Historically, periimplantitis has been associated with macro-rough, porous coatings,
such as titanium plasma spray and hydroxyapatite, which saw a very aggressive form
of infection with rapid bone loss leading to implant failure. In contrast, implants with
a microroughened surface texture have presented excellent long-term data22123 and
until recently there has been very little published in the literature demonstrating a
susceptibility of these surfaces to this condition. However, the application of implants
in the partially dentate patient is unquestionably leading to higher incidences of cross-
infection of periimplant sites.24,25
While the use of lasers has been extensively reportect,26-29 this methodology remains
outside the reach of most general practitioners and much attention remains focused
on physical debridement and antimicrobial therapy. To this end the topical use of
tetracyclines remains a firm favorite, not least because they chelate to hydroxyapatite
in bone from where they can mediate their effect.30
The following surgical protocol has proven reliable and predictable in the treatment of
advanced periimplantitis lesions:
• Systemic antibiotics equivalent to metronidazole 400 mg TDS for three days
9. preoperatively.
• Preoperative 1 minute mouthwash with 0.2°/o chlorhexidine.
• Full thickness flap elevation extending beyond the infected area to sound
tissues.
• Comprehensive debridement and curettage down to fresh bone, including
mechanical curettage of implant surface with carbon fiber curettes.
• Pack gauze strips soaked in 0.2°/o chlorhexidine around implant, into defect and
under the mucoperiosteal flap. Leave in situ for 5 minutes.
• Remove gauze and wash defect with tetracycline solution 1 gm in 20 ml of
sterile saline.
• Graft defect with hydroxyapatite bone mineral of allogeneic or xenogenic
derivation rehydrated in the tetracycline solution.
• Trim and overlay graft with double layer of resorbable collagen membrane,
rehydrated in tetracycline solution. It is usual to expect some hard and soft
tissues recession
postoperatively, which may result in exposure of implant surface and as such place
the implants to future risk of periimplant mucositis. However, this also has the
advantage that it results in pocket reduction thereby reducing the risk of an infective
periimplantitis. As such, regular follow-up and occasional decontamination therapy as
described for the treatment of mucositis is recommended.
IMPLANT MAINTENANCE
Cumulative Interceptive Supportive Therapy
• The principle of this method is to detect periimplant infections as early as
possible and to intercept the problems with appropriate therapy.
• The basis for this system is a regular recall of the implant patient and the
repeated assessment of the following key parameters around each implant.
• The presence of plaque
• The bleeding tendency of the periimplant tissues
• Suppuration
• Presence of periimplant pockets
• Radiological evidence of bone loss.
• Optimally, an implant should yield negative results for all these parameters. In
this case, no therapy is needed and one may consider increasing the length of
10. recall interval.
• If plaque and/or an increased tendency to bleed are detected, then the implants
are mechanically cleaned using a rubber cup and polishing paste. Instruments
made of softer material than titanium may be used to remove hard deposits.
Oral hygiene practices should be checked and the proper plaque control technique
should be instructed and reinforced.
• In the presence of pus or if first signs of periimplant tissue destruction are
detected (pockets 4-5 mm and slight bone loss), the periimplant pockets are
irrigated with 0.2°/o chlorhexidine and the patient is advised to rinse twice daily
with 0.12°/o chlorhexidine (A) along with local application of antiseptic (B).
• If pocket depth >5 mm, radiograph is taken. If there is clear evidence of bone
loss, then a microbiological sample is taken. Evidence of anerobic flora,
treatment A+B and in addition systemic antimicrobial therapy (C)
• If the bone destruction has advanced considerably, surgical intervention to
correct the tissue morphology on to apply GBR techniques may be necessary (D).
• The goal of this cumulative treatment approach is to intercept periimplant tissue
destruction as early as possible.
After the implants are removed, the ridge defects can be reconstructed to their
original level using bone graft and membrane techniques. This treatment enables the
clinician to place new implants in a previously compromised situation.
Removal of Failed Implants
Indications for removal are as follows:
• Severe periimplant bone loss (>50°/o of implant length)
• Bone loss involving implant vents or hole
• Unfavorable advanced bone defect (one wall)
• Rapid, severe bone destruction (with in 1 year of loading)
• Nonsurgical or surgical therapy ineffective
• Esthetic area precluding implant surface exposure
• Demonstrates mobility.
JAYPEE
Periimplantitis
11. SUMMARY
Periimplant lesions may develop after several years. Patients who have lost their teeth
due to periodontal disease seem to be at greater risk. Although several antiinfective
treatment strategies have demonstrated beneficial clinical effects in humans (ex,
resolution of inflammation, decrease in probing depth and gain of bone in the
defects), there is insufficient evidence to support a specific treatment protocol.
Available studies on the treatment of periimplantitis have included only a small
number of subjects, and in general, the study periods have been relatively short. To
date, there is no reliable evidence that suggests which interventions could be the most
effective for treating periimplantitis. This is not to say, however, that currently used
interventions are not effective.
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International Journal of Oral Implantology and Clinical Research, May-August
2012;3(2):71-76
Himanshu Khashu et al
14. ABOUT THE AUTHORS
Himanshu Khashu (Corresponding Author)
Professor, Department of Periodontics, Sudha Rustagi College of Dental Sciences and
Research, Faridabad, Haryana, India Phone: +91-9818339669, e-mail:
adhimanlO@yahoo.co.in
CS Baiju
Professor and Head, Department of Periodontics, Sudha Rustagi College of Dental
Sciences and Research, Faridabad, Haryana, India
Gunjan Gupta
Postgraduate Student, Department of Periodontics, Sudha Rustagi College of Dental
Sciences and Research, Faridabad, Haryana, India
Praful Bali
Prosthodontist and Implantologist, Private Practitioner, New Delhi, India