PeriImplantitis Concepts.pptx
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The document discusses key concepts regarding peri-implantitis and peri-implant mucositis. Some of the main points made include: 1) Peri-implantitis is not the same as periodontitis and should be considered a distinct disease process with its own diagnostic criteria and treatment approaches. 2) Peri-implant mucositis is also distinct from gingivitis and may require longer than 3 weeks for resolution of inflammation. 3) Some amount of marginal bone loss within the first year of implant placement should be considered normal remodeling rather than a disease process. 4) Periodontal indices alone cannot adequately assess peri-implant health and disease status due to differences in
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PeriImplantitis Concepts.pptx
- 1. PERIIMPLANTITIS Clarity on the Concepts
- 4. PERIIMPLANTITIS IS NOT PERIODONTITIS
- 5. *Consensus report of 7th European Workshop on Periodontology, 2011 It was always assumed that’s that the common etiology for peri- implant disease is the presence of a bacterial biofilm and excessive occlusal load* PERIIMPLANTITIS IS NOT PERIODONTITIS
- 6. Donath K. Pathogenesis of bony pocket formation around dental implants. J. Dent. Assoc. S. Afr. 1992;47:204–208. *Bosshardt DD, Brodbeck UR, Rathe F, Stumpf T, Imber JC, Weigl P, Schlee M. Evidence of re-osseointegration after electrolytic cleaning and regenerative therapy of peri-implantitis in humans: a case report with four implants. Clin Oral Investig. 2022 Apr;26(4):3735-3746. PERIIMPLANTITIS IS NOT PERIODONTITIS Marginal Bone Loss OSSEOINTEGRATION*
- 7. Kotsakis GA, Olmedo DG. Peri-implantitis is not periodontitis: Scientific discoveries shed light on microbiome-biomaterial interactions that may determine disease phenotype. Periodontol 2000. 2021 Jun;86(1):231-240. doi: 10.1111/prd.12372. Epub 2021 Mar 10. PMID: 33690947. Antibiotic Resistance Titanium Dissolution Products
- 8. PERIIMPLANTITIS IS NOT PERIODONTITIS Mombelli A, Hashim D, Cionca N. What is the impact of titanium particles and biocorrosion on implant survival and complications? A critical review. Clin Oral Implants Res. 2018 Oct;29 Suppl 18:37-53. doi: 10.1111/clr.13305. PMID: 30306693.
- 9. PERIIMPLANTITIS IS NOT PERIODONTITIS 1.52 µm-94.00 µm Gianfreda F, Punzo A, Pistilli V, Bollero P, Cervino G, D'Amico C, Cairo F, Cicciù M. Electrolytic Cleaning and Regenerative Therapy of Peri-implantitis in the Esthetic Area: A Case Report. Eur J Dent. 2022 Oct;16(4):950-956. doi: 10.1055/s-0042-1750773. Epub 2022 Jul 4. PMID: 35785819; PMCID: PMC9683897
- 10. PERIIMPLANT MUCOSITIS IS NOT GINGIVITIS
- 11. • More PMNs • Less plasma cells and lymphocytes • Peri-implant lesion was less immunologically regulated Peri-implant mucositis has to be diagnosed properly Peri-implant soft tissues develop a stronger inflammatory response Inflammation was reversible only at the biomarker level 3-weeks was not sufficient for inflammation reversal PERIIMPLANT MUCOSITIS IS NOT GINGIVITIS
- 12. PERIIMPLANT MUCOSITIS IS NOT GINGIVITIS Non-surgical therapy has not been shown to be effective for the treatment of peri-implant mucositis Peri-implant mucositis appears to be reversible Peri-implant mucositis may be present for extensive periods of time without progression to peri-Implantitis Optimal biofilm control may take longer than 3 weeks
- 13. PERIIMPLANT MUCOSITIS IS NOT A DISEASE
- 14. Inflammatory connective tissue (ICT) infiltrate of the peri- implant mucosa in the microgap* This ICT zone indicates a response of the immune system to microorganisms and in generally considered as protective** If the microgap is located more coronally, ie, further from the alveolar crest, then we should expect less bone loss because of the greater distance between the bacteria and the alveolar Crest*** *Ericsson I, Persson LG, Berglundh T, Mariniello CP, Lindhe J, Klinge B. Different types of inflammatory reactions in periimplant soft tissues. J Clin Periodontol 1995;22:255–261. **Piattelli A, Vrespa G, Petrone G, Iezzi G, Annibali S, Scarano A. Role of the Microgap between implant and abutment: A retrospective histologic evaluation in monkeys. J Periodontol 2003;74:346–352. ***Luongo R, Traini T, Guidone PC, Bianco G, Cocchetto R, Celletti R. Hard and soft tissue responses to the platform-switching technique. Int J Periodontics Restorative Dent. 2008 Dec;28(6):551-7. PMID: 19146050. PERIIMPLANT MUCOSITIS IS NOT A DISEASE
- 15. PERIIMPLANT MUCOSITIS IS NOT A DISEASE The ICT is never in contact with the bone but was separated from it by an approximately 1-mm-wide layer of healthy connective tissue* This should be considered as a sort of barrier or protective seal capable of preserving bone complementing the biologic width IF IT IS PROTECTIVE, WHY IS IT A DISEASE? *Luongo R, Traini T, Guidone PC, Bianco G, Cocchetto R, Celletti R. Hard and soft tissue responses to the platform-switching technique. Int J Periodontics Restorative Dent. 2008 Dec;28(6):551-7. **Berglundh T, Lindhe J. Dimension of the periimplant mucosa. Biologic width revisited. J Clin Periodontol 1996;23:971–973
- 16. PERIODONTAL INDICES CANNOT ASSESS PERIIMPLANTITIS
- 17. PERIODONTAL INDICES CANNOT ASSESS PERIIMPLANTITIS BOP PPD Bone Loss Deep insertion of the implant Type and implant diameter Abutment connection materials Type of prosthetic suprastructure Atieh MA, Alsabeeha NH, Faggion CM Jr, Duncan WJ. The frequency of peri-implant diseases: a systematic review and meta-analysis. J Periodontol. 2013;84:1586–1598. Hammerle CH, Bragger U, Burgin W, Lang NP. The effect of subcrestal placement of the polished surface of ITI implants on marginal soft and hard tissues. Clin Oral Implants Res. 1996;7:111–119. The diagnostic criteria and treatments for peri-implant diseases are not currently standardized (Ramanauskaite et al 2016, Natto et al 2019, Scarano et al 2023). Peri-implant probing causes over-diagnosis and over-treatment (Coli & Sennerby 2019, Bornes et al, 2023).
- 18. PERIODONTAL INDICES CANNOT ASSESS PERIIMPLANTITIS Renvert S, Persson GR, Pirih FQ, Camargo PM. Peri-implant health, peri-implant mucositis, and peri-implantitis: Case definitions and diagnostic considerations. J Periodontol. 2018 Jun;89 Suppl 1:S304-S312. doi: 10.1002/JPER.17-0588. PMID: 29926953.
- 19. PERIODONTAL INDICES CANNOT ASSESS PERIIMPLANTITIS Case Definitions BOP PPD Bone Loss Periimplant Mucositis Erythema & BOP+ & PPD↗ & Absence of bone loss beyond initial remodeling 2017 World workshop BOP+ with ≤2 mm in the first year and ≤0.2 mm in each subsequent year and PD≥5 mm Natto et al 2019 Periimplantitis visual inflammatory changes + PPD↗ + Progressive bone loss + evidence of bone loss ≥3 mm with PPD≥6 mm 2017 World workshop Crestal bone loss of ≥2 mm and PD ≥3 mm Natto et al 2019
- 20. MARGINAL BONE LOSS (MBL) WITHIN THE FIRST YEAR IS NOT DISEASE
- 21. 6 Months 3 Months 9 Months MARGINAL BONE LOSS (MBL) WITHIN THE FIRST YEAR IS NOT DISEASE Early marginal bone loss (MBL) Is the bone loss pathologic? How much loss is normal? What is the acceptable bone loss at 1y, 2y or at 3y?
- 22. MARGINAL BONE LOSS (MBL) WITHIN THE FIRST YEAR IS NOT DISEASE Early marginal bone loss (MBL) is a non-infective remodeling occurring within the first year after implant placement The estimate for the mean MBL was 0.5 mm within the first year Implants that lose more than 0.5 mm of marginal bone 6-months after loading are at great risk of not being radiographically successful anymore. Galindo-Moreno P et al. Early marginal bone loss around dental implants to define success in implant dentistry: A retrospective study. Clin Implant Dent Relat Res. 2022 Oct;24(5):630-642.
- 23. MARGINAL BONE LOSS (MBL) WITHIN THE FIRST YEAR IS NOT DISEASE Fu PS, Tseng FC, Lan TH, Lai PL, Chen CH, Chen JH, Liu CT, Chen WC, Hung CC. Immediate implant placement with and without provisionalization: A comparison of a one-year longitudinal study. J Dent Sci. 2023 Jul;18(3):1361-1367.
- 24. IMPLANT DESIGN DOES NOT CORRELATE WITH INCIDENCE OF PERIIMPLANTITIS
- 25. Fu JH, Wang HL. Breaking the wave of peri-implantitis. Periodontol 2000. 2020 Oct;84(1):145-160. IMPLANT DESIGN
- 26. 1.5 Yrs 3 months Zirconia Implants IMPLANT DESIGN
- 28. THANK YOU
Editor's Notes
- a person falsely claiming to have a special knowledge or skil a person who claims to have a supernatural ability to perceive events in the future or beyond normal sensory contact.
- Risk factors for periimplant diseases are very similar to periodontitis risk factors Common etiology for peri-implant disease is the presence of a bacterial biofilm and excessive occlusal load*
- Most dental implants have a 2-stage design in which (1) the implant is placed and the surrounding tissues are allowed to heal, and then (2) the abutment is placed and the restoration is completed. To prevent the unsightly metal ring that occurs with supragingival placement of the IAJ, most implants involve subgingival placement. The implant and the abutment cannot be accurately matched because of the precision limit during production . This subgingival placement makes the IAJ inaccessible for routine hygiene care and raises legitimate concerns about bacterial colonization within the IAJ micro-gap. In vitro studies show that biofilm in sliding contact surfaces could act like a lubricant, resulting in a friction behavior and reducing the mechanical integrity of the joint vs COLD WELDING Around implant-abutment connections, a lower pH value of 3–4 can induce corrosion at the contacting surfaces. Galvanic corrosion is the most common type of corrosion in dental implants. The study of the simultaneous degradation by wear and corrosion that occurs at the sliding contacts is known as tribocorrosion
- The internal cavity of implant is similar to a reservoir (Nayak et al., 2014; Orsini et al., 2000; Proff et al., 2006). When the abutment is removed and replaced, bacteria can enter the implant internal cavity, where they reside and proliferate. The bacteria with their toxic by-products and small nutritious molecules can freely penetrate into the implant internal cavity or reverse through the IAI microgap. The destruction of the IAI micromotion is mainly displayed in two aspects. First, micromotion interferes the attachment of soft tissue around the implant neck and disrupts the stability of soft tissue that has completed integration (Passos, Gressler May, Faria, Ozcan, & Bottino, 2013). Second, micromotion causes a micropumping effect (Ericsson, et al., 1995), which intensifies the leakage of bacteria and their toxic by-products and accelerates the blood, saliva, and proteoglycans (including the extracellular matrix and mucus layer) into the internal cavity of implant (Baixe, Tenenbaum, & Etienne, 2016). Mechanical damages of microgap and micromotion include fretting wear, adhesive wear, and screw loosening (Jorn, Kohorst, Besdo, Borchers, & Stiesch, 2016; Sakamoto et al., 2016). Fretting wear refers to microfracture and chipping between the IAI, whereas adhesive wear is defined as the plastic deformation in the IAI (
- The host response to biofilms does not differ substantially at teeth or implants. The most obvious sign clinically is the development of an inflammatory lesion as a result of the bacterial challenge. Gingivitis at teeth or peri-implant mucositis at implants are precursors for more detrimental lesions, and hence have to be diagnosed properly and prevented by applying anti-infective therapy. Non-surgical interventions are usually sufficient for the treatment of both gingivitis and mucositis.