Peri implantitis

1. PERI ITIS

2. Swedish orthopedic surgeon and research professor.
PER INGVAR BRANEMARK

3.  IMPLANTS ARE USED AS REPLACEMENT FOR NATURAL ROOT
 Dental implants?????? Why
 Maintenance of alveolar bone……

10. DISEASES AFFECTING
IMPLANTS
PERIMUCOSITIS
PERIIMPLANTITIS

11. PERI-IMPLANT MUCOSITIS
 Inflammatory changes are confined to soft tissues surrounding an implant

12.  Similar to gingivitis- BACTERIAL PLAQUE

13.  Similar to gingivitis
 Symptoms of inflammation
 Bleeding on probing
 Difference in morphology of periimplant
mucosa and gingiva around tooth and
lack of light transmission through metal
may mask visible signs of inflammation
 Suppuration and slight increase in PPD
may be present

15. mobility

17.  Bacterial infection
 Biomechanical factors-excess forces
 Co-factors- smoking, compromised host, traumatic surgery….

18.  Class I : slight horizontal bone loss with minimal peri-implant defect
 Class 2: moderate horizontal bone loss with isolated vertical defect
 Class 3: moderate to advanced horizontal bone loss with broad circular bony defect
 Class 4: advanced horizontal bone loss with broad circumferential vertical defect
as well as loss of oral and vestibular bony wall

19.  CLINCIAL ASSESSMENT: inflammation signs, BOP, suppuration, mobility, peri-
implant radiography
 PERI-IMPLANT PROBING: USE ONLY BLUNT ,STRAIGHT PLASTIC
PERIODONTAL PROBE
 Probing depth of more than 4mm suggestive of peri-implant disease

20. PERI-IMPLANT
RADIOGRAPHY

21. MOMBELLI suggested 5 considerations in periimplantitis therapy
 1. Removal of bacterial biofilm
 2.Decontamination and conditioning of implant surface
 3.Correction via reduction or elimination of site that cannot be maintained by oral
hygiene measures
 4.Establishment of effective plaque control regime
 5.Re-osseointegration

22. Treatment of periimplantitis
Initial
therapeutic phase
Surgical phase

23. INITIAL THERAPEUTIC
PHASE
 Occlusal therapy-prosthesis analysis and
occlusal evaluation
 Anti-infective therapy-remove plaque with
plastic instruments ,irrigate pockets with 0.12%
chlorhexidine
 Systemic antibiotics: doxycycline,
metronidazole, or combination of amox and
metronidazole
 Implant surface preparation: in periimplantitis
implant surface is contaminated with bacteria
and its byproducts.thus wound healing is
compromised.
 Air powder abrasive
 Apply tetracycline HCL
 Lasers –CO2

24. Periimplant resective therapy-Flap is raised and bone recontouring is
done. And sutured by apically positioning the flap. Done in peri-implant lesions
with horizontal bone loss or moderate vertical bone defects.
Periimplant regenerative therapy- guided bone regeneration in
moderate to deep vertical defects . Surgical therapy includes removal of
granulation tissue after flap elevation, implant surface preparation and use of
bone grafts and barrier membranes.
 Re-osseointegration: treatment goal – denovo bone formation at the portion of
implant that has lost its osseointegration in the inflammatory process.

25. CIST
Cumulative
Interceptive
Supportive
Therapy
Protocol for monitoring healthy implants and
interception of peri-implant diseases.

26.  CIST PROTOCOL A (mechanical debridement)
 PPD < 4mm , oral hygiene improved by scaler, rubber cup and paste.
 CIST PROTOCOL A+ B ( antiseptic therapy)
 PPD 4-5mm chlorhexidine is used with step A
 CIST PROTOCOL A+B+C (antibiotic therapy)
 PPD > or = to 6mm ,tetracycline fibers for 10 days and systemic antibiotic for 10
days along with step A+B
 CIST PROTOCOL A+B+C+D(regeneration and resective therapy)
 Considerable amount of bone loss and pocket depth are present surgical therapy
along with step A+B+C.

28.  GOAL OF CIST: to intercept peri-implant tissue destruction as early as possible.

29.  PLAQUE CONTROL
 INTERDENTAL CLEANING AIDS
 PERIODIC RECALL