DENTAL IMPLANT MAINTENANCE - Burlington Dental Clinic · 2012-12-14 · Consensus report of 7th...
Transcript of DENTAL IMPLANT MAINTENANCE - Burlington Dental Clinic · 2012-12-14 · Consensus report of 7th...
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S
Maintenance of Dental
Implants Dr. Ronan Allen BDentSc MS
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Beautiful teeth now!
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Reality?
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Consensus report of 7th European Workshop on
Periodontology, 2011
S Peri-implant diseases are common
S 80% peri-implant mucositis
S 20% peri-implantitis
S Aetiology for peri-implant disease is the presence of a bacterial biofilm
S Risk factors for peri-implant diseases are very similar to periodontitis risk factors
S Treatments are primarily based on anti-infective therapy
What does this mean for implant success?
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Risk Indicators
General Factors
Local Factors
Oral Pathogens
Susceptibility of the Host
Peri-implantitis
1. poor oral hygiene
2. history of periodontitis
3. smoking
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Peri-Implant Diseases
Prevention
Diagnosis Therapy
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Biological principles
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Biological Width
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S
Subgingival plaque and loss of
attachment in periodontosis as
observed in autopsy material. Waerhaug J. 1976 J Perio
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Apical
Epithelial
migration
Inflammatory
Infiltrate
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S
Long-standing plaque and gingivitis
at implants and teeth in the dog.
Ericsson I, Berglundh T, Marinello C, Liljenberg B,
Lindhe Clin Oral Implants Res. 1992
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S
Histopathological
observations of human
periimplantitis lesions.
Berglundh T, Gislason O, Lekholm U, Sennerby L,
Lindhe J. J Clin Periodontol. 2004
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Immunological Differences
S Many more PMNs
S Less plasma cells
and lymphocytes
S Concluded that the
peri-implant lesion
was less
immunologically
regulated
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Peri-Implant Diseases
Prevention
Diagnosis Therapy
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Peri-implant soft tissues
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Peri-implant soft tissues
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S Bouri et al. JOMI 2008
S implant sites with less
than 2mm of
keratinized tissue
showed significantly
more BOP and bone loss
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Augmentation
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Cementitis
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Cleansable Restorations
S Adjust Prosthesis
S Plaque Control
S Biofilm Removal
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Interpoximal Cleaning
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Interpoximal Cleaning
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Implant Configuration
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Implant Configuration
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Surfaces
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Patients with Periodontitis
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Patients with Periodontitis
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Choice of Restoration
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Choose the right
restoration for your
patient
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Choose the right
restoration for your
patient
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Implant placement
Make Impression
Fit Restoration
Maintenance
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Maintenance
S Establish practice protocols
S A baseline assessment at 3 months
S Probing depths
S Bleeding on probing
S Occlusion
S Re-assess every 3 months for the first year
S Radiograph at baseline (3 months) and again at 12 months
S Radiographs every 1-2 years depending on clinical findings (5mm PD and BOP) and maintenance frequency
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Peri-Implant Diseases
Prevention
Diagnosis Therapy
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Peri-implant Mucositis
S Clinical Presentation
S Usually Plaque accumulation
S Redness
S Swelling
S Bleeding on Probing
S No bone loss
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Peri-implantitis
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S Metal Probes used appropriately do not damage implant surface
S Probing using a light force (0.25 N) does not damage the peri-implant
tissues.
S BOP indicates presence of inflammation and may also be an indicator
of disease progression (Lang et al. 2000)
Probing
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Probing
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Diagnosis
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Probing
S Increasing probing depth over time is associated with bone loss
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Probing
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S
Radiographic Exam
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Differential Diagnosis
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Differential Diagnosis
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Peri-Implant Diseases
Prevention
Diagnosis Therapy
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PROTOCOL FOR
TREATING PERI-
IMPLANT MUCOSITIS
1.Mechanical scaling of
implant surface with plastic,
titanium or carbon fibre or
ultrasonic instruments.
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PROTOCOL FOR
TREATING PERI-
IMPLANT MUCOSITIS
2. Apply gauze strips soaked
with chlorhexidene (0.2 per
cent) to any exposed implant
surface
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PROTOCOL FOR
TREATING PERI-
IMPLANT MUCOSITIS
3. Sub-mucosal
circumferential irrigation of
the implant pocket with 5ml
chlorhexidene (0.2 per cent).
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Peri-implantitis
Peri-implantitis destructive
inflammatory process around implants,
leading to the loss of supporting bone
(Albrektsson, 1993)
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Nonsurgical Therapy
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Nonsurgical Therapy
S Mechanical instrumentation is difficult and often
insufficient to resolve disease
Lindhe J, Meyle J. Peri-implant diseases: Consensus Report of the Sixth European Workshop on Periodontology. J Clin Periodontol
2008; 35 (Suppl. 8):
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Limitations
S Accessibility
S Implant configuration
S Implant surface structure
S Soft tissue conditions
S Defect configuration
S Amount of bone loss
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SURGICAL PROTOCOL FOR TREATING PERI-
IMPLANTITIS
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1. Full thickness muco-periosteal flap.
2. Thorough debridement of the implant surface with titanium
curettes
3. Pack gauze strips soaked in chlorhexidene placed around implant
defect for five minutes.
4. Decontaminate surface with EDTA (straumann™) for 2 mins
5. If possible, graft defect with hydroxyapatite bone mineral
6. Place barrier membrane if dehisence or unprotected defect
7. Systemic antibiotics for five days post-operatively.
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Defect Morphology
Access Surgery
4 walls Regeneration with bone
substitute only
3 walls
Regeneration with bone and
membrane Dehisence
2 walls Resective therapy
with apically positioned flap
1 wall
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Home Care
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Prosthetically driven implant
placement
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Biologically driven implant
placement
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Next Lecture
22nd November