Managing Peri Im Bone Loss
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Transcript of Managing Peri Im Bone Loss
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Introduction
When losing teeth
RPD (Removal Partial Denture)
FPD (Fixed Partial Denture)
ISP (Implant Support Denture)
Increasing of implant placement, but there are many
complications
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Introduction
International Congress of Oral Implantologist Pisa
Consensus Conference report give a definition of
Implant failure: remove or lost
Implant complication: deviation of standard tx
outcome, and requires further tx
Peri-implantitis (survival rate 89&-95% in 10y reports)
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Peri-implantitis
A systemic review of 51 prospective studies reported
0%-14.4% in 5 year follow up
Other reported
11.3%-47.1% in 10-16 years
Biological and mechanical factors
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Biological factor
Micro-organism especially periopathic bacterial: P.g,
T.f, T.d
Smoking
Diabetes
Others : compression necrosis, infection,overheating of bone during operative
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Schwarz peri-implantitis
Class I: intrabonydefect
a: dehiscences defect
b: buccal & interproximal defect
c: class Ib + lingual defect
d: buccal and lingual dehiscence
e: circurferential
Class II: suprabony defect
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Mechanical factor
Occlusal over loading is considered the primary
factor
Poor prosthetic design
Inadequate number, dimensions
Non ideal position Parafunction habit
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Complication of Implant
Failure
Effect quality of life
Function
Esthetics
Time
Money
Psychological stress
Management of this failure to reosteointegration
GBR
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Treatment Modalities
Goal is trying to eliminate and restoring lost struturesand function
It is divided as periodontal treatment
Non-surgical
Antimicrobial therapy & mechanical debridement
Surgical
Surgical debridement, implantoplasty, dental lasers Regenerative
GBR
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Non-Surgical
Local tetracycline combines with debridement
6% bone filled on x-ray
0.2-0.3mm clinical significant
Evident review an ineffective method in
management peri-implantitis
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Surface Decontamination
Eliminating etiological factor
Several agents use for decontamination found no significant oversuperior
Saline, Abrasive pumice, Citric acid, CHX, Air power abrasive
Systemic review shows SD improve re-osteointergration
Dental laser and PDT
CO2 reduce amount ofS. sanguis and P. gingivalis
Nd:YAG=Er:YAG=diode laser
Laser + bone graft + collagen membrane: almost complete bonefill
No long term study report
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Surface Decontamination
Implantoplasty: archive smooth surface & plaque
adhesion
Poor effects:
increase heat, damage adjacent tissue, metallic
debris
Diamond bur with water irrigation only 1.5 degree C No surrounding tissue damage
Rubber dam might helpful
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Surgical Debridement
Surgical re-entry examination
GBR>Bone graft alone>flap debridement: bone fill
GBR with / without bone graft no significant different
GBR still not predictable as a Systemic review
reported
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Decision Tree
Management in horizontal defect
APF & implantoplasty
Management in vertical defects
Dependent on patient related (OHI, smoking)
Systemic condition(uDM)
Defects
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Defects
Ochsenbien and Cortellini and Tonetti
1 wall APF
2, 3 wall GBR with non resorbable membrane
3 wall (contained) GBR with resorbable membrane
Circumferential defect occlusal evaluation
Release heavy loading
Not ideal implant position remove
hard & soft tissue graft
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Others
PASS principle GBR must be done with primary
closure
Reduce bacterial/foreign bodies contaminated
OFD and GBR
Debridement + Antibiotic (local / systemic)