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Diagnosis and Treatment of Peri-implantitis

Diagnosis and Treatment of Peri-implantitis . Dent 664 August 30, 2007. Which factors most often contribute to failure of osseointegrated implants that were previously stable and functional?. Excessive loading Infection. Peri-implant mucositis.

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Diagnosis and Treatment of Peri-implantitis

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  1. Diagnosis and Treatment of Peri-implantitis Dent 664 August 30, 2007

  2. Which factors most often contribute to failure of osseointegrated implants that were previously stable and functional? • Excessive loading • Infection

  3. Peri-implant mucositis • The gingiva around teeth and the mucosa around implants exhibit responses to plaque that are somewhat similar. • However, histological studies suggest that peri-implant mucosa is less capable of containing and repairing the damage caused by plaque-induced inflammation

  4. Peri-implantitis: histology • Experimental periodontitis and peri-implantitis have been compared in dogs. • The plaque associated with periodontitis and peri-implantitis sites is similar. • The inflammatory lesion associated with peri-implantitis tends to extend to involve the bone. In contrast, there is typically a zone of non-inflamed connective tissue interposed between the inflammatory lesion and the bone in periodontitis.

  5. Peri-implantitis histology (continued) • Human peri-implantitis lesions are characterized by the presence of numerous neutrophils in the tissue surrounding the implant and direct contact between plaque on the implant surface and inflamed connective tissue. These features are not seen in periodontitis.

  6. Diagnosis of peri-implant infections is based on the following findings: • Bleeding on probing (BOP) around the implant • Suppuration around the implant • Probing depth around the implant • Mobility of the implant • Radiographic evidence of bone loss around the implant

  7. Criteria for a successful implant (Albrektsson et al, 1986) • The implant is immobile • Absence of peri-implant radiolucency • Absence of pain, infection, neuropathy or paresthesia • At 1 year in function, < 0.2 mm vertical bone loss

  8. When things go wrong: Definitions • Failing implant: has progressive alveolar bone loss, pocket formation, bleeding on probing, or suppuration. • Failed implant: a hopeless and nonfunctional implant requiring removal. It may exhibit loss of osseointegration, mobility, or pain.

  9. Treatment of failing implants • Resolution of inflammation (debridement of plaque, improvement of oral hygiene, use of adjunctive antibiotics) • Correction of unfavorable soft tissue morphology (pseudopockets) by flap surgery or gingivectomy • Re-osseointegration (decontaminate the implant surface with citric acid or tetracycline solutions, guided bone regeneration.

  10. Treatment of failed implants • Remove the implant. • Implant removal, followed by guided bone regeneration and subsequent placement of a replacement implant. • Remove the implant from function, decontaminate it and submerge it.

  11. Case 1: Bone graft around a failing implant

  12. Case 2: Removal of a failed implant

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