New treatment concepts to prevent and manage peri-implant diseases - part 3 a new treatment approach
- Discuss the aim of peri-implantitis therapy
- Compare the available treatment concepts for peri-implantitis
- Explain the role of electrolytic approach in peri-implantitis treatment
How can you achieve a good long-term result when dealing with peri-implantitis therapy? This is the first question Dr. Markus Schlee addresses in his presentation on therapies for peri-implantitis. He states the goal of any therapy: a therapy should have the aim to heal. In relation to implantology, this means a bone-level implant is covered in surrounding bone up to the implant collar. Peri-implantitis therapy should thus regain bone and enable osseointegration and achieve a stable situation. The next important question addressed is, what is managed in cases of peri-implantitis? As a clinician, the focus is on an infection, caused by a biofilm, which is on the implant and in the implant.
When reviewing the literature, no clear definition can be found to define a good outcome of peri-implantitis therapy. What outcome would be considered as a success? And, what percentage of patients treated successfully would be sufficient – 10 or 70%? The treating surgeon selects one of the established surgeries or treatment modalities and needs to be able to answer this question. Dr. Schlee highlights that peri-implantitis also needs to be considered in a wider context, meaning what does an infection in the mouth cause? When looking at periodontitis, it is known that there are a lot of side effects present, such as an increased number of leukocytes and pro-inflammatory cytokines. This means that there is a systemic impact.
There is a common understanding that a current therapy requires open flap debridement and removal of granulation tissue. This is followed by decontamination of the exposed surface and then in some cases augmentation, a resective approach or a combination of approaches is needed. What happens to an implant surface that is exposed in the oral cavity? There will be an immediate colonization of bacteria. Does the implant surface have an influence on this? Is there a difference between smooth and rough implant surfaces? The literature shows that there is no significant difference related to the implant surface. However, one needs to be cautious when reviewing the clinical data as there are conflicting results.
Why are existing treatment approaches so complicated and why don't they produce the desired results? Ablative removal of the biofilm, which is a known treatment of periodontitis, does not result in a satisfactory outcome. Similarly, powder spray, brushes or currettes, do not produce an acceptable result. They reach their limit when an undercut or a crater-like bone defect making the access to all exposed implant areas even more difficult.
Experience with the existing therapy approaches and various evaluations led to the development of a new therapy, using an electrolytic approach. The electrolytic approach aims to remove the biofilm covering the implant in an easily applicable manner. The therapy works with the restoration in place or removed and with any implant system. Dr. Schlee presents the available clinical data, comparing this new therapy with the established therapies such as powder spray, or brushes. The data show highly promising results, achieving the ultimate aim of therapy, the re-osseointegration of every treated implant.
View part one of this series here with Dr. France Lambert’s introduction to the topic and Dr. Giacomo Fabbri’s discussion on the prosthetic aspects of prevention of peri-implant disease. In part two, Dr. Alberto Monje reviews the surgical therapy options.
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