Peri-implantitis

Peri-implantitis - peri-implant tissue inflammation

Peri-implantitis is an infection around implants associated with the presence of submucosal bacterial biofilm adhering on surface structures such as crown margins, unfavorably designed restoration areas and the implant surface. Treatment objective is reduction of bacterial load under a critical threshold. Measures to reduce bacterial contamination comprise surgical or non-surgical debridement, implant surface decontamination, local and systemic antibiotics, antimicrobial treatment techniques, implant surface modification like smoothening and thread removal, prosthesis modification to improve hygiene and cleanability aspects, bony defect corrections, regenerative therapy etc. Non-surgical treatment seems ineffective, as well as light acticated disinfection (LAD) techniques. There is scientific debate about in how far etiologies of periodontitis and peri-implantitis may share a number of common analogies, and about comparable treatment approaches. Discussion if implants fail or if failure of implant treatment is rather a host reponse to a foreign body or to an inappropriate treatment concept. Implant failure may be surgery-, implant- or patient-related. There is no universal agreement on what clinical and diagnostic parameters should be assessed and monitored, and the question if 'peri-implantitis might be an overused and misused term.

Expert insights

Starting 9:35. (Foreign body response to implants). In their long-term follow up, since 1985 till today, including 11.000 patients and 40.000 implants placed, the Branemark clinic team focusses on failures and tries to detect patterns and rationales. Reviews aspects of osseointegration and periimplantitis, and discusses potential influences of immune system, foreign body response, general health condition, and implant surface design. Implant failure may be surgery-, implant- or patient-related.
Discussion if implants fail or if failure of implant treatment is rather a host reponse to a foreign body or to an inappropriate treatment concept. Osseosufficiency describes, when the net contribution of host, clinician and implant is sufficient to promote and perpetuate osseointegration. Discusses the scientific debate on implant surface as influencing factor for crestal bone loss and peri-implant tissue reaction.
Starting at 6:53. Modern implant protocols with deep gingival pockets do not allow to remove all excess cement. Residual excess cement has been identified as one of the main risk factors for peri-implant disease, higher fistula formation and suppuration. Whenever possible, screw-retained systems should be the method of choice
Reviews the measures and options for treatment of peri-implantitis. Etiologies to periodontitis and peri-implantitis share a number of common analogies, and discusses comparable treatment approaches. Non surgical treatment is quite ineffective and and a layered, combined therapeutic approach including implantoplasty, resection and regeneration is recommended. Surface decontamination is imperative.
Peri-implantitis is an infection around implants associated with the presence of submucosal bacterial biofilm adhering on surface structures such as unfavorably designed restoration areas and the implant surface. Review of type of microrganisms involved. Discussion of treatment concepts, comprising mechanical cleaning options, saline decontamination, antibiotic therapy, CHX solution.
Review of surgical and non-surgical measures to reduce bacterial contamination. For a long term effect, effective plaque control is critical. Discusses the effect of adjunct therapy with antimicrobial techniques using the LAD (light activated disinfection), also known as PACT (photodynamic antimicrobial chemo therapy) or PDT (photodynamic therapy), in comparison to traditional debridement and scaling treatment techniques. Conclusion, that there is no statistical difference between the two methods and that adjunctive LAD treatment was ineffective.
Starting at 4:51; and more at 10:34 on peri-implantitis. Distinguishing normal and abnormal marginal bone behaviour around osseointegrated implants is a complex and controversial topic. Discussion of reasons such as the existence of multiple proposed etiologies, deficiencies in existing knowledge, shortcomings in the currently used clinical parameters and imperfect and inconsistent terminology. Dr Chvartszaid concludes that therefore 'peri-implantitis is an abused, overused and misused term.
Today there are solid data that there is an association between history of periodontitis and later peri-implant inflammation and infection. However this finding does not necessarily imply a cause relation effect, and could also be based on general hyperinflammatory response of the patient.

トリートメントガイドライン

Peri-implantitis is is the inflammatory process of soft and hard tissues surrounding the implant, leading to marginal bone resorption, and eventually to implant loss. There is no consensus on the threshold of marginal bone loss to define presence of periimplantitis. Possible etiologies reach from subgingival cement remnants to occlusal overload and from surgical bone trauma at implant insertion to untreated prolonged perimucositis. It is not enough to deal with the infection and inflammation. An etiologic treatment should be instituted.
Post-treatment recall measures: Mucositis and Peri-implantitis treatments focus on elimination of pathogenic biofilm and removal of causal or supporting factors such as subgingival cement remnants, restoration cleansability, hygiene etc. Typical antimicrobials are 0.2 % Chlorhexidine, and adjunctive therapy options with antibiotics. Consider increasing recall frequency and hygiene instructions to patient.

Digital Textbooks

Single Implants and their Restoration
Single implants and their restoration
"While there are variations in the above reports regarding the time at which implants are lost (pre-prosthetic versus post-prosthetic), the data appear to suggest there may be an approximately equal chance of having a pre-prosthetic (during the surgical healing phase) implant loss as having the loss be post-prosthetic (after crown placement)."