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Peri implantitis
- 2. Background • Peri-implant disease : An inflammatory reaction around the tissue surrounding an implant consist of two forms • Peri-implant mucositis • Peri-implantitis Mombelli A. et al. Periodontol 2000 1998;17:63-76. The Sixth European Workshop on Periodontoloy 2008
- 3. Peri-implant mucositis • The presence of inflammation • Confine to the soft tissue • No signs of loss of supporting bone following initial bone remodeling • Reversible condition : early intervention and remove etiology San M. et al. J Clin Periodontol 2012;39(Suppl.12):202-206.
- 4. Peri-implant mucositis • Clinical findings • Bleeding on probing / gingival redness • Probing depth ≥ 4 mm • No radiographic bone loss • Prevalence : 48% of implants San M. et al. J Clin Periodontol 2012;39(Suppl.12):202-206. Roos-Jansaker AM. J Clin Periodontol 2006;33:290-295.
- 6. Peri-implantitis • An inflammatory process • Soft tissue inflammation, Bleeding on probing • Probing depth ≥ 5 mm • Suppuration
- 7. • Progressive loss of supporting bone beyond biological bone remodeling • Mean crestal bone loss of 0.9-1.6 mm in first post-surgical year • Then annual bone loss of 0.02-0.15 mm • In case of no baseline radiograph, 2 mm vertical distance from expected marginal bone level • Prevalence : varied from 11%-47% depending on the threshold used Peri-implantitis Koldlands OC. et al. J Periodontol 2010;81:231-238. San M. et al. J Clin Periodontol 2012;39(Suppl.12):202-206.
- 9. Etiologies • Formation of biofilm • Gram-negative anaerobic bacteria : similar to natural teeth in periodontal disease • Peri-implant mucositis – Gingivitis • Peri-implantitis – Periodontitis : S.aureus could be found as the initiation of peri- implantitis Heit-Mayfield LJ. et al. Periodontol 2000 2010;53:167-181. Leohardt A. et al. Clin Oral Implants Res 1999;10:399-345.
- 10. Factors associated Peri-implantitis • History of periodontitis : two times • Smoking : 3-4 times increased risk for peri-implantitis • Residual cement : Rough area beneath gingival margin Bacterial attachment • Implant position and design : inability to clean Mombelli A. et al. Clin Oral Implants Res 2012;23(Suppl.6):67-76. Linkevicius T. et al. Clin Oral Implants Res 2012 published online
- 11. Treatment • Primary goals • Resolve inflammation • Arrest the progression of disease
- 12. Treatment
- 14. Non-Surgical treatment • Mechanical debridement • Ultrasonic scaler • Hand instruments : Plastic curette • Rubber cup & pumice • Plaque control
- 16. • Effective in Peri-implant mucositis • carbon fibers curette, rubber cup, pumice • In peri-implantitis, mechanical debridement alone was found not to be effective Non-Surgical treatment
- 17. • Use in conjunction with mechanical debridement and chemical disinfection • Local : high concentration, reduce side & adverse effect • Tetracyclin HCL (Actisite® ) • Minocyclin • Systemic : ornidazole 1000 mg daily, metronidazole, amoxicillin Antibiotic
- 18. Antibiotic
- 19. Surgical approach • Surgical approach • Access surgery : apically positioned flap, surface modification • Resective • Regenerative : guided tissue regeneration, bone grafting • Surface decontamination
- 22. Surface decontamination • Chemical agents • hydrogen peroxide, citric acid, 35% phosphoric acid • Photodynamic therapy • Photosensitizer + high energy laser light -> destroy bacterial cells • Laser treatment • combined with Chemical agents to archieve higher re-osseointegration
- 25. Anti-infective protocol • Peri-implantitis VS Periodontitis • Eiology • Treatment • Anti-infective protocol have been adopted to treat peri-implantitis • Open flap debridement • Implant surface decontamination • Systemic antibiotic : Amoxicillin (500 mg) + Metronidazole (400 mg) 7-10 days
- 28. Conclusions • Non-surgical treatment alone was found to be effective in peri-implant mucositis : carbon fibers curette, rubber cup, pumice • Peri-implantitis with mild bone loss : Mechanical debridement, Antiseptic(CHX mouthwash), Systemic/Local Antibiotic, Resective surgery • Peri-implantitis with moderate bone loss : Mechanical debridement, Antiseptic(CHX mouthwash), Systemic/Local Antibiotic, Open flap debridement, Surface decontamination, Regenerative surgery
- 30. Conclusions • Bone fill & Re-osseointegraion • Regenerative procedure > Open flap debridement • Membrane did not improve treatment outcome in comparison to the use of autogenous bone alone • Systemic antibiotic (Amoxicilin plus metronidazole) and antiseptic mouthrinse(CHX) : improved clinical outcomes
- 31. Conclusions • No single method of surface decontamination(Chemical agents, air abrasive, lasers) was found to be superior • Citric acid(40%,30-60 sec) has proved to be most effective agent for bacterial growth reduction on HA surfaces • The simplest method of surface decontamination; gauze soaked alternately in CHX and saline, should be preferred when combined with membrane- covered autogenous bone graft