treatment planning and seminars i

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Khaled Saleh – 200820054Mohammad Muneer - 200811346

Presented By:



A 38 year old Brazilian lady presented complainingof loose implants. The implants were inserted inBrazil on 9/12. She also complained of pain andswelling related to the upper canine and implanted

lateral incisor tooth. The radiograph showed aradiolucency associated with both ‘teeth’ with no

mobility.



Differential Diagnosis

Dental abscess

Peri-implantitis

Final Diagnosis?

Peri-implantitis



Diagnosis?...

An inflammatory process thataffects the tissue around an

osseo-integrated dental implantand results in exaggeratedmarginal bone loss.

Peri-ImplantitisPeri-Implant Mucositis

The presence of inflammationin the soft tissue surrounding a

dental implant without signs ofany loss of supporting bone.



Etiology of Implant Failure…

1) Presence of aggressive bacteria.

2) Implant structure.

3) Biomechanical factors

• Occlusal overload

• Traumatic failure

4) Other factors?



Signs & Symptoms of Peri-Implantitis



Diagnostic Aspects of Peri-Implantitis

The size (point diameter) of theprobe applied and the applicationforce should standardized.

In healthy and normalperiodontium, the probing forceused is 0.25N.

At any rate, a pocket larger than 5mm is deemed to have a greaterlikelihood of being contaminated.

1) Bleeding on Probing




To determine probingdepth and level of

periodontal attachmentin relation to the CEJ.

2) Pocket Depth




Pus formation is always a sign of infection with acute tissuedestructive processes taking place.

Peri-implantitis lesions usually yield some pus formation upon

provocation, while mucositis may not.

Pressure on the buccal mucosa aspect may result in a discharge of pus in sites of peri-implantitis.

3) Pus Formation




The bone loss encounteredin association with the

development of Peri-implantitis is marginal.

This means that theimplant still remains fully

osseo-integrated in theapical portion.

4) Mobility




Conventional radiography isused to evaluate the bonystructures adjacent to theimplants over long periods.

However, minor changes inbone morphology in the

crestal area may not berevealed until they reach asignificant size and shape.

5) Radiographic Interpretation



Preventive Aspects of Peri-Implantitis

Oral infections such as existing periodontal disease have to betreated before implant therapy.

Plaque control forms the basis for the prevention future disease.

Instructions in oral hygiene and patient motivation

Clinical Implications

• Overcontoured restorations may prevent the patient from

attaining optimal oral hygiene.• Interproximal contours adjacent to abutment teeth or implantshave to be shaped appropriately.•Precise marginal fit is a requisite.



Management of Peri-Implantitis

When the main etiological factoris bacterial infection; the first

phase involves the control of theacute infection and the reductionof inflammation.

Removal of the plaque deposits with plastic instruments.

Polishing with pumice. Subgingival irrigation with 0.2%

Chlorhexidine.

Non-Surgical Phase



Management of Peri-Implantitis

Systemic anti-microbialtherapy for 10 consecutive

days. Oral hygiene maintenance.

The use of prophy jet.

Soft laser irradiation. Local delivery device, eg

Actisite.



Management of Peri-Implantitis Various bone graft techniques

and guided bone regeneration

(GBR). The membrane should be left

undisturbed for 4-6 weeks.

Intra-oral autogenous bonegrafts most commonly used.

Other bone graft materialsinclude hydroxyapatite andde-mineralized freeze-driedbone.

Surgical Phase

Bone defect covered with a GTR membrane.



Protocol of Treating Peri-Implantitis

Systemic antibiotics

(Metronidazole 400mg TDSfor 3 days).

1 minute mouth wash pre-operatively with

chlorhexidine 0.2%



Protocol of Treating Peri-Implantitis Mechanical curettage of

implant surface andcurettage down to freshbone after full thicknessflap elevation.



Protocol of Treating Peri-Implantitis Packing gauze strips soaked

in Chlorhexidine 0.2% intodefect and under the flapfor 5 minutes.



Protocol of Treating Peri-Implantitis After gauze removing,

washing the defect withtetracycline solution 1g in20ml of sterile saline.



Protocol of Treating Peri-Implantitis

Apply the graft materialhydrated with thetetracycline solution.

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