Peri implant diseaes.pptx in periodontics

Peri implant diseaes.pptx in periodontics

1. Periimplant tissue by maria.h 1

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3. Osseointegration Dynamic process Healing phase: 0 - 12 months Remodeling phase: 3 - 18 months Steady state: 18 months --- 3

4. Dental implants have a high success rate in general, and results may be maintained over many years . Nevertheless, pathological conditions may develop in the peri-implant tissues putting implants and reconstructions at risk and potentially affecting the patient’s health . 4

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6. Although there are developmental differences of junctional epithelia at teeth and implants, there is no evidence for structural or functional diversity and hence, the ‘‘epithelial sealing ’’ around implants is considered to be identical to that of teeth . In both, this soft tissue complex acts as a mucosal barrier against bacterial invasion and food ingress. 6

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8. Peri implant diseases 8

9. Peri-implants diseases are defined according to the 6th European Workshop on Periodontology 2008 as that: The peri-implant mucositis which is the inflammation of peri-implant mucosa with no signs of bone loss. The peri-implantitis in addition to the inflamed mucosa ,it characterized by the loss of supporting bone . 9

10. A NEW CLASSIFICATION FOR PERI-IMPLANT DISEASES AND CONDITIONS Peri‐implant health Peri‐implant health was defined both clinically and histologically. Clinically, peri‐implant health is characterized by an absence of visual signs of inflammation and bleeding on probing. Peri‐implant health can exist around implants with normal or reduced bone support. 10

11. Peri‐implant mucositis Peri‐implant mucositis is characterized by bleeding on probing and visual signs of inflammation. While there is strong evidence that peri‐implant mucositis is caused by plaque, there is very limited evidence for non‐plaque induced peri‐implant mucositis. Peri‐implant mucositis can be reversed with measures aimed at eliminating the plaque. 11 A NEW CLASSIFICATION FOR PERI-IMPLANT DISEASES AND CONDITIONS

12. A NEW CLASSIFICATION FOR PERI-IMPLANT DISEASES AND CONDITIONS 12

13. Peri‐implantitis Peri‐implantitis was defined as a plaque‐associated pathologic condition occurring in the tissue around dental implants, characterized by inflammation in the peri‐implant mucosa and subsequent progressive loss of supporting bone. 13 A NEW CLASSIFICATION FOR PERI-IMPLANT DISEASES AND CONDITIONS

14. Peri‐implant mucositis is assumed to precede peri‐implantitis. Peri‐implantitis is associated with poor plaque control and with patients with a history of severe periodontitis. 14 A NEW CLASSIFICATION FOR PERI-IMPLANT DISEASES AND CONDITIONS

15. The aetiology, risk assessment, diagnosis as well as the pathogencity of the peri-implant diseases were not fundamentally different compared to their counterparts around teeth (gingivitis and periodontitis). 15

16. Clinical signs of peri-implant diseases include : B leeding on probing BOP and suppuration. Increase pocket depth (PD). M ucosal recession. Bone loss. If these signs left untreated lead to complete loss of osseointegration, mobility and implant loss. 16

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19. Implant mobility Over the years, rigid fixation and osseointegration have been used interchangeably. Rigid fixation is a clinical term for implants, which describes the absence of observed clinical mobility with vertical or horizontal forces under 500 g,similar to evaluating teeth. Osseointegration is a histological term defined as the surrounding bone in direct contact with an implant surface at the magnification of a light microscope 19

20. the clinical term “ lack of mobility ” may be used to describe implant movement, and is a clinical condition most often used to determine as to whether the implant is integrated. Lack of clinical movement does not mean the true absence of mobility. A healthy implant may move less than 75 µm; yet, it appears as zero clinical mobility. Implant “mobility” may be assessed by computer or various instruments 20

21. Risk indicators of peri-implant diseases including : Poor oral hygiene, History of periodontitis, Tobacco consumption, Diabetes, Alcohol consumption, Genetic trait . 21

22. Diagnosis of peri implant diseases 22

23. 1- History: Patient demographic data. Patient health (past and current systemic diseases, medications ,allergies, smoking history clenching/bruxism history,, oral hygiene status). Data for the specific implant ( Numbers of implants, implant manufacturer, date of placement, implant dimensions, stage, antibiotics prescribed, and type of restoration placed). 23

24. 2-Clinical examination 24

25. Examination includes measurements of: plaque index . Modified gingival index, and bleeding on probing (BOP). Pocket depth. Implant mobility. Relative attachment level . Mucosal recession Calculus recorded on the basis of present or absent. 25

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27. 3- Radiographic evaluation performed using periapical radiographs or OPG, radiographs used to observe marginal bone loss between implant shoulder and interproximal bone. 27

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29. Criteria for diagnosis Mucositis Peri implantitis 1- Bleeding on 1- Pocket depth (PD) and probing probable attachment 2- No radiographic loss (PAL) of ≥ 5mm . signs of bone loss. 2- Bleeding in probing (BOP)in more than one site of the implant. 3- Radiographic signs of bone loss. 29

30. Treatment of periimplant diseases 30

31. Hygiene Aids Super - floss End tufted brushes Proxy brushes Tarter control dentrifices Mechanical instruments Peridex 31

32. Super -floss Butler Post Care Floss Aid - Excellent for implant bars and fixed hybrid prostheses. Excellent for all types of implant restorations 32

33. Fixed Hybrid Prosthesis - Hygiene care with a proxy brush 33

34. Plastic probes are used when checking for evidence of disease. Implants are similar to the natural tooth. Implantitis vs. Periodontal disease have similar clinical presentations 34

35. Patient presents with a maxillary RPD with an implant bar/clip component to the anterior edentulous area. (next slide) 35

36. Butler Floss Aid is used to clean the bar including the area contacting the tissue. (next slide) 36

37. The bar may be removed with the appropriate screw driver, polished and the torque of all the abutments checked prior to replacement. 37

38. Prophy paste and a rubber cup on a prophy head / handpiece can be used to polish implant bars when removal is not indicated 38

39. Plastic scalers are appropriate for cleaning around standard abutments supporting implant bar substructures, hybrid prostheses and implant supported splinted restorations. Plastic scaler tips are also available for metal handle scalers. 39

40. Implant supported fixed partial denture Scaler tips are designed to fit the curvature of the standard abutment. 40

41. Implant Maintenance 41

42. Maintenance and Recall Annually periapical radiographs should be taken to monitor the crestal bone levels. (crestal bone can be at the level of the first thread in one year with 0.1mm continued loss to approximately 1. 5 mm total bone loss) remove and reinsert screw retained implant prostheses every 2 years unless indicated otherwise. Replace prosthesis with new retaining screws if removed. Cemented restorations are usually permanent (no retrievable). 42

43. Recall focus on : Occlusion - verify there are no excursive contacts. Better to be out of occlusion Oral hygiene - same requirements as for natural teeth. Soft tissue health - periodontal probing for evidence of disease. Screw joint torque - check for loosened screws (most common problem). Integrity of attachments - applies to overdenture / overpartials . Stability of implants - must be stable (non mobile) to be successful 43

44. Thank you 44

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