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Risk factors of peri-implant mucositis and peri-implantitis are comparable to those of gingivitis and periodontitis.
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The ideal management of peri-implant diseases focuses on infection control, detoxification of implant surfaces, regeneration of lost tissues, and plaque control regimens via mechanical debridement.
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Implantoplasty (modification in implant surface topography), when used in combination with resective surgery, has been reported to significantly reduce the clinical parameters of
Peri-implant Diseases: A Review of Treatment Interventions
Section snippets
Key points
Peri-implant diseases: peri-implant mucositis and peri-implantitis
Peri-implant diseases are categorized into 2 types: peri-implant mucositis and peri-implantitis. Peri-implant mucositis is characterized by inflammation of the soft tissues surrounding the implant without any signs of bone loss (Fig. 1).8 The clinical signs of peri-implant mucositis include bleeding on probing (BOP) and/or suppuration, which are usually associated with probing depth (PD) of at least 4 mm with no evidence of radiographic loss of bone.24, 25 It has been reported that inflammatory
Risk factors of peri-implant diseases
Risk factors of peri-implant mucositis and peri-implantitis are comparable to those of gingivitis and periodontitis.27, 32 The following risk factors have been associated with the etiology of peri-implant diseases.
Incidence and prevalence of peri-implant diseases
There is a lack of information regarding the incidence of peri-implant mucositis and peri-implantitis, as the interpretation of data is difficult. In this regard, the incidence of peri-implantitis may be underestimated. Renvert and colleagues81 investigated the incidence of peri-implantitis over a period of 13 years between 2 dental implant systems (TiOBlast AstraTech [AT] and machine-etched Brånemark Nobel Biocare [NB] system, Gothenburg, Sweden, respectively). In this study,81 the incidences
Classification of peri-implantitis
To our knowledge from indexed literature, there is no globally accepted classification of peri-implantitis. However, Froum and Rosen89 recently proposed a classification that differentiated peri-implantitis according the severity of inflammation and extent of bone loss around the implant. This classification was based on 3 different clinical stages of peri-implantitis: (1) early peri-implantitis, (2) moderate peri-implantitis, and (3) advanced peri-implantitis (see Fig. 4).89 Early
Assessment of end points among studies on the treatment of peri-implantitis
End points are commonly used to determine the effectiveness of a clinical treatment. In studies addressing the treatment of peri-implantitis, ‘‘true end points” are preferred over ‘‘surrogate end points,’’ because they are able to depict a considerable proportion of the effect of treatment on an outcome of interest, such as implant failure.90, 91, 92 In a systematic review, Faggion and colleagues91 explored indexed literature to determine the type of end points reported regarding
Etiology and pathogenesis of peri-implantitis
Microbial colonization is the chief predisposing factor in the etiology of peri-implantitis. Subgingival microbes (such as Aggregatibacter actinomycetemcomitans, Prevotella intermedia, P gingivalis, and Treponema denticola) associated with the etiology of periodontitis are similar to those of peri-implantitis.78 In addition, it also has been reported that patterns of plaque formation and accumulation on implant surfaces are comparable to those seen on teeth.93
The pathogenesis of
Management of peri-implantitis
A variety of treatment protocols have been proposed for the management of peri-implantitis.97 The management of peri-implantitis can be divided into (1) nonsurgical management and (2) surgical management; surgical management encompass resective and regenerative treatment.97, 98, 99, 100 However, there is lack of standardized treatment protocols for peri-implant disease. The following text comprehensively reviews the different therapeutic protocols that have been proposed for the management of
Proposed guidelines for the management of peri-implantitis
Authors of the present review propose the following sequential guidelines for the management of peri-implantitis: (1) elevation of a full-thickness mucoperiosteal flap; (2) mechanical debridement of implant surface(s) using hand instruments (such as curettes) followed by decontamination using CO2 laser (2-Watt, pulsed-mode or continuous wave); (3) guided bone regeneration using particular graft material and resorbable membrane; and (4) closure of the defect using resorbable sutures.
Summary
There seems to be a lack of consensus over the treatment protocol that would yield the best outcomes in terms of management of peri-implant diseases in humans. Regardless of which therapeutic treatment protocol is adopted for the management of peri-implant diseases, a proficient diagnosis, patient compliance (plaque-control), control of possible risk factors, and skillful decontamination of implant surfaces influence the overall outcome of the treatment.
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