35
Volume1 Issue6
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S
upporting
Y
our
P
ractice
mentof implantnumberandposition, occlusal equilibration,
andocclusal splint forpatientswithparafunction) canarrest the
progressionofperi-implant tissuebreakdown.
•
Perform the surgical procedure, if necessary.
– Detoxify the implant surfacebyusingmechanical
devices (e.g., highpressure air powder abrasive,
laser decontamination) and/or by applying
chemotherapeutic agents (e.g., supersaturated citric
acidor tetracycline appliedwith cottonpellets or a
brush)
– Performflapmanagementwitheither or both resective
and regenerative approaches, dependingon the
morphology and sizeof thebonedestruction.
– Systemic antibiotics are suggestedpostoperatively.
EtiologiesActingasCo-Factors
Other etiologic factorsmayact as co-factors in the
development of peri-implantitis. Nonetheless, treatment still
consistsof removing thebacterial infectionor correcting the
biomechanical forces.
PossibleCo-Factors
•
Anatomical limitations: inadequate amount of bone in
recipient siteat the timeof the implant placement
•
Surgical trauma: overheatingof boneduring implant
placement
•
Compromisedhost response
AddressingPotentialRiskFactors
•
Treatment of activeperiodontal diseaseand improvement
of oral hygiene
•
Counseling thepatient on tobaccocessation
Notes
•
There isnoconsensus regarding thebest regenerative
material andno long-termdata regarding successof
regenerative treatment.
•
It is important for patients tounderstand that regenera-
tions areneither predictablenor reliableonan integrated
and restored implant. Patientsmust be involved in the
decision to saveor replace the implant.
•
Many techniques for implant surfacedetoxificationhave
beenusedbut there isnot yet adefined standardprotocol.
TreatmentofFailed Implants
In thepresenceof extensivebone lossor implantmobility,
the implantmaybe removedandalternativeoptions to
replace themissing tooth shouldbediscussed (replacement
of failed implant, fixedpartial denture, removablepartial
denture, etc.).
SuggestedResources
1. IaconoVJ;CommitteeonResearch,ScienceandTherapy,theAmericanAcademyofPeriodontology.Dental
implants inperiodontaltherapy.JPeriodontol.2000;71(12):1934-42.
2.LindheJ,MeyleJ;GoupDofEuropeanWorkshoponPeriodontology.Peri-implantdiseases:Consensus
ReportoftheSixthEuropeanWorkshoponPeriodontology.JClinPeriodontol.
2008;35(8Suppl):282-5.
3.Heitz-MayfieldL,Huynh-BaG.Historyoftreatedperiodontitisandsmokingasrisks for implanttherapy.
IntJOralMaxillofac Implants.2009;24Suppl:39-68.
4.NewmanMG,TakeiH,KlokkevoldPR,CarranzaFA.Carranza’sClinicalPeriodontology:ExpertConsult.11thed.
St.Louis,Missouri:Elsevier,2011.
5.MischCE.Contemporary ImplantDentistry.3rded.St.Louis,Missouri:Elsevier,2008.
6.OhTJ,YoonJ,MischCE,WangHL.Thecausesofearly implantbone loss:mythorscience?JPeriodontol.
2002;73(3):322-33.
7.JovanovicSA.Themanagementofperi-implantbreakdownaround functioningosseointegrateddental
implants.JPeriodontol.1993;64(11Suppl):1176-83.
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