Aim
To examine the existing evidence in identifying risk indicators in the etiology of peri‐implantitis.
Material and methods
A literature search was performed in MEDLINE via PubMed database of the ...US National Library of Medicine, for articles published until October 2014 using Medical Subject Heading search terms + free text terms and in different combinations.
Results
The microbiota associated with peri‐implantitis is complex, demonstrating differences and similarities to the one seen at periodontitis sites. Plaque accumulation at dental implants triggers the inflammatory response leading to peri‐implant mucositis/peri‐implantitis. Individuals with a history of periodontal disease and smokers have an increased risk of developing peri‐implantitis. There is some evidence to support the role of genetic polymorphism, diabetes, and excess cement as risk indicators for the development of peri‐implantitis. There is also evidence to support that individuals on regular maintenance are less likely to develop peri‐implantitis and that successful treatment of periodontitis prior to implant placement lowers the risk of peri‐implantitis.
Conclusions
Plaque accumulation at implants will result in the development of an inflammation at implants. A history of periodontal disease, smoking, excess cement, and lack of supportive therapy should be considered as risk indicators for the development of peri‐implantitis.
Peri‐implant and periodontal pockets share a number of anatomical features but also have distinct differences. These differences make peri‐implant pockets more susceptible to trauma and infection ...than periodontal pockets. Inadequate maintenance can lead to infections (defined as peri‐implant mucositis and peri‐implantitis) within peri‐implant pockets. These infections are recognized as inflammatory diseases, which ultimately lead to the loss of supporting bone. Diagnostic and treatment methods conventionally used in periodontics have been adopted to assess and treat these diseases. Controlling infection includes elimination of the biofilm from the implant surface and efficient mechanical debridement. However, the prosthetic supra‐structure and implant surface characteristics can complicate treatment. Evidence shows that when appropriately managed, peri‐implant mucositis is reversible. Nonsurgical therapy, with or without the use of antimicrobials, will occasionally resolve peri‐implantitis, but for the majority of advanced lesions this approach is insufficient and surgery is indicated. The major objective of the surgical approach is to provide access and visualize the clinical situation. Hence, a more informed decision can be made regarding whether to use a resective or a regenerative surgical technique. Evidence shows that following successful decontamination, surgical treatment to regenerate the bone can be performed, and a number of regenerative techniques have been proposed. After treatment, regular maintenance and good oral hygiene are essential for a predictable outcome and long‐term stability.
Objectives
To examine the existing evidence in identifying risk indicators in the aetiology of peri‐implant mucositis.
Material and Methods
A search was performed in PubMed, Web of Science (WOS) and ...The Cochrane Library databases for articles published until June 2014.
Results
This search gave 3135 results of which 15 studies fulfilled the inclusion criteria. The current review revealed that only a few studies provided data on risk indicators for the development of peri‐implant mucositis. Based on the data available, there is evidence that plaque is a risk indicator for peri‐implant mucositis. Smoking has also been identified as an independent risk indicator whereas the overall evidence for surface roughness, residual cement, the dimension of the keratinized tissue and time of implant in function is weak. There are limited data available to support systemic conditions as risk indicators for peri‐implant mucositis.
Conclusions
Plaque accumulation at implants will result in development of peri‐implant mucositis. Smoking should also be considered as a risk indicator for the development of peri‐implant mucositis.
The objective of this review is to identify case definitions and clinical criteria of peri‐implant healthy tissues, peri‐implant mucositis, and peri‐implantitis. The case definitions were constructed ...based on a review of the evidence applicable for diagnostic considerations. In summary, the diagnostic definition of peri‐implant health is based on the following criteria: 1) absence of peri‐implant signs of soft tissue inflammation (redness, swelling, profuse bleeding on probing), and 2) the absence of further additional bone loss following initial healing. The diagnostic definition of peri‐implant mucositis is based on following criteria: 1) presence of peri‐implant signs of inflammation (redness, swelling, line or drop of bleeding within 30 seconds following probing), combined with 2) no additional bone loss following initial healing. The clinical definition of peri‐implantitis is based on following criteria: 1) presence of peri‐implant signs of inflammation, 2) radiographic evidence of bone loss following initial healing, and 3) increasing probing depth as compared to probing depth values collected after placement of the prosthetic reconstruction. In the absence of previous radiographs, radiographic bone level ≥3 mm in combination with BOP and probing depths ≥6 mm is indicative of peri‐implantitis.
A classification for peri‐implant diseases and conditions was presented. Focused questions on the characteristics of peri‐implant health, peri‐implant mucositis, peri‐implantitis, and soft‐ and ...hard‐tissue deficiencies were addressed.
Peri‐implant health is characterized by the absence of erythema, bleeding on probing, swelling, and suppuration. It is not possible to define a range of probing depths compatible with health; Peri‐implant health can exist around implants with reduced bone support.
The main clinical characteristic of peri‐implant mucositis is bleeding on gentle probing. Erythema, swelling, and/or suppuration may also be present. An increase in probing depth is often observed in the presence of peri‐implant mucositis due to swelling or decrease in probing resistance. There is strong evidence from animal and human experimental studies that plaque is the etiological factor for peri‐implant mucositis.
Peri‐implantitis is a plaque‐associated pathological condition occurring in tissues around dental implants, characterized by inflammation in the peri‐implant mucosa and subsequent progressive loss of supporting bone. Peri‐implantitis sites exhibit clinical signs of inflammation, bleeding on probing, and/or suppuration, increased probing depths and/or recession of the mucosal margin in addition to radiographic bone loss.
The evidence is equivocal regarding the effect of keratinized mucosa on the long‐term health of the peri‐implant tissue. It appears, however, that keratinized mucosa may have advantages regarding patient comfort and ease of plaque removal.
Case definitions in day‐to‐day clinical practice and in epidemiological or disease‐surveillance studies for peri‐implant health, peri‐implant mucositis, and peri‐implantitis were introduced. The proposed case definitions should be viewed within the context that there is no generic implant and that there are numerous implant designs with different surface characteristics, surgical and loading protocols. It is recommended that the clinician obtain baseline radiographic and probing measurements following the completion of the implant‐supported prosthesis.
Focused Question
In patients suffering from peri‐implant diseases, what is the efficacy of air polishing on changing signs of inflammation compared with control treatments (i.e. alternative measures ...for plaque removal with or without adjunctive antiseptic and/ or antibiotic therapy)?
Material & Methods
After electronic database and hand search, 10 full‐text articles were independently screened by two reviewers. Finally, a total of five studies (six publications) fulfilled the inclusion criteria. The weighted mean difference (WMD) p; 95% CI in bleeding on probing‐ (BOP) (primary outcome) and probing pocket depth‐ (PD) reductions was estimated using a random effect model.
Results
All studies reported on residual BOP scores after therapy. A narrative data synthesis did not reveal any major improvement of bleeding index/ BOP or disease resolution following air polishing over mechanical debridement at mucositis sites. At peri‐implantitis sites, WMD in BOP reduction between test and control (mechanical debridement with or without local antiseptic therapy, Er:YAG laser) groups was −23.83% p = 0.048; 95% CI (−47.47, −0.20) favouring air polishing over control measures.
Conclusions
While glycine powder air polishing is as effective as the control treatments at mucositis sites, it may improve the efficacy of non‐surgical treatment of peri‐implantitis over the control measures investigated. A complete disease resolution was commonly not obtained.
Therapies proposed for the treatment of peri‐implant diseases are primarily based on the evidence available from treating periodontitis. The primary objective is elimination of the biofilm from the ...implant surface, and nonsurgical therapy is a commonly used treatment. A number of adjunctive therapies have been introduced to overcome accessibility problems or difficulties with decontamination of implant surfaces as a result of specific surface characteristics. It is now accepted that following successful decontamination, clinicians can attempt to regenerate the bone that was lost as a result of infection. The ultimate goal is re‐osseointegration, and a number of regenerative techniques have been introduced. By reviewing the existing evidence, it seems that peri‐implant mucositis is reversible when appropriately treated. Additionally, a combined therapy (mechanical therapy with local antimicrobials as adjuncts) can serve as an alternative to surgical intervention when treating peri‐implantits in cases not suitable for surgery. Surgical therapy is an effective method for treating peri‐implantitis, and various degrees of success of the use of regenerative procedures have been reported, regardless of whether or not radiographic evidence of defect fill has been achieved. Finally, no matter which therapy is employed, a prerequisite for the long‐term stability of treatment results obtained is the ability of the patient to maintain good oral hygiene.
A classification for peri‐implant diseases and conditions was presented. Focused questions on the characteristics of peri‐implant health, peri‐implant mucositis, peri‐implantitis, and soft‐ and ...hard‐tissue deficiencies were addressed.
Peri‐implant health is characterized by the absence of erythema, bleeding on probing, swelling, and suppuration. It is not possible to define a range of probing depths compatible with health; Peri‐implant health can exist around implants with reduced bone support.
The main clinical characteristic of peri‐implant mucositis is bleeding on gentle probing. Erythema, swelling, and/or suppuration may also be present. An increase in probing depth is often observed in the presence of peri‐implant mucositis due to swelling or decrease in probing resistance. There is strong evidence from animal and human experimental studies that plaque is the etiological factor for peri‐implant mucositis.
Peri‐implantitis is a plaque‐associated pathological condition occurring in tissues around dental implants, characterized by inflammation in the peri‐implant mucosa and subsequent progressive loss of supporting bone. Peri‐implantitis sites exhibit clinical signs of inflammation, bleeding on probing, and/or suppuration, increased probing depths and/or recession of the mucosal margin in addition to radiographic bone loss.
The evidence is equivocal regarding the effect of keratinized mucosa on the long‐term health of the peri‐implant tissue. It appears, however, that keratinized mucosa may have advantages regarding patient comfort and ease of plaque removal.
Case definitions in day‐to‐day clinical practice and in epidemiological or disease‐surveillance studies for peri‐implant health, peri‐implant mucositis, and peri‐implantitis were introduced. The proposed case definitions should be viewed within the context that there is no generic implant and that there are numerous implant designs with different surface characteristics, surgical and loading protocols. It is recommended that the clinician obtain baseline radiographic and probing measurements following the completion of the implant‐supported prosthesis.
Surgical treatment of peri-implantitis Claffey, Noel; Clarke, Emily; Polyzois, Ioannis ...
Journal of clinical periodontology,
September 2008, Letnik:
35, Številka:
s8
Journal Article, Conference Proceeding
Recenzirano
Objectives: To review the literature on surgical treatment of peri‐implantitis.
Material and Methods: A search of PubMed and as well as a hand search of articles were conducted. Publications and ...articles accepted for publication up to November 2007 were included.
Results: A total of 43 studies were selected for the review. Only 13 of these were studies in humans and only one study directly addressed disease resolution. Thus the available evidence for surgical treatment of peri‐implantitis is extremely limited.
Animal studies: Re‐osseointegration can occur on previously contaminated surfaces. The surface characteristics are decisive for regeneration and re‐osseointegration. No single surface decontamination method appears to be distinctly superior. Open debridement with surface decontamination can achieve resolution.
Human studies: Access surgery has been investigated in one study demonstrating that resolution occurred in 58% of the lesions. No single method of surface decontamination (chemical agents, air abrasives and lasers) was found to be superior. The use of regenerative procedures such as bone graft techniques with or without the use of barrier membranes has been reported with various degrees of success. However, it must be stressed that such techniques do not address disease resolution but rather merely attempt to fill the osseous defect.
Material and methods
Articles on surgical treatment of peri‐implantitis in humans published up to December 2011 were included.
ResultsTwenty‐six studies were selected, thus limiting the available ...evidence. There is marked heterogeneity between study designs and case definitions for peri‐implantitis in the studies cited, limiting the generalization of the reported results. Adjunctive systemic antibiotics were used in most studies, but no study evaluated the adjunctive benefit of systemic antibiotics. Access flap surgery, removal of granulation tissue and implant surface decontamination has been demonstrated to decrease plaque index, BOP, suppuration, probing depths and to arrest bone loss for 58% of implant sites over 5 years. Laser treatment of the exposed implant surface during surgery was not shown to be beneficial. Available data indicate that it is possible to obtain defect fill of peri‐implantitis defects following surgical‐treatment modalities with concomitant placement of bone or bone substitutes in such defects. However, there is lack of evidence that placement of membranes in addition to grafting procedures provides any additional defect fill.
Conclusions
Surgical therapy for treating peri‐implantitis is a predictable method for treating peri‐implant disease and patients receiving this therapy have benefited from it in the short term.
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