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Peri-implantitis must involve:
-Inflammatory process
-Involved a functioning implant. Not a submerged implant
-Loss of peri-implant bone
Differences between teeth and implants
Debriding- more difficult topography in implants because of texture and threads as
opposed to smooth roots on teeth
On implants can debriding may cause titanium negative effects.
Chlorhexidine does not work well on biofilm bacteria and doesn’t work well for peri-
implantitis decontamination. Also has been shown to limit reosseointegration (Parlar
2009: formation of new bone onto a previously biofilm contaminated implant surface”)
because of its limitation on pre-osteoblasts.
Chlorhexidine forms an organic coating on the implant surface that prevents adhesion of
osteoblastic cells
Brings up Cell proliferation vs. antimicrobial effect
Peri-implant defects occur quicker and are more destructive than periodontal disease in
natural teeth.
Ways to clean: water pick with sterile saline
Case with cortical perforations
Why do you scale teeth? Cementum is mineralized and is prone to calculus formation.
When we scale and remove it, we still have underlying dentin that can support bone
formation. Implants have an oxide layer that bone attaches to….if there’s damage to the
layer, then bone will not bind to it.
Breakdown of titanium particles around peri-implant defects was injected into mice and
was able to cause an upregulation of osteoclastic activity
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Regenerative potential of a defect around an implant is less than an edentulous site
because the surface is not as biocompatible anymore
3rd stage surgery - remove crown, debride peri-implant defect, graft and close with
primary closure. When you open back up to place the crown, this is now the 3rd stage
surgery.
Re-osseointegration: formation of new bone on a previously biofilm contaminated
implant surface (Parlor 2009)
QUESTIONS:
1. Using cavitron to clean around implants for peri-implantitis
We rarely see calculus around implants. Therefore using cavitron (which helps remove
calculus) will not help the debridement. It is not very effective in removal of biofilm
either and may further cause damage to the implant surface.
2. Do you need piezo to clean the granulation tissue around implants?
Not necessary to remove the granulation tissue. Generally it is pretty easy to remove
that tissue because of how dense it is.
3. What are better options than a titanium brush?
Nylon brush is being studied and even a proxybrush can be used as long as the bristles
don’t frey. You don’t want any of the particles left in the area. You can even use
superfloss soaked in saline.
4. Can hydrogen peroxide help remove the biofilm around implants?
Hydrogen peroxide may help if there isn’t inflammation in the area. Otherwise it may
cause oxide attack and cause more disruption to the titanium oxide level.
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5. Can lasers help in debriding the implant surface?
There is not enough clinical research that shows the effectiveness of lasers on cleaning
the implant surface and successfully removing the biofilm and inflammatory infiltrate
6. Regenerative potential of a defect around an implant is less than an edentulous
site because the surface is not as biocompatible anymore
7. Can PRF improve the healing and biocompatibility around implants?
It may expedite the healing process during the first 3 months as seen in natural
teeth, but those areas seem to have the same amount of vital bone fill at the 6
month mark.
8. When do you evaluate your treatment after grafting around an implant?
Wait for 6 months to take an x-ray. Especially if you removed the prosthesis, grafted the
area, added cover screw….you wait at least 6 months for the healing. Depending on the
x-ray you may wait up to 9 months to re-enter.
Because of the compromised regenerative potential we wait at least 6 months.
9. Is there any difference in treatment protocol in terms of the implant surface
roughness?
There is no difference in protocols at this time
10. Do you always have to take off the prosthesis?
It is dependent on the case, but with grafting, we like to submerge it to get primary
closure and abide by classic gbr principles.
11. Do you use a membrane around implants?
There is no consensus on using membranes at this time.
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12. What factors are considered in choosing to regenerate peri-implant defects?
Horizontal bone loss does not respond well to treatment. The target should be
intrabony defects.
13. What is the best way to maintain implants? What would you tell your hygienist to
do?
Do not damage the implant surface. No need to scale surfaces because there isn’t any
calculus. Use superfloss to remove biofilm, use water irrigation to displace the biofilm.
Best therapy is a “powerwash” of the implant, which has a large surface coverage which
facilitates biofilm removal.
The maintenance is every 6 months, unless pathology or inflammation is noted and
needs to be addressed.
14. What advice do you give patients about maintaining the implants?
Start brushing the implants with a toothbrush dipped in water. No toothpaste because
the fluoride can be burnished on to the surface of the implant. Because fluoride is so
electronegative, it can corrode the metal surface of the implant.
For periodontits patients, floss is not as useful. Better to use interdental brushes and
waterpik.
15. Does emgodain help in regeneration around implants?
There is a study that used emdogain offlabel in edentulous ridges to promote
osteoblastic activity and proliferation. It can be used similarly around implants, but
there is no data to support it.
Future thought processes should be patient based. And we need to establish an implant
life-span that will help determine if we should do resective, regenerative or explantation
treatment.
You can potentially have regeneration in the area, but not re-osseointegration. It may
be hard to see on a PA radiograph that there isn’t direct contact of bone to implant, but
then a year later after potential bacterial insult have major bone loss in the area.

Unformatted Attachment Preview

Peri-implantitis must involve: -Inflammatory process -Involved a functioning implant. Not a submerged implant -Loss of peri-implant bone Differences between teeth and implants Debriding- more difficult topography in implants because of texture and threads as opposed to smooth roots on teeth On implants can debriding may cause titanium negative effects. Chlorhexidine does not work well on biofilm bacteria and doesn’t work well for periimplantitis decontamination. Also has been shown to limit reosseointegration (Parlar 2009: formation of new bone onto a previously biofilm contaminated implant surface”) because of its limitation on pre-osteoblasts. Chlorhexidine forms an organic coating on the implant surface that prevents adhesion of osteoblastic cells Brings up Cell proliferation vs. antimicrobial effect Peri-implant defects occur quicker and are more destructive than periodontal disease in natural teeth. Ways to clean: water pick with sterile saline Case with cortical perforations Why do you scale teeth? Cementum is mineralized and is prone to calculus formation. When we scale and remove it, we still have underlying dentin that can support bone formation. Implants have an oxide layer that bone attaches to….if there’s damage to the layer, then bone will not bind to it. Breakdown of titanium particles around peri-implant defects was injected into mice and was able to cause an upregulation of osteoclastic activity Regenerative potential of a defect around an implant is less than an edentulous site because the surface is not as biocompatible anymore 3rd stage surgery - remove crown, debride peri-implant defect, graft and close with primary closure. When you open back up to place the crown, this is now the 3rd stage surgery. Re-osseointegration: formation of new bone on a previously biofilm contaminated implant surface (Parlor 2009) QUESTIONS: 1. Using cavitron to clean around implants for peri-implantitis We rarely see calculus around implants. Therefore using cavitron (which helps remove calculus) will not help the debridement. It is not very effective in removal of biofilm either and may further cause damage to the implant surface. 2. Do you need piezo to clean the granulation tissue around implants? Not necessary to remove the granulation tissue. Generally it is pretty easy to remove that tissue because of how dense it is. 3. What are better options than a titanium brush? Nylon brush is being studied and even a proxybrush can be used as long as the bristles don’t frey. You don’t want any of the particles left in the area. You can even use superfloss soaked in saline. 4. Can hydrogen peroxide help remove the biofilm around implants? Hydrogen peroxide may help if there isn’t inflammation in the area. Otherwise it may cause oxide attack and cause more disruption to the titanium oxide level. 5. Can lasers help in debriding the implant surface? There is not enough clinical research that shows the effectiveness of lasers on cleaning the implant surface and successfully removing the biofilm and inflammatory infiltrate 6. Regenerative potential of a defect around an implant is less than an edentulous site because the surface is not as biocompatible anymore 7. Can PRF improve the healing and biocompatibility around implants? It may expedite the healing process during the first 3 months as seen in natural teeth, but those areas seem to have the same amount of vital bone fill at the 6 month mark. 8. When do you evaluate your treatment after grafting around an implant? Wait for 6 months to take an x-ray. Especially if you removed the prosthesis, grafted the area, added cover screw….you wait at least 6 months for the healing. Depending on the x-ray you may wait up to 9 months to re-enter. Because of the compromised regenerative potential we wait at least 6 months. 9. Is there any difference in treatment protocol in terms of the implant surface roughness? There is no difference in protocols at this time 10. Do you always have to take off the prosthesis? It is dependent on the case, but with grafting, we like to submerge it to get primary closure and abide by classic gbr principles. 11. Do you use a membrane around implants? There is no consensus on using membranes at this time. 12. What factors are considered in choosing to regenerate peri-implant defects? Horizontal bone loss does not respond well to treatment. The target should be intrabony defects. 13. What is the best way to maintain implants? What would you tell your hygienist to do? Do not damage the implant surface. No need to scale surfaces because there isn’t any calculus. Use superfloss to remove biofilm, use water irrigation to displace the biofilm. Best therapy is a “powerwash” of the implant, which has a large surface coverage which facilitates biofilm removal. The maintenance is every 6 months, unless pathology or inflammation is noted and needs to be addressed. 14. What advice do you give patients about maintaining the implants? Start brushing the implants with a toothbrush dipped in water. No toothpaste because the fluoride can be burnished on to the surface of the implant. Because fluoride is so electronegative, it can corrode the metal surface of the implant. For periodontits patients, floss is not as useful. Better to use interdental brushes and waterpik. 15. Does emgodain help in regeneration around implants? There is a study that used emdogain offlabel in edentulous ridges to promote osteoblastic activity and proliferation. It can be used similarly around implants, but there is no data to support it. Future thought processes should be patient based. And we need to establish an implant life-span that will help determine if we should do resective, regenerative or explantation treatment. You can potentially have regeneration in the area, but not re-osseointegration. It may be hard to see on a PA radiograph that there isn’t direct contact of bone to implant, but then a year later after potential bacterial insult have major bone loss in the area. Name: Description: ...
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