PERIIMPLANTITS: Challenge in Implant Success

Periimplantitis is an inflammatory process affecting the hard and soft tissues around the functional implant with progressive marginal bone loss eventually resulting in loss of osseointegration

Etiology: Poor oral hygiene, implant design, occlusal disharmony, surgical trauma, periimplant microgap.

Pathophysiology:

Periimplantitis can occur in two different ways depending on the type of etiology:

1. Traditional pathway

Accumulation of plaque debris around the implant leads to the inflammation of periimplant tissues subsequently damaging the supporting osseous tissues.

2. Retrograde pathway

o Occlusal trauma or defective restorations causes micro fractures of the bone-implant interface leading to bone loss and loosening of implant.
o Implant contamination

Diagnostics:

(a)Clinical diagnosis: Based on the following parameters

* Bleeding on probing
* Probing depth
* Mobility
* Suppuration
* Erythema
* Flaccidity of tissues

(b)Microbiological diagnosis:

* Bacterial cultures
* Antibiotic sensitivity tests

(c)Radiological diagnosis:

* Level and amount of bone loss
* Depth of pocket

Differential diagnosis: Peri-implant mucositis

Management: 3 approaches

1. Therapeutic:

* Antimicrobials(Metronidazole, Vancomycin, Amoxicillin) +surgical debridement

* Decontamination(0.10 ml,0.12 % chlorhexidine and saline-Submucosal + 0.2 w/w Minocycline HCl –Subtopical)
* Ozone therapy
* Radiation therapy(Er:YAG laser,CO2 laser, Vector R System)

2. Surgical methods:

* Resective surgical techniques

* Guided tissue regeneration
* Bone grafts/barrier membranes

All these procedures when formulated and performed as a single management plan it is termed as Cummulative Interceptive Supportive Therapy (CISP)

About The Author:

Dr. Dipika Bumb; www.omrcafe.blogspot.com;

Contact email: drdipikabumb@gmail.com

PG,MDS Oral Medicine and Radiology