DTUK2010

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E & OE A4 - Pdf Ripper.qxd:Text pasting Document.qxd 13/04/2010 11:26 Page 1 P eri-implantitis is an in- flammatory process af- fecting the soft and hard tissues resulting in rapid loss of supporting bone, often associated with bleeding and suppuration. The etiopathogenesis of peri- implantitis is complex and is re- lated to a variety of factors. The peri-implant environment and soft tissue-implant interface has a major impact on the progression of peri-implantitis. Patient-related factors in- clude: 1) systemic diseases (for example, diabetes, osteoporosis), 2) social factors such as adequate oral hygiene, smoking, drug abuse, 3) parafunctional habits (bruxism) 4) and previous dental history of periodontitis. In addi- tion to the above etiologies, iatro- genic factors can also play a sig- nificant role in the development of peri-implantitis. Although restorations of en- dosseous implants have demon- strated a very high survival rate (1) , one study suggested that over a five-year period, 0 to 14.4 per cent of dental implants demon- strated peri-implant inflamma- tory reactions associated with crestal bone loss (2) . The etiology of failure has classically been be related to in- fection. Bleeding, suppuration, pain, and plaque accumulation (5) along with progressive bone loss was defined as peri-implantitis (3) . It was initially thought that peri-implantitis was caused by bacteria, thus initial treatment was focused on bacterial remov- al and surface decontamination of implants. Currently, different methods of implant decontami- nation have been proposed for ailing implant surfaces (6, 10, 13) . The treatment modalities are: 1) administration of sys- temic antibiotics, 2) mechani- cal debridement with or without chlorhexidine oral rinses or an- tibiotics 3) mechanical debride- ment combined with LASER de- contamination, 4) debridement combined with a flap access and more recently, 5) debridement was combined with guided bone regeneration (GBR) for repairing of osseous defects (6, 7, 8) . GBR has limited predictability (9) and some case series have demonstrated limited bone fill after GBR pro- cedures (6) . There is insufficient evidence to support any one of the aforementioned treatment strategies for peri-implantitis (4, 5) . Therefore, different treatment modalities for peri-implantitis will be compaired from previ- ously published studies. Points for discussion One study (21) demonstrated the importance of bacterial plaque accumulation in the development of inflammation around implants (peri-implantitis) while another (15) showed that, if this condition is left untreated and the surface is not decontaminated, it will lead to peri-implant pocketing, alveolar bone loss, and eventually to im- plant failure. Because there are biologic differences between teeth and implants, the advancement of infection around implants is also different than natural teeth. The inflammatory cell infil- trate around implants was report- ed to be larger and extend more apical when compared to a cor- responding lesion in the gingival tissue around natural teeth (29) . In addition, the tissues around im- plants seem to be unable to resist the plaque associated infection and antibiotics may be necessary for the treatment of peri-implan- titis (29) . Bacteria on the implant sur- face are the target in treating in- fections around implants and tra- ditional therapeutic approaches have been directed towards im- plant surface decontamination. Systemic administration of antibi- otics were also used in the treat- ment of peri-implantitis with an immediate reduction of inflam- mation, bone re-growth and grad- ual reduction of pocket depth, but a three-month recurrence of peri- implantitis was observed due to bacterial re-colonisation of the implant surface (14) . To date, there is no reliable evidence that suggests which in- tervention (chemical agents, me- chanical debridement, surgical procedures, lasers or a combina- tion of Guided Bone Regenera- tion (GBR) with the former tech- niques) is the most effective for treating peri-implantitis (4, 22, 24) . Therefore, there is no gold stand- ard approach for the treatment of peri-implantitis. Some of the treatment modali- ties suggested for peri-implantitis are: 1) sub-mucosal mechanical debridement and antimicrobial minocycline spheres (Arestin), 2) mechanical ultrasound debride- ment without antibiotics, 3) laser ablation (Er:YAG) with mechani- cal debridement, chlorohexidine, with and without open flap sur- gery, 4) antimicrobial therapy with open flap debridement, 5) access flap surgery and bone sub- stitute or bone graft. Furthermore, it was compared the combination of oral hygiene instructions, mechanical debride- ment and topical application of minocycline microspheres (Ares- tin) in peri-implant lesions (with bone loss corresponding to no more than three implant threads) to the combination of oral hygiene instructions, mechanical debride- ment and one per cent chlorhexi- dine gel application. The results obtained after a follow-up period of 12 months on sub-mucosal mechanical debri- dement and antimicrobial minoc- ycline spheres showed that only a Peri-implantitis: definition, etiology and treatment By Vavalekas Michail of the Ashman Department of Periodontology and Implant Dentistry at New York University College of Dentistry Peri-implantitis is an inflammatory process affecting hard & soft tissues around an implant