Presented By:

Khaled Saleh 200820054 Mohammad Muneer - 200811346

 A 38 year old Brazilian lady presented complaining

of loose implants. The implants were inserted in Brazil on 9/12. She also complained of pain and swelling related to the upper canine and implanted lateral incisor tooth. The radiograph showed a radiolucency associated with both teeth with no mobility.

Differential Diagnosis
Dental abscess
Peri-implantitis

Final Diagnosis?
Peri-implantitis

Diagnosis?...
Peri-Implant Mucositis
The presence of inflammation in the soft tissue surrounding a dental implant without signs of any loss of supporting bone.

Peri-Implantitis
An inflammatory process that affects the tissue around an osseo-integrated dental implant and results in exaggerated marginal bone loss.

Etiology of Implant Failure

1) Presence of aggressive bacteria. 2) Implant structure. 3) Biomechanical factors Occlusal overload Traumatic failure 4) Other factors?

Signs & Symptoms of Peri-Implantitis

Diagnostic Aspects of Peri-Implantitis

1) Bleeding on Probing
The size (point diameter) of the

probe applied and the application force should standardized. In healthy and normal periodontium, the probing force used is 0.25N. At any rate, a pocket larger than 5 mm is deemed to have a greater likelihood of being contaminated.

Diagnostic Aspects of Peri-Implantitis

2) Pocket Depth

To determine probing

depth and level of periodontal attachment in relation to the CEJ.

Diagnostic Aspects of Peri-Implantitis

3) Pus Formation
Pus formation is always a sign of infection with acute tissue

destructive processes taking place. Peri-implantitis lesions usually yield some pus formation upon provocation, while mucositis may not.

Pressure on the buccal mucosa aspect may result in a discharge of pus in sites of peri-implantitis.

Diagnostic Aspects of Peri-Implantitis

4) Mobility

The bone loss encountered

in association with the development of Periimplantitis is marginal. This means that the implant still remains fully osseo-integrated in the apical portion.

Diagnostic Aspects of Peri-Implantitis

5) Radiographic Interpretation
Conventional radiography is

used to evaluate the bony structures adjacent to the implants over long periods. However, minor changes in bone morphology in the crestal area may not be revealed until they reach a significant size and shape.

Preventive Aspects of Peri-Implantitis

Instructions in oral hygiene and patient motivation
Oral infections such as existing periodontal disease have to be

treated before implant therapy. Plaque control forms the basis for the prevention future disease.

Clinical Implications
Overcontoured restorations may prevent the patient from attaining optimal oral hygiene. Interproximal contours adjacent to abutment teeth or implants have to be shaped appropriately. Precise marginal fit is a requisite.

Management of Peri-Implantitis
Non-Surgical Phase
When the main etiological factor

is bacterial infection; the first phase involves the control of the acute infection and the reduction of inflammation. Removal of the plaque deposits with plastic instruments. Polishing with pumice. Subgingival irrigation with 0.2% Chlorhexidine.

Management of Peri-Implantitis
Systemic anti-microbial therapy for 10 consecutive days. Oral hygiene maintenance.
The use of prophy jet. Soft laser irradiation.

Local delivery device, eg Actisite.

Management of Peri-Implantitis
Surgical Phase
Various bone graft techniques

and guided bone regeneration (GBR). The membrane should be left undisturbed for 4-6 weeks. Intra-oral autogenous bone grafts most commonly used. Other bone graft materials include hydroxyapatite and de-mineralized freeze-dried bone.

Bone defect covered with a GTR membrane.

Protocol of Treating Peri-Implantitis

Systemic antibiotics

(Metronidazole 400mg TDS for 3 days). 1 minute mouth wash preoperatively with chlorhexidine 0.2%

Protocol of Treating Peri-Implantitis

Mechanical curettage of

implant surface and curettage down to fresh bone after full thickness flap elevation.

Protocol of Treating Peri-Implantitis

Packing gauze strips soaked

in Chlorhexidine 0.2% into defect and under the flap for 5 minutes.

Protocol of Treating Peri-Implantitis

After gauze removing,

washing the defect with tetracycline solution 1g in 20ml of sterile saline.

Protocol of Treating Peri-Implantitis

Apply the graft material

hydrated with the tetracycline solution.

Protocol of Treating Peri-Implantitis

Rehydrate a collagen

membrane with the same solution and overlay the graft.

Protocol of Treating Peri-Implantitis

Flap closed.