Definition and prevalence of peri-implant diseases

Objectives: The aim of the current review was to describe the prevalence of peri-implant diseases including peri-implant mucositis and peri-implantitis.
Material and Methods: A MEDLINE search (PubMed) until December 2007 was conducted and different keywords related to the prevalence of peri-implant diseases were used. Cross-sectional and longitudinal studies including 50 implant-treated subjects exhibiting a function time of 5 years were considered.
Results and Conclusion: The current review revealed that only a few studies provided data on the prevalence of peri-implant diseases. Cross-sectional studies on implant-treated subjects are rare and data from only two study samples were available. Peri-implant mucositis occurred in approximately 80% of the subjects and in 50% of the implants. Peri-implantitis was found in 28% and 56% of subjects and in 12% and 43% of implant sites.     

Treatment of peri-implant infections: a literature review

OBJECTIVES: The purpose of the present paper is to review available information on the treatment of peri-implant mucositis and peri-implantitis. MATERIALS AND METHODS: The results of animal research and human studies are presented. Proposed strategies for the treatment of peri-implantitis presented in the literature are also included. RESULTS: Most of the information accessible at this time derives from case reports. The reports provide evidence that efforts to reduce the submucosal infection may result in short-term improvements of the peri-implant lesion. They also indicate that regenerative procedures in intrabony peri-implant defects can result in the formation of new bone. CONCLUSIONS: Several uncertainties remain regarding the treatment of peri-implantitis. Properly conducted long-term follow-ups of consecutively treated cases would seem to be a realistic avenue for accumulation of more information. This may assist in establishing the predictability, magnitude and stability of improvements that can be achieved.     

种植体植入15年内种植体周围炎和种植周黏膜炎发生率调查

目的:探讨种植体植入15年中种植体周围炎(peri-implantitis,PI)和种植体周围黏膜炎(peri-implant mucosi-tis,PM)的发生率.方法:回顾性分析南昌大学附属口腔医院2001年1月-2005年12月收治的口腔种植修复患者507例(共1162颗种植体),随访12～15年,收集患者临床资...     

Dental implants: maintenance, care and treatment of peri-implant infection

Osseointegration is becoming increasingly routine in the rehabilitation of partially or fully edentulous patients. However, the surrounding tissues may be subject to inflammatory conditions similar to periodontal disease and so require maintenance. This article discusses the background, aetiology, diagnosis of peri-implant diseases, and the maintenance, care and treatment of peri-implant infection in osseointegrated implants. Three case studies are presented to illustrate points in the care of implants.     

Impact of local predisposing/precipitating factors and systemic drivers on peri-implant diseases

Background

Strong evidence suggests the infectious nature of peri-implant diseases occurring in susceptible hosts. Epidemiological reports, though, indicate that peri-implantitis is a site-specific entity. Hence, the significance of local factors that may predispose/precipitate plaque accumulation and the impact of systemic drivers that alter the immune response are relevant in the prevention and management of peri-implant disorders.

Purpose

The purpose of the present review is to shed light on the significance of local and systemic factors on peri-implant diseases, making special emphasis on the associations with peri-implantitis.

Methods

The biologic plausibility and supporting evidence aiming at providing a concluding remark were explored in the recent scientific literature for local predisposing/precipitating factors and systemic drivers related to peri-implant diseases.

Results

Local predisposing factors such as soft tissue characteristics, implant position and prosthetic design proved being strongly associated with the occurrence of peri-implant diseases. Hard tissue characteristics, however, failed to demonstrate having a direct association with peri-implant diseases. Robust data points toward the strong link between residual sub-mucosal cement and peri-implant diseases, while limited data suggests the impact of residual sub-mucosal floss and peri-implantitis. Systemic drivers/habits such as hyperglycemia and smoking showed a strong negative impact on peri-implantitis. However, there is insufficient evidence to claim for any link between metabolic syndrome, atherosclerotic cardiovascular disease, and obesity and peri-implant diseases.

Conclusion

Local predisposing/precipitating factors and systemic drivers may increase the risk of peri-implant diseases. Therefore, comprehensive anamnesis of the patients, educational/motivational programs and exhaustive prosthetically-driven treatment planning must be fostered aiming at reducing the rate of biological complications in implant dentistry.     

Prevalence and risk variables for peri-implant disease in Brazilian subjects

OBJECTIVES: The aim of this study was to verify the prevalence of peri-implant disease and analyse possible risk variables associated with peri-implant mucositis and peri-implantitis. The study group consisted of 212 partially edentulous subjects rehabilitated with osseointegrated implants. MATERIAL AND METHODS: The implants placed were examined clinically and radiographically to assess the peri-implant status. The degree of association between peri-implant disease and various independent variables was investigated using a multinomial regression analysis. RESULTS: The prevalence of peri-implant mucositis and peri-implantitis were 64.6% and 8.9%, respectively. In univariate modelling, healthy peri-implant subjects presented lower plaque scores, less periodontal bleeding on probing, and less time elapsed since placement of supra-structures. In multivariate analyses, the risk variables associated with increased odds for having peri-implant disease included: gender, plaque scores, and periodontal bleeding on probing. Presence of periodontitis and diabetes were statistically associated with increased risk of peri-implantitis. The only two factors, which did not contribute to the presence of the disease, were the time elapsed since placement of supra-structures and the frequency of visits for maintenance care. CONCLUSION: Our data suggest that subjects with periodontitis, diabetes, and poor oral hygiene were more prone to develop peri-implantitis.     

个体化口腔卫生指导对种植体周围黏膜炎治疗效果的影响

目的:探讨个体化口腔卫生指导对种植体周围黏膜炎的临床疗效的影响。方法:将36名种植体周围黏膜炎患者随机分为实验组和对照组。对照组用碳纤维工作头对种植体周围进行刮治,不作口腔卫生指导;实验组用同样方法刮治后进行个体化口腔卫生指导。分别于术后第1,3,6周记录改良菌斑指数(mPLI)、改良龈沟出血指数(mSBI)、探诊深度(PD)以评价口腔卫生指导的效果。结果:在第1周,两组病例各指标差异无统计学意义(P>0.05)。到第3,6周,实验组与对照组相比mPLI及mSBI改善效果明显,两组PD稳定。结论:个体化口腔卫生指导可以有效提高种植体周围黏膜炎的治疗效果。     

Non-surgical treatment of peri-implant mucositis and peri-implantitis: a literature review

Objectives: To review the literature on non-surgical treatment of peri-implant mucositis and peri-implantitis.
Material and Methods: A search of PubMed and The Cochrane Library of the Cochrane Collaboration (CENTRAL) as well as a hand search of articles were conducted. Publications and articles accepted for publication up to November 2007 were included.
Results: Out of 437 studies retrieved a total of 24 studies were selected for the review. Thus the available evidence for non-surgical treatment of peri-implant mucositis and peri-implantitis is scarce.
Conclusions: It was observed that mechanical non-surgical therapy could be effective in the treatment of peri-implant mucositis lesions. Furthermore, the adjunctive use of antimicrobial mouth rinses enhanced the outcome of mechanical therapy of such mucositis lesions. In peri-implantitis lesions non-surgical therapy was not found to be effective. Adjunctive chlorhexidine application had only limited effects on clinical and microbiological parameters. However, adjunctive local or systemic antibiotics were shown to reduce bleeding on probing and probing depths. Minor beneficial effects of laser therapy on peri-implantitis have been shown; this approach needs to be further evaluated. There is a need for randomized-controlled studies evaluating treatment models of non-surgical therapy of peri-implant mucositis and peri-implantitis.     

Complications and treatment errors in peri-implant soft tissue management

Inadequate quality, quantity, or aesthetics of the peri-implant soft tissues can result from a combination of factors related to the outcome of treatments performed before, during, or after implant placement. In this paper, we describe in detail the treatment errors that can pave the way for the onset of mucositis or give rise to soft tissue complications such as peri-implant soft tissue discoloration or dehiscence, graft exposure, or scar formation. By tracing the error back to the planning or surgical stage, clinical insights on surgical soft tissue management are provided to avoid or treat complications that affect the status of the peri-implant soft tissues. Mastering the learning curve and knowing the limitations of each technique are fundamental for preventing added treatment failures that can result in increased patient morbidity and overall discontent.     

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目的探讨盐酸二甲胺环素配合治疗种植体周围黏膜炎的临床对照疗效。方法2004年6月至2007年8月在青岛市口腔医院口腔种植中心,将患有种植体周围黏膜炎的患者种植体24颗随机分为试验组和对照组,试验组行碳纤维刮治器洁刮治+抛光喷砂+局部应用盐酸二甲胺四环素软膏;对照组应用碳纤维刮治器洁刮治+抛光喷砂治疗。结果两组治疗后菌斑指数、龈沟出血指数及种植体周围探诊深度较治疗前均明显降低(P<0.05),但两种治疗方法间疗效差异无统计学意义。结论使用机械性洁治和抛光以及有效控制菌斑是治疗种植体周围黏膜炎的有效方法,局部应用盐酸二甲胺四环素软膏短期内有一定疗效。     

Peri-implant diseases: diagnosis and risk indicators

Background: Peri-implant diseases include peri-implant mucositis, describing an inflammatory lesion of the peri-implant mucosa, and peri-implantitis, which also includes loss of supporting bone.
Methods: A literature search of the Medline database (Ovid), up to 21 January 2008 was carried out using a systematic approach, in order to review the evidence for diagnosis and the risk indicators for peri-implant diseases.
Results: Experimental and clinical studies have identified various diagnostic criteria including probing parameters, radiographic assessment and peri-implant crevicular fluid and saliva analyses. Cross-sectional analyses have investigated potential risk indicators for peri-implant disease including poor oral hygiene, smoking, history of periodontitis, diabetes, genetic traits, alcohol consumption and implant surface. There is evidence that probing using a light force (0.25 N) does not damage the peri-implant tissues and that bleeding on probing (BOP) indicates presence of inflammation in the peri-implant mucosa. The probing depth, the presence of BOP, and suppuration should be assessed regularly for the diagnosis of peri-implant diseases. Radiographs are required to evaluate supporting bone levels around implants. The review identified strong evidence that poor oral hygiene, a history of periodontitis and cigarette smoking, are risk indicators for peri-implant disease. Future prospective studies are required to confirm these factors as true risk factors.     

Management of peri-implantitis – A contemporary synopsis

Prevalence of peri-implant complication is expected to be on the rise with the increased number of implants being placed. Depending on the degree of osseous involvement, the clinician needs to decide if the treatment goal is to arrest the disease progression, regeneration or explantation and replacement. Host's medical status, defect configuration, aesthetic outcome, ability to access for plaque control post-treatment, and the patient's wishes are key factors to consider. The purpose of this review is to provide a contemporary synopsis on the management of peri-implantitis with emphasis on explantation. Guidance on the identification of factors/situations where salvaging an implant may be less favourable is discussed and the various techniques to remove a fractured, or peri-implantitis-affected non-mobile implant are described.     

牙种植体周围微生物研究

牙种植术是目前修复牙列缺损和牙列缺失的主要治疗方案,但是种植体周围微生态失衡易造成种植体周围疾病的发生,进而导致种植失败。从20世纪80年代开始,种植体周围微生物的研究就成为了口腔微生物研究的热点之一。正常种植体周围微生物和种植体周围炎症相关微生物存在着差异,这些差异直接或间接增加了种植体周围疾病的风险,因此寻找种植体周围黏膜炎和种植体周围炎“核心微生物组”是目前研究的关键。