Treatment of pathologic peri‐implant pockets

Abstract

Peri-implant and periodontal pockets share a number of anatomical features but also have distinct differences. These differences make peri-implant pockets more susceptible to trauma and infection than periodontal pockets. Inadequate maintenance can lead to infections (defined as peri-implant mucositis and peri-implantitis) within peri-implant pockets. These infections are recognized as inflammatory diseases, which ultimately lead to the loss of supporting bone. Diagnostic and treatment methods conventionally used in periodontics have been adopted to assess and treat these diseases. Controlling infection includes elimination of the biofilm from the implant surface and efficient mechanical debridement. However, the prosthetic supra-structure and implant surface characteristics can complicate treatment. Evidence shows that when appropriately managed, peri-implant mucositis is reversible. Nonsurgical therapy, with or without the use of antimicrobials, will occasionally resolve peri-implantitis, but for the majority of advanced lesions this approach is insufficient and surgery is indicated. The major objective of the surgical approach is to provide access and visualize the clinical situation. Hence, a more informed decision can be made regarding whether to use a resective or a regenerative surgical technique. Evidence shows that following successful decontamination, surgical treatment to regenerate the bone can be performed, and a number of regenerative techniques have been proposed. After treatment, regular maintenance and good oral hygiene are essential for a predictable outcome and long-term stability.

Pyrosequencing of the subgingival microbiome in peri‐implantitis after non‐surgical mechanical debridement therapy

“…The elimination of biofilms on implant surfaces is one of the most important factors to promote proper healing as any residual pathogens may be eliminated by the host's immune system . In this study, periodontal pathogens were found, which may play an important role in the pathogenesis of peri‐implantitis.…”

“…Non‐surgical mechanical debridement therapy should always be performed prior to other treatments for peri‐implantitis, as dentists can monitor the soft tissue healing process as well as guide patients to achieve effective oral hygiene . However, the prognosis of the treatment for peri‐implantitis remains poor .…”

Use of TiBrush for surface decontamination at peri‐implantitis sites in dogs: Radiographic and histological outcomes

“…However, it was concluded that the available evidence did not allow any recommendations for peri‐implantitis treatment. Nevertheless, surgical peri‐implantitis treatment has been shown to be more effective when compared to non‐surgical treatment, even though the evidence available does not allow strong conclusions due to the limited number and low methodological quality of the studies . Moreover, there is still no clear evidence as to the best mechanical approach, even though air abrasive devices might present better surface decontamination …”

Biomaterial‐based possibilities for managing peri‐implantitis

“…In an advanced stage of the disease, with the constant and increased presence of dangerous bacterial products and consequent immune inflammatory biological response, elimination of the biofilm from the implant surface is the prime process to interrupt disease progression . However, depending on the bone loss extension, complete eradication of biofilm attached on dental implants is not easy, mainly in the apical region because peri‐implant pocket becomes deeper as the bone resorbs. Nowadays, focus on peri‐implantitis treatment requires primarily mechanical nonsurgical/surgical therapy for removal of the biofilm and calcified deposits from the implant surface .…”

“…However, depending on the bone loss extension, complete eradication of biofilm attached on dental implants is not easy, mainly in the apical region because peri‐implant pocket becomes deeper as the bone resorbs. Nowadays, focus on peri‐implantitis treatment requires primarily mechanical nonsurgical/surgical therapy for removal of the biofilm and calcified deposits from the implant surface . Although, those current therapies have been found to reduce probe depth and bleeding, from a clinical perspective, the evidences on their efficacy to treat peri‐implantitis are still limited.…”