Peri-implant Diseases and Conditions

what are 3 dx aids for perio-implantitis?

1. visual inspection

2. probing (plastic here)

3. x-rays at and 1 yr after connection

osteointegration means...

above bone in base of pocket = junctional epithelium

what are the 4 things you check for when a pt has an implant? how long should you do a check/ re-eval after the implant is placed

1. mobility

2. purulent/ pus out of the pocket

3. pain

4. bone loss- take x-ray

*eval after 1 mo

on follow-up PA, should you have bone loss around the implant?

Yes, normal to have a little bone loss after it has been placed, this is a baseline.

-baseline = after bone resorbs a little

what are signs of peri-implant health?

-no redness, BOP, swelling, or suppuration

-PDs are NOT a good indicator

what are signs of peri-implantitis?

-BOP, redness, swelling, and or suppuration

-increased PD

-bone loss compared to 1 mo post op apt

-plaque = etiological factor

inflammation, presence of BOP, swelling, NO BL

peri-implant mucositis

inflammation, presence of BOP, swelling, PD is greater or equal to 4-8 mm, and progressive and subsequent BL, and plaque present indicates what implant disease?

Peri-implantitis

what is the implant disease if you DO NOT have previous post op ex and x-rays, but have PDs greater or equal to 6mm, BOP, and BL greater or equal to 3mm?

peri-implantitis

conditions following the normal healing process of tooth loss that leads to diminished dimensions of the alveolar process, resulting in both hard and soft tissue deficiences?

peri-implant soft and hard tissue deficiencies; taking out too much B or L plate- large defect = worse prognosis for an implant

one of the biggest reasons for a GP to get sued is...

observe and neglect, also implants

can the stage change? can grade change?

-yes, but very difficult/ rare to go backwards, and takes about a yr

-yes, smoking and Hba1c can change

T/F: Only ONE stage and ONE grade will be assigned to each periodontitis patient

T

estimate on what you expect from tx is called...

prognosis

Your assessment of the expected outcomes of suggested treatment modalities

PROGNOSIS- can be favorable, QUESTIONABLE, or UNFAVORABLE

-can be determined by plaque index, smoking status, and diabetes

how many OHI codes per pt?

-one code per pt then reinforced at every apt

The periodontal status of the tooth can be stabilized withcomprehensive periodontal treatment and periodontalmaintenance. Future loss of the periodontal supportingtissues is unlikely if these conditions are met.

FAVORABLE

The periodontal status of the tooth is influenced by local and/or systemic factors that may or may not be able to be controlled. The periodontium can be stabilized with comprehensive treatment and periodontal maintenance if these factors are controlled; otherwise, future periodontal breakdown may occur

QUESTIONABLE

The periodontal status of the tooth is influenced by local and/or systemic factors that cannot be controlled. Periodontal breakdown is likely to occur even with comprehensive periodontal treatment and maintenance

UNFAVORABLE

if someone is grade B, what is their likely prognosis?

questionable

if someone is grade C, what is their likely prognosis?

unfavorable

The tooth must be extracted, then it is deemed....

HOPELESS

T/F: it it okay to perio chart one tooth

F: legal issues, have to perio chart them all- observed neglect

if a tooth is already deemed "hopeless", should you still probe it?

probing can be painful/ uncomfortable- put 9mm PDs on B and L, but ONLY if the tooth is non-restorable

what does the miller prognosis encompass?

perio NOT restorability

bone loss and furcation on a molar but needs to be crowned- need to do a miller prognosis but why would you do this?

-tells the pt the % that they can keep the tooth and cover you legally if they ever return back on you with a lawsuit over over treating.

EX: "you had me invest $650 in crowning a periodontally compromised tooth that just had to be EXT", then you can come back and say "we ran a Miller Prognosis and on 2/2/25 and calculated that the tooth has a 75% probability of success only if you are making all of the perio maint apts, GOH, etc"

if a pt is 39, what value do you place on the miller prognosis chart?

0, over 40 it's a 1

For Miller Prognosis, why do mand molars do not count? Mand = 0, max 1st = 1, max 2nd = 2?

mand do not have the palatal root, max have have 3 but the max 2nd molar has the worst prognosis of any tooth in the mouth due to being more posterior

what tooth has the worst prognosis of any tooth in the mouth?

max 2nd- 3 roots, more posterior so more difficult to clean

what is the most common dental emergency?

hypoglycemia

if someone smokes, what is the chances of losing your teeth?

246% chanceof losing teeth

difference btw stage III and IV on perio class?

# of missing teeth and need for prostho

examine the pic fo the perio chart and classify the perio (stage I, II, III, IV)

stage III - only said this because not many teeth missing

-1st look at attachment loss- 8mm (puts at stage III or IV already)

-to jump from a 3 to 8mm, this is not normal- likely another factor (iatrogenic, root fracture, diastema, etc)

what are the criteria for pristine clinical health?

-3mm and under PDs

-no attachment loss

-BOP less than 10%

-no pus/ inflammation

what are the criteria for clinical health?

-same as pristine except for attachment loss that is due to toothbrush abrasion/ bruxism- this is recession due to factors other than perio disease

what is it called when pt initially has 6-8mm PDs, tx is rendered, pt returns after 1 yr w/ 3-4mm, with NO BOP, how do you classify this? previous dx: stage 3 grade B

periodontal disease stability- recession is marked but pt has NO BOP= healthy

-healthy with reduced periodontium

*means damamge was done (bone loss) but no longer active disease

***PUT IN PARENTHESIS WHAT THE PREVIOUS STAGE AND GRADE WAS** (stage 3 grade B at previous/ initial diagnosis)- identifyign them as needing more tx and needing to keep up perio maint apts