chapter 8: peri-implant health and diseases

components of an implant system

implant, abutment, crown

implant body

portion that is surgically placed into the living, vital alveolar bone

varying shapes and roughness provide greater surface area → engage peri-implant bone so there’s better stress distribution and lowering micromotion

why is titanium commonly used for conventional dental implants

titanium is a lightweight metal with high strength and durability

biocompatible, doesn’t readily corrode

poor conductor of heat and electricity

disadvantages of titanium for implants

softer and scratched easily by instruments → bacterial adherence

some report adverse reactions to titanium particles from corrosion/wear

grayish dark color that could shine through thin gingiva

zirconia for dental implants

ceramic material with similar/superior biocompatibility can characteristics to titanium

better esthetics (whitish color, high degree of translucency) with thin gingival phenotypes

implant abutment

metal post that connects the implant prosthesis to the implant body and secures the prosthesis in place

either protrudes partially or completely through the gingival tissue

also made from either titanium or zirconia

tissues surrounding a dental implant

junctional epithelium- attaches to the implant or abutment surface (biologic seal)

connective tissue (supragingival fiber bundles)- run parallel or obliquely to the implant/abutment or encircles it entirely

no pdl or cementum

alveolar bone is in direct contact with the implant surface (osteointegration)

implications of an implant having no pdl fibers

periodontal pathogens can create inflammation and destroy bone much more rapidly along a dental implant (no protective barrier)

osseointegration

the direct contact of the living bone with the surface of the implant body

success: no clinical mobility of the implant, no discomfort or pain when the implant is in function, no increased bone loss or radiolucency on rads, less than 0.2 mm of bone loss annually after the first year

peri-implant health

absence of erythema, BOP, swelling, and suppuration

no visual difference compared to healthy periodontal tissues

probing depths may still be deeper due to less resistance

peri-implant mucositis

plaque biofilm-induced inflammation of the soft tissues with no loss of supporting bone

reversible if etiologic factors are removed

includes red inflammation

peri-implantitis

periodontitis affecting the soft and hard tissues surrounding a functioning osseointegrated dental implant

plaque-biofilm inflammation with progressive loss of supporting alveolar bone

can be a nonlinear accelerated pattern of progression

implant does not become mobile until the final stages (loss of osseointegration)

factors contributing to hard tissue deficiencies

loss of periodontal support caused by periodontitis, endodontic infections, thin buccal bone plates, traumatic injury

primary etiology of peri-implant mucositis and peri-implantitis

dental biofilm

is there any single microorganism that has ever been implicated to be the causative agent of peri-implantitis

no, it is a polymicrobial infection

risk factors of peri-implantitis

history of previous periodontal disease

poor plaque biofilm control

smoking

residual cement may induce inflammation

biomechanical overload (forces and duration of them on the tooth) (can also lead to implant failure even w/o plaque)

clinical signs of a failing implant

soft tissue indicators: BOP, suppuration, pain usually not present

implant mobility (loss of osseointegration)

radiographic signs of a failing implant

vertical destruction of the crestal bone around the implant- assumes shape of a saucer

treatment modalities for failing implants

NSPT, anti-septics, local/systemic antibodies, access flap surgery

when should probing of the implant occur

once the final restoration has been installed

use a weak hand

probing depths alone < changes in probing depths over time