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Introduction

When losing teeth

RPD (Removal Partial Denture)

FPD (Fixed Partial Denture)

ISP (Implant Support Denture)

Increasing of implant placement, but there are many

complications

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Introduction

International Congress of Oral Implantologist Pisa

Consensus Conference report give a definition of

Implant failure: remove or lost

Implant complication: deviation of standard tx

outcome, and requires further tx

Peri-implantitis (survival rate 89&-95% in 10y reports)

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Peri-implantitis

A systemic review of 51 prospective studies reported

0%-14.4% in 5 year follow up

Other reported

11.3%-47.1% in 10-16 years

Biological and mechanical factors

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Biological factor

Micro-organism especially periopathic bacterial: P.g,

T.f, T.d

Smoking

Diabetes

Others : compression necrosis, infection,overheating of bone during operative

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Schwarz peri-implantitis

Class I: intrabonydefect

a: dehiscences defect

b: buccal & interproximal defect

c: class Ib + lingual defect

d: buccal and lingual dehiscence

e: circurferential

Class II: suprabony defect

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Mechanical factor

Occlusal over loading is considered the primary

factor

Poor prosthetic design

Inadequate number, dimensions

Non ideal position Parafunction habit

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Complication of Implant

Failure

Effect quality of life

Function

Esthetics

Time

Money

Psychological stress

Management of this failure to reosteointegration

GBR

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Treatment Modalities

Goal is trying to eliminate and restoring lost struturesand function

It is divided as periodontal treatment

Non-surgical

Antimicrobial therapy & mechanical debridement

Surgical

Surgical debridement, implantoplasty, dental lasers Regenerative

GBR

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Non-Surgical

Local tetracycline combines with debridement

6% bone filled on x-ray

0.2-0.3mm clinical significant

Evident review an ineffective method in

management peri-implantitis

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Surface Decontamination

Eliminating etiological factor

Several agents use for decontamination found no significant oversuperior

Saline, Abrasive pumice, Citric acid, CHX, Air power abrasive

Systemic review shows SD improve re-osteointergration

Dental laser and PDT

CO2 reduce amount ofS. sanguis and P. gingivalis

Nd:YAG=Er:YAG=diode laser

Laser + bone graft + collagen membrane: almost complete bonefill

No long term study report

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Surface Decontamination

Implantoplasty: archive smooth surface & plaque

adhesion

Poor effects:

increase heat, damage adjacent tissue, metallic

debris

Diamond bur with water irrigation only 1.5 degree C No surrounding tissue damage

Rubber dam might helpful

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Surgical Debridement

Surgical re-entry examination

GBR>Bone graft alone>flap debridement: bone fill

GBR with / without bone graft no significant different

GBR still not predictable as a Systemic review

reported

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Decision Tree

Management in horizontal defect

APF & implantoplasty

Management in vertical defects

Dependent on patient related (OHI, smoking)

Systemic condition(uDM)

Defects

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Defects

Ochsenbien and Cortellini and Tonetti

1 wall APF

2, 3 wall GBR with non resorbable membrane

3 wall (contained) GBR with resorbable membrane

Circumferential defect occlusal evaluation

Release heavy loading

Not ideal implant position remove

hard & soft tissue graft

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Others

PASS principle GBR must be done with primary

closure

Reduce bacterial/foreign bodies contaminated

OFD and GBR

Debridement + Antibiotic (local / systemic)