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    Peri-Implant Complications: A Clinical Guide to Diagnosis and Treatment
    Peri-Implant Complications: A Clinical Guide to Diagnosis and Treatment
    Peri-Implant Complications: A Clinical Guide to Diagnosis and Treatment
    Ebook249 pages1 hour

    Peri-Implant Complications: A Clinical Guide to Diagnosis and Treatment

    By Anastasia Kelekis-Cholakis, Reem Atout, Nader Hamdan and Ioannis Tsourounakis

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    About this ebook

    This book is an up-to-date reference that provides detailed guidance on how to diagnose and manage the soft and hard tissue complications that may be associated with a functioning dental implant placement, such as peri-implant mucositis, soft tissue loss, and peri-implantitis. Treatment options for each complication are described and illustrated step by step and carefully selected cases are presented to further explain the individual stages in management and to highlight key learning points. Practical advice is offered on all aspects of diagnosis, and information is also presented on the definition and etiology of the various complications. The book is in an easy-to-read format and includes a review of the latest literature on the topic.
    LanguageEnglish
    PublisherSpringer
    Release dateJul 30, 2018
    ISBN9783319637198
    Peri-Implant Complications: A Clinical Guide to Diagnosis and Treatment

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      Book preview

      Peri-Implant Complications - Anastasia Kelekis-Cholakis

      Anastasia Kelekis-Cholakis, Reem Atout, Nader Hamdan and Ioannis Tsourounakis

      Peri-Implant ComplicationsA Clinical Guide to Diagnosis and Treatment

      ../images/334261_1_En_BookFrontmatter_Figa_HTML.png

      Anastasia Kelekis-Cholakis

      University of Manitoba College of Dentistry, Winnipeg, Manitoba, Canada

      Reem Atout

      University of Manitoba College of Dentistry, Winnipeg, Manitoba, Canada

      Nader Hamdan

      Faculty of Dentistry, Dalhousie University, Halifax, Nova Scotia, Canada

      Ioannis Tsourounakis

      Southwest Specialty Group, Winnipeg, Manitoba, Canada

      ISBN 978-3-319-63717-4e-ISBN 978-3-319-63719-8

      https://doi.org/10.1007/978-3-319-63719-8

      Library of Congress Control Number: 2018935192

      © Springer International Publishing AG, part of Springer Nature 2018

      This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed.

      The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use.

      The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

      This Springer imprint is published by the registered company Springer International Publishing AG part of Springer Nature

      The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland

      Preface

      With the ever increasing use of dental implants aimed at restoring function and esthetics, it is anticipated that the oral healthcare team will encounter peri-implant diseases more frequently.

      In addition, given the increasing life spans of treated populations and the parallel advances in biomaterials and implant designs, dental implants are expected to function for longer periods of time. It is therefore incumbent on the oral healthcare team to diagnose, treat, and prevent peri-implant diseases.

      This clinical guide has endeavored to address biologic soft and hard tissue complications that occur after loading of dental implants. The etiology, diagnosis, and treatment options for each condition are discussed in each chapter. Possible risk indicators for the development of these conditions are reviewed based on current scientific evidence.

      This book is recommended for any member of the oral healthcare team that maintains dental implants.

      It provides a comprehensive, yet simple, review of peri-implant diseases that will guide the practitioner in the long-term maintenance of dental implants.

      Anastasia Kelekis-Cholakis

      Reem Atout

      Nader Hamdan

      Ioannis Tsourounakis

      Winnipeg, MB, CanadaWinnipeg, MB, CanadaHalifax, NS, CanadaWinnipeg, MB, Canada

      Contents

      1 An Introduction to Understanding the Basics of Teeth vs.​ Dental Implants:​ Similarities and Differences 1

      1.​1 Definitions 1

      1.​2 Epidemiology 2

      1.​3 Classification of Peri-Implant Diseases 2

      1.​4 Peri-Implant Mucositis vs.​ Peri-Implantitis 5

      1.​4.​1 Peri-Implant Mucositis 5

      1.​4.​2 Peri-Implantitis 5

      1.​5 Teeth vs.​ Dental Implants 6

      1.​5.​1 Soft Tissues around Implants and Teeth 6

      1.​5.​2 Fiber Arrangement 9

      1.​5.​3 Periodontal Probing 10

      1.​5.​4 Inflammatory Response 11

      1.​5.​5 Biofilm 13

      1.​5.​6 Microflora around Dental Implants 14

      1.​5.​7 Healing 14

      1.​6 Summary of Important Concepts 16

      References 16

      2 Peri-implant Soft Tissue Deficiencies 21

      2.​1 Introduction 21

      2.​1.​1 Etiology 21

      2.​2 Diagnosis 33

      2.​3 Management/​Treatment Options 40

      2.​3.​1 Improving Peri-implant Soft Tissue Volume 43

      2.​3.​2 Improving the Width of Keratinized Mucosa 48

      2.​4 Summary 53

      References 53

      3 Peri-implant Mucositis 59

      3.​1 Introduction 59

      3.​2 Etiology 59

      3.​2.​1 Risk Indicators 59

      3.​3 Diagnosis 61

      3.​3.​1 Bleeding on Probing 61

      3.​3.​2 Probing Depths/​Radiographic Evaluation 61

      3.​3.​3 Prevalence 62

      3.​4 Management/​Treatment Options 62

      3.​4.​1 Patient Education 64

      3.​4.​2 Systemic and Local Factors 64

      3.​4.​3 Patient-Administered Plaque Control 69

      3.​4.​4 Mechanical Plaque Control 69

      3.​4.​5 Chemical Plaque Control 71

      3.​4.​6 Professional Debridement 72

      3.​5 Summary 74

      References 75

      4 Hard Tissue Complications/​ Peri-implantitis 79

      4.​1 Introduction 79

      4.​2 Etiology 80

      4.​2.​1 History of Periodontal Disease 81

      4.​2.​2 Smoking 84

      4.​2.​3 Poor Oral Hygiene/​Lack of Maintenance 84

      4.​2.​4 Diabetes, Alcohol Consumption, and Genetic Factors IL-1 Polymorphisms 85

      4.​2.​5 Dental Implant Surface 86

      4.​2.​6 Occlusal Overload 86

      4.​2.​7 Lack of Keratinized Tissue 88

      4.​2.​8 Iatrogenic Factors 88

      4.​3 Diagnosis 91

      4.​3.​1 Bleeding on Probing 91

      4.​3.​2 Probing Depths and Radiographic Evaluation 92

      4.​3.​3 Suppuration 92

      4.​3.​4 Mobility 94

      4.​3.​5 Prevalence 94

      4.​3.​6 Disease Progression 95

      4.​4 Management/​Treatment Options 95

      4.​4.​1 Removal of Etiologic Factors 96

      4.​4.​2 Nonsurgical Treatment of Peri-implantitis 96

      4.​4.​3 Surgical Treatment of Peri-implantitis 96

      4.​5 Summary 113

      References 114

      © Springer International Publishing AG, part of Springer Nature 2018

      Anastasia Kelekis-Cholakis, Reem Atout, Nader Hamdan and Ioannis TsourounakisPeri-Implant Complicationshttps://doi.org/10.1007/978-3-319-63719-8_1

      1. An Introduction to Understanding the Basics of Teeth vs. Dental Implants: Similarities and Differences

      Anastasia Kelekis-Cholakis¹ , Reem Atout¹, Nader Hamdan² and Ioannis Tsourounakis³

      (1)

      University of Manitoba College of Dentistry, Winnipeg, Manitoba, Canada

      (2)

      Faculty of Dentistry, Dalhousie University, Halifax, Nova Scotia, Canada

      (3)

      Southwest Specialty Group, Winnipeg, Manitoba, Canada

      1.1 Definitions

      Throughout the next sections of this book, the reader will encounter a host of terms. For purposes of clarity, this is a list of some important definitions taken from the American Academy of Periodontology (AAP) Glossary of Periodontal Terms [1]:

      Peri-implant mucositis: A disease in which the presence of inflammation is confined to the mucosa surrounding a dental implant with no signs of loss of supporting bone.

      Peri-implantitis: An inflammatory process around a dental implant which includes both soft tissue inflammation and loss of supporting bone.

      Biotype: The thickness or dimension of the soft and hard tissue surrounding natural teeth or dental implants.

      Osseointegration: A direct contact, on the light microscopic level, between living bone tissue and a dental implant.

      Fibro-osseous integration: The interposition of healthy dense collagenous tissue between a dental implant and bone. Also known as fibro-osteal integration.

      Implant, oral: Endosseous root-form implant – an implant placed into the alveolar process and/or basal bone that derives its support from a vertical length of bone and supports a prosthesis or other devices. Most commonly made of titanium, it can be cylindrical, tapered, etc.

      Implant fixture: A synonym for a dental implant, especially an endosseous implant.

      Implant abutment: That part of an implant system that connects the dental implant with a prosthesis or other devices.

      Overdenture: Complete or partial removable denture supported by soft tissue and retained roots or implants to provide support, retention, and stability and reduce ridge resorption.

      Recession: The migration of the marginal soft tissue to a point apical to the cementoenamel junction of a tooth or the platform of a dental implant.

      Biologic width: The dimension of soft tissue composed of a connective tissue and epithelial attachment extending from the crest of bone to the most apical extent of the pocket or sulcus.

      Occlusal trauma: Injury resulting in tissue changes within the attachment apparatus due to physiologic or parafunctional forces which may exceed its adaptive capacity.

      Piezoelectric surgery: A surgery performed using an instrument which generates micro-vibrating motion via the application of electromagnetic forces on a polycrystal; the micro-vibration of the metallic tip results in ostectomy and osteoplasty of the bone in contact with the tip.

      Peri-implant mucositis is a disease confined to the mucosa and is reversible.

      Peri-implantitis includes both soft tissue inflammation and loss of supporting bone and is irreversible.

      1.2 Epidemiology

      The prevalence of peri-implant diseases has been reported to range from 5 to 63.4% according to different reports [2]. This variability is due to various studies reporting different findings depending on the study design, the definitions (threshold of bone loss) adopted for peri-implant diseases, population size, and other factors.

      A better understanding of peri-implant diseases and a consensus on the diagnostic criteria will eventually help in reducing some of this variability in the prevalence of peri-implant mucositis and peri-implantitis.

      1.3 Classification of Peri-Implant Diseases

      A classification system for peri-implant diseases is highly desirable. This will assist healthcare professionals in determining accurate prevalence estimates, providing clear diagnoses, and assigning prognoses. It will also improve the communication between health professionals and researchers, as well as the evaluation of treatment outcomes. However, to date, there is no consensus on a certain classification system as far as the authors know. This is consistent with the lack of clarity on established diagnostic criteria, as well as management protocols of peri-implant diseases.

      In this section, two proposed classification systems will be provided as examples:

      The first was proposed by Froum and Rosen in [3]. This classification for peri-implantitis is based on the severity of the disease. A combination of bleeding on probing and/or suppuration, probing depth, and extent of radiographic bone loss around the dental implant is used to classify the severity of peri-implantitis into early, moderate, and advanced categories (Table 1.1, Figs. 1.1, 1.2 and 1.3).

      The second classification system was proposed by Ata-Ali et al. in [4]. In their article Ata-Ali et al. proposed a classification for peri-implant mucositis and peri-implantitis based on the severity of the disease, using a combination of peri-implant clinical and radiological parameters to classify severity into several stages (stage 0A and 0B = peri-implant mucositis and stage 1 to 4 = peri-implantitis) (Tables 1.2 and 1.3).

      Table 1.1

      Classification of peri-implantitis as proposed by Froum and Rosen [3]

      aNoted on two or more aspects of the implant

      bMeasured on radiographs from time of definitive prosthesis loading to current radiograph. If not available, the earliest available radiograph following loading should be used

      ../images/334261_1_En_1_Chapter/334261_1_En_1_Fig1_HTML.jpg

      Fig. 1.1

      Early peri-implantitis as proposed by Froum and Rosen [3]. (a) (left) Clinical photograph of early peri-implantitis at an implant at the maxillary left lateral incisor position. Note the inflamed tissue and exudate. (Froum and Rosen [3]). (b) (right) Radiograph of maxillary left lateral incisor with bone loss <25% of the implant length, depicting early peri-implantitis (Froum and Rosen [3])

      ../images/334261_1_En_1_Chapter/334261_1_En_1_Fig2_HTML.png

      Fig. 1.2

      Moderate peri-implantitis as proposed by Froum and Rosen [3]. (a) (left) Clinical view of an implant in the mandibular left first molar site. Note the exudate (Froum and Rosen [3]). (b) (right) Radiograph depicting moderate peri-implantitis, with bone loss of 25–50% of the implant length on the mesial and distal aspects of the implant (Froum and Rosen [3])

      ../images/334261_1_En_1_Chapter/334261_1_En_1_Fig3_HTML.png
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