Implants are becoming a lot more popular amongst patients and are more readily available. All dentists should be able to regularly review implants and help maintain them to enhance their longevity. Importantly, it is essential to spot when things are going wrong as quick diagnosis can lead to prompt management and potentially stop Peri Implant Mucositis developing into Peri-Implantitis.
Implant dentists must take baseline radiographic measurements following the completion of the implant supported prosthesis. An additional radiograph after a loading period should be taken to establish a bone level reference following physiological remodelling. The pocket depths around the implant are usually probed and also recorded as a baseline.
If a patient attends your practice with an implant you should consider the following:
Existing implant-supported prosthesis - try to obtain clinical records and previous radiographs in order to assess changes in bone levels.
If unable to obtain previous radiographs to assess bone levels, take a new radiograph as baseline.
Regarding implants the actual pocket depths do not actually matter so much, it is the increase in PPD that matters. E.g. If it was initially 4mm but remained 4mm after a few years we are not concerned. However an increase to 7mm matters - REFER!
Probe implants to pick up Peri-Implantitis quickly as it progresses fast.
Visually INSPECT, PROBE and PALPATE!
Check for bleeding on probing, PPD changes and mucosal margin migration.
Note: The BPE is not appropriate for the assessment of dental implants.
Peri Implant Health:
Health is defined as:
No erythema, BoP, swelling and/or suppuration.
No increase in probing depth compared to previous examinations.
Absence of bone loss beyond crestal bone level changes resulting from initial bone remodelling.
Note: Peri-implant tissue health can exist around implants with reduced bone support.
Peri-Implant Mucositis:
Bleeding on gentle probing!
Erythema, swelling and/or suppuration may also be present.
An increase in probing depth is often observed in the presence of peri-implant mucositis due to swelling or decrease in probing resistance.
Absence of bone loss beyond crestal bone level changes resulting from initial bone remodelling.
Peri-Implantitis:
Diagnosis of peri-implantitis requires:
Presence of bleeding and/or suppuration on gentle probing.
Increased probing depth compared to previous examinations.
Presence of bone loss beyond crestal bone level changes resulting from initial bone remodelling.
Probing depth is correlated with bone loss and is, hence, an indicator for the severity of disease.
Rate of progression of bone loss may vary between patients.
In the absence of previous examination data, diagnosis of peri-implantitis can be based on the combination of:
Presence of bleeding and/or suppuration on gentle probing.
Probing depths of ≥6 mm.
Bone levels ≥3 mm apical of the most coronal portion of the intraosseous part of the implant.
If clinically significant progressing crestal bone loss is detected, refer back to the clinician who placed the implant. If this is not possible seek advice/refer to secondary care.
Annual recall is generally recommended for all patients with implants, however those considered high risk with specific risk factors such as smoking, or poorly controlled diabetes may require to be seen more regularly.
Prevention is always better than cure.
It is very challenging to treat Peri-Implantitis and so we must strive to avoid it. It is essential that the patient is equipped with the skills and knowledge to carry out effective oral hygiene to ensure the longevity of the implant. A few tips:
Encourage patients to clean single implanted crowns just as their natural dentition. Clean with a toothbrush, interdental brushes and implant floss.
Important the interdental brushes fit snugly into the interdental space without the wire rubbing against the superstructure or adjacent tooth.
Stress gentle flossing technique and that the floss should not be forced below the peri-implant mucosal margin.
Rechargeable electric toothbrushes may be useful for any patient who cannot clean effectively with a manual brush.
I hope you enjoyed this post. Please let me know if you have any queries or comments below!
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