Definition, etiology, prevention and treatment of peri-implantitis--a review

Ralf Smeets, Anders Henningsen, Ole Jung, Max Heiland, Christian Hammächer, Jamal M Stein, Ralf Smeets, Anders Henningsen, Ole Jung, Max Heiland, Christian Hammächer, Jamal M Stein

Abstract

Peri-implant inflammations represent serious diseases after dental implant treatment, which affect both the surrounding hard and soft tissue. Due to prevalence rates up to 56%, peri-implantitis can lead to the loss of the implant without multilateral prevention and therapy concepts. Specific continuous check-ups with evaluation and elimination of risk factors (e.g. smoking, systemic diseases and periodontitis) are effective precautions. In addition to aspects of osseointegration, type and structure of the implant surface are of importance. For the treatment of peri-implant disease various conservative and surgical approaches are available. Mucositis and moderate forms of peri-implantitis can obviously be treated effectively using conservative methods. These include the utilization of different manual ablations, laser-supported systems as well as photodynamic therapy, which may be extended by local or systemic antibiotics. It is possible to regain osseointegration. In cases with advanced peri-implantitis surgical therapies are more effective than conservative approaches. Depending on the configuration of the defects, resective surgery can be carried out for elimination of peri-implant lesions, whereas regenerative therapies may be applicable for defect filling. The cumulative interceptive supportive therapy (CIST) protocol serves as guidance for the treatment of the peri-implantitis. The aim of this review is to provide an overview about current data and to give advices regarding diagnosis, prevention and treatment of peri-implant disease for practitioners.

Figures

Figure 1
Figure 1
Peri-implantitis with increased probing depth (12 mm).
Figure 2
Figure 2
Conservative therapy – example of the use of a carbone curette.
Figure 3
Figure 3
Conservative therapy – detoxification using an air polishing device with glycin powder.
Figure 4
Figure 4
Peri-implantitis with granulation tissue.
Figure 5
Figure 5
Peri-implantation 1 week after resective therapy.
Figure 6
Figure 6
Regenerative therapie – defect after degranulation.
Figure 7
Figure 7
Regenerative therapie – defect fill with a xenograft material (BioOss ®, Geistlich, Switzerland).
Figure 8
Figure 8
Regenerative therapie – membrane application (BioGide ®, Geistlich, Switzerland).
Figure 9
Figure 9
Preoperative radiograph of the peri-implant defect.
Figure 10
Figure 10
Postoperative radiograph 12 months after regenerative therapy.

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