Peri-implantitis

Last updated
A radiograph two years after implant placement, then seven years later in a heavy smoker, demonstrating progression of bone loss due to peri-implantitis Periimplantitis progression over 5 years in heavy smoker.gif
A radiograph two years after implant placement, then seven years later in a heavy smoker, demonstrating progression of bone loss due to peri-implantitis

Peri-implantitis is a destructive inflammatory process affecting the soft and hard tissues surrounding dental implants. [1] The soft tissues become inflamed whereas the alveolar bone (hard tissue), which surrounds the implant for the purposes of retention, is lost over time.

Contents

The bone loss involved in peri-implantitis differentiates this condition from peri-mucositis, a reversible inflammatory reaction involving only the soft tissues around the implant. [2] [3] [4]

Signs and symptoms

Peri-implantitis does not present in the same way for all patients. [4] Patients are recommended to regularly attend dental appointments and to seek advice from their dentist if they have any concerns for their oral health. [5]

Before the signs and symptoms are explained, it is worth noting that healthy peri-implant tissue should not be swollen, bleeding, producing pus, or have a reddened appearance. [2]

From a patient's perspective, he/she may notice loosening or wobbling of the implant. [5] This symptom does not usually present at the early stages of peri-implantitis as the implant will still be fused to bone at its deeper aspects. [4] [6] It is more likely that the patient will notice bleeding whilst brushing their teeth. A patient may also notice swelling around the implant, bad breath and/or foul taste. [5]

Clinically, peri-implantitis involves both inflammation of soft tissues and destruction of bone, therefore, there is usually evidence of both bone loss (assessed by a radiograph) and bleeding when nearby tissues are probed, a common finding for soft tissue inflammation. There have been reports of bone loss without any accompanying sign of soft tissue inflammation. Without evidence of bone loss, the diagnosis is restricted to peri-mucositis (see comparison between peri-implantitis and peri-implant mucositis below for more information). [2] [3] [4] [5] [7]

Other reported features include pain and gingival hyperplasia. [3] [6] Pain is thought to be a rare symptom and is usually linked to an acute infection. [3]

Bone loss

In healthy situation, there should be no sign of bone loss other than potential bone remodelling at the alveolar crest following implant placement. [2]

The shape of the alveolar bone in regions of bone loss varies depending on the buccal-lingual length (or cheek-to-tongue length) of the bone. Where this length is greater than the extent of the peri-implantitis, the region of bone loss can take the shape of a crater, with walls of bone surrounding the pathology; [4] this is the most common presentation of bone loss. [3] Where the buccal-lingual length is smaller, there may be no walls of bone surrounding the pathology. [4]

Probing

Bleeding on probing is considered normal whilst tissues are healing shortly after implant placement, however, if bleeding is present months or years after placement, inflammation should be suspected. [5] Other features which may be present whilst probing include pus, the presence of a pocket around the implant and/or recession of the gums. The dental professional may also notice swelling and redness of the gums, the latter of which is termed erythema. [2] [3] [4] [6] [7]

During probing, it is important to note that the pocket depth around an implant is typically greater than around natural teeth. [8] Also, the value for the pocket depth around an implant is variable in health, therefore, diagnosis of a pocket is reliant on a change in pocket depth when comparing measurements from different appointments. [2] For this reason, a Basic Periodontal Examination (BPE) is not appropriate, and a 4 or 6 point pocket chart is instead recommended. [8]

Below is a summary table of signs and symptoms associated with peri-implantitis. [2] [3] [4] [5] [6] [7]

Signs and symptoms of peri-implantitis
Signs (identified by health professional)Symptoms (patient presents with these issues)
Bleeding (and possible discharge of pus) on probingBleeding when brushing teeth
SwellingSwelling around implant
Pocket formation and/or gum recessionFoul taste
Redness (erythema)Bad breath
Hyperplasia Loose implant
Radiographic evidence of bone loss around implantPain (rare)

Causes & pathology

Studies in both human and animal specimens found that the presence of plaque and its conglomeration around tissues invariably concluded in inflammation around the peri-implant soft tissue.

To find the pathology of peri-implantitis, experiments were compared to peri-mucositis, and found that in peri-implantitis, there were more neutrophil granulocytes and a bigger proportion of (CD19+) B-cells. Similarly in periodontitis, peri-implantitis lesions contained many plasma cells and lymphocytes, however there were a larger ratio of macrophage cells and leukocytic cells. [9] [10]

Risk factors

The risk factors have been sub-divided to distinguish those with strong supporting evidence (below the sub-heading ‘risk factor’) from those with conflicting evidence (below the sub-heading ‘potential risk factors’).

Risk factors

Lack of regular maintenance therapy. To avoid this, regular dental visits should be arranged to enable early detection and management of peri-implantitis. [11]

Potential risk factors

Diabetes mellitus (commonly known as type 1 and type 2 diabetes)

Excess cement. The cement is used to retain the implant, although its potentially rough surface may aid with plaque retention. Therefore, any residual cement surrounding the implant abutment interface can give rise to peri-implantitis. The alternative to cement is a screw-retained implant, although some studies have reported a higher risk of peri-implantitis with these compared to cement-retained implants.

Further research is required to establish whether the following are indeed risk factors for peri-implantitis:

Despite its association with a number of oral maladies, there is some debate as to whether smoking is a risk factor for peri-implantitis despite its association with periodontitis. [10] [17] [18]

Peri-implantitis vs peri-implant mucositis

Peri-implant disease is an umbrella term for inflammatory diseases of tissues including both peri-implantitis and peri-implant mucositis. Peri-implant mucositis is a disease where inflammation is limited to the surrounding mucosa of an implant whereby peri-implantitis an inflammatory disease affecting mucosa as well as bone. [4]

In health, peri-implant mucosa is described as “oral epithelium extending into a non-keratinised barrier epithelium with basal lamina and hemidesmosomes facing the implant or abutment surface”. Healthy peri-implant mucosa becomes peri-implant mucositis when biofilms housing bacteria colonise implants and elicit an inflammatory response. [19] The characteristics of peri-implant mucositis are very similar to that of gingivitis: redness, swelling and inflammation. In order to diagnose peri-implant mucositis, bleeding in response to probing of the gingiva must be identified. Research has stated that the cause of this disease is similar to that of gingivitis: inadequate plaque removal in areas surrounding the implant. [4] Zitzmann et al. (2001) enlisted 12 partially dentate participants with implants who had healthy periodontal tissues. They were asked to refrain from carrying out oral hygiene for a period of 3 weeks. The results of this study demonstrated that the accumulation of plaque had led to the development of inflammation coupled with an increase in the gingival infiltrate containing immune cells [20]

Research has highlighted that the mechanisms of peri-implant mucositis and gingivitis are very similar with bacterial invasion from plaque triggering redness, swelling and inflammation within soft tissues. Peri-implant mucositis has the ability to transform into peri-implantitis if no action is taken to reverse signs of peri-implant mucositis, similar to gingivitis and periodontitis. To reverse peri-implant mucositis, good oral hygiene must be performed regularly to remove plaque which initiated this disease. [21]

Peri-implant mucositis becomes peri-implantitis when bone resorption is identified around the implant on a radiograph as well as all the signs associated with peri-implant mucositis is seen. Often, pus may also exude from the tissues surrounding the implant. However, mobility of the implant is not a sign of peri-implantitis as this disease begins at the margins of the implant. Only in the most severe cases of peri-implantitis, implant mobility may be observed where minimal bone tissue remains.

Prevention

If peri-implant mucositis is present, it must be treated to deter it from progressing to peri-implantitis, for which currently, there are no treatments to reverse its effects.

Patients must carry out plaque removal regularly to prevent and treat peri-implant mucositis by the act of tooth-brushing. Dentists must deliver oral hygiene instruction to ensure their patients are removing plaque sufficiently as well as removing their calculus which is a known plaque-retentive factor. The prognosis for implants are significantly higher in those who do smoke compared to those who not do. Therefore, patients should be encouraged to quit smoking in order to achieve the best results.

Dentists are responsible for ensuring that different elements of the implant should be of the correct size to avoid creating additional surfaces which bacteria can colonise. Margins of the restoration should be placed supra-gingivally in order to remove any extruded cement during placement. After implant placement, dentists must carefully and regularly monitor the health of the peri-implant mucosa at suitable intervals, e.g. every 3/6/12 months. [7] [19] [22]

Treatment

It is challenging to treat peri-implantitis. Depending on the nature of the disease, treatment can vary significantly – from non-surgical therapy with an aim to control the infection and detoxify the implant surface, to surgical procedures to regenerate the alveolar bone that has been lost. [3]

Due to the screw-shaped design and titanium surface modifications of the implants, mechanical debridement on the surface of the implant is ineffective in removing all adhering microorganisms. Therefore, to enhance the non-surgical treatment options of peri-implantitis, mechanical debridement can be used in combination with antiseptic, antibiotic therapy and/or resective or regenerative surgery. The combination of treatments can vary depending on the severity of the peri-implantitis, and cumulative interceptive support therapy provides guidance in this aspect. [23]

Cumulative interceptive supportive therapy, a protocol of therapeutic measures, provides guidance for clinicians to decide which regime should be used to treat peri-implantitis, depending on the mucosal condition (whether there is a presence of dental plaque, bleeding on gentle probing, suppuration), peri-implant probing depth, and evidence of radiographic bone loss. [23]

Mechanical debridement

To prevent roughening and damaging of the implant surface, ultrasonic scalers with a non-metallic tip or resin/carbon fiber curettes are used for calculus removal. [3] Conventional steel curettes or ultrasonic instruments with metal tips should be avoided as implant surface can be damaged, and any residual marks increase implant susceptibility to plaque accumulation in the future. Polishing with rubber cups and polishing paste also aids in plaque removal. [23]

Antiseptic treatment

This is performed in conjunction with mechanical debridement based on an empirical basis. The most commonly employed antiseptic applied is chlorhexidine digluconate, an antimicrobial commonly used in periodontitis. This antiseptic has been recommended to maintain satisfactory plaque control around implants primarily based on data from studies around teeth, but long-term use is not recommended due to adverse events including staining of teeth and oral tissues and altered taste sensation. [23] Chlorhexidine may slightly improve the mucosal condition in regards to bleeding on probing, which is a measure of tissue inflammation. [24] 1% concentration of hydrogen peroxide has shown to be as effective as chlorhexidine without the side effect of staining. [25] Recently, concerns have been raised regarding the direct application of chlorhexidine on implant surfaces during the treatment of peri-implant inflammation, because it becomes adsorbed on the implants and exhibits strong cytotoxic effects to fibroblasts and osteoblasts that may prevent peri-implantitis healing. [26] However, current preponderance of evidence supports that that the long-term antimicrobial effect of the use of chlorhexidine significantly outweighs the comparatively brief period of cytotoxicity.

Antibiotic treatment

This approach is aiming to eliminate or at least significantly reduce the pathogens in the submucosal biofilm. An antibiotic targeting gram-negative anaerobic bacteria – e.g. metronidazole or ornidazole is administered during the last ten days of antiseptic treatment, allowing peri-implant infection to be treated successfully and remain stable. Reinfection is subsequently prevented by instituting prophylactic procedures. [23] Alternatively, tetracycline periodontal fibers can be inserted locally for a period of ten days; this creates an environment of sustained high dose of the antimicrobial agent at the affected site for several days. [27] Another method is to use minocycline microspheres in conjunction with mechanical debridement; this has shown to improve probing depths, but the treatment may have to be repeated in future. [28] Oral systemic antibiotic intake has not shown a permanent solution without adjunct therapy being mechanical and/or local application of doxycycline and 1% hydrogen peroxide. [29]

Surgical treatment

Surgical flap management with either (or both) resective and regenerative approaches is only considered if infection is controlled successfully. This treatment is used to restore the bony support through guided bone regeneration, or to reshape the peri-implant soft tissue. [23] This also helps in comprehensive debridement and local decontamination of the affected implant. [3] It is vital to consider the aesthetic and morphological characteristics of the peri-implant lesion when considering resective surgical techniques. [23]

Current research

Preventing peri-implantitis using Biomaterial strategies to prevent or eliminate initial bacterial attachment are currently being researched. These biomaterial strategies are aiming at suppressing or inhibiting bacterial colonization of implant surfaces in favor or host cells and tissues. Additionally, new studies suggest that implant-specific instruments need to be used that reduce peri-implant bacteria while maintaining the integrity of the surface of the implant. [30] In contrast, if the implant surface is damaged by abrasive instruments, such as titanium brushes, titanium microparticles are released to the peri-implant environment that contribute to inflammation. Various combinations of strategies like antimicrobial surfaces and or delivery mechanisms coupled with methods to favor stable osseointegration and permucosal seal are being developed, these type of surfaces will be most effective in developing implants resistant to peri-implant disease. [31]

Related Research Articles

<span class="mw-page-title-main">Mouthwash</span> Liquid rinse for oral hygiene

Mouthwash, mouth rinse, oral rinse, or mouth bath is a liquid which is held in the mouth passively or swirled around the mouth by contraction of the perioral muscles and/or movement of the head, and may be gargled, where the head is tilted back and the liquid bubbled at the back of the mouth.

<span class="mw-page-title-main">Periodontal disease</span> Medical condition

Periodontal disease, also known as gum disease, is a set of inflammatory conditions affecting the tissues surrounding the teeth. In its early stage, called gingivitis, the gums become swollen and red and may bleed. It is considered the main cause of tooth loss for adults worldwide. In its more serious form, called periodontitis, the gums can pull away from the tooth, bone can be lost, and the teeth may loosen or fall out. Bad breath may also occur.

<span class="mw-page-title-main">Dental implant</span> Surgical component that interfaces with the bone of the jaw

A dental implant is a prosthesis that interfaces with the bone of the jaw or skull to support a dental prosthesis such as a crown, bridge, denture, or facial prosthesis or to act as an orthodontic anchor. The basis for modern dental implants is a biological process called osseointegration, in which materials such as titanium or zirconia form an intimate bond to the bone. The implant fixture is first placed so that it is likely to osseointegrate, then a dental prosthetic is added. A variable amount of healing time is required for osseointegration before either the dental prosthetic is attached to the implant or an abutment is placed which will hold a dental prosthetic/crown.

Osseointegration is the direct structural and functional connection between living bone and the surface of a load-bearing artificial implant. A more recent definition defines osseointegration as "functional ankylosis ", where new bone is laid down directly on the implant surface and the implant exhibits mechanical stability. Osseointegration has enhanced the science of medical bone and joint replacement techniques as well as dental implants and improving prosthetics for amputees.

Periodontology or periodontics is the specialty of dentistry that studies supporting structures of teeth, as well as diseases and conditions that affect them. The supporting tissues are known as the periodontium, which includes the gingiva (gums), alveolar bone, cementum, and the periodontal ligament. A periodontist is a dentist that specializes in the prevention, diagnosis and treatment of periodontal disease and in the placement of dental implants.

Dental plaque is a biofilm of microorganisms that grows on surfaces within the mouth. It is a sticky colorless deposit at first, but when it forms tartar, it is often brown or pale yellow. It is commonly found between the teeth, on the front of teeth, behind teeth, on chewing surfaces, along the gumline (supragingival), or below the gumline cervical margins (subgingival). Dental plaque is also known as microbial plaque, oral biofilm, dental biofilm, dental plaque biofilm or bacterial plaque biofilm. Bacterial plaque is one of the major causes for dental decay and gum disease.

<span class="mw-page-title-main">Gingival sulcus</span> Space between tooth and gums

The gingival sulcus is an area of potential space between a tooth and the surrounding gingival tissue and is lined by sulcular epithelium. The depth of the sulcus is bounded by two entities: apically by the gingival fibers of the connective tissue attachment and coronally by the free gingival margin. A healthy sulcular depth is three millimeters or less, which is readily self-cleansable with a properly used toothbrush or the supplemental use of other oral hygiene aids.

<span class="mw-page-title-main">Crown lengthening</span> Dental procedure

Crown lengthening is a surgical procedure performed by a dentist, or more frequently a periodontist, where more tooth is exposed by removing some of the gingival margin (gum) and supporting bone. Crown lengthening can also be achieved orthodontically by extruding the tooth.

Bleeding on probing (BoP) which is also known as bleeding gums or gingival bleeding is a term used by dentists and dental hygienists when referring to bleeding that is induced by gentle manipulation of the tissue at the depth of the gingival sulcus, or interface between the gingiva and a tooth. BoP is a sign of periodontal inflammation and indicates some sort of destruction and erosion to the lining of the sulcus or the ulceration of sulcular epithelium. The blood comes from lamina propria after the ulceration of the lining. BoP seems to be correlated with Periodontal Inflamed Surface Area (PISA).

<span class="mw-page-title-main">Scaling and root planing</span> Dental procedure

Scaling and root planing, also known as conventional periodontal therapy, non-surgical periodontal therapy or deep cleaning, is a procedure involving removal of dental plaque and calculus and then smoothing, or planing, of the (exposed) surfaces of the roots, removing cementum or dentine that is impregnated with calculus, toxins, or microorganisms, the agents that cause inflammation. It is a part of non-surgical periodontal therapy. This helps to establish a periodontium that is in remission of periodontal disease. Periodontal scalers and periodontal curettes are some of the tools involved.

Gingivectomy is a dental procedure in which a dentist or oral surgeon cuts away part of the gums in the mouth.

<span class="mw-page-title-main">Oral hygiene</span> Cleaning the mouth by brushing the teeth and cleaning in between the teeth

Oral hygiene is the practice of keeping one's oral cavity clean and free of disease and other problems by regular brushing of the teeth and adopting good hygiene habits. It is important that oral hygiene be carried out on a regular basis to enable prevention of dental disease and bad breath. The most common types of dental disease are tooth decay and gum diseases, including gingivitis, and periodontitis.

Guided bone regeneration (GBR) and guided tissue regeneration (GTR) are dental surgical procedures that use barrier membranes to direct the growth of new bone and gingival tissue at sites with insufficient volumes or dimensions of bone or gingiva for proper function, esthetics or prosthetic restoration. Guided bone regeneration typically refers to ridge augmentation or bone regenerative procedures; guided tissue regeneration typically refers to regeneration of periodontal attachment.

<span class="mw-page-title-main">Gingivitis</span> Inflammation of the gums

Gingivitis is a non-destructive disease that causes inflammation of the gums; ulitis is an alternative term. The most common form of gingivitis, and the most common form of periodontal disease overall, is in response to bacterial biofilms that are attached to tooth surfaces, termed plaque-induced gingivitis. Most forms of gingivitis are plaque-induced.

Chronic periodontitis is one of the seven categories of periodontitis as defined by the American Academy of Periodontology 1999 classification system. Chronic periodontitis is a common disease of the oral cavity consisting of chronic inflammation of the periodontal tissues that is caused by the accumulation of profuse amounts of dental plaque. Periodontitis initially begins as gingivitis and can progress onto chronic and subsequent aggressive periodontitis according to the 1999 classification.

Aggressive periodontitis describes a type of periodontal disease and includes two of the seven classifications of periodontitis as defined by the 1999 classification system:

  1. Localized aggressive periodontitis (LAP)
  2. Generalized aggressive periodontitis (GAP)

Metallosis is the medical condition involving deposition and build-up of metal debris in the soft tissues of the body.

Peri-implant mucositis is defined as an inflammatory lesion of the peri-implant mucosa in the absence of continuing marginal bone loss.

Periodontal surgery is a form of dental surgery that prevents or corrects anatomical, traumatic, developmental, or plaque-induced defects in the bone, gingiva, or alveolar mucosa. The objectives of this surgery include accessibility of instruments to root surface, elimination of inflammation, creation of an oral environment for plaque control, periodontal diseases control, oral hygiene maintenance, maintain proper embrasure space, address gingiva-alveolar mucosa problems, and esthetic improvement. The surgical procedures include crown lengthening, frenectomy, and mucogingival flap surgery.

References

  1. ↑ Custom made root analogue zirconia implants Fernando Pessoa University . 2017.
  2. 1 2 3 4 5 6 7 Berglundh, Tord; Armitage, Gary; Araujo, Mauricio G.; Avila-Ortiz, Gustavo; Blanco, Juan; Camargo, Paulo M.; Chen, Stephen; Cochran, David; Derks, Jan (June 2018). "Peri-implant diseases and conditions: Consensus report of workgroup 4 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions". Journal of Clinical Periodontology. 45 (Suppl 20): S286–S291. doi: 10.1111/jcpe.12957 . hdl: 2027.42/144618 . ISSN   1600-051X. PMID   29926491.
  3. 1 2 3 4 5 6 7 8 9 10 Prathapachandran, Jayachandran; Suresh, Neethu (2012). "Management of peri-implantitis". Dental Research Journal. 9 (5): 516–521. doi: 10.4103/1735-3327.104867 . ISSN   1735-3327. PMC   3612185 . PMID   23559913.
  4. 1 2 3 4 5 6 7 8 9 10 P., Lang, Niklaus (2015). Clinical Periodontology and Implant Dentistry. Wiley. ISBN   9781118940488. OCLC   956687931.{{cite book}}: CS1 maint: multiple names: authors list (link)
  5. 1 2 3 4 5 6 "European Federation of Periodontology". www.efp.org. Retrieved 2018-11-26.
  6. 1 2 3 4 "Peri-implantitis and Management". DGOI (in German). 2016-05-03. Retrieved 2018-11-26.
  7. 1 2 3 4 Fransson, Christer; Wennström, Jan; Berglundh, Tord (February 2008). "Clinical characteristics at implants with a history of progressive bone loss". Clinical Oral Implants Research. 19 (2): 142–147. doi:10.1111/j.1600-0501.2007.01448.x. ISSN   0905-7161. PMID   18184340.
  8. 1 2 British Society of Periodontology. "The Good Practitioner's Guide to Periodontology" (PDF). British Society of Periodontology. Retrieved 21 January 2019.
  9. ↑ Smeets, Ralf; Henningsen, Anders; Jung, Ole; Heiland, Max; Hammächer, Christian; Stein, Jamal M (2014-09-03). "Definition, etiology, prevention and treatment of peri-implantitis – a review". Head & Face Medicine. 10: 34. doi: 10.1186/1746-160X-10-34 . ISSN   1746-160X. PMC   4164121 . PMID   25185675.
  10. 1 2 Schwarz, Frank; Derks, Jan; Monje, Alberto; Wang, Hom-Lay (2018). "Peri-implantitis". Journal of Clinical Periodontology. 45: S246–S266. doi: 10.1111/jcpe.12954 . hdl: 2027.42/144649 . PMID   29926484.
  11. ↑ Costa, Fernando Oliveira; Takenaka‐Martinez, Satoshi; Cota, Luís Otávio Miranda; Ferreira, Sergio Diniz; Silva, Geraldo Lúcio Magalhães; Costa, José Eustáquio (2012). "Peri-implant disease in subjects with and without preventive maintenance: a 5-year follow-up". Journal of Clinical Periodontology. 39 (2): 173–181. doi:10.1111/j.1600-051X.2011.01819.x. ISSN   1600-051X. PMID   22111654.
  12. ↑ Olmedo, Daniel; Fernández, María Marta; Guglielmotti, María Beatriz; Cabrini, Rómulo Luis (March 2003). "Macrophages Related to Dental Implant Failure". Implant Dentistry. 12 (1): 75–80. doi: 10.1097/01.id.0000041425.36813.a9 . PMID   12704960. S2CID   9924890.
  13. 1 2 Safioti, Luciana M.; Kotsakis, Georgios A.; Pozhitkov, Alex E.; Chung, Whasun O.; Daubert, Diane M. (May 2017). "Increased Levels of Dissolved Titanium Are Associated With Peri-Implantitis – A Cross-Sectional Study". Journal of Periodontology. 88 (5): 436–442. doi:10.1902/jop.2016.160524. PMID   27858551. S2CID   23063156.
  14. ↑ ZANDIM-BARCELOS, Daniela Leal; CARVALHO, Gabriel Garcia de; SAPATA, Vitor Marques; VILLAR, Cristina Cunha; HÄMMERLE, Christoph; ROMITO, Giuseppe Alexandre (2019). "Implant-based factor as possible risk for peri-implantitis". Brazilian Oral Research. 33 (suppl 1): e067. doi: 10.1590/1807-3107bor-2019.vol33.0067 . hdl: 11449/199458 . PMID   31576951.
  15. ↑ Bruno, Marcos E.; Sittner, Maximiliano; Cabrini, Rómulo L.; Guglielmotti, María B.; Olmedo, Daniel G.; Tasat, Deborah R. (February 2015). "age dependent response of macrophages to micro and nano titanium dioxide particles". Journal of Biomedical Materials Research Part A. 103 (2): 471–478. doi:10.1002/jbm.a.35194. hdl: 11336/16781 . PMID   24733814.
  16. ↑ Eger, Michal; Sterer, Nir; Liron, Tamar; Kohavi, David; Gabet, Yankel (6 January 2017). "Scaling of titanium implants entrains inflammation-induced osteolysis". Scientific Reports. 7 (1): 39612. Bibcode:2017NatSR...739612E. doi: 10.1038/srep39612 . PMC   5216395 . PMID   28059080.
  17. ↑ Rokaya, Dinesh; Srimaneepong, Viritpon; Wisitrasameewon, Wichaya; Humagain, Manoj; Thunyakitpisal, Pasutha (October 2020). "Peri-implantitis Update: Risk Indicators, Diagnosis, and Treatment". European Journal of Dentistry. 14 (4): 672–682. doi:10.1055/s-0040-1715779. ISSN   1305-7456. PMC   7536094 . PMID   32882741.
  18. ↑ Kasat, V.; Ladda, R. (July 2012). "Smoking and dental implants". Journal of International Society of Preventive & Community Dentistry. 2 (2): 38–41. doi: 10.4103/2231-0762.109358 . ISSN   2231-0762. PMC   3894084 . PMID   24478965.
  19. 1 2 Heitz-Mayfield, Lisa J.A.; Salvi, Giovanni E. (June 2018). "Peri-implant mucositis". Journal of Clinical Periodontology. 45: S237–S245. doi: 10.1111/jcpe.12953 . ISSN   0303-6979. PMID   29926488.
  20. ↑ Zitzmann, N. U.; Berglundh, T.; Marinello, C. P.; Lindhe, J. (June 2001). "Experimental peri-implant mucositis in man". Journal of Clinical Periodontology. 28 (6): 517–523. doi:10.1034/j.1600-051x.2001.028006517.x. ISSN   0303-6979. PMID   11350518.
  21. ↑ Caton, Jack G.; Armitage, Gary; Berglundh, Tord; Chapple, Iain L.C.; Jepsen, Søren; Kornman, Kenneth S.; Mealey, Brian L.; Papapanou, Panos N.; Sanz, Mariano (June 2018). "A new classification scheme for periodontal and peri-implant diseases and conditions - Introduction and key changes from the 1999 classification" (PDF). Journal of Clinical Periodontology. 45: S1–S8. doi: 10.1111/jcpe.12935 . ISSN   0303-6979. PMID   29926489. S2CID   206033355.
  22. ↑ Jepsen, Søren; Berglundh, Tord; Genco, Robert; Aass, Anne Merete; Demirel, Korkud; Derks, Jan; Figuero, Elena; Giovannoli, Jean Louis; Goldstein, Moshe (2015-03-31). "Primary prevention of peri-implantitis: Managing peri-implant mucositis". Journal of Clinical Periodontology. 42: S152–S157. doi: 10.1111/jcpe.12369 . ISSN   0303-6979. PMID   25626479.
  23. 1 2 3 4 5 6 7 Froum, Stuart J. (2015-10-05). Dental implant complications : etiology, prevention, and treatment. Froum, Stuart J. (Second ed.). Hoboken, New Jersey. ISBN   9781118976463. OCLC   922529540.{{cite book}}: CS1 maint: location missing publisher (link)
  24. ↑ Schwarz, Frank; Sculean, Anton; Bieling, Katrin; Ferrari, Daniel; Rothamel, Daniel; Becker, Jürgen (2007-12-18). "Two-year clinical results following treatment of peri-implantitis lesions using a nanocrystalline hydroxyapatite or a natural bone mineral in combination with a collagen membrane". Journal of Clinical Periodontology. 35 (1): 80–87. doi:10.1111/j.1600-051x.2007.01168.x. ISSN   0303-6979. PMID   18173402.
  25. ↑ Gosau M, Hahnel S, Schwarz F, Gerlach T, Reichert TE, Bürgers R. Effect of six different peri-implantitis disinfection methods on in vivo human oral biofilm.Clin. Oral Impl. Res. 21, 2010; 866–872 doi : 10.1111/j.1600-0501.2009.01908.x
  26. ↑ Kotsakis, Georgios A.; Lan, Caixia; Barbosa, Joao; Lill, Krista; Chen, Ruoqiong; Rudney, Joel; Aparicio, Conrado (July 2016). "Antimicrobial Agents Used in the Treatment of Peri-Implantitis Alter the Physicochemistry and Cytocompatibility of Titanium Surfaces". Journal of Periodontology. 87 (7): 809–819. doi: 10.1902/jop.2016.150684 . PMID   26923474.
  27. ↑ Lang, Niklaus P.; Wilson, Thomas G.; Corbet, Esmonde F. (September 2000). "Biological complications with dental implants: their prevention, diagnosis and treatment". Clinical Oral Implants Research. 11: 146–155. doi:10.1034/j.1600-0501.2000.011s1146.x. ISSN   0905-7161. PMID   11168263.
  28. ↑ Renvert, Stefan; Lessem, Jan; Dahlen, Gunnar; Lindahl, Christel; Svensson, Marie (May 2006). "Topical minocycline microspheres versus topical chlorhexidine gel as an adjunct to mechanical debridement of incipient peri-implant infections: a randomized clinical trial". Journal of Clinical Periodontology. 33 (5): 362–369. doi:10.1111/j.1600-051x.2006.00919.x. ISSN   0303-6979. PMID   16634959.
  29. ↑ Stein, Jamal M., Christian Hammächer, and Sareh Said‐Yekta Michael. "Combination of ultrasonic decontamination, soft tissue curettage, and submucosal air polishing with povidone‐iodine application for non‐surgical therapy of peri‐implantitis: 12‐month clinical outcomes." Journal of periodontology 89.2 (2018): 139–147.
  30. ↑ Kotsakis, Georgios A.; Black, Rachel; Kum, Jason; Berbel, Larissa; Sadr, Ali; Karoussis, Ioannis; Simopoulou, Mara; Daubert, Diane (April 2021). "Effect of implant cleaning on titanium particle dissolution and cytocompatibility". Journal of Periodontology. 92 (4): 580–591. doi:10.1002/JPER.20-0186. PMID   32846000. S2CID   221346473.
  31. ↑ Bumgardner, Joel D.; Adatrow, Pradeep; Haggard, Warren O.; Norowski, P. Andrew (May 2011). "Emerging antibacterial biomaterial strategies for the prevention of peri-implant inflammatory diseases". The International Journal of Oral & Maxillofacial Implants. 26 (3): 553–560. ISSN   1942-4434. PMID   21691602.
This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.