Peri-Implant Complications

122 Pages·2018·8.25 MB·English

by  Anastasia Kelekis-Cholakis

Peri-Implant
Complications
A Clinical Guide to
Diagnosis and Treatment
Anastasia Kelekis-Cholakis
Reem Atout
Nader Hamdan
Ioannis John Tsourounakis
123
Peri-Implant Complications
Anastasia Kelekis-Cholakis • Reem Atout
Nader Hamdan • Ioannis Tsourounakis
Peri-Implant Complications
A Clinical Guide to Diagnosis
and Treatment
Anastasia Kelekis-Cholakis Reem Atout
University of Manitoba College of Dentistry University of Manitoba College of Dentistry
Winnipeg Winnipeg
Manitoba Manitoba
Canada Canada
Nader Hamdan Ioannis Tsourounakis
Faculty of Dentistry Southwest Specialty Group
Dalhousie University Winnipeg
Halifax Manitoba
Nova Scotia Canada
Canada
ISBN 978-3-319-63717-4 ISBN 978-3-319-63719-8 (eBook)
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, recita-
tion, broadcasting, reproduction on microfilms or in any other physical way, and transmission or infor-
mation 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 publica-
tion 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.
Printed on acid-free paper
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 func-
tion 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 com-
plications 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.
Winnipeg, MB, Canada Anastasia Kelekis-Cholakis
Winnipeg, MB, Canada Reem Atout
Halifax, NS, Canada Nader Hamdan
Winnipeg, MB, Canada Ioannis John Tsourounakis
v
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
vii
viii Contents
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
An Introduction to Understanding 1
the Basics of Teeth vs. Dental Implants:
Similarities and Differences
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 con-
fined to the mucosa surrounding a dental implant with no signs of loss of sup-
porting 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 alveo-
lar 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 tita-
nium, 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.
© Springer International Publishing AG, part of Springer Nature 2018 1
A. Kelekis-Cholakis et al., Peri-Implant Complications,
https://doi.org/10.1007/978-3-319-63719-8_1
2 1 An Introduction to Understanding the Basics of Teeth vs. Dental Implants
• 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 poly-
crystal; the micro-vibration of the metallic tip results in ostectomy and osteo-
plasty 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 support-
ing 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 diagnos-
tic 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).
1.3 Classification of Peri-Implant Diseases 3
Table 1.1 Classification of peri-implantitis as proposed by Froum and Rosen [3]
Staging Definition
Early PD ≥ 4 mm (bleeding and/or suppuration on probinga)
Bone loss <25% of the implant lengthb
Moderate PD ≥ 6 mm (bleeding and/or suppuration on probinga)
Bone loss 25% to 50% of the implant lengthb
Advanced PD ≥ 8 mm (bleeding and/or suppuration on probinga)
Bone loss >50% of the implant lengthb
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
a b
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])
a b
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])