Dentaltown September 2013 - (Page 82)

lasers feature by Allen S. Honigman, DDS, MS Unforeseen complications in dentistry can create uncomfortable and possibly irreversible conditions for patients who require difficult treatment planning for clinicians. Up to 80 percent of dental implant patients experience complications due to inflammation,1 making the longevity of dental implants dependent on maintaining the healthy tissues around them.2 When implants fail, a number of reasons could be to blame, including peri-implantitis. Peri-implantitis is the progressive inflammation of periimplant mucostits, an inflammatory disease involving bacterial contamination of the peri-implant surface.3 It presents around dental implants with clinically significant progressive crestal bone loss (CBL). Peri-mucositis may present clinically with increased probing depths and bleeding upon probing (BOP), although there is no correlation to marginal bone loss. If the presence of suppuration along with progressing CBL occurs, treatment is required. Patients might experience discomfort while in the acute phase, but suppuration on palpation may be present. The presence of gramnegative pathogens and the persistent presence of bacterial biofilm determine the progressive nature of peri-implantitis. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 82 Several iatrogenic factors can cause peri-implant diseases and subsequent implant failure.4 Improperly seated or contoured restorations can also lead to peri-implantitis. Other iatrogenic factors include excess biomechanical stresses, overheating of the bone, implant fracture, surgical inexperience and poor undocumented implant systems. Besides the iatrogenic factors, other predisposing risks for peri-implantitis include smoking, genetic factors, periodontal disease history, poor oral hygiene and alcohol use.5 Various treatment protocols for peri-implantitis are described in the literature.6 However, there is no compelling evidence to suggest a superior surgical procedure for more advanced cases,7 and more evidence is needed to fully evaluate alternative lightactivated disinfection (LAD).8 A frequent non-surgical treatment option for peri-implantitis is the use of antibiotics and antiseptics, but again, more clinical trials are necessary to fully understand the effects of antibiotics on peri-implantitis.9 Basic and complex interventions also have been reviewed, but no reliable evidence was found to suggest the most effective interventions for treatment.10 Zeza B, Pilloni A. Peri-implant mucositis treatments in humans: a systematic review. Ann Stomatol (Roma). 2012;3(3-4):83-9. Esposito M, Grusovin MG, Worthington HV. Interventions for replacing missing teeth: treatment of peri-implantitis. Cochrane Database Syst Rev. 2012 Jan 18;1:CD004970. Dortbudak O, Haas R, Bernhart T, Mailath-Pokorny G. Lethal photosensitization for decontamination of implant surfaces in the treatment of peri-implantitis. Clin Oral Implants Res. 2001;12(20:104-8. Shapoff CA, Lahey BJ. Crestal bone loss and the consequences of retained excess cement around dental implants. Compend Contin Educ Dent. 2012;33(2):94-6, 98-101; quiz 102, 112. Heitz-Mayfield LJ. Peri-implant diseases: diagnosis and risk indicators. J Clinc Periodontol. 2008;35(8 Suppl):292-304 Nguyen-Hieu T, Borghetti A, Aboudharam G. Peri-implantitis: from diagnosis to therapeutics. J Investig Clin Dent. 2012;3(2):79-94. Romanos Ge, Weitz D. Therapy of peri-implant diseases. Where is the evidence? J Evid Based Dent Pract. 2012;12(3 Suppl):204-8. De Angelis N, Felice P, Grusovin MG, Camurati A, Esposito M. The effectiveness of adjunctive light-activated disinfection (LAD) in the treatment of peri-implantitis: 4-month results from a multicenter pragmatic randomized controlled trial. Eur J Oral Implantol. 2012;5(4):321-31. Van Winkelhoff AJ. Antibiotics in the treatment of peri-implantitis. Eur J Oral Implantol. 2012;5 Suppl:S43-50. Esposito M, Grusovin MG, Worthington HV. Treatment of peri-implantitis: what interventions are effective? A Cochrane systematic review. Eur J Oral Implantol. 2012;5 Suppl:S21-41. SEPTEMBER 2013 » dentaltown.com http://www.dentaltown.com

Table of Contents for the Digital Edition of Dentaltown September 2013

Howard Speaks: Getting Poised for Growth
Professional Courtesy: Say Hello to Great Service
Second Opinion: Why Won’t My Practice Sell?
Advice Regarding #8 RCT and Large Apex
Patients Who Refuse Perio Treatment
Corporate Profile: Sesame Communications
Office Visit: Building Bridges in Dentistry
Enhancing a Smile with Cosmetic Dentistry in the New Economy
Top 10 Questions Dentists Ask When Buying or Selling a Practice
Women’s Time in Dentistry Has Come
The Benefit of Associate Agreements in Dental Practice Sales
Retirement Transition: “Mr.” Instead of “Dr.”, What Do I Do Now?
Paperless is NOT the New Black
Simple Safe Gingivectomy Around Implants Prior to Impression
Laser-Assisted Peri-Implantitis Procedure
In This Issue: Close Your Mouth
Perio Reports
Profile in Oral Health: Nose Breathing for Good Health, Fitness and Correct Craniofacial Development

Dentaltown September 2013