The Role of Titanium Particles Periapical Lesions on Implants Peri-Implantitis Probing Depths Involved in Peri-Implantitis Perio & Implant Centers The majority of studies reported a direct The results from available studies The Team for of the Monterey Bay (831) 648-8800 Jochen P. Pechak, DDS, MSD Available evidence does not allow an correlation between retrograde peri- document that the peri-implant mucosa is mobile app: www.GumsRusApp.com in Silicon Valley (408) 738-3423 evaluation of the role of titanium or metal implantitis and the existence of periapical about 3 to 4 mm high, and the epithelium web: GumsRus.com particles in the pathogenesis of peri- endodontic lesions at adjacent teeth. is about 2 mm high. The zone of connective implant diseases. The scarce evidence available indicates tissue averaged 1.5 mm. In the absence that sites with periapical infections have of previous radiographs, radiographic The Risk of Peri-Implantitis in survival and complication rates similar to bone level loss of 3 mm or greater, and implants placed in non-infected sites. tm Cement-Retained Restorations vs. probing depths 6 mm or more. indicate PDL Screw-Retained Implants peri-implantitis. Occlusal Overload as a Risk Factor for Peri-Implantitis PerioDontaLetter Properly cemented restorations with no Conclusion: Jochen P. Pechak, DDS, MSD, Periodontics, Implant & Laser Dentistry Spring excess cement were not found to be at There is currently no evidence that higher risk for peri-implantitis when The Most Important occlusal overload constitutes a risk factor/ compared to screw-retained restorations. indicator for the onset or progression of Factors for Controlling Certain cements are radiopaque and they peri-implantitis. It did find that thin soft From Our Office The 2017 World Workshop on should be used. Periodontitis and tissues lead to increased marginal bone to Yours... Nevertheless, a systematic review loss compared to thick soft tissues at Peri-Implantitis Periodontology and Implantology: emphasized the rough surface structure of implants. cement remnants may facilitate retention The Workshop concluded that In November 2017, 175 researchers, Essential New Clinical, Diagnostic educators and clinicians from around of the bacteria which causes peri- Discrepancies Between adequate motivation in the patient’s implantitis and biofilm formation. the world met in Chicago to update and Treatment Information Implants And Teeth Over Time own plaque control, and compliance and standardize the definitions, with maintenance protocols, appear to diagnosis and treatment of periodontal he first World Workshop on pathogenesis, natural history, and Lack of Keratinized Gingiva as a Discrepancies between teeth and be the most important factors in and peri-implant diseases that will periodontics since 1999 was treatment of the diseases and conditions. Risk Factor for Peri-Implantitis implants may develop due to tooth wear, limiting or avoiding potential negative be used by dental professionals intended to account for the It agreed that bleeding on probing and changes in the anatomy of the face and effects on the periodontium. around the world. T notable advancements in the diagnosis (BOP) should be the primary parameter While studies suggest that the absence or jaws, which occur continuously. It found there is evidence that poor They produced 24 reports in 320 and treatment of periodontal disease in to set thresholds for gingivitis. It agreed a reduced width of keratinized gingiva may In one study, the maxillary arch length plaque control and lack of regular pages, which were collated and the past 18 years. that a patient with gingivitis can negatively affect self-performed oral hygiene decreased by an average of 5 mm, and the maintenance constitute risk factors/ published in July 2018 as the In addition, the proceedings, for the revert to a state of health, but a measures, there is limited evidence that this mandibular arch decreased by an average indicators for peri-implantitis. proceedings of The World Workshop first time, addressed the diagnosis and periodontitis patient remains a factor constitutes a risk for peri-implantitis. of 8 mm, between the ages of 13 and 45. on the Classification of Periodontal PDL tm treatment of peri-implant diseases and periodontitis patient for life, even and Peri-Implant Diseases and conditions within the classifications of following successful therapy, and Conditions. periodontal disease. requires life-long supportive care to This issue of The PerioDontaLetter The World Workshop agreed a new prevent recurrence of disease. summarizes the proceedings of the classification system for periodontal Studies investigated the predictive World Workshop. It is a “Cliff’s Notes” and peri-implant diseases and conditions values of absence of BOP as an indicator synopsis which includes answers to is necessary for clinicians to properly for periodontal stability. While the many of the most clinically-pertinent diagnose and treat patients, as well as positive predictive value remained rather questions the experts debated. The for scientists to investigate etiology, low for repeated BOP prevalence — copy is taken almost verbatim from the reports. Some of the findings are controversial, and even surprising. Figure 1. Acute Selipsky, in the International Journal necrotizing ulcerative Figure 5. A radiograph of Figure 6. Flap entry reveals Figure 7. Another example of of Periodontics and Restorative gingivitis with 3-4 mm peri-implantitis caused by the primary etiology is peri-implantitis caused by Dentistry, October 2018, stated: probing depth and 15% plaque? excess cement? subgingival cement which failure to remove excess “Current absence of evidence is not horizontal bone loss in necessarily evidence of absence. occlusal trauma? was not removed when the cement from the restoration. Scientific studies point the way, but a a 24-year-old male. (See Figure 6) crown was placed. wise therapist chooses the path.” (Stage 2, Grade B.) Dr Pechak is a board certified Periodontist embracing the evolution of better options with a focus on minimally-invasive techniques for gum disease, oral 21 Upper Ragsdale Drive • Monterey, CA 93940 • (831) 648-8800 • [email protected] Jochen P. Pechak, DDS, MSD surgery, dental implants, and implant-supported dentures. As a CE provider for the State of California, he lectures and hosts educational events for Dentists, 516 W. Remington Drive, Suite 5A • Sunnyvale, CA 94087 (408) 738-3423 • [email protected] dental teams and the community of Dental Hygienists. He is the Founder and Director of a chapter of the Seattle Study Club network, as well as our Hygiene Diplomate, American Board of Periodontology Study Club. Please contact us if you wish to be a part of our continuing education series, in which CEU’s are earned. mobile app: GumsRusApp.com • website: GumsRus.com • Dr. Pechak’s direct email: [email protected] less than 30 percent — the negative Staging was determined to be largely Summary of Occlusal Trauma and • Available evidence supports that Probing of peri-implant tissue with predictive value in the same studies was dependent upon the severity of disease at Gingival Recession infringement is associated with light force was determined to be a safe nearly 100 percent. presentation, as well as on the complexity Additional Workshop inflammation and loss of periodontal and important part of a complete oral The Workshop agreed this demonstrated of disease management. Findings There is a lack of evidence from human support. examination. that absence of BOP at repeated Four stages, 1 through 4, are each to be studies implicating occlusal trauma in the examinations represented periodontal determined after considering several cause or progression of gingival recession. New Classification for A Common Finding in health and was a very reliable indicator for variables, including clinical attachment Evidence Regarding the Favorable Mucogingival Defects Infected Implants periodontal stability. loss, amount and percentage of bone loss, Influence of Periodontal Treatment The Association of Removable or Based on Interproximal probing depth, presence and extent of on Systemic Diseases Fixed Appliances with Bone Levels When compared with healthy implant angular bony defects, and furcation Periodontitis sites alone, peri-implantitis is associated A New Classification involvement, tooth mobility, and tooth Current evidence that effective treatment Mucogingival defects based on with higher counts of 19 bacterial species, System for loss due to periodontitis. of periodontitis can favorably influence The available evidence does not support interproximal bone levels were placed including Prophyromonas gingivalis and Grading was established to provide systemic diseases, although limited, is that optimal fixed or removable appliances into three new classifications. Tannerella forsythia. Periodontal Disease supplemental information about biological intriguing and should definitely be assessed. are associated with periodontitis. • Recession Type 1 (RT1): Gingival Several consensus statements features of the disease, including a history- Several studies show that periodontitis However, evidence was found that recession with no loss of concluded: based analysis of the rate of disease contributes to the overall inflammatory prosthesis design can be associated with interproximal attachment. (This new • Suppuration is a common finding at The Workshop agreed that, consistent burden, which is strongly implicated in progression,