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The Management of Periodontal and Peri Implant Disease

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The Management of Periodontal and Peri Implant Disease FEATURE The management of periodontal and peri implant disease ©alex-mit/iStock/Getty Images Plus ©alex-mit/iStock/Getty Dental hygienist and reader panel member Justine Nicholls explains periodontal and peri implant disease and its management for the dental care professional (DCP). Introduction Peri implant disease Periodontal disease is the most prevalent Peri implant disease is a collective term for preventable disease globally and can have reversible peri implant mucositis and the serious health consequences and impact on irreversible peri implantitis. quality of life and productivity. Peri implant mucositis involves In recent years dental implant placement infammatory changes within the peri implant has become more frequent in order to treat sof tissues without bone loss. aesthetic and functional problems due to Peri implantitis involves infammatory natural tooth loss. changes afecting the sof tissues surrounding When considering restoration of the the implant resulting in loss of the supporting dentition, minimally invasive dentistry bone surrounding the implant. favours the adjacent teeth remaining intact for As dental care professionals (DCPs) we are functionality and aesthetics. used to periodontitis around natural teeth I have endeavoured to provide an where plaque bioflm induced infammatory informative and interesting, thought changes of the gingivae are followed by the provoking article which is limited to the non- loss of clinical attachment due to breakdown surgical treatment of peri implant disease, of the periodontal ligament and loss of the its presentation and clinical and oral hygiene adjacent supporting bone. protocols. Peri implantitis follows similar clinical 34 BDJ Team www.nature.com/BDJTeam © 2020 British Dental Association. All rights reserved. FEATURE signs and symptoms, with peri mucositis performed to maintain the peri implant Excess cement must be removed as the rapidly progressing to peri implantitis if not health; the aim is for manageable self- presence of residual cement can lead to peri managed frstly by careful diagnosis and performed techniques, carried out implant infammation. It is important that secondly by the implementation of remedial consistently and thoroughly by the patient. all underlying dental disease is treated or professional debridement and self-performed Te role of the hygienist and therapist stabilised before implant placement. Tis oral hygiene measures with clear, manageable, or nurse oral health educator is in oral is of great importance when patients are well taught and demonstrated plaque control health promotion, and dental education, susceptible to periodontal disease. interventions. demonstrating and observing the correct use Periodontal and peri implant disease is Peri implantitis occurs from an of the toothbrush, super foss, interdental linked to patient lifestyle. Smoking has been incompatibility between host defences and brushes and water fossing and many other shown to be a risk factor as has a history of increased bacterial load. Peri implant disease techniques relevant to the individual. periodontitis, diabetes and other systemic has a multi-factorial aetiology which occurs It is important that the regime is not diseases; genetic predisposition, alcohol quietly and without pain. complicated or overwhelming but achievable consumption and other systemic factors and simple so that it becomes embedded in predispose to disease. Maintaining healthy tissues the patient’s daily routine. Manual dexterity Localised predisposing factors include the One of the most important factors for the varies and some patients may struggle to wrap presence of plaque pathogenic bioflm and long term success of dental implants is the the foss, in the case of a single implant, or its endotoxins due to lack of maintenance maintenance of healthy peri implant tissues. gain access to a posterior bridge. adherence, prosthetic design and occlusal It is essential to be methodical and thorough when monitoring peri implant tissues. Firstly and crucially there must be a recording of ‘The cornerstone of successful therapy an initial baseline assessment and taking of radiographs. Te indication for further radiographs is optimal oral hygiene delivered by should be made following methodical clinical assessment at regular review appointments, early careful diagnosis and spotting the the patient in the home setting and clinical markers to assess the presence and severity of infammation around the implant. there is a huge part to play by the It is important to note the presence of bioflm, infammation of the peri implant tissues, increase in peri implant probing depth, professional in offering optimal support’ bleeding on probing, suppuration from the peri implant pocket, mobility and resulting radiographic changes. Some patients are heavy handed and overload, retained cement, sof tissue quality It is also important to remember that most patience in encouraging and teaching and quantity and salivary reduction in implants show evidence of a small amount of techniques will begin to see resulting abilities. patients with xerostomia. bone loss within the frst year of function. Careful and empathic two-way discussion will Te infuence of the diferent risk factors When probing peri implant tissues the tailor a manageable routine. can negatively afect the predictability of dental probing depths need to be recorded from Te cornerstone of successful therapy is implants. It must not be underestimated that a fxed landmark, the abutment implant optimal oral hygiene delivered by the patient this is a multi-factorial pathology. junction, and it is essential that a light in the home setting and there is a huge part Smoking negatively afects bone mineral force is used (0.25 Ncm) to avoid trauma to play by the professional in ofering optimal density and wound healing. to the parallel attachment of the junctional support to the patient during the instruction Alcohol consumption is a risk as it results epithelium to the implant surface. and educational phases and beyond. Te in a reduction in vitamin K; alcohol can Tere is therefore less resistance when DCP will customise a dedicated personalised break the prothrombin repletion afecting the probing around an implant and deeper peri regime to follow in bioflm management. coagulation mechanisms. implant probing depths compared to natural Complications of diabetes are well teeth. Tese probing depths are usually 2-4 Non-surgical treatment and documented: current evidence does point mm under healthy conditions. predisposing factors to periodontal therapy playing a role in Bacterial induced infammation is initially glycaemic control; infammatory markers in Good oral hygiene treated non-surgically with the use of locally the blood due to periodontal disease lead to It is important that good oral hygiene is administered treatments and adjuncts. decreased insulin sensitivity. www.nature.com/BDJTeam BDJ Team 35 © 2020 British Dental Association. All rights reserved. FEATURE Oral pathogens protocols than was once thought. Tere has foss pressurised water fossing to control Oral pathogens associated with periodontal been a paradigm shif in the management of bioflm is extremely useful in preventing peri disease are comparable to peri implant disease periodontal disease in treating surfaces with mucocitis and peri implantitis. however dentate patients have a difering reduced instrumentation pressures and in bioflm challenge to those patients where the case of the tooth surface, the preservation COVID-19 implants are placed in the edentulous mouth. of the cementum. Tis thinking will have In recent years there has been a minimally At-risk patients may require additional particular relevance when considering the invasive approach in using aerosol generating support from chemotherapeutic agents treatment for the implant surface as care must procedures (AGPs) in bioflm disruption, such as chlorhexidine digluconate, a broad be taken not to scratch the titanium surface of especially for implant maintenance spectrum antimicrobial efective against gram the implant. procedures. Guidance currently available positive and gram negative pathogens. Tere have been developments in the at the time of writing due to COVID-19 Essential oils mouthwashes also ofer protocols for implant instrumentation: a ‘like does not permit this approach. Tere is a compelling evidence of a greater reduction in with like’ approach recommending titanium temporary return to non-AGP treatment. plaque bioflm than with mechanical methods probes, scalers and curettes, and linear action Titanium hand scalers, curettes and actually alone - managing the overall bacterial piezoelectric titanium tips for ultrasonic using what the patient uses is a recommended load and penetrating the bioflm, reducing bioflm disruption. Tese are less likely approach to professional hygiene care at this maturation. to overheat than the metal stack cavitron time, with virtual consulting and oral hygiene advice. ‘There has been a paradigm shift In summary When treating patients with dental implants, raise concerns regarding periodontal and in the management of periodontal peri implant disease early. If in doubt, refer to whoever placed the implants. If this is not disease in treating surfaces with possible then refer to an experienced implant dentist or periodontal specialist. reduced instrumentation pressures and in the case of the tooth surface, the Useful resources 1. Rasperini G, Pellegrini G, Cortella preservation of the cementum.’ A, Rocchietta
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