Peri-Implant Disease: What We at the Abutment/Implant Margin

Fig. 6 Fig. 7 Fig. 8 PDL tm Figures 6, 7 and 8. Following decontamination of the implant surface and bone grafting, the post- PerioDontaLetter op X-ray reveals regeneration of new bone. Thomas K. McCawley, D.D.S. • Mark N. McCawley, D.M.D. , “Saving Lives By Saving Smiles” Spring bacteria and their byproducts, and/or regenerating bone using laser therapy. Conclusion eliminating sub gingival excess cement The laser has been shown to help FromFrom OurOur OfficeOffice Peri-Implant Disease: What We at the abutment/implant margin. mitigate the bacterial infection without Current knowledge suggests that toto Yours....Yours.... The use of antimicrobial oral rinses, apparent damage to the implant itself or Know and What We Need to Know peri-implant disease is a condition that, DentalDespite theimplants formidable are success a irrigation, and local drug delivery systems the surrounding tissues. while having several traits in common breakthroughof dental implants, in replacing complications lost The 2017 World Workshop on around the implants, bleeding when has been shown to have a limited McCawley and Rams found laser with periodontal disease — in particular teeth.and failureHowever, rates peri-implantitis have been Periodontology and Implantology brushing, suppuration and pocket beneficial adjunctive effect on peri- treatment on mostly natural teeth and a the Porphyromonas gingivalis bacteria hasprogressively been progressively rising. increasing. issued new classifications of peri- depth greater them 5mm. implantitis when used in combination few implants immediately suppressed which causes it — is probably much OurPeri-implantitis office has is onepioneered of the mostthe implant disease: Peri-implant mucositis is an with mechanical debridement. If putative bacterial pathogens in deep more complex, and with unique and antibacterialcommon biological treatment complications of peri- 1. Peri-Implant Health. inflammation confined to the soft nonsurgical therapy has been attempted periodontal pockets to below culture distinctive features that need to be implantitiswhich may withlead tothe eventual Nd:YAG loss laser of 2. Peri-Implant Mucositis tissues surrounding a dental implant, and the inflammation has not resolved, detection limits. thoroughly investigated. usingthe implant, the Laserand it isAssisted now regarded Peri- 3. Peri-Implantitis. with no signs of radiographic bone surgical therapy is required. A recent publication demonstrated Control of periodontal disease in Implantitisas a public Procedurehealth issue. (LAPIP). Peri-implant health is characterized loss. The main clinical characteristic laser treatment was able to increase other areas of the mouth prior to implant ThisSome newsletterapproaches isto acare short are by the absence of erythema, bleeding of peri-implant mucositis is bleeding crestal bone mass around the implant placement is critical to preventing Surgical Treatment summaryshowing ofencouraging the three-hour results lecture at on probing, swelling, and suppuration. on gentle probing. Erythema, and reduce probing depth, thus cross-infection of the implant. Poor wetreating give theon diseaseperi-implantitis effectively. at the In health, there are no visual swelling, and/or suppuration may permitting resolution of peri-implantitis. plaque control and lack of regular A full-thickness flap around the NovaIdentifying Southeastern patient andUniversity implant differences between peri-implant also be present. An increase in maintenance constitute major risk affected dental implant must be elevated Collegerelated riskof Dentalfactors Medicinecontributing Maxi to tissues and periodontal tissues. probing depth is often observed in factors for peri-implantitis. to completely visualize the implant Implantthe onset course. of peri-implant disease will However, the probing depths may the presence of peri-implant Regenerative Strict adherence to regular periodic surface. The implant can then be helpWe in have tailoring enclosed supportive a case treatment study be greater at the implant site versus mucositis due to swelling or decrease maintenance is the most important protocols and procedures. mechanically debrided to fully remove Treatment from this lecture showing new tooth sites, as attachment to teeth and in probing resistance due to preventive measure, permitting early The patient’s own plaque control any retained cement, the adherent biofilm, bone regeneration on ailing implants are different. inflammation. The optimal outcome of peri- detection of peri-implant disease. and compliance with maintenance or inflamed granulomatous tissue. implants after LAPIP that has now Signs of peri-implant diseases are There is strong evidence from implantitis treatment is regeneration of Improved methods of cementation protocols appear to be the most Other methods to debride a plaque- maintained for seven years. similar to symptoms of periodontal animal and human experimental the lost hard tissue around the implant. technique, shallow subgingival margins important factors for preventing contaminated abutment or implant We have also enclosed a case diseases — red or tender gingiva studies that bacterial plaque is the Following successful implant surface with the use of custom abutments, and and controlling peri-implantitis. surface include appropriate use of sonic repaired with LAPIP and bone decontamination, various bone early and frequent follow-up visits in a This current issue of The and ultrasonic scalers, lasers, air- grafting where bone was regenerative techniques utilizing shared maintenance approach will PerioDontaLetter addresses the Figure 1. Circumferential powder abrasion, and various chemical regenerated and pockets reduced autogenous, allograft or xenographt bone minimize the often irreversible effects latest thinking about peri-implant bone loss is typical with peri- solutions such as citric acid, hydrogen from 13mm to 3mm. and growth factors (bone morphogenetic of peri-implantitis. diseases and discusses the most implantitis. The only hope peroxide and saline. LAPIP is an exciting breakthrough proteins (BMPs), recombinant human Clearly, however, the best approach, promising treatments which have for treatment is to debride in treating peri-implantitis. platelet-derived growth factor (rPDGF), as always, is prevention. shown that peri-implantitis can be and decontaminate the

Laser Treatment autologous platelet-rich fibrin (PRF) and successfully managed. implant surface. Supplemental tm Yours in better implant health, barrier membranes) have been used to PDL As always, we welcome your bone grafting is also Mark and Tom McCawley Some clinicians have reported rebuild lost bone support around the comments and suggestions. indicated. success in removing infection and even “ailing” implant.

If implants are showing signs of infection, more damage will occur McCawley Center for Laser Periodontics and Implants McCawley Center for Laser Periodontics and Implants Thomas K. McCawley, D.D.S. • Mark N. McCawley, D.M.D. Thomas K. McCawley, D.D.S. • Markfrom N. not McCawley, instrumenting D.M.D. the threads than cleaning them even if it 800 East Broward Blvd., Suite 706 • Fort Lauderdale, FL 33301 results in a scratched implant surface.800 East They Broward are already Blvd., corroded! Suite 706 • Fort Lauderdale, FL 33301 “Excellence in Microbiological Periodontics, Implants & Laser Treatment” (954) 522-3228 • email: [email protected] “Excellence in Microbiological Periodontics, Implants & Laser Treatment” (954) 522-3228 • email: [email protected] • The patient must be able to provide a better esthetic and functional Custom abutments have generally often sufficient to resolve peri-implant adequately clean the restoration with an outcome for the patient. become the treatment of choice. These mucositis. Cervitec Plus, a chlorhexidine oral hygiene device such as an The risk of peri-implant disease is permit the design of the abutment/ and thymol varnish, has been used. interproximal brush. The embrasure substantially greater with cemented crown interface to be well-controlled Using a water irrigator with space simplifies access for enhanced restorations compared to screw- just .5-1mm subgingivally allowing for chlorhexidine has been shown to reduce plaque control. retained restorations. efficient cleansability. peri-implant mucositis by up to 70%. • Pontic areas should be convex • Residual cement must be removed Screw-retained restorations virtually Some practitioners have found air rather than concave to ensure when placing a cement-retained eliminate the problems associated with polishing with glycine powder effective cleansability. restoration. Cement provides a favorable cement-retained restorations. The at removing plaque from dental implants. • The peri-implant tissues should be platform for plaque deposition, much implant industry is developing new, The onset of peri-implantitis may Figure 2. This radiograph Figure 3. The lack of keratinized monitored for early indications of like calculus on a tooth. The onset of innovative designs which simplify occur early following implant placement. reveals radiopaque subgingival gingiva has contributed disease. Treatment should begin inflammatory signs and suppuration screw-retained restorations. Radiographic bone level loss of 3mm or cement, which is beginning to significantly to the loss of bone immediately to prevent the can take years to develop and is often The evidence strongly supports the greater, and probing depths of 6mm or destroy the surrounding bone support around these implants. development of peri-implantitis not discovered until there is substantial benefits of a thick gingival biotype and more, indicate peri-implantitis. on this implant. associated with bone loss. loss of attachment. an adequate zone of keratinized gingiva Peri-implantitis, in the absence of • A radiograph should be taken • The cementation process can be on the long-term health of the peri- treatment, seems to progress in a non- annually or every other year to monitor well controlled by using a duplicate implant tissues. Keratinized gingiva may linear and accelerating pattern. The major etiological factor for peri- 18.5 percent of patients will develop for crestal bone loss changes suggesting (mock) abutment inserted into the also have advantages regarding patient tissues supporting an implant are more implant mucositis. Peri-implant peri-implantitis. An even greater the onset of a peri-implantitis lesion. crown. This allows all excess cement to comfort and ease of plaque removal. vulnerable to periodontal pathogens mucositis develops due to an imbalance frequency of peri-implant diseases was Patient selection prior to dental be extruded and removed prior to than teeth. Most implants lack a between the bacterial challenges of the recorded for smokers, diabetics, implant consideration is important in permanent cementation. connective tissue attachment to the microbial biofilm and the local host excessive luting cement, and minimizing the risk of future peri- • Cements which are radiopaque Diagnosing implant collar. Once infection starts, response. Evidence suggests that peri- individuals with active periodontal implant complications. Patients with should be used rather than those that and Treating these implants are much more implant mucositis can be successfully disease elsewhere in the mouth. active and previously treated are radiolucent in order to identify the vulnerable to disease progression than and predictably treated, and is reversible periodontitis have a higher risk of peri- Peri-Implant Diseases One study following 2,300 implants possible presence of excess cement on natural teeth, which do have an if caught early. Peri-implant mucositis implantitis. In addition, many studies for ten years found that the risk of a radiograph. attachment to the cementum. The loss has been identified as a precursor to indicate that patients with diabetes or a Probing of peri-implant tissue with implant failure was eight times greater • The soft tissues adhere to an of attachment and bone support around peri-implantitis. smoking habit also will have a higher light force has been determined to be a in patients with severe periodontal abutment surface via a fragile an implant tends to be circular, rather Peri-implantitis is a plaque- disease than in patients with healthy risk of peri-implantitis. hemidesmosomal attachment. This soft safe and important part of a complete than vertical, as it is with natural teeth. associated pathological condition supporting tissue and bone. The role of periodic supportive tissue attachment can be readily examination. occurring in dental implant supporting When compared with healthy periodontal maintenance (SPT) for disrupted by excess cement flow. Peri-implant mucositis is a reversible tissues characterized by inflammation implant sites alone, peri-implantitis patients with dental implant restorations condition and requires immediate intervention to treat and prevent further Nonsurgical in the peri-implant tissues and is associated with a higher percentage has been shown to be very effective in Implant subsequent progressive radiographic of anerobic bacteria — the same addressing inflammatory issues and deterioration. Treatment loss of supporting bone. bacteria which cause periodontitis. monitoring crestal bone levels Considerations Thorough mechanical debridement of Other clinical signs are bleeding on compared to those patients without the area along with improved plaque Currently, the only proven way to probing, increased probing depths, supportive periodontal maintenance. In health, the soft tissues attached to control and local anti-microbials such as stop the progress of peri-implantitis is suppuration, and possibly recession of Preventing Research has found patients who the implant collar and abutment have a Betadine or chlorhexidine irrigation is mechanical debridement to remove the the gingival margin around the crown. Peri-Implant Disease regularly comply with periodontal weak epithelium hemidesmosomal Peri-implantitis usually requires maintenance, with a minimum recall attachment, or a connective tissue surgical treatment to prevent It appears that both the clinicians interval of five to six months, attachment. This attachment is the first progressive bone loss and/or implant who place the implant and those who experience significantly reduced line of defense against inflammatory failure. restore it can mitigate some of the risk associations with peri-implant changes of peri-implantitis. The principal factors for recession of factors for peri-implant disease. mucositis (-55%), marginal bone loss Numerous research publications and the peri-implant mucosa around the The surgical placement should be as (-34%) and peri-implantitis (-77%). clinical case reports have described the crown margins are loss of supporting ideal as clinically possible. Adequate Alveolar bone and soft tissue different soft tissue attachment bone, thin gingival biotype (phenotype), bone volume (reconstructed if deficiencies may occur following responses to various implant collar, implant and abutment surfaces (smooth lack of keratinized tissue, loss of indicated), appropriate diameter of the extractions and healing without alveolar Fig. 4 Fig. 5 attachment on adjacent teeth, and implant fixture relative to the bone ridge preservation. When extracting metal, roughened, microtextured or sometimes facially-positioned implants. anatomy, and depth and angulation of teeth, every precaution should be taken ceramic). Several studies have suggested that the implant will minimize restorative to preserve and regenerate hard and soft Shapoff and others have demonstrated Figures 4 and 5. Contrary to expectations, the anterior implant is the as many as 80 percent of patients will in case reports successful, long-term complications. A prosthetically-driven tissue to provide an optimum site. one exhibiting distal bone loss. develop peri-implant mucositis, and as treatment plan is imperative for a Compromised implant sites will often clinical outcomes utilizing micro- many as 40 percent of implants and predictable outcome. require augmentation procedures to textured implant technology.

PerioDontaLetter, Spring • The patient must be able to provide a better esthetic and functional Custom abutments have generally often sufficient to resolve peri-implant adequately clean the restoration with an outcome for the patient. become the treatment of choice. These mucositis. Cervitec Plus, a chlorhexidine oral hygiene device such as an The risk of peri-implant disease is permit the design of the abutment/ and thymol varnish, has been used. interproximal brush. The embrasure substantially greater with cemented crown interface to be well-controlled Using a water irrigator with space simplifies access for enhanced restorations compared to screw- just .5-1mm subgingivally allowing for chlorhexidine has been shown to reduce plaque control. retained restorations. efficient cleansability. peri-implant mucositis by up to 70%. • Pontic areas should be convex • Residual cement must be removed Screw-retained restorations virtually Some practitioners have found air rather than concave to ensure when placing a cement-retained eliminate the problems associated with polishing with glycine powder effective cleansability. restoration. Cement provides a favorable cement-retained restorations. The at removing plaque from dental implants. • The peri-implant tissues should be platform for plaque deposition, much implant industry is developing new, The onset of peri-implantitis may Figure 2. This radiograph Figure 3. The lack of keratinized monitored for early indications of like calculus on a tooth. The onset of innovative designs which simplify occur early following implant placement. reveals radiopaque subgingival gingiva has contributed disease. Treatment should begin inflammatory signs and suppuration screw-retained restorations. Radiographic bone level loss of 3mm or cement, which is beginning to significantly to the loss of bone immediately to prevent the can take years to develop and is often The evidence strongly supports the greater, and probing depths of 6mm or destroy the surrounding bone support around these implants. development of peri-implantitis not discovered until there is substantial benefits of a thick gingival biotype and more, indicate peri-implantitis. on this implant. associated with bone loss. loss of attachment. an adequate zone of keratinized gingiva Peri-implantitis, in the absence of • A radiograph should be taken • The cementation process can be on the long-term health of the peri- treatment, seems to progress in a non- annually or every other year to monitor well controlled by using a duplicate implant tissues. Keratinized gingiva may linear and accelerating pattern. The major etiological factor for peri- 18.5 percent of patients will develop for crestal bone loss changes suggesting (mock) abutment inserted into the also have advantages regarding patient tissues supporting an implant are more implant mucositis. Peri-implant peri-implantitis. An even greater the onset of a peri-implantitis lesion. crown. This allows all excess cement to comfort and ease of plaque removal. vulnerable to periodontal pathogens mucositis develops due to an imbalance frequency of peri-implant diseases was Patient selection prior to dental be extruded and removed prior to than teeth. Most implants lack a between the bacterial challenges of the recorded for smokers, diabetics, implant consideration is important in permanent cementation. connective tissue attachment to the microbial biofilm and the local host excessive luting cement, and minimizing the risk of future peri- • Cements which are radiopaque Diagnosing implant collar. Once infection starts, response. Evidence suggests that peri- individuals with active periodontal implant complications. Patients with should be used rather than those that and Treating these implants are much more implant mucositis can be successfully disease elsewhere in the mouth. active and previously treated are radiolucent in order to identify the vulnerable to disease progression than and predictably treated, and is reversible periodontitis have a higher risk of peri- Peri-Implant Diseases One study following 2,300 implants possible presence of excess cement on natural teeth, which do have an if caught early. Peri-implant mucositis implantitis. In addition, many studies for ten years found that the risk of a radiograph. attachment to the cementum. The loss has been identified as a precursor to indicate that patients with diabetes or a Probing of peri-implant tissue with implant failure was eight times greater • The soft tissues adhere to an of attachment and bone support around peri-implantitis. smoking habit also will have a higher light force has been determined to be a in patients with severe periodontal abutment surface via a fragile an implant tends to be circular, rather Peri-implantitis is a plaque- disease than in patients with healthy risk of peri-implantitis. hemidesmosomal attachment. This soft safe and important part of a complete than vertical, as it is with natural teeth. associated pathological condition supporting tissue and bone. The role of periodic supportive tissue attachment can be readily examination. occurring in dental implant supporting When compared with healthy periodontal maintenance (SPT) for disrupted by excess cement flow. Peri-implant mucositis is a reversible tissues characterized by inflammation implant sites alone, peri-implantitis patients with dental implant restorations condition and requires immediate intervention to treat and prevent further Nonsurgical in the peri-implant tissues and is associated with a higher percentage has been shown to be very effective in Implant subsequent progressive radiographic of anerobic bacteria — the same addressing inflammatory issues and deterioration. Treatment loss of supporting bone. bacteria which cause periodontitis. monitoring crestal bone levels Considerations Thorough mechanical debridement of Other clinical signs are bleeding on compared to those patients without the area along with improved plaque Currently, the only proven way to probing, increased probing depths, supportive periodontal maintenance. In health, the soft tissues attached to control and local anti-microbials such as stop the progress of peri-implantitis is suppuration, and possibly recession of Preventing Research has found patients who the implant collar and abutment have a Betadine or chlorhexidine irrigation is mechanical debridement to remove the the gingival margin around the crown. Peri-Implant Disease regularly comply with periodontal weak epithelium hemidesmosomal Peri-implantitis usually requires maintenance, with a minimum recall attachment, or a connective tissue surgical treatment to prevent It appears that both the clinicians interval of five to six months, attachment. This attachment is the first progressive bone loss and/or implant who place the implant and those who experience significantly reduced line of defense against inflammatory failure. restore it can mitigate some of the risk associations with peri-implant changes of peri-implantitis. The principal factors for recession of factors for peri-implant disease. mucositis (-55%), marginal bone loss Numerous research publications and the peri-implant mucosa around the The surgical placement should be as (-34%) and peri-implantitis (-77%). clinical case reports have described the crown margins are loss of supporting ideal as clinically possible. Adequate Alveolar bone and soft tissue different soft tissue attachment bone, thin gingival biotype (phenotype), bone volume (reconstructed if deficiencies may occur following responses to various implant collar, implant and abutment surfaces (smooth lack of keratinized tissue, loss of indicated), appropriate diameter of the extractions and healing without alveolar Fig. 4 Fig. 5 attachment on adjacent teeth, and implant fixture relative to the bone ridge preservation. When extracting metal, roughened, microtextured or sometimes facially-positioned implants. anatomy, and depth and angulation of teeth, every precaution should be taken ceramic). Several studies have suggested that the implant will minimize restorative to preserve and regenerate hard and soft Shapoff and others have demonstrated Figures 4 and 5. Contrary to expectations, the anterior implant is the as many as 80 percent of patients will in case reports successful, long-term complications. A prosthetically-driven tissue to provide an optimum site. one exhibiting distal bone loss. develop peri-implant mucositis, and as treatment plan is imperative for a Compromised implant sites will often clinical outcomes utilizing micro- many as 40 percent of implants and predictable outcome. require augmentation procedures to textured implant technology.

PerioDontaLetter, Spring Fig. 6 Fig. 7 Fig. 8 PDL tm Figures 6, 7 and 8. Following decontamination of the implant surface and bone grafting, the post- PerioDontaLetter op X-ray reveals regeneration of new bone. Thomas K. McCawley, D.D.S. • Mark N. McCawley, D.M.D. , “Saving Lives By Saving Smiles” Spring bacteria and their byproducts, and/or regenerating bone using laser therapy. Conclusion eliminating sub gingival excess cement The laser has been shown to help FromFrom OurOur OfficeOffice Peri-Implant Disease: What We at the abutment/implant margin. mitigate the bacterial infection without Current knowledge suggests that toto Yours....Yours.... The use of antimicrobial oral rinses, apparent damage to the implant itself or Know and What We Need to Know peri-implant disease is a condition that, DentalDespite theimplants formidable are success a irrigation, and local drug delivery systems the surrounding tissues. while having several traits in common breakthroughof dental implants, in replacing complications lost The 2017 World Workshop on around the implants, bleeding when has been shown to have a limited McCawley and Rams found laser with periodontal disease — in particular teeth.and failureHowever, rates peri-implantitis have been Periodontology and Implantology brushing, suppuration and pocket beneficial adjunctive effect on peri- treatment on mostly natural teeth and a the Porphyromonas gingivalis bacteria hasprogressively been progressively rising. increasing. issued new classifications of peri- depth greater them 5mm. implantitis when used in combination few implants immediately suppressed which causes it — is probably much OurPeri-implantitis office has is onepioneered of the mostthe implant disease: Peri-implant mucositis is an with mechanical debridement. If putative bacterial pathogens in deep more complex, and with unique and antibacterialcommon biological treatment complications of peri- 1. Peri-Implant Health. inflammation confined to the soft nonsurgical therapy has been attempted periodontal pockets to below culture distinctive features that need to be implantitiswhich may withlead tothe eventual Nd:YAG loss laser of 2. Peri-Implant Mucositis tissues surrounding a dental implant, and the inflammation has not resolved, detection limits. thoroughly investigated. usingthe implant, the Laserand it isAssisted now regarded Peri- 3. Peri-Implantitis. with no signs of radiographic bone surgical therapy is required. A recent publication demonstrated Control of periodontal disease in Implantitisas a public Procedurehealth issue. (LAPIP). Peri-implant health is characterized loss. The main clinical characteristic laser treatment was able to increase other areas of the mouth prior to implant ThisSome newsletterapproaches isto acare short are by the absence of erythema, bleeding of peri-implant mucositis is bleeding crestal bone mass around the implant placement is critical to preventing Surgical Treatment summaryshowing ofencouraging the three-hour results lecture at on probing, swelling, and suppuration. on gentle probing. Erythema, and reduce probing depth, thus cross-infection of the implant. Poor wetreating give theon diseaseperi-implantitis effectively. at the In health, there are no visual swelling, and/or suppuration may permitting resolution of peri-implantitis. plaque control and lack of regular A full-thickness flap around the NovaIdentifying Southeastern patient andUniversity implant differences between peri-implant also be present. An increase in maintenance constitute major risk affected dental implant must be elevated Collegerelated riskof Dentalfactors Medicinecontributing Maxi to tissues and periodontal tissues. probing depth is often observed in factors for peri-implantitis. to completely visualize the implant Implantthe onset course. of peri-implant disease will However, the probing depths may the presence of peri-implant Regenerative Strict adherence to regular periodic surface. The implant can then be helpWe in have tailoring enclosed supportive a case treatment study be greater at the implant site versus mucositis due to swelling or decrease maintenance is the most important protocols and procedures. mechanically debrided to fully remove Treatment from this lecture showing new tooth sites, as attachment to teeth and in probing resistance due to preventive measure, permitting early The patient’s own plaque control any retained cement, the adherent biofilm, bone regeneration on ailing implants are different. inflammation. The optimal outcome of peri- detection of peri-implant disease. and compliance with maintenance or inflamed granulomatous tissue. implants after LAPIP that has now Signs of peri-implant diseases are There is strong evidence from implantitis treatment is regeneration of Improved methods of cementation protocols appear to be the most Other methods to debride a plaque- maintained for seven years. similar to symptoms of periodontal animal and human experimental the lost hard tissue around the implant. technique, shallow subgingival margins important factors for preventing contaminated abutment or implant We have also enclosed a case diseases — red or tender gingiva studies that bacterial plaque is the Following successful implant surface with the use of custom abutments, and and controlling peri-implantitis. surface include appropriate use of sonic repaired with LAPIP and bone decontamination, various bone early and frequent follow-up visits in a This current issue of The and ultrasonic scalers, lasers, air- grafting where bone was regenerative techniques utilizing shared maintenance approach will PerioDontaLetter addresses the Figure 1. Circumferential powder abrasion, and various chemical regenerated and pockets reduced autogenous, allograft or xenographt bone minimize the often irreversible effects latest thinking about peri-implant bone loss is typical with peri- solutions such as citric acid, hydrogen from 13mm to 3mm. and growth factors (bone morphogenetic of peri-implantitis. diseases and discusses the most implantitis. The only hope peroxide and saline. LAPIP is an exciting breakthrough proteins (BMPs), recombinant human Clearly, however, the best approach, promising treatments which have for treatment is to debride in treating peri-implantitis. platelet-derived growth factor (rPDGF), as always, is prevention. shown that peri-implantitis can be and decontaminate the