implants - international magazine of oral implantology

I industry report Fig. 1_Periapical radiograph of a dental implant with bone loss of > 3 mm. Fig. 2_Implant site prior to measurement (implant suprastructure still in place). Pus discharge is evident. _Introduction With oral implantology experience its Renais- sance, the growing incidence of peri-implantitis worldwidetodayispointofinterestforbothscientists andclinicians.Peri-implantitisisadiseaseofinflam- matory nature which leads to the loss of the implant when left untreated.11,24 The aetiological factors of peri-implantitis are very similar to periodontitis.2,24 Differenttreatmentmodalitiesfortheinflammatory soft tissue and bone lesions in peri-implants have been proposed—antibiotics, antiseptics, mechanical debridement, and surgical procedures have been suggested,dependingonthegradeoftheclinicaland radiographicmanifestations.6,7,10,16,17 Treatment modalities such as scaling and root planing,usedtotreatrootswithperiodontitis,cannot be used in the same way on the threaded and reten- tiveimplantsurfaces.Theroughimplantsurfacepro- vides bacteria with shelter, unapproachable to con- ventionalmechanicalremoval.23 Conventionaltreat- ment procedures like closed peri-implant pocket de- bridement have shown limited success7,10 whereas the treatment of peri-implantitis using open-flap procedures has shown more promising results.17 Al- though the improved access to the implant surface withopenprocedurescanbeseenasafact,clinicians meet the same problems as encountered with open periodontal therapy. The decontamination of the re- tentive implant surface is much more complicated than the decontamination of a plane root surface.23 The instruments used in periodontal treatment are too large to clean an implant surface from bacteria and any metal to metal contact during mechanical debridementhasthepotentialtodamagetheimplant surface.12,13 Thecommonantiseptictherapyseemsto beeffectiveagainstbacterialbiofilmininvitrocondi- tions.5 Inaddition,thelocalantibioticsusedasanad- junct therapy to mechanical debridement has been advocatedandshowntoreducebleedingonprobing and probing pocket depth in patients with peri-im- plantitis,16 buttherearenodatasupportingtheeffect ofantibioticsonthedecontaminationofimplantsur- faces and more specifically the endotoxin elimina- tion.10,16,18 Currently, there are no clinical studies or case se- ries documenting successful regenerative proce- dures in periimplant bony lesions after conventional treatment. Some case series demonstrated limited bone fill after GBR procedures.6 Another treatment modality that may offer an advantage over tradi- tional mechanical treatment is the use of lasers.25,26 The use of the LiteTouch Er:YAG laser in peri-implantitis treatment Authors_Prof. Tzi Kang Peng, Taiwan & Prof. Georgi Tomov, Bulgaria 30 I implants3_2013 Fig. 1 Fig. 2