implants - international magazine of oral implantology

I industry report 42 I implants3_2013 comes clear that hardly any assembled implant is actually excluded from those facts.7 Ofcourse,theseconsiderationsapplytoscrewed superstructures as well. Cemented superstructures seem to be sealed at first by the fastening cement, but everyone knows the smell that emerges when cement is drilled from crown and bridgework and gives evidence of germs permeating here as well. The access paths of germs into the implant inte- rior are easily comprehendible, and we were able to provide evidence by taking light and electron mi- croscopic exposures of a used implant (Fig. 2). The paper"ImplantComponentCompatibility“byBinon et al. confirms this matter quite impressively.3 The resultsshowedthatthemacroscopicallygoodfitre- vealed severe flaws under electron microscopic ex- amination. Furthermore, the capillary forces and micro mo- tions18 between implant and abutment promote theexchangeofinfectiousmaterial,forwhichsaliva is a good vehicle. Figure 3 shows the proportion of the gap located between implant and abutment compared to an erythrocyte.7 In order to make the dimensionsevenmoreclearly,therandomlychosen germsshownarealsomatchedtoanerythrocyteex- actly to scale.13 _Peri-implantitis through re-infection from an implant The implant is contaminated with germs from the oral cavity as soon as it is opened for placement of the insertion tool. Germ growth starts immedi- ately after fastening the locking screw, unless the implantinteriorswerepreviouslytreatedwithama- terial for sealing and combatting germs. Thebreedingconditions—warmth,humidityand supply—enable bacterial growth and fungal coloni- sation in an ideal manner, so that re-infection of periimplanttissuesviathegapsleadingoutwardsis given.Regardlessofwhichtreatmentofthisimpor- tantareaaroundtheimplantisapplied,itwillalways remain short-lived. _Development and efficacy of GapSeal® Inordertocounteractthesere-infections,wede- velopedamaterialbasedonahighlyviscoussilicone matrix and a bactericidal disinfectant in 1996. An- tibiotics would not be sufficiently intensive or ef- fective in a low dose. Moreover, they would con- tribute to sensitisation and the development of re- sistance. Afterwards we employed the so-called split-mouth technique to test the material against white Vaseline and determine the required admix- ture of disinfectant.15 The sealing material thymol has bactericidal, virucidalandfungicidalproperties.Itbelongstothe microbiologically very effective materials, but is largelyharmlesstohumans.Itsdisinfectingeffectis about 30 times higher than that of phenol, but thy- molhasonlyaquarterofitstoxicity.Italsodoesnot cause allergies.10,16 The material met its purpose as gap and interior sealant more than satisfactorily and was subsequently named "GapSeal®“ (Fig. 4).6 For the split-mouth studies, GapSeal® was ap- plied to the right sides of the implants, and Vaseline totheleftsides.Duringthisclinicalcomparison,the Vaselineturnedouttobethoroughlycontaminated, Fig. 2 Fig. 3 Fig. 4 Fig. 2_Used implant randomly chosen, on which the marked area was light and electron microscopically examined (Brand is unnamed intentionally). Fig. 3_Gap situation between implant and abutment compared to an erythrocyte with a diameter of 7µ (1µ = 10-6 m), 745 times enlarged. The randomly chosen germs are depicted true to scale and compared to an erythrocyte. Fig. 4_Sterilisable GapSeal® applicator with GapSeal® carpules.