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implants – international magazine of oral implantology

research I I 15implants3_2015 Table 1_Key treatment issues to combat periimplant damage, to a large extent being prevented by early and carefull implant planning. Table 2_Surgical revision of advanced periimplant bony defects is limited to single clinical settings due to the time and extent of surgery and additional patient expenses. –Defect depths ≤4–5 mm: Additionally 0.2 % CHX, Er:YAGdecontamination,ifapplicable(dentist). –Defect depths ≥ 6 mm: Periimplant plus periodon- tal cleaning, systemic antibiotics: amoxicilline 500mg20TandClont400mg20T,t.i.dfor7days. Togetherwithdecompensationbyocclusalappli- ances (mentioned above), safeguarding by front-ca- nine equilibration and removal of implanto-pros- thetic restoration, the clinical situation often im- proves.Theprocedurecanbeeasilyrepeated. Therec- ommendation to removably screwfix implant restorations axially (only premolars and molars) is becoming a strong relevance in the treatment of periimplantdamage. Periimplantitis: Advancedperiimplantdamagewithcircumferen- tialangularbonelossencompasses –Defect depths ≥ 8 mm: Explantation, surgical revi- sion(ifapplicable). Intheseclinicalsettings,implantremovalwithre- peated insertion, augmentation (where appropriate) andprostheticrestorationfollowinghealingisadvo- cated,iftheclientapprovesthetreatment. Inperiim- plantdamage,thebenefitofrapidimplantboneheal- ing following insertion of short and diameter-re- duced implants becomes obvious. In individual, strategically important implant sites, i.e. canine im- plantareainedentulism,revisionisemphazisedwith thefollowingsurgicalprotocol(Tab.2):21 –Removal of implanto-prosthetic restoration, if screw-fixed. –Horizontal ridge incision with a mucoperiostal flap andmesialverticalextension. –Curettageofimplantbonedefect. –Irrigationwith0.2%CHX,supplementedbyEr.YAG- decontamination. –Stimulation of bleeding plus autogenous bone graftsfordefectfillandreconstruction,defectcov- eragewithrotatedpediclesofttissueflap. –Close, tension-free wound closure, no functional loading. –Systemicantibiotics. _Summary Thepreventionofperiimplantdiseasesisbasedon a comprehensive analysis, evaluation and planning prior to implant placement. Securing the residual dentition from periodontal disease, on time removal of compromised teeth and functional decompensa- tionwithfocusonfront-canineequilibrationarethe key issues during implant planning. Prior to surgery, DVT diagnostic evaluation is required if proximity to anatomical structures is anticipated, and short and diameter-reduced implants are advocated to deter- mine interimplant distances and safeguard implant treatment. Implant placement succeeds with mini- mal mechanical loading of implant bone and imple- mentation of perfusion during surgery. Periimplant enlargementisscheduledduringimplanthealing,ei- ther by free gingival graft or pedicle flap. Premolar and molar implant restorations are screw-fixed axi- ally to ease handling in case of periimplant damage. The concerted action of eliminating inflammation, stabilizingfunctionwhileminimizingsurgerysecures implant success, prevents periimplant diseases and promotes the reputation of dental health care providersinthecommunity._ Author’snote:Iappreciatetheencouragementandsupport ofDrGerhardKochhan,Düsseldorf,inperiimplantcooper- ation. Editorialnote:Alistofreferencesisavailablefromthepub- lisher. contact Prof.Dr Rainer Buchmann Specialist Periodontics and Oral Preventive Medicine Königsallee 12 40212 Düsseldorf,Germany Tel.:+49 211 8629120 Fax:+49 211 8629129 info@perioimplant.eu Surgical Reentry 1.Removal of suprastructure (screw-fixed). 2.Horizontal alveolar ridge incision with vertical mucoperiostal flap reflection. 3.Intrabony defect curettage. 4.0,2% CHX irrigation,Er:YAG-decontamination. 5. Stimulation of spongious bleeding plus autogenous bone grafts for defect fill and reconstruction. 6.Close,tension-free defect closure,no functional implant loading. 7.Systemic antibiotics. Periimplant Therapy Step Defect (PD in mm) Treatment A ≤ 3 mm Oral Hygiene + IMP Cleaning B ≤ 4–5 mm CHX 0.2 %,Er:YAG C ≥ 6 mm SystemicAntibiotics D ≥ 8 mm Implant Removal/RegenerativeTherapy Tel.:+492118629120 Fax:+492118629129

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