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science & practice10 EAO Annual Scientific Congress 2015 · 24 September to the implant for surface deconta- mination. The author’s preference until now has been to use chlor- hexidine and tetracycline solution for this purpose while others have reported the use of citric acid and hydrogen peroxide amongst oth- ers.17 The use of lasers has also been extensively reported.6, 7, 18–20 However in a recent systematic re- view a meta-analysis could only be done for Er:YAG laser as the litera- ture on all other laser types was weak or heterogenous.21 The author has recently com- pleted the acquisition and treat- ment of 20 patients in an efficacy study using Er:YAG water laser (Morita, AdvErl Evo) and it is hoped that publication of the re- sults will be forthcoming. Indeed promising data has already been published to date using this same machine.22, 23 Nonetheless this methodology remains outside the reach of most generalpractitionersandhasyetto beprovenpredictablyeffective.As such most attention therefore re- mainsfocusedonphysicaldebride- ment via surgical intervention and topical antimicrobial therapies. Open flap debridement, defect de- contamination, and repair as well as pocket elimination have all be- come the mainstay of those treat- ing this condition. Soisthereacrisis?Theproblem is that there is no clear consensus on the prevalence of the disease since this will vary according to thecutoffvaluesfortheclinicalpa- rameters measured24 and to date there appears to have been little consensus of these cut off values. As such estimates of incidence of the disease appear to vary from 28 to 56 per cent of subjects and 12 to 43 per cent of implant sites.25 Furthermore there is an ongo- ing controversy about the initiat- ingprocessofperi-implantdisease since it is potentially considered a primary infection of periodonto- pathic origin by some26 while oth- ers hold that it is a secondary op- portunistic infection subsequent to bone loss caused by other etio- logical factors27 such as a pro- voked foreign body reaction or iatrogenic dehiscence of the bone, exogenous irritants such as dental cement, bone loss through oc- clusal overload etc. If the latter is truethencontrollingthediseaseis theoreticallymademoresimpleby controlling the conditions for the implant, such as ensuring ade- quate buccal bone thickness, avoiding or controlling more care- fully the use of dental cement, and paying closer attention to the oc- clusion. In an effort to gauge the rate of mucositis and peri-implantitis re- quiring surgical intervention, the author audited his patient pool in the year 2014. Out of a total of 191 patient reviews constituting 795 implants only 15 patients (7.9 per cent) required triple ther- apyat20implants(2.5percent)for mucositis while 10 patients (5.2 per cent) required surgical decon- tamination at 10 implants (1.3 per cent). Ascanbeseenthisiswellbelow the figures proposed in the article by Zitzmann & Berglundh (2005).25 This may of course reflect a more liberal approach to cut off values for parameters such as pocket depth and bleeding on probing as proposed Klinge in 2012. Nonetheless after over 20 years runningapracticededicatedtoim- plant dentistry the author’s own audited failure rates indicate that less than 1 per cent of implants present as late failures, owing to peri-implantitis or fixture fracture as a result of bone loss. This would corroboratethefindingsbyJemtet al in which a cohort of patients al- ready diagnosed with peri-implant bone loss showed a slow rate of ad- ditionalprogressivebonelossover a 9-year follow-up with an implant failure rate of 3 per cent.28 Inalllikelihooditistheauthor’s view that peri-implantitis is only a crisis if we allow bad implant den- tistry to persist where there is a lack of control of the initiating fac- tors as described above, and that it is more rather than less likely that itistheresultofasecondaryoppor- tunistic infection rather than a di- rect susceptibility to primary in- fection of periodontopathic origin. However, there will clearly be some patients with a high genetic susceptibility with other predis- posingfactorssuchasthepresence of untreated periodontal disease, smoking and diabetes who may well succumb as a result of pri- mary infection. Furthermore there remains a clear need to better define the dif- ferent types of peri-implant dis- ease and to establish a consensus astothecutoffvaluesforthediffer- ent parameters used to evaluate the disease so that future figures for incidence and prevalence are comparable. Editorial note: A complete list of ref- erence is available from the pub- lisher. Made in Switzerland Toll free Infoline: 00800 3313 3313 www.tri-implants.com Stockholm 2015, 24th - 26th September : Meet us at Booth S5 and win a iWatch! UNIQUE ESTHETIC OUTCOMES - BOTH IN THE POSTERIOR OR ANTERIOR REGION The TRI® Esthetic Line sets new stan- dards with its novel soft tissue neck design and pink coloured compo- nents for the treatment of esthetic cases: from implant and provisional to the final restoration. Learn more about this innovation for the esthe- tic zone on www.tri-implants.com TRI® Esthetic Line 1st Int. Congress of TRI Dental Implants Istanbul 2016, 05th - 07th May SAVETHE DATE Speakers: Dr. Marius Steigmann (D) Prof. Dr. Hom-lay wang (USA) Prof. Dr. Ralf Smeets (D) Prof. Dr. Dan Brener (AUS) Prof. Dr. Ronald Jung (CH) … and many more AD Toll free Infoline: 0080033133313 www.tri-implants.com