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Dental Tribune Italian Edition

29SpecialePerio Tribune Italian Edition - Ottobre 2015 29•30 gennaio 2016 - VIAREGGIO Segreteria organizzativa Tueor Servizi Srl - Via D. Guidobono, 13 - 10137 Torino Tel. +39 011 3110675 - segreteria@tueorservizi.it FARMACOLOGIA ODONTOIATRICA: gliaggiornamentiirrinunciabili 3° CONGRESSO ISTITUTO STOMATOLOGICO TOSCANO << pagina 28 The author’s preference until now has been to use chlorhexidine and tetracycline solution for this pur- pose while others have reported the use of citric acid and hydrogen peroxide amongst others17 . The use of lasers has also been ex- tensively reported6,7,18-20 . However in a recent systematic review a me- ta-analysis could only be done for Er:YAG laser as the literature on all other laser types was weak or het- erogenous21.The author has recent- ly completed the acquisition and treatment of 20 patients in an effi- cacy study using Er:YAG water laser (Morita, AdvErl Evo) and it is hoped that publication of the results will be forthcoming. Indeed promising data has already been published to date using this same machine22,23 . Nonetheless this methodology re- mains outside the reach of most general practitioners and has yet to be proven predictably effective. As such most attention therefore re- mains focused on physical debride- ment via surgical intervention and topical antimicrobial therapies. Open flap debridement, defect decontamination, and repair as well as pocket elimination have all become the mainstay of those treating this condition. So is there a crisis? The problem is that there is no clear consensus on the prev- alence of the disease since this will vary according to the cut off values for the clinical parameters meas- ured24 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 sites25 . Furthermore there is an ongoing controversy about the initiating process of peri-im- plant disease since it is potentially considered a primary infection of periodontopathic origin by some26 while others hold that it is a sec- ondary opportunistic infection subsequent to bone loss caused by other etiological factors27 such as a provoked foreign body reaction or iatrogenic dehiscence of the bone, exogenous irritants such as den- tal cement, bone loss through oc- clusal overload etc. If the latter is true then controlling the disease is theoretically made more sim- ple by controlling the conditions for the implant, such as ensuring adequate 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-implan- titis requiring surgical interven- tion, 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 therapy at 20 implants (2.5 per cent) for mu- cositis while 10 patients (5.2 per cent) required surgical decontami- nation at 10 implants (1.3 per cent). As can be seen this is well below 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 pro- posed Klinge in 2012. Nonetheless after over 20 years running a prac- tice dedicated to implant dentistry the author’s own audited failure rates indicate that less than 1 per cent of implants present as late fail- ures, owing to peri-implantitis or fixture fracture as a result of bone loss. This would corroborate the findings by Jemt et al. in which a co- hort of patients already diagnosed with peri-implant bone loss showed a slow rate of additional progressive bone loss over a 9-year follow-up with an implant failure rate of 3 per cent28 . In all likelihood it is the au- thor’s view that peri-implantitis is only a crisis if we allow bad implant dentistry 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 it is the result of a secondary op- portunistic infection rather than Dr. Michael R. Norton runs a practice dedicated to implant & reconstructive denti- stry in London in the UK. He can be contacted at: drnorton@nortonimplants.com. autore a direct susceptibility to primary infection of periodontopathic ori- gin. However, there will clearly be some patients with a high genetic susceptibility with other predis- posing factors such as the presence of untreated periodontal disease, smoking and diabetes who may well succumb as a result of prima- ry infection. Furthermore there re- mains a clear need to better define the different types of peri-implant disease and to establish a consensus as to the cut off values for the dif- ferent parameters used to evaluate the disease so that future figures for incidence and prevalence are com- parable. Editorial note: a complete list of reference is available from the publisher. Tel. +390113110675 - segreteria@tueorservizi.it

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