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ePaper created 2016-02-02, 09:24:34 | version 1.38.0
33 33 4_2015 laser laser_research research I Inadvancedperiimplantitis,asurgicalprocedure canbeindicatedinordertoremovethebiofilm.Are- generative treatment can be done in the course of those surgical procedures in order to replace lost bone. Therapy interventions in periimplantitis are stillpredominantlybasedontheclinicalexperience, as reliable clinical data have not yet been available. However, research activities in this field have been numerous and new data a generated constantly, which is why more distinct guidelines for the treat- mentofthosediseasescanbeexpected.1 Earlydiag- nosis by periodontal probing and the evaluation of thehealthstatusofperiimplanttissuesareessential for the prevention of periimplant mucositis and periimplantitis. Early diagnostic identification per- mits early intervention, which can be clinically ef- fective. If early symptoms are misjudged, a complex therapyisnecessary,butmayproduceresultswhich are less predictable. _Aetiology and pathogenesis Theliteraturehasproventhatthepresenceofmi- croorganismsisanessentialprerequisiteforthede- velopment of periimplant infections. We know to- day that glycoproteins from the saliva accumulate atthetitaniumsurfacesoftheimplantorabutment which are exposed towards the oral cavity immedi- ately after implantation. This glycoprotein layer is then colonised by microorganisms. A subgingival microflora forms within a short amount of time after implantation, which is dominated by Pep- tostreptococcus micros, Fusobacterium nucleatum and Prevotella intermedia. The majority of periim- plant diseases are characterised by gram-negative, anaerobic microflora, which is found in a similar fashion in periodontitis. High concentrations of periodontal pathogens, such as Aggregatibacter actinomycetemcomitans, Porphyromonas gingi- valis, Prevotella intermedia, Tannerella forsythia and Treponema denticola, have been detected in periimplantitis cases. Moreover, studies suggest that the microflora often contains Fusobacterium nucleatum,Actinomyces as well as Staphylococcus aureus and enterococci. Staphylococcus aureus also colonise other foreign elements, which, for example, may lead to complications in hip transplants. Titanium seems to promote the ad- hesion of S.aureus, which is often found in dental implants.1 The implant’s soft tissue collar consists of an epithelialandaconnective-tissueattachment.The epithelial periimplant mucosa, which consists of oral gingiva epithelium, oral sulcus ephitelium and non-keratinised junctional epithelium corre- sponds largely with the epithelial tooth-mucosa contact. The connective-tissue attachment to the implant is achieved via fibre bundles which are in- serted in the marginal bone. They arrange them- selvescloselytotheimplant,parallelyandcircularly to its surface. Other than the connective tissue sur- rounding the tooth, the supraalveolar connective tissueisdeficientincellsaswellasvessels.Thisleads to a reduction of the defense mechanisms against bacterial influences on the implant. Periimplant in- flammations can thus spread faster than compara- ble inflammations of the periodontium. Missing desmodontalstructureslimitthedefensecapacities of the host organism to the vessel proliferation within the marginal soft-tissue collar, which leads toanincreaseinthemanifestationoftheclinicalin- flammation symptoms of the marginal soft tissue. There probably is a connection between the mi- croflora present in the oral cavity during implanta- Fig. 1_Sequence of a systematic therapy of periimplant infections. Table 1_Symptoms of periimplant infections. I 07 laser 3_2014 Therapy concept anamnesis/findings · acute treatment · optimisation of oral hygiene · periodontal pretreatment determining risk factors · germination test · IL genotype systemic phase, hygiene phase diagnosis, prognosis treatment plan explantation corrective phase non-surgical pretreatment · mechanical (manual instruments, ultrasound) · local/systematic antibiotics · laser (diode or Er:YAG laser) reevaluation maintenance phase corrective phase surgical therapy · resective with Er:YAG laser · regenerative (GBR combined with laser) mucositis periimplantitis bleeding on probing bleeding and/or pus on probing reddening and swelling reddening and swelling surface inflammation probing > 4 mm no loss of bone loss of bone slight pocket formation increased pocket formation