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ePaper created 2016-02-02, 09:24:34 | version 1.38.0
36 4_2015 laser 36 laser_research I research 10 I laser 3_2014 ofperiimplantitisvariesandthetermisusedincon- sistently in the literature. It was decided on a recent consensusconferencethatthedefinitionofperiim- plantitis as an inflammatory lesion leading to bone loss was acceptable, but that the diagnostic criteria are anything but explicit. For example, it should be taken into account that bone remodelling occurs during implant healing, during which the most coronal periimplant bone can be lost. This physio- logical rearrangement can take up to one year and should not be seen as a pathological process. From the clinical point of view, the bone level at the mo- ment of prosthetic restoration should be the de- fined as the reference value for future radiological changes of the bone height. Only in this moment should the reference X-ray be produced, which is then used for the assessment of the periimplant bone loss. It should be noted that measurement er- rors can occur even under ideal conditions: in cases of double measurement, a deviation of about 0.5 mm was documented. The diagnosis of periim- plantitisisjustifiedifthereisaradiologicalboneloss of 2 mm compared to the initial values and com- bined with bleeding and/or pus on probing. In im- mediate loading, an X-ray after one year is recom- mended as a reference for future X-rays.1 _Periimplant mucositis and periimplantitis: frequent complications in implant patients Periimplantmucositisisdescribedasareversible inflammatory reaction of the periimplant mucosa without any symptoms of periimplant bone loss, comparabletogingivitis.Periimplantitisisdescribed as the further progression of plaque accumulation and consequently the spreading of the bacterial in- fection to the periimplant bone, characterised by bonedestructionduetotheinflammation.Itisseen as the pendant to periodontitis. – Roughly four in five implant patients exhibit peri- implant mucositis. – After ten years, one in five patients develops peri- implantitis. – Periimplantitis is especially frequent in smokers, patients with insufficient oral hygiene and pa- tients who have already had periodontitis. – Implants with a rough surface accumulate more plaquewhenexposedtowardstheoralcavitythan smooth implants. – The prevalence of periimplantitis can be expected to rise in the future due the increasing replace- ment of teeth by implants and the use of moder- ately rough surfaces. _Our therapy concept In principle, a procedure analogous to the sys- tematic periodontal therapy, consisting of systemic phase,hygienephase,correctivephaseandsupervi- sion phase should be maintained in the therapy of periimplant infections. Figure 1 is the schematic representationofthesystematictherapyofperiim- plantinfectionsasperformedinourclinic.Primarily, die pathogenic microflora must be reduced by a Fig. 7_Periimplant brightening in form of a significantly enlargened split in the course of the covering the complete implant surface between implant and surrounding alveolar bone. Fig. 8_Careful uncovering of the alveolar process in region 36–38 under local anaesthesia, after forming the mucoperiosteal flap and exposing the bone defect in implant region 37. Fig. 9_Granulation tissue is depicted in the cervical implant area. Figs. 10 & 11_Settings for “implantitis” therapy (Fig. 10), which can be altered according to the experience and knowledge of the user (Fig. 11). Fig. 7 Fig. 8 Fig. 9 Fig. 10