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Implant Tribune Italian Edition No.1, 2017

Implant Tribune Italian Edition - Marzo 2017 Revisione della Letteratura 21 < pagina 20 In fact, periodontitis is character- ized by inflammatory destruc- tion of the supporting apparatus of the dentition (periodontium), including the periodontal liga- ment and alveolar bone. Owing to the diferent composition of the two supporting tissues, sim- ilar tissue reactions around an implant and a tooth seem most unlikely. The term “osseoinsufi- ciency” was proposed by Zarb and Koka to describe the diference between periimplantitis and peri- odontitis-induced bone loss.72 The anatomical image of bone re- sorption due to periodontitis or periimplantitis difers, in many situations with very wide bone craters being typical for the im- plant but not for the tooth. Hence, periimplantitis may be consid- ered distinct from periodontitis in that it significantly difers re- garding onset and progression and has poor treatment predict- ability; consequently, its treat- ment must be focused on early diagnosis and controlling the risk factors or indicators to prevent it from occurring. To date, there have been no standardized pa- rameters to clinically diferentiate the various stages and severities of periimplantitis.28 The criteria used to diagnose periimplantitis remain inconclu- sive. Most existing studies used clinical parameters in combina- tion with radiographic findings to define periimplantitis. How- ever, clinical parameters such as BOP and PPD around implants are less predictable, since they are influenced by more confounding factors compared with natural dentition.2,3 Furthermore, any factor that fa- cilitates plaque formation (e.g., poor oral hygiene) or host defense capability (e.g., smoking habit, ex- cessive alcohol consumption, ge- netic traits, history of periodon- titis or use of bisphosphonates) might contribute to the develop- ment of periimplantitis.16,73,74 The diagnosis and progression of periimplantitis may be character- ized by increased measurements for clinical parameters (PPD, BOP, SUP or even mobility), MBL and microbiology. Regarding clinical parameters, PPD is a valid method of assessment, as correlation ex- ists between bone levels recorded and radiographic probe penetra- tion. 41,75 Nevertheless, in a cross-sectional study, the intraoperatively mea- sured periimplant bone levels were more apical than the radio- graphic bone levels.76 SUP occurs more frequently in implants with than without pro- gressive bone loss, particularly in smokers, and may be associated with episodes of active tissue de- struction. 4 In a systematic review, Berglundh et al. defined periim- plantitis as having a PPD ≥ 6 mm or MBL ≥ 2.5 mm.77 Lang and Berglundh, in the 2011 European Federation of Periodon- Table 2 - Original articles included in the systematic review on the clinical diagnosis of periimplantitis. tology consensus, stated that clin- ical and radiographic data should routinely be obtained after pros- thesis installation on implants in order to establish a baseline for the diagnosis of periimplantitis during maintenance of implant patients.8 A meta-analysis by Derks and Tomasi clear ly showed a positive relationship between the prevalence of periimplantitis and function time.78 The presence of bone loss and PPD alone may not be enough to establish a diag- nosis of periimplantitis.78 One important factor that poten- tially influences the wide range of periimplantitis prevalence is the lack of consensus regarding the clinical parameters. For example, one study reported that if PPD > 4 mm was used as criterion, then 74.8% individuals had periim- plantitis, but if this measurement was changed to > 6 mm, then the prevalence dropped to 43.9%. 47 When radiographic MBL was con- sidered for defining periimplanti- tis, 25.3% individuals showed > 2 mm, while 13.1% had > 3 mm. 47 Indeed, if PPD is considered, some further heterogeneity can be found. Probing around implants is influenced by many factors, such as the size of the probe, the probing force, the direction of the probe, the health and thickness of the periimplant softtissue, and the design of the implant neck and the superstructure.1 In fact, the platform-switched design, as well as defective restorations, can complicate probing and, thus, hide the true extent of periim- plantitis.16,17,79 Furthermore, the pre sence of discrepancies in the buccolingual hard- and soft-tissue levels may result in diferent PPD readings. Owing to the lack of standard pa- rameters to determine the pres- ence and severity of periimplant disease, it is dificult to develop a clinical strategy based upon PPD in managing this common prob- lem in implant dentistry. How- ever, Froum and Rosen proposed a classification system to deter- mine periimplantitis severity based upon PPD, MBL and clinical signs of BOP and/or SUP,28 but this system remains to be validated. > pagina 22

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