Professor Stefan Renvert

Epidemiology and therapy of peri-implant disease

Report by Aase Elniff Larsen

Professor Renvert began a superb lecture on Mucositis and Peri-implantitis, a new aspect to implantology, where he is one of the pioneers, by pointing out the issues he was going to discuss specifically:

• WHAT IS THE INCIDENCE OF PERI-IMPLANTITIS?
• WHICH ARE THE RISK FACTORS?
• EFFECT OF NON SURGICAL THERAPY?
• EFFECT OF SURGICAL THERAPY?
• CAN WE OBTAIN OSSEO REINTEGRATION AFTER THERAPY?

He asked the question - how many patients are we talking about ?
With a survival rate over 10 years of >95% of implants placed.
IS THIS REALLY A PROBLEM ?
Studies by Prof Berglund et al, from 1988 - 1992 shows that 5%  failure rate may be underestimating the problem and of the 300 implant  patients who took part in Berglund’s study 28% showed bone loss around implants after 10 years. The patients does not always know they have a problem (peri-implantitis) they are asymptomatic. THEY FEEL FINE !

WHICH INDIVIDUALS DO WE TALK ABOUT?

1. Patients with a previous history of periodontitis. Research shows that if these patients'  has lost 1 implant, 
       they are likely to loose 1 more.
2. Smokers

Professor Renvert’s Definition of Peri-implantitis:

1. Bleeding and/or pus when probing around the implant
2. =>3 treads visible on x-rays

Yes "PROBING" - x-rays and the naked eye not sufficient - TIME FOR CHANGE!

Unfortunately very little research in this area. But Prof Renvert guided us through a couple of his own cases and recommended - SLOW APPROACH - Treat any periodontitis present in the oral cavity, - establish optimal hygiene  "Vital that we are in control of risk factors" - infection control - beware your prosthetic restorations are hygiene friendly - Maintain oral hygiene.

NON SURGICAL THERAPY:

Mechanical debrisment (curretage) plus local Antibiotics.
Ultrasonic or hand scalers, titanium or plastic scalers, just take  care and remove all debris present from implant surface 360 degree around the  implant plus irrigation with 0.2% Chlorhexidine or Doxycycline.
Brilliant result when MUCOSITIS, not sufficient when PERI-IMPLANTITIS

VISUAL INSPECTION when PERI-IMPLANTITIS = SURGICAL THERAPY

Raise a flap - remove granulation tissue - mechanical debrisment – remove smearlayer with chemicals - maybe polish implant surface? but rough surface
better for osseointegration than machine surfaces, so your choice. Reposition flaps and place sutures. Systemic Antibiotics has been the  norm, but no scientific proof pro/con. Chemicals can be Chlorhexidin or H2O2  3%, but no studies to support either. Remove suprastructure if possible.

REGENERATIVE STRATEGIES:

Submerge the implant if possible, grafting material in bone defect  if saucer shaped defect, with/ without membrane which can be resorbable or not.  Systemic antibiotics. Surgery with grafting has proven to result in 3  mm pocket reduction even after 3 years if hygiene standard maintained. Prof Renvert showed several cases with positive outcome.

CONCLUSION

Yes it is possible to treat PERI-IMPLANTITIS, but fare better to  avoid the problem in the first place, Be aware of risk patients, former periodontitis sufferers or heavy smokers.  Adequate oral hygiene essential. Restorative design must be hygiene friendly, screwed in suprastructures easier to remove  than cemented if problems occur. Follow up visits for early detection.

Unfortunately

ONLY DIAMONDS ARE FOREVER !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!