Learning Objectives

By the end of this webinar the participant will be able to: 

• Have an understanding of peri-implant diseases 
• Be able to provide diagnosis for peri-implant mucositis and peri-implantitis 
• Be exposed to an overview of the treatment modalities for periimplant diseases 
• Understand the clinical challenges associated to explantation procedures

Professor Nikos Donos is the Director of Research, Professor & Chair of Periodontology and Implant Dentistry, Director of Clinical Research, Director of the Centre for Oral Clinical Research at the Institute of Dentistry, Barts & The London School of Medicine and Dentistry, Queen Mary University of London (QMUL). Prof. Donos is also the Director of the ITI scholarship Centre and the Director of the Osteology Research Scholarship Centre, both at QMUL.

In 2009, Professor Donos has been awarded the title of Honorary Professor at the Faculty of Dentistry in Hong Kong, in 2012 the title of Adjunct Professor at the Dental School, Griffith University in Australia,  in 2015 the title of Honorary Professor at UCL-Eastman Dental Institute and in 2019 the title of Honorary Professor, School of Dentistry,  University of Queensland, Australia.

Professor Donos was the President of the British Society of Periodontology & Implant Dentistry (BSP) (2020) and is a board member at the Osteology Foundation- Switzerland as well as the Academic Representative at the Committee of the Association of Dental Implantology (ADI)(UK).

Professor Donos is involved as editorial board member in international peer-reviewed journals in the field of Periodontology and Implant Dentistry where he has published more than 240 scientific publications. Professor Donos is/has been involved in most of consensus conferences for the European Federation of Periodontology (EFP), the European Association of Osseointegration (EAO), The International Team for Oral Implantology (ITI) and the Osteology Foundation all of which provide the most up-to-date evidence- based information for different clinical situations in the fields of Periodontology and Implant Dentistry.   

Prof Donos has significant clinical experience in providing advanced treatment modalities to patients suffering from severe periodontal disease. Those modalities include all steps (non-surgical and surgical) for the treatment of periodontal disease including periodontal and bone tissue regeneration and replacement of missing teeth with dental implants. Furthermore, Professor Donos has significant experience in non-surgical and surgical treatment of peri-implant diseases (peri-implant mucositis and peri-implantitis). All the above clinical problems and their treatments are topics that Professor Donos regularly covers in his lectures on a national and international level.

Implant therapy has enhanced treatment options for patients and improved our ability to provide optimal care. Initial studies implied that implants were impervious to “periodontal” type disease however current data suggests that peri-implantitis may be more common than originally thought. Etiology of disease is often times difficult to assess which creates challenges in managing this dilemma. Similarly, there are various definitions for the diagnosis of peri-implantitis. This course will review criteria to evaluate implants once they are restored and establish parameters to identify disease, establish diagnosis and provide appropriate treatment. Therapeutic options from non-surgical approaches to surgery with regenerative therapy and finally explantation will be reviewed.

Learning Objectives

• List the clinical criteria for evaluating implant health
• Identify the diagnosis and etiology of peri-implantitis
• Review the therapeutic alternatives in managing peri-implant disease

Dr Pamela McClain maintains a full time private practice in periodontics incorporating clinical research and is an Associate Clinical Professor in the Department of Surgical Dentistry at the School of Dental Medicine, University of Colorado, Anschutz Medical Campus. She served as Research Professor at the University of Maryland Dental School, Department of Periodontics from 1994 - 2001. Dr McClain is a Diplomate of the American Board of Periodontology, Past President of the American Academy of Periodontology (AAP - 2012) as well as the American Academy of Periodontology Foundation (2018) and has been active on numerous committees with the AAP and other organizations. She co-chaired the AAP International Workshop on Regeneration in 2014, and currently sits on the Board of the Osteology Foundation where she has chaired several national and international meetings. Dr McClain has received a number of prestigious awards for her research including the R. Earl Robinson Periodontal Regeneration Award in 1989, 2004, 2006, 2014 and 2017 and other accomplishments such as the Master Clinician Award from the AAP (2020). She lectures on a variety of topics in the United States and abroad and has 26 publications in professional journals and books.

Qualifications: DDS, PhD

The effectiveness of reconstructive treatment approaches is influenced by several factors, such as the configuration of the defect, the type of bone filler, implant surface characteristics, as well as the method of surface decontamination.

Learning Objectives

• The Surgical techniques and materials used for reconstructive therapy of peri-implantitis associated defects 
• The effectiveness of various decontamination protocols 
• The applicability of specific flap designs and suturing trechniques
• The indication for combination procedures (resective/reconstructive)
• The need for additional soft tissue volume grafting procedures  

Frank Schwarz is Professor and Chairman of the Department of Oral Surgery and Implantology at the Centre for Dentistry and Oral Medicine (Carolinum), Johann Wolfgang Goethe-University Frankfurt, Germany. He serves as an Associate Editor for the Journal of Clinical Periodontology and Editorial Board Member for Periodontology 2000 and Clinical Oral Implants Research. He is Past President of the German Association of Oral Implantology (DGI), Executive Board Member of the Osteology Foundation and was awarded the André Schröder Research Prize in 2007, the Miller Research Prize in 2012 and the Jan Lindhe Award in 2017.

Periimplant pathology turns out to be a frequent problem. Incidence increases because of the raising number of installed implants and the cumulated time of their incorporation. Reviews on effectiveness and efficacy of treatment as well as dental community´s clinical experience demonstrate that a reasonable long-term result is difficult to achieve. Defect anatomy, macro- and micro-design of the implant compromise an adequate decontamination of the implant surface. Neither complete removal of the biofilm nor acceptable amount of re-osseointegration were achievable yet.

Dr Schlee will compare the in vitro results of classical cleaning concepts to anew electrolytic approach to clean infected implant surfaces. 4,5 year clinical results will be presented. Complete re-osseointegration is possible but limited by the skills of the surgeon and anatomical characteristics like defect morphology. Clear treatment strategies and surgical techniques will be addressed and appraised.

Learning Objectives

• To understand the limitations and possibilities of different methods to clean implant surfaces
• To understand the clinical impact
• To redefine an acceptable endpoint of treatment

Dr Markus Schlee runs a private practice specialized in periodontology and implantology in Forchheim, Germany since 1990.

He holds the specialist qualifications in periodontology of the DGP and in implantology of BDIZ and DGI.

He is a member of numerous professional associations, including Neue Gruppe, DGP, DGI, AAP, IADR, ECDI, DGÄZ and APW.

He received his external professorship at Goethe University of Frankfurt 2015 and is still affiliated there. He lectures in the master programs of Goethe University of Frankfurt (MOI), DGI at the Steinbeis University in Berlin, DGP at Dresden International University and DGÄZ at University of Greifswald.

He has lectured and published extensively, both nationally and internationally in the fields of periodontology, implantology, periimplantitis bone augmentation, soft-tissue management, microsurgery, piezosurgery, and esthetics.

Implantoplasty involves the mechanical removal of implant threads not supported by the surrounding bone. These smoothened implant surfaces were proven to be less prone to plaque accumulation and, thus re-infection. Properly performed implantoplasty was proven to be associated with a high clinical efficacy without showing any remarkable short- or medium-term mechanical or biological complications.

Learning Objectives

• The scientific rational for choosing implantoplasty
• The potential clinical indications and step-by-step procedure
• The clinical efficacy and limitations

Frank Schwarz is Professor and Chairman of the Department of Oral Surgery and Implantology at the Centre for Dentistry and Oral Medicine (Carolinum), Johann Wolfgang Goethe-University Frankfurt, Germany. He serves as an Associate Editor for the Journal of Clinical Periodontology and Editorial Board Member for Periodontology 2000 and Clinical Oral Implants Research. He is Past President of the German Association of Oral Implantology (DGI), Executive Board Member of the Osteology Foundation and was awarded the André Schröder Research Prize in 2007, the Miller Research Prize in 2012 and the Jan Lindhe Award in 2017.

Abstract

Dental implants are a very successful treatment strategy. However, due to periimplantitis or or other major tissue alterations, explantation of dental implants is sometimes necessary. It has been documented that explantation of dental implants is on one side followed by major tissue damage and on the other hand, that the re-restoration following explantation is less successful in short-term but also long-term.  In particular in the esthetic zone, tissue deficiencies cannot be accepted. This presentation focuses on measures of correction muco-gingval and bony alterations following implant explantation.

Learning Objectives

• Understand the difficulties of implant removal

• See the necessity of hard- and soft tissue augmentation

• Understand the importance of 3D prosthetically driven implant placement

Dr Fickl received his dental degree from Erlangen University, Germany in 2003 and completed his postgraduate training in Periodontology and Implant Dentistry in Munich, Germany in 2007. From 2007 to 2009 he served as a Faculty Member at the Department of Peridontology and Implant Dentistry (Chair: Dr. Dennis Tarnow) at New York University, New York, United States. He then joined Würzburg University, Germany, where he received his PhD in 2011 and since then serves as an Associate Professor for Periodontology and Implant Dentistry. Dr Fickl maintains at the same time a private office in Nuremberg-Fuerth, Germany dedicated to periodontics, implant dentistry and esthetics. Dr Fickl is an internationally known speaker in the field of Periodontology and Implant Dentistry and author of numerous scientific publications in peer-reviewed journals and book chapters.

Qualifications: DMD, PhD

As utilization of dental implants continues to rise, so does the incidence of complications. When peri-implantitis has already caused extensive bone resorption, the dentist faces the dilemma of when therapy is appropriate to maintain the implant or removal and replacement with a new implant should be preferred. Nevertheless, it should be clear, by now, that soft-tissue integration is of significant importance and that an effective mucosal barrier, capable of biologically protecting the peri-implant structures is therefore essential in both circumstances.

Even though, the literature no surgical technique is currently available to predictably regain osseo-integration, a protocol for hard tissue reconstruction will be described. The positive results in regenerative surgical treatment of peri-implantitis are based on:

1. Defect selection
2. Patient preparation
3. Surgical flap management
4. Post-operative care

A new useful decision-making process tree along with 10-year follow-up results will be presented. 

Learning Objectives

• Identify peri-implantitis cases where regeneration is indicated
• Learn the steps for an ideal regenerative surgical treatment
• Select the path for a successful second implant placement

Mario Roccuzzo is Adjunct Professor in the Division of Maxillofacial Surgery at the University of Torino, and Adjunct Clinical Assistant Professor in the Department of Periodontics and Oral Medicine at the University of Michigan, USA. He teaches Periodontology in several Master courses at the Universities of Torino, Bologna and Milano. He is an ITI fellow, past-president of the Italian section, chair of the Leadership Development Committee, Study Club director in Torino, and member of the Osteology Expert Council. He serves on the editorial board of Clinical Oral Implants Research, the International Journal of Esthetic Dentistry, and the International Journal of Periodontics & Restorative Dentistry. Dr. Roccuzzo has been invited to lecture in 50 countries of all continents, and maintains a private practice limited to Periodontology and Implantology, in Torino. Awarded for the best clinical presentation on implants in periodontally compromised patients at the 2009 EAO Congress in Montecarlo and for the best published research article on the same subject by the DGP in 2010. Winner of the 2013 Osteology Clinical Research Prize. Mario is co-author of the recent book “Peri-implant Soft-Tissue Integration and Management”.