Diagnosis and non-surgical treatment of peri-implant diseases and maintenance care of patients with dental implants - Consensus report of working group 3.

The following consensus report is based on four background reviews. The frequency of maintenance visits is based on patient risk indicators, homecare compliance and prosthetic design. Generally, a 6-month visit interval or shorter is preferred. At these visits, peri-implant probing, assessment of bleeding on probing and, if warranted, a radiographic examination is performed. Diagnosis of peri-implant mucositis requires: (i) bleeding or suppuration on gentle probing with or without increased probing depth compared with previous examinations; and (ii) no bone loss beyond crestal bone level changes resulting from initial bone remodelling. Diagnosis of peri-implantitis requires: (i) bleeding and/or suppuration on gentle probing; (ii) an increased probing depth compared with previous examinations; and (iii) bone loss beyond crestal bone level changes resulting from initial bone remodelling. If diagnosis of disease is established, the inflammation should be resolved. Non-surgical therapy is always the first choice. Access and motivation for optimal oral hygiene are key. The patient should have a course of mechanical therapy and, if a smoker, be encouraged not to smoke. Non-surgical mechanical therapy and oral hygiene reinforcement are useful in treating peri-implant mucositis. Power-driven subgingival air-polishing devices, Er: YAG lasers, metal curettes or ultrasonic curettes with or without plastic sleeves can be used to treat peri-implantitis. Such treatment usually provides clinical improvements such as reduced bleeding tendency, and in some cases a pocket-depth reduction of ≤ 1 mm. In advanced cases, however, complete resolution of the disease is unlikely.

Diagnosis of Periimplant Disease.

PURPOSE: The aim of this review is to describe the current guidelines for the differential diagnosis of periimplant diseases. MATERIALS AND METHODS: Synopsis reviews were conducted to define the differential diagnosis of periimplant disease through an electronic literature search in MEDLINE up to February 2018. DISCUSSION: Periimplant mucositis is defined by the presence of bleeding and/or suppuration on gentle probing with or without an increased probing depth compared with previous examinations and by the absence of bone loss beyond crestal bone-level changes resulting from initial bone remodeling. Periimplantitis is defined by the presence of bleeding and/or suppuration on gentle probing with an increased probing depth compared with previous examinations and by the presence of bone loss beyond crestal bone-level changes resulting from initial bone remodeling. Thus, a combination of clinical registrations (probing pocket depth, bleeding on probing, and presence of pus) combined with radiographic signs of possible bone loss is needed for differential diagnosis. CONCLUSIONS: An accurate baseline registration at the time of placement of the prosthesis (probing pocket depth and bone level) with ongoing yearly monitoring is essential for diagnosis and appropriate disease management.

[What prosthodontic therapy should we select for periodontally compromised patients? Part 1: Review of the literature focusing on implant therapy for periodontally compromised patients].

PURPOSE: From a large number of experimental and clinical studies, it has been suggested that dental implant therapy has good prognosis for totally and partially edentulous patients. However, it is unclear whether we can use the implants for periodontally compromised patients. The aim of the present study was is to consider scientific evidence on implant treatment for periodontitis-susceptible subjects with partially edentulous dentate. STUDY SELECTION: Clinical studies that documented survival rates or success rates of implant therapy for periodontally compromised patients were selected and reviewed. RESULTS: Most of the 22 reports that were reviewed suggested good survival or success rate of implant therapy in short-term or medium-term clinical results. CONCLUSION: Although there were only a few long-term follow up studies, it was indicated that individuals who had susceptibility to periodontal disease can be treated successfully with the implants. In all reports, treatment for infection was done before implants installation, and the importance of regular maintenance after the installation has been emphasized. From this literature review, it was advocated that periodontally compromised patients could be treated successfully with the implants. However, implant therapy should be reconsidered if oral infection cannot be satisfactorily controlled.

[What prosthodontic therapy should we select for periodontally compromised patients? Part 2: Review of the literature focusing on conventional prosthodontic therapy for periodontally compromised patients and clinical implication (RPD vs FPD vs implant)].

PURPOSE: To review the clinical literature on fixed partial denture (FPD) and removable partial denture (RPD)treatment for periodontally compromised patients with partial dentate. In addition, prosthodontic management in periodontitis-susceptible subjects was evaluated from the results of Part 1 and Part 2. STUDY SELECTION: Clinical studies that documented survival rates of FPD in periodontally compromised patients were selected and reviewed. RESULTS: There was no RPD study that fulfilled the criteria of this review paper. On the other hand, 8 reports that were reviewed in this study showed good survival rate of FPD in long-term clinical results. CONCLUSION: Since the number of reports on RPD is very few, it was difficult to evaluate the RPD treatment for periodontally compromised patients. From the results of some long-term follow-up retrospective studies, however, it was suggested that FPD of high-risk design showed excellent results. Regarding management in periodontits- susceptible subjects, it should be discussed whether positive prosthodontic treatment is necessary. Strict plaque control by both doctors and patients before/after treatment is indispensable for prosthodontic management in periodontally compromised patients.