Smeets et al. Head & Face Medicine 2014, 10:34 http://www.head-face-med.com/content/10/1/34 HEAD & FACE MEDICINE
REVIEW
Open Access
Definition, etiology, prevention and treatment of peri-implantitis – a review
Ralf Smeets1*, Anders Henningsen1, Ole Jung1, Max Heiland1, Christian Hammächer2 and Jamal M Stein3
Abstract
Peri-implant inflammations represent serious diseases after dental implant treatment, which affect both the surrounding hard and soft tissue. Due to prevalence rates up to 56%, peri-implantitis can lead to the loss of the implant without multilateral prevention and therapy concepts. Specific continuous check-ups with evaluation and elimination of risk factors (e.g. smoking, systemic diseases and periodontitis) are effective precautions. In addition to aspects of osseointegration, type and structure of the implant surface are of importance. For the treatment of peri-implant disease various conservative and surgical approaches are available. Mucositis and moderate forms of peri-implantitis can obviously be treated effectively using conservative methods. These include the utilization of different manual ablations, laser-supported systems as well as photodynamic therapy, which may be extended by local or systemic antibiotics. It is possible to regain osseointegration. In cases with advanced peri-implantitis surgical therapies are more effective than conservative approaches. Depending on the configuration of the defects, resective surgery can be carried out for elimination of peri-implant lesions, whereas regenerative therapies may be applicable for defect filling. The cumulative interceptive supportive therapy (CIST) protocol serves as guidance for the treatment of the peri-implantitis. The aim of this review is to provide an overview about current data and to give advices regarding diagnosis, prevention and treatment of peri-implant disease for practitioners.
Keywords: Peri-implantitis, Peri-implant disease, Review, Periodontal disease, Mucositis, Peri-implantitis therapy,
Epidemiology, Etiology
Introduction
Dental implants have become an indispensable established therapy in dentistry in order to replace missing teeth in different clinical situations. Success rates of
82,9% after 16 years follow-up have been reported [1].
Under care and attention of indications, anatomical and intra-individual limiting factors, insertion of dental implants seems to represent a “safe” treatment option.
Nevertheless, in the last decades increasing evidence raised on the presence of peri-implant inflammations representing one of the most frequent complications affecting both the surrounding soft and hard tissues which can lead to the loss of the implant. Therefore, strategies for prevention and treatment of peri-implant disease should be integrated in modern rehabilitation concepts in dentistry. The present review gives an updated overview
* Correspondence: r.smeets@uke.de
1
Department of Oral and Maxillofacial Surgery, University Medical Center
Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
Full list of author information is available at the end of the article
on the pathogenesis, etiology, risk factors and prevention of peri-implantitis, but also on actual recommendations in treatment and therapy options.
Review
Definition und pathogenesis
In analogy to gingivitis and periodontitis affecting the periodontium of natural teeth, an inflammation and destruction of soft and hard tissues surrounding dental implants is termed as mucositis and peri-implantitis [2-4].
Thereby, transitions are often fluent and not clinically clearly separable [5].
Mucositis describes a bacteria-induced, reversible inflammatory process of the peri-implant soft tissue with reddening, swelling and bleeding on periodontal probing
(Figure 1) [2-6]. These are typical signs, but they are sometimes not clearly visible. Furthermore, bleeding on probing (BOP) might be an indicator for peri-implant disease, but sufficient evidence according to the
