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MAINTENANCE OF THE IMPLANT PATIENT

MAINTENANCE OF THE IMPLANT PATIENT. The examination of the tissues around implants has many features in common with the periodontal examination and must include parameters relevant to the pathogenic process of the peri-implant infection. Bleeding on probing (BoP) Suppuration

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MAINTENANCE OF THE IMPLANT PATIENT

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  1. MAINTENANCE OF THE IMPLANT PATIENT

  2. The examination of the tissues around implants has many features in common with the periodontal examination and must include parameters relevant to the pathogenic process of the peri-implant infection.

  3. Bleeding on probing (BoP) Suppuration Probing depth (PPD) Radiographic bone loss Implant mobility.

  4. Assessments of BoP, suppuration and PPD must be made at four surfaces (mesial, buccal, distal and lingual) of each implant, while radiographic interpretation is limited to the evaluation of the mesial and distal aspects.

  5. 1. Bleeding on probing (BoP+) occurring following the application of the probe with a light pressure (0.25 N) reveals the presence of an inflammatory lesion in the gingiva around teeth. Although this symptom (BoP+) may have a limited predictive value for periodontal disease progression, its absence (BoP—) indicates periodontal stability. With regard to the mucosa around implants, the diagnostic accuracy of BoP appears to be even better than that of BoP in a periodontal examination.

  6. 2. Pus formation, suppuration and the development of a fistula indicate presence of active disease process with collagen destruction and indicates a need for anti-infective therapy.

  7. 3. Probing in the peri-implant sulcus must be made with a light probing force (about 0.2-0.3 N) to avoid overextension into the healthy tissues. If a light probing pressure is applied during probing, the epithelial attachment of the trans mucosal tissue seal will be disrupted but will heal within 5-7 days.

  8. 4. In the absence of clinical signs of infection, it is recommended to take radiographs 1 year after implant installation and no more than every other year thereafter. Additional radiographs may be obtained to determine the extent of marginal bone loss if clinical parameters (e.g. BoP+, suppuration, and increased probing depth) indicate presence of peri-implant infection.

  9. 5. Mobility in implants is more dangerous sign than in periodontitis. It is a specific diagnostic tool for loss of osseointegration and is decisive in making the decision to remove the affected implant.

  10. CUMULATIVE INTERCEPTIVE SUPPORTIVE THERAPY (CIST)

  11. This system of supportive therapy is cumulative in nature and includes four steps which should not be used as single procedures but as a sequence of therapeutic processes.

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