Signs, Symptoms, and Diagnosis of Peri-implantitis - Swollen, bleeding, or reddened peri-implant tissue - Loosening or wobbling of the implant - Bleeding while brushing teeth - Swelling around the implant - Bad breath or foul taste - Bone loss and soft tissue inflammation - Pain and gingival hyperplasia - No sign of bone loss in healthy situations - Bone loss can take the shape of a crater with surrounding bone walls - Bone loss may have no surrounding bone walls - Alveolar bone shape depends on buccal-lingual length - Bone remodeling at the alveolar crest is normal after implant placement - Bleeding on probing may indicate inflammation - Pus, pocket formation, and gum recession may be present during probing - Swelling and redness of the gums (erythema) may be observed - Pocket depth around an implant is typically greater than around natural teeth - Change in pocket depth between appointments is used for diagnosis - Peri-implant disease includes peri-implantitis and peri-implant mucositis - Peri-implant mucositis affects the surrounding mucosa, while peri-implantitis affects both mucosa and bone - Peri-implant mucositis is similar to gingivitis in terms of symptoms and cause - Diagnosis of peri-implant mucositis involves identifying bleeding upon probing - Inadequate plaque removal is a common cause of peri-implant mucositis - Clinical signs of peri-implantitis include bleeding on probing, suppuration, and increased probing depths - Radiographic examination is essential for diagnosing peri-implantitis and assessing bone loss - Peri-implant pocket depth and bleeding on probing are commonly used clinical parameters for diagnosis - The presence of peri-implant mucositis can precede the development of peri-implantitis - A comprehensive clinical examination, including assessment of soft and hard tissues, is necessary for accurate diagnosis

Risk Factors for Peri-implantitis - Poor plaque control - Lack of regular maintenance therapy - Presence of titanium implant degradation products - Presence of peri-implant bacterial plaque - Diabetes mellitus (potential risk factor) - Excess cement around the implant (potential risk factor) - Width of keratinised mucosa around the implant (potential risk factor) - Genetics (potential risk factor) - Systemic conditions (e.g., cardiovascular disease, rheumatoid arthritis) (potential risk factor) - Iatrogenic factors (e.g., implant positioning, bone grafting) (potential risk factor) - Occlusal overloading of the implant (potential risk factor) - Smoking (debated potential risk factor)

Prevention of Peri-implantitis - Treat peri-implant mucositis to prevent it from progressing to peri-implantitis. - Regular plaque removal through tooth-brushing is essential for preventing and treating peri-implant mucositis. - Dentists should provide oral hygiene instruction to ensure proper plaque removal and calculus removal. - Smoking negatively affects the prognosis of implants, so patients should be encouraged to quit smoking. - Dentists should ensure correct sizing of implant elements to prevent bacterial colonization and place restoration margins supra-gingivally. - Implementing proper oral hygiene practices, including regular brushing and flossing, is essential for preventing peri-implantitis. - Smoking cessation is strongly recommended to reduce the risk of peri-implantitis. - Regular professional maintenance visits, including professional cleaning and assessment of implant stability, are important for prevention. - Patient education on the importance of oral hygiene and the risks associated with peri-implantitis is crucial. - Early detection and treatment of peri-implant mucositis can help prevent the progression to peri-implantitis.

Treatment of Peri-implantitis - Non-surgical therapy aims to control infection and detoxify the implant surface. - Surgical procedures may be necessary to regenerate lost alveolar bone. - Mechanical debridement alone is ineffective in removing all microorganisms from implant surfaces. - Antiseptic, antibiotic therapy, and/or surgery can be combined with mechanical debridement for treatment. - Ultrasonic scalers with non-metallic tips or resin/carbon fiber curettes are used for calculus removal. - Conventional steel curettes or ultrasonic instruments with metal tips should be avoided to prevent implant surface damage. - Polishing with rubber cups and polishing paste aids in plaque removal. - Proper debridement techniques help reduce future plaque accumulation. - Chlorhexidine digluconate is commonly used as an antiseptic to maintain plaque control around implants. - Long-term use of chlorhexidine is not recommended due to adverse events. - Chlorhexidine may slightly improve tissue inflammation. - Hydrogen peroxide at a 1% concentration can be as effective as chlorhexidine without staining side effects. - Concerns have been raised about the direct application of chlorhexidine on implant surfaces due to cytotoxic effects. - Antibiotics targeting gram-negative anaerobic bacteria can be administered during antiseptic treatment. - Local antibiotic application, such as tetracycline periodontal fibers, can create a sustained high dose at the affected site. - Minocycline microspheres, in combination with mechanical debridement, can improve probing depths. - Oral systemic antibiotic intake alone is not a permanent solution. - Mechanical and/or local application of doxycycline and hydrogen peroxide may be necessary. - Surgical flap management with resective and/or regenerative approaches can be considered if infection is controlled. - Guided bone regeneration can restore bony support, while reshaping peri-implant soft tissue can improve aesthetics. - Surgical treatment allows comprehensive debridement and local decontamination. - Consideration of peri-implant lesion characteristics is vital for selecting appropriate surgical techniques. - Successful infection control is a prerequisite for surgical treatment.

Group 5