periodontitis implants

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Does it seem "strange" placing implants into patient with periodontits, even if it is controlled and patient is following maintenance. Periodontitis ... to ... Peri-implantitis.

 

[toofshucker]

Does it seem "strange" placing implants into patient with periodontits, even if it is controlled and patient is following maintenance. Periodontitis ... to ... Peri-implantitis.

What are you talking about?

 

[DrJeff]

Does it seem "strange" placing implants into patient with periodontits, even if it is controlled and patient is following maintenance. Periodontitis ... to ... Peri-implantitis.

except that bone loss rates around implants are much less than around a natural tooth. Implants in cases like these can actually be a significant bone preservation treatment option.
👍

 

[Ebull]

except that bone loss rates around implants are much less than around a natural tooth. Implants in cases like these can actually be a significant bone preservation treatment option.
👍

Why is this? I can understand the etiology of the periodontal disease process, so why would it be different if you have a titanium implant instead of natural tooth structure if ultimately it leads to alveolar bone loss?

 

[charlestweed]

Tooth w/ perio disease usually has deep pocket (ie greater than 5-6mm) and bony crater around it. This makes it very difficult for pt to maintain. This is why periodontists usually recommend resective surgery to change the pocket anatomy and oppose the nonsurgical approach and Arestin treatment.

After the perio tooth is removed and the implant is placed, the perio pocket is eliminated….this now makes it easier for pt to maintain the implant (w/ normal 2-3mm pocket). Another good thing about implant is its smooth surface, which makes it harder for the perio bacteria to colonize around an implant tooth. You rarely see tartar buildup around implants. Of course, good oral hygiene is still the single most important factor in determining the long-term success of implants.

 

[Ebull]

Tooth w/ perio disease usually has deep pocket (ie greater than 5-6mm) and bony crater around it. This makes it very difficult for pt to maintain. This is why periodontists usually recommend resective surgery to change the pocket anatomy and oppose the nonsurgical approach and Arestin treatment.

After the perio tooth is removed and the implant is placed, the perio pocket is eliminated….this now makes it easier for pt to maintain the implant (w/ normal 2-3mm pocket). Another good thing about implant is its smooth surface, which makes it harder for the perio bacteria to colonize around an implant tooth. You rarely see tartar buildup around implants. Of course, good oral hygiene is still the single most important factor in determining the long-term success of implants.

Yeah I understand all that reasoning, thanks for the reply, but Dr Jeff said "except that bone loss rates around implants are much less than around a natural tooth". If a patient has a history of periodontal disease, which is a bacterial infection of the periodontium why would the rate of bone loss be slower or less in the same patient with an implant?

 

[abcdefghijklm]

But the patient still will have the pathogens that should, if oral health is not maintained, predispose them to higher rate of peri-implantitis. Even though studies do not show this in any definitive manner.

 

[PFM]

Yeah I understand all that reasoning, thanks for the reply, but Dr Jeff said "except that bone loss rates around implants are much less than around a natural tooth". If a patient has a history of periodontal disease, which is a bacterial infection of the periodontium why would the rate of bone loss be slower or less in the same patient with an implant?

I think this is still unknown...the best explanation would be the intrinsic property of titanium ******s bone loss for some reason. Maybe there are different types of bacterial colonies in periimplant pockets compared to natural tooth....

 

[Istr8nthem]

But the patient still will have the pathogens that should, if oral health is not maintained, predispose them to higher rate of peri-implantitis. Even though studies do not show this in any definitive manner.

With implants, you have osteointegration occurring. A natural tooth with an intact PDL (not akylosed) allows periodontal disease to occur more easily as there is greater potential for attachment loss, bone loss and periodontal inflammation. When an implant "takes" it becomes integrated within the bone and the likelihood that pathogens are seeping between implant and bone are less likely then a tooth with a PDL and a periodontal pocket housing periodontal pathogens. That being said, pockets can develop around implants, but are less likely due to integration of bone and implant.

 

[UBDENT2008]

With implants, you have osteointegration occurring. A natural tooth with an intact PDL (not akylosed) allows periodontal disease to occur more easily as there is greater potential for attachment loss, bone loss and periodontal inflammation. When an implant "takes" it becomes integrated within the bone and the likelihood that pathogens are seeping between implant and bone are less likely then a tooth with a PDL and a periodontal pocket housing periodontal pathogens. That being said, pockets can develop around implants, but are less likely due to integration of bone and implant.

OR maybe the plaque that initiates periodontal disease has a more difficult time sticking to titanium than enamel/cementum...no plaque, hence, no periodontitis...but im not a periodontist/implantologist so I really dont know.....just being a smart ass and thought it would be funny to come up with a much simpler answer

 

[charlestweed]

With implants, you have osteointegration occurring. A natural tooth with an intact PDL (not akylosed) allows periodontal disease to occur more easily as there is greater potential for attachment loss, bone loss and periodontal inflammation. When an implant "takes" it becomes integrated within the bone and the likelihood that pathogens are seeping between implant and bone are less likely then a tooth with a PDL and a periodontal pocket housing periodontal pathogens. That being said, pockets can develop around implants, but are less likely due to integration of bone and implant.

Yes, my wife (who is a periodontist) said exactly the same things (absence of PDL and osteointegration of implants). She placed 6 implants on her referring dentist who lost his teeth b/c of Juvenile periodontitis. Two years later, there are still no noticeable bony changes around these implants from the most recent radiographs.

OR maybe the plaque that initiates periodontal disease has a more difficult time sticking to titanium than enamel/cementum...no plaque, hence, no periodontitis...but im not a periodontist/implantologist so I really dont know.....just being a smart ass and thought it would be funny to come up with a much simpler answer

And this is a good answer.

 

[jaxdds]

Yes, my wife (who is a periodontist) said exactly the same things (absence of PDL and osteointegration of implants). She placed 6 implants on her referring dentist who lost his teeth b/c of Juvenile periodontitis. Two years later, there are still no noticeable bony changes around these implants from the most recent radiographs.
.

There is no PDL, there is no PDL, there is no PDL, there is no PDL......

In case there is any confusion, there is no PDL, so the periodontal pathogens do not attack the collagen attachment in the, what is it, oh, the PDL. My bet is that at least half of implants placed are due to perio tooth loss. I have a great case now of a pt with full blown perio, the lower has 8 implants and fixed implant bridge, the upper is flapping in the wind and we are awaiting until after the holidays to do an immediate denture and then do 6 implants and a hybrid screw retained upper. (He has a lot of defects so he doesn't want a lot of grafting, hence the upper fixed denture)

So, with all the pathogens, the lower implants are fine and show no sign of bone loss or problems, yet.


-Dr. J