Treatment of Peri-implantitis with GBR

Video from Dr. Howard Gluckman, of Implant & Aesthetic Academy.

This video below shows the protocols in Dr. Howard Gluckman’s clinic for the treatment of Peri-implantitis with Sodium Bicarbonate prophyjet as well as the Waterless iPlus 2.0 laser from Biolase with subsequent GBR procedures using Jason membrane, Xenograft, as well as Joseph Choukrouns Sticky bone and A-PRF.

Background: One of the key factors for the long-term success of dental implants is the maintenance of healthy tissues around them. Bacterial plaque accumulation induces inflammatory changes in the soft tissues surrounding implants. Due to prevalence rates up to 56%, peri-implantitis can lead to the loss of the implant without multilateral prevention and therapy concepts.1

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What is peri-implantitis?

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. Mucositis describes a bacteria-induced, reversible inflammatory process of the peri-implant soft tissue with reddening, swelling and bleeding on periodontal probing. These are typical signs, but they are sometimes not clearly visible. Furthermore, bleeding on probing (BOP) might be an indicator for peri-implant disease. In contrast to mucositis, peri-implantitis is a progressive and irreversible disease of implant-surrounding hard and soft tissues and is accompanied with bone resorption, decreased osseointegration, increased pocket formation and purulence

Which treatment strategies for peri-implantitis are the most effective.?

According to Esposito et al.7: There is no reliable evidence suggesting which could be the most effective interventions for treating peri-implantitis. This is not to say that currently used interventions are not effective…There is no evidence from four trials that the more complex and expensive therapies were more beneficial than the control therapies which basically consisted of simple subgingival mechanical debridement….Larger well-designed RCTs with follow-up longer than 1 year are needed.7

Additional information and resources (click PubMed links for research abstracts):

1. Head Face Med. 2014; 10: 34. Definition, etiology, prevention and treatment of peri-implantitis – a review Ralf Smeets, Anders Henningsen,Ole Jung,Max Heiland, Christian Hammächer,2 and Jamal M Stein. [Pubmed] 2. Khammissa RAG, Feller L, Meyerov R, Lemmer J. Peri-implant mucositis and peri-implantitis: clinical and histopathological characteristics and treatment. SADJ. 2012;67(122):124–126. [PubMed] 3. Zitzmann NU, Walter C, Berglundh T. Ätiologie, Diagnostik und Therapie der Periimplantitis – eine Übersicht. Deutsche Zahnärztliche Zeitschrift. 2006;61:642–649.
4. Wilson V. An insight into peri-implantitis: a systematic literature review. Prim Dent J. 2013;2:69–73. doi: 10.1308/205016813806144209. [PubMed] 5. Schwarz F, Sahm N, Becker J. Aktuelle Aspekte zur Therapie periimplantärer Entzündungen. Quintessenz. 2008;59:00.
6. Periimplantäre Entzündungen. [] 7. Cochrane Database Syst Rev. 2012 Jan 18;1:Interventions for replacing missing teeth: treatment of peri-implantitis. Esposito M1, Grusovin MG, Worthington HV. [PubMed]

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