The EAO Congress in Lisbon hosted an enlightening session on peri-implantitis, featuring Ignacio Sanz Sanchez and Jan Derks. Both speakers presented their perspectives and approaches to treating this challenging condition, offering valuable insights for clinicians. This article summarizes their key points and recommendations.
Understanding Peri-Implantitis Peri-implantitis is an inflammatory condition affecting the tissues around dental implants, leading to bone loss and, potentially, implant failure. The condition's complexity and the varying treatment responses make it a significant concern in implant dentistry.
Ignacio Sanz Sanchez: A Comprehensive Approach Ignacio Sanz Sanchez presented a structured approach to treating peri-implantitis, emphasizing both non-surgical and surgical methods.
Initial Assessment and Non-Surgical Treatment:
Sanz Sanchez emphasized the importance of a thorough initial assessment to identify the factors contributing to peri-implantitis. This involves evaluating the implant site, the patient's oral hygiene, and any contributing systemic factors. Non-surgical treatments, including mechanical debridement and antimicrobial therapy, are the first line of defense. These methods aim to reduce bacterial load and inflammation, providing a foundation for potential surgical intervention if necessary. Surgical Approaches:
For cases where non-surgical methods are insufficient, surgical intervention is necessary. Sanz Sanchez highlighted three main approaches: Implantoplasty: Grinding down the exposed implant surface to smooth it and reduce bacterial adhesion. This technique, while controversial, aims to make the implant surface easier to clean. Antimicrobial Therapy: Using local or systemic antibiotics to manage infection. Regenerative Techniques: Utilizing bone grafts and other regenerative materials to restore lost bone around the implant. Decision Tree for Treatment:
Sanz Sanchez presented a decision tree to guide clinicians in choosing the appropriate treatment. If more than two-thirds of the implant surface is exposed or if there is more than seven millimeters of bone loss, he recommends considering implant removal and subsequent ridge regeneration. Jan Derks: A Focus on Regeneration Jan Derks provided a detailed overview of regenerative approaches to treating peri-implantitis, focusing on restoring both bone and soft tissue.
Decontamination:
Derks emphasized the importance of thoroughly decontaminating the implant surface. He noted the effectiveness of various decontamination methods, including air polishing and the use of titanium brushes. However, he cautioned against altering the implant geometry significantly due to potential complications such as heat generation and the creation of microscopically rough surfaces. Regenerative Techniques:
Derks discussed the importance of regenerative procedures to rebuild the lost bone and soft tissue around the implant. He highlighted the use of bone grafts and guided bone regeneration (GBR) techniques as effective methods for achieving this goal. He stressed that regeneration should be tailored to the specific needs of each patient, taking into account the extent of bone loss and the overall condition of the implant site. Primary Prevention:
Both speakers agreed on the critical role of primary prevention in managing peri-implantitis. Derks highlighted the need for meticulous surgical planning and execution to minimize the risk of peri-implantitis. This includes proper implant placement, ensuring sufficient bone support, and maintaining good oral hygiene practices. Future Directions Both Ignacio Sanz Sanchez and Jan Derks expressed optimism about future advancements in peri-implantitis treatment. They highlighted the ongoing research into bioactive implant surfaces with antimicrobial properties and the potential for stem cell technology to enhance regenerative outcomes. However, they emphasized that prevention remains the best strategy. Ensuring proper implant placement, promoting good oral hygiene, and implementing regular maintenance protocols are key to reducing the incidence of peri-implantitis.
Conclusion Treating peri-implantitis requires a comprehensive approach that includes both non-surgical and surgical methods. Ignacio Sanz Sanchez and Jan Derks provided valuable insights into the current best practices and future directions in managing this challenging condition. By focusing on prevention, thorough decontamination, and effective regeneration, clinicians can improve outcomes for patients with peri-implantitis.