1. An inflammatory reaction, with the loss of supporting bone in the tissues surrounding a functioning implant.

2.  What Is peri-implantitis?  Clinical findings to look for  Contributing factors  Prevention  Treatment

3.  Starts with a less threatening disease called Peri-Implant mucositis.  Peri-implantitis -described as an inflammatory, bacterial driven destruction of the implant-supporting apparatus.  Inflammation -a complex reaction of the body in response to an infectious agent, antigen challenge, or injury.  Accumulation of plaque aggravates the inflammatory reaction over time, resulting in irreversible tissue destruction.  Inflammation visible within 10 to 20 days of plaque  Even during early stages of inflammation,considerable tissue damage occurs  Site-specific infection yielding many features in common with chronic adult periodontitis

4. Composed of three parts: Titanium implant - fuses with the jawbone Abutment - fits over portion of the implant that protrudes from the gum line. Crown - created by a restorative dentist and fitted onto abutment for natural appearance.

5.  Poor oral hygiene ◦ Teeth serve as reservoirs for pathogens  As early as 1 month after implantation, putative periodontal pathogens were detected around the implants of partially edentulous patients  History of periodontitis ◦ Periimplant microbiota resembles that of adult periodontitis  Occlusal overload ◦ Loosening of screws  Systemic influences ◦ Diabetes (uncontrolled glucose levels) ◦ Osteoporosis (Bisphosphonate drugs)

6.  Smoking ◦ Higher bleeding scores ◦ Deeper pocket depths ◦ More signs of inflammation ◦ More radiographic bone loss around implants ◦ Failure rates Smokers:11.3% Non-smokers: 4.8%  Chances of developing peri-implantitis are automatically greater if original teeth were lost because of periodontal disease, caries, or recurrent trauma.

7. Prevention is our main purpose as dental hygienists  Regular dental visits  Education  Plaque control procedures ◦ Particularly around implants  Mechanical instrumentation of the affected areas possessing surgical flap access should be performed.  Routine radiographs

8.  Lack of keratinized tissue around an implant  Bleeding & suppuration upon probing  Mobility  Retention of restorations  Radiographic findings

9.  Open flap debridement ◦ Alveolar bone and root surfaces of teeth are exposed for scaling and root planing  Implant detoxification ◦ Calcium hydroxide and chlorhexidine gluconate may provide an antimicrobial action for detoxifying. ◦ Calcium hydroxide should not be left in the surgical site.

10. Implantic Debrider Water cooling agent Cleans down between threads of visible fixture ◦ Rotary motion - designed to remove deposits from exposed threads of affected implants  Laser therapy ◦ Becoming increasingly common in dentistry ◦ Applications in soft tissue surgery, caries removal, and in treatment of peri- implantitis. ◦ Lasers irradiate the whole surface

11.  Because dental implants are becoming more in demand, peri- implantitis is becoming more common in individuals.  Peri-implantitis is difficult to treat, therefore early detection and prevention are key.  It is crucial for patients with dental implants to have the professional care and support of a dental team. A hygienist’s goals are to encourage outstanding oral hygiene and to teach the patient which tools to use for homecare as well as to urge the patient to desire a healthy oral environment

12.  Fletcher, P. (2011). Concepts for modern implantology. Dimensions of Dental Hygiene, 9(9), 44,46-48.  Heasman, P., Esmail, Z., & Barclay, C. (2010). Peri-implant disease. Dental Update, (37), 511-516.  Hempton, T. J., Bonacci, F. J., Lancaster, D., & Pechter, J. E. (2011). Implant maintenance. Dimensions of Dental Hygiene, 9(1), 58-61.  Hempton, T. J., Bonnaci, F. J., & Lassonde, M. (2011). Identifying the risks. Dimensions of Dental Hygiene, 9(5), 60-63.  Terracciano-Mortilla, L. D. (2010). Effective implant care. Dimensions of Dental Hygiene, 8(9), 30-32,34.  Petkovic-Curcin, A., Matic, S., Vojvodic, D., Stamatovic, N., & Todorovic, T., (2011). Cytokines in pathogenesis of peri-implantitis. Vojnosaniteski Pregled: Military Medical & Pharmaceutical Journal of Serbia & Montenegro, 68(5), 435-440. doi:10.2298/VSP1105435P

13.  http://www.drchetan.com/dentalpics/dental- instruments/dental-implants/dental- implant-7/ http://www.drchetan.com/dentalpics/dental- instruments/dental-implants/dental- implant-7/  http://www.exodontia.info/files/Dental_Upda te_2010._Peri-Implant_Diseases.pdf http://www.exodontia.info/files/Dental_Upda te_2010._Peri-Implant_Diseases.pdf