Prosthodontic Planning and Procedures
Consensus Statement
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Terms related to biologic complications/periimplant disease:
Terms related to technical complications:
Single Crowns and Overdentures
A recently published systematic review addressed the incidence of implant loss and complications of oral implants supporting single crowns over at least 5 years(1). The analysis was based on 8 studies and yielded an early loss of 0.8% before prosthetic placement and an incidence of 2% to 2.5% loss during 5 years of function. The same systematic review reported 2.5% implant loss prior to the placement of overdentures and nearly 6% implant loss during 5 years of function.
Fixed Partial Dentures
The systematic reviews prepared for this consensus workshop reported exclusively on complica-tion and survival rates of fixed partial dentures (FPDs), either implant-supported or implant/ tooth-supported.
For implant-supported FPDs(2) the following conclusions were drawn:
For the combined tooth/implant-supported FPDs(3) the following conclusions were drawn:
References:
(1) Berglundh T, Persson L, Klinge B. A systematic review of the incidence of biological and technical complications in implant dentistry reported in prospective longitudinal studies of at least 5 years. J Clin Periodontol 2002;29(suppl 3): 197–212.
(2) Pjetursson BE, Tan K, Lang NP, Egger M, Zwahlen M. A systematic review of the survival and complication rates of fixed partial dentures (FPDs) after an observation period of at least 5 years. I. Implant-supported FPDs. Clin Oral Implants Res 2004;15:625–642.
(3) Lang NP, Pjetursson BE, Tan K, Brägger U, Zwahlen M. A systematic review of the survival and complication rates of fixed partial dentures (FPDs) after an observation period of at least 5 years. II. Combined tooth–implant-supported FPDs Clin Oral Implants Res 2004;15:643–653.
Implant-supported and implant/tooth-supported FPDs present with high implant and restoration survival rates. However, biologic and technical complications occurred in about half the cases after 5 years of function.
The combined implant/tooth-supported FPDs showed slightly elevated rates of technical complications after 5 years of function. In addition to the expected complications encountered with oral implants or components, abutment teeth may develop additional biologic complications (endodontic, caries, fracture) leading to abutment loss. Therefore, implant-supported FPDs appear to be preferable to combined tooth/implant-supported FPDs.
Because of the limited availability of long-term documentation (10 years) for combined implant/ tooth-supported FPDs, no clinical estimates can be made with regard to longevity or complication rates.
Diagnostic Parameters
For the review of diagnostic parameters(1) the following conclusions and clinical recommendations are presented:
Evaluation of the Bone-Implant Interface
Treatment of Peri-implant Diseases
For the review of antimicrobial treatment of periimplant diseases(2) and surgical treatment of periimplantitis(3), the following conclusions are presented:
Recommendations
The CIST protocol is also in agreement with the systematic review(5) presented at the 4th European Workshop on Periodontology in Ittingen, Switzerland, which suggested a combination of various anti-infective therapies (mechanical, antiseptic, and antibiotic) to prior surgical intervention.
Fig 1: Cumulative Interceptive Supportive Therapy (CIST) protocol. Note that PDs may exceed the normal range stated here, so that PDs used to determine the protocol may have to be adjusted for these differences. In part A of the CIST protocol, typically initiated when plaque and BOP are present but PDs are 3 mm or less, patients are re-instructed in oral hygiene and motivated to initiate and continue maintenance; mechanical debridement is performed using nonmetallic curettes; and polishing takes place using a rubber cup and nonabrasive polishing paste. Part B, when PDs of 4 to 5 mm are found, consists of antiseptic treatment. Here, chemical plaque control is performed using chlorhexidine digluconate, typically as mouthrinses with 0.1% to 0.2% chlorhexidine for 30 seconds using approximately 10 mL, application of local chlorhexidine gel (0.2%), and/or local irrigation with chlorhexidine (0.2%), 2 times a day for 3 to 4 weeks. Protocol C, systemic or local antibiotic treatment, is initiated when PDs are greater than 5 mm. In addition, radiography should be used to supplement clinical findings. Typical systemic treatment is with ornidazole (1,000 mg 1) or metronidazole (250 mg 3) for 10 days, or a combination of amoxicillin (375 mg 3) and metronidazole (250 mg 3) for 10 days. Local treatment might include local application of antibiotics using a controlled-release device for 10 days, eg, tetracycline fibers and minocycline microspheres. Once treatment modalities A, B, and C have been completed, a surgical approach (D) may be considered. Surgical therapy for peri-implantitis should be performed in conjunction with systemic antibiotics and implant surface decontamination. If regenerative treatment is chosen, a barrier membrane technique alone or in combination with autogenous grafts and/or bone substitutes (deproteinized bovine bone mineral) may be considered. Resective surgery may be considered when the peri-implant defect is not suitable for regenerative techniques.
References:
(1) Salvi GE, Lang NP. Diagnostic parameters for monitoring peri-implant conditions. Int J Oral Maxillofac Implants 2004;19(suppl):116–127.
(2) Heitz-Mayfield LJA, Lang NP. Antimicrobial treatment of peri-implant diseases. Int J Oral Maxillofac Implants 2004; 19(suppl):128–139.
(3) Schou S, Berglundh T, Lang NP. Surgical treatment of peri-implantitis. Int J Oral Maxillofac Implants 2004;19 (suppl):140–149.
(4) Lang NP, Wilson TG, Corbet EF. Biological complications with dental implants: Their prevention, diagnosis and treatment. Clin Oral Implants Res 2000;11(suppl 1):146–155.
(5) Klinge B, Gustafsson A, Berglundh T. A systematic review of the effect of anti-infective therapy in the treatment of peri-implantitis. J Clin Periodontol 2002;29(suppl 3): 213–225.
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