Professional Documents
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Discuss the effect GBR in management peri-implant bone loss Evident base supporting a decision tree as a guide line
Introduction
When losing teeth
RPD (Removal Partial Denture) FPD (Fixed Partial Denture) ISP (Implant Support Denture)
Introduction
International Congress of Oral Implantologist Pisa Consensus Conference report give a definition of
Implant failure: remove or lost Implant complication: deviation of standard tx outcome, and requires further tx
Peri-implantitis (survival rate 89&-95% in 10y reports)
Peri-implantitis
A systemic review of 51 prospective studies reported
0%-14.4% in 5 year follow up
Other reported
11.3%-47.1% in 10-16 years
Biological factor
Micro-organism especially periopathic bacterial: P.g, T.f, T.d Smoking Diabetes Others : compression necrosis, infection, overheating of bone during operative
Schwarz peri-implantitis
Class I: intrabonydefect
a: dehiscences defect b: buccal & interproximal defect c: class Ib + lingual defect d: buccal and lingual dehiscence e: circurferential
Mechanical factor
Occlusal over loading is considered the primary factor Poor prosthetic design Inadequate number, dimensions Non ideal position
Parafunction habit
Treatment Modalities
Goal is trying to eliminate and restoring lost strutures and function It is divided as periodontal treatment
Non-surgical
Antimicrobial therapy & mechanical debridement
Surgical
Surgical debridement, implantoplasty, dental lasers
Regenerative
GBR
Non-Surgical
Local tetracycline combines with debridement
6% bone filled on x-ray 0.2-0.3mm clinical significant
Surface Decontamination
Eliminating etiological factor Several agents use for decontamination found no significant over superior
Saline, Abrasive pumice, Citric acid, CHX, Air power abrasive
Surface Decontamination
Implantoplasty: archive smooth surface & plaque adhesion Poor effects:
increase heat, damage adjacent tissue, metallic debris
Surgical Debridement
Surgical re-entry examination
GBR>Bone graft alone>flap debridement: bone fill
GBR with / without bone graft no significant different GBR still not predictable as a Systemic review reported
Decision Tree
Decision Tree
Management in horizontal defect
APF & implantoplasty
Defects
Ochsenbien and Cortellini and Tonetti
1 wall APF 2, 3 wall GBR with non resorbable membrane 3 wall (contained) GBR with resorbable membrane Circumferential defect occlusal evaluation
Release heavy loading
Others
PASS principle GBR must be done with primary closure
Reduce bacterial/foreign bodies contaminated