22AAP-FCE9: Peri-Implantitis: Regenerate, Resect, or Restart

Speakers: Ignacio Sanz Sanchez, Junichi Tatsumi, Hom-Lay Wang

Both periodontitis and peri-implantitis are known to be caused by bacterial infections, but there are fundamental differences in the host-microbial interactions in the oral mucosal tissues surrounding implants versus teeth. First, the techniques and objectives to minimize the development of peri-implantitis by obtaining a keratinized mucosa around the implant will be discussed. Next, insights into the regenerative and resective approaches employed to manage peri-implant disease will be examined. This course will also illustrate what’s new in the management of implant complications through regenerative surgical approaches such as EP-DDS surgical protocol for predictable infraosseous peri-implant defects regeneration.

Peri-implantitis is a challenging disease in which the treatment choice should be based on disease severity and peri-implant defect configuration. Resective approaches have shown to be the choice of therapy when dealing with horizontal and/or wide vertical bone defects. Different protocols have been proposed to improve predictability of these resective approaches, such as the implementation of implantoplasty, the use of systemic antibiotics or the modification of the quality of peri-implant soft tissues. Moreover, the role of supportive therapy in the long-term should be emphasized.

Educational Objectives:
• Recognize that loss of keratinized mucosa may be one of the risk indicators.
• Appreciate that obtaining a non-mobile keratinized mucosa around the implant will facilitate plaque control by the patient.
• Identify the proper defect for peri-implantitis defect regeneration.
• Learn EP-DDS guided bone regeneration protocol to predictably regenerate peri-implantitis defects.
• Realize when resective approaches are indicated.
• Evaluate step-by-step the surgical protocol of resective peri-implant surgery.