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Periospectives April-June 2013 : Page 8

LEADING the WAY: Dental implant placement in clinical practice has revolutionized the treatment of partially and fully edentulous patients. Rather than being limited to the traditional options of fixed or removable prostheses which can adversely impact other teeth in the arch, patients facing tooth loss can now rely on implants to restore esthetics and function. Despite their high level of predictability and capacity for a variety of treatment options, implants are not immune from complications. Peri-implant diseases, inflammatory conditions of the soft and hard tissues surrounding a dental implant, can lead to tissue destruction and ultimately implant failure. “Periodontists are experts in the placement and long-term management of dental implants,” said AAP President Dr. Nancy L. Newhouse. “We should now also lead in the management of implant complications, including peri-implantitis and peri-implant mucositis.” Peri-implant diseases can take one of two forms: peri-implant mucositis affects only the soft tissues with no sign of supporting bone loss, whereas peri-implantitis affects both the soft tissues and supporting bone beyond biological bone remodeling. Peri-implant mucositis is generally the precursor to peri-implantitis. “These conditions may arise from a failure to identify risk factors, improper treatment planning, suboptimal The AAP guides dentistry to a better understanding of peri-implant diseases surgical or prosthetic execution, and/or improper maintenance care,” said Dr. Paul Rosen, chair of the AAP’s Task Force on Peri-Implantitis. With the proliferation of dental implants over the last 25 years, the AAP has taken notice of associated complications that can arise with implants, including peri-implantitis. “In 2011, the Academy recognized the need to establish helpful information on peri-implant diseases for those who place and manage implants,” explained Dr. Newhouse. “To that end, the AAP published a report on the topic, has developed resources for practicing periodontists to reference when managing implant treatment, and planned CE programs at both the 2012 Annual Meeting as well as the 2013 Spring Conference.” she said. The AAP’s Task Force on Peri-Implantitis consisted of Chair Dr. Rosen and members Drs. Donald Clem, David Cochran, Stuart Froum, and Bradley McAllister. This group of experts, along with additional authors Drs. Stefan Renvert and Hom-Lay Wang, spent several months researching and developing the Academy Report, titled “Peri-Implant Mucositis and Peri-Implantitis: A Current Understanding of Their Diagnoses and Clinical Implications,” which was published in the April 2013 issue of the J ournal of Periodontology . Included in the report is information about how to diagnose peri-implant diseases, incidence and prevalence, pathology and etiology, risk factors, and clinical implications. AAP Perio spectives | 8

Leading The Way

The AAP guides dentistry to a better understanding of peri-implant diseases

Dental implant placement in clinical practice has revolutionized the treatment of partially and fully edentulous patients. Rather than being limited to the traditional options of fixed or removable prostheses which can adversely impact other teeth in the arch, patients facing tooth loss can now rely on implants to restore esthetics and function. Despite their high level of predictability and capacity for a variety of treatment options, implants are not immune from complications. Peri-implant diseases, inflammatory conditions of the soft and hard tissues surrounding a dental implant, can lead to tissue destruction and ultimately implant failure.

“Periodontists are experts in the placement and long-term management of dental implants,” said AAP President Dr. Nancy L. Newhouse. “We should now also lead in the management of implant complications, including peri-implantitis and peri-implant mucositis.”

Peri-implant diseases can take one of two forms: peri-implant mucositis affects only the soft tissues with no sign of supporting bone loss, whereas periimplantitis affects both the soft tissues and supporting bone beyond biological bone remodeling. Peri-implant mucositis is generally the precursor to peri-implantitis. “These conditions may arise from a failure to identify risk factors, improper treatment planning, suboptimal surgical or prosthetic execution, and/or improper maintenance care,” said Dr. Paul Rosen, chair of the AAP’s Task Force on Peri-Implantitis.

With the proliferation of dental implants over the last 25 years, the AAP has taken notice of associated complications that can arise with implants, including peri-implantitis. “In 2011, the Academy recognized the need to establish helpful information on peri-implant diseases for those who place and manage implants,” explained Dr. Newhouse. “To that end, the AAP published a report on the topic, has developed resources for practicing periodontists to reference when managing implant treatment, and planned CE programs at both the 2012 Annual Meeting as well as the 2013 Spring Conference.” she said.

The AAP’s Task Force on Peri-Implantitis consisted of Chair Dr. Rosen and members Drs. Donald Clem, David Cochran, Stuart Froum, and Bradley McAllister. This group of experts, along with additional authors Drs. Stefan Renvert and Hom- Lay Wang, spent several months researching and developing the Academy Report, titled “Peri- Implant Mucositis and Peri-Implantitis: A Current Understanding of Their Diagnoses and Clinical Implications,” which was published in the April 2013 issue of the Journal of Periodontology.

Included in the report is information about how to diagnose peri-implant diseases, incidence and prevalence, pathology and etiology, risk factors, and clinical implications.

“The report frames the issues so clinicians can thoroughly understand peri-implant diseases and aid the clinician in diagnosing these diseases,” explained task force member Dr. Clem. “For example, for an accurate diagnosis, clinicians should probe, assess radiographs, and check for mobility of restorative and implant components. It is important to remember that there is no one single definitive diagnostic tool to establish a diagnosis of peri-implant disease.” A dentist must combine multiple clinical findings to confirm a diagnosis. Partnering with a periodontist early in the diagnosis may provide the best opportunity for successful treatment due to the potentially rapid and devastating bone loss that can occur. While other diagnostic tools may prove valuable, they are still in the developmental stage and must be confirmed as a site-specific option. This is because much like periodontitis, peri-implant disease is site-specific, either affecting one site around one implant or many sites around many implants.

“At this time, published evidence suggests that peri-implant mucositis may be successfully treated and is reversible if caught early. Unfortunately bone loss associated with peri-implantitis is not reversible and if not treated can lead to greater bone loss. Therefore, it is essential to routinely monitor dental implants as part of a comprehensive periodontal evaluation,” explained Dr. Stuart Froum, AAP president-elect and task force member. All clinicians are urged to adhere to the following recommendations when working with patients with dental implants:

• Identify risk factors associated with developing peri-implant diseases.

• Establish radiographic baseline at the time of implant placement and at final prosthesis insertion.

• Monitor implant health and determine inflammatory complications as part of a regular periodontal maintenance program.

• Establish an early diagnosis and intervention.

The publication of the Academy report on peri-implant diseases coincided with the AAP’s 2013 Spring Conference: “The Team Approach to Managing Implant Complications.” Copies of the paper were distributed to all attendees. Dr. Rosen presented on the treatment of peri-implant diseases. “It is important to educate all members of the dental team about the risk factors, and the signs and symptoms of peri-implantitis and peri-implant mucositis so they know how to best manage these cases,” said Dr. Rosen. “These diseases are best managed by a collaborative relationship between the general dentist and the periodontist.”

In addition to this Academy report, a systematic review on peri-implant diseases is planned for publication in the Journal of Periodontology. “For the best interests of our patients, the Academy is committed to advancing knowledge of peri-implant diseases. We will continue to provide educational and supporting resources to members to meet this goal,” said Dr. Newhouse.

Download the Academy report from joponline.org and view Academy resources on peri-implantitis in AAP Connect. Contact Stephanie Heffner in Public, Practice, and Scientific Affairs (telephone 800/282- 4867 ext. 3248 or 312/573-3248; email stephanie@perio.org).

Are your patients at risk for developing peri-implantitis?

Several factors may increase a patient’s risk of developing peri-implant diseases, including:

• Previous periodontal disease

• Poor plaque control

• Residual cement

• Smoking

• Diabetes

• Occlusal overload

Peri-implantitis resources from the AAP

Start the conversation about peri-implantitis with your patients and general dentists in your area. Visit AAP Connect, the Academy’s online community, to access these member-only resources.

• A customizable PowerPoint presentation to educate your referring colleagues about peri-implant diseases.

• A customizable template letter informing your referring colleagues of peri-implant diseases, including a reprint or link to the Academy’s report on peri-implantitis and peri-implant mucositis to help them better understand the symptoms, diagnoses, and clinical impact of peri-implant diseases.

• A past "Best Practice" column from Periospectives on how to become the implant complications expert in your area.

Read the full article at http://onlinedigeditions.com/article/Leading+The+Way/1413895/161101/article.html.

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