Balmasov
R.S.
Bashkir
state medical University (Ufa)
Some aspects of periimplantitis
In recent years, dental implants are gaining great
momentum in developed countries. Scientific observations and studies of
clinicians demonstrate good results of implantation, which allows to achieve a
full restoration of chewing efficiency, speech formation and aesthetics of the
dentition [5,6]. The problem of finding the optimal technologies of
implantation, as well as methods of prevention and treatment of periimplantitis
is relevant to date and includes not only the development of new methods of
surgical interventions, the use of additional measures during prosthetics, but
also the creation of new implant systems that fully meet the requirements of
prevention of inflammatory diseases in the periimplantation zone[1,4,8]. With
the development of dental implantation in dentistry appeared complications such
as peri-implantation mucositis and peri-implantitis. Peri-implantation
mucositis-inflammation of soft tissues near the implant without violation of
osseointegration. Periimplantitis is an inflammatory reaction of the tissues
surrounding the osteointegrated implant accompanied by loss of the supporting
bone [6,2]. To distinguish between both complications can be radiologically
and, if mukozita the implant is not mobile in the alveolar ridge, and when
implantate celebrated his mobility [2]. Diagnosis of periimplantitis is carried
out through visual and instrumental examination of the oral cavity, during
which edema, redness of the mucous membrane and bleeding of the gums are
detected. The palpation method allows to determine the flow of purulent
process, as well as the mobility of the implant [2]. The main methods of
diagnosis: a sample using a solution of Schiller-Pisarev, revealing the latent
inflammatory process, as well as the stage of periimplantitis; CT; periodontal
Russell index, which helps to determine the degree and depth of inflammation;
bacteriological and biochemical laboratory tests and radiography, allowing to
diagnose peri-implantitis in the picture.[5] The purpose of the peri-implant
therapy are: to prevent further bone loss, and (ideally)
"reactionary" of the implant (new bone formation in direct contact
with a previously contaminated implant surface). [3] Full-fledged treatment of
periimplantitis is usually carried out in two stages and involves the
elimination of gingival inflammation and surgical sanitation of the focus with
directed bone regeneration. [1] The most important part of peri-implantitis treatment
is to stop the progressive loss of bone by controlling plaque and remove the
pocket. Full treatment usually involves
two phases, similar to periodontal therapy. The causally related initial phase
consists of the removal of plaque and Tartar. The result is elimination of
gingival inflammation [4]. Conservative phase of treatment of periimplantitis
includes conducting professional hygiene of the oral cavity, irrigation
periimplantation pockets by ozonized solution, laser therapy, mouth trays and applications.
Particular attention is paid to the removal of dental deposits from the crown
and abutment. If necessary, a modification of the suprastructure is made, which
allows to eliminate the biomechanical overload of the implant [6]. In special
cases, an attempt to restore bone loss by surgical procedures (directed bone
regeneration) is possible. If the initial phase of therapy is successful, you can start the
second (surgical) phase. [5] During the surgical procedure, it is imperative
that the infected surface of the implant be completely cleaned. During surgical stage of treatment of
peri-implantitis is an incision and tilting the periodontal flap, osseous
revision of pocket, removal of the peri-implant granulation tissue, cleaning
the implant surface using special curets or Perio-Flow [2,3,4], detoxification
of the implant surface with citric acid, thorough washing of the pocket [6].
The operation ends with the introduction into the bone pocket of
osteoconductive material and barrier membrane and suturing the operating wound
with a protective periodontal bandage. In the postoperative period, antibiotics
and antiseptic rinsing are prescribed. [8] in case of recurrent or far-advanced
peri-implantitis, the implant is removed with subsequent re-implantation. [5,7,8]
To prevent the development of peri-implantitis
patients should be under the supervision of a surgeon-implantologist and
periodontist, to observe the rules of care of teeth and prosthetic
constructions on dental implants are to pass the procedure of professional
hygiene in the recommended time. The frequency of professional hygiene sessions
depends on local and General risk factors for the recurrence of
peri-implantitis.[6] in patients with partial Edentia, this periodicity
corresponds to the period of periodontological control examinations and depends
on the individual situation. The interval between visits varies from two to six
months.[2, 4]
Thus, only regular visits as part of maintenance
therapy and high-quality individual care will help to reduce the number of
complications after dental implantation in patients, improving their quality of
life.
List
of
references
1. Аверьянов С.В., Гуляева О.А. Повышение
эффективности консервативного лечения воспалительных осложнений после
дентальной имплантации //Стоматология.
2017. Т. 96. № 6-2.
С. 20.
2. Буляков
Р.Т., Гуляева О.А., Тухватуллина Д.Н., Сабитова Р.И. Постимплантационное
ведение пациентов с дентальными имплантатами при наличии сопутствующей
патологии пародонта // Dental magazine .
– 2012. - № 9.- С. 52 – 55.
3. Буляков Р.Т., Гуляева О.А., Чемикосова Т.С.,
Тухватуллина Д.Н., Саляхова Г.А., Гумерова М.И., Сабитова Р.И. Опыт
применения аквакинетического метода для лечения периимплантита
//Проблемы стоматологии.
2012. № 4.
С. 24-28.
4. Гуляева О.А., Аверьянов С.В. Профилактика
воспалительных осложнений после дентальной имплантации // Пародонтология. –
2017. – № 2. – С. 84-88.
5.
Иванов
С.Ю., Бизяев А.Ф., Ломакин М.В., Панин А.М. Стоматологическая имплантология. /
Учебное пособие. – М.: ГОУ ВУНМЦ МЗ РФ, 2010. – 96 с.
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Сельский Н.Е., Буляков Р.Т., Галиева
Э.И., Гуляева О.А., Викторов С.В., Трохалин А.В., Коротик И.О. Дентальная имплантация:
учебное пособие. - Уфа: Изд-во ФГБОУ ВО БГМУ МЗ РФ, 2016. - 116 с.
7.
С.
Ренверт, Ж. Джованьоли Периимплантит. – М., «Азбука». –2014 г. 255 с.
8.
Тимофеев
А.А. Хирургические методы дентальной имплантации. – К.: ООО «Червона
Рута-Турс», 2012. – 128 с.
9.
Шварц
Ф., Бекер Ю. Периимплантит: Этиология, диагностика и лечение. – М., «Азбука». –
2014г. – 300с.