ITI Theme Night UGent with Dr. Laurence Adriaens

Decision making in the treatment of advanced peri-implantitis lesions.

Preserving teeth with periodontitis: a multidisciplinary approach.

Decision making in the treatment of advanced peri-implantitis lesions.

Today implants are a common way to rehabilitate lost teeth in our patients. But we should also know that implants can be affected by the oral environment and that they need special care which we have to transmit to our patients from the start. Problems around implants are known as peri-implant mucositis which can progress and turn into peri-implantitis. Several approaches, depending on the severity of the bone loss around the implant, can be adopted. 

• The first step in treating peri-implantitis (as in periodontitis) is professional non-surgical therapy together with the use of chlorhexidine mouthwashes and gels to decrease the number of bacterial deposits.
• At re-evaluation, after six to eight weeks, if the significant bone loss around the implant has not been resolved and bleeding and pus are still present (after the non-surgical therapy), various forms of treatment can be adopted. However, non-surgical treatment should first be repeated to control the bleeding and inflammation.
• In some cases, following non-surgical treatment, antibiotics may be given to help control the infection before other treatments are tried. 
• Once the inflammation around the implant has been controlled, if the problem requires surgical treatment the dentist or periodontist will decide which approach to use. This will depend on the nature of the damage caused by peri-implantitis.
• Bone regeneration using bone grafts.
• Resective surgery, which removes bony ledges and flattens the bone irregularities around the implant.
• Implantoplasty, where the threads on the screw of the implant are removed to leave a polished implant surface.
• In some cases, explantation is the only solution. 

Very often many steps are required to treat peri-implantitis, to return a patient to peri-implant health, and prolong the life of an implant. Some cases will require only non-surgical therapy while others will need additional treatment.

The earlier that peri-implant mucositis and peri-implantitis are detected, the better are the chances of successful treatment.

But better still is preventing disease in the first place, through correct oral hygiene and regular professional cleaning of teeth, implants, and gums.

Preserving teeth with periodontitis: a multidisciplinary approach.

Periodontitis is an infectious disease which affects the supporting tissues surrounding the tooth (alveolar bone, gums, periodontal ligament and cementum). 

Periodontal treatment can be divided in two phases. During the first phase, the basic periodontal treatment, bacteria are removed from periodontal pockets using scaling and root-surface debridement (non-surgical periodontal therapy) to obtain smooth root surfaces ‘free’ of bacteria, plaque and calculus. 

After 8 weeks a reevaluation is performed and in some cases a second treatment phase is required, during which periodontal surgery is performed to eliminate residual deep pockets (access surgery, resective surgery). 

Due to periodontal disease smiles of our patients are affected and when looking for an aesthetic result very often we will have to work with different specialists to return a nice smile to our periodontal patient. And this can go from mucogingival surgery or regenerative surgery to collaborations with orthodontists, prosthodontists and/or implantologists. 

Dra. Laurence Adriaens. Degree in dentistry, University of Ghent, Belgium. 

Master Degree of Advanced Studies in Periodontology, University of Berne, Switzerland. Specialist in Periodontology recognized by the European Federation of Periodontology (EFP). 

ITI Fellow since 2008 and ITI Study Club Director since 2009 in Palma de Mallorca. 

Publications in national and international dental journals. Oral and poster presentations in national and international dental meetings. 

Co-director of the official Journal of SEPA (Sociedad Española de Periodoncia y Osteointegracion) published 3 times a year. 

Founding member of WIN group (Women Implantology Network) since 2016. 

Owner of a private practice in Palma de Mallorca, working as a specialist in Periodontology and Implantology.