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Diagnosing Peri-Implant Disease

I’ve just returned from the RDH Under One Roof conference in Las Vegas.  I presented the lecture, “Diagnosis, Prevention, and Treatment of Implant Complications: A Hygienist’s Role,” along with Dr. Scott Froum (periodontist) and Rebekah Duffy (hygienist).  The conference was awesome and the audience was super excited to learn more about this mysterious subject.

Why is peri-implant disease a mystery?  Dentists have been so focused on implant surgery and implant prosthetics that we almost completely ignored implant hygiene.  There hasn’t been a lot of research on the subject.  Heck, it’s only been few years since we reached consensus on the terms “peri-implantitis” and “peri-implant mucositis.”  Most dentists and hygienists will struggle to tell the difference between the two, which is where our lecture comes into play.

In my first slides I showed a case and then asked the attendees to answer some questions using their cell phones and  Twtpoll.  Let’s set the stage:

Initial presentation of peri-implant disease.

A 50 year-old woman with negative medical history presents to our office for a “cleaning.”  She states she had “an implant bridge” done three years ago on her maxilla.  She hasn’t had an exam or hygiene visit since.  We take a panoramic radiograph and see this:

Panoramic of maxillary hybrid and mandibular over-denture restorations.

Detail of maxillary hybrid.

So we have a maxillary acrylic-to-metal restoration (AKA “hybrid”) on five implants and a mandibular complete denture retained by two implants.  Let’s just focus on the maxillary hybrid.  We see some bright red tissue around the acrylic flange of the restoration.  We also note a moderate amount of plaque around three exposed metal surfaces, which are likely the abutments.

The question is… what now?  Here are the three questions we asked and the hygienists’ responses:

The answers are: yes, you always probe implants, the prosthesis should be removed to adequately debride the area, and there is evidence of peri-implant mucositis.  I’ll go into detail about this topics in future posts.  In the mean time, check out this article by Rebekah Duffy to learn more about implant maintenance protocols.

So what can we conclude about the survey data?  There are misconceptions about peri-implant disease, certainly.  But there’s more.  I think it’s safe to say that many dentists and hygienists have no conceptions about this subject.  It’s just not something we pay much attention to.  As we learn more and develop protocols based on sound research, i hope to see that change.


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