Dental Asia Jul/Aug 2017 - page 61

59
DENTAL ASIA
JULY / AUGUST 2017
USER REPORT
can gently remove calculus at the fixture
crown interfacewithout causing abrasion to
the titanium as well as the ceramic surface
of the crown (Figure 3).
iii) Sub-gingival biofilm removal using
erythritol powder (EMS Plus powder)
with a sub-gingival nozzle (EMS Perio-
Flow
®
nozzle) if probing depth is
5mm or more (Figure 5). This may
be applicable in implant with a long
abutment if it has been more apically
placed.
Peri-implantmucositis (bleeding on probing
but absence of bone loss):
i) Using the PEEK-coated piezoelectric
ultrasonic tip (EMS PI tip) for calculus
removal if required.
Peri-implantitis (bleeding on probing with
bone loss):
• Non-surgical approach prior to surgical
intervention
i) Using the PEEK-coated piezoelectric
ultrasonic tip (EMS PI tip) for calculus
removal if required.
ii) Supra- and sub-gingival biofilm removal
using erythritol powder (EMS Plus
powder) ifprobingdepthislessthan4mm.
iii) Sub-gingival biofilm removal using
erythritolpowder(EMSPluspowder)with
a sub-gingival nozzle (EMS Perio-Flow
®
nozzle) ) if probingdepth is 5mmormore
(Figure 5).
iv) Use of local anti-bacterial agent eg
chlorhexidine gel or mouthwash or
systemic antibiotic if indicated.
Fig. 3: EMS PI tip.
Fig. 4: CIST (Lang & Mombelli 1998).
Fig. 6: Decontamination
of implant surface using
erythritol powder.
ii) Supra- and sub-gingival biofilmremoval
using erythritol powder (EMS Plus
powder) if probing depth is less than
4mm.
iii) Sub-gingival biofilm removal using
erythritol powder (EMS Plus powder)
with a sub-gingival nozzle (EMS Perio-
Flow
®
nozzle) if probing depth is 5mm
or more (Figure 5).
iv) Use of local anti-bacterial agent,
for example, chlorhexidine gel or
mouthwash.
Incorporating air polishing and
piezoelectric devices in
implant maintenance
The Cumulative Interceptive Supportive
Therapy (CIST) is a well-established
treatment strategy adopted by clinicians
over the years for implant maintenance
(Figure 4).
11
Building on this treatment
regime, air polishing (using erythritol
p owd e r ) a n d u l t r a s o n i c d e v i c e
( us i ng PEEK - coa t ed p i ezoe l ec t r i c
ultrasonic tip) can be incorporated into
the different stages of implantmaintenance
and disease management.
12
Healthy peri-implant mucosa (absence of
bleeding on probing and bone loss):
i) Using the PEEK-coated piezoelectric
ultrasonic tip (EMS PI tip) for calculus
removal if required.
ii) Supra- and sub-gingival biofilm removal
using erythritolpowder(EMSPluspowder)
if probing depth is less than4mm.
Fig. 5: EMS
Perio-Flow
®
nozzle.
• Surgical intervention –resective or
regenerative (if indicated)
i) Decontamination of implant surface and
biofilm removal using erythritol powder
(EMS Plus powder) during surgery after
the flaphas been raised (Figure 6).
ii) Resectiveapproachforpocketelimination
or regenerative approach with bone
grafting.
iii) Use of local anti-bacterial agent eg
chlorhexidine gel or mouthwash or
systemic antibiotic if indicated.
Case discussion
A 55 year-oldman had an implant-supported
single crown done on the upper left central
incisor (#21) more than 15 years ago.
On his first consult visit in 2015, #21 was
presentedwith soft tissue inflammation and
CIST
A
B
C
D
PPD ≤ 3 mm
Plaque index < 1
and BOP – (neg.)
Mechanical debridement
Polishing and scaling
+
+
+
+
+
+
AnƟsepƟc cleansing
0.1% CHX gel 2 x daily
for 3-4 weeks
Systemic or local
anƟbioƟc therapy
ResecƟve or
regeneraƟve surgery
Plaque index ≥ 1
and BOP + (pos.)
BOP + (pos.)
no cratering
BOP + (pos.)
notable cratering ≤ 2 mm
BOP + (pos.)
bone loss > 2 mm
PPD 4-5 mm
take an X-ray
PPD > 5 mm
1...,51,52,53,54,55,56,57,58,59,60 62,63,64,65,66,67,68,69,70,71,...88
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