2022 Volume 35 Issue 2 Pages 61-72
Implant dentistry has developed based on clinical science, while periodontics provides clinical treatments with an emphasis on basic medicine. Therefore, when peri-implantitis occurs, a knowledge of periodontitis is required because the pathological signs of pocket formation and bone resorption are very similar in the two inflammations. This knowledge is also useful in the treatment and prevention of peri-implantitis.
The pathogenesis of periodontitis and peri-implantitis is caused by a disruption of the bacterial flora (dysbiosis) of the biofilm in the pocket. In the chronic process, pathogen-associated molecular patterns (PAMPs) and danger- or damage-associated molecular patterns (DAMPs) react with TLRs (Toll-like receptors) of macrophages and fibroblasts. As a result, inflammatory cytokines (IL-1β, TNF-α, IL-6, IL-17, etc.) and PGE2 are produced. These cytokines differentiate and activate osteoclasts via a RANKL-RANK dependent signaling. In diabetes mellitus with periodontitis, advanced glycation end-products (AGEs) react with RAGE (receptor of AGEs), and inflammatory cytokines are excessively released, resulting in sterile inflammation with bone resorption. Periodontitis and peri-implantitis as well as diabetes are also chronic inflammations that trigger systemic diseases, therefore, two-way treatments are important.
In terms of treatment, ridge defects on the alveolar bone are classified as periodontal disease, so bone grafting is an essential technique for treatment. Especially in the case of implant reconstruction of extensive defects, due to restrictions on the use of GBR, extensive surgery such as iliac bone grafting or distraction osteogenesis is necessary. In this sense, education and practice from periodontal surgery to alveolar surgery are important. However, one should not simply insert implants after a strategic tooth extraction without prioritizing periodontal disease treatment. Periodontal treatment should be prioritized under strict diagnostic criteria before treating implants.
