Fast Facts: Perio Edition Episode 71
[Andrew Johnston, RDH]
Welcome back everyone! You are listening to another episode of Fast Facts- Perio Edition brought to you by A Tale of Two Hygienists in partnership with DentistRX. And now, please welcome your host, Katrina Sanders.
[Katrina Sanders, RDH]
Hello, and welcome to Fast Facts: Perio Edition. Today we are beginning the conversation in deep diving around how we now classify diseases of the periodontium associated with dental implants. Now, this is a very interesting concept because for the first time, dental implants have been located in the mouth long enough to actually develop disease around them. And so in 2017, published in 2018, the American Academy of Periodontology began to classify four major classification systems as they relate to peri-implant health or peri-implant disease and peri implant disease or peri-implant health are going to fit into one of four specific categories. This is where we're looking at things like peri-implant health, peri-implant mucositis, peri-implantitis or peri-implant soft and hard tissue deficiencies.
Now to begin this conversation about peri-implant diseases, I want to be very clear, the American Academy of Periodontology has really kicked open the door on this drama, so to speak, around how we as clinicians are expected to evaluate diseases around peri-implant mucosa. You see, the vast majority of us were taught in dental and dental hygiene school to be very careful around dental implants. Many implants were regular implants. Some of us were taught to leave the dental implant alone unless the tissue began to observe otherwise. Many of us were taught to not probe a dental implant. Some of us were taught to probe a dental implant. Many of us were taught to take radiographs around a dental implant to evaluate changes in the bone. And yet, many of us were taught that oftentimes a two dimensional image of a three dimensional object is not going to give you the most optimal display. And so the data continues to unfold. The current statement from the American Academy of Periodontology states as such, when we take a look at implant studies and I want to be very clear, these are implant studies of humans as well as animals (we love beagle studies) When we take a look at a lot of these studies and we find that these dental implants are placed within an Edentulous Ridge, what we're really looking for is what does an optimal anatomy look like? So when we take a look at optimal peri-implant mucosa, we see that on the buckle aspect that that mucosa averages about three to 4 mm high from the mucosal margin to the crest of that peri implant bone. This is where we started to look at when our probing depths are in advanced depth around a dental implant or is this due to the collar of tissue around a dental implant or is this truly due to peri-implant mucosal disease? See when we take a look at how the gingiva and peri-implant mucosa seal, we know that in dental implant experience that there can be consistent challenges from the oral environment and so we know that it is important for the implant surfaces to be appropriately sealed with high level attachment around the apparatus.
So let's look at the drama around probing peri-implant tissues. You see, for many years, it was incorrectly assumed that the tip of a periodontal probe in a probing depth would identify the most apical base of that dentogingival epithelium. We've now acknowledged that that may not necessarily be the case. In healthy sites that tip of that probe oftentimes fails to reach the most apical portion, while in diseased sites we find that there is not as much resistance and so the probe can actually find not only the apical base but can also allow for infiltration of inflammatory cells. This is where there were concerns. If dental professionals were probing a dental implant, could they theoretically break through the surrounding tissues into the underlying connective tissue? We began to understand that while probing a dental implant is a critical aspect of identifying peri implant disease or peri implant health, it should be noted that when probing a dental implant, clinicians should ensure that we are not jeopardizing the integrity of our soft tissue adhesion. So the statement was made that, yes, clinical probing should be done. However, when probing a dental implant, about 50% of the PSI or pressure that is typically used around a tooth structure should be applied to identify the base around a pocket affiliated with a dental implant. What's more, it's important for us to remember that in a healthy tooth situation, the attachment will likely follow the contour of the CEJ or the cemento enamel junction. However, we do acknowledge that in a dental implant situation, we're not looking at a CEJ or Cemento enamel junction and so oftentimes we will denote that in the interproximal space, a probing depth of a greater reading could be observed simply due to the tissue that is occupying that inner dental space. Well, that's all we have today for the drama around to probe or not to probe a dental implant. Know that if you are probing dental implants, that the pressure with which you use and the evaluation of the anatomical observation or display of that gingiva is going to be a critical layer in identifying the health or disease level of the tissue.
Join us next time as we begin critically looking at the four classifications of peri-implant health and peri-implant disease. Cheers!
This has been another episode of Fast Facts - Perio Edition with Katrina Sanders, RDH. Please feel free to reach me on Instagram @thedentalwinegenist or on my website www.KatrinaSanders.com Cheers.
[Andrew Johnston, RDH]
Thank you for listening to another episode of Fast Facts - Perio Edition, brought to you in part by DentistRX makers of the InteliSonic line of power brushes. Find out more by visiting their website at www.dentistrx.com. We'll see you next week for another Fast Fact!
Papapanou, P. N., Sanz, M., Buduneli, N., Dietrich, T., Feres, M., Fine, D. H., ... & Tonetti, M. S. (2018). Jepsen S, Caton JG, Albandar JM, Bissada NF, Bouchard P, Cortellini P, Demirel K, de Sanctis M, Ercoli C, Fan J, Geurs NC, Hughes FJ, Jin L, Kantarci A, Lalla E, Madianos PN, Matthews D, McGuire MK, Mills MP, Preshaw PM, Reynolds MA, Sculean A, Susin C, West NX, Yamazaki K. Periodontal manifestations of systemic diseases and developmental and acquired conditions: Consensus report of workgroup 3 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. J Periodontol. 2018 Jun;89 Suppl 1:S237-S248. doi: 10.1002/JPER.17-0733. PMID: 29926943.
Botelho, J., Machado, V. & Mendes, J.J. Periodontal Health and Blood Disorders. Curr Oral Health Rep 8, 107–116 (2021). https://doi.org/10.1007/s40496-021-00301-w