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Fast Facts: Perio Edition – Peri-Implant Soft and Hard Tissue Deficiencies Part I

Fast Facts: Perio Edition Episode 72
[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’re going to move on to looking at some interesting new findings that have come down from our friends at the American Academy of Periodontology around what we understand about the etiology of… Are you ready for this mouthful? Hard and soft tissue deficiencies at dental implants. Okay, so let’s unpack really what that looks like. Essentially, the American Academy of Periodontology acknowledges that there are common complications that will happen within our patients that are going to compromise the implant’s ability to survive and therefore might require advanced interventions on the therapy side. So this is where they have developed a very specific diagnostic classification system where we as clinicians are expected to understand the etiology of these deficiencies, and based on these understandings, then build out strategies to correct these deficiencies. These deficiencies will fall either into soft tissue deficiencies or hard tissue deficiencies. I use the word deficiencies a lot in that sentence, my goodness. But our goal, really, when we see a patient who’s experiencing either soft or hard tissue deficiency is to, of course, make sure that we rectify these in order to improve the clinical outcomes of our patients receiving dental implants.
So a few things that I want to do from an overview perspective, there are several different types of deficiencies that we can see prior to dental implant placement. And so I want to unpack what some of these things look like. From a soft tissue perspective, tooth loss can be a contributory factor. Now, when we’re looking specifically at tooth loss as an ideological factor, one of the important pieces for us to better understand is why did our patient lose this tooth to begin with? The loss of these teeth provides us a lot of evidence about potential risk down the road. So was this trauma from a history of tooth extraction where maybe there’s a challenge with bone healing at the extraction site? Was there chronic periodontitis in the area in which we could likely say that there was an infectious disease within the supporting tissues of the tooth? And so that tooth loss is now an area of compromised stability. We also look at did the patient experience an endodontic infection? We know that endodontic infections are common findings that we’ll find that lead to resorption of bone, where we might see the marginal bone intact. The bone around that apex of the tooth we know can be compromised. And so we can see a lot of interesting challenges there.
We can also see longitudinal root fractures. We know that longitudinal root fractures can lead to bone resorption, thus making it difficult for the hard tissue to sustain in these areas. And we can even see things like generalized trauma to the area. Trauma we know affects the stability not just of the tooth structure, but, of course, loss of that surrounding tissue. Some of the other things that we do look at when it comes to a prior dental implant placement can even be things like systemic diseases. So before we’re even going to load a dental implant, we look at various types of systemic diseases or abnormalities that can impact development of bone formation, like ectodermal dysplasia, for example. We understand that a lot of these systemic diseases that our patients may present with certainly can impact the ability for a dental implant to sustain and for us to acquire osseointegration.
So when we take a look at some of these conditions, and these, of course, are all of the conditions that can impact the success of a dental implant even before the implant is placed. Things like tooth loss, periodontitis, even things like trauma from tooth extraction, endodontic infections, longitudinal root factors, trauma, bony height, and even systemic diseases can deeply impact the ability for a dental implant to be successful. And these deficiencies, we do believe, will contribute or can contribute to eventual failure of a dental implant. So our ability to identify these deficiencies and subsequently address these deficiencies before loading a dental implant will be critical.
Stay tuned as we continue the conversation next week where we will look at hard and soft tissue deficiencies that can occur after a dental implant has been placed.
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!

Resource: ​​
Renvert, Stefan, G. Rutger Persson, Flavia Q. Pirih, and Paulo M. Camargo. “Peri‐implant health, peri‐implant mucositis, and peri‐implantitis: Case definitions and diagnostic considerations.” Journal of clinical periodontology 45 (2018): S278-S285.

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