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Implant Maintenance - Coggle Diagram

- - - - Without maintenance
        
        Higher bacterial load
        
        More p.gingivalis, t.denticola, f.nucleatum
        
        therefor higher incidence of peri-implantitis
  - - - Eliminate contributing factors
      - Re-establish function & aesthetics
- - - - Greater increase in bleeding sites
      - Takes longer time to resolve
      - More pronounced inflammatory response
      - Accelerated progression
- - - - Implant position
      - Contour of prostheses
      - Health of tissues
      - Probing force, type and angulation
    - - Suppuration on probing peri-implant bone loss
      - Probing depths
        
        5mm or shallower are associated with health
      - BOP
        
        Absence of BOP is a reliable indicator of peri-implant tissue stability (Lang et al 1990)
      - Presence or absence of plaque
- - - - Cause-effect relationship between plaque accumulation and development of mucositis
      - Age is not a deterrent
      - 3 weeks of resumed health did not yield health
    - - Gram -ve anaerobic bacteria
      - High levels of spirochetes
      - AA, F. nucleatum, strep spp, p.gingivalis
    - - larger proportion of neutrophils and osteoclasts
      - extends closer to bone
      - more bone loss (2.28mm vs 0.44mm)
        
        NOTE: peri-implant bone loss progresses in a non-linear, accelerating manner so prevention and detection are critical
  - - - Smoking
      - Diabetes
    - - Presence of keratinized mucosa: gain in KG will reduce peri-implant marginal bone loss
      - Excess cement: --> roughness --> plaque acccumulation
      - Genetics: probable association b/w IL-1 gene polymorphism and peri-implantitis
      - Occlusal overload: no conclusive evidence
- - - - Chemotherapeutics
        
        CHX mouthrinse/ gel (NO EFFECT)
        
        Systemic antibiotics (NO EFFECT)
        
        Probiotics
      - Instrumentation
        
        Resin curette
        
        Titanium curette
        
        Ultrasonic with plastic tips
    - - Bass technique
      - Interdental cleaning