Unfolding Peri-Implantitis

Lecture 1 - The management of peri-implantitis: a complete overview

This first introductory video lecture is preparatory to understanding the topics covered in subsequent presentations and aims to provide participants with a theoretical skill set on the subject of peri-implant disease management. Participants will have the chance to discover which are the primary diagnostic tools and the most important dental implant anomalies, i.e. pocket depth, progressive bone loss, mucositis, and pathological conditions.

In particular, this lecture covers the following topics:

• How to identify the predisposing and precipitating factors associated with periimplantitis
• How to manage peri-implantitis according to different therapeutic protocols
• History of periodontitis and peri-implantitis management
• Bleeding on probing, suppuration and pocket depth
• Which are the primary diagnostic tools?

Factors affecting the accuracy of probing

Duration: 35 min

Lecture 2 - Predisposing and precipitating factors

In this second presentation, Dr. Monje illustrates step by step the predisposing and precipitating factors of peri-implantitis, also explaining the differences between them. Participants will understand that a predisposing factor is a condition that places a given element at risk of developing a problem, while a precipitating factor is a a condition that worsens the severity of the problem and emphasizes it. In the second part of the lesson, Dr. Monje focuses on the analysis of soft tissues characteristics, the dimensional changes of the anatomical site, and the gold standard for gaining band of keratinized mucosa.

In particular, this lesson covers the following topics:

• Soft tissue conditioning to gain keratinized mucosa and deepen the vestibule
• The role of the free epithelized gingival graft
• Which is the gingival graft dimension needed to compensate dimensional changes?

Duration: 25 min

Lecture 3 - Defect configuration and anatomical relevant factors

Participants will be able to observe the most important patient-specific factors to be considered when dealing with peri-implant diseases. Dr. Monje discusses, in this regard, which hard and soft tissue characteristics may be the prelude to subsequent peri-implant disease.

In particular, this lesson covers the following topics:

• Peri-implantitis defect configuration
• Bone remodelling and flap design procedures
• The clinical significance of guided healing
• Vascular necrosis and bone loss
• Step-by-step approach on contour augmentation
• When are immediate implants indicated?

Why is it so important to minimize the physiological bone remodelling in the interproximal area?

Duration: 1 h

Lecture 4 - Peri-implantitis therapeutic protocols

In this video lecture, Dr. Monje provides information on how to manage peri-implant diseases. In particular, the specialist illustrates which patient-specific conditions allow the clinician to initiate the treatment and which conditions are likely to lead to treatment failure.

In particular, this lesson covers the following topics:

• How to compensate and restore peri-implant health
• Bone loss management
• Why is a flat bone architecture needed?

Indicators of therapeutic failure: plaque, bad habits, suppuration, history of periodontitis, other factors

Duration: 13 min

Lecture 5 - Different classes of peri-implant diseases

This video lecture is dedicated to the presentation of the different classes of periimplant diseases and defect configuration. Participants will learn about the characteristics of each of these different types of periimplant disease and discover the checklist for a predictable management and treatment of peri-implantitis.

In particular, this lesson covers the following topics:

• Defect configuration, implant position and soft tissue characteristics
• What do clinicians have to check while planning a predictable peri-implantitis therapy?

• Principles and considerations in the management of peri-implantitis
• Methods for surface decontamination
• Non-surgical therapies to reduce pocket depth and bleeding on probing
• Pre-, intra- and post-operative considerations

Duration: 28 min

Lecture 6 - Different therapeutic protocols for different peri-implantitis classes

In this lecture, Dr Monje illustrates the correct treatment protocol for each of the different possible classes of peri-implant disease. The specialist focuses on the correct implant position and reconstructive surgical therapies including the diagnosis, flap design, mechanical decontamination, membrane positioning, incision protocol, debridement, implantoplasty, surface decontamination, and bone degranulation.

In particular, this lesson covers the following topics:

• Step-by-step approach to choose the proper implant position
• Management of Class 1A, 1B, 1C, and 2
• Soft tissue conditioning to minimize recession
• Barrier membrane in the reconstructive therapy
• The role of implantoplasty

Duration: 28 min

Lecture 7 - Soft tissues conditioning and class 3 management

In this lecture, Dr. Monje discusses the management of Class 3 peri-implantitis and the protocols for proper soft tissue reconditioning.

In particular, this lesson covers the following topics:

• Management of Class 3A, 3B, and 3CFeatures of class 3 peri-implantitis
• Reconstructive therapy for combined defects
• The impact of buccinator path on the vestibular depth

Duration: 20 min

Lecture 8 - Final considerations

In this brief final lecture, Dr. Monje presents an overview of the simplified decisionmaking process to deal with peri-implantitis.

Duration: 3 min