Periodontitis to Peri-Implantitis
Pre and post-implant microbiological testing with GUIDOR diagnostic test can result in lower incidence of peri-implantitis leading to more implant success in the longer term.
Long term success of implant treatment relies upon a healthy periodontium i.e. avoiding plaque accumulation by effective dental and implant hygiene through brushing, flossing and rinsing with Sunstar GUM products. Plaque accumulation and the associated inflammation of the surrounding soft tissues (mucositis) can, if not diagnosed and treated, progress to bone destruction, peri-implantitis and disrupt the long term viability of the implant restoration.
Mombelli & Décaillet (2011) defined periimplant disease as the result of an imbalance between host response and bacterial load in susceptible patients. This infection is supported by gram-anaerobic microflora and some of those were also associated with periodontal disease as Porphyromonas gingivalis, Treponema denticola, Tannerella forsythia, Fusobacterium sp., Prevotella intermedia, Aggregatibacter actinomycetemcomitans, Staphylococcus aureus, and Candida albicans (Lang et al. 2011, Klinge et al. 2012, Sanz & Chapple 2012; American Academy 2013). Numerous risk factors contribute to the development of peri-implantitis, such as poor oral hygiene, smoking habit, history/presence of periodontitis, genetic traits, excessive alcohol consumption (Heitz-Mayfield 2008; Heitz-Mayfield &Huynh-Ba 2009; Renvert & Persson 2009), local factors as implant surface and topology (Pesce et al. 2014) and bacterial contamination at the implant/abutment junction (Canullo et al. 2014)(1).
“Elimination of these periodontal pathogens from the patient’s oral cavity before administering dental implant treatment may inhibit colonization by these pathogens and reduce the risk of peri-implantitis” (Sumida S, et al. 2002)(2).
In addition to these bacteria, the fungus C. albicans is capable of colonizing the periodontal pockets in patients with chronic periodontitis and has been identified in the subgingiva of healthy individuals and patients with aggressive periodontitis (Urzúa B, et al. 2008)(3). It is recovered from periodontal pockets in 7.1% to 19.6% of patients with chronic periodontitis (Sardi JC, et al. 2010)(4).
- 28-56% of patients have peri-implantitis at one or more implants (Zitzmann et Berglundh, 2008)(5)
- 16% of patients / 6.6% of the implants have ≥1.8mm bone loss after 1 year of implantation (Roos-Jansaker et al., 2006)(6)
- 28% of patients have progressive bone loss over 5 years of post-implantation (Fransson et al., 2005)(7)
1. Canullo L., Peñarrocha-Oltra D, Covani U, Botticelli D, Serino G, Penarrocha M., Clinical and microbiological findings in patients with peri-implantitis: a cross-sectional study., Clin. Oral Impl. Res. 00, 2014, 1–7.
2. Sumida S, Ishihara K, Kishi M, Okuda K. (2002), Transmission of periodontal disease-associated bacteria from teeth to osseointegrated implant regions. Int J Oral Maxillofac Implants. Sep-Oct; 17(5):696-702.
3. Urzúa B1, Hermosilla G, Gamonal J, Morales-Bozo I, Canals M, Barahona S, Cóccola C, Cifuentes V., Yeast diversity in the oral microbiota of subjects with periodontitis: Candida albicans and Candida dubliniensis colonize the periodontal pockets., Med Mycol. 2008 Dec;46(8):783-93.
4. Sardi JC, Duque C, Mariano FS, Peixoto IT, Höfling JF, Gonçalves RB. (2010), Candida spp. in periodontal disease: a brief review, J Oral Sci. 2010 Jun; 52(2): 177-85.
5. Zitzmann N. U., Berglundh T., Definition and prevalence of peri-implant diseases. J Clin Periodontol 2008, 35: 286–291.
6. Roos-Jansåker AM, Lindahl C, Renvert H, Renvert S., Nine- to fourteen-year follow-up of implant treatment. Part I: implant loss and associations to various factors., J Clin Periodontol. 2006 Apr;33(4).
7. Fransson, C., Lekholm, U., Jemt, T. and Berglundh, T. (2005), Prevalence of subjects with progressive bone loss at implants., Clin. Oral Impl. Res.16: 440–446.
Use GUIDOR diagnostic test to provide a microbiological analysis in the following situations
- Preparation of the implant placement: background with periodontitis and control of the stabilization of the disease
- To help diagnose specific periodontal diseases: persistent pocket depth >4mm (in spite of initial treatment)
- During periodontal and implant maintenance
Features of the microbiological test
- Real-time PCR with GUIDOR diagnostic test identifies and quantifies major bone-destroying pathogens and the fungus C. albicans.
- Cost-effective therapy guidance to maximize implant success rates
- Facilitates a rapid decision to secure treatment and clinical decision at an early stage
- Increases patient motivation and adherence to treatment and builds trust: motivation to continue with thorough periodontal treatment to ensure success of implant integration, both before and after placement
- Information and motivation of the patient to maintain his treatment and his oral hygiene on the long run
- Serves as proof of due diligence in case of medico-legal complications arising from implant failure and liability: to prove that the dentist used every available tool to assess the possibility to place an implant and as an external expertise.
Note: please refer to local IFU for further indications, precautions and possible adverse effects.
Three steps to receive a specific patient's microbiological report
(Step 1) Sample collection: collect sample from patient site.
(Step 2) Send sample and order form to laboratory via free-post envelope
(Step 3) Laboratory performs analysis and delivers report by e-mail within 5 days
Note: process is country dependant. Please contact our local affiliate and see IFU for local processes.
Clinicians choosing the GUIDOR diagnostic test receive an easy-to-understand report.
To allow simple comparison of pathogenic counts versus thresholds, clinicians receive clear tables and graphs highlighting the bacteria group color coding according to the Socranky’s classification.
Microbiological results (example):
Reader friendly report (example):
To assist clinicians in their therapeutic and treatment planning, the report includes clear inputs (clinical interpretations and therapeutic decisions remain at clinician's discretion.)