PATHOGENESIS AND THERAPY OF PERI-IMPLANT DISEASES

Periimplantatne bolesti su bolesti infektivne prirode koje zahvaćaju tkiva u okolici dentalnog implantata u funkciji. Iako patogenetski dijele mnogo sličnosti s parodontnim bolestima, postoje i znatne razlike, pogotovo u njihovu terapijskom zbrinjavanju. Etiologija periimplantatnih bolesti povezana je s prisutnošću mikrobnog biofilma na površini implantata, u čijem se sastavu nalazi specifična parodontopatogena mikrobna flora, te s postojanjem određenih čimbenika rizika povezanih sa samim pacijentom. Ovisno o tome koja su tkiva zahvaćena upalnim procesom, periimplantatne bolesti klasificiramo na periimplantatni mukozitis, kod kojeg je upalom zahvaćeno samo meko tkivo oko implantata, te periimplantitis, kod kojeg upalni proces prodire dublje u vezivno tkivo i dovodi do resorpcije kosti, što rezultira gubitkom oseointegracije implantata. Koja su tkiva zahvaćena upalnim procesom procjenjujemo na temelju određenih kliničkih dijagnostičkih parametara. Bez terapijskog postupka periimplantatna lezija će progredirati duboko u koštano tkivo i s vremenom rezultirati gubitkom implantata. Terapija periimplantatnih bolesti može biti nekirurška ili kirurška, a odabir metode ovisi o težini i uznapredovalosti lezije. U svakom slučaju, najvažniji su koraci terapije mehanička instrumentacija površine implantata i njezina dekontaminacija, upute o oralnoj higijeni, te uključivanje pacijenta u program potporne terapije u kojem se prilikom svakog kontrolnog pregleda procjenjuje stanje periimplantatnih tkiva te, ovisno o nalazu, provode određeni protokoli terapijskih postupaka. S obzirom na to da suvremena stomatologija pruža učinkovite metode za zaustavljanje ovih bolesti i sprječavanje nepotrebnog gubitka implantata, iznimno je važno na vrijeme prepoznati patološki proces i uputiti pacijenta na daljnju obradbu.Peri-implant diseases are diseases of infectious nature that affect the tissues surrounding a dental implant in function. Although periodontal and peri-implant diseases share many similarities there are also significant differences, especially regarding their treatment. The etiology of peri-implant diseases is closely related to the presence of a microbial biofilm on an implant surface, which consists of various bacterial species including specific periodontal pathogens, and to the existence of certain risk factors tied to the patient himself. Depending on which tissues are affected by the inflammatory process, peri-implant diseases are classified into peri-implant mucositis, in which the inflammatory process affects only the soft tissue surrounding an implant, and peri-implantitis, in which the process extends deeper into the connective tissue and leads to bone loss, compromising the osseointegration of an implant. Which tissues are affected by the inflammatory process is assessed during clinical examination, based on certain clinical diagnostic parameters. Without treatment, a peri-implant lesion will progress deep into the supporting bone and eventually result in implant loss. Treatment of peri-implant diseases can be non-surgical or surgical, depending on the severity and stage of the disease. In both cases, the most important steps of the treatment plan are: mechanical debridement of the implant surface and its decontamination, instructions on oral hygiene measures given to the patient and inclusion of the patient into a support therapy programme in which, during each recall, the state of the peri-implant tissues is evaluated and appropriate treatment protocols utilised. Given that modern dentistry offers many effective methods for dealing with peri-implant diseases, their early recognition is vital to stop the progression of the disease and prevent unnecessary implant loss