Review of mechanical and biological complications of implantoplasty in the tratment of periimplantitis

Sa sve širom upotrebom dentalnih implantata u stomatologiji, sve se više javljaju i upalne bolesti tkiva oko implantata. Kroz godine su predlagani razni protokoli u liječenju periimplantatnih bolesti. Danas imamo konsenzus u obliku CIST protokola koji se provodi ovisno o fazi i opsegu bolesti. Cilj je uvijek regeneracija tkiva no ponekad to nije moguće te se pristupa resektivnim metodama. Kod uznapredovalih oblika bolesti sa velikim koštanim defektom dok implantat nije za eksplantaciju postoji metoda koja se pokazala značajnom u smanjivanju znakova upale u tkivu i produljenju vijeka implantata. Implantoplastika je metoda kojom se suprakrestalno izloženi navoji implantata uklanjaju i površina se polira kako bi se smanjilo nakupljanje bakterija i plaka za površinu implantata. Time dolazi do cijeljenja upale u okolnom tkivu te se olakšava održavanje oralne higijene u budućnosti. Resektivni postupci, implantoplastika i osteoplastika nisu preporučljivi u estetskoj zoni da se ne narušava estetika. Samim brušenjem i poliranjem navoja postoji opasnost od oštećenja implantata ili veze između implantata i suprastrukture. Sistematični pregledi istraživanja pokazuju kako pažljivim poliranjem navoja na implantatu preostaje dovoljna debljina stijenke te rizik od pucanja implantata nije značajno uvećan. Kod implantata uskog promjera se ipak ne preporuča raditi implantoplastiku jer dodatno smanjivanje promjera narušava čvrstoću implantata. Osim mehaničkih rizika, implantoplastika nosi i rizik od pregrijavanja tkiva uslijed brušenja. Ponovno, istraživanja pokazuju kako obilno vodeno hlađenje prilikom implantoplastike ne dovodi do povećanja temperature koje bi uzrokovalo oštećenje okolnog tkiva. S druge strane, još uvijek je nedovoljno istražen rizik od djelovanja čestica koje zaostaju nakon brušenja u okolnom tkivu.Considering the increasingly widespread usage of dental implants in dentistry, the number of peri-implant tissue inflammations is also increasing. Regarding with peri-implant diseases, today we have a consensus in the form of a CIST protocol. The goal is always tissue regeneration, but sometimes this is not possible and resective methods are used. In advanced forms of the disease with a large bone defect while the implant is not for explantation, there is a method that has been shown to be significant in reducing the signs of inflammation in the tissue and prolonging the life of the implant. Implantoplasty is a method by which supracrestally exposed threads of implants are removed and the surface is polished to reduce the accumulation of bacteria and plaque on the surface of the implant. This heals the inflammation in the surrounding tissue and makes it easier to maintain oral hygiene in the future. This is not recommended in the aesthetic zone so as not to disturb the aesthetics. There is a risk of damaging the implant or the connection between the implant and the superstructure. Systematic reviews of the research show that careful polishing of the threads on the implant leaves a sufficient wall thickness and the risk of implant cracking is not significantly increased. With narrow diameter implants, however, it is not recommended to do implantoplasty because further reduction of the diameter impairs the strength of the implant. In addition to mechanical risks, implantoplasty also carries the risk of tissue overheating due to grinding. Again, studies show that copious water cooling during implantoplasty does not lead to an increase in temperature that would cause damage to the surrounding tissue. On the other hand, the risk of the action of particles remaining after grinding in the surrounding tissue is still insufficiently investigated