ABSTRACT
The regeneration of soft and hard tissues around dental implants naturally happens following implant placement, and is also the goal in treatment of peri-implantitis as a restitutio ad integrum. A thorough understanding of the morphology of the tissues surrounding dental implants and differences compared to natural teeth is essential
8.1 Introduction .................................................................................................. 161 8.2 Morphologic Background of Periodontal and Peri-Implant Tissues ............ 162 8.3 Biological Implications of Implant Surface ModiŒcations ........................... 165
8.3.1 Enossal Implant Portion.................................................................... 165 8.3.2 Transmucosal Implant Compartment ............................................... 166
8.3.2.1 Surface Roughness in Transmucosal Implant Portion ....... 167 8.3.2.2 Geometric Designs and Abutment Materials in
Transmucosal Implant Compartment ................................ 168 8.4 Etiology and Risk Factors of Periodontitis and Peri-Implantitis .................. 168
8.4.1 DeŒnition of Peri-Implantitis and BioŒlm as Major Etiologic Factor ................................................................................. 168
8.4.2 Risk Factors ...................................................................................... 170 8.4.3 Iatrogenic Factors ............................................................................. 171
8.5 Diagnosis ...................................................................................................... 172 8.6 Treatment of Peri-Implant Diseases ............................................................. 173
8.6.1 Initial Nonsurgical Treatment for Infection Control ........................ 173 8.6.2 Surface Decontamination in Nonsurgical and Surgical Treatment ........175 8.6.3 Surgical Peri-Implantitis Therapy .................................................... 176
8.7 Healing After Periodontal and Peri-Implantitis Therapy ............................. 179 8.8 Conclusions and Consequences for Future Surface Developments .............. 180 References .............................................................................................................. 181
in compiling an adequate treatment strategy for diseased sites. Furthermore, options for future developments should be based on this knowledge. Current therapeutic concepts have been derived mainly from periodontitis treatment and focus on the removal of the bioŒlm as the major disease etiology, combined with the debridement and decontamination of the involved surface areas. Although nonsurgical approaches are less successful in peri-implantitis therapy due to the limited access to the undercuts of the screw-shaped implants and the circumferential defect morphologies, they serve as the mandatory initial treatment phase. After this nonsurgical pretreatment, surgical interventions aim at a resolution of the infection and are either conducted as a resective or a regenerative approach.
