• no evidence of radiographic loss of bone beyond bone
both bone/soft tissue
If no baseline, a vertical distance of 2 mm from the expected marginal bone level following remodeling
post-implant placement is recommended as the threshold for diagnosing peri-implantitis
G+ facultative cocci, rods
G- anaerobes in small numbers(increase in disease)
Red: P.ging, Treponema denticola and Tannerella forsythia
Orange: Fusobacterium, Prevotella intermedia
peri-implantitis: S. Aureus, Candida, enteric rods
B-lymph, plasma cells
cytokines IL-1B, 6,8,12, TNFa
Implant bone susceptible because absence of ___
inserting collagen fibers
peri-implantitis risk factors
increased loading time possibly one
clinical consequences peri-implantitis, mucositis
mucositis successful w/o surgery if early
surgery for peri-implantitis unpredictable
Phase I Therapy
Oral Hygiene Instructions
Subgingival Scaling & Root Planing
Re-evaluation and Reassessing the Periodontal Status
____ margin of mand posterior always generate plaque
concave area, bass method
bleeding/tenderness for 2 weeks
shrink in papilla
as the pocket progresses apically
localized areas of root resorption
localized areas of hypomineralization
cementum becomes soft
toxic material gets incorporated into cementum (becoming “diseased cementum”)
_____ has the shortest root trunk most likely tooth to have a furcation involvement
mandibular 1st molar
maxillary molars and maxillary first bicuspids presents root trunk concavities and furcation openings facing the ____ which makes plaque removal difficult.
Palatal concavity on
max lateral incisor
Most Common Areas of Recurrent Pockets
1. maxillary first premolar (mesial aspect)
2. maxillary first molar (mesial aspect)
Mandibular First Molar internal concavity
mesial 0.7mm 100%
distal 0.5mm 99%
Maxillary First Molar internal concavities
MB root presents a 0.3mm concavity in 94% of the extracted teeth studied.
DB root presented insignificant amount of concavity in 31% of the extracted teeth studied.
P presented insignificant amount of concavity in 17% of the extracted teeth studied.
58% of these cases studied, both in the maxillary first molar (buccal) and the mandibular first molar (buccal), the standard Gracey curette blade does not fit into the furcation opening.
Cervical Enamel Projections:
An apical extension of the cemento-enamel junction in the area above the furcation opening
These projections shortens the root trunk, therefore leading to an earlier furcation opening and predisposes the area to furcation lesions
Intermediate Bifurcation Ridge:
A narrow, uneven ridge of enamel which extends from the mesial to the distal root at the furcation opening. Found in 30% of cases studied.
Conclusion: plaque and calculus can accumulate onto this ridge.
Apical Fused Roots:
The apical portion of the roots fuses creating a cul-de-sac like opening between the two roots. Found most often in the maxillary and mandibular second molars.
Conclusion: plaque and calculus accumulates inside this opening, which is impossible to clean or instrument
Accessory Canals in the Furcation Area:
In numerous cases, caries involvement of the pulp can lead to bone loss in the furcation area via the accessory canal. If this bone loss communicates with the oral environment, a periodontal furcation defect can result.
Conclusion: plaque and calculus can contaminate the root surfaces of the furcation area due to bone loss from the pulpal lesion.
Specific biofilm removal (rubber tip, proximal, dry toothbrush)
Scaling and root planing
Soft tissue surgery
Crown / Restoration recontouring
Extraction and Implant placement
spoon looking for furca
CAL (clinical attachment loss) and Radio correlation
health = 0
slight = 1-2mm
moderate = 3-4mm
Radio distance from crest to CEJ (mm)
Goal of Perio therapy:
plaque and calculus-free environment around the dentogingival area
Instrumentation in furcation area is difficult, unpredictable and sometimes impossible
Furcation Area: pocket bounded by root surfaces
Removal of this pocket by resection or regeneration is very unpredictable