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Peri-implantitis can be explained using a multicausality model. Many factors are involved in the etiology of peri-implantitis, but patient compliance also plays a key role. Oral hygiene, attending recall visits, smoking behavior, and therapy comprehension are relevant factors that contribute to peri-implant health. The clinician should create the most optimal conditions for patients to facilitate adequate oral self-care and to help patients improve their oral hygiene skills. Implementation of a supportive periodontal therapy program is mandatory to control inflammation and plaque accumulation, as well as to keep the incidence of peri-implant diseases low. Patient compliance, including plaque control and dental follow-up, must be optimal. Consequently, precautions must be taken with patients treated with dental implants. ispartof: PERIODONTOLOGY 2000 vol:81 issue:1 pages:209-225 ispartof: location:Denmark status: published

The widespread use of oral implants in recent years has resulted in various types of complications. One of those complications is the periapical implant lesion. Different factors have been proposed to play a role in the development and emergence of a periapical implant lesion. To date, there is no consensus on the etiology and therefore periapical lesions around dental implants are considered to have a multifactorial etiology. The diagnosis of an implant periapical lesion should be based on both clinical and radiological findings. Additionally, in order to apply the best treatment strategy the evolution of the lesion should be taken into account. The treatment of this kind of lesion, however, is still empiric. Data, primarily from case reports, seem to indicate that the removal of all granulation tissue is a first step to arrest the progression of the bone destruction. The removal of the apical part of the implant seems a valuable treatment strategy.

Despite etiological differences between aggressive and chronic periodontitis, the treatment concept for aggressive periodontitis is largely similar to that for chronic periodontitis. The goal of treatment is to create a clinical condition that is conducive to retaining as many teeth as possible for as long as possible. When a diagnosis has been made and risk factors have been identified, active treatment is commenced. The initial phase of active treatment consists of mechanical debridement, either alone or supplemented with antimicrobial drugs. Scaling and root planing has been shown to be effective in improving clinical indices, but does not always guarantee long-term stability. Antimicrobials can play a significant role in controlling aggressive periodontitis. Few studies have been published on this subject for localized aggressive periodontitis, but generalized aggressive periodontitis has been subject to more scrutiny. Studies have demonstrated that systemic antibiotics as an adjuvant to scaling and root planing are more effective in controlling disease compared with scaling and root planing alone or with supplemental application of local antibiotics or antiseptics. It has also become apparent that antibiotics ought to be administered with, or just after, mechanical debridement. Several studies have shown that regimens of amoxicillin combined with metronidazole or regimens of clindamycin are the most effective and are preferable to regimens containing doxycycline. Azithromycin has been shown to be a valid alternative to the regimen of amoxicillin plus metronidazole. A limited number of studies have been published on surgical treatment in patients with aggressive periodontitis, but the studies available show that the effect can be comparable with the effect on patients with chronic periodontitis, provided that proper oral hygiene is maintained, a strict maintenance program is followed and modifiable risk factors are controlled. Both access surgery and regenerative techniques have shown good results in patients with aggressive periodontitis. Once good periodontal health has been obtained, patients must be enrolled in a strict maintenance program that is directed toward controlling risk factors for disease recurrence and tooth loss. The most significant risk factors are noncompliance with regular maintenance care, smoking, high gingival bleeding index and poor plaque control. There is no evidence to suggest that daily use of antiseptic agents should be part of the supportive periodontal therapy for aggressive periodontitis. ispartof: Periodontology 2000 vol:65 issue:1 pages:107-33 ispartof: location:Denmark status: published

ispartof: Periodontology 2000 vol:48 issue:1 pages:111-147 ispartof: location:Denmark status: published

Bad breath (halitosis) is an important social complaint. In most cases (≥90%), the cause of halitosis can be found within the oral cavity. Under this circumstance, the term oral malodor applies. It affects both healthy and periodontally diseased individuals. Oral malodor is mainly caused by a microbial degradation of both sulfur-containing and nonsulfur-containing amino acids into volatile, bad-smelling gases. Anaerobic gram-negative bacteria, the same species that have been linked to periodontal diseases, are especially involved in this process, explaining why clinicians often associate oral malodor with periodontitis. Some volatile organic compounds render patients more susceptible to periodontitis and this supports the malodor-periodontitis link. This review investigates the interaction between oral malodor and periodontal diseases. Pro and con arguments regarding the mechanisms of halitosis and clinical implications will be presented. In general, however, the impact of tongue coatings has been found to be the dominant factor, besides gingivitis and periodontitis. The last part of this review discusses the treatment of bad breath, with different options. ispartof: Periodontology 2000 vol:71 issue:1 pages:213-227 ispartof: location:Denmark status: published

Implant placement has become a well-established and highly successful therapy in the rehabilitation of partially and fully edentulous patients. The 'original' treatment protocol, which aimed to demonstrate implant 'biocompatibility' and the achievement of osseointegration, has evolved over the past 40 years into a broader treatment approach in which the esthetic and patient-related objectives have become the main focus. This volume of Periodontology 2000 summarizes, via narrative reviews, the advantages and disadvantages of this evolution in implantology and offers recommendations on where and when to apply the new therapeutic protocols, without jeopardizing the outcome for the patient. It also discusses current treatments of the most common implant-associated complications. Many of the implant innovations and new therapeutic protocols are supported by evidence-based knowledge and have provided clear benefits for both the patient and the clinician. ispartof: Periodontology 2000 vol:66 issue:1 pages:7-12 ispartof: location:Denmark status: published

For computer-guided surgery a static surgical guide is used that transfers the virtual implant position from computerized tomographic data to the surgical site. These guides are produced by computer-aided design/computer-assisted manufacture technology, such as stereolithography, or manually in a dental laboratory (using mechanical positioning devices or drilling machines). With computer-navigated surgery the position of the instruments in the surgical area is constantly displayed on a screen with a three-dimensional image of the patient. In this way, the system allows real-time transfer of the preoperative planning and visual feedback on the screen. A workflow of the different systems is presented in this review. ispartof: Periodontology 2000 vol:66 issue:1 pages:214-27 ispartof: location:Denmark status: published

Intra-oral and panoramic radiographs are most frequently used in oral health care. Yet, the inherent nature of jaws and teeth renders three-dimensional diagnosis essential, especially in relation to oral surgery. Nowadays, this can be accomplished by dental cone beam computed tomography, which provides high-quality images at low radiation doses and low costs. Nonetheless, the effective dose ranges of cone beam computed tomography machines may easily vary from 10 to 1000 μSv, this being equivalent to two to 200 panoramic radiographs, even for similar presurgical indications. Moreover, the diagnostic image quality varies massively among available machines and parameter settings. Apart from the radiodiagnostic possibilities, dental cone beam computed tomography may offer a vast therapeutic potential, including opportunities for surgical guidance and further prosthetic rehabilitation via computer-aided design/computer-aided manufacturing solutions. These additional options may definitely explain part of the success of cone beam computed tomography for oral implant placement. In conclusion, dental cone beam computed tomography imaging could be justified for oral implant-related diagnosis, planning and transfer to surgical and further prosthetic treatment, but guidelines for justification and cone beam computed tomography optimization remain mandatory. ispartof: Periodontology 2000 vol:66 issue:1 pages:203-13 ispartof: location:Denmark status: published

Different computer-assisted implant-placement procedures are currently available. These differ in software, template manufacture, guiding device, stabilization and fixation. The literature seems to indicate that one has to accept a certain inaccuracy of ±2.0 mm, which seems large initially but is clearly smaller than for nonguided surgery. A reduction of accuracy to below 0.5 mm seems extremely difficult. A common shortcoming identified in the studies included in this review is inconsistency in how clinical data and outcome variables are reported. Another limitation is the small number of comparative clinical studies. In order to find the best guiding system or the most important parameters for optimal accuracy, more randomized clinical trials are necessary. Information on cost-effectiveness and patient-centered evaluations (i.e. questionnaires and interviews) must also be included.