Does it exist at the Osseo integration?
When we opted for surgical treatment (opening retail and direct access to the implant) in a peri-implant, the first step is to determine whether the implant is able to remain in the mouth or whether it should be removed. In short, when more than two thirds of the length of the implant already suffered bone resorption, this implant must be removed. In other situations, one can perform a predictable surgical treatment that would maintain the implant in the mouth health. One of these treatments are bone grafts and membranes used in an attempt to regain what was lost. We call this the guided bone regeneration for the reosseointegração.
The reosseointegração is a phenomenon that occurs after the implant treatment of peri-implant disease. Actually, after the therapy, what is required is that the newly formed bone osseointegre again the threads of the implant were decontaminated, reproducing the situation that existed before the peri-implant disease. It would be the same reasoning we do when we performed a guided tissue regeneration in periodontology. However, like natural teeth, dental implants in this regeneration is also difficult to occur.
After the complete decontamination of surfaces of implants, surgical therapy may be given as complete once the infection has been removed. However, there are studies that were able to demonstrate some potential reosseointegração on implants that had periimplantitis and were adequately treated. Several techniques have been used for this purpose, but we have achieved success over those that were used for guided bone regeneration.
However, when it comes to implants, the surfaces thereof may also play a role in this process. There seems to be agreement between the authors with respect to the machined surfaces that have low reosseointegração rate compared to treated surfaces, which respond best to therapy with bone grafts, allowing perhaps a reosseointegração.
Another aspect to be considered in therapy are the chemicals that we apply the implants before we put the bone graft. The saline, citric acid, hydrogen peroxide and digluconate chlorhexidine, which are used as decontaminating agents have only had their action related to reosseointegração when associated with guided bone regeneration procedures, namely: only the chemical decontamination offers not reosseointegração. But do we really need this reosseointegração?
It is still very difficult to obtain and proven. The total proven only occurs through difficult histological methods to quantify and perform clinically. The clinical way we used to see if there was a really reosseointegração are the postoperative periapical radiographs and the absence of clinical signs of inflammation. However, an X-ray can only show that there was an increase in bone density around the implants, but does not prove that the bone is in close contact with the surface of this implant and re-instated him.
So we should keep in mind that the primary goal of treatment of peri -implant is the decontamination of the area and the interruption of progressive bone loss. The absence of clinical signs of inflammation ( increased probing depth and bleeding and / or suppuration the survey ) and bone loss in the parade will offer a clinical conclusion that the treatment worked and the implant need not be removed .
Removal of the infectious process can enable formation of a fibrous connective tissue on these threads. This will promote a biological tissue sealing , preventing the progress of periimplantitis and restoring the health of hard and soft tissue . Therefore, we maintain the implant in the mouth, even though a portion of the peri-implant bone has been lost . For this to occur , there is no need to reosseointegração , though it is very welcome .
Source: INPN, by Marco Bianchini