Peri-implantitis: Prevention and Management

Faculty: Dr. Hom-Lay Wang, DDS., MSD., Ph D.

March 25 2023

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Abstract: Implant complications have become a major challenge for many dentists who placed implants. This lecture is designed to help dentists who placed or restored implant understand what’s new in implant complications, how to avoid these problems and how to predictably mange this emerging concern. Recent research findings of how surface coating or the titanium particles or restorative designs influence the incidence of implant complications will be discussed. Specifically, the link between restorative designs (e.g., crown contour, distance between crown margin and fixture bone level, residual cement, occlusion…etc) and implant complications will be thoroughly explored. In addition, this lecture will provide the mechanisms (e.g., surgically triggered, prosthetically triggered and biological induced implant complications) of how implant bone loss and implant failure occurred. Specifically, how to manage implant esthetic and biological complications using submerged (EP-DDS) or non-submerged surgical protocol will be demonstrated. Three decision trees (implant biological complication management, implant treatment based upon defect morphology and implant soft tissue recession classification and proposed management) will be proposed. The treatments for implant diseases/complications include: chemotherapeutic agents, lasers de-contamination, apically positioned flap with or without implantoplasty, implant surface detoxification, lasers, guided bone regeneration, soft tissue grafts (conditioning), implant removal as well as re-implantation will be thoroughly discussed.

Learning Objectives

• Recognize predisposing and precipitating factors associated with peri-implant complications

• Learn how to prevent future implant complications

• Recognize restorative related predisposing factors associated with peri-implant complications

• Learn how to prevent restorative related implant complications via implant placement and careful restorative reconstruction

• Understand what is supracrestal tissue adhesion around dental implants in both tissue and bone level implants.

• Know how to select proper treatment for different implant complications

• Learn EP-DDS guided bone regeneration protocol to predictably regenerate peri-implantitis defects

Course Outline

0900 – 1015 hrs: Definition of new implant diseases (peri-implant mucositis and peri-implantitis) as well as to understand the etiology associated implant complications (surgically triggered, prosthetically triggered and biological triggered implant complications)

1015 – 1045 hrs: Coffee Break

1045 – 1200 hrs: How to prevent common implant complications?

Position, Surface coating, Restorative designs and other factors considerations

1200– 1300 hrs: Lunch

1300 – 1415 hrs: Biologic implant complications and management - I

- Implant surface detoxification, surgical management, submerged (EP-DDS) and non-submerged GBR

1415 – 1445 hrs: Coffee Break

1445 – 1600 hrs: Biologic implant complications and management - II

- Implantoplasty, soft tissue conditioning and remove implant

1600 – 1630 hrs: Questions and summary

Dr. Hom-Lay Wang, DDS., MSD., Ph D.

Hom-Lay Wang, DDS., MSD., Ph D, Professor and Director of Graduate Periodontics at the University of Michigan. Dr. Wang has been with the University of Michigan, School of dentistry since 1989 and is appointed to be the Director of Graduate Periodontics since 1995. He received his DDS from Taipei Medical College, Taipei, Taiwan, DDS, MSD from Case Western Reserve University, Cleveland, Ohio and Ph D from Hiroshima University, Japan. He has co-editor three textbooks, published more than 50 book chapters/invited reviews and more than 770 peer-reviewed scientific articles.
Dr. Wang currently serves as a member of Task Force as Future Science Strategy for the American Academy of Periodontology (AAP), President-Elect of the Academy of Osseointegration (AO). Dr. Wang is a Diplomate and a Former Chair and Director of the American Board of Periodontology, a Fellow of American College of Dentists as well as a Fellow and a Former Board of Director of AO, a Diplomate and Former President and Board Director of the ICOI, a former President of Midwest Society of Periodontology. former Consultant for the ADA Commission on Dental Accreditation, former AAP committee member of Continuing Education Oversight Committee, Scientific Oversight Committee, Leadership, and Development Committee, Nevins Teaching and Clinical Research Fellowship Selection Committee, Task Force on Annual Meeting Innovation, In-Service Examination Committee and Research Submissions Subcommittee, a former member and Chair of Website Online Education Committee Member as well as a member of Clinical Innovation Committee for the AO, a former member of the Scientific Information Committee for the AADR and have also served on more than 30 different Committees at University of Michigan. He currently serves as a visiting professor at Taipei Medical University, Taiwan, Peking University, Xiamen Stomatology Hospital and West China University, China and many others.
Dr. Wang serves as a Co-Editor-in-Chief for Clinical Implant Dentistry and Related Research, an Associate Editor for The International Journal of Oral & Maxillofacial Implants, International Journal of Oral Implantology, eJournal of Oral & Maxillofacial Research, Section Editors for Journal of Esthetic and Restorative Dentistry and Founding Editorial board member for Clinical Advances in Periodontics, Editorial Board member for the Journal of Periodontology, International Journal of Oral Science, Clinical Oral Implants Research, International Journal of Periodontics & Restorative Dentistry, Journal of Clinical Periodontology, Periodontology 2000, and many others.
Dr. Wang’s research focuses on guided tissue/bone regeneration in attempts to repair and/or regenerate various periodontal and implant-related defects as well as oral plastic surgery. Because of his expertise in regeneration and manage of peri-implantitis, he is the author of AAP position paper entitled “Periodontal Regeneration” and a member of task force to develop the white paper on peri-implantitis. He is a constant participant for many AAP, AO and FDI consensus conferences, summits, best evidence consensus as well as a member for developing “World Workshop for Classification of Periodontal and Peri-implant Diseases and Conditions” in 2017.
Dr. Wang is the recipient of many awards/honors including but are not limited to: AADS clinical research fellowship award (1992), Best Faculty Award (2003), The Charles E. English Annual Award in Clinical Science and Techniques (2004), Best papers in Journal of Oral Implantology (2004) and Implant Dentistry (2004), Morton L. Perel Annual Award for Dental Implant Educator (2007), AAP University of Michigan Outstanding Teaching and Mentoring in Periodontics (2010), ITI Andre Schroeder Research Prize (2014), AO Osseointegration Foundation Clinical Research Recipient (2016), AAP Outstanding Educator Award (2017), AAP Distinguished Scientist Award (2017), ADEA William J. Gies Annual Periodontology Award (2018), University of Michigan Distinguished Faculty Research Mentoring Award (2019), AAP Master Clinician Award (2019), AAP Distinguished Service Award (2021), AAP Clinical Research Award (2021) and ADEA William J. Gies Annual Periodontology Award (2022).