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Implant And Other Prosthesis Related Microflora Changes

INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com

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Contents Introduction Microbial colonization of the mouth Microbiota around stable implants Microbiota around failing implants Effect of mucosal clinical variables and bone level on microflora Other prosthesis related microflora changes Conclusion References www.indiandentalacademy.com


Introduction Microorganisms are continuously introduced into the oral cavity. Grouping of organisms at sites in which they can flourish and establishment in different niches.

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Introduction As more species become established , the opportunity for new species becomes limited and a degree of stability may be attained. Upon the insertion of prosthesis this stability may be disrupted.

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Microbial Colonization of the Mouth

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Gram +ve cocci & rods o . S

s i l ra

s o r c i P.m ae i r e s nc e r e g

A. naeslundii A.

Gram -ve anaerobic rods (13%)

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Microbial colonization of the mouth

Decreased Cocci and increased No. of Motile Rods And Spirochetes www.indiandentalacademy.com


Microbial colonization of the mouth Porphyromonas Gingivalis, A.actinomycetemcomitans Bacteroides Forsythus, And Species Of Prevotella, Fusobacterium, Campylobacter & Treponema Have Been Detected

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Microbial colonization of the mouth Other bacteria associated with periodontal destruction include: – Fusobacterium nucleatum – Campylobacter rectus – P micros – Treponema denticola – Treponema vincentii www.indiandentalacademy.com


Microbial colonization of the mouth Following full mouth tooth extraction, changes occur in the tissues and / or surfaces that are available for microorganism adherence. When patients with severe periodontits become edentulous, A actinomycetemcomitans and P gingivalis are no longer detectable www.indiandentalacademy.com


Microbial colonization of the mouth Within a month after full mouth tooth extraction, suggesting that their primary habitat is the dentition or the periodontal sulcus. Furthermore, a marked reduction or even elimination of Spirochetes, as well as a reduction in Lactobacilli, yeasts , Streptococcus mutans, and www.indiandentalacademy.com


Microbial colonization of the mouth Streptococcus sanguis occurs in edentulous adults with or without conventional removable dentures compared to dentate patients. Seems that no significant periodontopathic flora capable of constituting a risk factor for implants,is left after full mouth extraction. www.indiandentalacademy.com


Microbiota Around Stable Implants

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Microbiota of Stable Implants Gram Positive Facultative Cocci Non Motile Rods

S sanguis and S mitis are the most predominant organisms www.indiandentalacademy.com


Microbiota of Stable Implants INFREQUENT Motile Rods Spirochetes, Fusiforms & Filaments

A actinomycetemcomitans & P gingivalis seldom detected P intermedia and P nigrescens are ďƒ  more common www.indiandentalacademy.com


Microbiota of Stable Implants The microflora that is present in the oral cavity before implant placement determines the composition of the newly establishing microflora around implants. Implants with signs of deterioration show a microbiota resembling that of adult or refractory periodontitis. www.indiandentalacademy.com


Microbiota Around Failing Implants

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B.forsythus P. gingivalis P. intermedia Spirochetes Gram negative anaerobic rods

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P intermedia P.micros Fusobacteria C.rectus


Microbiota of Failing Implants Presence of periodontal pathogens

Development of Peri-implantitis Presence of other co-factors is required as well. Local or systemic circumstances are needed

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Microbiota of Failing Implants It seems realistic to conclude that it is possible to place implants with acceptable rates in periodontal patients as long as the number of potential periodontal pathogens is kept at a low level and co-factors are in normal limits.

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Effect of Mucosal Clinical Variables and Peri-implant Bone Level

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Effect of Mucosal Clinical Variables and Peri-implant Bone Level Plaque Index, Bleeding Index, Gingival Index, Probing Pocket Depth

Probing Pocket Depth

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Effect of Mucosal Clinical Variables and Peri-implant Bone Level Few studies have reported on the microbiota of implants with peri-implant bone defects. -could not be related specifically to the presence of certain microorganisms, but certain microorganisms were detectable or present at higher levels in perimplant bone defects www.indiandentalacademy.com


Effect of Mucosal Clinical Variables and Peri-implant Bone Level Local circumstances ( oral hygiene, bone defects, deep pockets, overload) as well as systemic conditions (diabetes, smoking, genetic factors) maybe contributing factors.

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Effect of Mucosal Clinical Variables and Peri-implant Bone Level Hypothesis postulated Microorganisms act as promoters or catalysts in implant failure, but they need a suitable environment.

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Other Prosthesis Related Microflora Changes

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C. albicans most frequent (62.1% )

Gram-positive cocci C. albicans, C. glabrata and C. tropicalis

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Other Prosthesis Related Changes Plaque Index And The Frequency Of Yeasts Patients With Prosthetic Stomatitis

Higher

Patients Without Prosthetic Stomatitis

Lower

Candida albicans was 10 times higher in DIS patients www.indiandentalacademy.com


Other Prosthesis Related Changes Staph. aureus

S sanguis S mutans Lactobacilli www.indiandentalacademy.com


Cocci

Filamentous

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Motile Forms

Spirochetes

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Stable Implants

S sanguis and S mitis MOST PREDOMINANT P intermedia and P nigrescens are more common Gram Positive Facultative Cocci Non Motile Rods INFREQUENT Motile Rods Spirochetes, Fusiforms & Filaments; A actinomycetemcomitans & P gingivalis ďƒ  seldom detected

Failing Implants

P intermedia, Fusobacteria and spirochetes P micros, P intermedia, C rectus, species

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Conclusion The microflora of the oral cavity prior to implantation determines the composition of the flora in the periimplant area. The microflora around stable implants resembles that of the subgingival flora of healthy dentate patients. www.indiandentalacademy.com


Conclusion microflora of peri-implantitis lesions resembles that of adult or refractory periodontitis. Potential pathogens present in the oral cavity do not necessarily act as periimplant pathogens

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Conclusion Various prosthesis may provide means of mechanical attachment to the microflora. This in turn allows their aggregation and colonization Bielby’s layer or providing smooth polished surfaces may reduce microbial colonization. www.indiandentalacademy.com


References Microbiota around root form endosseous implants: a review of literature Int j Oral Maxillofac Implants 2002; 17:829-38 The oral microbiota of man from birth to senility. J Periodontol 1971;42:485-96 Short term effect of full mouth extraction on periodontal pathogens colonizing the oral mucous membranes. J Clin Periodontol 1994;21:484-89 Development of dental plaque on epoxy resin crowns in man. A light and electron microscopic study. J Periodontol.1975;46:10-26 Bacterial involvement in denture induced stomatitis. J Dent Res 1988 ;67(9):1246-50 www.indiandentalacademy.com


References Denture plaque- past and recent concerns. J Dent.1998;26(4):299-304. Are certain oral pathogens part of normal oral flora in denture wearing edentulous subjects? Oral-Microbiol-Immunol.1991;6(2):119-22 Cultivable microflora of plaque from full denture bases and adjacent palatal mucosa. J-Biol-Buccale.1985;13(3)227-36

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Implant microflora dental implants course/ dental implant courses by Indian dental academy