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Semelhanças e diferenças entre periodontite e peri-implantite : revisão narrativa
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Advisor(s)
Abstract(s)
A Periodontite é uma doença crónica inflamatória multifatorial associada a um biofilme disbiótico e caracterizada pela destruição progressiva do aparelho de suporte do dente.
A peri-implantite é uma patologia associada à placa bacteriana que se desenvolve nos tecidos em redor dos implantes dentários. Caracteriza-se pela inflamação da mucosa periimplantar e subsequente perda progressiva do osso de suporte.
Apesar das semelhanças entre as duas doenças, existem diferenças importantes a nível anatómico, imunológico e microbiológico. A periodontite tem uma prevalência estimada de 50% na população adulta, sendo a sua forma severa considerada a sexta doença mais prevalente a nível global. A peri-implantite, por sua vez, afeta cerca de 20% dos portadores de implantes, segundo revisões recentes.
A microbiota associada a ambas é composta por bactérias anaeróbias, mas a periimplantite pode envolver espécies adicionais, como Peptostreptococcus spp. e Staphylococcus spp.. Os tecidos peri-implantares diferem dos periodontais por não apresentarem cemento nem ligamento periodontal, por terem menor vascularização e por possuírem um epitélio juncional mais longo, sem fibras colagénicas de inserção direta.
Do ponto de vista clínico, os tecidos peri-implantares saudáveis não se distinguem visualmente dos periodontais, embora as sondagens ao redor de implantes sejam geralmente mais profundas. Contudo, no caso dos implantes, não se define uma profundidade "normal", sendo os sinais de inflamação o principal critério diagnóstico.
A resposta imunológica na peri-implantite tende a ser mais agressiva, com maior infiltração inflamatória e perda óssea mais rápida. No que diz respeito ao tratamento, a periodontite dispõe de protocolos bem definidos e eficazes nas fases de controlo do biofilme.
Já na peri-implantite, a evidência científica para o sucesso terapêutico ainda é limitada, sendo o principal objetivo a descontaminação da superfície do implante.
Periodontitis is a chronic multifactorial inflammatory disease associated with a dysbiotic biofilm and characterised by the progressive destruction of the tooth's supporting apparatus. Peri-implantitis is a pathology associated with bacterial plaque that develops in the tissues around dental implants. It is characterised by inflammation of the peri-implant mucosa and subsequent progressive loss of the supporting bone. Despite the similarities between the two diseases, there are important anatomical, immunological and microbiological differences. Periodontitis has an estimated prevalence of 50 per cent in the adult population, and its severe form is considered the sixth most prevalent disease globally. Peri-implantitis, on the other hand, affects around 20 per cent of implant wearers, according to recent reviews. The microbiota associated with both is composed of anaerobic bacteria, but periimplantitis can involve additional species such as Peptostreptococcus spp. and Staphylococcus spp. Peri-implant tissues differ from periodontal tissues in that they have no cementum or periodontal ligament, less vascularisation and a longer junctional epithelium with no collagen fibres for direct insertion. From a clinical point of view, healthy peri-implant tissues are not visually distinguishable from periodontal tissues, although probing around implants is generally deeper. However, in the case of implants, a "normal" depth is not defined, and signs of inflammation are the main diagnostic criterion. The immunological response in peri-implantitis tends to be more aggressive, with greater inflammatory infiltration and faster bone loss. As far as treatment is concerned, periodontitis has well-defined and effective protocols in the biofilm control phases. In periimplantitis, the scientific evidence for therapeutic success is still limited, and the main objective is to decontaminate the implant surface.
Periodontitis is a chronic multifactorial inflammatory disease associated with a dysbiotic biofilm and characterised by the progressive destruction of the tooth's supporting apparatus. Peri-implantitis is a pathology associated with bacterial plaque that develops in the tissues around dental implants. It is characterised by inflammation of the peri-implant mucosa and subsequent progressive loss of the supporting bone. Despite the similarities between the two diseases, there are important anatomical, immunological and microbiological differences. Periodontitis has an estimated prevalence of 50 per cent in the adult population, and its severe form is considered the sixth most prevalent disease globally. Peri-implantitis, on the other hand, affects around 20 per cent of implant wearers, according to recent reviews. The microbiota associated with both is composed of anaerobic bacteria, but periimplantitis can involve additional species such as Peptostreptococcus spp. and Staphylococcus spp. Peri-implant tissues differ from periodontal tissues in that they have no cementum or periodontal ligament, less vascularisation and a longer junctional epithelium with no collagen fibres for direct insertion. From a clinical point of view, healthy peri-implant tissues are not visually distinguishable from periodontal tissues, although probing around implants is generally deeper. However, in the case of implants, a "normal" depth is not defined, and signs of inflammation are the main diagnostic criterion. The immunological response in peri-implantitis tends to be more aggressive, with greater inflammatory infiltration and faster bone loss. As far as treatment is concerned, periodontitis has well-defined and effective protocols in the biofilm control phases. In periimplantitis, the scientific evidence for therapeutic success is still limited, and the main objective is to decontaminate the implant surface.
Description
Dissertação para obtenção do grau de Mestre no Instituto Universitário Egas Moniz
Keywords
Periodontite Peri-implantite Implantes dentários Periodonto