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Interview on national television to Dr. Martelli about peri-implantitis
I - Welcome back to Uno Mattina Estate
health segment, we're talking about dental disease
an infection which is very widespread and strikes
those who have braces, implants, or dentures.
We're speaking with Dr. Francesco Martelli
MD, dentist, and of course dental surgeon.
The word itself "peri-implantitis", what does it mean?
Can you tell us briefly what it means?
Dr - In brief
implants are small titanium screws
which replace the roots of the missing teeth.
Peri-implantitis is an infection that strikes
the support bones and tissue that surround these implants.
I - So the numbers are important
because it means 600,000 people have an implant;
in Italy every year there are 600,000
so the risk is very high.
So let's listen to Caterina Laurenzi
who will tell us a little bit about it
Then we will return to the heart of this topic.
The enemy of dental implants is called peri-implantitis
and it is an infection.
It strikes the tissues that surround the dental prosthesis
causing the reabsorption of the support bone
and the loss of the reconstructed tooth.
Peri-implantitis is caused by
the same bacteria as periodontisis
herefore it is caused mostly by inadequate oral hygiene
but is also due to genetic predisposition.
When periodontal bacteria are present in the oral cavity
contamination of the implant's surface occurs
almost always within a few hours
after the surgical placement of the implants.
Scientific studies have demonstrated
how high the incidence of peri-implantitis is in the world
it fluctuates between 38 and 60%.
In Italy alone, for example about 600,000 dental prostheses
are used every year.
Our country is the leader for the treatment and prevention of this disease
thanks to the use of new technologie and equipment
such as the laser and the operating microscope
which are being used more and more even abroad.
I - Doctor, we heard from Caterina Laurenzi
that oral hygiene is the minimum precaution we can take.
How do you know you are affected?
What are the symptoms of this peri-implantitis?
Dr - The symptoms are:
redness, edema of the gums surrounding the implants
and suppuration (pus formation and discharge).
At a certain point this infection evolves
into an actual suppuration
and so the discharge of pus from the gums around the implant
is unequivocally a sign of peri-implantitis.
I - An abscess is produced, then comes a fever
are there also cases of this...? Dr -- No, there is no fever
however, when this mechanism is activated
the bone is slowly reabsorbed.
If the implant loses the property of osseointegration
the direct and intimate connection between the bone and the implant
it must be removed at a certain point.
I - Is it possible to prevent? We heard some basic advice
before in the report what else can we do?
Dr - The first thing to do is to evaluate its presence
before the insertion of the implants
the presence of a periodontisis and consequently
treat it if it is there.
The bacteria, as I like to say
live in the Schengen area.
When they are in the mouth
they don't need passports to move from
one tooth to the other.
in fact we conducted a study that demonstrated
that they pass from one mouth to another.
So if I have bacteria around the teeth
if they are not eliminated before putting in implants
I will easily have these bacteria around the implants.
I - We have certified that the disease is there
what is the treatment at that point?
Dr - he therapy for peri-implantitis is, so far, not set down, it's unclear
however we have developed a therapeutic protocol with the laser
and we have published it
so the surface of the implant which is titanium is decontaminated
in a very effective way by different types of lasers.
I - Naturally whoever gets an implant has expenses
and then in some cases this disease may occur.
At that point what happens?
Is there the risk that this implant is lost?
Dr - Yes, the real risk is exactly that
and we must always start off with the idea
that implantology is a very economically expensive procedure.
When we lose the implant the cost becomes also biological
because we also lose a lot of bone.
So we have the cost of the operation
the cost of the prosthetic rehabilitation
and we have to start again from square one.
Very often these implants are found in elderly patients
who have an extreme need to chew
in order to avoid an impoverished diet
and therefore it is understood
that starting again with a continuation... I - Because at that point you must...
you need a so-called bone transplant
you must reconstruct the bone. Dr - You have to go
and reconstruct the bone with very invasive surgical operations
very difficult ones
therefore doing this to a young person
may make sense from a procedural point of view
doing this to an elderly person is much more complicated.
I - Naturally an implant is a...
it's called an implant because it gives us a certain guarantee.
If this risk were to appear, at that point
for an elderly person is it better to have dentures or implants?
Dr - In my opinion implants are always the best solution
however they should be put in
after a preliminary evaluation
regarding the presence of these periodontal bacteria
that are the same bacteria which later cause peri-implantitis.
So a few small measures would be enough
to lower the risk factor of this phenomenon significantly.
I - You were speaking about the elderly
who are watching us in a large number at this hour.
Is there an age limit after which you say "it's better to forget about implants"?
Since implants is also a bit of an invasive procedure.
Dr - No, absolutely not.
I've put implants even in hundred year old patients
actually, the older you get the more advisable the use of implants is
because these are the patients who have
an extreme need to avoid an impoverished diet
which automatically happens in the instant that there is
difficulty chewing because certain foods get eliminated.
I - One of the first consequences of aging is precisely the teeth
the smile, but also proper chewing.
Dr - The teeth and the bone
because the implants and the teeth are in the bone
but an impoverished diet could compromise or raise
the risk even from a general standpoint.
Let's not forget that osteoporosis is a very serious problem
and most fractures in the elderly, femoral fractures
crushed vertebra, is tied to the problem of osteoporosis.
I - Great.
Thank you Dr. Francesco Martelli for this thorough explanation.