An Innovative Technique to Help Treat Peri-implantitis
Inside Dentistry provides the latest in endodontics, implantology, periodontics, and more, with in-depth articles, expert videos, and top industry insights.
June 1, 2023
Volume 19, Issue 6, June 2023
Page(s): p. 46
Dennis Tarnow, DDS, and Paul Rosen, DMD, MS
Dennis Tarnow, DDS, and Paul Rosen, DMD, MS, have helped thousands of patients during the course of their decades in practice. However, they are just as proud—if not more so—of the impact that they have had on other clinicians around the world, and by extension, an exponential number of patients. Both Tarnow and Rosen are prolific educators and researchers who have made lasting contributions to the profession. "Whenever you teach someone something and he or she puts it into practice, you touch so many people that way," Tarnow says. "Hopefully, the people that you teach go on to teach another generation. The propagation of knowledge is what it is all about. That's the real key to better quality dentistry—better thinkers and better doers."
Rosen, whose father was a schoolteacher, agrees. "I have always enjoyed the exchange of ideas, but more importantly, education comes down to trying to achieve the best for our patients—not only today but also in our future," he says.
Tarnow and Rosen have known each other for decades too, occasionally lecturing together and serving on panels through the American Academy of Periodontology. Therefore, when Tarnow came up with a new idea for addressing intrabony peri-implantitis defects, one of the first people that he contacted was Rosen. "When we treat an intrabony defect associated with a natural tooth, we root plane the whole tooth," Tarnow says. "Dr. Rosen has done an amazing amount of work treating intrabony defects associated with implants, including using chemicals, debridement, and other methods." Tarnow told Rosen about his idea to remove the threads from the subcrestal portion of affected implants. "The subcrestal threads are difficult to get into when cleaning, and their microscopic surfaces have bacteria," Tarnow says. "Chemicals, titanium brushes, and lasers can accomplish a certain amount, but to really clean out the nooks and crannies, you almost need to eliminate them. We have not seen much research yet regarding what happens if we remove not only the supracrestal threading of the implant, which will be exposed to saliva, but also the subcrestal portion. If we remove the threads from the subcrestal portion and completely get rid of the surface texture, we might be able to predictably eliminate the biofilm that initially caused the peri-implantitis. In addition, elimination of the threads may improve the possibility of getting tissue and bone to re-adhere on a more predictable basis. That is what we are studying now."
According to Tarnow, the issue has been addressed in a number of ways over the years but never by modifying the implant surface texture subcrestally. "What has been reported extensively in the literature is the use of a bur to modify the part of the implant that remains supracrestal above the bone because that is where the soft tissue will be and that is the part that will be exposed to bacteria from the saliva after the healing, assuming that the patient has recession around the implant," he says. "This existing technique does not involve the subcrestal part of the implant; the bony part is not touched. However, modifying this technique to include the subcrestal areas offers the unique potential to not only take away the threads that are laden with bacteria from the disease process but also create a fresh new surface on the implant for the bone to integrate with. This might be the most effective way to create an opportunity for tissue—and hopefully even bone-to adhere to the implant after cleaning."
In order to effectively reach those subcrestal areas, Tarnow knew he needed burs with longer shanks, so he reached out to Brasseler USA. The company responded almost immediately and worked with Tarnow and Rosen to develop the C-Series™ K0429 Tarnow & Rosen: Peri-implantitis Kit. "I have been working with Brasseler's other burs for many years," Tarnow says. "They have almost everything that you could imagine, and this kit was just a perfect extension."
The kit optimizes operational efficiency because it provides the full range of these long shank burs (10 C-Series carbide burs) in a concise block. "This kit really addresses some of the needs that we have in treating peri-implantitis," Rosen says. "The biggest and most difficult hurdle is accomplishing surface decontamination that is effective and predictable. I really feel that these burs provide an advantage in that regard because they include not only a traditional 12-blade standard finishing bur but also a 30-blade ultra-fine one and they come in a variety of shapes—all of which feature extra-long 30-mm surgical-length shanks to provide optimal access and visibility."
Rosen addresses the widespread belief that when an implant loses bone, it will not grow back. "In a number of situations, we cannot regrow the bone because of the implant position," he says. "This kit will allow us to not only treat the subcrestal component with implantoplasty, which no one has really explored until now, but at the same time treat the supracrestal component. This goes a long way toward giving us a more predictable means to control this problem."
Tarnow notes that the technique still requires research. "We need to show its clinical advantages and eventually the histology," he says. "However, the initial results are promising."
Both doctors have started spreading the word. "People are excited about the possibility of this," Rosen says. "Treating implant complications is an increasingly large part of our practices. This kit is a very exciting development because it is giving us the tools that we feel can finally help handle, with greater predictability, the biologic complications that we have been seeing. I just treated a case with this technique, and the surfaces of the implant looked fabulous after using the Brasseler finishing burs. There were no tissue tags, and the implant demonstrated a matte-like finish. It was the best I have seen."
If the development of this technique continues to progress positively, Tarnow and Rosen will have contributed a major improvement to the field of periodontology—which has always been their goal—with the help of Brasseler. "It has been a great collaboration," Rosen says. "Brasseler has listened to us, and they have refined the product, going so far as to redesign their bur blocks to accommodate the longer shank burs. They can see the merits of these longer burs for the future development of surgical products."
"Brasseler has been a great collaborator and partner in this venture, and I am thrilled to be a part of it," Tarnow adds. "We are hoping that this technique becomes a breakthrough in the treatment of peri-implantitis, and we are grateful to Brasseler for developing the burs that we needed."
• The C-Series K0429 Tarnow & Rosen: Peri-Implantitis Kit was developed with Dennis Tarnow, DDS, and Paul Rosen, DMD, MS, to reach the subcrestal areas of intrabony defects when performing implantoplasty.
• The kit contains all 10 C-Series carbide burs that feature an extra-long 30-mm surgical-length FG shank for optimal access and visibility.
• The kit optimizes operational efficiency because it provides all of the products in a concise block, enabling access to a wide range of burs for a variety of cases.
MANUFACTURER INFORMATION
Brasseler
brasselerusa.com
800-841-4522
