Patients with partial or complete edentulism are encouraged (when possible) to have dental implants placed, due to their versatility in treatment options and high success and patient satisfaction rate. While dental implants will restore a patient back to significantly improved functionality and reduce their risk of developing additional issues that increase in likelihood when teeth are missing, periodontal issues can still develop over time, especially if proper oral hygiene is not practiced. One of the most common complication associated with dental implants is per-implant disease, an inflammatory reaction that occurs in response to the buildup of bacteria. One of the biggest dangers of peri-implant disease is that it happens very gradually and does not cause any pain or display any symptoms until it has already progressed to the point of causing enough damage that the implant may need to be removed.
There are two stages of peri-implant disease: peri-implant mucositis and peri-implantitis. Peri-implant mucositis is the early stage of peri-implant disease and does not affect the supporting bone, only the soft tissues that surround the dental implant. If peri-mucositis is not treated, it will eventually progress to peri-implantitis. At this stage, the bone supporting the dental implant will start to be affected in addition to the soft tissues around the implant. If this issue is not treated quickly enough, the implant can fail due to the loss of too much bone.
This inflammatory process occurs due to glycoproteins adhering to surfaces of the titanium, which forms a biofilm that results in infections. It is estimated that peri-implant mucositis will occur in approximately half of all patients, although the real number may be much higher, as many cases may not be reported. Fortunately, if identified at the peri-implant mucositis stage, the biofilm that has formed on the implant surfaces can typically be removed and the implant can be saved.
Peri-implant disease can be diagnosed during a clinical examination, during which your periodontist will use a probe to measure the depth of your pockets. If the pockets are deeper than 4 mm, this indicates that peri-implant disease has developed. Common signs of peri implant disease include:
- Sensitivity and bleeding on probing
- Edema
- Hyperplasia
- Redness
- Pus discharge from the implant site
- Gum recession
To determine a diagnosis of peri-implantitis, it will be necessary to compare baseline radiographs from the time of your initial placement. If this radiograph indicates 2 mm of bone loss or more, this may indicate that peri-implantitis has developed.
Factors That May Inhibit Your Ability to Get Dental Implants
While dental implants are recommended when possible, not every patient is a suitable candidate for this procedure. To determine your suitability, an initial examination will be necessary. If it is determined that you are a viable candidate to have the procedure performed, it will be necessary to determine the underlying reasons why this treatment is necessary and determine if your lifestyle habits make you a good fit for this procedure.
Patients who have been diagnosed with periodontitis are at an increased risk of developing peri-implant disease. The largest contributing factor to both periodontal disease and peri-implant disease developing is poor oral hygiene habits. This can either be due too the patient not performing oral health care frequently enough or the patient not being able to mechanically use dental floss and interdental brushes to clean their dental implants. The positioning of the implant can also cause problems when the placement of the implant is done with more consideration for aesthetic appearance, and less so with maintenance and hygiene.
People who smoke or use tobacco are also at an increased risk of developing peri-implant disease, with nearly 80% of all smokers being diagnosed with peri-implantitis.
How to Reduce Your Risk of Developing Peri-implant Disease
While peri-implant disease is prevalent, it is also preventable. One of the most effective ways you can prevent peri-implant disease is to have your procedure performed by a highly skilled periodontist who will carefully review your oral and health history and perform a thorough evaluation in order to properly place your implants and reduce your risk of developing peri-implant disease.
There are several factors a periodontist should consider when determining your treatment plan to help reduce your risk of peri-implant disease, such as:
- Whether or not to use a custom abutment. Custom abutments are typically more expensive, but they can help ensure you are able to properly maintain good oral hygiene.
- Where the implant should be placed. In order for the implant to have long-term success, it is essential that it is placed in healthy and vital bone.
- Screw retained or cement retained implant. While both of these approaches can provide good results, if your periodontist uses cement to retain your implant, it is essential that they remove any residual cement, which can be difficult due to implant design and positioning. If residual cement is left, this can result in inflammation and create an environment where bacteria can thrive.
Practicing Good Self-Care
To reduce your risk of developing peri-implant disease or other oral health issues, it is important that you are properly educated on how to properly care for your dental implants and are instructed in techniques such as proper brushing and interdental cleaning. Following this instruction, it is important that you regularly clean your teeth twice daily, eat a healthy diet, and avoid using tobacco. If you have any concerns or questions about how to properly care for your implants, be sure to discuss these with your periodontist.
Schedule Your Appointment Today
In addition to practicing good self-care at home, the best thing you can do to avoid developing peri-implant disease is to schedule regular periodontal examinations, during which your periodontist can evaluate your overall oral health and the state of your implants. If an issue is identified, it can be corrected before unnecessary damage occurs. The frequency of these preventative maintenance appointments will largely depend on your medical and dental history, which will include when your implant was placed, the type of implant that was used and its coronal design, and whether your restoration was cement or screw-retained. If you are displaying sings of peri-implant disease or have not had a periodontal examination in over six months, schedule an appointment today.