While dental implants can restore the aesthetic appearance and functionality to patients with missing teeth and reduce their risk of developing additional oral health issues, it is important to understand that oral health issues can still develop, the most common being peri-implantitis, an inflammatory disease that can affect the tissues surrounding the dental implant. If left untreated for long enough, peri-implantitis can begin to erode the bone structure responsible for supporting the implant.
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 that is 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.
Please refer to the following to learn more about common symptoms and causes of peri-implantitis, how peri-implantitis is diagnosed, and what treatment options are available to halt the progression of peri-implantitis.
Common Symptoms of Peri-implantitis
One of the biggest dangers of peri-implant disease is that it happens very gradually and does not cause any pain until it has already progressed to the point of causing enough damage that the implant may need to be removed. If you notice any of the following, schedule an appointment with your periodontist, as these may indicate peri-implantitis:
- Gums that are tender
- Dull aching of the gums
- Swelling and redness of the soft tissue
- Swollen lymph nodes
- Bad taste in one’s mouth
- Presence of pus in the gums
- Gums that easily bleed when brushing or during a probe
- Implant feels loose
If you have been experiencing any of these symptoms or have not had a periodontal evaluation in over six months, schedule an appointment as soon as possible. If peri-implant disease is treated in the early stages, it will be easier to halt its progression and you may be able to avoid developing any unnecessary issues or have to have your implant replaced.
Common Causes of Peri-implantitis
Unfortunately, all patients who have dental implants placed are at some risk of developing peri-implantitis, however the most common factors that increase an individual’s risk of developing periimplantitis include the following:
- Earlier diagnosis of periodontal disease
- Improper or insufficient oral hygiene habits
- Underlying systemic condition, such as osteoporosis or diabetes
- Use of tobacco
- Implant was not properly placed or did not load properly during the healing process
- Bruxism (grinding of one’s teeth)
Diagnosing Peri-implantitis
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 is a strong indication that peri-implantitis has developed.
How to Treat Peri-implantitis
Following a positive diagnosis of periimplantitis, your periodontist will determine a treatment plan that will focus on controlling the infection, detoxifying the surface of the implant, and regenerating the alveolar bone. Surgical treatment may be necessary, but for less severe cases patients may be able to correct their periimplantitis through the use of laser or ultrasonic treatments, antiseptics, and/or antibiotic treatment.
- Mechanical debridement: Ultrasonic scalers with carbon/resin fiber curettes or a non-metallic tip are used to remove calculus in addition to polishing paste and rubber cups to remove plaque.
- Antiseptic treatment: Antiseptic treatment may be performed along with mechanical debridement. In most cases, a patient will use a gel or daily rinse for three to four weeks, which should improve the clinical attachment level, probing pocket depth, and mucosal condition.
- Antibiotic treatment: Antibiotic treatment may be performed to reduce or eliminate the pathogens present in the biofilm. During the last ten days of treatment, an antibiotic targeting gram-negative anaerobic bacteria is used to ensure the infection is treated.
- Surgical treatment: If the infection is successfully controlled, surgical treatment to reshape the peri-implant soft tissue or restore the bone through guided tissue regeneration may be performed. This will also help in complete local decontamination and debridement of the implant.
Preventing Peri-implantitis
If you have previously been diagnosed with periodontal disease or have a history of gum inflammation, your risk of developing peri-implantitis is much higher. Fortunately, there are several steps you can take to reduce your risk of developing peri-implantitis. The most important thing you can do to reduce your risk of developing peri-implantitis is to have good oral hygiene habits and to carefully clean around your dental implant. By brushing after meals or twice a day, flossing regularly (especially before sleeping) and not smoking, you will reduce your risk of developing peri-implantitis.
The other important thing you can do to prevent developing peri-implantitis is to receive care from a highly trained periodontist who is committed to understanding your unique needs, precisely placing your dental implant, and who can instruct you and who emphasizes the importance of aftercare and maintaining your oral health. It is also important 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 required a dental implant due to periodontal disease, you may require maintenance every three or four months instead of every six.
If you are displaying sings of peri-implant disease or have not had a periodontal examination in over six months, schedule an appointment today.