Peri-implantitis is an advanced stage of periodontal disease during which both the soft tissues and bone surrounding your implant are affected. 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. This inflammatory process occurs due to glycoproteins adhering to surfaces of the titanium, which forms a biofilm that results in infections. 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.
Once peri-implantitis develops, the alveolar bone responsible for supporting the implant will be lost over time. 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. Common symptoms may include any of the following.
- 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
Because peri-implantitis happens so gradually and often does not cause any visible signs, it is strongly encouraged that patients schedule regular periodontal maintenance at least every six months. During these appointments, your periodontist can evaluate your overall oral health and evaluate the condition of your implants. If any issues are identified, they will be more likely to be correctible and not cause additional issues than if they were allowed to progress.
To diagnose peri-implantitis, your periodontist will look for indications of the followings signs:
- Evidence of bone loss
- Hyperplasia
- Redness
- Gum recession and/pocket formation
- Swelling
- Discharge of pus or bleeding during probe
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. 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.
Causes of Peri-implantitis
Unfortunately, every patient who has dental implants placed is at some risk of developing peri-implantitis, however there are several common causes that increase a person’s risk of developing peri-implantitis, which include:
- Poor oral hygiene habits: 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 things like tobacco use. If you have any concerns or questions about how to properly care for your implants, be sure to discuss these with your periodontist.
- Not scheduling regular periodontal maintenance: 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
- Titanium implant degradation: There is believed to be a causative relation between internalized titanium particles causing an inflammatory response and bone resorption.
- Underlying systemic issues: Patients who have underlying systemic issues such as osteoporosis or diabetes are at an increased risk of developing peri-implantitis.
- Cement retained implant: 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.
Treatment Options for Peri-implantitis
Treating peri-implantitis can be very difficult and will depend on the nature of the disease. In some cases, treatment will involve detoxifying the surface of the implant and controlling the infection with non-surgical therapy, and in other cases surgical regeneration of the alveolar bone will be necessary. Your periodontist will determine which treatment option is best suited for your needs after reviewing your oral and medical health history, the results of diagnostic exams and whether there is evidence of bone loss, the severity or your case, and discussing your specific treatment goals.
- 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 also 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.
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.