It was once believed that dental implants were impervious to dental infections. However, increasing evidence suggests that dental implants can be affected by gum disease similar to teeth.
There is a varying spectrum just like Periodontal Disease of natural teeth as to how infection affects and damages the interface between implant and bone. Thus, proper post-treatment care of any implant is critical to the longevity of the treatment. Read more on importance of gum health.
The Peri-Implantitis Process
It can start with a type of allergic reaction to the bacteria that is left sitting around an implant and not cleaning away. This plaque becomes hardened over time only to attract more plaque.
This causes the soft tissues and gums to react by swelling and easily bleeding on brush or with simple agitation.
This is then followed by an invasive process starting with a loss of detachment of the gum and soft tissues that surround the dental implant. It is seen as pocketing around the implant.
The inflammation is as a result of the toxins in bacteria. This causes further bleeding and swelling.
If left to persist then the infection spreads to the bone. Here, the bacteria invade the bone breaking it down and causing further tissue damage.
The whole process of osseointegration (where the bone connected with the threading in the dental implant during healing phase) is unravelled. The bone supporting the implant then begins to deteriorate away loosening the implant.
Since the dental implant is often covered with a crown, bridge or prosthetic (denture), any biting pressure will simply make the infection around the implant worse.
Causes of Peri-Implantitis
- Poor Oral Hygiene. If regular hygiene appointments are not maintained and there is a lapse of good home teeth cleaning then infection can build up.
- Ill-fitting crown or prosthesis which prevent optimal cleaning.
- Over bulbous prothesis or crown again preventing easy cleaning ability.
- Loose screw in a screw-retained crown on the implant. This can act as a plaque trap.
- Excess cement which was not removed during fitting of a crown. This can act as a plaque trap.
- Incorrect Implant position. If a 3-4 mm biological barrier is invaded during positioning of the implant then any subsequent infection will easily invade the osteointegration zone of the implant.
- Incorrect loading placed from the prosthesis, bridge or crown surface. This means the bite is unbalanced and unstable causing at first mechanical loading on the implant and subsequently biological degradation.
- Incorrect Implant design used which is incompatible with the patient’s mouth.
This requires both clinical examination of the tissues around the implant and radiographic evaluation. Read more on our dental care assessments.
The dentist will look at all the following aspects of the dental implant:
Occlusal Loading | Gingival evaluation | Both vertical and horizontal bone loss around the implant.
Any detachment of gum | Signs and symptoms indicating infection | Extent of mobility of the implant
Types of Peri-Implantitis
- Peri-Implant Mucositis. This is when there is infection around the soft tissues and gums that surround the gum. This starts of an inflammatory process. Statistics are showing that 30% of dental implant failures are because of gum disease around the implant.
- Peri-Implantitis. This is when there is both soft and hard tissue deterioration. It starts off as an infection in the gums but then becomes aggressive to infect the bone. When this happens, the bone begins to detach and disintegrate.
Symptoms of Peri-Implantitis
The symptoms will vary according to the severity of the condition and type of peri-implantitis:
Bleeding | Changes in colour of the gums | Swelling and oedema | Pus | Pocketing | Pain | Prosthesis instability
Gum detachment | Bone loss | Bone disintegration | Loose implants
Prevention of Peri-Implantitis
You should follow a strict home teeth cleaning program as soon as you decide to have implants placed.
It will become very important that you are regularly seen by our Hygiene Therapist so that she can keep any eye on you before, during and after your dental implant treatment.
Prevention is definitely better than any treatment protocol subsequently. Early detection is key to a successful outcome.
It is important to minimise any risk factors that can worsen the problem such as smoking.
Treatment of Peri-Implantitis
Our treatment will differ depending upon whether the diagnosis is Peri-Implant Mucositis or Peri-Implantitis. The first protocol regardless of which diagnosis involves management and control of the infection.
The treatment involves removal and debridement of the infected tissue. This can be carried out under local anaesthesia.
It may or may not involve surgery of the gums. It can also include regenerative and resective surgical techniques. We care for nervous patients.
It is important to use instruments that are softer than titanium to clean the implant site. These can be non-metallic tip or resin/carbon fibre curettes and the ultrasonic cleaner.
Mechanical debridement is usually necessary.
There is now also laser therapy that can be done to facilitate better healing and bio-stimulation of the bone.
The treatment is often supported with antibiotics. This is then followed by a healing phase and subsequently a re-assessment phase.
(Your first initial consultation is free of charge.)