Peri-implantitis

Periimplantitis is a harmful inflammatory process.

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Management of Peri-implantitis

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, like Periodontal Disease of natural teeth, as to how the 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.

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 cleaned 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 followed by an invasive process starting with a loss of detachment of the gum and soft tissues surrounding 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. The bacteria invade the bone, breaking it down and causing further tissue damage.

The process of osseointegration (where the bone connected with the threading in the dental implant during the 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.

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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.
  • An ill-fitting crown or prosthesis prevents optimal cleaning.
  • Over bulbous prosthesis or crown again preventing easy cleaning ability.
  • A loose screw in a screw-retained crown on the implant. This can act as a plaque trap.
  • Excess cement was not removed during the fitting of a crown. This can act as a plaque trap.
  • Incorrect Implant position. If a 3-4 mm biological barrier is invaded during the 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 subsequent biological degradation.
  • Incorrect Implant design used which is incompatible with the patient’s mouth.

Correct Diagnosis

This requires a clinical examination of the tissues around the implant and a radiographic evaluation. Read more.

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 the gum
  • Signs and symptoms indicating infection
  • The extent of mobility of the implant

Types of Peri-implantitis

  • Peri-Implant Mucositis is when there is an infection around the soft tissues and gums surrounding the gum. This starts off an inflammatory process. Statistics show that 30% of dental implant failures are because of gum disease around the implant.
  • Peri-Implantitis is when there is both soft and hard tissue deterioration. It starts 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 and changes in the colour of the gums 
  • Swelling and oedema 
  • Pus, pocketing and pain
  • Prosthesis instability
  • Gum detachment
  • Bone loss & disintegration
  • Loose implants

Treatment of Peri-implantitis

Our treatment will differ depending on whether the diagnosis is Peri-Implant Mucositis or Peri-Implantitis. The first protocol, regardless of diagnosis, involves management and control of the infection.

The treatment involves the 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 respective 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 a non-metallic tip, resin/carbon fibre curettes, or an ultrasonic cleaner.

Prevention of Peri-implantitis

Prevention is better than any treatment protocol subsequently. Early detection is key to a successful outcome.

It is essential to minimise any risk factors that can worsen the problem, such as smoking.

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.

Antibiotics often support the treatment. This is then followed by a healing phase and subsequently a re-assessment phase.

You should follow a strict home tooth 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 an eye on you before, during and after your dental implant treatment.

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