Peri-implantitis
What causes peri-implantitis? Get all the information about the causes, symptoms, and treatments of this disease.
Symptoms and Causes
Peri-implantitis is an inflammatory process affecting the soft tissues surrounding dental implants (peri-implant tissue) and leading to progressive loss of the supporting bone in which the implant is integrated. This process compromises the stability and functionality of the implant.
The disease is considered to have two stages:
- Peri-implant mucositis: In the initial stage, inflammation affects only the mucosa and soft tissues around the implant. It is reversible.
- Peri-implantitis: Mucositis worsens, affecting the bone mass. Lost bone tissue cannot regenerate naturally.
This is a common condition that progresses rapidly, as dental implants lack the natural defense mechanisms against infections that natural teeth have.
Symptoms
The most common symptoms of peri-implantitis include:
- Redness and inflammation of the gum tissue surrounding the implant.
- Pain when touching the implant and surrounding area.
- Accumulation of tartar and plaque.
- Bleeding when pressing on the implant.
- Implant mobility.
- Development of deep periodontal pockets: increased space between the implant and the gum.
- In some cases, pus formation.
Causes
Peri-implantitis is caused by an infection resulting from the accumulation of bacteria in the oral cavity and on the implant surface. The infection triggers peri-implant mucositis, which can progress to peri-implantitis when aggravated by poor oral hygiene, smoking, or occlusal overload—excessive force applied to the implant when biting, which can lead to implant fracture or loosening.
Risk Factors
Several factors increase the likelihood of developing peri-implantitis after implant placement:
- Previous periodontal diseases: A predisposition to gingival problems.
- Diabetes: High glucose levels affect tissue regeneration.
- Poor prosthetic design or incorrect placement: A defective implant often causes occlusal overload.
- Poor oral hygiene: Smoking reduces blood flow to the gums, weakens the oral immune system, and impairs tissue healing.
- Lack of keratinized mucosa in the gums: The absence of keratin can lead to gum recession.
- Congenital bone fragility.
Complications
In addition to potentially causing persistent gum bleeding, the primary issue with peri-implantitis is bone destruction, which may lead to implant loss and affect the natural teeth surrounding the implant.
Prevention
Peri-implantitis can be prevented by following these measures:
- Maintaining strict oral hygiene: brushing after every meal, using dental floss, and mouthwash.
- Avoiding tobacco use.
- Scheduling regular dental check-ups and cleanings.
Which Specialist Treats Peri-implantitis?
Peri-implantitis is diagnosed and treated by specialists in dentistry and oral and maxillofacial surgery.
Diagnosis
Whether during a routine implant check-up or upon the appearance of initial symptoms, several tests are conducted to confirm or rule out peri-implantitis:
- Periodontal physical examination to assess the condition of the gums, plaque levels, inflammation, periodontal pocket depth, and implant stability.
- Periapical X-ray to confirm bone loss if signs of peri-implantitis are present.
- Biological sample collection from the peri-implant tissue: A culture may be performed to identify the pathogenic agents responsible for the infection.
Treatment
Treatment is applied depending on the stage of the disease:
Reversible peri-implant mucositis treatment:
- Removal of bacterial plaque deposits using manual instruments, ultrasound, or laser.
- Use of antiseptic mouth rinses to control the infection.
- Non-surgical debridement or subgingival scaling: In cases where deep peri-implant pockets are present, tissue is lifted to remove plaque beneath the gum, followed by restoration. This is combined with the application of local antiseptics.
Advanced peri-implantitis treatment:
- Oral antibiotic therapy.
- Surgical treatment for bone regeneration: Surgical debridement involves multiple steps, depending on the severity of the damage.
- Access surgery: The mucosa surrounding the implant (flap) is lifted and removed, all granulation tissue and bacteria are eliminated, and the implant surface is cleaned and polished.
- Resective surgery: The remaining bone mass and soft tissues are reshaped to reduce peri-implant pockets.
- Regenerative surgery: Lost bone is restored using grafts, barrier membranes, or a combination of both.
- Implant removal: If the implant is mobile or fractured, it is extracted before surgery, and a new implant is placed after bone regeneration.
