Not unlike periodontitis, peri-implantitis starts when bacteria develop along the gumline around an implant that, if untreated, eventually damages soft and hard tissue.
Peri-implantitis: Know the Facts to Ensure Good Outcomes
Peri-implantitis risk factors
Oral hygiene: Research indicates that lack of oral hygiene is strongly associated with peri-implant disease.
Implant surfaces: Machined implant surfaces have a lower survival rate compared to rough surfaces. Rough surfaces show better osseointegration.
Periodontitis history: Because periodontal disease may jeopardize implant success, it should be treated before proceeding.
Occlusion: Implants that fail as a result of excessive biomechanical forces don’t typically show signs of inflammation or discharge.
Excess cement: Rough implant surfaces lend themselves to cement residue adherence, which can allow bacterial plaque buildup, which increases soft-tissue inflammation.
Systemic diseases: Conditions such as heart disease, diabetes, and osteoporosis may increase a patient’s risk for peri-implantitis.
Tobacco: Use of tobacco products increases the risk of implant failure and biological complications.
Keratinized tissue: Some researchers suggest that no connection exists between lack of keratinized tissue around implants and periimplantitis. Other researchers state that adequate oral hygiene will mitigate the effects of a lack of keratinized tissue.
Titanium allergy: Ongoing studies are looking into the connection between titanium allergies and peri-implantitis. Some studies indicate that titanium allergies are the least common among dental materials.
Genetics: A connection may exist between the polymorphism of the IL-1 gene and peri-implantitis, but no consensus has been reached.
Diagnosing health vs. disease
Diagnose peri-implant health if you find:
• No clinical signs of inflammation
• No bleeding and suppuration on gentle probing
• No increase in probing depth compared with previous examinations
• No bone loss beyond crestal bone level changes resulting from initial bone remodeling
Diagnose peri-implant mucositis if you find:
• Bleeding and/or suppuration on gentle probing with or without increased probing depth compared with previous examinations
• No bone loss beyond crestal bone level changes resulting from initial bone remodeling
Diagnose peri-implantitis if you find:
• Bleeding and/or suppuration on gentle probing
• Increased probing depth compared with previous examinations
• Bone loss beyond crestal bone level changes resulting from initial bone remodeling
• If previous exams aren’t available, diagnose peri-implantitis if you find a combination of:
- Bleeding and/or suppuration on gentle probing
- Probing depths ≥6 mm
- Bone levels ≥3 mm apical of the most coronal portion of the intraosseous part of the implant
Peri-implantitis treatment plan
• Nonsurgical therapy consisting of mechanical therapy, locally delivered antibiotics, and reinforcement of home oral hygiene routines
• If nonsurgical therapy proves unsuccessful, surgery, consisting of one of the following approaches, depending on the type of defect and implant position, may be required:
- Access
- Resective
- Regenerative
When is implant removal necessary?
• Implant-supported restoration prevents diagnosis or impedes oral hygiene access
• Nonsurgical treatment fails
Source:
Renvert S, Hirooka H, Polyzois I, et al. Diagnosis and nonsurgical treatment of peri-implant diseases and maintenance care of patients with dental implants – Consensus report of working group 3. Int Dent J. 2019;69(suppl 2):12-17.
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This blog post originally appeared in OnTarget. Read the full issue and see current highlighted promotions: pattersondental.com/dental/ontarget
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