Peri-implantitis - is a destructive process affecting the gums and bone surrounding dental implants. The various periodontal bacteria found surrounding failing dental implants (those affected by peri-implantitis) are very similar to those found in association with various forms of periodontal disease.
Peri-implantitis is a unique complication when dealing with dental implants. Dental implants have a very high success rate but do fail for various reasons. These can include failure to integrate with bone, poor oral hygiene by patient, rejection by the body, trauma, or peri-implantitis. Peri-implantitis becomes a factor in patients with poor oral hygiene, diabetes, smoking, and when there is residual cement stuck to the implant surface. Peri-implantitis will cause the destruction of bone and gum tissue exposing part of the dental implant to the outside. This will cause the possibility for the dental implant to become less stable and cause the patient to lose the implant and restoration if not treated in a timely manner.
How Is It Diagnosed?
A dentist will use x-rays and measuring instruments to determine the level of the bone surrounding the dental implant. If it is found there is some level of bone loss beyond normal surrounding the dental implant, then the diagnosis becomes that of peri-implantitis. It is normal to see some minor bone loss 1-2 years out following placement of the dental implants. It should be no more than 1-1.5 mm in the first year and no more than 0.2 mm in each subsequent year. As stated earlier peri-implantitis of a dental implant that goes undiagnosed will lead to complete failure and have to be removed.
Peri-implantitis can be diagnosed early or once clear clinical evidence has developed. The most common signs and symptoms are:
- Color changes of the gum tissue around the implant.
- Bleeding during brushing, probing or measuring.
- Increased pocket depth around the implant.
- Pus drainage from around the dental implant.
- Thinning of the tissue causing transparency around the implant..
- Progressive loss of bone height around the implant.
-X-rays showing loss of bone around the implant.
Peri-Implantitis Treatment Options
The course and success of treatment revolves around when the peri-implantitis is diagnosed. If the initial bone loss is limited there will be a higher chance of success in saving the dental implant. However, the later treatment begins the lower the chance of saving the dental implants. There are various methods used to treat peri-implantitis. All have varying degrees of success. These include the following:
-Mechanical Debridement (professional cleaning using instruments). A patient with dental implants must follow normal treatment schedules to maintain his/her dental implants. This includes regular dental visits. At these visits radiographs will be taken to ensure the dental implant and surrounding tissues are in a healthy state. At these visits the patient will also undergo a professional cleaning for the dental implants and/or natural teeth. Dental implants require special tools for cleanings. The standard dental implant instruments used for cleaning include plastic, graphite, or gold tipped instruments. Ultrasonic tips may be used. The goal in cleaning the implant is to remove debris and bacteria without damaging the exterior coating of the dental implant.
-Perioscope. A microscope guided cleaning deep below the tissues to remove debris and otherwise undetectable cement residue.
-Localized Drug Delivery. Since dental implants by nature have rough surfaces (to allow better integration with surrounding bone), removing infection tends to be quite a challenge using just hand instruments. It is recommended that a chemical anti microbial agent be used along side hand instrumentation. Recent studies have shown the combination of hand instruments and chemical agents have proven effective in eliminating peri-implantitis in its earliest stages. Drugs used can include chlorhexidine rinse, oral antibiotics such as tetracycline, minocycline, doxycycline hyclate, or Arestin, an antibiotic placed directly into the pocket.
-Bone regrowth factors. Emdogain can be placed along with bone grafting material to help stimulate new bone growth.
The primary goal once peri-implantitis has been diagnosed is to stop the disease process from progressing. If untreated, it will ultimately lead to loss of the dental implants. The #1 goal should be to see your dentist regularly to avoid the complication of peri-implantitis. It is important to note any signs that may be occurring so you can be proactive about your dental health.