Avoid Peri-Implant Disease
In a relatively brief period of time, dental implants have become the gold standard for treating the loss of one or more of the natural teeth. Dental implants are highly reliable and versatile, providing a broad array of possibilities for highly natural-looking, stable, and comfortable replacement teeth. While dental implants are frequently successful, providing a long-term dental replacement option for the vast majority of patients, sometimes, complications can arise. Peri-implant disease is one of these possible complications. Peri-implant disease appears as peri-implant mucositis, and as peri-implantitis. While each of these is its own distinct disease, untreated peri-implant mucositis commonly develops into peri-implantitis. Both diseases are characterized by inflammation in the tissues that surround a dental implant, and in both diseases this inflammation arises due to the buildup of bacteria in the tissues around the implant. In cases of peri-implant mucositis, however, only the soft tissues inside the mouth are affected, while peri-implantitis affects both the soft tissues and the alveolar bone that surrounds and supports the dental implant. The bone loss that is associated with peri-implantitis can, eventually, lead to implant failure.
The inflammation that presents as peri-implant mucositis is similar to the inflammation of gingivitis in many ways. Gingivitis, which is reversible, is caused by the bacteria in plaque biofilm interacting with the host’s immune system and triggering inflammation. When the irritating plaque is thoroughly cleaned away from the teeth and from the gums, both above and below the gum line, the inflammation associated with gingivitis can subside and return the oral cavity to health. When dental implants are placed, saliva adheres to exposed implant surfaces and interacts with bacteria and debris in the mouth, forming a plaque biofilm. The bacteria associated with peri-implant disease is frequently anaerobic, which helps it thrive below the gum line and in the oxygen-deprived areas inside tissues and in smaller, hard-to-reach areas of the mouth. Just as gingivitis that isn’t effectively treated can lead to periodontitis, peri-implant mucositis that isn’t addressed is likely to lead to peri-implantitis. Thoroughly removing the plaque biofilm from surfaces of the implants can reverse peri-implant mucositis and prevent it from developing into peri-implantitis, just as correct treatment of gingivitis can often prevent periodontitis from developing.
Peri-implant mucositis is believed to occur in as many as half of all implant cases, though because symptoms may often be hard to detect, or cases may be unreported, the incidence may actually be higher. Peri-implant mucositis can be diagnosed with a simple clinical examination in which probing depths are measured and doctors look for signs of sensitivity or bleeding on probing. Peri-implant mucositis may also present with redness, swelling of the gum tissue, or the appearance that the gum tissues have increased in size, though this does not always occur. While there may be pus present near the implant site, the gums may appear normal, and x-rays and other radiologic images do not show any signs of bone loss. Peri-implantitis shares these same signs as peri-implant mucositis, but peri-implantitis also includes a demonstrable loss of the bone that surrounds and supports the implant. The diagnosis process for peri-implantitis involves measuring the bone depth in a baseline radiographic image, taken at the time that the implants were placed, and then comparing it with a radiographic image taken at the time of the examination. When there is bone loss of at least two millimeters, peri-implantitis may be present.
Before planning dental implant treatment, patients should consider the risk factors for peri-implant diseases that may be present. When patients have previously had periodontitis, they may be at greater risk of developing peri-implant disease, though this is not always the case. The primary risk factor for peri-implant disease is poor oral hygiene; even people who have had periodontitis can modify their hygiene habits to help ensure the success of their dental implants. Dentists should take hygiene and maintenance into consideration when planning the placement, positioning, and materials of dental implants, designing a dental restoration plan that will allow patients to effectively clean their implants while also providing aesthetically pleasing and highly functional restorations. Dentists must meticulously remove all residual cement from implants once they are placed, as any cement that extrudes from the implant and hardens below the gum line can attract the accumulation of bacteria and encourage inflammation. This is only an issue with cement-retained implant crowns. Peri-implant disease is also more likely among people who use tobacco products; studies have shown that almost 80% of implants placed in smokers develop peri-implantitis, compared to closer to 60% in non-smokers. An excessive amount of pressure or force that is placed on implants that have not fully healed may also contribute to peri-implant disease, by causing tiny fractures in the jaw that gradually lead to bone loss. While these risk factors can all contribute to peri-implant disease, the primary contributing factor is oral hygiene in a huge majority of cases.
It is important to factor the possibility of peri-implant disease into the planning of any dental implant treatment plan. Dentists can take extensive measures, ensuring the placement of the implant in a suitable location and in bone that is as healthy as possible, which will encourage the success of the dental implants. For people with more complicated clinical needs, custom abutments can help guarantee the most effective placement of the implants to allow the patient to clean and maintain the area properly. If cement-retained restorations are used, dentists should take particular care to remove any residual cement that may remain below the gum line. Dentists should take the patient’s medical and dental history into account when planning treatment and when scheduling maintenance, recommending maintenance appointments at a greater frequency for high-risk patients. Dentists should also record the manufacturer, material, and type of implant, in addition to the date of placement, and they should note the baseline measure of the probing depth on radiographic images taken at the time of implant placement. Patients must be taught proper aftercare and maintenance methods, and they must be made aware of the risks of neglecting or insufficiently caring for their dental implants. Regularly scheduled professional checkups and cleanings can help dentists monitor patients’ oral hygiene habits and detect any early-onset symptoms of peri-implant disease, recommending adjustments to ongoing treatment as necessary. With a comprehensive treatment plan, skillful dentists, and behavior modification on the part of the patient when necessary, peri-implant disease can be prevented, and dental implant restorations can provide patients with a lifetime of enjoyable meals, articulate speech, and satisfied, natural-looking smiles.