Peri-Implantitis Symptoms, Causes, Diagnosis, Treatment

Peri-implantitis is a disease that can affect the oral tissues of people who have dental implants, causing inflammation of the soft tissues and destruction of the bone that surrounds and supports the implant. While peri-implantitis may not have symptoms in its early stages, when symptoms do appear, they resemble the symptoms of gum disease. Earlier symptoms may include swelling and redness of the gum tissue, a noticeable crater-like shape in the bone around the implant, a bad taste in the mouth or bad smell coming from the mouth, bleeding upon brushing or flossing, an aching or tender feeling in the gum tissue, and swollen lymph nodes. Before peri-implantitis appears, peri-implant mucositis may develop; the symptoms of this disease are similar but the bone is not affected. If left untreated, peri-implant mucositis usually develops into peri-implantitis. Because peri-implant mucositis is reversible, the earlier it can be detected, the better, and because it may have few or no symptoms, periodic dental checkups that include dental x-rays are an integral part of preventing peri-implantitis from developing. At these examinations, your dentist will also examine your gums, determining the bleeding and probing depth of any pockets around the implants and looking for any pus or other clear signs of infection. While some bleeding on probing shortly following dental implant surgery can be expected as the tissues heal, when bleeding persists for a month or longer after dental implants are placed, it is likely that inflammation is present. The depth of pockets around dental implants is expected to be greater than the depth of pockets surrounding natural teeth, so dentists will measure and record the baseline depth of the implant in health, allowing them to measure against this baseline at each follow-up visit. Diagnosis of pockets is therefore based on changes in measured depth between visits.

Although dental implants have a consistently high success rate, any patient who has dental implants faces some risk of developing peri-implantitis, which is triggered when the gum tissue surrounding the dental implant becomes infected. This infection is primarily caused by poor oral hygiene and can also be exacerbated by tobacco use, certain systemic diseases like diabetes or osteoporosis, a history of periodontitis, grinding of the teeth, or poorly placed dental implants that have not been given sufficient time to heal. Predisposition to infection can be assessed by reviewing the tissue around the implant, the design and material of the implant, the shape of the jaw and mouth, and the likelihood of excess force being applied to the teeth. People with a history of inflammation in the gums are more likely to develop peri-implantitis, but proper oral hygiene and comprehensive aftercare following dental implant procedures can help prevent the disease from occurring. The dental implant site is most susceptible to bacteria accumulation during the healing process, making effective aftercare an especially crucial part of the success of dental implants. Smoking cessation is strongly recommended, as smoking has particularly negative effects on the health of the gum tissues and the periodontium overall. Systemic diseases and conditions, like diabetes, cardiovascular disease, and rheumatoid arthritis, can also increase the risk of peri-implantitis, and some people simply have a genetic predisposition to systemic inflammation. Even when there are no natural teeth present, dental implant wearers should brush the teeth at least twice a day, using a soft-bristled toothbrush and fluoride toothpaste and focusing on cleaning at and just beneath the gum line when the natural teeth aren’t present. Patients should also clean between the teeth daily, using floss or another interdental cleaning tool.

Some people have expressed discomfort with brushing around dental implants, as they aren’t entirely sure how to best care for their new dental restorations. However, effective plaque control is the most important part of preventing peri-implantitis, and dentists can provide instruction on how to properly care for dental restorations. Because some areas of the mouth may be harder to clean than others, dentists may recommend using a water irrigation tool or electric toothbrush or other devices that can help reach these areas. Lack of adequate follow-up therapy is also a contributing factor for peri-implantitis, as regular dental checkups can help detect peri-implant diseases in their earliest stages, when they are reversible and before they do permanent damage. The professional cleanings performed by dental hygienists are also an important part of maintaining the health of the surrounding tissues and ensuring the success of the implants. Peri-implantitis can also lead to the degradation of titanium implants, allowing microparticles to infiltrate the peri-implant tissue and increase the effects of inflammation and bone resorption. An additional risk factor for peri-implantitis includes the possibility of excess, residual cement remaining around the implant site. Cement is used to retain implants, but if there is excess cement around the abutment, its rough surface can attract the buildup of bacteria; for this reason, restorations may be placed slightly above the gum line, to allow any excess, extruded cement to be easily removed. Dentists should also ensure that all components of a dental implant are the proper size, as any overhanging or protruding elements can attract bacteria, which can build up, colonize, and lead to disease.

When peri-implantitis does occur, the primary treatment goals include controlling the infection, thoroughly cleaning and disinfecting the implant surface, and regenerating the alveolar bone. Surgery is usually necessary, though in some cases, non-surgical therapies may be sufficient. Non-surgical treatment options include antibiotics, antiseptic solutions, and ultrasonic or laser treatments. Procedures that aim to regenerate lost alveolar bone may combine guided tissue regeneration and bone grafts, but these treatments must follow thorough mechanical debridement and surface decontamination of the implant. Current research involves the use of biomaterials to prevent the initial bacterial attachment that can lead to peri-implantitis by suppressing or otherwise impeding the colonization of bacteria on implant surfaces. Researchers have been developing microbial surfaces and other methods of delivering antimicrobial treatments, which they are combining with bone stimulants that encourage successful osseointegration and sealants that protect the tissues of the mouth. These research innovations show tremendous promise in achieving the goal of successful implants that can effectively resist peri-implant diseases.

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