Introduction
Early apical periimplantitis, or the short form of EAP, is designated to clinically emphasize the periapical lesions surrounding a dental implant. While the infection of the soft tissue or the gingival tissues surrounding the dental implant area would be commonly referred to as periimplantitis, the difference in EAP is the specificity with which the implant periapical area is affected. When an infectious or inflammatory process starts around the implant apex area, clinicians then detect it to be one of the first initial stages that can subsequently lead to dental implant failure if left untreated.
Often, you may be wondering why your implant dentist or surgeon would be recommending frequent or periodic recall visits or follow-ups to keep your dental implant parameters in check or update you about the implant status. Exactly, this would be the reason to prevent any possibility either of biological or prosthetic dental implant failure - because when the soft tissue inflammatory processes permeate around the dental implants, the long-term survival rates also get affected eventually. When EAP is detected through periodic follow-ups or during a routine dental examination, then there is a definite possibility that your coronal or prosthetic structure of the implant can still be well preserved and unaffected by the disease or pathogenesis around the tooth apex. With timely dental management, the preservation of the prosthetic or the coronal structure of the dental implant would mean preventing the progress of an infection leading to osseointegration failure or bone implant fusion failure.
What Are the Clinical Signs and Symptoms of EAP?
Clinically, the signs associated with EAP would usually manifest in the patient's implantation area with pain, swelling of the soft tissues surrounding the dental implant, visible fistulas or antral communication, and drainage that would be of varying intensity. This depends on the extent of the periapical lesions surrounding the dental implant.
Though dental implant literature shows that the incidence of EAP is quite low in a frequency of usually 0.2 to 7.8 percent in all implant cases, dental research indicates that many implant failures that have not been recorded in literature would be actually because of undiagnosed and untreated EAP lesions causing a subsequent dental implant failure.
What Does Early vs Late Failure of EAP Mean?
Let us look at the different types of failures that can biologically occur due to EAP:
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Firstly, biological failure would be "early failure" when there's even a failure of the implant to undergo osseointegration or establish bone-implant fusion into the alveolar bone of your jaw.
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The second type of biological failure is the "late failure" stage when an established contact between the bone and dental implant breaks down or gets adversely impacted by the inflammatory process around the periapical area of the dental implant. In such cases, even though it may appear as though the implants have lasted for a few years or they had short-term survival rates, the actual reason for the late failure of these implants would be mainly owing to EAP or the inflammatory process surrounding the apex of the implant.
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Early failure can be easily detected by your implant dentist or oral and maxillofacial surgeon because it can be diagnosed in the initial follow-up protocols after dental implantation surgery. Postoperatively, your dentist can detect between the seventh day to three-month or six-month osseointegration period whether the bone-implant fusion is happening properly or if there is a failure to establish contact with the jaw bone. Both by clinical as well as radiographic examination and findings, preventing early implant failure is certainly possible hence calls for the necessity of regular post-operative dental checkups or follow-ups and prophylactic dental regimens.
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According to dental research, the answer is definitely multi-faceted because many factors including the patient's own local and systemic health factors or even operator tactility or the surgeon's tactility would also be responsible for causing EAP.
What Are the Etiologic Risk Factors Causing EAP?
Some of the main factors that can cause EAP are as follows:
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The surface contamination of dental implants, in the operative arena or field ineffective sterilization of dental implants before placement or dental implantation.
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Overheated implant surface contacting the jaw bone during the osteotomy preparation or implant drilling.
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Ignorance of patient’s local risk factors by the dentist (either local factors such as pre-existing periodontal disease or severe gingival or granulomatous disease conditions making dental implants unfavorable in such cases).
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Ignorance of patient's systemic risk factors (presence of systemic diabetes, thyroid, hypertension, immunocompromised status, endocrine or electrolyte imbalance disorders, etc).
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Endodontic diseases are associated with adjacent teeth or the extracted tooth itself, which can, in turn, cause a disease of the underlying alveolar bone of the jaw (where the dental implantation is done).
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Pre-existing bone diseases.Presence of possible root fragments or remnants, improper extraction of the tooth at the implantation area.
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Presence of foreign bodies.
An important note to be taken by dental operators, that is, implant surgeons or maxillofacial surgeons, before dental implant placement is always the pre-operative evaluation phase, where there should be a complete assessment of the inclusion criterion for implants, the patient's medical and dental history, the patient's age, gender, expectations esthetically and functionally, the width and height of the bone available, the condition of the adjacent teeth, etc. After careful consideration of these factors, the implant dentist takes a call on how best to proceed with the surgical process of dental implantation.
Conclusion
EAP hence is associated with a multifaceted origin, involving possible exposure of the alveolar bone of the jaw, i.e., the site of dental implantation, to various risk factors that can trigger the failure of the implant indirectly. An inflammatory process that starts around the apex of the implant can be associated with these varied factors listed above that should be an early diagnosis and treatment initiative by the dental surgeon. If not managed on time, eventually, the primary stability of the dental implant in question would be compromised, leading to the loss of the implant. If the pre-operative evaluation is improper on behalf of the operator, then EAP can be an easy possibility that would predispose the patient to implant failure. Similarly, the necessity of post-operative healing has been highlighted in dental research as well because periodic follow-ups radiographically and clinically post-dental implantation can ensure that early and late EAP at any point in time can be quelled, preventing the risk of implant loss.
