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Non-surgical Therapy for Dental Implant Diseases

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Read the article to learn about the diagnosis and non-surgical modalities for preventing implant disease that leads to dental implant failure.

Medically reviewed by

Dr. Sowmiya D

Published At June 21, 2022
Reviewed AtAugust 2, 2023

Introduction:

The reason dental implants are considered a good standard prosthesis is because of their permanent integration or fusion into the alveolar bone and either by cement retained or screw-retained crowns they can be adjusted to the patient's occlusion restoring the masticatory forces as close as possible to the natural efficiency and chewing forces associated with natural teeth when compared to the crown, bridge or removable dental prosthesis that has limited efficiency and capacity or support. But dental implant success is not only dependent upon various factors like the patient's age, their systemic condition, the local conditions of the oral cavity in the patient, and the bone density or the width available that all need to be planned preoperatively by the dental implantologist prior to implantation. It is also dependent long term for its success only upon not developing any form of implant-related diseases like peri-implant disease ie peri-implant mucositis and periimplantitis.

What Is the Focus of the Implant Dentist for Long-Term Implant Survival?

The most common risk factor, of course, is considered to be periodontal disease or periodontitis which is a locally aggravating factor that may contribute to dental implant failure in the long term affecting the five to seven-year survival rates. Research in implant dentistry hence focuses upon the various surgical and non-surgical strategies available to the implant dentist to rectify the issues cropping up due to the development of peri-implant diseases and the key to prevent them is always said to be by primary prevention of bacterial film accumulation or biofilm accumulation. The accumulation of the biofilm is considered mainly to be the primary etiologic factor in invoking host Inflammatory mediators or inflammatory reactions causing peri-implant disease and in turn affecting the primary stability of the dental implant predisposing it to failure by anchorage or unstable fixture in the alveolar bone.

How to Diagnose Peri-Implant Disease?

The diagnosis of peri-implant mucositis is characterized by clinical features observed by the dentist.

  1. Bleeding or suppuration upon gentle probing: This is observed either with or without increased probing depth in comparison to the previous examinations.

  2. There is no observable bone loss beyond crestal bone level that may have resulted from initial bone remodeling.

If the diagnosis of this disease is established, the inflammation should be resolved hence primarily by adopting non-surgical treatment strategies. In advanced cases of peri-implant diseases be it mucositis or implantitis. However, surgical therapies like augmentative and non augmentative approaches that include resective or flap debridement procedures will also not be sometimes efficacious in such disease progressions. Hence prevention or non-surgical management initially remains the key to stopping further advances in peri-implant disease.

Is Peri-Implant Disease Reversible?

According to implant literature and documentation, just as in the example wherein the periodontal disease or bone disease follows the gingival disease. Similarly, peri-implant diseases follow peri-implant mucositis which is the primary precursor or disease wherein the mucosal structure around the implant gets inflamed. In this inflammatory state as well though, the marginal bone is still not lost beyond the initial phase of physiologic bone settlement. Hence this disease of peri-implant mucositis that can lead to peri-implant disease or periimplantitis resulting in implant infection, instability, mobility, failure, and exfoliation can be prevented by certain non-surgical strategies that are adopted in timely assessment and management by the implant dentist. The focus of the implant dentist is to resolve the inflammatory reaction that is invoked around the dental implant and when addressed in the initial or developing stages on time and with regular follow-ups to ensure the health of the dental implant post-implantation like six-monthly to 12 monthly intervals, implant disease is not only a reversible condition but also can be altogether prevented by maintaining adequate oral hygiene, chemical or mechanical plaque control forms and dentist support or management in clinic.

What Are the Non-surgical Modalities?

Let us take a look into the various non-surgical modalities to prevent implant diseases that will be considered by your dental surgeon in preventing dental implant failure and managing or restoring the implant to successful form and function.

  1. Non-surgical Mechanical Therapy or Debridement: Either by the usage of mechanical instruments like curettes alone, curettes plus ultrasonic device or only through ultrasonic devices, the implant dentist will aim to reduce the probing pocket depth (PPD), Plaque index (PI), Bleeding on Probing (BOP) parameters.

  2. Chlorhexidine Adjuvant Therapy: Many randomized controlled trials have reported the efficacy of applicator chlorhexidine gel 0.2 % or chlorhexidine mouthwash as adjuvant therapy to non-surgical mechanical debridement that can improve or lessen the symptoms of clinical inflammation around the implant tissue.

  3. Probiotic Therapy: The implant dentist can recommend conventional mechanical prophylaxis with probiotic therapy like with probiotic Lactobacillus reuteri that would have a potent antimicrobial effect along with a significant reduction in the bleeding on probing (BOP) sites at 6-week intervals after this therapy. 

  4. GPAP or Glycine Powder Air-Polishing: When GPAP is used alongside non-surgical debridement of inflamed tissues like with cigarettes and ultrasonic devices as mentioned earlier it would aid in reducing the viable bacterial count and in aiding the removal of Biofilm. 

  5. Antimicrobial Therapy: The supplemented use of antibiotics post non-surgical therapy or debridement such as locally delivered tetracycline into the peri-implant tissue or short-term use of the systemic antibiotic Azithromycin can be considered by some implant dentists to maintain the health of the soft tissue around the implant.

Conclusion:

To conclude, though the focus of the dentist through the initial phases of peri-implant disease diagnosis remains the non-surgical strategies elaborated, for complete resolution and health of soft tissue around the dental implant ie the peri-implant health - Regular dental follow-ups post-implantation, proper oral hygiene, and antimicrobial prophylaxis plays an important role in shaping long term survival outcomes of implants. Also in advanced cases of Periimplant disease, surgical therapies may be indicated by your implant dentist.

Frequently Asked Questions

1.

What Is the Most Effective Treatment for Managing Peri-Implantitis?

Peri-implantitis is a type of infection that affects the soft and hard tissues surrounding dental implants. The most effective therapy for managing peri-implantitis is a combination of mechanical and chemical debridement, followed by the administration of antibiotics, and supported by regular maintenance therapy. However, the success of the treatment depends on the severity of the disease, the extent of bone loss, and the patient's overall health. In advanced cases, surgical intervention may be necessary.

2.

In Which Type of Therapy Are Dental Implants Useful?

Dental implants are useful in both endosseous and subperiosteal implant therapies. In endosseous implant therapy, the implant is inserted into the jawbone, while in subperiosteal implant therapy, the implant is placed under the gum tissue but above the jawbone. Dental implants are an effective treatment option for patients who have lost one or more teeth due to injury, disease, or decay. They can improve chewing function, enhance speech, and restore aesthetic appearance.

3.

What Are the Risks Associated with Dental Implant Therapy?

Dental implant therapy, like any other medical procedure, carries some risks. These risks include infection, nerve damage, implant failure, rejection, and sinus problems. Other factors that can increase the risk of complications include smoking, diabetes, gum disease, and poor oral hygiene. To minimize the risks associated with dental implant therapy, patients should be thoroughly evaluated before the procedure, and a qualified and experienced dental professional should perform the procedure. Patients should also follow post-operative care instructions to promote healing and reduce the risk of infection.

4.

What Can Promote Faster Healing of Dental Implants?

Several factors can promote faster healing of dental implants, including proper oral hygiene, good nutrition, and avoiding smoking or tobacco use. Regular dental check-ups and cleanings are essential for maintaining healthy gum tissue and preventing infections. Patients should also follow any specific post-operative instructions provided by their dentist, such as avoiding hard or chewy foods for a certain period, to allow the implant to integrate properly with the surrounding bone.

5.

What Factors Can Enhance the Success of Dental Implants?

Several factors can enhance the success of dental implants, including proper patient selection, adequate bone quantity and quality, proper implant placement, and careful maintenance. Patients with good oral health and adequate bone volume are likelier to have a successful implant procedure. Proper implant placement by an experienced dental professional ensures the implant integrates well with the surrounding bone. Finally, regular maintenance and good oral hygiene are essential for preventing infections and ensuring the longevity of the implant.

6.

What Is the Most Common Issue with Dental Implants?

The most common issue with dental implants is peri-implantitis, a type of infection affecting the soft and hard tissues surrounding the implant. If left untreated, this infection can cause bone loss, implant mobility, and implant failure. Other issues with dental implants may include nerve damage, implant rejection, and implant fracture. However, proper patient selection, implant placement, and post-operative care can often avoid these rare issues.

7.

What Is the Primary Problem Associated with Dental Implants?

The primary problem associated with dental implants is implant failure, which can occur due to various reasons such as infection, implant rejection, implant fracture, or insufficient bone volume to support the implant. Patients with certain medical conditions, such as autoimmune diseases or uncontrolled diabetes, may be at a higher risk of implant failure. Smoking, poor oral hygiene, and a history of radiation therapy to the head and neck can also increase the risk of implant failure. Proper patient selection, implant placement, and post-operative care are crucial to reduce the risk of implant failure.

8.

What Is a Non-Surgical Treatment for Peri-Implantitis?

Non-surgical treatment for peri-implantitis involves the mechanical and chemical debridement of the infected implant surface, followed by the administration of antibiotics, and supported by regular maintenance therapy. This treatment aims to remove the bacterial biofilm surrounding the implant, promote tissue healing, and prevent further bone loss. However, non-surgical treatment may not be effective in advanced cases of peri-implantitis where bone loss is severe, and surgical intervention may be necessary.

9.

What About the Risk of Infection With Dental Implants?

Like any surgical procedure, there is a risk of infection associated with dental implant therapy. However, the risk of infection can be minimized by proper patient selection, implant placement, and post-operative care. Patients should maintain good oral hygiene by brushing and flossing regularly and avoiding tobacco products. Additionally, patients should follow any specific post-operative instructions provided by their dentist, such as taking antibiotics or using an antimicrobial mouthwash, to reduce the risk of infection.

10.

Can Antibiotics Help in Treating Peri-Implantitis?

Antibiotics may treat peri-implantitis, but they are not always effective. Antibiotics may sometimes be combined with non-surgical or surgical interventions to treat peri-implantitis. The choice of antibiotic and duration of treatment may vary depending on the severity of the infection and the patient's medical history. However, antibiotics should not be relied upon as the sole treatment for peri-implantitis, and proper debridement of the infected implant surface is also essential.

11.

What Are the Antibiotics Used for Treating Peri-Implantitis?

The choice of antibiotic for peri-implantitis treatment may depend on the type and severity of the infection, as well as the patient's medical history. Antibiotics such as Amoxicillin, Metronidazole, and Clindamycin have effectively treated peri-implantitis. However, the use of antibiotics should be carefully considered, and the duration of treatment should be appropriate to avoid the development of antibiotic resistance. Antibiotics should be combined with mechanical debridement to achieve optimal treatment outcomes.

12.

What Are the Signs of Peri-Implantitis?

Signs of peri-implantitis may include redness, swelling, and bleeding of the gums surrounding the implant, as well as implant mobility and discomfort. As the infection progresses, bone loss may occur, leading to further implant instability and, eventually, implant failure. Early diagnosis and treatment of peri-implantitis are crucial to prevent further bone loss and preserve the implant. Patients should regularly visit their dentist and report any symptoms or changes they notice around their dental implant.

13.

What Are the Stages of Peri-Implantitis?

The early stages of peri-implantitis may involve inflammation of the soft tissues surrounding the implant, which may cause redness, swelling, and bleeding upon probing. Additionally, patients may experience discomfort or sensitivity in the affected area. As the infection progresses, bone loss may occur, leading to further implant instability and, eventually, implant failure. Regular dental check-ups and proper oral hygiene practices can help identify and prevent the progression of peri-implantitis in the early stages.

14.

Can Antibiotics Help in Clearing an Infection Around Dental Implant?

Antibiotics may be used to treat a dental implant infection, but their effectiveness depends on the severity of the infection and the patient's medical history. Antibiotics can help control the infection and prevent further bone loss, but they should be combined with mechanical debridement of the infected implant surface. Proper oral hygiene practices and regular dental check-ups can help prevent the development of dental implant infections. If a patient suspects a dental implant infection, they should contact their dentist immediately for evaluation and treatment.

15.

How to Clean an Area Affected by Peri-Implantitis?

Cleaning peri-implantitis involves the mechanical and chemical debridement of the infected implant surface to remove the bacterial biofilm and promote tissue healing. This may involve using special instruments or ultrasonic scalers to clean the implant surface. Additionally, antibiotics may be administered to control the infection. Patients should also maintain good oral hygiene practices and follow any specific post-operative instructions their dentist provides. Regular dental check-ups and professional cleaning can help prevent the development of peri-implantitis.
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Dr. Achanta Krishna Swaroop
Dr. Achanta Krishna Swaroop

Dentistry

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