Periimplantitis - An Overview

Introduction:

Dental implants are creating a new revolution in the field of dentistry. Crowns, bridges, and dentures are replaced with implants for superior aesthetics and quality. Although dental implants are expensive, they offer an excellent finish and long-term validity. As a result, implants are now considered a treatment of choice for replacing a missing tooth. Additionally, dental implants have several advantages over conventional options. However, like all other dental prostheses, implants are prone to infections. In addition, they are affected by a condition known as periimplantitis.

What Is Periimplantitis?

Periimplantitis is characterized by infection, inflammation, and destruction of the tissues around the implant. It is known as peri-implant mucositis if the implant's soft tissues (gums and the oral mucosa) are affected. Likewise, if the hard tissue (bone) around the implant is inflamed, it is called periimplantitis. However, the two terms can be used interchangeably. Periimplantitis is caused by a bacterial infection that leads to inflammation of the tissues around the implant. Additionally, several risk factors contribute to the occurrence of periimplantitis.

What Causes Periimplantitis?

Besides the associated risk factors, bacteria are the main culprits behind periimplantitis. The species of bacteria that cause periimplantitis are:

• Prevotella intermedia.

• Prevotella nigrescens.

• Streptococcus constellatus.

• Aggregatibacter actinomycetemcomitans.

• Porphyromonas gingivalis.

• Treponema denticola.

• Tannereall forsythia.

What Are the Risk Factors Associated With Periimplantitis?

The common risk factors associated with the occurrence of periimplantitis are:

• Smoking.

• Previous history of severe gum infection (periodontitis).

• Poor oral hygiene.

• Immunocompromised conditions like diabetes, AIDS (acquired immunodeficiency syndrome), etc.

• Cardiovascular diseases.

• History of implant failure.

• Quality of area of the implant (lack of healthy gums and poor bone density).

• Iatrogenic causes.

• Overloading the dental implant with stress.

• Poor quality of implant material or faulty technique.

How Commonly Does Periimplantitis Occur?

• The prevalence rate of periimplantitis is estimated to be around 56 percent.

• Implants have a success rate of around 82 percent, even after 16 years of implant placement.

• Some studies have shown the incidence of periimplantitis in the range of 5 to 63 percent.

• 10 to 50 percent of implants show signs of periimplantitis after ten years.

What Are the Signs and Symptoms of Periimplantitis?

The Symptoms of Periimplantitis Include:

1. Red and swollen gums around the implant.

2. Bleeding around the implant while brushing.

3. Wobbling or loose implant.

4. Bad breath or halitosis.

5. Foul taste while eating.

6. Sometimes, the patient might experience mild pain.

7. Pus discharge from the tissues around the implant.

Clinical Signs of Periimplantitis:

1. Bleeding on Probing - When the doctor examines the gums around the implant using an instrument called a dental probe, the gums start to bleed or show pus discharge.

2. Hyperplasia of the Gingiva - Gums appear swollen and enlarged on examination due to inflammation.

3. Pocket Formation or Gum Recession - When the dentist runs a probe around the implant, the probe tends to go deeper, suggesting bone or gum loss due to periimplantitis.

4. Erythema of the Gums - The area around the implant appears red on examination, indicating inflammation of the tissues.

5. Bone Loss - On an X-ray, the bone loss around the implant suggests periimplantitis.

How Is Periimplantitis Diagnosed?

The diagnosis of Periimplantitis can be established with the following steps:

1. Case History - The clinician will ask a series of questions related to the implant’s placement pre-operative and post-operative status, history of symptoms, etc. Additionally, the patient’s systemic condition, habit, personal history, and overall health status are noted down.

2. Clinical Examination - It is crucial for diagnosing periimplantitis as it can reveal signs of periimplantitis. The dentist will look for signs like bleeding on probing, implant mobility, bone loss, gingival recession, and other signs of inflammation (red and swollen gingiva).

3. X-Rays - A radiograph of the implant and the surrounding bone appears distorted with periimplantitis. Bone loss can be seen around the implant compared to other regions of the oral cavity.

What Is the Treatment of Periimplantitis?

The treatment of periimplantitis involves -

A. Scaling or Curettage: This involves debridement of the implant surface with a piezoelectric or manual scaler. The procedure significantly decreases the microbial load and reduces the signs of inflammation. The treatment can be provided with Teflon, carbon, plastic, and titanium curettes.

B. Pharmacological Therapy: The doctor might prescribe an antiseptic mouth rinse like Chlorhexidine or Betadine to reduce the microbial load. Additionally, topical or systemic antibiotics might be given depending on the extent of the condition. The commonly prescribed antibiotics are -

• Tetracycline.

• Doxycycline.

• Amoxicillin.

• Metronidazole.

• Ciprofloxacin.

C. Laser Therapy: Laser therapy offers an excellent advantage compared to conventional treatment modalities. They have a bactericidal effect and yield better results, including decreased bleeding and pocket depth. However, lasers are used as an adjunct to manual therapy.

D. Photodynamic Therapy: A newer approach involves generating reactive oxygen molecules using a high-energy diode laser. Photosensitizers like toluidine blue are used along with the laser diode to produce a bactericidal effect. Photodynamic therapy is considered adjunctive care as enough data is not available to prove its efficacy.

E. Surgical Therapy: Surgical intervention is considered when other approaches fail to relieve the symptoms. If the defects are too significant (probing depth of more than 5 mm), procedures like resection and regeneration are practiced.

• Resection - This involves the elimination of bone defects, microbial load reduction, or decontamination. Later, the implant surface is polished and smoothened (implantoplasty).

• Regeneration - It involves the use of graft materials or membranes for the regeneration of bone. Regeneration is carried out for long-term functional and aesthetic benefits.

How Can Periimplantitis Be Prevented?

Untreated cases of periimplantitis can lead to significant bone loss and implant failure. Although the condition is irreversible, preventive measures must be taken. These include:

• Maintaining good oral hygiene, plaque control measures, and regular dental visits.

• After the implant placement, ensure to follow oral hygiene measures as instructed by the dentist.

• Avoid smoking and consuming alcohol.

• Maintain blood sugar levels and good overall health.

• Lastly, regularly follow up with your dentist.

Conclusion:

Dental implants are creating a new revolution in the field of dentistry. Periimplantitis is characterized by infection, inflammation, and destruction of the tissues around the implant. The prevalence rate of periimplantitis is estimated to be around 56 %. The symptoms of periimplantitis include implant mobility, bleeding gums, bad breath, etc. Periimplantitis is a progressive condition that leads to implant failure and bone loss. Although the condition is irreversible, measures can be taken to prevent periimplantitis.