What Is Peri-Implantitis?
Peri-implantitis would be termed as a pathological condition that occurs in the tissues around dental implants, mainly characterized by inflammation in the peri-implant connective tissue and, in most cases, by progressive, supporting bone loss. The histopathologic and clinical conditions leading to mucosa inflammation around the implant (peri-implant mucositis) and its eventual transformation to peri-implantitis remain factors that vary depending on individual oral hygiene, systemic health, and regular follow-up by the implantologist.
Treatment concepts for peri-implantitis are thus briefly elaborated here. The prevention of the condition is a priority in current implant dentistry for the long-term success of dental implants.
What Can Be Done to Remove Microbial Layer?
Although there is no standardized protocol for the peri-implantitis treatment through decontamination of implant, multiple methods exist that have been proposed. These include mechanical methods, chemical methods, laser, photodynamic therapy, and implantoplasty, usually combined with systemic antibiotics administration. All these strategies would prevent the onset or correct existing peri-implant disease.
Various implant surfaces developed over the recent decades have the same goal to enhance the osseointegration mechanism that accelerates and strengthens the new bone formation, providing better implant stability to the bone. Additional modification of implant surfaces also improves the surface roughness that can significantly enhance bone healing, especially in the regions with insufficient bone quantity enabling bone growth.
The implantologist can start with immediate or early loading protocols. These surface modifications of conventional titanium implants with microbial layer removal enhance surface roughness, a critical parameter for effective osseointegration.
1. Microbial Layer Removal:
Removing microbes from the implant surface can cause potential implant surface damage. As a result of damage to the implant surface, the chemical oxide layer of the surface changes, inducing corrosion, acidic pH, the implant surface roughness, and consequently plaque accumulation. Finally, osteoclast activation impairs the biocompatibility of the implant. Additionally, different decontamination methods would also be capable of generating mechanical or chemical processes on these surfaces, releasing titanium ions and particles. Then the pathogenic biofilm growth on treated surfaces can be influenced.
2. Establishing Biologic Seal Around the Implant:
If the implant's biological seal or proper gingival contour and attachment are violated, the adjacent soft tissues can become inflamed. This may be followed by osteoclastic activity of the underlying hard tissue and chronic resorption of the underlying alveolar bone. Suppose there is continued loss of this supporting bone.
In that case, the defect can fill with granulation tissue. In addition, the implant tends to become increasingly mobile with time, resulting in the entry of the bacterial toxins and destructive agents released into the previously healthy oral internal environment around the implant. Ultimately, this accessory destruction will occur, giving rise to acute suppurative inflammation or acute inflammation with pain. These clinical features are aggravated particularly upon mastication or characterized by extensive mobility that renders support of the dental prosthesis poor.
If degenerative processes are allowed to progress to this extent, the only effective treatment is removing the implant and debridement of the lesion. Furthermore, if sufficient bone is lost due to this destructive procedure, subsequent support of other implants or other therapeutic devices may be severely compromised.
3. Bacterial Ingress:
Major etiological factors in the development of peri-implantitis are due to the virulence factors of pathogenetic anaerobic bacteria that destroy the healthy microflora of the oral cavity. For example, Porphyromonas gingivalis (a keystone pathogen in periodontitis), Prevotella intermedia, A. actinomycetemcomitans, Tannerella forsythia, Treponema denticola, etc. These anaerobic organisms can be isolated from the plaque or biofilm around the implant (that has triggered the deleterious immunological reaction in host tissue). Detection of these pathogens can also help plan treatment modalities for preventing progressive surrounding bone loss.
Also, specific facultative isolated gram-positive pathogens like Staphylococcus aureus and fungi (C. Albicans) are used as causative agents for Peri-implantitis. In addition, systemic and local oral antibiotic therapy and antiseptic mouthwash may prove helpful along with adequate oral hygiene by the patient in controlling bacterial ingress causing Peri-implantitis.
4. Systemic Condition of the Patient:
There may exist a myriad of patient-related factors of multiple origins like genetic factors, general systemic disorders like diabetes mellitus, cardiovascular diseases, etc., local factors like periodontitis, residual retained cement restorations, poor oral hygiene, etc., smoking and chronic alcoholism, detrimental habits like tobacco chewing, addictions to drugs (cannabis, cocaine, etc.), or implant-based factors. These are definite risks that could induce the onset of implant disease and mobility and cause a failure by the aggravating severity of peri-implantitis.
What Are the Treatment Strategies for Peri-implantitis?
A. Mechanical and Chemical Methods:
These methods of implant surface decontamination deal mainly with the removal of biofilms and calculus and are essential for long-term success in the regeneration of surrounding bone around the implant area. Mechanical removal of infected granulation tissue and surface cleaning are primary steps in peri-implantitis. In addition, periodontal therapy methods like acid-etching, sandblasting, or functionally anodizing the implant surfaces are also practiced. Still, they are less effective than electrolytic processes that effectively eradicate biofilms from treated implant surfaces.
B. Implantoplasty:
This is a mechanical method of implant surface decontamination generally used during the surgical treatment of peri-implantitis. This is done by smoothening the exposed supracrestal implant surface and filling any persistent supracrestal bone defects. Implantoplasty is regarded as one of the many effective modalities for mechanical Peri-implantitis treatment. Evidence shows low bacterial counts and low bacterial adhesion after this procedure.
C. Chlorhexidine (CHX):
The CHX is a widely used ‘gold standard’ treatment for antiseptic therapy and irrigation in various implant treatment procedures. CHX is a potent chemical agent which exhibits both bactericidal and bacteriostatic effects. Research on regular use of CHX after treatment of periodontitis shows an increase in CHX concertation in both pure titanium and titanium-zirconium alloy discs. In addition, a significant decrease in the bacterial colony-forming units was observed, indicating good antibacterial response and biofilm control results. 
D. Lasers:
The laser’s satisfactory cutting capacity also induces good coagulation. Along with the antibacterial effect, the laser is a widely used strategy in dental implantology for:
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The second stage surgery of submerged implants.
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Peri-implant soft tissue surgeries.
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Surface decontamination of implants
Lasers, hence, have great potential to facilitate implant site preparation and, consequently, enhance bone healing and osseointegration.
Conclusion:
Hence to conclude, even though Peri-implantitis may be common sequelae indicating or causing implant failure, timely prevention and management by the dental implantologist or implant dentist can prevent long-term implant failure and bone loss.
