Peri-implantitis is the medical term for an implant bed inflammation in dental implants. The preliminary stage of so-called peri-implantitis is called mucositis and describes an inflammation of the mucosa surrounding the implant neck. In the advanced stage, it is an irreversible disease; the earlier peri-implantitis is detected, the higher the chances of complete healing.
What is peri-implantitis?
Many individuals who have dental implants are often unaware of the potential health risks. These include peri-implantitis, which describes an advanced inflammatory process of the gums and only occurs when implant procedures have been performed. The inflammation spreads to the depths of the jaw bones. In the initial stage, the physician still speaks of mucositis or peri-implant mucositis. Mucositis is an inflammation of the tissue surrounding the implant. After treatment, the mucositis recedes. However, if the physician detects peri-implantitis, an irreversible condition has already occurred, which sometimes also causes bone resorption. If peri-implantitis is treated too late or not at all, the patient can expect to lose his or her dental implant.
Causes
The cause of peri-implantitis can be compared to periodontitis. This is because plaque also accumulates in the course of periodontitis or periimplantitis. If the affected person removes this plaque irregularly or not thoroughly enough, bacteria begin to form at the gum junction and can work their way up to the implant neck. Subsequently, the affected person complains of pain. Inadequate and lacking oral hygiene can also be responsible for the development of peri-implantitis. The following factors also promote peri-implantitis: smoking, untreated periodontitis, diabetes mellitus, medications (such as immunosuppressants), a periodontal history, hormonal changes, osteoporosis. However, prolonged stress, poor implant or even dental care, irregular medical dental check-ups as well as poor healing of the implants can also promote peri-implantitis – whereby it can be caused not only by the affected person, but also by the doctor treating him or her.
Symptoms, complaints and signs
At the beginning, the affected person feels slight pain when touching his gums at the edge of the implant. Sometimes the gums near the implant may turn reddish or patients also state that the implant causes pain. These factors can be the first signs of inflammation; a dentist should be consulted at the slightest symptoms. If peri-implantitis is already in an advanced stage, the affected person complains of bone pain, which is mainly localized in the jaw region. The gums recede and the dental implant feels “loose”. Sometimes the feeling that the implant is “loose” can be another sign of peri-implantitis. The symptoms are relatively difficult to interpret; for this reason, it is important to notice regular dental check-ups. This is because the dentist not only checks the depth of the gingival pocket, but can also use marker tests to determine within a very short time whether the dreaded peri-implantitis is present.
Diagnosis and course of the disease
For peri-implantitis to be diagnosed, two steps are essential. First, the classic clinical diagnosis of the area is performed; for this purpose, the physician uses so-called periodontal probes. If bleeding occurs, which may also be an indication of pus discharge, the suspected diagnosis of peri-implantitis can be made. X-rays enable the physician to obtain a precise picture of the condition of the affected region. Intraoral dental film exposures are taken, which confirm the suspected diagnosis. The course and prognosis depend on the severity. This means that the physician will check the degradation of the bone to make any prediction. Respective and augmentative treatment procedures may very well arrest peri-implantitis; in many cases, complete regeneration of the bone can also be observed. In some cases, however, only implant removal is possible.Only when the physician has removed the implant again can the bone regenerate and be rebuilt. After regeneration, a new implant can be placed.
Complications
In most cases, peri-implantitis is associated with severe pain in the mouth and teeth. Affected individuals are also significantly restricted in their intake of food and fluids, so it is not uncommon for them to become underweight or deficient. Dehydration can also occur as a result of peri-implantitis. The pain from the teeth not infrequently spreads to the ears or head, so that most sufferers also suffer from depression or psychological discomfort, as the pain is permanent. The treatment of this complaint is carried out with the help of antibiotics or radiation. As a rule, no particular complications occur. Also, the life expectancy of the patient is not affected or reduced by this disease. Furthermore, in severe cases, however, the implant must be completely removed and replaced. Without treatment, the inflammation can also spread to the neighboring teeth and affect them. If the bone has already been degraded by the disease, it must be filled with a filling material. However, this also does not lead to further complications.
When should you go to the doctor?
Carriers of dental implants who suddenly notice a sweetish mouth odor or pain when brushing their teeth should consult the dentist. Peri-implantitis is a serious condition that must be clarified quickly. Medical help is necessary at the latest when there is noticeable loosening of the implant. If the complaints occur shortly after insertion of the dental implant, the responsible physician must be informed immediately. There is a particular risk if the patient does not maintain adequate oral hygiene or suffers from other diseases of the teeth or gums. If these risk factors are present, a doctor who can diagnose and treat the condition should be consulted immediately in the event of the aforementioned complaints. The first point of contact is the dentist. The physician can examine the oral cavity and the implant and, if necessary, consult the responsible surgeon. Depending on the severity of the condition, peri-implantitis can be cured with the help of rinsing solutions or by professional cleaning of the implant. In addition, the patient must optimize oral hygiene at home to prevent the spread of inflammation in the long term.
Treatment and therapy
The top priority of treatment is the complete removal of the bacteria that subsequently triggered the peri-implantitis or inflammation. The treatment depends on the extent to which the inflammation is already advanced or how aggressive the bacteria actually are. If the peri-implantitis is still in the initial stage, special rinsing solutions can lead to success. Professional oral cleaning and dental hygiene as well as professional cleaning of the dental implant can also lead to success. In many cases, the affected person must also take antibiotics. Laser therapy (photo-thermal therapy, also called PTT) is another option. By means of laser therapy, the physician can remove bacteria and germs that are responsible for the breakdown of tissue. In this way, any degradation of tissue can be stopped. However, if the physician has diagnosed advanced peri-implantitis, which has also already caused bone resorption, in many cases only a surgical intervention can help. In this case, the physician fills the bone pocket using bone substitute material so that the implant can be anchored anew in the jawbone.
Outlook and prognosis
The prognosis for peri-implantitis depends on the extent of the disease and the cause of its development. Precise information on the outlook is provided by the treating dentist or oral surgeon. Oral hygiene is an important factor in peeriimplantitis, both in terms of the development and healing of this inflammatory disease. Therefore, the patient’s cooperation is very important in terms of the most favorable prognosis. Teeth should be brushed very thoroughly and, of course, regularly. Once or twice a year, the PZR, the professional tooth cleaning by specially trained assistants, which is covered by most health insurance companies, is important. The dental practice also offers special cleaning of implants.This is also recommended once or twice a year and contributes to a favorable prognosis with regard to peri-implantitis. Smoking may promote susceptibility to the inflammation while masking the symptoms. Nicotine is often associated with a negative prognosis. Implant loading is also closely related to the outlook for peri-implantitis. The healing phase of the implant, which is determined by the dentist, is essential to consider in terms of loading. The prognosis of peeriimplantitis may be worse if the tissue is loaded more intensively by the patient than advised by the dentist.
Prevention
For peri-implantitis to be prevented, oral hygiene is, of course, paramount. Only in this way can the affected person avoid deposits and plaque, which subsequently lead to bacteria. Furthermore, professional implant cleanings and semi-annual or annual dental check-ups and also professional dental as well as implant cleanings are essential.
Aftercare
Peri-implantitis involves an inflammatory reaction around the area of the implant as a dreaded complication. This can often be prevented by regular and thorough cleaning, which is why oral hygiene plays an important role in aftercare. After the dental implant has been placed, the dentist will provide detailed information on the precautions to be taken during aftercare in order to prevent the development of peri-implantitis as far as possible. Brushing technique is just as important as regularity and the use of dental floss or interdental brushes and mouthwash. Still, there are areas that are not reached by toothbrushes. Here, PZR (professional teeth cleaning) is important, which can also cover the gum line and interdental spaces and prevent the settlement of bacteria that cause inflammation. PZR should also be regularly supplemented by professional implant cleaning in the dental office. In addition, attention should be paid to the dosed loading of the implant during the healing phase. Nicotine is a factor to be avoided at all costs around perimplantitis. As with periodontitis, nicotine also hides the first signs of inflammation in peri-implantitis, so that patients often visit their dentist very late. Stopping in the frame with aftercare is a step in the right direction for teeth and gums as well as health in general.
What you can do yourself
Peri-implantitis is a condition following implant placement that can often be prevented by the individual as well as improved by supporting the treatment in everyday life. In this context, it is important that measures ordered by the dentist must be followed. It is particularly important to refrain from smoking, as nicotine promotes peri-implantitis and can significantly delay its healing. Also, complete exposure of the implant site by chewing hard foods is not allowed until the dentist has permitted it. Alcohol is also a factor that can delay regeneration, so abstaining from alcoholic beverages is also part of self-help against peri-implantitis. Cleanliness and hygiene are among the most important measures that can be used to combat peri-implantitis and, incidentally, prevent it from occurring in the first place. Many patients are reluctant to clean this area intensively because they do not want to irritate it further. But exactly the opposite is the case. The more carefully the area around the implant is cleaned, the better the bacteria that can cause inflammation can be eliminated. During the twice-yearly recommended professional implant cleaning, the dentist also points out any errors in the cleaning technique and thus helps the patient to optimally organize the so important oral hygiene at home on their own.
