Pathogenesis (development of disease)
Peri-implantitis is a progressive inflammation of the bony bearing of a dental implant with peri-implant bone loss. Reversible inflammation of the soft tissue only is peri-implant mucositis (inflammation of the oral mucosa).
The disease is caused by mixed anaerobic germs. Periodontopathogenic germs (germs that cause disease in the periodontium) can be transferred from remaining teeth to implants. Persistence of periodontopathogenic germs is also present in edentulous patients.
The primary factor for the development and progression of peri-implantitis is microbial colonization of subgingival implant surfaces. Significantly more biofilm (plaque, bacterial plaque) is deposited on rough surfaces than on smooth surfaces.
The risk factors listed below have a favorable effect on the course of the disease.
Etiology (causes)
Biographic causes
- Age of life – increasing age
Behavioral causes
- Consumption of stimulants
- Tobacco (smoking) – is considered a major risk factor, as in the development of periodontitis (inflammation of the periodontium/parodont).
- Oral hygiene
- Plaque accumulation (accumulation of bacterial plaque) due to hygiene not adapted to the increased requirements of an implant.
Disease-related causes
- Bacterial infection
- Bruxism – grinding and pressing
- Chronic stress – promotes proinflammatory cytokines.
- Diabetes mellitus
- Immunosuppression
- Osteoporosis (bone loss)
- Periodontitis
- On remaining teeth
- In the edentulous patient as a pre-existing condition
- Saliva
- Composition
- Flow rate
- Viscosity
Medication
- Bisphosphonates (drugs used to treat osteoporosis).
- Salivation-inhibiting medications (medications that inhibit salivation).
X-rays
- Radiatio (radiotherapy) – irradiations in the head and neck area.
Operations
- Intraoperative damage to the implant bed
- Thermal trauma (heat-related injuries).
- Mechanical trauma
- Intraoperative (“during a surgical procedure”) misplacement of the implant.
- Wound dehiscence (wound-induced separation of related tissue structures) after augmentation (procedure to build up bony substance defects using bone grafts/replacement materials).
Other causes
- Implant-specific factors
- Poor hygienic ability of the implant
- Defective superstructure
- Occlusal (in the occlusal surface area) overloading.
- Exposed textured (rough) implant surfaces after physiological peri-implant bone resorption.
- Loosened abutment
- Microfractures (minute fissures and cracks in the bone mass).
- Overload during the healing phase
- Overload after the healing phase
- Excess of luting cement
