Peri-implantitis is a disease that can occur in implant carriers.It is similar to periodontitis of the natural tooth. Peri-implantitis is accompanied by inflammation and recession of mucosa – peri-implant mucositis – and bone – peri-implantitis – in the area of one or more implants and, if left untreated, will inevitably lead to loss of the implant. Four classes are distinguished according to the extent of bone loss:
- Mucositis with slight bone loss < 1/4 of the implant length.
- Mucositis with moderate bone loss <2/4 of the implant length.
- Mucositis with severe bone loss < 3/4 of the implant length.
- Mucositis with severe bone loss up to 4/4 of the implant length.
Radiologically, bone loss can be divided into horizontal, funnel-shaped, key-shaped and cleft-shaped. The different types of bone resorption entail different therapeutic consequences.
Symptoms – Complaints
Symptoms and complaints are similar to those of periodontitis:
- Sweetish bad breath
- Pain when brushing teeth – in the area of the implant.
- Bleeding gums
- Gum recession
- Bone recession – radiographic
- Implant loosening
- Implant loss
Pathogenesis (disease development) – etiology (causes)
Implants are anchored in the bone. Above the implant lies mucosa and above it the superstructure, for example, a crown or prosthesis.As on the natural tooth so also on implants and implant-supported dental prosthesis deposits, which consist of food residues, bacteria and saliva components.If these deposits are regularly removed thoroughly, the implant can have a long life in the mouth.However, if the deposits are not removed, then initially a peri-implant mucositis, an inflammation of the mucosa over the implant develops. This inflammation is roughly equivalent to gingivitis, the inflammation of the gums. Peri-implant mucositis usually heals without complications by removing the plaque that caused it.However, if the plaque persists, the inflammation also attacks the bone, resulting in bone loss around the implant, which is called peri-implantitis.
Consequential diseases
The lost bone cannot regenerate and is irrevocably lost. In the worst case, so much bone is lost that loosening and eventual loss of the implant occurs. It is therefore imperative to first examine patients with a desire for an implant for their periodontal condition – the condition of the periodontium – and, if necessary, to sanitize it in order to prevent any existing periodontitis from spreading to a planned implant from the outset.Nevertheless, the risk of peri-implantitis is significantly higher in patients with previous periodontitis.
Diagnostics
Peri-implant mucositis can be clearly identified by the classic signs of inflammation in the mucosa surrounding the implant. These include redness, swelling, bleeding tendency, and pain. Peri-implant bone resorption can be detected using an x-ray – orthopantomogram (panoramic radiograph) or dental film.
Therapy
The therapy of peri-implant mucositis consists in the elimination of the infection by anti-infective and antimicrobial rinsing solutions (chlorhexidine rinsing solutions) for a maximum of four weeks and in the professional cleaning of the implant (implant decontamination) with plastic instruments and polishing cups. Furthermore, it is important to once again optimize the patient’s oral hygiene at home and to motivate him again to prevent the spread of inflammation to the bone in the long term. Another procedure to decontaminate the implant surface is the use of suitable laser beams. Erbium:YAG laser and CO2 laser are considered to be basically suitable for this purpose. The aim of laser treatment is to remove the plaque or sterilize it without causing excessive heating of the tissue or implant, as this would result in long-term damage. The laser is used in particular for otherwise difficult-to-access, gap-shaped bone defects that are hardly accessible with conventional dental instruments.If periiplantitis with bone loss is already present, additional surgical intervention is required after cleaning and antimicrobial therapy. Sometimes, after removal of the inflammation, the resulting bone pockets can be filled with bone or bone substitute material in order to anchor the implant firmly in the bone again. In addition, if the inflammation persists, an antibiotic adjunctive therapy with a combination of amoxicillin and metronidazole for about one week may be useful. However, it should always be borne in mind that not only the implant but also the remaining dentition must be treated in order to prevent the transmission of germs and to preserve the natural teeth. If the therapy is not successful or the implant loosens, explantation should be performed to prevent further bone loss.
