Peri-implantitis. Causes. Treatment

Implants are the optimal solution for replacing a lost tooth unit.

The stability and the ability to perform the normal functions of the replaced tooth is largely due to the bone insertion of the implant.

However, in some cases, infections may develop at the interface between the bone and the implant, causing resorption of hard tissue.

These infections are called peri-implantitis and are equivalent to periodontitis occurring in natural teeth.

Risk factors

  • General pathologies: uncontrolled diabetes mellitus (high blood glucose levels have been identified in many studies as an accelerator of bone resorption), osteoporosis (responsible for the decrease in bone density)

  • Poor oral hygiene: cervical line, both in implants and in natural teeth, being close to the gum, escapes rigorous brushing, so a high degree of bacteremia will be present at this level.

  • Smoking: the toxins contained in cigarette smoke deposit particularly on the oral dental surfaces, leading to bacterial growth at these levels.

  • History of periodontitis or untreated periodontal disease: uncleaned periodontal pockets are a rich subgingival source of bacteria, which will penetrate the bone, causing gradual resorption.

These risk factors have a common outcome: they lead to bacterial infiltration of bone, accompanied by resorption, which will result in mobilization and loss of implants.

Signs and symptoms

  • The classic signs of tissue inflammation such as bleeding, edema, changes in gum color are always present.

  • On clinical examination, the probe penetrates more and more into the sulcus: this is an indication that the bone is progressively receding under the action of pathogenic factors.

  • Halitosis, associated with purulent secretions in the space between the gum and the implant.

  • X-rays provide important clues to bone loss. If at each periodontal re-evaluation a radiological decrease in the amount of bone in the implants is observed, peri-implantitis could be suspected.

  • Pain: in most cases it is absent. As bone loss is chronic, slow, there are no sudden changes that trigger pain. However, in some cases, tenderness on brushing or palpation has been reported.

  • Implant mobility is usually the sign that alerts the patient and sends them to the dental surgery. With bone loss, the stability of the implant decreases as the bone’s supporting capacity decreases.

The dentist will carry out a full clinical examination to detect iatrogenic factors that promote inflammation.

Incorrectly performed fillings, excess cementing material not removed, parafunctions or poor occlusion are often promoters of gingival retraction and bone resorption.

Periodontal status should be reassessed every 6 months in patients who are not at risk of periodontitis and every 3 months in those who already have one of the forms of bone damage or general pathologies that may interfere with hard tissue health.

Treatment of peri-implantitis

Long-term goal is to stop the pathology from progressing, to stabilize the bone tissue and prevent relapses. In this way, the implants will be able to remain on the arch to serve their purpose.

Treatment is aimed at removing existing risk factors, carrying out local or systemic antibiotic therapy as necessary, and periodic scaling and root planing to maintain satisfactory oral hygiene.

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