Peri-Implantitis is an “infectious disease that causes inflammation of the surrounding gum and bone of an already integrated dental implant, leading to loss of supporting bone.” Most inflammatory episodes are caused by plaque biofilm colonizing around the implant. Peri-Implantitis begins as Peri-Implant Mucositis which is an inflammatory condition of the mucosa and can be compared to Gingivitis because it’s reversible and doesn’t include bone loss.
Without proper treatment, Mucositis can progress to Implantitis by involving the mucosa and supporting bone. Implantitis is characterized by Crestal Bone level loss along with bleeding upon probing and exudate, and there may or may not be deepening of the pocket around the implant.
It’s estimated that one in five patients will exhibit Peri-Implantitis and the shocking part is that many patients will never have any symptoms of Peri-Implant Mucositis or Peri-Implantitis. Either condition can also occur immediately following placement of the implant or years later.
Risk factors for this condition include smoking, diabetes, osteoporosis, periodontal disease of natural teeth, poor home care, compromised immune system, and bruxism. Sometimes, there is no reason at all for Peri-Implantitis. The good news is that it’s rare and treatment is available.
Symptoms of the disease include deepening pockets around the implant, exudate, bleeding, progressive loss of supporting bone, swelling, metal thread exposure, and mobility of the implant.
Causes of this disorder are soft bone, vertical bone graft placement, implant size too big for the site, lack of tightness when placing the implant, overheated bone, excess cement at the implant site, malocclusion, occlusal overload, and bruxism.
Treatment options consist of thoroughly cleaning the area, site-specific and/ or systemic antibiotics, bone grafting, surgery, and removal and replacement.
If you see any changes in an implant site such as bleeding, exudate, bone loss, sensitivity, loosening of the implant, and swelling, immediately refer the patient back to the specialist who placed the implant. As stated earlier, the patient may have no symptoms so a thorough exam including radiographs at each appointment may keep the implant from failing. Reassure the patient that just because one implant may have failed or developed peri-implantitis, it doesn’t mean that the second one will fail or develop any complications.