For millions of people, dental implants provide a long-lasting, predictable solution for missing teeth, though complications with dental implants can arise. One of the more common complications is peri-implant disease, which can develop even several years after the implants were placed. Peri-implant disease may occur as peri-implant mucositis, which affects the soft tissues surrounding the dental implant, or as peri-implantitis, which affects both the soft tissue and the bone that supports the dental implant. While peri-implant mucositis can be reversed if treated promptly, if it remains untreated, it usually develops into peri-implantitis, which can lead to implant failure if not intercepted with treatment. It is estimated that nearly half of all dental implant patients have or have had some level of peri-mucositis, though this is just an estimate; because peri-implant mucositis is reversible and may be free of symptoms, arriving at an exact number is impossible.
Like gingivitis, peri-mucositis is common and reversible in its early stages; also like gingivitis, peri-implant mucositis can develop into a more serious, more destructive condition the longer it is neglected. The earlier stages of peri-implant disease arise because of the accumulation of bacteria on exposed implant surfaces, where bacteria accumulate and lead to inflammation of the surrounding soft tissues, a condition called peri-implant mucositis. The primary goal of treatment for peri-mucositis is to remove the accumulated bacterial biofilm and allow the soft tissues of the gums to return to their normal, healthy state. While early peri-implant mucositis is reversible, diagnosis can be difficult, as the condition may be asymptomatic. When symptoms are present, they may include redness and swelling in the gums, which might bleed during brushing or flossing. Because it is often asymptomatic, however, in many cases, peri-implant mucositis is first diagnosed by a dentist during a clinical examination, using periodontal probing instruments to measure the depth of inflamed gingival pockets around the implants.
As it is a more advanced version of peri-mucositis, peri-implantitis shares characteristics with peri-implant mucositis but also involves the loss of the alveolar bone in the jaw. Peri-implantitis is measured with the same basic parameters as peri-implant mucositis, but, because it is also characterized by the loss of bone in the jaw, the diagnosis for peri-implantitis must include x-ray imaging. Bone loss can be diagnosed by comparing baseline measurements on x-ray images with measurements over time; if there is more than two millimeters of bone loss, around a dental implant, this can be an indication of peri-implantitis. Peri-implantitis can be treated with a few different treatment methods, some of which involve surgical bone regeneration, with the goal of preventing future implant failure and creating a secure base for an implant that will succeed over the long term.
One of the most significant risk factors for peri-implant disease is poor oral hygiene, though this can have different causes. Patients with a history of periodontitis face a greater risk of developing peri-implant disease, as the causes and biological processes involved with both conditions are very similar. In some cases, oral hygiene issues arise when patients aren’t able to fully, properly clean their dental implants, even when using specialized tools recommended by their dentist. This could be because of the position of the dental implant, the patient’s cleaning technique, or the dentist’s disproportionate focus on aesthetics over function and mechanics. Residual dental cement that remains in the oral cavity after implant placement can also lead to hygiene issues, as hardened, rough cement creates a welcoming surface for bacteria and leads to inflammation.
Smokers face an increased risk of peri-implant disease, just as smokers face a greater risk of periodontal disease. Some studies suggest that peri-implant disease can also be caused by microfractures in the jaw that arise because of excessive pressure on the bite, though poor oral hygiene is often an underlying factor in any patient with peri-implant disease, regardless of apparent external factors. Planning your dental implant restoration treatment with a qualified, experienced, and reputable implant dentist is one way to help avoid peri-implant disease. This includes accurately designing the implant restoration, considering the location of the implant and relying on custom implant components when necessary. For example, if a dental implant is needed in a hard-to-reach area, it may be preferable to create a custom, angled implant abutment that allows the implant and restoration to be more accessible to cleaning tools, or it may mean choosing to affix a dental prosthetic with screws instead of dental cement. When dental cement is used to secure restorations, your dentist should take additional considerations to prevent excess residual cement from extruding into the gum line, and they should make sure to thoroughly remove any excess cement and leave the implant site immaculate and free from bacteria attractors.
Implant dentists also need to evaluate risk factors as they plan implant restorations, providing education and ancillary medical treatments when needed; for example, dentists can offer smoking cessation guidelines to patients who smoke and help them continue a tobacco-free life during maintenance appointments. Each patient’s dental and medical history helps the implant dentist plan for a safe implant procedure and determine the proper schedule for maintenance following implant placement. When patients have a history of periodontitis or other inflammatory conditions, dentists will usually recommend more frequent maintenance visits to ensure that peri-implant disease hasn’t begun to develop, adjusting recommendations as needed. In turn, patients should expect to be comprehensively educated on effective oral hygiene methods and will learn about the potential risks of neglecting their oral hygiene, which could include implant failure. In light of the cost of dental implants, the risk of losing implants is often a good incentive for adopting healthier oral hygiene habits, but this risk is real for patients who neglect their oral hygiene or approach it ineffectively. With routine scheduled cleanings and dental checkups, dentists can monitor oral hygiene and make recommendations as needed, and they can treat any peri-implant disease that may have begun to develop, preferably before it begins to irreversibly destroy the supportive tissues of the oral cavity. In all cases, preventing peri-implant disease is preferable and far easier than treating a peri-implant disease, and closely adhering to your dentist’s recommendations is one way to ensure that you’ll avoid peri-implant disease and have decades of satisfaction from your dental implant restorations.