Peri-implantitis is a condition characterized by inflammation of the soft oral tissues that surround dental implants and by the degradation of the supporting bone in the jaw. In its earlier stages, peri-implantitis may be asymptomatic, though the symptoms that do appear closely resemble the symptoms of gum disease. While gum disease can develop in anyone, however, peri-implantitis only develops in people with dental implants. The initial symptoms of peri-implantitis could include red, swollen, visibly inflamed gum tissue; a visible depression in the bone surrounding a dental implant; a foul taste or smell in the mouth; soreness or tenderness in the gums; swollen lymph nodes; and bleeding while brushing or flossing. Similar symptoms can characterize peri-mucositis, a condition that is similar to peri-implantitis but that affects only the soft tissues and leaves the bone unaffected; when peri-mucositis goes untreated, however, it often develops into peri-implantitis.
Like gum disease, peri-mucositis is reversible when it is detected and treated early; also like gum disease, peri-mucositis becomes more severe and develops into a more serious condition – peri-implantitis – when it is left untreated. Because peri-mucositis is reversible but may not present symptoms, regular dental checkups that include dental x-rays could provide the first indications of problems with a patient’s dental implants and facilitate early treatment that can prevent peri-implantitis from developing. The teeth, gums, dental implant sites, and oral cavity are evaluated visually and manually, with modified evaluative measures used for implants. For example, the pockets that surround dental implants are, by design, deeper than the pockets that surround the natural teeth, and your dentist will measure and record the implant pockets in your initial follow-up visit to establish a baseline for future measurement. If the depth of the pockets around your implants increases between visits, this could be an early sign of peri-implantitis. Your dentist will also observe whether the gums bleed upon probing and check for pus or any other signs of inflammation or infection at each routine visit, providing prompt treatment if it is needed.
The success rates of dental implants are universally high, but, as with any invasive surgical procedure, dental implant treatment is not without its risks. One of the risks of dental implants is peri-implantitis, which occurs when the gum tissue around a dental implant grows infected. The most common cause of the infection that triggers peri-implantitis is poor oral hygiene, and the risk of infection increases in patients who use tobacco; have certain diseases like osteoporosis or diabetes or a history of periodontitis; patients who grind or clench their teeth; and patients whose doctor cut corners in their dental implant procedure, which can be a sign of inexperience or a side effect of a “budget” implant option. Experienced implant dentists will assess the oral tissues and ensure the likelihood of success before choosing implant materials and designs and implementing treatment.
As with any surgical site, dental implant sites face the greatest risk of infection while they are healing. This means that conscientious aftercare is an integral part of the long-term success of any dental implants. If you smoke, you’ll be strongly cautioned to avoid smoking while your dental implants heal, and it’s important to be aware of the overall detriments of smoking when it comes to both the oral health and the overall health. In some cases, patients successfully use the healing period following dental implant placement as a catalyst to quit smoking forever. If you have a medical condition that increases inflammation, like diabetes, rheumatoid arthritis, or cardiovascular disease, you also face a greater risk of peri-implantitis, and you and your dental implant team should review these risks as part of your implant planning. Meticulous care of the oral cavity, including the soft tissues, natural teeth, and dental implants, can help keep inflammation to a minimum and protect dental implants from peri-implantitis. Effective oral hygiene involves brushing twice daily with a soft toothbrush and fluoride toothpaste, taking special care to gently clean the gum line, and cleaning between the teeth daily, which helps keep bacteria away from the oral tissues and the dental implant sites. Regular dental checkups help your dentist monitor the health of your dental implants and provide prompt treatment if peri-mucositis does arise, and professional cleanings help keep bacteria from accumulating near the implants and elsewhere in the mouth.
Brushing dental implant restorations and the tissues that surround them might feel awkward at first, but dental implants deserve the same care as the natural teeth, if not more. Effectively controlling plaque accumulation is the most effective way to prevent peri-implantitis, and brushing and flossing are the best ways to help keep plaque to a minimum. You and your dentist can review the proper methods for brushing and cleaning dental implant restorations, and, if your dental implants have any complex fixtures that make them harder to clean, your dentist can recommend helpful tools like water irrigators or specialized devices that clean hard-to-reach areas gently yet effectively. Neglecting follow-up appointments also contributes to the likelihood of peri-implantitis developing, as only a dental professional can detect the early symptoms of the condition and intervene before it progresses.
In addition to destroying the oral tissues and eventually degrading the bone that supports dental implants, peri-implantitis can also compromise the dental implants themselves. The condition can degrade the titanium that implant posts are made of, which leads to titanium microparticles invading the tissues surrounding the implant and increasing inflammation. If there is excess cement remaining around a dental implant after the dental prosthetic is placed, this can also increase the risk of peri-implantitis, as areas of rough, hardened cement are more attractive to bacteria and can become breeding grounds for infection. Because of this possibility, many dental implant restorations are placed slightly above the gum line, to facilitate the easy removal of excess cement from the implant restoration. Dental implant components that are improperly fitted can also cause protrusions that attract bacteria and lead to disease, though this complication shouldn’t arise when an experienced, reputable implant dentist performs the restoration procedure.
The first step in treating peri-implantitis is to control infection by thoroughly cleaning and disinfecting the dental implant surface and surrounding area. Once the area is cleaned, the bone that supports the implant is rebuilt or regenerated, which often requires surgery; these surgeries include bone grafts and may be accompanied by guided tissue regeneration. In all cases, the first step in treating peri-implantitis is a thorough decontamination and comprehensive debridement of the dental implant, which could involve surgery or use non-surgical options like antiseptic solution, antibiotics, or laser or ultrasound treatments. More recent innovations in dental implant technology involve the use of antimicrobial treatments and sealants that protect the oral tissues and help them resist peri-implantitis. While these preventative methods and materials are still being developed, they show great promise for the continued success of healthy, safe, long-lasting dental implants.