When the tissues that surround dental implants, including both the gums and bone, become inflamed, the condition is known as peri-implantitis. Over time, the inflamed soft tissues become more inflamed and the underlying bone that supports the implants deteriorates, compromising the stability of the dental implant and increasing the likelihood of continued infection. At its onset, this inflammation affects only the soft tissues and is known as peri- implant mucositis, a reversible condition that can be treated when intercepted early enough. Because no two patients have exactly the same manifestations of peri-implant mucositis or peri-implantitis, and some patients are largely free of noticeable symptoms, consistent dental appointments are the first line of defense against the dangerous outcomes that can accompany peri-implantitis when it is allowed to proceed unchecked. Of course, there are some sure signs that something is amiss, so if you notice that the gum tissue around your dental implants is red, swelling, or bleeding, or if you notice visible pus, see your dentist right away. Other possible indications of peri-implantitis include noticeable loosening or wobbling in the dental implant, though this is usually a sign of more advanced stages of peri-implantitis.

The clinical definition of peri-implantitis includes inflammation in the soft tissues as well as destruction of the bone. Soft-tissue inflammation is most readily measured with a dental probe, which measures the depth of the pockets surrounding the teeth and which often triggers bleeding when the gums are inflamed, while bone loss is measured with x-ray imaging. While some cases of peri-implantitis display bone loss but don’t display inflammation in the soft tissue, when there is soft tissue inflammation and no bone loss, the diagnosis can’t include peri-implantitis and the condition is peri-implant mucositis; in short, peri-implantitis must include bone loss for the diagnosis to be met, and it is at this point that it cannot be reversed but can only be repaired. In many cases, peri-implantitis is relatively painless, with pain most often characterizing only more serious infection.

The clearest cause of peri-implantitis is the accumulation of bacterial plaque around the oral tissues, though there are multiple confirmed risk factors for peri-implantitis beyond mere plaque control. If you’re considering dental implants, be sure to talk to your implant dentist about how you’ll keep your dental restorations clean; in many cases, patients report that they’re unclear on how to care for their implants, which may contribute to their inadequate plaque control. It can also benefit patients to discuss cleaning challenges with their dentist, as some implant sites are harder to clean than others and may require special techniques or tools. Regular dental visits are another level of insurance against peri-implantitis, and, because it may be asymptomatic early on, could be the first indication that there’s anything amiss with a patient’s dental implants at all. While multiple correlations have been observed, there are also some possible risk factors that have not been consistently clinically proven to contribute to the likelihood of peri-implantitis despite demonstrating clear connections with the disease. These include diabetes and other inflammatory conditions, excess cement that remains after implant restoration placement, implant positioning and bone grafts, excessive force on the implant from an improper bite, genetics, and smoking.

The umbrella term for inflammatory conditions around dental implants is peri-implant disease, which encompasses peri-implant mucositis and peri-implantitis. When inflammation is contained to the soft tissue surrounding a dental implant, the condition is peri-implant mucositis; when the inflammation affects both the soft tissue and the bone, the condition is peri-implantitis. Peri-implant mucositis develops into peri-implantitis once it includes bone resorption, which is visible on radiographic images. While visible pus may characterize many cases of peri-implantitis, this is not a qualification for the condition, nor is mobility of the dental implant. This is because the condition develops on the margins of the dental implant, which may remain firmly rooted in the depths of the alveolar bone. If peri-implantitis is allowed to progress, however, implant mobility may occur when the condition becomes severe and when a significant amount of bone tissue is lost.

When peri-implant mucositis exists, treatment is the only way to prevent this condition from developing into peri-implantitis, and, while peri-implant mucositis can be reversed, there are no treatments that reverse the effects of peri-implantitis. Peri-implant mucositis can be treated by effectively brushing and flossing the teeth to reduce the accumulation of plaque and dental calculus. Once peri-implantitis develops, however, treatment becomes more challenging. Some treatments rely on surgical procedures that are designed to replenish lost alveolar bone, while other treatments use non-surgical methods to sanitize the implant surface and manage infection. In many cases, mechanical treatments like debridement of the implant surface are combined with antibiotic or antiseptic treatment or with regenerative surgical procedures, and the combination of approaches will vary based on the severity and the specifics of the condition from patient to patient and from dentist to dentist. Most of the time, dentists use a combination of therapeutic measures called cumulative interceptive supportive therapy, which is based on the condition of the patient’s oral tissues, the probing depth around their implants, and any radiographic evidence of bone loss.

To avoid damaging the surface of a dental implant, dentists use ultrasonic scalers to remove calculus near dental implant sites and often rely on rubber polishing cups to help with plaque removal. In conjunction with mechanical debridement, dentists may also use topical antiseptics, like chlorhexidine digluconate, which helps maintain plaque control around implants. Treatment with antibiotics can also help reduce or even eliminate the pathogenic material in the oral biofilm. This antibiotic treatment could be delivered with a carefully timed cycle of oral antibiotics or through the use of periodontal fibers that are inserted into the gums for a ten-day period, where they release a high dose of antimicrobial agent over the course of several days. In most cases, antibiotic treatment is only temporarily effective unless it is combined with adjunct mechanical measures. When bone degradation is significant, surgical flap treatment combined with bone regeneration therapies can commence once infection is eliminated. These treatments rebuild the bone and can also be used to reshape the soft tissue around an implant. In more recent years, clinicians have focused on more ways to prevent peri-implantitis from occurring at all, through the use of biomaterials and more highly specialized, non-abrasive cleaning tools and clinical tools. As more therapies are developed and used in combination with one another, the future of implants that are highly resistant to peri-implant diseases looks brighter with each day.

Peri-implantitis Symptoms Causes Diagnosis Treatment