Peri-implantitis

Peri-implantitis is a medical condition that affects some people who undergo dental implant surgery. Dental implant surgery involves the insertion of a metal screw, topped with a replacement tooth, into the jaw bone. Following this surgery, bacteria and other harmful materials may gather in the gums near the implant and cause an infection. Infections that are detected early may be corrected easily with cleaning and medicine. More severe cases may involve removal of the implant and bone grafts to repair damaged bone. Patients who have harmful habits such as smoking or tooth-grinding, pre-existing medical conditions, or a lack of proper dental hygiene are more prone to experience peri-implantitis.

Background

Teeth are necessary for proper chewing as well as creating clear speech and symmetrical faces and smiles. However, teeth are also fragile. Many people lose teeth for a variety of reasons. These include injuries, dental disease, aging, surgical extraction, and poor dental hygiene. Many people seek dental help in replacing their missing teeth.

Improvements in medical technology have led to several options for people with missing or damaged teeth. Traditionally, people have replaced teeth with removable sets of synthetic teeth called dentures or various types of bridges—structures that connect replacement teeth to existing teeth. Dentures may be inconvenient, uncomfortable, or otherwise unappealing to patients. Bridges may also be a poor choice because of a lack of sufficient existing teeth, or teeth that are damaged or brittle.

For many patients, a preferable option is dental implant surgery. Dental implant surgery involves screwing metal posts into the jawbone. The tops of these posts are then fitted with artificial teeth. This technique requires a strong and healthy jawbone and may necessitate several procedures and a healing process of several months. However, when successful, dental implant surgery provides the benefit of a very solid and strong support for the new tooth.

For this strong support to develop, the bone has to heal correctly around the metal implant. In most cases, this occurs naturally with only basic care and patience. However, a variety of problems may arise during the post-operation period. One of these is peri-implantitis.

Overview

Peri-implantitis occurs when bacteria grow in the gums, the fleshy base of the teeth, near the implant. The condition is similar to other forms of gum disease that may affect the gums around natural teeth. However, it does not occur to all patients who receive implants, and may be effectively treated and corrected, particularly when identified in its early stages.

The initial signs of peri-implantitis include mild symptoms such as irritated, sensitive, or swollen gums around the implant. Although some degree of irritation may be expected from the procedure, significant or ongoing irritation may be a sign of developing infection. Patients who do not seek treatment risk a worsening of symptoms. In severe cases, peri-implantitis may cause serious damage to gums and bones and endanger the implant.

Dental experts have traced peri-implantitis to several risk factors. One of the most common and serious is poor dental hygiene. Peri-implantitis begins with bacteria and pieces of food that may gather around the gums near implants. These contaminants may help to form harmful plaque and tartar. Implant patients must be diligent with their hygiene. This includes regular tooth-brushing and careful flossing to avoid buildup of the materials that can trigger infection.

Patient habits are another common cause of peri-implantitis infections. Some of these habits are conscious ones, such as using non-prescribed drugs and alcohol or smoking. These activities are generally bad for dental health in general, and can be especially problematic for implant patients. Other troublesome habits may be something the patient does unknowingly, such as nail-biting or tooth-grinding during sleep.

In addition, the patient’s immune system plays an important role in peri-implantitis risk. Patients with strong immune systems may experience no problems. Patients with compromised immune systems, on the other hand, may be at higher risk of peri-implantitis as well as potentially dangerous complications. People with illnesses such as diabetes or osteoporosis, or a history of mouth infection, should consult their doctor before attempting dental implants.

Patients experiencing peri-implantitis may have multiple treatment options. In some cases, the infection might be minimal, or in its early stages. At these times, a thorough dental cleaning and possibly antiseptic and antibiotic medicines to combat the infection may suffice to stop the problem before it escalates. Ultrasonic and laser cleaning treatments have proven effective in many cases. Patients will also likely be advised about self-care techniques and improved hygiene.

Alternately, many patients do not seek treatment until the infection has become serious. In those cases, treatments must be more aggressive. Dental experts approach severe peri-implantitis with the goal of saving bone and, when possible, the implant. The medical staff will thoroughly clean the area and will often prescribe antibiotic medicines. In very serious cases in which the infection has caused permanent damage, the dental expert will generally remove the implant and arrange for bone-grafting procedures to replace bone that has suffered extensive damage. Bone grafting is a difficult and often uncertain process requiring high-level medical specialists.

One of the best approaches to peri-implantitis is to practice preventative steps to reduce its likelihood of the condition developing. Dentists advise everyone to practice consistent and careful dental hygiene, but this is especially important for people who have just had implants or other dental surgeries. To help prevent peri-implantitis, patients should follow their medical professional’s post-operation instructions. Beyond that, they should brush regularly, floss daily, and avoid smoking, particularly during the healing period.

Bibliography

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“Peri-implant Diseases.” American Academy of Periodontology, 2021, www.perio.org/consumer/peri-implant-disease. Accessed 11 Feb. 2021.

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Wang, Wendy C.W., et al. “Management of Peri-implantitis—A Contemporary Synopsis.” Singapore Dental Journal, 38, Dec. 2017, pp. 8–16.