Peri-implantitis refers to inflammatory reactions with loss of bone supporting functioning implant (Albrektsson & Isidor 1994). The disease of peri-implant mucositis has been shown to occur in about 80% of subjects with an endosseous dental implant (50% of sites).
Peri-implantitis has been defined as a progressive inflammatory bacterial- infectious process deteriorating and destructing the supporting soft and hard tissues around functional osseointegrated implant eliciting bacterial, clinical and radiographic signs and symptoms, e.g. bleeding and suppuration (Mombelli et al. 1987).
A cause-effect relationship between bacterial plaque accumulation and the development of inflammatory changes in the soft tissues surrounding dental implants has been shown (Pontoriero 1994).
The existing scientific evidence demonstrates a direct association between oral microbiota and bacterial peri-implant inflammatory lesions in the form of Peri-implant mucositis or peri-implantitis.
In both experimental research and human trials (Lang et al. 2000), it has been demonstrated that prolonged accumulation of bacterial plaque over a long period of time may develop the reversible nature of peri-implant mucositis into the irreversible peri-implantitis rendering such complications either amenable to treatment (ailing) or untreatable (failing).
Therefore, the presence of risk factors, especially the standard of oral hygiene, should be reinforced. The periodontal tissues' general health status around the remaining teeth should be monitored during the maintenance phase.
Diagnosis of Peri-implantitis
Baseline probing measurements (PIPD) and radiographs should be obtained once the implant's final restoration is processed and fitted to follow up longitudinal monitoring of peri-implant conditions.
Standardized radiographs should be taken and compared to reference radiographs taken at the time of prosthesis insertion.
The combination of Radiographic evaluation and evidence of marginal bone loss (MBL) following initial healing and bone remodelling and clinical assessment of the presence of inflammation, e.g., bleeding on probing (BOP), suppuration, and deepened Peri-Implant Pocket Depth (PIPD) os required to verify the extent and severity of relevant pathological parameters, and to diagnose the peri-implant disease.
Treatment of Peri-implantitis
A plethora of literature published so far represents insufficient evidence for the effectiveness of advocated treatment modalities of peri-implantitis. The synopsis of accumulated data from experimental research and clinical experience may classify such treatment strategies into 2 main categories:
Nonsurgical therapeutic strategies:
- elimination of the peri-implant granulation tissues;
- decontamination of the implant surface (e.g. laser devices, adjunctive local sustained delivery antimicrobial agents /systemic antibiotics alone or in combination).
- debridement of the peri-implant biofilm utilizing mechanical surface debridement (e.g. carbon or plastic curettes, ultrasonic, and air abrasive devices);
The review of the literature on the various nonsurgical treatment strategies for peri-implant lesions in animal research and human studies provides evidence that most of the nonsurgical treatment modalities directed to reduce the submucosal infection may result in a short-term improvement of peri-implantitis.
Surgical therapeutic strategies:
The aims and objectives of surgical therapeutic strategies involved in the treatment of peri-implantitis:
- Elimination of the peri-implant granulation tissues
- Eradication of the interfacial biofilm employing mechanical surface debridement (e.g. ultrasonic, carbon or plastic curettes, air abrasive);
- Decontamination of the infected interface via non-mechanical surface decontamination techniques (e.g. laser devices, adjunctive local sustained-delivery antimicrobial agents, systemic antibiotics alone or in combination).
- Modification of the implant surface architecture to eliminate the micro-mechanical retention niche for pathogenic micro-organisms via resection (implantoplasty)
- Bio-surface modification to promote re-osseointegration (e.g. EDTA., BMP, L-PRF).
- Restoration/ regenerative of the peri-implant lesion
The extent and quality of bone regeneration and Osseo-reintegration at the interface following the regenerative treatment of peri-implantitis lesions have been variable in various trials and case reports. This could be because the currently advocated regenerative techniques are not performed consistently according to the appropriate clinical protocols and specific indication criteria to perform sufficient debridement, elimination of the residual debris, and effective interface decontamination.
The current treatment modalities advocated in treating peri-implantitis have been reported to exert some beneficial and successful effect. However, up to the present, none of the advocated therapeutic strategies in treating advanced peri-implantitis with specific morphology, extent, and severity has proved to be the most efficacious. Incomplete debridement and surface decontamination seem to be the major obstacle to resolving the lesion and bone regeneration at the implant-tissue interface.
These findings consistently indicate that up to the present, there is no specific individual or combination treatment strategy that has yet been recognised as a gold standard approach for the treatment of peri-implantitis and that the currently available evidence does not specify the superiority of each technique in certain sub-type of peri-implantitis.
Treatment of peri-implantitis
The main problems around implants come from gum disease. These can be resolved with the right treatment, provided it is delivered early enough.
Peri-Implantitis (Courtesy: Dr Alan Sidi)
The most common cause of implants failure is gum disease, known as peri-implantitis. This is caused by a build-up of plaque bacteria and leads to a loss of bone around the implant area. If this gets too severe, the implant will need to be removed.
Peri-implantitis can be treated if caught early!
Initially, the gum inflammation is treated with the cleaning of the implant and advice given in regard to targeting the oral hygiene to the affected areas. Repair of the bone defect can then proceed. This is carried out with a localized surgical procedure to remove all the inflamed tissue and usually to graft the bone defect that has developed around the implant.
Sometimes the crown on the implant is removed, and the implant is left buried for 6 months for optimal healing. The same crown is then re-fitted on the implant