Peri-implant disease is a condition affecting the soft and hard tissue around a dental implant. Just like a natural tooth, bacteria can also build up at the base of the implant. With time, the bacteria will irritate the soft tissue, causing swelling and inflammation, damaging the tissue, and then even causing the jawbone to deteriorate.
With a success rate of around 95 percent, dental implants have become the new gold standard as reliable replacements for one or more missing teeth, according to the ACP, or American College of Prosthodontists. Just like your natural teeth, implants require proper daily care to ensure their healthy extended life expectancy. Problems like peri-implantitis, an infection in the tissue around your implant, can develop without proper daily care.
Dental Implants
Innovatively developed to replace a missing tooth, a dental implant is comprised of three basic parts, a small titanium artificial root, an abutment or extension, and the artificial crown attached to the top. An extremely successful and popular choice, the benefits of dental implants include:
- Provides a normal, healthy bite and the ability to chew.
- Will not slip or come loose, like traditional dentures.
- Looks like a natural tooth and will never develop a cavity.
- The artificial root provides necessary natural stimulation to the jawbone to maintain integrity, mass, and density.
Dental implants are not immune to any plaque buildup. Bacterial plaque accumulation on your implant will cause peri-implantitis. Peri-implantitis is the soft tissue inflammation around the implant, resulting in deterioration in both the gums and in the jawbone supporting the dental implant.
Risk Factors for Peri-Implantitis
When evaluating your case for a dental implant, it is also important to identify the risk factors for peri-implant disease. If you have suffered from a previous gum disease you may be more at risk of developing a peri-implant disease.
One of the single biggest risk factors is simple poor oral hygiene and plaque buildup. This can occur if you are unable to properly clean your new dental implant with a toothbrush and floss. This issue may develop from the implant positioning. The implant may have been placed to meet both aesthetic concerns and functionality without considering hygiene.
Another identifiable risk is residual cement, where cement is left around the implant. When a crown is affixed with cement it may be difficult to remove the cement. Residual cement can cause inflammation resulting from rough surface topography, which can create an environment for bacteria.
If you smoke, you have an elevated risk for peri-implant disease. A study confirmed that 78% of implants in smokers had peri-implantitis, compared to just 64% of non-smokers.
Signs and Symptoms of Peri-Implantitis
Peri-implantitis has different signs for everyone. You need to continue to schedule checkups every six months to monitor your implant and address any other concerns about your oral health.
To begin, healthy peri-implant soft tissue should not be inflamed, swollen, bleeding, producing pus, or appear red in color.
From your perspective, you might think that your implant is loosening or even wobbling. This symptom is more evident with an advanced stage of peri-implantitis, because by now the fusion and integration of the implant into the jawbone has been compromised. It is most likely you will notice some bleeding while you are brushing your teeth. You might also notice some swelling, and you have constant bad breath or a foul taste present in your mouth.
From a clinical point of view, peri-implantitis includes both the inflammation of your soft tissue as well as the damage to the jawbone, which is clarified with an x-ray and when bleeding happens with nearby tissue probing, which is common for soft tissue inflammation. On some rare occasions you could have bone loss without any soft tissue inflammation. If there is no evidence of bone loss, then the diagnosis is peri-mucositis disease.
Other symptoms might include discomfort and gingival hyperplasia. Pain is quite rare and is usually associated with an acute infection.
Signs most often identified by you:
- Bleeding when brushing your teeth.
- You can feel swelling around your implant.
- A constant foul taste in your mouth.
- Annoying bad breath.
- A loose or wobbly implant.
- Discomfort or unusual pain.
Symptoms most often identified by your dentist:
- Bleeding and even the discharge of pus with soft tissue probing.
- Swelling and inflammation.
- Sagging pocket formation or gum recession.
- A change in color from a healthy pink to redness.
- Hyperplasia.
- X-ray evidence of bone mass loss around implant.
Treatment for Peri-Implantitis
It can certainly be challenging to treat peri-implantitis. Depending on the nature of your disease, your treatment might vary significantly, from a non-surgical treatment to try and control the infection and detoxify the implant surface, to a more invasive surgical approach to regenerate the bone that has been lost.
Because of the screw-shaped design of the titanium implant, mechanical removal of the bacteria on the surface of the implant is basically ineffective. To intensify the non-surgical treatment option, mechanical debridement can be combined with an antiseptic, antibiotic therapy, or regenerative surgery. The actual combination of your treatment may vary depending on the severity of your peri-implantitis.
Providing guidance for your dentist to decide which approach is best in treating your peri-implantitis is cumulative interceptive supportive therapy, which is a protocol of therapeutic measures, measuring the condition of your soft tissue, whether there is plaque, any bleeding with gentle probing, and any evidence of bone loss on your x-rays.
Prevention of Peri Implant Diseases
If peri-implant mucositis is indeed identified, it needs to be treated promptly to avoid the progression to peri-implantitis, for which there are no easy and simple treatments to reverse it.
You need to exercise simple plaque removal daily to prevent or treat peri-implant mucositis by brushing twice a day. Your dentist will provide proper oral hygiene instructions to make sure you are removing plaque sufficiently. Any risk of an implant disease is significantly higher if you smoke. You may want to consider quitting smoking to achieve the best results.
Your dentist will always qualify factors to make sure that the elements of your implant are the correct size to avoid creating additional problems. They will monitor the restoration placement and remove any extruded cement when the crown is placed. After your implant placement, your dentist will continue to monitor the health of your implant carefully and regularly at each checkup.