A dental implant infection, professionally known as peri-implant disease, is an inflammatory condition affecting the soft and hard tissues surrounding a functional dental implant. Similar to gum disease, it begins with a buildup of bacterial plaque and biofilm on the implant surface, typically below the gum line. If left unaddressed, this bacterial irritation causes inflammation, damages the surrounding gum tissue, and ultimately leads to the deterioration of the supporting jawbone structure. Seeking prompt professional dental care is the most effective approach, as early intervention significantly increases the likelihood of a successful outcome and the long-term survival of the implant.
Recognizing the Signs of Infection
The initial indications of an infection are often subtle but become more noticeable as the disease progresses. One of the earliest signs is bleeding when gently brushing or probing the tissue surrounding the implant. Healthy implant tissue should not bleed.
The soft tissue may also exhibit visible inflammation, appearing redder and more swollen than adjacent healthy gums. Patients may experience a persistent bad taste or foul odor, often resulting from bacterial accumulation and the discharge of pus (suppuration) from the infected area. Pus is a clear warning sign of an active bacterial infection requiring immediate attention.
Discomfort or pain that persists or increases, especially when chewing, can signal deeper tissue involvement. In advanced stages, the implant may feel loose or wobbly. This late-stage symptom indicates that a significant amount of supporting bone has been lost.
Understanding Peri-Implant Disease Stages
Peri-implant disease is categorized into two stages that guide the treatment approach. The initial stage is peri-mucositis, which involves inflammation limited solely to the soft tissues surrounding the implant. This condition is characterized by redness and bleeding on probing, but there is no evidence of progressive loss of the supporting bone structure.
Peri-mucositis is considered a reversible condition, much like gingivitis, and is the precursor to the more destructive stage. If the inflammation is not resolved, it progresses to peri-implantitis. Peri-implantitis is characterized by soft tissue inflammation and the progressive, irreversible loss of the alveolar bone that anchors the implant, posing a significant threat to stability.
To confirm the diagnosis, the dentist uses a specialized probe to measure the depth of the gum pocket and takes radiographs (X-rays). A diagnosis of peri-implantitis requires radiographic evidence of bone loss beyond the initial remodeling phase, often specified as three millimeters or more, combined with signs of inflammation like bleeding or pus discharge.
Non-Surgical Treatment Options
The initial approach to treating peri-implant disease, especially peri-mucositis and early-stage peri-implantitis, involves non-surgical mechanical debridement. This process focuses on removing the bacterial plaque, calculus, and biofilm accumulated on the exposed implant surface. Specialized instruments made of plastic, titanium, or graphite are used to clean the implant surface without scratching the material.
Air-polishing devices utilizing powders like glycine are frequently employed to decontaminate the surface below the gum line. This professional cleaning is often accompanied by antiseptic solutions, such as chlorhexidine mouthwash or gel, applied to the infected area to reduce the bacterial load. Mechanical removal of the irritants remains the primary goal of this initial therapy.
In some cases, local or systemic antibiotics may be prescribed to help control the infection, particularly when pus is present. Local antibiotics are often delivered directly into the cleaned gum pocket to concentrate the medication where the bacteria reside. While non-surgical methods can effectively resolve peri-mucositis and reduce inflammation in early peri-implantitis, they are often insufficient for resolving advanced cases with significant bone loss.
Advanced Surgical Interventions
When non-surgical therapies fail or when significant bone loss has occurred, advanced surgical procedures are necessary. The primary goal is to gain direct access to the contaminated implant surface for thorough cleaning and, if possible, to regenerate lost bone. This process typically begins with access flap surgery, where the gum tissue is carefully lifted away from the implant and bone to fully expose the infected site.
Once exposed, the surgeon meticulously removes all inflamed tissue and decontaminates the implant surface using mechanical instruments and chemical agents. A technique called implantoplasty may be performed, which involves smoothing and polishing the exposed threads of the implant to discourage future bacterial accumulation. This surface modification aims to make the implant easier to clean for both the patient and the dental professional during maintenance appointments.
If the bone defect is suitable, a reconstructive or augmentative procedure may be performed to restore lost bone support. This involves placing a bone graft material, often mixed with a barrier membrane, into the defect to encourage new bone growth. However, if the bone loss is too extensive, or if the implant is unstable and the disease is uncontrollable, the implant may need to be surgically removed to prevent further jawbone damage.
Long-Term Care and Prevention
Successful treatment requires a commitment to long-term care to prevent recurrence. Excellent daily oral hygiene is the foundation of maintenance, focusing on meticulous cleaning around the implant restoration. Patients should use specialized oral hygiene aids to effectively clean the difficult-to-reach areas beneath the crown and around the implant post.
Professional maintenance visits are necessary to remove plaque and calculus that home care cannot reach, and these appointments are scheduled more frequently than standard check-ups. The dental team monitors implant health by reassessing probing depths, checking for bleeding, and taking periodic X-rays to ensure the bone level remains stable.
Lifestyle modifications play a significant role in long-term success, particularly quitting smoking, as tobacco use is a major risk factor for peri-implant disease. Maintaining control over systemic conditions, such as diabetes, is also important because uncontrolled blood sugar levels compromise the body’s ability to fight infection and heal. Adhering to these preventive measures is the most effective way to ensure the longevity of the dental implant.