Peri-implantitis is an inflammatory disease that affects the soft and hard tissues surrounding a dental implant. The condition involves inflammation in the gum tissue and progressive destruction of the bone that anchors the implant. If this bone loss becomes too severe, it can lead to the failure of the implant itself. It is a condition that requires professional intervention to manage effectively.
Peri-Implant Mucositis and Disease Progression
Peri-implant disease progresses in two distinct stages. The initial phase is called peri-implant mucositis, a reversible condition characterized by inflammation confined to the soft gum tissue surrounding the implant, without any loss of the underlying bone. The signs often include redness, swelling, and bleeding of the gums when brushing. Peri-implant mucositis is analogous to gingivitis, the gum inflammation that occurs around natural teeth.
If left untreated, peri-implant mucositis can advance to peri-implantitis. This progression is marked by the inflammatory response spreading deeper to affect the jawbone, causing irreversible bone loss. This bone destruction weakens the implant’s foundation and can eventually lead to its loosening and loss.
Causes and Key Risk Factors
The primary cause of peri-implant disease is the accumulation of bacterial plaque, forming a biofilm on the implant’s surface at the gumline. This persistent bacterial presence triggers an inflammatory response in the surrounding tissues, which initiates the disease process.
Several factors can increase an individual’s susceptibility to developing peri-implantitis. A history of periodontitis, a severe gum disease affecting natural teeth, is a significant risk factor. Smoking is also strongly linked to the condition, as tobacco use can impair blood flow and the healing capacity of gum tissues. Inadequate oral hygiene that fails to consistently remove plaque from around the implant is another contributor. Systemic health conditions, such as uncontrolled diabetes or diseases that compromise the immune system, can also heighten the risk. Furthermore, issues with the implant hardware, like residual dental cement or a poorly fitting crown, can create areas where bacteria thrive.
Identifying the Warning Signs
Recognizing the signs of peri-implantitis is important for seeking timely treatment. Symptoms a person might notice include redness, puffiness, or swelling in the gums directly around the dental implant. Bleeding when brushing or flossing the area is a common early indicator of inflammation. Another sign can be the presence of pus discharged from the gums near the implant when pressure is applied.
A dental professional identifies other indicators during an examination. One diagnostic step is measuring the depth of the gum pockets around the implant. An increase in pocket depth over time suggests that the supporting bone is being lost. An X-ray is used to confirm this, as it can reveal the extent of bone destruction. Pain is often not a symptom in the early stages, while mobility of the implant is a sign of advanced peri-implantitis where significant bone support has been destroyed.
Professional Treatment Options
The approach to treating peri-implantitis depends on the severity of the disease and is aimed at stopping its progression and decontaminating the implant surface. For peri-implant mucositis and very early peri-implantitis, non-surgical methods are the first line of defense. This involves a thorough professional cleaning where a dentist or hygienist uses specialized instruments, sometimes including ultrasonic devices or lasers, to remove the bacterial biofilm from the implant surface without surgery. This is often paired with antimicrobial rinses and a renewed focus on the patient’s at-home oral hygiene practices.
For more advanced cases where significant bone loss has occurred, surgical intervention becomes necessary. This involves a procedure where the gum tissue is lifted away, creating a surgical flap to give the clinician direct visual access to the contaminated implant surfaces for cleaning. During this procedure, the surgeon may perform an implantoplasty, which involves smoothing the implant’s threaded surface to make it more difficult for bacteria to attach in the future. In some situations, a bone graft may be placed in the defect to regenerate some of the lost bone structure.
In the most severe instances of peri-implantitis, the bone loss may be so extensive that the implant can no longer be saved. When the infection cannot be resolved, the remaining treatment option is the removal of the dental implant. This step is taken to eliminate the source of the infection and halt further destruction of the jawbone, allowing the site to heal.