Peri-implantitis is an inflammatory condition affecting the tissues surrounding a dental implant, similar to gum disease around natural teeth. It involves inflammation of soft tissues and progressive loss of supporting bone. When left unaddressed, this condition can lead to pain, swelling, and eventually the failure of the dental implant.
The disease begins with peri-implant mucositis, which is inflammation confined to the soft tissues around the implant without bone loss. If peri-implant mucositis is not treated, it can advance to peri-implantitis, where the inflammation spreads to the supporting bone, causing irreversible bone destruction. Early detection of signs like bleeding or pus discharge around the implant, along with radiographic evidence of bone loss, is important for diagnosis and managing the condition.
Initial Non-Surgical Interventions
Initial management for early or moderate peri-implantitis aims to control the infection and halt disease progression without surgical intervention. This approach primarily involves mechanical debridement, where professionals meticulously clean the implant surface to remove plaque and calculus. Specialized tools are employed to ensure effective cleaning while protecting the implant surface from damage.
Dentists and hygienists use instruments such as titanium or carbon fiber curettes, which are designed to gently remove debris without scratching the implant’s surface. Ultrasonic scalers equipped with non-metallic tips, like plastic or silicone, are also used for their ability to dislodge biofilms and calculus with vibrations and water irrigation. Air-abrasive devices with agents like amino acid glycine powder or erythritol powder offer another method for decontamination, effectively removing biofilm from the implant surface.
Adjunctive therapies may be used in conjunction with mechanical debridement to further reduce bacterial load and inflammation. These can include antiseptic rinses, such as chlorhexidine gluconate solutions, or the local application of antibiotic gels directly into the peri-implant pockets. While these adjunctive measures can help suppress inflammation, mechanical debridement remains the primary method for biofilm removal in non-surgical treatment.
Surgical Treatment Options
When non-surgical methods prove insufficient to resolve peri-implantitis, surgical interventions become necessary to gain direct access to the contaminated implant surface and address bone defects. The goal is to eliminate infection and stabilize or regenerate lost supporting bone around the implant. These often combine procedures tailored to the implant’s condition.
One common surgical approach is flap surgery, where the gum tissue around the implant is carefully lifted to expose the underlying implant and bone. This allows the clinician direct visibility and access for thorough cleaning and decontamination of the implant surface, removing granulation tissue and bacterial biofilms. After the cleaning, the gum tissue is repositioned and sutured back into place.
Bone grafting is frequently performed in conjunction with flap surgery, especially when significant bone loss has occurred around the implant. This procedure aims to regenerate the lost bone by placing bone graft materials into the bone defect surrounding the implant. A collagen membrane may also be placed over the graft to protect it and guide bone regeneration.
Implantoplasty is another surgical technique that involves carefully smoothing and polishing the exposed, roughened surface of the implant, particularly the threads that have become contaminated. This process uses specialized burs or polishing instruments to create a smoother surface, which makes it more difficult for bacteria to adhere and form new biofilms in the future. Implantoplasty can significantly reduce bleeding upon probing and probing depth, contributing to a more favorable long-term outcome.
Managing Severe Cases and Implant Removal
In advanced stages of peri-implantitis, when the condition has significantly progressed and the implant cannot be saved, implant removal, known as explantation, becomes the necessary course of action. This decision is often made when there is extensive bone loss, typically exceeding 50% of the implant’s length, or when the implant exhibits mobility due to a complete loss of osseointegration. Other indicators include persistent infection despite multiple treatments, or implant fractures.
If the implant is mobile, it can often be unscrewed using specialized instruments. If the implant remains partially integrated, removal might require the use of burs or trephines, although these methods can lead to additional bone loss. The goal of removal is to eliminate the source of infection and preserve the remaining jawbone, preventing further destruction and preparing the site for potential future restorative options.
Following implant removal, the site is thoroughly cleaned to ensure all infected tissue is gone. Often, the resulting bone defect may require bone grafting to rebuild the lost volume and create a suitable foundation for a future dental implant or other prostheses. This site preparation is important for successful long-term rehabilitation, potentially allowing for new implant placement or alternative solutions.
Post-Treatment Maintenance and Prognosis
After active treatment for peri-implantitis, rigorous post-treatment maintenance is important for long-term success, as the condition is chronic and prone to recurrence. A strict maintenance program involves frequent professional cleanings to continually remove plaque and prevent bacterial re-colonization around the implant. These appointments are typically scheduled every three to four months, depending on the individual’s risk factors and oral hygiene status.
During professional maintenance visits, dental professionals will meticulously clean the implant surfaces using specialized non-metallic instruments to avoid damaging the implant. They also monitor the health of the peri-implant tissues, assessing for any signs of inflammation, bleeding, or changes in probing depths. Regular X-rays are taken to monitor the bone levels around the implant and detect any signs of recurrent bone loss.
Patient compliance with at-home oral hygiene practices is equally important for preventing disease recurrence. This includes diligent brushing, flossing, and the use of interdental brushes or water flossers to clean around the implant and maintain plaque control. With successful treatment and consistent, high-quality maintenance, an implant affected by peri-implantitis can often be maintained for many years. Regenerative surgical approaches often show more favorable long-term outcomes and higher implant survival rates.