Peri-implantitis, as defined by Wikipedia, is the destructive inflammatory process affecting
the soft and hard tissues surrounding dental implants. The array of periodontal pathogens
found around failing implants (those affected by peri-implantitis) are very similar to
those found in association with various forms of periodontal disease.
While implants are meant to last a lifetime, there are some factors that help
ensure their success. Some of the risk factors for infections
around implants include:
- History of periodontal disease and presence of periodontal pathogens:
Implants should be placed in a dentition with stable gums. If the gums are not
stable, treatment of the periodontal disease is indicated prior to implant placement.
- Cement residue (on the restoration):
This can be prevented with a few methods. One method is fabrication of a custom
abutment with margins slightly subgingival. This allows the clinician to remove
cement excess easily. Another common method to avoid cement residue is to place
a screw-retained restoration.
- Implant load:
If the patient has any parafunctional habits (ie-clenching, bruxism), an occlusal
guard is indicated to protect the implant and the adjacent teeth.
- Oral hygiene and plaque control:
Good oral hygiene around your implant and all of your teeth will help prevent disease.
Do not be afraid to clean around it and I urge hygienists to not worry about using
metal scalers around implants. Metal won’t cause an implant to fail but
- Cleaning intervals:
Every patient is different in terms of their ideal cleaning interval. Whether
you are on a 3, 4, or 6 month schedule, it is important to keep these visits.
Smokers have increased bone loss and soft tissue complications
- Uncontrolled systemic illness including diabetes
- Cleaning access:
The shape of the restoration is an important factor in long term success.
There are instances where we choose to create a larger space for cleaning
with a proxabrush. This allows better access. This is not our goal in
esthetic areas, but this is a consideration if the implant is
- Amount of attached/keratinized tissue:
The magic number is 2 mm, however, our contention is that the most important
thing is that the tissue around the implant is being cleaned and is healthy
and free of inflammation.
- Type of restoration:
Oral hygiene instruction around your implant restoration is imperative to
maintaining its health. When there are larger restorations to fill a space,
or the restoration is a bridge between two implants, it is important to
clean not just in-between the teeth, but underneath the teeth until you
are hitting the implant body.
When do you see a periodontist?
If you, your general dentist or hygienist are noticing bleeding or discomfort
around your implants, please call our office for an appointment. These signs and
- purulence (pus)
- plaque debris
- thin tissue
How often do you like to see your implant patients?
We recommend maintenance of these implants in our office once a year. At this visit,
we will evaluate the tissue, do a cursory exam of the remaining dentition to check for
any untreated gum disease, take a radiograph and check the bite.
How do you treat infections around an implant?
We treat peri-implantitis similar to treating periodontal disease. We use a combination
approach by using our Nd:YAG and Er:YAG lasers to aid in decontamination, surgical
access to clean thoroughly, a host of agents to clean the surface if needed and
bone/soft tissue grafting as needed to restore the lost structure.