What is Peri-Implantitis?

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 debris/cement/plaque will.
  • 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.
  • Smoking:
    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 becoming infected.
  • 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 symptoms include:

  • bleeding
  • purulence (pus)
  • redness
  • plaque debris
  • thin tissue
  • discomfort

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.