Peri-implantitis: what it is, what are the causes and how to treat it


With the introduction and progressive diffusion of implant therapies, the peri-implantitis has become one of the most common dental pathologies frequent among those that dentists and hygienists have to face every day.

“Peri-implantitis is abacterial infection which causes the progressive loss of bone structure around dental implants. It is very similar to periodontal disease involving natural teeth, where inflammation starts in the gums and then progresses deeper, involving the supporting tissues of the teeth and causing bone resorption,” describes Dr Michael Cassettacoordinator of the Dental Unit at the Villalba Clinic in Bologna.

«Likewise, peri-implantitis begins with a milder, more defined form mucositis, in which the gum begins to redden, change color, bleed. At that point, just like in periodontitis, the normal gingival sulcus deepens and forms the so-called peri-implant pockets, inside which the bacteria present in the oral cavity begin to proliferate undisturbed, seriously damaging the support structures of the titanium root, which loses its initial stability and risk of detaching completely from the bone tissue.

What are the causes of peri-implantitis

Peri-implantitis can arise even after a few years from implant placement who generally don’t get “sick” right away.

“In fact, after their insertion, any pain or other discomfort is due to a lack of osteo-integration, that biological process through which the bone integrates the artificial screw through the production of new tissue,” explains Dr. Cassetta.

«After some time, on the other hand, I am one to act as a risk factor bad oral hygiene which causes an uncontrolled accumulation of bacterial plaque, the lack of periodic checks by the dentist, previous periodontal disease, cigarette smoking and inadequate prosthesis design. Recently, the link with diabetes is also being investigated, because it seems that this metabolic pathology may predispose to peri-implantitis”.

What are the symptoms of peri-implantitis

The first three alarm bells that should make us suspicious are swelling, discomfort and pain in the gum around the implant.

«Fortunately, with the right precautions and adequate care, the process is reversible. On the contrary, if it is underestimated, it leads to real peri-implantitis, which is often difficult to treat», admits Dr. Cassetta.

Over time, in fact, the initial mucositis leads to the formation of deep fissures between the implant and the bone (peri-implant pockets) which can be measured using small probes to be gently inserted into the gingival sulcus. «Under normal conditions, the probing depth should not exceed 1-1.5 mm, while in pathological situations it progressively increases. The higher this value is, the more severe the peri-implantitis is».

How to diagnose peri-implantitis

As with any disease, a correct diagnosis of peri-implantitis is essential for effective treatment. in addition toobjective examinationwhich allows the specialist to observe any warning signs and evaluate the clinical signs of inflammation affecting the gingiva (redness, swelling, bleeding, pus production or abnormalities of the contour, consistency or shape), the peri-implant probing serves to measure the depth of the peri-implant pockets, while an intraoral radiograph can show the actual loss of bone attachment on the implant.

«When, on the other hand, you are faced with a mobile implant, it means that the situation is already very advanced and, often, not even surgical techniques can remedy it», Dr. Cassetta is keen to point out.

How to treat peri-implantitis

Once the problem is ascertained, what can be done? Generally, we start with some professional hygiene sessions, which have the purpose of reducing the bacterial load, interrupting the inflammation of the peri-implant tissue. This mechanical technique is equivalent to the ablation and root planing used in periodontal therapy, even if the characteristics of the implants – in terms of structure and surface – require a different approach.

“Thanks to polishing brushes, prophylaxis pastes, ultrasonic tips or high-pressure particle jets the tissue around the implant is cleaned: when possible, the treatment is carried out by removing the prosthetic crown, otherwise we proceed in any case by “decontaminating” the peri-implant pocket», says the expert. «Things get complicated, however, if the peri-implantitis has already compromised the bone: in this case, one can resort to surgical techniques aim to regenerate the one around the plant. If the situation is very compromised, it may be necessary to proceed with the removal of the titanium screw, in order to eliminate the infection and regenerate the bone which, after some time and after complete healing, will be able to accommodate a new implant”. .

What are the dangers of peri-implantitis

For a long time, peri-implantitis was considered a possible infectious focus for the whole organism, a sort of “time bomb” due to the fact that the pathogenic bacteria present in the peri-implant pockets can enter the circulatory stream, i.e. in the blood, and settle in other locations, such as blood vessels, joints, organs or tissues.

“Today this hypothesis is redimensioned, but certainly those with heart valve pathologies or immunosuppressed patients must pay attention to any condition of inflammation or chronic infection”, concludes Dr. Cassetta. “Especially when the infectious foci are multiple, for example in the case of multiple dental implants, the situation can be dangerous in fragile subjects and should never be underestimated”.

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