Peri-implantitis: diagnosis, prevention and treatments to protect dental implants

Peri-implantitis can have a great impact can have a major impact on the success of implants if it is not diagnosed and treated in time. The differences between peri-implant mucositis and peri-implantitis, their clinical consequences and risk factors should be considered before deciding whether to use non-surgical or surgical treatment. For diagnosis, it is important to use the necessary techniques to identify risks and educate patients on care protocols.

What is peri-implantitis?

Peri-implantitis is an inflammatory disease that occurs in the peri-implant tissues, i.e. the soft and hard tissues surrounding an osseointegrated dental implant. osseointegrated dental implantThis causes a progressive and irreversible loss of the alveolar bone that supports the implant. It arises as a consequence of the accumulation of bacterial biofilm on the implant surface.

This condition represents a dental challenge given its complex etiology. It progresses without noticeable symptoms in the early stages, so the diagnosis is usually late, and it can arise for different reasons: bacteria, poor hygiene, smoking, poor implant position, etc. In addition, treatments are not always effective. A comprehensive approach combining prevention, early diagnosis and non-surgical or surgical treatment if necessary is recommended.

Difference between peri-implant mucositis and peri-implantitis

Peri-implant mucositis is an "early warning", a mild inflammation that has not yet affected the bone, so it is possible to cure it, while peri-implantitis is the more advanced stage, involving loss of bone which involves the loss of bone support and can result in the failure or loss of the dental implant. It is important to detect and treat the first stage before it worsens.

Prevalence, impact on implants and clinical consequences.

Several studies have found that peri-implant mucositis affects approximately 46% of patients, while peri-implantitis affects between 22% and 19% of patients. This prevalence shows that it is not a rare condition, but can occur frequently, and that it has a major impact on the success of implantology treatments.

The clinical consequences of peri-implantitis include persistent inflammation in the peri-implant soft tissues, oozing and bleeding when probing the area with a probe, increased probing depth, and progressive bone loss which eventually destabilizes the implant.

Risk factors and etiology of peri-implantitis

The etiology of peri-implantitis is multifactorial.. Among the most common reasons for which it may appear are bacterial biofilm, excessive force on the implant, certain patient habits (such as smoking, lack of oral hygiene or bruxism), or problems with the prosthesis in question. or problems with the prosthesis in question.

Bacterial biofilm

Bacterial biofilm is usually the main cause of peri-implantitis. The accumulation of plaque plaque on the implant surface causes inflammation and eventually damages the tissues.

2. Excessive biomechanical load

If the implant too much pressure, e.g. in poorly positioned implants or implants without proper occlusal controlIf the implant is subjected to too much pressure, for example, in poorly positioned implants or without proper occlusal control, it may cause bone microfractures and stimulate bone resorption.

3. Patient habits

Harmful habits such as smoking, poor oral hygiene or a history of periodontitis damage the tissues and cause bacteria to accumulate, thus increasing the risk.

4. Prosthetic factors

Other causes may be problems with the crown or implantThe causes can range from overloading due to the prosthetic design itself or misalignments that facilitate the accumulation of bacteria to the lack of professional maintenance.

Diagnosis: how to detect peri-implantitis in time

To diagnose peri-implantitis, periodontal probing, radiographs, clinical evaluation and, optionally, microbiological analysis should be performed. It is important to make periodical revisions after implant placement and keep reference radiographs to detect possible changes in time.

Periodontal probing

If, when measuring the gum depth with the millimeter probe, it is greater than 4 mm, the gum depth will be greater than 4 mmand there is bleeding or pus, it is a clear indication of inflammation and possible peri-implantitis.

2. X-rays

Periodically take X-rays to detect bone loss detect bone loss around the implant. It is possible to detect small changes before swelling or pain is evident.

3. Clinical evaluation

Perform a physical physical examination on the soft and hard tissues for signs of inflammation, implant mobility or infection, such as redness or pain.

4. Microbiological analysis

Optionally, a test may be performed to detect bacteria that could be causing the infection. A sample of sample of tissue or discharge is taken is taken and sent to the laboratory.

Non-surgical treatment of peri-implantitis

The less invasive treatments are to treat mucositis and mild to moderate cases of peri-implantitis, these would be mechanical debridement, chemical decontamination and laser or photodynamic therapy. In case of bone loss, non-surgical treatments cannot cause the bone to regenerate, but they can clean and stop the infection from developing.

Surgical treatment of peri-implantitis

Surgical treatments are used when patients are in an advanced stage of the disease, helping to eliminate the inflammatory tissue, clean the implant and regenerate the bone defect.

Combined surgical protocol

Combined surgical protocols have been shown to reduce the depth of inflamed gums by up to 3 mm, regain 2 to 4 mm of lost bone in only six months, and improve both clinically and radiographically the treated area.

Hygiene protocols for patients with implants

To minimize infections around implants, it is sufficient for patients to follow certain hygiene protocols: follow a constant and adapted oral hygiene routine; and have a professional follow-up of the patient. professional follow-up periodically.

Oral hygiene at home

Patients should follow a good hygiene routine that includes daily brushing, flossing, interproximal brushes to clean between implants, oral irrigators for difficult areas and, in case of inflammation or infection, occasional use of toothpaste or Mouthwash with chlorhexidine.

Professional follow-up

Visits to the dentist should take place every three to six months to eliminate bacterial plaque without damaging the implant and to detect in time, by means of physical examinations and X-rays, complications that could lead to peri-implantitis: bleeding, redness, inflammation, pain, implant mobility, etc.