Causes, Symptoms and Prevention of Peri-Implantitis

Dental implants are an aesthetic and durable solution to replace missing teeth but there can be complications, such as peri-implantitis. Today's article will tell you everything you might want to know about this consequence.
Causes, Symptoms and Prevention of Peri-Implantitis

Last update: 26 July, 2021

Currently, there are different solutions to replace missing teeth, although some common ones, like dental implants, can lead to peri-implantitis. Indeed, complications may arise even though they’re effective, aesthetically accurate, durable, and safe for the most part.

This condition manifests as inflammation of the soft and hard tissues surrounding an implant. It involves both the mucosa and the supporting bone, leading to progressive destruction of the bone structure that holds the implant in place.

This article will detail the causes and symptoms of this complication. In addition, we’ll tell you how to treat it. Read on and find out more.

Causes of peri-implantitis

Bone loss around the implant has a multifactorial origin. Furthermore, there are two main etiological causes of peri-implantitis:

  • Bacterial flora is the presence and accumulation of bacteria from the mouth on the implant surface
  • Occlusal overload is the biomechanical stress generated during masticatory movements that can lead to fractures and resorption of the peri-implant bone (this happens when the implant placement is incorrect and the mechanical forces aren’t distributed in a balanced way)
A mouth with bacteria.
Oral bacteria can lodge around the implants, causing inflammations that complicate the treatment.

Risk factors

As mentioned above, peri-implantitis is due to bacterial colonization and occlusal overload of the implant. However, there are other factors that lead to this disease.

The patient’s habits, genetic conditions, or the presence of any pathology may predispose a person to this condition. The dentist must take these into account before carrying out the implant. Accurate diagnosis and evaluation of the bone and gums prior to surgery is crucial to prevent complications.

Some of the risk factors for peri-implantitis are:

  • Smoking
  • Poor quality of the supporting bone
  • Periodontal disease and gingivitis
  • Systemic diseases: osteoporosis, some cancers, or diabetes, among others
  • Poor oral hygiene
  • Bacterial contamination during implant placement
  • Poor distribution of occlusal forces that generate overload
  • Stress

What are the symptoms of peri-implantitis?

These are similar to the symptoms of periodontal disease in natural teeth. As we said above, it’s the inflammation of the tissues that surround and support the implant.

There’s bacterial plaque and tartar, an increase in size, and reddening of the mucous membranes surrounding the implant. In addition, there may be bleeding from the area when brushing, rubbing, and during dental probing.

Sometimes, suppuration also appears around the implant. Especially if the pocket is greater than six millimeters [when the dentist performs a probing that measures the distance from the gum margin to the bottom of the sulcus].

They can also verify the loss of bone tissue through radiographs. In fact, the mobility of the implant is a sign of the progression of this condition. In addition, it’s usually painless but some patients experience discomfort when clenching the teeth.

A person with these symptoms must immediately consult their dentist. This is because the sooner they address this complication, the better the prognosis.

In any case, regular check-ups after having an implant are also important. Few people are aware of having this disease.

Diagnosing peri-implantitis

As we mentioned above, regular visits to the dentist for the evaluation of the tissues surrounding the implant and the levels of bacterial plaque in the mouth are fundamental. Thus, they can address it early to stop its progression ASAP.

The diagnosis of the pathology focuses on detecting the changes in the soft tissues and in the bone surrounding the implant. Clinical examination and probing depth measurement allow evaluation of the presence of pockets, gingival inflammation, bleeding, suppuration, and implant mobility.

Radiographs are also necessary. This is because they allow you to analyze the bone density and whether there’s reabsorption around the device.

Peri-implantitis treatment options

Treatments for peri-implantitis seek to control the infection in order to stop further damage and bone loss. The dentist should be able to choose the most appropriate treatment option depending on the severity of the situation.

They may prescribe antibiotics to treat the infection, be they oral or local — by placing devices that release them inside the pocket.

In addition, they may do subgingival debridement or scaling. This consists of separating the gingival tissue manually to eliminate inflammation and promote its recovery.

Surgical treatment will be necessary when peri-implantitis has significantly destructed the bone. There are different techniques you can use to meet your specific needs:

  • Access surgery consists of opening a flap to remove the damaged tissue and clean and disinfect the implant surface
  • In resection surgery, the characteristics of the bone and soft tissue are modified to avoid the formation of new pockets in addition to the above
  • Regenerative procedures consist of the placement of grafts or barrier membranes to recover the lost bone

Adjustments of the prosthetic portion of the implant are also part of the treatment. It prevents occlusal overload.

In addition, there’s also the improvement of the patient’s hygiene habits. The dentist should give instructions on the necessary measures to control the cleanliness of the mouth. In addition, the professional may prescribe the use of antiseptic rinses, such as chlorhexidine digluconate, to reduce bacterial proliferation.

A woman at the dentist.
Only a dental professional can treat peri-implantitis and choose the most appropriate technique for the case.

Taking care of the implant is fundamental

Some non-controllable factors can give rise to peri-implantitis. However, the care of an implant after its placement is fundamental in order to reduce the risk of complications.

Thus, oral hygiene is essential so brushing at least three times a day and after each meal can prevent the accumulation of bacteria that can lead to problems with the implant.

One must also pay special attention to reach the most inaccessible areas and clean all the teeth and appendages present in the mouth. Complementing hygiene with the use of dental floss, oral irrigators, and mouthwashes greatly helps.

Smoking significantly increases the risk of peri-implantitis as this habit is related to mucosal inflammation and bone loss.

In the case of bruxism or teeth clenching due to stress, its treatment and the use of a relaxation plate are necessary to avoid occlusal overload on the implants. And, as already mentioned, regular dental check-ups are also essential to detect any problems in time. Finally, the sooner a dentist makes a diagnosis and prescribes treatment, the better the prognosis of the implant in the mouth.



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