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peri implantitis front tooth

Peri-implantitis and peri-implant mucositis treatment, laser and surgery

Peri-implantitis and peri-implant mucositis are two different stages of the same inflammatory process that destroys gum and alveolar bone around the dental implant causing its failure. The primary cause of peri-implantitis are the same bacteria that form dental plaque and cause periodontal disease around natural teeth.

Peri-implantitis Vs implant mucositis

What is the difference between peri-implantitis and implant mucositis ?

  • Peri-implant mucositis
    As many studies show, mucositis comes before peri-implantitis as first stage of it. The inflammation affects only the gingival tissue around the dental implant and there are no signs of bone loss.
    If caught in time, implant mucositis is a reversible disease. It means that it is possible to treat the gum pathology and save the dental implant.
    Implant mucositis is often compared to gingivitis (gum disease) around natural teeth
  • Peri-implantitis
    When mucositis is left untreated the infection involves the tissue under the marginal gingiva and the surface of the implant that offers bacteria the way to reach the alveolar bone which starts to reabsorb / recede. In case of severe peri-implantitis it is difficult to reverse the pathology and surgical or laser treatment are often required.
    Peri-implantitis is compared to periodontitis because they have similar symptoms, causes and both lead to implant failure and tooth loss respectively.

Causes

The main peri-implantitis cause is the poor oral hygiene but there are other factors that you should consider such as:

Bacteria and plaque biofilm

Implants wearers who do not brush and floss after each meal and do not use an antibacterial mouthwash, may  leave plaque biofilm to form in between the prosthetic crown and the implant. At this stage the plaque inflames the adjacent gingival tissue which becomes red and easy to bleed and mucositis develops.

Peri implantitis caused by excess of cement

In order to keep the dental crown in place attached to the implant abutment, dentists use a special cement. It may happens that they leave too much cement there that becomes the source of the inflammation that lead to mucositis first and peri-implantitis in the second stage. Instead of cement it is high recommended to use a titanium screw to connect the crown to the implant.

Occlusal overload (heavy bite) or low-budget implants / crown

Patient with heavy bite (those who put a lot of power chewing) need proper prosthetic restoration in order to protect the implant and avoid peri-implantitis to appear.

When the design of the implant surface is not correct, osseointegration may fail because of micro-movements of the screw that creates a little gap in between the implant and the bone tissue. Bacteria can reach that space and develop the peri-implantitis inflammatory process that leads to bone reabsorption.

Early signs and symptoms

Here is a brief list of the most common peri-implantitis symptoms:

  • Redness, Swelling, Gum bleeding
    The early sign of mucositis it the gum bleeding at the marginal gingiva level due to the inflammation that makes them being very sensitive. The tissue around the implant can easily bleed while brushing and flossing or by itself without any touch. It may also happens bleeding on probing meaning that the blood comes out while the dentist evaluated the periodontal pocket deep.
  • Gingival recession
    Due to the peri-implant mucositis inflammation, gums recede living the head of the titanium implant exposed.
  • Bad taste in your mouth
    When the pus forms and gets out from the gum pocket, you can feel the bad taste in the mouth.
  • Swollen neck glands
    If peri-implantitis is very severe, the glands in your neck may become swollen and you can even feel the dental implants being loose

Is peri implantitis painful ?

Peri implantitis is a silent periodontal pathology, meaning that most of the times there is no pain at all. Implant mucositis can easily develop without the patient being aware of it. That’s  why it is so important not to skip follow-ups.

Some patients reported a mild sore or increased sensitivity when they brush or touch the area with the tongue or a finger.

Diagnosis

The main scope of the peri-implantitis treatment is to remove the infected and necrotic tissue from the bone and from the implant surface. In this way it is possible to stop the periodontal disease and save the implant itself.

How to reach this big goal ? Well, dentists, periodontists and prosthodontists have different treatment protocols to choose from. The choice depends on the peri-implant disease status or progression.

A meticulous diagnosis is the base of the right peri-implantitis treatment so the patient should get a full periodontal examination before any therapy beginning.

The diagnosis includes X-rays exam to check the bone loss and the gum pocket probing to estimate its depth and create the periodontal chart.

Nonsurgical treatments and antibiotics

In both situations, peri-implantitis and mucositis, the conventional treatment begins with the removal of the plaque and tartar calculus from the uncovered part of the affected implants. The periodontist will use manual instruments such as: plastic curettes, scalers and a ultrasonic debridement device.

The second important step is the complete mouth disinfection with an antibacterial solution such as chlorhexidine.

By removing the source of the inflammation the surrounding soft tissue will heal by its own in a few weeks. Your dentist will prescribe you to continue keeping your mouth disinfected by using a chlorhexidine mouthwash (0.2% chlorhexidine digluconate) and, in some cases, a round of antibiotics  is required to destroy all bad bacteria.

The procedure described above is usually enough to reduce the inflammation associated with peri-implant mucositis and to get rid of that mild periodontal disease.

The case is different if the dentist is in front of peri-implantitis.

The infection removal procedure has to go more in depth along the surface of the implant so local anesthesia is often required.

Laser therapy to manage peri-implantitis

How can peri-implantitis laser treatment improve the therapy ?

The biggest problem dentist experience when they have to decontaminate the implant is its surface that is roughened (like honeycomb cells) by manufacturers to promote and ensure the best and fastest osseointegration. This offers bacteria micro places where to hide.

Erbium, Diode or Er:YAG laser in combination with mechanical debridement have shown benefits of reduction in inflammation and improvement in connective tissue tone.

A very high regenerative rate of alveolar bone is achieved after the laser treatment of the implant surface affected by peri-implantitis as well as the bony implant site.

Peri-implantitis surgical treatment

When non-surgical treatments of peri-implantitis using laser or air abrasive tools can’t stop the periodontal infection, the surgical approach is usually the last resort.

In short, the oral surgeon or your periodontist has to cut the gingiva to create a tissue flap that allows the infected area exposure. The next step involves surgical techniques to remove the infection either from the gum and from the implant. The doctor has to pay attention not to ruin the titanium screw surface.

In case of large bone loss, the hard tissue regeneration therapy (bone grafting) is required to guaranty the necessary implant support.

iBrush: a new tool to debride the implant surface

In order to help periodontists in their mission to remove soft infected tissue granulation from the implant and from the surrounding bone, NeoBiotech company created iBrush, a debridement instrument for dental implants subjected to peri-implantitis.

iBrush is made of stainless steel bristles with a stainless steel shaft and it is indicated for the open debridement of titanium implant surfaces.

Risk factors

There are many factors that can put you at the risk of mucositis first and, if not treated, of peri-implantitis as last stage of the periodontal disease that affects gum and alveolar bone tissue and may cause the implant to fail.

Some of peri-implantitis risk factors are directly connected with daily patient oral habits while others are related to health conditions or medical therapies that cause the issue or worsen it.

Poor oral hygiene and inadequate plaque control

As soon as you have your implants in place, you should care of them as you would with your natural teeth or even better. So brushing (electric toothbrush) and flossing twice a day or after each meal is what dentist always recommend to their patients.

In addition you can improve the overall teeth and gum health by using a water flosser to better and easier wash away food debrides from between dental elements and from the gingiva tissue and the dental prostheses. In this way you can be more sure to lower the risk of dental plaque to form as well as avoiding gum inflammation and bone loss around dental implants.

Smoking and chewing tobacco

Smoking is the worst enemy of the gums; It inflame them. Smoking reduce the size of arteries that leads to less oxygen supply. Less oxygen means less white blood cells and, therefore, less possibility for the body to fight infection (implant mucositis included).

Diabetes and other systemic condition

Systemic pathologies like diabetes, osteoporosis, compromised immune systems (nutrition deficiency, HIV) or even genetic factors may play an important role in peri-implantitis development, jawbone receding and the dental implant failure. People affected by these pathologies should get more attention by dentists.

Previous periodontal disease

If you have had gum disease in the past which resulted in your tooth loss, you are at greater risk to get implants and gums affected by implant mucositis bacteria.

Peri implantitis and pregnancy

Since peri-implantitis treatment involves antibiotics, x-rays and antibacterial agents such as chlorhexidine, the dentist should seriously consider all these factors before formulating the right therapy for pregnant and nursing women.

Prevention

How to prevent mucositis and peri-implantitis to form ? Each dentist can easily answer this question by suggesting to keep as adequate daily oral hygiene.

As mentioned above, the bacteria that cause periodontal disease are the same that cause implant disease.

The most important thing is to avoid plaque and tartar to form. So brushing and flossing properly at least twice a day and rinsing your mouth with an antibacterial mouthwash with chlorhexidine gluconate or hydrogen peroxide is enough to preserve your oral health and implants.

Do not forget to visit the dental office every 6 month so your dentist can take x-rays exam and check the health of the alveolar bone and proceed quickly in case of necessity.

Retrograde peri implantitis

What is the retrograde peri-implantitis ? In the most cases implants disease affects the head of the implant leaved uncovered by the surrounding gums due to the soft tissue inflammation. In the last stage the infection can reach the tip of the titanium screw.

In case of retrograde peri-implantitis the bone loss is located around the periapical region of dental implant while its upper portion fused well with the bone.

Bone loss due to this condition may be regenerated with the surgical protocol called guided bone regeneration or, more easily, bone graft.