Peri-implantitis

Peri-implantitis

Peri-implantitis is defined as an inflammatory process that affects the tissues around an osseointegrated implant and results in the loss of supporting bone.

The term peri-implantitis was introduced in 1987 by Andrea Mombelli.

Peri-implant mucositis is the term used to describe reversible inflammatory reactions in the mucosa adjacent to an implant. These inflammatory reactions progress subsequently and causes loss of the supporting bone, resulting an irreversible condition known as peri-implantitis.

Potential Risk Factors for Peri-implantitis

• Local factors
  • Thin gingival biotypes
  • Non-keratinized tissue
  • Periodontally involved teeth
  • Poor bone quality
  • Surgical trauma
  • Immediate implants placed into extraction sockets
  • Improper angulation of the implants
  • Augmented bone
• Restoration related factors
  • Over engineered restorations with too many implants
  • Too closely placed implants making cleaning difficult
  • Fixed bridges with wide spread flanges
  • Limited embrasure area between implants
  • Restorations with extensive cantilevers which increases plaque retention
• Patient related factors
  • Smokers
  • Poor oral hygiene and compliance
  • History of parafunctional habits (bruxism)
• Systemic factors
  • Diabetes mellitus
  • Systemic medications that can affect bone turnover.

Sign Peri-implantitis and Symptoms of Peri-implantitis

• Presence of pockets, bleeding, suppuration, swelling of peri-implant tissues and vertical destruction of crestal bone are associated with peri-implantitis.
• Defect is of saucer shaped with osseointegration only at the apical part of fixture.
• Pain is an unusual factor but when present, it is associated with acute infection.
• Peri-implantitis if remain untreated can progress deep into the supporting bone and lead to loss of implant.

Peri implantitis Treatment

• Overall goal of the therapy is to establish a functional restoration and an acceptable aesthetics. So any therapy provided should arrest further loss of bone support and re-establish a healthy peri-implant mucosal seal.
• Treatment of peri-implantitis is divided into an initial therapeutic phase and surgical phase

Peri-implantitis – Initial Therapeutic Phase

• Occlusal therapy: Since excessive occlusal forces leads to peri-implant bone loss. Change in the design of prosthesis and improvement in the implant number as well as position helps to arrest progression of peri-implant tissue breakdown.
• Anti-infective therapy: Remove plaque debris by using plastic instrument and polishing all accessible surfaces with pumice. Additionally peri-implant pockets can be irrigated by help of 0.12% chlorhexidine for 10 days to 3 weeks (2 to 3 times per 24 hourly) or local anti-microbials.
• Systemic antibiotics: They are administered as supportive therapy. Frequently used antibiotics are metronidazole, doxycycline or combination of metronidazole and amoxicillin.
• Implant surface preparation: This is done with the supersaturated solution of citric acid for 30 to 60 seconds in order to remove endotoxin from implant surfaces. Irradiation with soft laser for elimination of bacteria associated with peri-implantitis has shown good results in destruction of bacteria and provide proper surface decontamination and preparation.

Peri-implantitis – Surgical Phase

• Peri-implant resective therapy: This is suitable for periimplant lesion with horizontal or vertical bone loss (<3 mm). In order to access the surgical area, a full thickness flap is raised and degranulation of the defect and resective therapy is done.
• Implantoplasty: Implant surfaces presenting with threads, roughened topography, or hydroxyapatite surfaces are treated by using high-speed finishing burs and produce a smooth, polished and continuous titanium surface. It is performed with profuse irrigation before osseous resective therapy.
• Osseous resective therapy: Bone around implant is recontoured and flap is apically repositioned and is sutured.
• Peri-implant regenerative therapy: Use of guided bone regeneration is recommended in cases where moderate to deep vertical defects are seen in peri-implant bone. The surgical therapy includes removal of granulation tissue after elevation of flap, implant surface preparation and use of bone graft and barrier membrane on the defect. The membrane is extended 3-4 mm beyond the defect and flap is closed over it.
• Re-osseointegration: The treatment goal of peri-implant regenerative therapy is de novo bone formation at the portion of implant that has lost its osseointegration in the inflammatory process. This increase in height of bone leads to marginal shift of mucosa thereby enhancing soft tissue aesthetics