Peri-implantitis: severe inflammation around an implant

More and more people have one or more implants in their mouth. Implants are placed in thousands of people every year. An implant is a type of screw that is placed in the lower and/or upper jaw to replace a natural tooth and thus forms the basis for a crown, bridge or prosthesis. After having an implant placed, you may experience inflammation around the implant. This is called a peri-implant infection. When the infection is located around the gum of the implant, it is called peri-implant muscositis. When the inflammation spreads further and also affects the jawbone, it is called peri-implantitis. The consequences of peri-implantitis are serious, the implant can become loose and you can even lose the implant.

  • Peri-implant infection
  • Peri-implant mucositis
  • Peri-implantitis
  • Preventing peri-implantitis
  • Risk factors for peri-implantitis
  • Diagnosis of peri-implantitis
  • Symptoms of peri-implantitis
  • X-ray
  • Consequences of peri-implantitis
  • Treatment of peri-implantitis
  • Non-surgical treatment
  • Surgical treatment / flap surgery
  • Removal of the implant

 

Peri-implant infection

A peri-implant infection is an inflammation around the tissue of an implant and is common in people with an implant. Normally gums attach to teeth naturally. This does not happen with an implant, the gums often remain loose around the implant, making it much easier for bacteria to get under the gums. This can cause inflammation. A distinction is made between peri-implant mucositis and peri-implantitis.

Peri-implant mucositis

Peri-implant mucositis is the precursor to peri-implantitis. There is gingivitis around the implant. The gums may feel painful, be red and swollen and may bleed slightly when touched. Peri-mucositis is comparable to gingivitis as a precursor to periodontitis. Thanks to proper treatment, the process is reversible.

Peri-implantitis

If left untreated, the inflammation will spread deep under the gums and reach the jawbone. This is called peri-implantitis. Inflammation of the jaw bone will lead to bone loss. This process is faster than with natural teeth. Bone loss deepens the pocket, which is the space between the gum and the implant. As the pocket becomes deeper, bone loss will continue to increase and the implant support material will be lost. This causes the implant to become loose and the implant may even be lost. Treatment of peri-implantitis is complex and is best prevented.

Preventing peri-implantitis

To prevent peri-implantitis, the oral tissue must be in good condition and free of inflammation before an implant is placed. Good aftercare is necessary after placement of an implant. An X-ray must be taken within six months after placement, which records the depth of the pockets, the so-called baseline measurement. This is a reference point of the pocket depth, to be able to check whether the pocket is getting deeper. During check-up appointments, which take place once or twice a year, this pocket depth and the condition of the gums are checked, among other things. If plaque and tartar are present, the teeth will be professionally cleaned to prevent or timely treat peri-implant infections, such as peri-mucositis and peri-implantitis.

Risk factors for peri-implantitis

Major risk factors for developing peri-implantitis include:

  • lifestyle factors such as smoking and alcohol consumption
  • pre-existing periodontal disease
  • underlying diseases such as poorly controlled diabetes mellitus
  • inadequate oral hygiene
  • a lot of stress or insufficient rest
  • genetic predisposition

 

Diagnosis of peri-implantitis

Peri-implantitis is diagnosed by clinical examination and x-ray.

Symptoms of peri-implantitis

  • the color and condition of the gums such as swelling and redness
  • the formation of pus
  • tenderness or pain
  • bleeding after probing (applying light force on the gums)

 

X-ray

If the pocket measurement shows an increase of more than 2 mm, an x-ray should be taken. Bone loss becomes visible via an X-ray by comparing the depth of the pockets with the baseline measurement or with previous measurements.

Consequences of peri-implantitis

Due to the reduction of the jawbone, the space between the tooth and the gums increases (pocket depth), causing the implant to become loose and the implant may even be lost. To prevent this, it is very important to treat the inflammation in a timely manner.

Treatment of peri-implantitis

Once the diagnosis of peri-implantitis has been made, several treatments are available to treat the inflammation.

Non-surgical treatment

First, non-surgical treatment will take place. This will consist of a thorough supra- and sub-cleaning of the teeth, a dental cleaning from above, but especially deep below the gums. This is done with special instruments that can easily reach and clean the space around and under the implant. As long as bacteria remain, the inflammation will remain present. In addition to dental cleaning, antibacterial agents can be used such as antibiotics or disinfectant mouth rinse or gel.

Surgical treatment / flap surgery

If the response to non-surgical treatment is not sufficient, surgical intervention will be necessary. Flap surgery then takes place under local anesthesia. This involves pushing the gums aside, exposing the implant and allowing it to be thoroughly cleaned. The infected tissue is removed and when too much bone has been lost, artificial bone is added (osteoplasty).

Removal of the implant

If surgical intervention does not help enough, removal of the implant is the only solution.

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