Periimplant diseases

In modern dentistry, surgical insertion of implants into the missing teeth area has become a routine treatment method, but as the number of implanted implants and patients with implanted implants increases, inflammatory problems are increasingly being identified, which have progressed largely without the patient noticing their existence themselves.

Whether inflammation develops and if it develops as quickly as possible depends on many factors, but the main periimplant condition, like the exciting factor for periodontal conditions, is the bacterial application. If a doctor who advises and says putting implants in 100% of cases will solve the missing tooth problem without any risk of developing inflammation around an implant or even loss of an implant fails to provide objective information.

Inflammation, which develops around the implant, can only affect gum tissue, but, as inflammation progresses, without gum tissue, the bone already surrounding the implant. Therefore, there are two forms of periimplant disease: periimplant mucositis and periimplitis. In periimplant mucositis, inflammation is seen in soft tissue around the tooth implant, while periimplitis – free of inflammatory gum tissue – already shows bone breakdown, reduction in osseointegration, abnormal formation of periodontal pockets and possibly pus from them.

Bone loss around implants

Usually, periimplitis prepares painlessly and symptoms can be felt relatively late in the patient when inflammation and bone loss around the implant have already developed strongly. Periimplitis itself “doesn’t hurt.” The implant area can only be sensitive when touching or cleaning the area, Diego. May have a bad taste in the mouth when pus is released. Local lymph nodes may increase in cases of severe inflammation.

Signs of periimplitis

• gum haemorrhage/redness
• application/denture;
• periodontal pockets around the implant/pus excretion;
• progressive bone loss around the implant
• implant thread expositions.

Risk factors associated with the development of periimplitis:

• During the insertion of implants of untreated periodontal disease leading to the release of pathogenic microflora from periodontal pockets to the site of implantation;
• Persistent periodontal pockets around the teeth, which serve as a reservoir for micro-organisms, so that the surface of implanted implants can be colonised;
• Smoking;
• General health problems such as diabetes, disorders of the ammunition system
• Surgical risk factors;
• Inadequate prosthes/crown/bridge design on implant.

Treatment

Periimplitis affects a relatively small proportion of patients, but admittedly it is difficult to succumb to treatment.

First, the doctor conducts a thorough clinical and radiological examination for the exact diagnosis and preparation of the treatment plan before starting treatment, first by seriously motivating the patient to continue and regularly cooperate with oral health professionals to control the course of the disease, as well as by instructing on the necessity and technique of oral care.

For the most part, periimplant treatment is performed by surgery so that the implant surface can be efficiently treated and disinfected. If the possibility of regeneration is expected, biomaterials contributing to regeneration shall be used. In addition, antiseptics and, relatively often, antimicrobials are prescribed.

At times, the bone around the implant has been affected so badly that the implant needs to be removed and a serious rethink or put new one instead. Not all implants affected by periimplitis can be saved.

Key recommendations for preventing periimplitis development:

1. Never rush implant insertion – think about whether your oral health condition and your own motivation to ensure the long-term health of gum tissue will be sufficient.
   Remember, about 70% of your gums will depend on your own health!
2. Implants may be inserted in patients with good oral hygiene, hence healthy or recovered gums with no signs of inflammation.
   If the patient has previously been dieagnostically diagnosed with periodontological conditions, the periodont must first be recovered and implants may be inserted only after stable gum health has been achieved.
   The patient should know and understand that routine controls and presence in periodontal maintenance therapy are the basis for long term implant maintenance.
3. Your doctor should inform you about possible risk factors that may affect the course of treatment and increase the risk of developing periimplitis.
4. The insertion of implants must be carried out by a certified physician in accordance with generally accepted standards and the protocol of treatment and the prosthetic part of the implants must be designed in such a way that the patient can ensure oral hygiene and control of the lining.
5. Regular controls should be carried out not only in the first years following implant insertion but over a long period of time.