Dr. Mehdi Noroozi comes back to speak to us about peri-implant diseases through the presentation of few cases.
In this presentation, Dr. Noroozi talks about peri-implant disease which is often a result of improper diagnosis and treatment planning. It is important to educate our patients about the risk of peri-implant diseases. Currently, there are a significant number of implants that have inflammation or infection in practice.
However, not all bone loss around implants is attributable to peri-implantitis. Bone loss could result from biologic width establishment, bone remodelling and early implant failure. Peri-implantitis is an inflammatory reaction around the tissues of the implant with the progressive loss of supporting bone beyond the biologic bone remodelling. It is essentially, a pathologic and bacterial infection.
Peri-implant diseases are a group of diseases similar to periodontal diseases. The disease begins as peri-implant mucositis which is reversible and presents with bleeding upon probing. This is similar to gingivitis and resides in the soft tissue around the implant. Marginal or crestal peri-implantitis occurs when the inflammation extends to the bone and there is evidence of radiographic bone loss. Its prevalence ranges from 12-15%. Clinically, it presents as bleeding on probing, deep probing depths and radiographic bone loss beyond biologic bone remodelling. Apical or retrograde peri-implantitis is less well-known and has a prevalence of ~1.6-2.7%. It is similar to chronic periapical periodontitis and is asymptomatic. It normally develops after placement of the implant while the crestal bone remains intact but the apical bone is lost. Causes or apical or retrograde peri-implantitis may include extreme heat production at the time of osteotomy which results in bone necrosis, the presence of a chronic granuloma or chronic periapical periodontitis, infected root canal systems in neighbouring teeth or a failed previous root canal at the implant site. Peri-implant disease is progressive and not self-arresting and responsiveness to treatment may not be idea due to the limited vascularity of the surrounding tissues.
Risk Considerations for Peri-Implant Disease
• Poor oral hygiene
• Exposed implant threads which leads to bacterial colonization
• History of periodontal disease with several pockets of 5mm and higher
• Poorly controlled diabetes
• Alcohol use
• Implant position
• Excess cement
• Passivity of prosthetics
• Lack of keratinized gingival tissue
Diagnosis of Peri-Implantitis
• Mobility due to the implant not the implant crown
• Baseline probing depth at the time of implant placement to compare with at subsequent visits
• Bleeding on probing indicates inflammation
• Presence of suppuration
• Radiographic evaluation of bone loss or progressive bone loss
The goal of peri-implantitis treatment is surface decontamination and detoxification by reducing the bacterial load by dilution to allow healing and this is difficult to achieve by mechanical means alone. Peri-implant mucositis can be dealt with non-surgical management via scaling with implant-specific instruments; however, there is no definitive, non-surgical treatment for peri-implantitis which requires surgical treatment.