Peri-implantitis
Peri-implantitis is a destructive inflammatory process affecting the soft and hard tissues surrounding dental implants.
[4] Patients are recommended to regularly attend dental appointments and to seek advice from their dentist if they have any concerns for their oral health.
[5] Before the signs and symptoms are explained, it is worth noting that healthy peri-implant tissue should not be swollen, bleeding, producing pus, or have a reddened appearance.
The results of this study demonstrated that the accumulation of plaque had led to the development of inflammation coupled with an increase in the gingival infiltrate containing immune cells[20] Research has highlighted that the mechanisms of peri-implant mucositis and gingivitis are very similar with bacterial invasion from plaque triggering redness, swelling and inflammation within soft tissues.
To reverse peri-implant mucositis, good oral hygiene must be performed regularly to remove plaque which initiated this disease.
Dentists are responsible for ensuring that different elements of the implant should be of the correct size to avoid creating additional surfaces which bacteria can colonise.
After implant placement, dentists must carefully and regularly monitor the health of the peri-implant mucosa at suitable intervals, e.g. every 3/6/12 months.
Depending on the nature of the disease, treatment can vary significantly – from non-surgical therapy with an aim to control the infection and detoxify the implant surface, to surgical procedures to regenerate the alveolar bone that has been lost.
Therefore, to enhance the non-surgical treatment options of peri-implantitis, mechanical debridement can be used in combination with antiseptic, antibiotic therapy and/or resective or regenerative surgery.
The combination of treatments can vary depending on the severity of the peri-implantitis, and cumulative interceptive support therapy provides guidance in this aspect.
[23] Cumulative interceptive supportive therapy, a protocol of therapeutic measures, provides guidance for clinicians to decide which regime should be used to treat peri-implantitis, depending on the mucosal condition (whether there is a presence of dental plaque, bleeding on gentle probing, suppuration), peri-implant probing depth, and evidence of radiographic bone loss.
[23] To prevent roughening and damaging of the implant surface, ultrasonic scalers with a non-metallic tip or resin/carbon fiber curettes are used for calculus removal.
[26] However, current preponderance of evidence supports that the long-term antimicrobial effect of the use of chlorhexidine significantly outweighs the comparatively brief period of cytotoxicity.
An antibiotic targeting gram-negative anaerobic bacteria – e.g. metronidazole or ornidazole is administered during the last ten days of antiseptic treatment, allowing peri-implant infection to be treated successfully and remain stable.
[27] Another method is to use minocycline microspheres in conjunction with mechanical debridement; this has shown to improve probing depths, but the treatment may have to be repeated in future.
[28] Oral systemic antibiotic intake has not shown a permanent solution without adjunct therapy being mechanical and/or local application of doxycycline and 1% hydrogen peroxide.
These biomaterial strategies are aiming at suppressing or inhibiting bacterial colonization of implant surfaces in favor or host cells and tissues.
Additionally, new studies suggest that implant-specific instruments need to be used that reduce peri-implant bacteria while maintaining the integrity of the surface of the implant.
