What is Peri-Implantitis?

Peri-implantitis, as defined by Wikipedia, is the destructive inflammatory process affecting the soft and hard tissues surrounding dental implants. The array of periodontal pathogens found around failing implants (those affected by peri-implantitis) are very similar to those found in association with various forms of periodontal disease.

While implants are meant to last a lifetime, there are some factors that help ensure their success. The need for follow-up care is very important. Regular monitoring of dental implants as part of a comprehensive periodontal evaluation and proper at home maintenance is crucial to a patient's implant health. Does your implant surgeon offer these maintenance services?

At this time, we recommend a yearly recall examination at our office, regardless of when your implant(s) was placed. The goal is to try and help prevent any possible infections from getting too advanced. Some of the risk factors for infections around implants include:

  • History of periodontal disease and presence of periodontal pathogens:
    Implants should be placed in a dentition with stable gums. If the gums are not stable, treatment of the periodontal disease is indicated prior to implant placement. Those with periodontal disease have up to eight times the risk of implant failure due to cross bacterial contamination between infected teeth and the implant.
  • Cement residue (on the restoration):
    This can be prevented with a few methods. One method is fabrication of a custom abutment with margins slightly subgingival. This allows the clinician to remove cement excess easily. Another common method to avoid cement residue is to place a screw-retained restoration.
  • Implant load:
    If the patient has any parafunctional habits (ie-clenching, bruxism), an occlusal guard is indicated to protect the implant and the adjacent teeth.
  • Oral hygiene and plaque control:
    Good oral hygiene around your implant and all of your teeth will help prevent disease. Do not be afraid to clean around it and I urge hygienists to not worry about using metal scalers around implants. Metal won't cause an implant to fail but debris/cement/plaque will.
  • Cleaning intervals:
    Every patient is different in terms of their ideal cleaning interval. Whether you are on a 3, 4, or 6 month schedule, it is important to keep these visits.
  • Smoking:
    Smokers have increased bone loss and soft tissue complications
  • Uncontrolled systemic illness including diabetes
  • Cleaning access:
    The shape of the restoration is an important factor in long term success. There are instances where we choose to create a larger space for cleaning with a proxabrush. This allows better access. This is not our goal in esthetic areas, but this is a consideration if the implant is becoming infected.
  • Amount of attached/keratinized tissue:
    The magic number is 2 mm, however, our contention is that the most important thing is that the tissue around the implant is being cleaned and is healthy and free of inflammation.
  • Type of restoration:
    Oral hygiene instruction around your implant restoration is imperative to maintaining its health. When there are larger restorations to fill a space, or the restoration is a bridge between two implants, it is important to clean not just in-between the teeth, but underneath the teeth until you are hitting the implant body.

When do you see a periodontist?

If you, your general dentist or hygienist are noticing bleeding or discomfort around your implants, please call our office for an appointment. These signs and symptoms include:

  • bleeding
  • purulence (pus)
  • redness
  • plaque debris
  • thin tissue
  • discomfort

View some of our common questions here.