What is Peri-Implantitis?

Peri-implantitis is the inflammation of the soft tissues around a dental implant, leading to bone loss. Current studies show that as many as 20% of implants develop peri-implantitis by 6-7 years after placement. If left untreated, it can lead to implant failure. The good news is that it can be prevented with proper strategies.

Are certain implants more prone to peri-implantitis?

Several factors influence this, like:

• Poor Oral Hygiene: Poor oral hygiene and a history of tooth loss resulting from gum disease are definite risk factors, and one of the main causes of peri-implantitis. Genetics also play a role. This is why good home care is vital.
• Smoking: Smokers are not only more likely to develop peri-implantitis than non-smokers, the level of severity of the condition is also associated with the habit.
• High Alcohol Consumption: Research shows that heavy alcohol consumption is associated with an increased risk of peri-implantitis.
• Exposed Surface Texture: Rough surfaces can be more susceptible to peri-implantitis, but bacterial exposure is crucial. Properly placed implants ensure that the rough surface remains embedded in the bone, not exposed above the gum line. This placement minimizes the risk of bacterial colonization and subsequent inflammation.
• Poor Placement: Correctly planned implant placement is important. Incorrect positioning and insufficient bone or gum coverage increase risk of peri-implantitis. Incorrect implant placement position with too little investing bone or too thin a layer of gum over the implant are risk factors. This is one reason it is important to use an experienced dental implant surgeon.
• Poor Prosthesis Design: It should allow good access for the patient to clean under and around them, allowing for good hygiene practices at home. Materials like titanium and zirconia are good for gum health. (We have a full page dedicated to the correct design of a cleansable full arch implant bridge prosthesis).
• Excess Cement: Excess cement can lead to inflammation and bone loss. This is sometimes referred to as peri-implant cementitis. To avoid this, our (fixed) implant prostheses are screw-retained instead of cement-retained. We transitioned to this method about a decade ago after determining that cement retention is inferior. This change is well-documented and addresses the issues associated with outdated cement-retained processes.

What are the warning signs of peri-implantitis?

They are much like gum disease. Signs include:

• Bleeding when brushing
• Swollen, dark red gum tissues
• Discharge at gum level
• Bad taste/ bad breath
• Recession of gums exposing the implant
• Bone loss around the implant
• Loosening of the implant

Though it often causes little pain, X-rays can show bone loss as the disease progresses. Since early signs can be detected this way, we recommend keeping up with routine exams, just as if you still had natural teeth.

How often should I see the dentist for implant health?

Typically, twice a year visits are recommended, with more frequent visits for cases of peri-implantitis.

Cleaning tips to prevent peri-implantitis?

The best way to prevent it is to practice good oral hygiene. Thorough but gentle cleaning is vital. Use appropriate hygiene aids like floss, water-piks (and interdental brushes, when recommended). Professional advice is essential. Our hygienist can show you the most appropriate hygiene aids for your particular design of implant prosthesis.

How is peri-implantitis treated?

The treatment depends on the severity:

• Early Stages: Known as peri-implant mucositis, where bone loss has not yet started, can resolve easily like gingivitis around natural teeth. Professional cleaning and good home care practices can resolve inflammation and allow the gum tissues to go back to normal.
• Advanced Stages: With advanced peri-implantitis, surgery to clean around the implant and restore bone is necessary. The good news is, if you’re seen as recommended for routine follow-ups after implant placement and maintain good oral hygiene habits, you likely will have caught it before it gets to this advanced stage.
• Severe Bone Loss: Replacement of the implant may be required.

As you can see, the risks of developing peri-implantitis are shared between the patient and dentist. In addition to doing YOUR PART, it is important to choose an implant surgeon well-versed in dental implant placement AND dental implant prosthesis design and fabrication. As Prosthodontists, Dr. McFadden & Dr. Tan have more training in these types of treatments than general dentists or other dental specialists. They are heavily trained in this type of tooth replacement, and they do them every day.

Although this is largely a preventable problem, and thankfully, one we don’t see very often in our office, if you have any of the above-mentioned symptoms of peri-implantitis, schedule a consultation with us promptly.