While dental implants have many benefits to patients, there is a long-term risk associated with them and it’s a condition called peri-implantitis. Peri-implantitis is an infectious disease that leads to inflammation of the bone and gums around an integrated dental implant. This destructive inflammatory process leads to loss of the bone supporting the implant and it’s difficult to treat. Most dental implant patients won’t develop this condition, but it’s important to understand the symptoms and warning signs that indicate a problem.
Causes of peri-implantitis
During peri-implantitis, patients lose bone around a dental implant and are usually unaware that it’s happening because it progresses painlessly. This bone loss and it can happen early after placement of the crown on the implants or it may occur years after the implant procedure. Certain risk factors increase the potential for the development of peri-implantitis and they include:
- Smoking – Constricts blood vessels, which can lead to bone loss
- Medical conditions – osteoporosis, diabetes, immune system disorders
- Poor oral hygiene – brushing twice a day and flossing once a day must occur to maintain good oral health and protect the health of implants
- Gum disease – gum disease present on surrounding teeth can infect the implant
- Teeth grinding – voluntary or involuntary teeth grinding can wear down surfaces and lead to damage, infection and bone loss
- Surgical factors – improper bone grafting, wrong size implant, lack of tightness around implant, soft bone, overheated bone
- Extra cement during placement – cement seeps into the gum near the bone and becomes an irritant
Once peri-implantitis establishes itself around the implant, patients begin to develop symptoms.
Symptoms of peri-implantitis
Although peri-implantitis is often painless and progresses without the patient’s awareness, eventually it leads to obvious signs and symptoms such as:
- Gum line bleeding
- Red or bluish purple gums
- Tartar/plaque buildup at gum line
- Deepening gum pockets
- Pus from gums and implants
- Exposure of implant’s metal threads
- Longer looking tooth
- X-ray showing loss of bone support
While peri-implantitis can cause the above symptoms, it’s important to note that the condition doesn’t always present noticeable signs or discomfort. Patients may only experience a slight tenderness or dull ache when contacting the area. Sometimes there is a bad taste in the mouth if pus has developed around the implant. In severe cases, neck glands can swell or the implant may feel loose.
An x-ray and/or 3-D scanning are possible first steps to determining the extent of the condition and the proper course of treatment. The dentist checks for an improperly made bridge or crown and/or a loose or broken abutment screw caused by improper torque or a patient with a heavy bite. Often, a patient needs exploratory surgery to discover the cause and at this time, the dentist may do a bone graft in an attempt to save the implant. Not all dental implants suffering peri-implantitis are savable.
Treating peri-implantitis involves correcting the problems with the existing, affected dental implant(s). A dentist with extensive experience in dental implant must do the correction to avoid recurrence of the issue. Dental implants affected by peri-implantitis usually require bone grafting and surgery, which opens up and detoxifies the gum area. Killing off all the existing bacteria is essential to regraft bone onto implants.
The long-term goal of any treatment is to halt the progress of peri-implantitis and maintain existing dental implants and this involves cleaning the area thoroughly, prescribing antibiotics and applying antibacterials to the implants. It takes time to see if the treatment worked and there’s no guarantee that bone grafting on implants with bone loss will be successful, but it is possible to regenerate bone loss from peri-implantitis. The success rate for bone grafting in this instance is around 35-50% and in severe cases, the best course of action is removing the existing implant and replacing it. The failure of one dental implant doesn’t indicate that future implants will fail too.