Peri-implant Diseases
Mucositis and Peri-implantitis
Peri-implant diseases affect the tissues surrounding dental implants. Depending on the severity and the tissue affected, we distinguish between peri-implant mucositis (initial stage) and peri-implantitis (advanced stage).
1. What is peri-implant mucositis?
Suffering from peri-implant mucositis implies a lack of health in the soft tissues surrounding dental implants. This manifests as gum inflammation and is primarily caused by the accumulation of bacterial plaque.
According to statistics from scientific studies, 8 out of 10 patients who have received dental implant treatment will suffer from this disease. Regarding the implants themselves, half of them will be affected at some point.
It is very similar to gingivitis, which affects natural teeth. Mucositis also presents with redness and bleeding of the gums. Scientific studies on initial bacterial colonization indicate that the peri-implant mucosa’s response to plaque exposure is identical in both implants and natural teeth during both initial and prolonged periods.
Once these symptoms appear and the diagnosis is confirmed, it is essential to begin treatment immediately. At this stage, the pathology is still reversible; however, if left untreated, it can progress to peri-implantitis, risking the overall failure of the dental implant treatment at our center in Valencia.
All these reasons underscore the importance of our maintenance program for implant patients, whose primary goal is to prevent the development of this pathology and ensure the early detection of any peri-implant disease. This allows us to treat the condition before it causes irreversible damage.
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2. Peri-implantitis
Peri-implantitis is a peri-implant disease consisting of a severe inflammatory process that affects the tissues surrounding the implant, resulting in the loss of the supporting bone.
This is the second stage of peri-implant disease. In its first stage—when it only affects the soft tissues—it is called mucositis. It becomes peri-implantitis when it is not treated in time and begins to affect the bone support, potentially leading to the loss of the implant.
More about peri-implant mucositis
More about peri-implantitis
Diagnosing peri-implant mucositis
To detect lesions in the peri-implant soft tissues, a clinical examination must be performed, very similar to the one used for periodontal disease in natural teeth. The specialist evaluates bleeding on probing (BOP), suppuration, and probing depth using various techniques. This allows for a diagnosis when peri-implant diseases are suspected. If bleeding on probing is negative, the tissues are considered healthy and stable.
When inflammation and bleeding on probing are present, X-rays are indicated to differentiate between mucositis—which only affects the gums—and peri-implantitis, which already involves the loss of the implant’s supporting bone.
Causes and symptoms of peri-implant mucositis
As previously mentioned, peri-implant mucositis is caused by the accumulation of bacterial plaque around the implant. This leads to bacterial proliferation, which triggers symptoms starting with inflammation of the gums surrounding the implant, redness, and bleeding.
There are risk factors that significantly increase the likelihood of its appearance. One major factor is poor oral hygiene; many patients mistakenly believe that an artificial tooth, such as an implant, requires less care, when in reality, it demands even more rigorous maintenance.
Smoking and implant-supported prostheses with designs that make proper cleaning difficult for the patient also act as significant risk factors.
Treatment of Peri-implant Mucositis
We emphasize that a patient with implants must maintain much more rigorous care than a patient with all their natural teeth. Once infected, bacteria cling more easily to implants compared to natural teeth. Furthermore, there is a risk that these bacteria will accumulate and form adjacent pseudo-pockets, creating an oxygen-poor environment that aids the proliferation of pathogenic anaerobic bacteria.
Therefore, before placing implants, it is vital to control the oral biofilm through necessary periodontal treatment using mechanical and chemical techniques based on Chlorhexidine and Cetylpyridinium Chloride. The patient must achieve an excellent level of oral hygiene prior to implant treatment to avoid future conditions, such as peri-implant diseases.
In cases of diagnosed peri-implant mucositis, the specialist employs mechanical techniques, such as curettes and ultrasound, to eliminate the infection without damaging the surface of the implant neck.
The use of antiseptics—primarily chlorhexidine mouthwashes—during the following days will be a significant support to the mechanical treatment performed at the dental clinic.
Maintaining a consistent and proper dental hygiene technique is also essential to prevent and eradicate peri-implant mucositis. Patients must dedicate time and attention to their hygiene to prevent the pathology from evolving. Additionally, periodic visits to the specialist are vital to ensure the total elimination of any focus that could cause the mucositis to reappear.
At our dental clinic in Valencia, we are specialists in preventing and solving potential complications arising from dental implantology. Put yourself in the hands of true professionals—put yourself in our hands!
Diagnosis: Signs and Symptoms
Its signs are similar to periodontitis: bleeding and redness of the gums, occasional suppuration, and noticeable bone loss on X-rays. The dentist uses the same methods for the evaluation, diagnosis, and monitoring of this disease in implants as those used for periodontitis. However, it is important to know that the progression of infection in dental implants is faster and more aggressive than in natural teeth, as teeth have defense mechanisms that implants unfortunately lack.
Regarding symptoms, it is common for the patient to notice nothing, and the disease may go undetected until identified by a dentist or hygienist. However, this should not lead to complacency. Peri-implantitis does not always result in implant loss, but it does put it at risk. Early detection is vital, as prompt treatment is the most effective method to halt its progression.
Causes of peri-implantitis
Its appearance is primarily due to the accumulation of bacterial plaque around the implant caused by poor oral hygiene. There are also significant risk factors that can contribute to the pathology, such as smoking, pre-existing periodontal disease, inadequate prosthetic designs, occlusal overload (masticatory stress), or the type of implant surface.
Prevention
As mentioned, infections in implants are more aggressive than in natural teeth. Therefore, a patient with implants must maintain even better hygiene and schedule more frequent check-ups and maintenance visits than a regular patient.
Reducing risk factors—starting with meticulous oral hygiene and avoiding tobacco—is essential to prevent a disease that is notoriously difficult to treat.
The way the implant surgery is performed, the prosthetic design, and the materials used are also critical factors. For this reason, patients should carefully evaluate which dentists they trust with their oral health.
At IDIM, we are deeply committed to preventing peri-implant diseases.
Treatment
The goal of peri-implantitis treatment is to halt the progression of the disease and, in some cases, attempt to recover part of the lost bone support.
Treating peri-implantitis is not simple and requires significant commitment from the patient. Currently, most implants can be saved with proper treatment; just a few years ago, the only solution for this pathology was extraction.
The type of treatment will depend on the stage of progression presented by the patient:
- Step 1: The first step in all cases is to identify potential risk factors contributing to the disease and correct those that are manageable: quitting smoking, correcting inadequate prosthetic designs, improving oral hygiene techniques, etc.
- Step 2: Non-surgical cleaning of the implant and the peri-implant mucosa. This consists of cleaning with curettes and ultrasound (similar to periodontal treatment) while the patient is under local anesthesia.
- Step 3: Surgery. In most cases, a surgical phase is necessary..Depending on the severity and the type of bone defect created by the disease around the implant, we may apply a regenerative treatment for bone defects or a resective treatment, which aims to facilitate cleaning the area and halt progression.
In cases involving bone regeneration, surgical treatment is combined with the use of antibiotics.
- The final phase, and undoubtedly the most important, is maintenance. After surgery, the patient must attend regular follow-up and implant cleaning sessions. Without meticulous hygiene, an implant previously affected by peri-implantitis is highly likely to suffer a relapse in a relatively short period.
At our dental clinic in Valencia, we are specialists in preventing and resolving potential complications derived from dental implantology. Put yourself in the hands of true experts—put yourself in our hands!
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