What is peri-implantitis?
Another term one might run across in the literature is peri-implant gingivitis. The difference between peri-implant mucositis and peri-implant gingivitis is the later has keratinized gingiva.
Prevalence of periimplant diseases
The stats on this have wide ranges in the literature. Mucositis is at 43% with a 19-65% range and periimplantitis is 22% with ranges of 2-44%. Salvi Implant Dent April 2019
Causes of peri-implantitis is complex and related to a variety of factors:
- Patient-related factors including systemic diseases (e.g. diabetes, osteoporosis), dry mouth, and prior dental history. Patients with periodotnal disease have a 14 times greater risk Swierkot 2012.
- Social factors such as inadequate oral hygiene (18% for those that have maintenance program and 44% for those that do not Costa 2012), smoking, and drug abuse
- Parafunctional habits (bruxism and malocclusion) and occlusal over-load.
- Excess cement and loose, over-contoured, or poor fitting crowns. Incomplete crown or abutment seating.
- Lack of keratinized tissue (especially less than 2mm)
- Poorly positioned implants
Risk factors for peri-implantitis are similar to the causes but there is a nice risk assessment survey on FOR
Risk assessment for peri-implantitis on FOR and from playing around with it a little the biggest impacts are previous periodontal disease and and plaque.
Treatment of peri-implantitis
- Mechanical debridement with or without systemic antibiotic treatment (Metronidazole 250mg 2 tabs qid for 7 days) Liñares JOMI 2019
- Debridement with or without localized drug delivery and chlorhexidine oral rinses
- Mechanical debridement combined and CO2, LASER decontamination, or LAPIP protocol
- Surgical debridement with or without guided bone regeneration (GBR) for reparation of bony and soft-tissue defects.
To date, studies suggest that nonsurgical treatment of peri-implantitis is unpredictable, and the use of chemical agents such as chlorhexidine has only limited effects on clinical and microbiological parameters. Adjunctive local or systemic antibiotics have shown to reduce bleeding on probing and probing depths in combination with mechanical debridement. Beneficial effects of laser therapy on peri-implantitis have also been shown. Left untreated chronic peri-imlpantitis results in epithelial down-growth, bone resorption, soft tissue encapsulation and a hopeless implant.
My treatment protocol for peri-implantitis
- Double check bite to ensure tooth is not taking excessive biting force (malocclusion).
- Cemented crowns – access screw and removal; if find cement removal piezo if not add #3
- Piezo debridement, EDTA and citric acid then CHX then sterile saline rinse, localized dual drug delivery with Arestin antibiotic, and prescription for chlorhexidine rinse for 10 days. Only do this an an adjunct or pre-treatment to step 4.
- Open flap surgery, piezo debridement, air powder abrasive?*** (has tons of great studies), EDTA and citric acid treatment with Ti brush, CHX, saline flush, CO2 (or Er:YAG) laser treatment with guided bone regeneration.** (hydrogen peroxide irrigation daily, then saline, then minocycline for 3 days) or
- In complete vertical loss areas flap and smooth exposed threads, protocol below.*
|This example appears to use diode laser? Believe better to use CO2 or Er:YAG.|
Unknown what laser best CO2, Er:YAG, and maybe diode can decontaminate as well as sandblast. Natto JOMI 2015
If you have any questions about wheaton implant care or service please feel free to email me or contact my office. If you live in the Wheaton/Glen Ellyn area we would be happy to see you for a complimentary evaluation to see if you are an implant candidate.
Chemical disinfection of dental implant threads
There is no evidence of any chemical method being superior to another. Common agents that are in use include; hydrogen peroxide, chlorhexidine, citric acid, HCl, tetracycline, chloramines, NaOCl. Ntrouka 2011 COIR
How smooth dental implant threads
*Smooth threads by
- Course diamond
- 12 flute
- 30 flute
- brown point
- green point
- advance flap 1-2mm
An apicoectomy of the implant can be done as shown in JOI 2018 Manfro