What is peri-implantitis?
Peri-implantitis is an inflammatory process that affects the tissues surrounding a functionally loaded osseointegrated implant, resulting in loss of support for the alveolar bone.
This inflammation around the implant has an incidence of 8% in patients who are susceptible to periodontitis. It is a pathology with low prevalence but, finger that there are many patients who can go to the clinic with this problem, in the future it may be noticeable.
Clinically in periodontitis there is a reddening of the mucosa with bleeding. In addition, there is an increase in the depth of the pocket with a radiological loss of peri-implant bone height. Occasionally there may be a purulent discharge and pain on percussion or when clenching the teeth. In more advanced cases there is a progressive mobility of the implant.
Risk factors for dental implants
There are several predisposing factors which initiate or maintain the inflammatory process. The biological relationship that the peri-implant tissues have with the surface space is one of the factors. This is influenced by the relationship of the vascular supply, since the less vascular supply there is a predisposition to more aggressions, the union of the implant to the bone is different from the union of the tooth with the bone since between the implant and the bone the tissue is different and less responsive.
The design of the implant and the quality of the fit also allow for variations. The more rough the implant, it also means that there may be a greater adhesion of the dental plaque, as long as the implant is exposed. Implants with conical internal connection are known to have the best fit of their components.
Another predisposing factor can be the corrosion of metals. If there is a non-noble metal, such as chromium-nickel or chromium-cobalt, along with titanium corrosion occurs. The prosthesis that must be put in must have an adequate seal.
Bacterial colonization of the peri-implant pocket leads to a greater adherence of bacteria if the surfaces and the bacteria involved are the same as those of periodontitis. It is scientifically proven that there is no development of peri-implant disease when there is a coexistence in addition to local, systemic or genetic factors. It is also known that patients who have been previously treated for aggressive type periodontitis have a 10% lower success rate compared to those with controlled adult chronic periodontitis.
The mechanical overload of the implants causes stress in the area and therefore a greater susceptibility to peri-implantitis. Tobacco use is one of the main factors in peri-implantitis, since the smoker patient has a relationship with failure in the upper jaw, since it is a more cancellous bone. Other predisposing factors are chronic corticosteroid treatment, diabetes, or radio or chemotherapy.
Peri-implantitis is a disease with a multifactorial cause which multiple factors interact such as age, low bone quality, load factors, the location of the implant in the upper jaw, the amount of bone and genetic predisposition.
In order to diagnose peri-implantitis, taking X-rays is essential. In them, but it will only be evident as long as there is a bone loss greater than 30%. Different radiographic projections can be made using positioners to compare and observe the bone.
Treatment of peri-implantitis
The best treatment is the one that is not carried out, so prevention is essential to prevent peri-implantitis. The factors which may be predisposing to the pathology must be respected.
Preservation of the peri-implant mucosa is essential through the existence of the keratinized mucosa around the implant. Bacterial colonization of the peri-implant bag should be avoided, this can only be achieved with good control of the periodontal plaque and avoiding treatment with active periodontal disease. To control overload, it is essential to properly design the prosthesis, placing the appropriate number of implants for each type of prosthesis, as well as an adequate distribution of the implants, and also balancing the occlusion.
The treatment of peri-implantitis is based on eliminating the inflammation around the implant and, where possible, regenerating bone loss in the affected area.
If the loss is incipient, the same treatment as in mucositis can be instituted, that is, decontamination of the implant abutment and antibiotic therapy. When there is a very large defect or an aesthetic compromise, surgical treatment is performed, regenerative surgery is the most indicated. It is of great importance to decontaminate the implant surface before performing the surgery, using ultrasound, citric or hydrochloric acid, irrigation with saline solution or the use of the laser.
Regeneration of bone loss is done to seal the bursa and support the soft tissues. It is carried out as long as it is believed that decontamination of the affected area can be achieved. When decontamination is in doubt, poorly resorbable materials are chosen.
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