Diagnosis and Treatment of Peri-implantitis

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Diagnosis and Treatment of Peri-implantitis

• Dent 664
• August 30, 2007

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Which factors most often contribute to failure of
osseointegrated implants that were previously
stable and functional?

• Excessive loading
• Infection

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Peri-implant mucositis

• The gingiva around teeth and the mucosa around
  implants exhibit responses to plaque that are
  somewhat similar.
• However, histological studies suggest that
  peri-implant mucosa is less capable of containing
  and repairing the damage caused by plaque-induced
  inflammation

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Peri-implantitis histology

• Experimental periodontitis and peri-implantitis
  have been compared in dogs.
• The plaque associated with periodontitis and
  peri-implantitis sites is similar.
• The inflammatory lesion associated with
  peri-implantitis tends to extend to involve the
  bone. In contrast, there is typically a zone of
  non-inflamed connective tissue interposed between
  the inflammatory lesion and the bone in
  periodontitis.

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Peri-implantitis histology (continued)

• Human peri-implantitis lesions are characterized
  by the presence of numerous neutrophils in the
  tissue surrounding the implant and direct contact
  between plaque on the implant surface and
  inflamed connective tissue. These features are
  not seen in periodontitis.

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Diagnosis of peri-implant infections is based on
the following findings

• Bleeding on probing (BOP) around the implant
• Suppuration around the implant
• Probing depth around the implant
• Mobility of the implant
• Radiographic evidence of bone loss around the
  implant

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Criteria for a successful implant (Albrektsson et
al, 1986)

• The implant is immobile
• Absence of peri-implant radiolucency
• Absence of pain, infection, neuropathy or
  paresthesia
• At 1 year in function, lt 0.2 mm vertical bone
  loss

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When things go wrong Definitions

• Failing implant has progressive alveolar bone
  loss, pocket formation, bleeding on probing, or
  suppuration.
• Failed implant a hopeless and nonfunctional
  implant requiring removal. It may exhibit loss
  of osseointegration, mobility, or pain.

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Treatment of failing implants

• Resolution of inflammation (debridement of
  plaque, improvement of oral hygiene, use of
  adjunctive antibiotics)
• Correction of unfavorable soft tissue morphology
  (pseudopockets) by flap surgery or gingivectomy
• Re-osseointegration (decontaminate the implant
  surface with citric acid or tetracycline
  solutions, guided bone regeneration.

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Treatment of failed implants

• Remove the implant.
• Implant removal, followed by guided bone
  regeneration and subsequent placement of a
  replacement implant.
• Remove the implant from function, decontaminate
  it and submerge it.

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Case 1 Bone graft around a failing implant
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Case 2 Removal of a failed implant
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