Peri-implantitis (Inflammation in the peri-implant mucosa together with progressive loss of supporting bone)

Peri-implantitis is a hot topic in implant dentistry nowadays. Some estimates report as many as 1 in 10 implants experiencing peri-implantitis. Dental implants have clearly transformed how we go about treatment planning our patients. Modern planning is more open to extractions as a treatment option now that we have a simple, predictable and reliable tooth replacement alternative. Long-term success rates for dental implants have been shown to be excellent in many studies. If peri-implantitis substantially reduces those success rates, we will need to rethink our treatment strategies with important consequences for both completed and future patients. This article will look at inflammation in the peri-implant mucosa. 

So what causes Peri-implantitis? We can divide the causes into patient associated and implant-associated. Under patient causes, we include all the factors for Periodontitis including Genetics; Diabetes; Smoking and of course Dental Plaque. A good history and control where possible of these factors will improve implant success rates and help avoid peri-implantitis. Under the implant banner we should consider implant surface; method of retention (screw vs cemented) and surgical technique (adequate bone width; keratinized tissue). Familiarity and control of these factors is essential. Lastly a few words on treatment. There is no consensus on the ideal treatment for peri-implantitis. Surgical therapy has been shown to be more successful than conservative and should include decontamination of the implant surface- with implantoplasty combined with peri-implant pocket elimination either by regeneration or osteoplasty. Where keratinized tissue is deficient grafting to widen the zone of gingiva can help. Even with all these interventions, nearly 50% relapse rates are reported.

Despite the alarming prospect of 5% long-term failure of implants due to peri-implantitis, many Periodontists have found that applying the basics (patient selection; control of local factors; careful selection of implant manufacturer; surgical technique) has lead to predictable long-term success. Implants are clearly here to stay.  

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