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.

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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