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Peri-implantitis
Peri-implant infections are pathological conditions surrounding dental implants.
Mucositis refers to inflammation and ulceration in the soft tissues around an implant and is a reversible host response to periodontal pathogens. Peri-implantitis, the destructive inflammatory process affecting both soft and hard tissue surrounding a dental implant, is more severe and leads to bone loss1.
The typical signs and symptoms of the diseases, as discussed in various consensus conferences, can be described as follows2-8:
Mucositis
- Bleeding on probing
- Redness and swelling of soft tissue
- No loss of supporting bone
Peri-implantitis
- Crater-like bone defect
- Bleeding and/or suppuration on probing
- No implant mobility
- >4 mm peri-implant probing depth
Redness and swelling of the soft tissue as well as bleeding on probing can indicate a mucositis. Prevalence: about 50% of implants and about 80% of patients8. (Picture by courtesy of Dr. J.-L. Giovannoli and Prof. S. Renvert and Quintessence International)
A bony defect with a crater-like shape can (together with other signs and symptoms) indicate a peri-implantitis. Prevalence: about 10% of implants and about 20% of patients2. (Picture by courtesy of Prof. Andrea Mombelli, Geneva, Switzerland)
A peri-implant probing depth of more than 4 mm can (together with other signs and symptoms) indicate a peri-implantitis. Prevalence: about 10% of implants and about 20% of patients2. (Picture by courtesy of Prof. Andrea Mombelli, Geneva, Switzerland)
Treatment of peri-implantitis
Peri-implantitis should be treated systematically. Bacterial plaque removal with surgical and/or non-surgical therapy is essential to prevent further progression and prepare the defect for regenerative procedures9.
Guided bone regeneration with Geistlich Bio-Oss® and Geistlich Bio-Gide® regenerates the osseous defect after implant surface decontamination10.
A reliable diagnosis of peri-implantitis requires the simultaneous presence of all above listed signs and symptoms. A single feature alone is not sufficient for the diagnosis.
References:
- Lang NP, et al.: Ann Periodontol 1997; 2(1): 343-56.
- Mombelli A, et al.: Clin Oral Implants Res 2012; 23 Suppl 6: 67-76.
- Lang NP, et al.: J Clin Periodontol 2011; 38 Suppl 11: 178-81.
- Lindhe J, et al.: J Clin Periodontol 2008; 35(8 Suppl): 282-85.
- Mombelli A: Criteria for success. Monitoring In: Proceedings of the first European Workshop on Periodontology, (eds.) N.P. Lang & T. Karring, pp. 317–325. London: Quintessence 1994.
- Mombelli A: Prevention and therapy of peri-implant infections. In: Proceedings of the 3rd European Workshop on Periodontology, (eds.) N.P. Lang, T. Karring & J. Lindhe, pp. 281–303. Berlin: Quintessenz Verlag 1999.
- Tomasi DP & Derks J: J Clin Periodontol 2012; 39 Suppl 12: 207-23.
- Zitzmann NU & Berglundh T: J Clin Periodontol 2008; 35(8 Suppl): 286-91.
- Schwarz F & Becker J: Peri-implant Infection: Etiology, Diagnosis and Treatment. Quintessence Publishing 2007.
- Schwarz F, et al.: J Clin Periodontol 2009; 36(9): 807-14.