In the last blog we saw that bacteria invading into the subgingival area (below the gums) of the implant are responsible for peri-implantitis.
In this blog, we will discuss:
- The factors that predispose one to a bacterial invasion and
- How to treat peri-implantitis…here we go.
The factors that influence peri-implantitis are an individuals:
1) Medical history i.e. diabetes, osteoporosis. Both make one more predisposed.
2) Dental history: Does the individual have a prior history of periodontal disease? We will discuss this in the next blog.
3) Oral hygiene: How clean does one keep their mouth? How often do they floss?
4) Does the individual smoke? If so, this can affect one’s ‘healing’ capacity. Please see the blog series “Smoking and your Oral Health, “posted on January , 2015 till June 10th,2015.
5) Is there a history of drug abuse?
6) Habits such as bruxism and grinding of the teeth. In addition, a malocclusion (improper/non ideal) alignment of the teeth. Both of these can place excessive forces on the implants and lessen their chance of success.
One through six above may compromise one’s existing immunity, making peri-implantitis more likely to occur.
Other factors are iatrogenic. These include:
7) Excess cement left over after the abutment portion of the implant was cemented onto the implant fixture. (please see the last blog for a better understanding of this terminology). The excess cement acts as an irritant to the tissues.
8) If the tooth (abutment) portion of the implant was not firmly attached to the implant fixture, resulting in loose components.
Treatment of peri-implantitis
1) Oral antibiotics given alone.
2) Cleaning out the diseased tissue by using routine scaling (cleaning) instruments. This is known as a deep scaling.
3) Oral rinses i.e. Chlorhexidine (Periodex): This rinse is usually combined with mechanical debridement of the area (#2 above). We will discuss chlorohexidine in a future blog.
4) Debridement of the area (#2 above) can be done in conjunction with or without surgery. If we open up the area surgically, then there will be improved access and often better results.
5) We can take it one step further. This involves surgically opening up the area (#4 above) to clean out the diseased tissue and then placing a bone graft to repair areas of bone and soft tissue destruction. This is known as guided bone regeneration or GBR. This technique uses a bone graft and membrane to repair bone and soft tissue defects.
The above image shows an area around an implant that has received a bone graft.
Of the above, number five or GBR has proven to be the most successful treatment option.
With respect to numbers one through five above:
The best strategy in dealing with peri-implantitis is to be as thorough as possible with treatment. As we move from one to five above, the treatment becomes more comprehensive and the prognosis improves.
At this point, we have covered sufficient material…Let’s end this blog here. In the next one, we will finish our discussion of per-implantitis…until then.
Dr. F. Keshavarz Dentistry, Dentist in Brampton, ON
For any dental questions or concerns, please give us a call today @ 905.791.3867…you’ll be glad you did!