Peri-implantitis

Peri-implantitis is a destructive inflammatory process affecting the soft and hard tissues surrounding dental implants. The soft tissues become inflamed whereas the alveolar bone (hard tissue), which surrounds the implant for the purposes of retention, is lost overtime. The bone loss involved in peri-implantitis differentiates this condition from peri-mucositis, a reversible inflammatory reaction involving only the soft tissues around the implant. Peri-implantitis is a destructive inflammatory process affecting the soft and hard tissues surrounding dental implants. The soft tissues become inflamed whereas the alveolar bone (hard tissue), which surrounds the implant for the purposes of retention, is lost overtime. The bone loss involved in peri-implantitis differentiates this condition from peri-mucositis, a reversible inflammatory reaction involving only the soft tissues around the implant. Peri-implantitis does not present in the same way for all patients. Patients are recommended to regularly attend dental appointments and to seek advice from their dentist if they have any concerns for their oral health. Before the signs and symptoms are explained, it is worth noting that healthy peri-implant tissue should not be swollen, bleeding, producing pus, or have a reddened appearance. From a patient’s perspective, he/she may notice loosening or wobbling of the implant. This symptom does not usually present at the early stages of peri-implantitis as the implant will still be fused to bone at its deeper aspects. It is more likely that the patient will notice bleeding whilst brushing their teeth. A patient may also notice swelling around the implant, bad breath and/or foul taste. Clinically, peri-implantitis involves both inflammation of soft tissues and destruction of bone, therefore, there is usually evidence of both bone loss (assessed by a radiograph) and bleeding when nearby tissues are probed, a common finding for soft tissue inflammation. There has been reports of bone loss without any accompanying sign of soft tissue inflammation. Without evidence of bone loss, the diagnosis is restricted to peri-mucositis (see comparison between peri-implantitis and peri-implant mucositis below for more information). Other reported features include pain and gingival hyperplasia. Pain is thought to be a rare symptom and is usually linked to an acute infection. In health, there should be no sign of bone loss other than potential bone remodelling at the alveolar crest following implant placement. The shape of the alveolar bone in regions of bone loss varies depending on the buccal-lingual length (or cheek-to-tongue length) of the bone. Where this length is greater than the extent of the peri-implantitis, the region of bone loss can take the shape of a crater, with walls of bone surrounding the pathology; this is the most common presentation of bone loss. Where the buccal-lingual length is smaller, there may be no walls of bone surrounding the pathology. Bleeding on probing is considered normal whilst tissues are healing shortly after implant placement, however, if bleeding is present months or years after placement, inflammation should be suspected. Other features which may be present whilst probing include pus, the presence of a pocket around the implant and/or recession of the gums. The dental professional may also notice swelling and redness of the gums, the latter of which is termed erythema.