Peri-implantitis is gum/periodontal disease, but around implants instead of teeth. It is caused by bacteria that live between the gums and bone, and the dental implant itself. Healthy gums are usually firm and well adapted to your dental implant and implant crown restoration. When you brush and floss, you help to eliminate the “bad” bacteria from your gums.
When the “bad” bacteria begin to live and reproduce, your body detects this and tries to fight off the bacteria. Initially, this causes the gums to become inflamed, which we call “peri-implant mucositis,” which is basically means gingivitis around implants. Inflamed gums are puffy and reddish, tender to touch or brush, and bleeds very easily. At this point, the damage is largely reversible with proper treatment and home care.
If the “bad” bacteria is allowed to continue live and the peri-implantitis progresses, irreversible destruction of the bone and tissue surrounding the implant will occur. This causes the pockets to become deeper, creating more space for the bacteria to thrive, creating even more destruction, until so much of the bone is lost that the implants no longer have support, become loose and abscessed, and require extraction. Once bone loss occurs around dental implants, it becomes much more difficult and less predictable to treat compared to teeth. This is because implant surface on a microscopic level is extremely rough, which allows tiny spaces for bacteria to stick to and quickly and rapidly multiply. On a macroscopic level, implants are threaded, which make it difficult for our instruments to access.
Treatment for peri-implantitis include non-surgical surface debridement, flap/osseous surgery, regeneration, or implant removal.
The most difficult part about treating implants is eliminating all the bacteria that live on the exposed implant surface. This is because the implant surface is extremely rough which allow bacteria to live on the tiny spaces and make it difficult for us to clean. Implants are also threaded, which make it hard for our instruments to clean inside. Imagine a floor that has mud everywhere. Imagine trying to clean it if the floor was a single piece of smooth marble, compared to a rough tiled brick floor. Treating an implant surface is similar to the latter. This is why surgical access is often needed in order to visualize everything. In order to decontaminate the implant surface, multiple methods are often utilized, such as antibiotics, hydrogen peroxide, antiseptics, as well as different brushes and instruments. Quite often, the outer surface of the implant is removed and smoothed out to help eliminate all the bacteria, and to make it harder for the bacteria to repopulate. It also makes it easier for you to maintain the results at home.
Additional treatment may be needed to treat peri-implantitis. If the gum tissue was thin and delicate, which lead to infection of the implants, then gum grafting may be needed. Bone grafting may be able to be completed to regenerate some of the bone that was lost in the infection.