Signs, Symptoms, and Diagnosis of Peri-implantitis
- Swollen, bleeding, or reddened peri-implant tissue
- Loosening or wobbling of the implant
- Bleeding while brushing teeth
- Swelling around the implant
- Bad breath or foul taste
- Bone loss and soft tissue inflammation
- Pain and gingival hyperplasia
- No sign of bone loss in healthy situations
- Bone loss can take the shape of a crater with surrounding bone walls
- Bone loss may have no surrounding bone walls
- Alveolar bone shape depends on buccal-lingual length
- Bone remodeling at the alveolar crest is normal after implant placement
- Bleeding on probing may indicate inflammation
- Pus, pocket formation, and gum recession may be present during probing
- Swelling and redness of the gums (erythema) may be observed
- Pocket depth around an implant is typically greater than around natural teeth
- Change in pocket depth between appointments is used for diagnosis
- Peri-implant disease includes peri-implantitis and peri-implant mucositis
- Peri-implant mucositis affects the surrounding mucosa, while peri-implantitis affects both mucosa and bone
- Peri-implant mucositis is similar to gingivitis in terms of symptoms and cause
- Diagnosis of peri-implant mucositis involves identifying bleeding upon probing
- Inadequate plaque removal is a common cause of peri-implant mucositis
- Clinical signs of peri-implantitis include bleeding on probing, suppuration, and increased probing depths
- Radiographic examination is essential for diagnosing peri-implantitis and assessing bone loss
- Peri-implant pocket depth and bleeding on probing are commonly used clinical parameters for diagnosis
- The presence of peri-implant mucositis can precede the development of peri-implantitis
- A comprehensive clinical examination, including assessment of soft and hard tissues, is necessary for accurate diagnosis

Risk Factors for Peri-implantitis
- Poor plaque control
- Lack of regular maintenance therapy
- Presence of titanium implant degradation products
- Presence of peri-implant bacterial plaque
- Diabetes mellitus (potential risk factor)
- Excess cement around the implant (potential risk factor)
- Width of keratinised mucosa around the implant (potential risk factor)
- Genetics (potential risk factor)
- Systemic conditions (e.g., cardiovascular disease, rheumatoid arthritis) (potential risk factor)
- Iatrogenic factors (e.g., implant positioning, bone grafting) (potential risk factor)
- Occlusal overloading of the implant (potential risk factor)
- Smoking (debated potential risk factor)

Prevention of Peri-implantitis
- Treat peri-implant mucositis to prevent it from progressing to peri-implantitis.
- Regular plaque removal through tooth-brushing is essential for preventing and treating peri-implant mucositis.
- Dentists should provide oral hygiene instruction to ensure proper plaque removal and calculus removal.
- Smoking negatively affects the prognosis of implants, so patients should be encouraged to quit smoking.
- Dentists should ensure correct sizing of implant elements to prevent bacterial colonization and place restoration margins supra-gingivally.
- Implementing proper oral hygiene practices, including regular brushing and flossing, is essential for preventing peri-implantitis.
- Smoking cessation is strongly recommended to reduce the risk of peri-implantitis.
- Regular professional maintenance visits, including professional cleaning and assessment of implant stability, are important for prevention.
- Patient education on the importance of oral hygiene and the risks associated with peri-implantitis is crucial.
- Early detection and treatment of peri-implant mucositis can help prevent the progression to peri-implantitis.

Treatment of Peri-implantitis
- Non-surgical therapy aims to control infection and detoxify the implant surface.
- Surgical procedures may be necessary to regenerate lost alveolar bone.
- Mechanical debridement alone is ineffective in removing all microorganisms from implant surfaces.
- Antiseptic, antibiotic therapy, and/or surgery can be combined with mechanical debridement for treatment.
- Ultrasonic scalers with non-metallic tips or resin/carbon fiber curettes are used for calculus removal.
- Conventional steel curettes or ultrasonic instruments with metal tips should be avoided to prevent implant surface damage.
- Polishing with rubber cups and polishing paste aids in plaque removal.
- Proper debridement techniques help reduce future plaque accumulation.
- Chlorhexidine digluconate is commonly used as an antiseptic to maintain plaque control around implants.
- Long-term use of chlorhexidine is not recommended due to adverse events.
- Chlorhexidine may slightly improve tissue inflammation.
- Hydrogen peroxide at a 1% concentration can be as effective as chlorhexidine without staining side effects.
- Concerns have been raised about the direct application of chlorhexidine on implant surfaces due to cytotoxic effects.
- Antibiotics targeting gram-negative anaerobic bacteria can be administered during antiseptic treatment.
- Local antibiotic application, such as tetracycline periodontal fibers, can create a sustained high dose at the affected site.
- Minocycline microspheres, in combination with mechanical debridement, can improve probing depths.
- Oral systemic antibiotic intake alone is not a permanent solution.
- Mechanical and/or local application of doxycycline and hydrogen peroxide may be necessary.
- Surgical flap management with resective and/or regenerative approaches can be considered if infection is controlled.
- Guided bone regeneration can restore bony support, while reshaping peri-implant soft tissue can improve aesthetics.
- Surgical treatment allows comprehensive debridement and local decontamination.
- Consideration of peri-implant lesion characteristics is vital for selecting appropriate surgical techniques.
- Successful infection control is a prerequisite for surgical treatment.

Group 5

Peri-implantitis (Wikipedia)

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 over time.

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.