Peri-Implantitis Revisited

Dental implants have become a well-accepted treatment option for patients with partial or complete edentulism. The long-term success of the endosseous dental implant depends not only on osseointegration, but on the healthy soft tissue interface that surrounds the implant. Peri-implantitis is defined as an inflammatory process affecting the supporting hard and soft tissue around an implant in function, leading to loss of supporting bone. Peri-implant mucositis has been defined as a reversible inflammatory reaction in the peri-implant mucosa surrounding an osseointegrated dental implant. Peri-implant mucositis is assumed to precede peri-implantitis. Data indicate that patients diagnosed with peri-implant mucositis may develop peri-implantitis, especially in the absence of regular maintenance care. However, the features or conditions characterizing the progression from peri-implant mucositis to peri-implantitis in susceptible patients have not been identified. The most common etiological factors associated with the development of peri-implantitis are the presence of bacterial plaque and host response. The risk factors associated with peri-implant bone loss include smoking combined with IL-1 genotype polymorphism, a history of periodontitis, poor compliance with treatment and oral hygiene practices, the presence of systemic diseases affecting healing, cement left behind following cementation of the crowns, lack of keratinized gingiva, and previous history of implant failure There is strong evidence that there is an increased risk of developing peri-implantitis in patients who have a history of severe periodontitis, poor plaque control, and no regular maintenance care after implant therapy. Management of peri-implantitis generally works on the assumption that there is a primary microbial etiology. Furthermore, it is assumed that micro-organisms and/or their by-products lead to infection of the surrounding tissues and subsequent destruction of the alveolar bone surrounding an implant. A combination of surgical, open debridement, and antimicrobial treatment has been advocated for the treatment of peri-implantitis. Surgical intervention is required once a patient has bleeding on probing, greater than 5 mm of probing depth, and severe bone loss beyond that expected with remodeling. Access flaps require full-thickness elevation of the mucoperiosteum, facilitating debridement and decontamination of the implant surface via hand instruments, ultrasonic tips, or lasers. When necessary, surgical procedures may be used in conjunction with detoxification of the implant surface by mechanical devices, such as high-pressure air powder abrasion or laser.