What is Peri-implantitis?

Risk Factors in Implants Failure

Peri-implantitis is a more serious disease distinguishable from the condition of peri-implant mucositis.  It is characterized by an inflammatory process around an implant, which includes both soft tissue inflammation and progressive loss of supporting bone beyond biological bone remodeling.  It is present when there is bleeding on probing and/or suppuration and detectable bone loss.  Since after all dental implants are placed, the bone undergoes a process of remodeling that results in the loss of an average of 1mm of bone height, the only way to document further bone loss is by comparison to a baseline radiograph obtained at the time of suprastructure placement, or by (if no baseline radiograph is present) using a threshold vertical distance of 2mm from the expected marginal bone level following remodeling post implant placement.  Risk factors include:

• previous periodontal disease--does not affect implant survival rate, but is a more frequent finding in patients with a history of periodontitis
• poor plaque control or difficulty cleaning due to prosthesis design dictated by esthetics, phonetics and function
• residual cement that provides a positive environment for bacterial attachment
• smoking--a 3.6 to 4.6 times greater risk of inflammation
• genetic factors that contribute to patient susceptibility
• diabetes--which affects tissue repair ability and defense against inflammation
• possible bite overload

Diagnosis of Peri-implantitis

The presence of bone loss and probing depth alone is not enough to make the diagnosis.  Only in the presence of bacterial inflammation, is bone loss, seen over time, definitive for peri-implantitis.  Non-surgical therapy has not been shown to be effective in the treatment of peri-implantitis, therefore surgical intervention is necessary, and there are several ways to do it.  An understanding of peri-implant mucositis and peri-implantitis underscores the importance of regular monitoring and professional care for dental implants as well as natural teeth.

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309