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Periimplantitis: Causes, Symptoms & Treatment

Periimplantitis is an inflammatory disease affecting the tissue and bone surrounding a dental implant, which can lead to progressive bone loss.

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Things worth knowing about "Periimplantitis"

Periimplantitis is an inflammatory disease affecting the tissue and bone surrounding a dental implant, which can lead to progressive bone loss.

What Is Periimplantitis?

Periimplantitis is an inflammatory condition that affects the soft tissue and supporting bone surrounding a dental implant. It is one of the most common biological complications following implant placement and, if left untreated, can ultimately result in implant failure and loss. The condition is comparable to periodontitis (gum disease affecting natural teeth), but targets the implant and the surrounding osseous structures instead.

Causes

Periimplantitis is primarily caused by bacteria that colonise the implant surface in the form of a biofilm (dental plaque). If this biofilm is not regularly removed, a chronic inflammatory response can develop. Additional risk factors include:

Poor oral hygiene: Inadequate cleaning promotes plaque accumulation around the implant.
Smoking: Nicotine impairs blood circulation and the immune response in the oral cavity.
Diabetes mellitus: Poorly controlled blood sugar levels increase susceptibility to infection.
History of periodontitis: Patients with a prior history of gum disease are at higher risk.
Genetic predisposition: Certain genetic factors can influence the inflammatory response.
Improper implant positioning: An unfavourable implant location can make adequate cleaning more difficult.
Bruxism: Excessive grinding or clenching places mechanical stress on the implant and can damage surrounding tissue.

Symptoms

In the early stages, periimplantitis is often painless, meaning many patients are unaware of the condition. Common signs and symptoms include:

Redness, swelling, or tenderness of the gum tissue around the implant
Bleeding on probing or during tooth brushing
Discharge of pus from the gum (suppuration)
Bad breath (halitosis)
Loosening of the implant in advanced cases
Visible recession of the gum tissue around the implant
Pain or discomfort when chewing or applying pressure to the implant

Diagnosis

Diagnosis is carried out by a dentist or implantologist using a combination of clinical and radiographic assessments:

Probing: A periodontal probe is used to measure pocket depth around the implant. Depths exceeding 5 mm, especially with bleeding, are considered indicative of disease.
Radiographic examination (X-ray): Imaging reveals the extent of bone loss around the implant.
Bleeding on probing index: The presence of bleeding after probing is a key diagnostic marker.
Microbiological analysis: In selected cases, a microbial sample may be taken to identify the causative bacteria.

Treatment

Treatment is determined by the severity of the condition and may involve both non-surgical and surgical approaches.

Non-Surgical Treatment

In early-stage periimplantitis, conservative measures are applied first:

Professional cleaning: Removal of biofilm and calculus from the implant surface using specialised instruments such as curettes, ultrasonic devices, or air-polishing systems.
Antiseptic irrigation: Application of chlorhexidine or other antimicrobial agents to reduce the bacterial load.
Antibiotics: In selected cases, local or systemic antibiotics may be prescribed to support infection control.
Oral hygiene instruction: Patients receive tailored guidance on how to clean their implant effectively at home.

Surgical Treatment

Advanced periimplantitis with significant bone loss typically requires surgical intervention:

Flap surgery: The gum tissue is reflected to allow direct access to the implant surface for thorough debridement and decontamination.
Guided bone regeneration (GBR): Bone substitute materials and barrier membranes are used to attempt regeneration of lost bone around the implant.
Implant removal: In the most severe cases where the implant cannot be preserved, removal is necessary.

Prevention

The most effective strategy for preventing periimplantitis is a consistent oral hygiene routine combined with regular dental check-ups. Recommended measures include:

Daily brushing and interdental cleaning using dental floss or interdental brushes
Professional dental cleaning every three to six months
Cessation of smoking
Optimal management of systemic conditions such as diabetes
Regular radiographic monitoring to detect early signs of bone loss

References

Berglundh T, Armitage G, Araujo MG et al. - Peri-implant diseases and conditions: Consensus report of workgroup 4 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. Journal of Periodontology, 2018.
Schwarz F, Derks J, Monje A, Wang HL - Peri-implantitis. Journal of Periodontology, 2018; 89 Suppl 1: S267-S290.
Heitz-Mayfield LJA, Salvi GE - Peri-implant mucositis. Journal of Clinical Periodontology, 2018; 45 Suppl 20: S237-S245.

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