Implant Info

Peri-implant Health

The health of the gum tissue around an implant (called mucosa) is essential to the long term functional health of the implant itself since this creates a protective boundary that ensures the bone, which has bonded to the implant, is well maintained. Research has actually shown that there is an attachment between the deeper tissue compartment of the mucosa and titanium via special bridges called hemi-desmosomes and these are thought to play an essential role in the stability of this zone.

Many factors can lead to inflammation and /or disease of the mucosa and bone including but not restricted to poor oral hygiene, smoking, genetic predisposition, ill-fitting crown and bridgework and/or excess dental cement. The result of this inflammation is a condition termed peri‑implant mucositis which is recognised as an early warning for a deeper more serious problem called peri‑implantitis which is more correctly defined as an infection of the bone supporting the implant.

 

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Peri-implant Mucositis

This condition is the first sign that things are not well with the soft tissues, there being an inflammation with associated bleeding and pocket formation where the attachment between the mucosa and the titanium abutment has been weakened. Typically when probing around the implant there will be spontaneous bleeding and the mucosa may be tender. The gum is more red/mauve and less pink in colour. However the bone underneath is unaffected and there is no evidence of pus or an infection.

Usually we treat this condition conservatively with antimicrobial solutions and topical antibiotics. This can often be achieved without recourse to any anaesthetic, but for the more tender sites a simple local anaesthetic is all that is required. This condition can often recur and any potential causes for the inflammation such as excess dental cement may need to be addressed to prevent recurrence. In any event, close monitoring and repeat therapy may be indicated on a four or six monthly basis.

 

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Peri-implantitis

Peri-implantitis is a condition similar to periodontal disease seen around teeth. The diagnosis is fundamentally based on the presence of mucositis (see peri-implant mucositis) but with an underlying infection (pus) and bone loss around the implant itself which is evident on x-rays (see below). This bone loss is similar to the bone loss seen around teeth. Other contributory factors are smoking, poor oral hygiene and systemic conditions such as diabetes.

The treatment for peri-implantitis is initially conservative as with peri-implant mucositis, i.e. irrigation under the gum with antimicrobial agents but also with the topical application of antibiotic gels below the gum and into the pockets that form deeper down into the bone. This procedure can often be achieved without recourse to any anaesthetic, but for the more tender sites a simple local anaesthetic is all that is required.

If the more conservative treatment fails to address the infection or if the disease is already too extensive on presentation then surgical decontamination may be recommended. This will involve lifting the gum to remove the inflamed and infected tissue from around the implant/s and to decontaminate the surface of the implant/s which will have now become compromised. It may be necessary to undertake some form of bone grafting to repair any resultant defects. Such surgery is carried out under local anaesthetic and if required our anaesthetist can be employed to give intravenous sedation so that the experience is more comfortably accommodated and easily forgotten due to the amnesic properties of sedatives.

In the most extreme cases it may be necessary for implants to be removed. Clearly this is very upsetting, and we take every care to explain the reasons why and to support you through the treatment. However we can often repair the damage and subsequently replace the implant/s for new, ultimately restoring you to full dental health. You would then remain on regular recalls to ensure that the disease is kept at bay and does not affect your new implant/s.

 

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Retrograde Peri-implantitis

Retrograde peri-implantitis is a term used specifically to describe an infection at the apex of an implant deep in the bone. Fortunately such an infection is rare but it usually occurs very soon after implant placement, typically within the first 3 weeks and results in an intense throbbing pain. Such an infection does not normally occur after one month, so if problems present after this time it is probably not a retrograde peri-implantitis.

Retrograde peri-implantitis is thought to result from bacteria left over from a chronic tooth abscess which exist in a quiescent state in the bone and become disturbed on implant placement. Equally it is known to be a complication of immediate implant placement when an implant is placed directly into a fresh extraction socket, where bacteria related to the failed tooth can cross infect the deeper bone during the drilling preparation for the implant. More often than not this infection will respond to strong antibiotic therapy but occasionally it is necessary to undertake a surgical decontamination of the area, which usually arrests the condition although it is associated with some post-operative discomfort.

 

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Mechanical Failures

Dental implants are remarkably small devices placed under incredibly high loads and used on a constant basis. Indeed the forces applied to dental implants under clenching, biting and grinding are immense. Being made of metal and being generally modular in design where one component screws into another, they are prone to dynamic wear and fatigue just as you might expect from any such system. Unfortunately this can result in mechanical failure with parts fracturing often without warning.

Removing fractured screws from within the implant can be a difficult and time consuming affair, which requires great patience and skill. Unfortunately if one fails to remove the fractured fragment or indeed the implant itself has fractured, then there is no option but to remove the implant. This unfortunately involves cutting the implant out of the bone. The resultant defect can then be grafted and repaired, with the eventual possibility to replace with a new implant should it be desirable.

 

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