PERI-IMPLANTITIS

Peri-implantitis
Peri-implantitis is an inflammatory process affecting the soft and hard tissues surrounding an implant. This disease is associated with loss of supporting bone, bleeding on probing, and occasionally suppuration. The etiopathogenesis of peri-implantitis is complex and related to a variety of factors that affect the peri-implant environment. Peri-implantitis can be influenced by three factors: 

1. Patient-related factors including systemic diseases (e.g., diabetes, osteoporosis) and prior dental history (periodontitis)
2. Social factors such as inadequate oral hygiene, smoking, and drug abuse
3. Parafunctional habits (bruxism and malocclusion). 
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In addition to the above, iatrogenic factors such as faulty restorations, cement left following restoration delivery, and/or loose components can also play a significant role in the development of peri-implantitis.

Although restorations of endosseous implants have demonstrated a very high survival rate(1), one study suggested that over a five-year period, 0 to 14.4% of dental implants demonstrated peri-implant inflammatory reactions associated with crestal bone loss.(2) 

Many methods of treating peri-implantitis have been documented in the literature and most focus on removal of the contaminating agent from the implant surface. These treatments include: 

1. Administration of systemic antibiotics alone
2. Mechanical debridement with or without systemic antibiotic treatment(3)
3. Mechanical debridement with or without localized drug delivery and chlorhexidine oral rinses(3a)
4. Mechanical debridement combined with LASER decontamination(4)
5. Surgical debridement, and more recently…
6. Surgical debridement with guided bone regeneration (GBR) for reparation of bony and soft-tissue defects(5).
To date, GBR using a bone graft and membrane has had the best success as in demonstrating bone fill of the defects associated with peri-implantitis as described in the literature(6).

Because there are biologic differences between teeth and implants, the progression of infection around implants is different than natural teeth. The inflammatory cell infiltrate around implants was reported to be larger and extend more apically when compared to a corresponding lesion in the gingival tissue around natural teeth. In addition, the tissues around implants are more susceptible to plaque-associated infections that spread into the alveolar bone(7).

Implant surface bacterial decontamination is essential in treating peri-implantitis infections. Systemic administration of antibiotics has been used in the treatment of peri-implantitis, resulting in a reduction of inflammation. However, the efficacy of antibiotic therapy as a sole therapy has limited efficacy due to bacterial recolonization of the implat surface(8).

Because nonsurgical treatment approaches failed to promote the reosseointegration of the exposed implant sites(9), additional surgical interventions have been used in order to minimize the risk for a reinfection of the peri-implant pocket. Some of the treatment modalities suggested for peri-implantitis are:

1. Mechanical/ultrasonic debridement with localized drug delivery; i.e., antimicrobial minocycline spheres (Arestin®)
2. Laser treatment with and without flap access
3. Open flap debridement
4. Open flap debridement with guided bone regeneration
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