Periimplantitis. Aetiology, diagnosis, treatment. A review from the literature

Abstract

Orodental rehabilitation through the use of implants offers very high success rates. In this paper, we describe some of the complications involved with this technique, such as periimplant disease and, within this category, periimplantitis, an inflammatory reaction in which there is a loss of the bony support of the implant accompanied by inflammation. The aetiology of the disease is conditioned by the status of the tissue surrounding the implant, implant design, degree of roughness, external morphology and excessive mechanical load. The microorganisms most commonly associated with implant failure are spirochetes and mobile forms of Gram-negative anaerobes, unless the origin is the result of simple mechanical overload. Diagnosis is based on changes of colour in the gum, bleeding and probing depth of periimplant pockets, suppuration, x-ray and gradual loss of bone height around the tooth. Treatment will differ depending upon whether it is a case of mucositis or periimplantitis. Therapeutic objectives focus on correcting technical defects by means of surgery and decontamination techniques (abrasion with carbon particles, citric acid solution, topical tetracycline application and laser surgery).

Introduction

Implant-based dental rehabilitation techniques has come to offer highly predictable results, hence it has become one more element to be included in the wide range of therapeutic alternatives for totally or partially edentulous patients, albeit some complications have been described in relation with this type of treatment; of these complications, the progressive loss of alveolar bone surrounding the implant is perhaps the most salient.

The name periimplant disease refers to the pathological inflammatory changes that take place in the tissue surrounding a loadbearing implant ; for some authors it is the most common complication in orofacial implantology.

Two entities are described within the concept of periimplant disease:

  • Mucositis: a clinical manifestation characterised by the appearance of inflammatory changes restricted to the periimplant mucosa. If treated properly, it is a reversible process .
  • Periimplantitis: a clinical manifestation where clinically and radiologically evident loss of the bony support for the implant occurs, together with an inflammatory reaction of the periimplant mucosa.

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Osseointegration is defined as the direct connection between live bone and a functioning endosseous implant, the term “functioning” implying that the contact between live bone and the surface of the implant is sustained while active or load-bearing (5). This point must also be emphasised when referring to periimplantitis; the implant must be a “functioning” one, because this implies that all other inflammatory syndromes that course with loss of osseointegration, but that present in implants that do not support the forces transmitted to them by the prosthesis to which they are attached, have been ruled out.

Examples of non-integration or the loss of osseointegration that cannot be considered periimplantitis include processes that appear during the theoretical period of passive osseointegration. They are usually the consequence of poor surgical technique (overheating of the bone) or insufficient trabecular bone density in the receptor .

The so-called apical periimplantitis in which the periimplant infection is located in the apical region of the implant, would also be excluded from the disease category of periimplantitis. It may also be the result of implant contamination by epithelial rests of Malassez that remain within the bone despite proper alveolar scaling following extraction of the tooth to be replaced by the implant.

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