After dental implant placement oral surgery, you still need to visit your dentist for routine cleanings and examinations, including monitoring for signs of infection, particularly a condition called peri-implantitis.
Peri-implantitis is characterized by inflammation and infection around dental implants, which can lead to bone loss and potential implant failure if not treated promptly.
As a preventive measure, your dentist may recommend a procedure known as implant surface detoxification, which involves cleaning and disinfection of the implant surface to remove any bacteria or biofilm that may contribute to infection.
According to a consensus report from the first European Workshop on Periodontology, peri-implantitis is an inflammatory reaction associated with the loss of supporting bone around an implant.
Its clinical signs include:
- Redness and swelling in the gums: The gums around the implant site may appear red, swollen, and inflamed.
- Throbbing pain and discomfort: Persistent or increasing pain around the implant site, especially when biting or chewing, can indicate an underlying issue.
- Bleeding or pus on probing: Bleeding or the presence of pus (produced as a result of the body’s immune response to fight off infection) when brushing, flossing, or probing on the implant site may indicate an infection.
- Mobility or loosening of the implant: If the implant feels loose or moves when touched, it may be a sign of bone loss or implant failure.
- Bad taste or odor: An unpleasant taste or odor around the implant site can be a sign of an infection.
Increased probing depths: Probing depths refer to the measurement taken by a dental professional to assess the depth of the gum pocket around the implant. If there is an infection, the probing depths may increase, indicating the presence of inflammation and potential bone loss around the implant.
Mucosal recession: An underlying infection can cause your gums to pull away or recede from the implant, exposing more of the implant surface.
A draining sinus: This refers to a narrow tunnel or channel that forms between the infected implant site and the skin or oral cavity. It allows the pus or fluid to drain out, relieving pressure and reducing swelling. The presence of a draining sinus is a key sign of infection.
A fever: A systemic sign of infection is the presence of a fever. If you experience an elevated body temperature along with other symptoms such as pain, swelling, or discharge around the implant site, it may indicate a spreading infection that requires immediate attention.
Difficulty chewing your food: If you encounter difficulty or discomfort while chewing your food specifically around the implant area, it could be a sign of an infection that has resulted in inflammation and sensitivity, making it challenging to apply pressure while eating.
If you observe any of these signs, it is crucial to contact your dentist so they can evaluate the implant and surrounding tissues to determine the extent of the infection and recommend appropriate treatment.
Treatment options for implant infection
Treatment for implant infection may involve a combination of procedures such as:
- Thorough cleaning of the implant surface
- Removal of any infected tissue or granulation tissue
- Prescription of antibiotics to control the infection.
It is recommended that you address the infection promptly to prevent further complications and ensure the long-term success of your restoration, and also save your investment.
Regular follow-up visits and maintaining good oral hygiene habits are crucial to prevent and manage implant infections effectively.
Surgical treatment of peri-implantitis
Some of the recommended surgical therapies for peri-implantitis include guided bone regeneration, implantoplasty, open flap debridement, and eventual implant removal.
Guided Bone Regeneration (GBR):
This is a surgical procedure used to promote the growth of new bone in areas where bone loss has occurred. It involves placing a barrier membrane over the bone defect to prevent soft tissue from invading the space, allowing the bone to regenerate undisturbed. This technique is often used in implant dentistry to create a suitable environment for successful implant placement by augmenting the bone volume.
This is a procedure performed on dental implants to reshape or smoothen the surface of the implant. It is usually done to address issues such as rough or irregular implant surfaces that may contribute to soft tissue irritation or make oral hygiene maintenance difficult. During implantoplasty, the implant surface is carefully modified using specialized instruments to improve the implant’s contour and optimize the surrounding soft tissue response.
Open Flap Debridement:
This is a surgical procedure used to treat periodontal disease or peri-implantitis, which is inflammation and infection around dental implants. It involves accessing the affected area by lifting a flap of gum tissue, allowing the dentist to remove the accumulated plaque, tartar, and infected tissue from the tooth or implant surface. After thorough cleaning, the area is carefully sutured back into place, promoting healing and reducing the risk of further infection.
Ultimately, you may have to remove a dental implant that has failed or is causing significant complications. This decision is usually made after careful evaluation by a dental professional. Implant removal may be necessary due to factors such as:
- Implant infection
- Severe bone loss
- Implant fracture, or
- Lack of integration with the surrounding bone
The procedure involves surgically removing the implant and any associated infected or damaged tissue, followed by appropriate treatment and potential replacement with a new implant after the area has healed.
To ensure that the surgical outcome is successful, the contaminated surface must be completely detoxified through implant surface detoxification.
What is Implant Surface Detoxification?
Typically, non-surgical treatments are effective in the management of inflammatory lesions around implants without bone loss. But when bone loss is detected, surgical treatment is necessary. To ensure success of the treatment, all bacteria must be completely removed from the implant surface through a process known as Implant Surface Detoxification.
Agents and techniques used in Implant Surface Detoxification
There are numerous mechanical and chemical agents used for implant surface detoxification. Mechanical agents include abrasive pumice, implantoplasty, air powder abrasive, and laser and photodynamic therapy, while chemical agents include citric acid, saline, hydrogen peroxide, chlorhexidine, and antimicrobials.
Researches have shown varieties of outcomes using these agents, making it difficult to determine what approach provides the best chances of implant survival. As a result, there is no established standard of care for peri-implantitis. So, it is best to identify and address the causes of peri-implantitis, and minimise the risk factors as well.
How to prevent peri-implantitis or future bone loss
By assessing the width and thickness of keratinised gingiva around implants, it is possible to prevent peri-implantitis or future bone loss. Thin and loose gingiva may harbor food and plaque, and also increase inflammation around the implant.
Augmentation procedures to increase the thickness and with of soft tissues around the implants at the gingival margin should be done as early as possible, in the initial stages of peri-implant disease (reversible inflammatory in the soft tissues surrounding an implant), or during implant placement if thin gingiva is spotted.