Signs of infection after Dental Implant Placement oral surgery: Peri-implantitis and Implant Surface Detoxification

When a tooth and its root are severely damaged due to decay or trauma, such that the tooth has to be extracted, your dentist may recommend that you get dental implants to form the foundation of your replacement tooth through a crown or implant-supported dentures.

Source: AVperiodontics

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Treatment for Missing Teeth

When you lose your natural teeth, the underlying jaw bone in the gap left behind tends to weaken progressively. This may in turn cause adjacent teeth to shift, reducing your ability to chew and changing the shape of your face so you appear older.

Dental implants are usually the first choice for restoring missing or damaged teeth. Dental implants are usually made of titanium, because it is readily accepted by the body, plus it’s durable.

Over the last 30 years, implants have shown high success, ranging from 90 to 95 percent. The short-term and long-term success of the procedure largely depends on fast healing with safe integration into the jaw bone.

However, the success of dental implants can be affected by mechanical and/or biological complications known as peri-implantitis. But first, let’s look at the different types of implant placement procedures you may encounter.

3 Types of Dental Implants

Dental implant placement is usually performed in the dentist’s office, though the nature of each surgical procedure is unique depending on the clinical situation and preferences of the patient and oral surgeon.

There are generally three types of implants:

An endosteal implant

It is the most common, and derives its name from the thin film of connective tissue lining the bone’s marrow cavity. These implants are placed directly into the jawbone.

Sub-periostal or eposteal implant

It derives its name from the thin layer covering the surface of the bone (periosteum). These implants are placed underneath the gums but above the jawbone. They are not very common, but may be used on patients with insufficient healthy jawbone for the typical implant placement, yet they don’t want to undergo bone augmentation procedure.

Transosteal implant

It involves the placement of a U-shaped metal plate to the underside of the jawbone, with pins or screws drilled through the bone to secure the plate. The metal plate extends upwards through the gumline to support the replacement tooth. This type of implant is very unpopular, but may be used for patients with severe bone resorption or to replace missing teeth in the lower arch.

The ability to place an endosteal implant largely depends on the health of the patient, as well as the amount of healthy bone they have remaining in the jaw. If both are in great condition, then an endosteal is preferred. Otherwise, an eposteal implant may be recommended. The final option (transtosteal implant) is rarely used in today’s dentistry because it requires entry of the metal frame to jawbone via the skin along the bottom of the patient’s face.

Stages of Endosteal Implant Placement

An endosteal implant can be placed in one-stage, two-stages, or three-stages, depending on a number of aesthetic and health-related concerns.

One-stage

This method utilizes a non-submerged single-piece implant with a metal collar designed to protrude through the gum as the bone heals to the implant. After sufficient healing time (3-6 months), an abutment is connected to the implant, after which the crown can be fabricated to replace the missing tooth.

Two-stage

The process is the same as that of a single-stage procedure. But before the abutment is fitted, the dentist will conduct a second surgery, cutting through the gum over the healing cap to examine the stability and proper integration of the implant with the bone.

Three-stage

When the implants are completely healed, the patient may opt for a final restorative procedure, like connecting prosthetic teeth.

Contact your dentist or surgeon right away if you notice anything odd about your recuperation, such as excessive swelling, pain, or bleeding.

Signs of infection after Dental Implant oral surgery

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:

Increased probing depths
Implant feels loose
Mucosal recession

Redness and swelling in the gums.
Discharging pus
Bleeding on probing (BOP)

A draining sinus
A fever
Throbbing pain

Bad breath.
Difficulty chewing your food.

Peri-implantitis can only be treated using surgical approaches. Some of the recommended therapies include guided bone regeneration, implantoplasty, open flap debridement, and eventual implant removal.

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.

References:

https://www.patientconnect365.com/dentalhealthtopics/article/surgical_placement_of_implant_body_endosteal___dental_procedure_code_description

http://www.osseo.org/NEWhowAreImplantsPlaced.html

https://dental.washington.edu/wp-content/media/oral-surgery/Afteryouroralsurgery.pdf

http://coronationdentalspecialty.ca/patient-information/oral-surgery-instructions/

Tips on Recovering After an Oral Surgery

https://www.deltadentalins.com/oral_health/oral_surgery.html