Peri-implantitis in the remote period. Treatment of peri-implantitis - inflammation after implantation. What is peri-implantitis

Under what circumstances traditional two-stage implants inserted into the bones of the lower or upper jaw, this event begins the countdown to the appearance of peri-implantitis. The longer the implants are in the mouth, the more likely it is that the associated bone will be lost, eventually affecting the entire implant and leading to its removal. The latest treatment methods for the installation of traditional implants were powerless.

Peri-implantitis occurs after successful osseointegration implant. This is especially frustrating, because just at the moment when everything seems to be well and the patient begins to use implants, the disease attacks him.

Peri-implantitis begins in the cortical layer in the oral cavity and leads to the destruction of cortical bone tissue. Perimplantitis can be distinguished from endosseous "osteitis residual". The latter includes the reactivation of old (previously inactive) infections within the bone tissue, usually spreading from the roots of lost teeth (Fig. 1)


Rice. one This x-ray shows four various infections that resorb bone tissue.
  • Loss of the distal-alveolar part of the canine bone is seen due to periodontitis (infection).
  • There was excess endodontic filling at the root apex of this tooth, resulting in apical osteitis, and the bone around the apex was destroyed.
  • In the alveolar direction of the median implant, we can see a bone defect in the form of a crater, this is typical of peri-implantitis.
  • An osteitis is seen around the lower endosseous portion of the distal implant, possibly caused by residual filler that is opaque to x-rays.

Mild cases of peri-implantitis

In a mild case, bone loss around the implant is 1-3 mm, the mucosa shows slight signs of inflammation, which can cause mild pain. These cases can be treated symptomatically with topical disinfectants and painkillers. Treatment with antibiotics currently known does not give a successful stopping the development of peri-implantitis (regardless of the severity of the case).

Moderate cases

In moderate cases, about 50% of the vertical bone along the implant is lost. The main problem in such cases is the re-discharge of pus and bleeding, a bad appearance and an unpleasant smell.

Severe cases

In severe cases of peri-implantitis, virtually all of the bone is resorbed, resulting in deep pockets filled with soft tissue. As a result, there are persistent infections, the formation of pus, heavy bleeding. If the pockets are removed surgically, the teeth will look very bad, and a large amount of food will be stuck between the implant and the bridges. (Fig.1, Fig.2)



Rice. one: Example: The bone tissue around three implants in the upper jaw on the right was lost up to the top of the implant (in this case traditional monolithic threaded implants were used). Although the patient suffers from a permanent severe infection in her mouth, she does not agree with the removal of the implant, because she knows that in doing so she will lose all chewing functions. In addition, implants placed in the back of the mandible on both sides were lost due to peri-implantitis. There was a severely atrophied jaw left, it is not possible to apply a different approach to treatment with conventional two-stage implants.


Rice. one: Virtually all of the bone along these traditional two-stage implants has been lost due to infectious peri-implantitis. Most patients do not agree that peri-implantitis has reached this stage. They require the removal of the implant as early as possible.

Why does peri-implantitis occur, why is it so common?

There are millions of bacteria in the oral cavity, they are washed out from there along with drinks, food and saliva. Bacteria can settle (attach) to all hard surfaces in the mouth and multiply under favorable conditions. We know about this not an example of teeth.

A problem with almost all conventional two-stage implants is that they produce a rough endosseous surface during manufacture. This is done to obtain a reliable bond between the implant and the bone, that is, reliable osseointegration.
Today we know that already in the first months of operation of all implants of this type, the bone tissue along them is reduced by 1-3 mm. The rough surface of the implant extends into the oral cavity, and bacteria readily settle on it.

We must also take into account the fact that the typical patient receiving a dental implant may have lost teeth (most likely they did) due to a persistent lack of proper oral hygiene (i.e. due to negligence). In other words: those who don't like brushing their teeth get implants earlier than other members of their population. Traditional dental implants with a rough surface are larger in diameter, requiring special oral hygiene to prevent infection.

In other words: traditional dental implants (two-stage installation with a rough endosseous surface) are initially undesirable for use in those patients within the population who do not care about oral hygiene. In addition, most traditional two-stage implants have a very large endosseous surface area much larger than that required for the transmission of forces. Thus (due to the fact that a large contact area is exposed to harmful effects), one can in any case expect loss of vertical bone tissue along the implant.

A further general problem with the performance of conventional two-stage implants is that such implants exploit cortical alveolar bone and the underlying layer of cancellous bone. These bone tissues undergo resorption, again exposing the implant surfaces, which quickly become a breeding ground for bacteria and cause chronic disease and progressive bone loss. From this point of view, most of the two-stage implants are designed incorrectly, they should be banned or significantly reduced in their use.

Treatment of peri-implantitis

Until today, there is no effective (definitive) treatment for this disease. All attempts to clean the infected surface of the implant are ineffective, as millions of new bacteria constantly appear and multiply in the mouth. Similarly, attempts to "polish" rough surfaces in the mouth do not work because at the deepest level, where the implant touches the bone, such polishing is not possible. In addition, polishing waste remains on the implant and in deep pockets.

In some cases, peri-implantitis stops "on its own" when the bone loss reaches the non-resorbing "basal" areas of the bone.

In general, today it is considered that there is no reliable and successful treatment of peri-implantitis. Science is still hoping to find this cure:
www.perioimplantadvisory.com

Until today, the only absolutely safe way to avoid this disease is the timely removal of two-stage implants.

What healthcare providers know about peri-implantitis

The Swiss Monthly Journal of Dentistry (SMfZ; "SSO-Zeitung") has published a survey conducted among active dental practitioners in Switzerland on what they know about peri-implantitis.

It is not surprising that the responses of actively practicing dentists in Switzerland were far from the modern point of view on the problem. Here is an overview of their responses:

Suggested reasons for peri-implantitis (%)
- Periodontitis 79.7 0.194 72.0
- Smoking 76.9 0.365 71.4
- Bad compliance 53.2 0.247 60.9
- parafunction 20.3 0.618 23.1
- Smooth implant surface 24.4 0.126 16.2
- Rough implant surface 31.6 0.914 32.3
- short implants 17.7 0.012 7.1
- reduced diameter 16.5 0.008 6.0
- After sinus lift 10.1 0.999 10.1
- After Augmentation 21.5 0.799 20.1
31.6 0.671 29.0
Knowledge of CIST (%) 61.5 0.001 39.8

Only 31.6% of respondents could define "rough implant surface" as the cause of peri-implantitis. Two more reasons - multi-component implants and a wide diameter of mucosal damage - were not mentioned at all by actively practicing dentists in Switzerland.
Conclusion: The awareness of actively practicing dentists in Switzerland on this important issue is extremely poor. The survey found that neither university education nor continuing education provides insight into the real state of affairs. We believe that the reason for this is the strong pressure on university professors from the leading implant manufacturers.

We believe that the same shocking poll results could be obtained in most Western countries. It seems that not only knowledge is missing, but also "common sense" (which could suggest the correct answers to simple questions).

conclusions

Most of the very questionable designs for two-stage implants (two-piece designs, large diameters, rough endosseous surfaces) are the main cause of this common problem that significantly affects the quality of life of patients. For use in a permanently contaminated oral environment, the design of traditional two-stage implants is not suitable, this type of implant is mainly responsible for because there is no effective treatment for peri-implantitis.

We recommend avoiding these implant designs because today, with the invention of "basal implants" (strategic implants), new alternative treatment techniques and devices have become available. They avoid this serious medical problem and prevent other equally serious side effects.

Peri-implantitis is an inflammation of the tissues surrounding a dental implant, which is accompanied by a progressive loss of bone tissue around the implant (Fig. 1-3). Peri-implantitis can occur immediately after implant placement, either during osseointegration (engraftment to the bone), or after prosthetics.

But besides the “peri-implantitis itself”, there is another type of inflammatory process around the implant, which is called the term “mucositis”. Mucositis differs from peri-implantitis in that inflammation occurs only in the soft tissues of the gums around the implant (without affecting the bone). Accordingly, with mucositis, there is no loss of bone tissue.

What does peri-implantitis look like: photo

This article is written for patients. In it, we will dwell in more detail on the causes of peri-implantitis, as well as on what urgently needs to be done in such a situation. For colleagues - at the end of the article there are a couple of links to English-language clinical studies on peri-implantitis.

Mucositis and peri-implantitis: symptoms

The development of mucositis and peri-implantitis is associated with an infectious process. Microbiological studies have shown that they are most often caused by pathogenic microorganisms such as spirochetes and gram-negative anaerobes. In particular, they include: Treponema denticola, Prevotella intermedia, Prevotella nigrescens, Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, Bacterioides forsythus, Fusobacterium nucleatum.

Establishing diagnosis –
the diagnosis is made on the basis of an external examination, probing of the gingival pocket, as well as X-ray data. With mucositis, there is swelling, redness or cyanosis of the gums around the implant, bleeding occurs when probing the gum pocket. There is no evidence of bone loss on x-rays.

If peri-implantitis has developed, symptoms (in addition to swelling, redness or cyanosis of the gums, bleeding when probing the gums - characteristic of mucositis) will also include ...

  • release of purulent or serous exudate from the gum pocket and / or fistula,
  • probing depth of the gingival pocket is at least 5-6 mm,
  • X-rays will show bone loss around the implant.

Photo of a patient with peri-implantitis of the lateral incisor of the HF -

Important : according to different authors, the normal level of bone loss around the implant is considered to be bone loss at the level of 1.0-1.5 mm (during the 1st year), and then - no more than 0.2 mm per year for all subsequent years. Any amount of bone resorption above these values ​​is considered pathological.

Peri-implantitis: treatment

Treatment of peri-implantitis is carried out only if the implant is immobile. If the mobility of the implant is determined, only its removal is indicated. Also, before starting treatment, it is important to assess the presence of an increased masticatory load on the implant, and if it exists, it must first be neutralized.

In addition, if a purulent abscess has formed in the implant area, then an emergency opening of the abscess + systemic antibiotic therapy is necessary. For the treatment of mucositis, only conservative methods (such as mechanical and antiseptic treatment of implants, antibiotic therapy) are mainly used, and surgery may be required only to increase the thickness of the gingiva or the width of the attached gingiva.

But for the treatment of peri-implantitis, the main method will be only surgical treatment aimed at removing granulations from under the gums, bone graft replanting with the parallel use of a barrier membrane.

1. Implant surface treatment -

In peri-implantitis, bone tissue is destroyed, which leads to partial exposure of the root surface of the implant. Because the latter has a high porosity, it is subject to rapid contamination by pathogenic microflora. At the first stage of treatment, it is very important to carry out disinfection of the implant surface, removing all microbial plaques from the surface, plus antiseptic treatment.

For mechanical treatment of the implant surface can be used -

  • mechanical curettage,
  • erbium laser (video 1),
  • ultrasonic handpiece (video 2),
  • sandblasting (Air-Flow).

The disadvantage of cleaning the implant surface using curettage or ultrasonic tips with metal tips is a high risk of injury to the titanium oxide layer on the implant surface, which can cause corrosion of the implant and lead to new development of peri-implantitis. Therefore, it is best to use an erbium laser, if available.

Next, an antiseptic surface treatment is carried out either with 3% hydrogen peroxide or 0.1% chlorhexidine solution. Immediately after treatment with these antiseptics, it is necessary to treat the surface of the implant with a gauze swab with saline.

2. Systemic antibiotic therapy -

In other articles, we have already said that the ideal option for preventing peri-implantitis is a microbiological analysis of the microflora of the oral cavity, as well as its sensitivity to various antibiotics - performed even before the surgical stage of implantation. If at the same time extremely pathogenic microflora is sown, systemic antibiotic therapy is carried out even before the operation, which dramatically reduces the risk of developing inflammation around the implant.

However, if there is no antibiotics before surgery, this analysis will allow you to immediately prescribe the best antibiotic option in case of peri-implantitis development, which will hit exactly the specific pathogens in this patient. Believe me, this is important, because. very often there are cases of resistance to broad-spectrum antibiotics.

There are clinical cases when the microflora in peri-implantitis does not respond not only to Amoxicillin, but also to Rovamycin or Wilprofen (a group of macrolides), and even sometimes to Ceftriaxone (a group of cephalosporins). In this case, a preliminary study of the microflora will allow you to save patients from the removal of implants or large-scale reconstructive surgeries.

3. Surgical treatment (NTR method) -

If peri-implantitis has arisen, the treatment is mainly surgical, and all the preliminary points described above are only secondary-necessary (as a preparation for surgical intervention). Surgical treatment is aimed at removing inflammatory granulations that form at the site of resorbed bone, as well as increasing the level of bone tissue using guided tissue regeneration (GTR) techniques.

Only surgical access allows you to remove all inflammatory granulations from under the gums, as well as mechanically and antiseptically treat the surface of implants in bone pockets. Absolutely all clinical studies have shown that conservative therapy of peri-implantitis (without surgical intervention, aimed at removing granulations and allowing total disinfection of the implant root surface) is absolutely ineffective.

Operation strategy –
During the operation, a mucoperiosteal flap (gingiva) is peeled off to expose the surface of the implant and visualize the bone defect around the implant. Further, with the help of curettage, scaling, and an erbium laser, all inflammatory granulations are removed, and antimicrobial treatment of the surface of the implant and the bone defect is carried out. In implantology, it is customary to divide bone defects into 4-wall, 3-wall, 2-wall, single-wall and slit-like (Fig. 6).

It should be noted that the more preserved bone walls around the implant, the greater the chances for bone restoration around the implant during bone grafting. Therefore, if the bone defect around the implant in a patient is slit-like, 4-wall or 3-wall, then bone grafting using guided tissue regeneration is indicated in these cases (Fig. 7). But, if the bone defect is one- or two-wall, bone resection with apical displacement of the flap is indicated.

Clinical studies have shown that the most effective method of bone grafting for peri-implantitis is NTR, using autogenous bone graft + barrier membrane. At the same time, NTR can be carried out not only simultaneously with the removal of granulations and surface treatment of implants, but also 1-3 months after the removal of granulations. The latter is necessary in severe inflammation and the risk of suppuration of the bone graft.

Surgical treatment of peri-implantitis: video 1-2
in video 1, an erbium laser is used to disinfect the surface of the implant, and in video 2, an ultrasonic handpiece is used. Further, in both cases, the GTR technique (guided tissue regeneration) is used ...

4. Aesthetic surgery for peri-implantitis -

We have already said that the development of peri-implantitis can be caused, among other things, by a small gum thickness, as well as a lack of width of the attached (keratinized) gum around the implant. Therefore, in some cases, in addition to the operation to increase the level of the bone, additional operations may be required for -

  • increasing the width of the attached gingiva,
  • increasing the thickness of the gums,
  • lip frenuloplasty,
  • surgery to deepen the vestibule of the oral cavity.

Naturally, in a good way, all these interventions should be done before or during the implantation operation, and in case of peri-implantitis that has already occurred, they should prevent new inflammation. Also, indications for aesthetic surgery of the gums around the implant are gum recession (with exposure of the implant neck), as well as the absence of interdental papillae.

Reasons for the development of peri-implantitis -

As you will see below - in the vast majority of cases, the occurrence of peri-implantitis is not something unforeseen or occurring by chance. On the contrary, its appearance is always natural, because. in more than 90% of cases, it occurs as a result of the mistakes of doctors (implant surgeon, orthopedic dentist, dental technician). These errors can be related to −

  1. insufficient examination of the patient,
  2. poor preparation of the patient's oral cavity for surgery,
  3. errors in planning implantation,
  4. non-observance by the implantologist of the surgical protocol of the operation,
  5. errors in prosthetics.

1. Major mistakes in patient preparation –

  • If implantation is performed on the site of a tooth that was removed due to inflammation (periodontitis), peri-implantitis may occur as a result of the fact that the doctor did not scrape inflammatory granulations out of the hole well enough when removing the tooth.
  • If implantation is performed in a patient who has a chronic infection of the nose, tonsils, (sinusitis), as well as sources of infection associated with poorly treated teeth. In this case, the patient will have a rather aggressive pathogenic microflora in the oral cavity.
  • If during implantation in patients with periodontitis, periodontal pockets were not sanitized, as well as antibiotic therapy (preferably after a preliminary microbiological analysis of the microflora).
  • If the doctor ignored the presence of systemic concomitant diseases in the patient, for example, diabetes mellitus, during implantation in women, he did not take into account the peculiarities of fluctuations in their hormonal levels, or the fact that the patient is an active smoker. Read more about the features of implantation in these categories of patients in the articles -

2. Major mistakes when planning an operation –

When planning the number and location of the implant, it is very important to pay attention to the distances at which the implants will be installed from each other, as well as from neighboring teeth. It is also very important at the planning stage to determine the need for operations to increase the thickness of the gums and the volume of attached gums in the area of ​​future implants. The development of peri-implantitis can lead to -

  • Too small distance between the implant and adjacent tooth (less than 2.0 mm).
  • Too small distance between adjacent implants (less than 3.0 mm).
  • Too small gingival thickness (less than 2 mm) will not only prevent the formation of good gingival aesthetics around the implant, but is also a poor barrier against the penetration of infection from the oral cavity into the osseointegration zone.
  • Too little attached gingiva around the implant (less than 4 mm) – over time this will cause the mobile gingiva to tear off the “gingival cuff” around the implant. And the development of peri-implantitis is only a matter of time.

Optimal bone thickness and what the attached gum looks like: photo

3. Non-compliance with the surgical protocol -

Most often, the development of peri-implantitis is associated with non-compliance with the surgical protocol for implant placement by the implant surgeon. The following mistakes can be made during the operation phase...

  • Titanium implants have an oxide layer on their surface that protects them from corrosion. In case of accidental mechanical damage to the implant surface (for example, the doctor dropped the implant), the oxide layer is broken, which will first lead to corrosion of the implant, and later to the development of peri-implantitis.
  • Peri-implantitis can occur if bacterial contamination of the implant surface occurs before it is inserted into the bone. For example, when removing an implant from its packaging, a clinician may accidentally place or drop the implant on a non-sterile surface. Also, when inserting an implant into the mouth, the doctor may accidentally touch the lips or oral mucosa with it. And this will be enough for the development of inflammation.
  • If the doctor, when preparing the bone bed, takes the cutters with gloves that have talc on them. Particles of the latter will remain in the bone bed even after washing it with an antiseptic and will certainly cause aseptic inflammation. That is why it is so important to use sterile surgical gloves without talc, or carefully remove the talc from the gloves with a swab with 70 gr. alcohol.
  • Inflammation can hardly be avoided if saliva gets into the finally formed bone bed under the implant. Here, not only bacterial contamination occurs, but also, since saliva is very chemically aggressive, a superficial chemical burn of the bone occurs. The latter will interfere with osseointegration.
  • Normally, the diameter of the bone bed under the implant should be 0.5 mm less than the diameter of the implant. If the doctor has formed too narrow a bone bed for the implant, then the implant, after its insertion into the bone, will put too much pressure on the bone walls, which can provoke the development of inflammation.
  • If the doctor has formed a bone bed that is too wide compared to the diameter of the implant, this is also bad. This will lead not only to poor primary stability of the implant, but also to the fact that pathogenic bacteria can easily migrate along the surface of the implant.
  • Poor water cooling during the formation of the bone bed leads to bone burn and the development of peri-implantitis.
  • Inflammation is bound to occur if the Cover Screw or Healing Abutment was loosely screwed into the implant. In the existing gaps, the infection will multiply.
  • Incorrect suturing when suturing the mucous membrane over the implant can also lead to bacterial contamination of the osseointegration zone and the development of inflammation.

4. Mistakes in prosthetics -

In addition to the mistakes made by the implant surgeon, there are a number of mistakes that an orthopedic dentist and dental technician can make at the stage of manufacturing an orthopedic structure. Peri-implantitis can lead to -

  • excessive chewing load on the implant, which may occur, for example, due to an incorrect ratio of the height of the crown and the length of the root of the implant, or if the width of the crown significantly exceeds the diameter of the implant;
  • if a CCS abutment (cobalt-chromium alloy) is installed in a titanium implant, this can lead to corrosion and the development of inflammation;
  • if there is a loose connection between the implant and the abutment, or the abutment and the crown (in this case, infection will multiply in the micro-gaps);
  • if the crown was fixed on the implant by cement fixation, excess cement could remain under the gum, which would cause inevitable inflammation;
  • if the flushing space under the bridge prosthesis on implants is incorrectly created;
  • if the angle between the axis of the crown and the axis of the implant is more than 27 degrees,
  • etc…

5. Patient related factors -

The objective fault of the patient in the development of peri-implantitis concerns only poor oral hygiene, as well as smoking. Both of these factors greatly increase the risk of peri-implantitis. However, there are a number of other conditions and comorbidities that can also increase the risk of inflammation around implants.

  • bruxism (teeth grinding),
  • long-term treatment with corticosteroids,
  • previous chemotherapy,
  • concomitant systemic diseases, such as diabetes mellitus or osteoporosis, increase the risk of developing peri-implantitis (but are not independent factors in its occurrence).

Important : these conditions and diseases are not an absolute contraindication to implantation, but the doctor, when deciding on implantation, must carefully weigh the pros and cons, warning the patient about the increased risk of complications. Very often, doctors in pursuit of earnings take patients with extremely unfavorable health status for implantation, and patients then pay for this with the natural development of complications. We hope that our article was useful to you!

Sources:

1. Add. professional ,
2. Personal experience of a dental surgeon (implantologist),
3. The National Center for Biotechnology Information (USA),
4. "Complications in dental implantation" (A.V. Vasiliev),
5. " Professional hygiene in the field of implants and treatment of peri-implantitis ” (Susan S. Wingrove).

Affecting tissue around the implant. Inflammation develops due to the penetration of pathogenic microorganisms into the area between the titanium root and the gum. If you do not start treatment of peri-implantitis at the initial stage, then the process will take a chronic form.

In advanced cases, the gum becomes loose, a gum canal is formed, gradually increasing in size. Over time, food residues, microbes and saliva accumulate in the gum pocket, extensive suppuration begins, and the result is the destruction of bone tissue.

The discharge of pus at the site of installation of the dental structure may also indicate start of the rejection process implanted titanium root- rejection of the jawbone.

Pus can be released through a fistula formed in the area of ​​the implant, or flow directly from under the dental system when pressing on the gum.

Why did pus form

The reason for the appearance of pus near the implant depends on what complication this white or green discharge is a sign of.

If suppuration is caused by peri-implantitis

The reason may be:

  • The penetration of bacteria into the bone tissue during implantation of the structure or after implantation.
  • Non-compliance with the rules of oral hygiene during the engraftment of the titanium rod.
  • Formation between the gum and the supragingival plug of the hematoma.
  • The formation of an excessively large implant bed, which causes its mobility and facilitates the penetration of bacteria.
  • Displacement or damage to the dental system as a result of mechanical stress or excessive load.
  • Injury to the wall of the appendages of the nasal cavity (paranasal sinuses).
  • Making a mistake when closing a postoperative wound.
  • The presence of an inflammatory process in neighboring teeth.
  • Inaccurate prosthesis manufacturing.

The initial stage of purulent inflammation over the implant

If the gum near the implant began to fester due to rejection of the structure

The reasons for the development of complications can be the following:

  • Peri-implantitis.
  • Insufficient amount of bone tissue.
  • Deterioration of health - exacerbation of chronic ailments.
  • Allergic reaction to the implant material.
  • Use of low-quality or fake implant, instruments.
  • Mistakes made by the implantologist:
    • selection of an implant model that does not correspond to the size;
    • non-compliance with the conditions of sterility during implantation;
    • tissue necrosis caused by overheating of the instrument when drilling the implant bed in the jawbone;
    • installation of an artificial root in the wrong position;
    • carrying out implantation in the presence of foci of inflammation in the oral cavity;
    • incomplete study of the patient's history, as a result of which the existing contraindications were not identified.
  • Non-compliance by the patient with the recommendations of the doctor:
  • visiting a bathhouse, diving into an ice hole;
  • hiding from the implantologist the presence of any health problems - even the most minor pathologies could adversely affect the result of the operation;
  • self-prescribing or refusing to take medications;
  • insufficient oral hygiene;
  • smoking after implant placement - according to statistics, in 30% of smoking patients implant rejection occurred in the first five years.

What additional symptoms indicate inflammation

The development of the inflammatory process in the area of ​​the implant is evidenced not only by the release of pus, but also by the following symptoms:

  • The occurrence of severe pain that can spread throughout the mouth;
  • swelling and redness of the gums;
  • appearance and enlargement of the gum pocket;
  • occurrence of blood in the area of ​​implant placement;
  • mobility of the artificial root.

How to treat a complication

Treatment of peri-implantitis depends on the stage of development of the disease. It comes down to the following procedures:

  • surgical removal of the sac containing pus;
  • cleaning and removal of the gum pocket;
  • gum treatment with antiseptics;
  • removal of tartar and soft plaque formed on the crown using ultrasound, which also adversely affects pathogenic bacteria;
  • if necessary, they clean and disinfect the dental structure using a special device;
  • the patient is recommended to actively rinse the oral cavity with antibacterial solutions and infusions of medicinal herbs.


Removal of damaged tissues of the periodontal pocket

When acute tissue destruction is diagnosed, after removal of the lump with pus, the jawbone and normal microflora of the oral cavity are restored. So, without removing the implant, it is possible to perform an operation to replant chips from artificial bone or donor natural material. After the operation, the wound is closed with sutures and a bandage. The patient is prescribed the use of Diplen-Dent film, Metrogil-Dent gel, Solcoseryl dental adhesive paste.

To restore the tissues affected around the titanium root and accelerate the process of stopping inflammation, physiotherapy procedures are performed. Laser treatment is especially effective. Antibiotics are also prescribed.

If the inflammatory process and suppuration recur, the only way out is to remove the implant. The extraction of the dental structure is also resorted to in the event of the development of the process of its rejection.

Can re-implantation be performed after treatment?

In almost all cases, after the treatment of the inflammatory process and the cessation of purulent discharge, re-implantation is possible. But after the removal of the implant, no more than 1-2 months should pass, otherwise the jaw, without receiving the necessary load, will begin to atrophy.

If there is not enough bone tissue, an operation to build it up may be prescribed. Re-implantation is carried out after the restoration of injured tissues.

What to do to prevent complications after implantation

To begin with, it is worthwhile to carefully approach the choice of a clinic where implantation will be performed. Dentistry must have modern equipment and work with high-quality, proven dental systems, the manufacturers of which do not cause the slightest doubt. Doctors in the clinic must have the necessary skills, knowledge and experience. When choosing dentistry and an implantologist, you should carefully study the reviews of real patients of the clinic.

The dentist for preventive purposes should be visited at least every six months. If you experience any discomfort or symptoms of the development of pathological processes, a visit to dentistry should be immediate.

After implantation, you should stop drinking alcohol, smoking, any mechanical damage to the gums, cheeks and jawbone should be avoided. After implantation of the implant and a year after the operation, an x-ray should be taken, this will allow timely detection of jaw atrophy.

You need to brush your teeth twice a day, and you should not be limited to a regular toothbrush. To cleanse the oral cavity, dentists recommend using an irrigator, whose principle of operation is to remove food debris and bacteria from the interdental spaces and periodontal folds using strong water pressure. Electric, ultrasonic and ionic toothbrushes will help to effectively clean the oral cavity.

Doctors' opinion

Arkady Petrovich Androkhonin

“After implantation, swelling, pain and bleeding of the postoperative wound may occur. However, normally, these symptoms should not increase with time and disappear in a maximum of a week. If the above symptoms bother you for a longer time, you should seek medical help. If pus has gone on the seams or near the implant, this indicates the development of an inflammatory process and the presence of a serious risk of rejection of the structure.”

The installation of implants can sometimes be accompanied by complications - gum tissues and bones do not always accept a foreign body and may begin to reject it.

Rejection takes many forms, and one of them is peri-implantitis.

This disease is rare, averaging only one percent of patients with dental implants. However, of all possible complications, peri-implantitis is the most serious.

What is peri-implantitis and what causes it

- this is an inflammation of the soft tissues of the gums in the area of ​​​​contact with the implant. With the development of the disease, inflammation passes to the bone and causes its resorption - gradual degradation and resorption.

Inflammation is localized in the cortical plate - a thin bone wall surrounding the tooth socket. Progressive peri-implantitis leads to the complete destruction of the cortical bone and the formation of "pockets" filled with soft tissue, extremely vulnerable to any infection.

Dental implant rejection

It is important to distinguish peri-implantitis from mucositis - inflammation of the mucous membrane around the implant, which does not affect the bone tissue. However, neglected mucositis without proper treatment may well go to the bone.

The immediate causes of peri-implantitis are tissue rejection of a foreign object or infection. Many factors can lead to such situations.

Rejection of the artificial root can cause:

  • individual intolerance to implant materials. The introduction of foreign material into the tissue causes an allergic reaction. Leukocytes accumulate around the implant, which causes an inflammatory process, which eventually passes to the bone tissue;
  • immunodeficiency states, including those caused by prolonged general infectious diseases;
  • endocrine disorders;
  • diabetes.

Infection can provoke:

  • penetration of pathogenic bacteria into tissues during implant installation;
  • non-compliance with oral hygiene after surgery;
  • pin misalignment: a pin that has changed position creates a gap in the soft tissues where bacteria can enter and injures the bone, which contributes to its infection and inflammation. It can move when falling, hitting, in the process of chewing;
  • incorrectly selected pin size - too small a pin does not hold well and quickly loosens, too large - injures surrounding tissues;
  • inflammatory processes already present in the oral cavity -, etc .;
  • the formation of a subgingival hematoma and the development of an abscess in it. Hemorrhage in the gum tissue may occur as a result of incorrect actions of the doctor during the operation;
  • improper suturing;
  • displacement of bone structures with the formation of a gap in the tissues as a result of congenital anomalies of the jaw.

Types and stages of peri-implantitis

There are two forms of the disease - acute and subclinical. The acute form usually develops almost immediately after surgery; it is characterized by a pronounced severity of all symptoms. In the subclinical form, the disease can develop over the years, and there may be no symptoms at all, with the exception of minor painful sensations of the gums in the area of ​​the prosthesis.

Peri-implantitis is diagnosed only with a special examination and usually already in the later stages.

Also, peri-implantitis is classified according to the timing of development:

  • if the fusion of the pin with the bone did not occur, and rejection began already in the first month after the operation, the disease is called short-term; as a rule, its cause is a violation of the installation technology or poor-quality material;
  • if the rejection occurred after six months or a year, it is called medium-term; such a violation occurs as a result of delamination of the bone under the implant due to excessive loads on the bone tissue;
  • rejection of the prosthesis, which developed more than two years after the operation, is called long-term and occurs in the vast majority of cases due to the patient's non-compliance with oral hygiene.

Symptoms

The clinical manifestations of peri-implantitis depend on the stage of the disease. There are four stages in total:

  • the first is characterized by inflammation of the soft tissues around the implant and a slight degree of bone destruction in the horizontal direction;
  • the second - a decrease in the height of the jaw, the destruction of the bone vertically down from the area of ​​contact of the pin with the bone tissue;
  • the third - destruction of the bone in all directions from the area of ​​contact with the implant;
  • the fourth - the complete destruction of the alveolar process / alveolar socket.

There are also symptoms characteristic of all four stages of the disease:

  • reddening of the gums in the area of ​​implant installation;
  • mobility and instability of the implant - this indicates a significant degree of destruction of bone tissue;
  • soreness of the gum tissue;
  • separation of gum tissue from the tooth;
  • swelling, sometimes blue;
  • hyperthermia;
  • discharge of pus;
  • the formation of gum pockets, which become new foci of inflammation due to the pus accumulating in them;
  • fistula formation.

It is important to note that there are practically no specific symptoms in peri-implantitis - the manifestations listed above are to some extent characteristic of all inflammatory processes in the gum and tooth root.

The only symptom that clearly indicates this disease is the mobility of the implant, but it occurs already in the later stages. Therefore, it is necessary to carefully monitor the condition of the prosthesis and monitor all suspicious manifestations in time.

With a high degree of probability, rejection of the prosthesis can be indicated by a specific form of reddening of the gums at the root - usually it is a small, clearly visible spot, red or purple, with clearly defined edges.

At the slightest sign of inflammation in the pin area, you should contact your dentist. It is necessary to start treatment of peri-implantitis as early as possible - the longer the disease develops, the greater the likelihood of implant rejection and the higher the risk of infection spreading to healthy teeth.

The doctor can diagnose peri-implantitis by palpation of the inflamed gum area, radiography and computed tomography, which show the condition of the entire dentition and the location of the pins. However, it is important to keep in mind that the glass-ceramic pins are not visible on the x-ray - in such a situation, it is necessary to undergo a computer examination.

Treatment

Treatment of peri-implantitis is carried out in two stages. The first stage is conservative, aimed at stopping pathological processes in soft tissues and preventing infection of surrounding tissues and teeth. It includes the following procedures:

  • thorough sanitation of the oral cavity;
  • treatment of gum pockets around the implant with special ozonizing solutions;
  • treatment of damaged tissues with a laser - it improves blood circulation, has an antiseptic effect and at the same time “solders” the vessels, preventing bleeding;
  • then, for a certain period of time, the patient rinses the mouth with special anti-inflammatory drugs - until the active inflammatory process stops;
  • if necessary, correction and adjustment of crowns is carried out.

After the complete elimination of active inflammation, the surgical stage of treatment begins. It consists in cleaning and antiseptic treatment of the pin, as well as cleaning and sanitation of the gum pockets. Surgical treatment is carried out according to the following scheme:

  • the gum near the implant is incised to gain access to the post;
  • pus, granulation and destroyed bone tissue are removed;
  • the surface of the pin is thoroughly cleaned and treated with a citric acid solution for disinfection;
  • the gingival pocket is washed, disinfected and a special material is injected into it to replace the bone;
  • the postoperative wound is sutured, the patient is prescribed antibiotic therapy and rinsing the mouth and throat with antiseptic solutions.

In case of recurrence of inflammation or too severe atrophy of the bone, a complete removal of the implant is prescribed. If the condition of the bone tissue allows, after a while a new prosthesis is installed, more suitable in size and material.

Some experts believe that the complete removal of the prosthesis is justified at the first sign of rejection, some argue that it is necessary to keep the implant as long as there is a chance of engraftment. The final decision depends on the specific situation.

A photo

Peri-implantitis is an uncommon but very serious disease that can lead to bone destruction and infection of healthy teeth. You can prevent it by carefully observing oral hygiene and caring for the implant. However, if the implant is installed incorrectly or is made of low-quality material, it will not be able to take root under any circumstances - it is better to remove it, replacing it with a new one if possible.

X-ray of the jaw with peri-implantitis

Visible implant rejection

A modern person, to varying degrees, is concerned not only with the general physical state of the body's health, but with how it manifests itself outwardly. In dentistry, the aesthetic factor is especially relevant.

Medicine has many ways of artificial restoration of lost teeth, most of which are the latest, innovative techniques that allow you to achieve maximum comfort in the use of structures and excellent external attractiveness.

However, the implantation procedure, no matter how modern and high-quality it may be, involves the introduction of components and materials foreign to the body into the oral cavity. Often this causes complications, the most common of which is peri-implantitis.

The inflammatory process, in which the hard and soft tissues of the jaw, located in close proximity to the artificial implanted organ, gradually destroy it, is called peri-implantitis.

In the focus affected by the disease, the hard tissue becomes thinner over time and the “new” root is simply rejected. At the same time, the structure itself becomes unusable.

No matter how competently and accurately a substitute is installed, in every fifth case it is not accepted by the body, the development of this pathology manifests itself.

Symptoms

It is noteworthy that peri-implantitis can develop both after a long time after the procedure, and almost immediately after the operation.

The disease is diagnosed by the following symptoms:

  • pain syndrome that occurs at the time of mechanical pressure on a fixed structure, even with inadvertent contact with the tongue;
  • frequent bleeding of the gums, especially noticeable when brushing your teeth;
  • puffiness;
  • change in the color of the covers;
  • looseness of the body;
  • violation of the structure of bone tissue and its thinning;
  • the appearance of a periodontal pocket;
  • in the later stages of the anomaly - an abundant accumulation of purulent masses.

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The reasons

In three out of four cases, the pathology occurs against the background of a secondary penetrating infection, in particular, the presence of a number of dental diseases of the oral cavity.

Provoking factors in the development of the pathological process are also:

  • alcohol and nicotine addiction- the mucous membrane is irritated, an unpleasant odor and plaque appear, pathogenic microorganisms multiply rapidly;
  • festering of the subgingival plug- the infection accumulating there gets deep into the gums and causes a purulent abscess;
  • medical negligence when the implantation technique is chosen incorrectly or the design is made poorly;
  • decrease in the body's immune forces;
  • improper enforcement of rules oral care;
  • mechanical injury in the area of ​​product installation, as well as regular excessive load;
  • the presence of concomitant serious diagnoses- diabetes, HIV infection, bruxism, metabolic disorders.

In addition, neglect of preventive visits to the dentist, irregular removal of stony deposits are a common cause of foci of inflammation in the construction area, provoking disease and rejection of the artificial root.

Classification

The mechanism of expulsion of foreign material occurs gradually, in several stages, which have their own manifesting specifics.

By stages

  1. First stage, on which the inflammation process is only gaining momentum, but already manifests itself outwardly in the form of specific plaques located close to the implanted element. The gum tissue begins to bleed occasionally. At this stage, the first pockets appear, small in size and not always noticeable. Despite the already visible swelling in the area of ​​inflammation, the bone integrity of the gums is still preserved;
  2. The anomaly is gaining momentum- pockets increase in size, creating favorable conditions for the reproduction of microbes that provoke suppuration. The bone begins to slowly break down. The design is still functioning normally, but the patient is already experiencing some discomfort;
  3. Purulent masses increase in volume, nearby soft tissues are quickly affected. The bone is already significantly depleted, it is no longer able to fix the implant, which loses its fastening strength, gradually loosens and does not cope with its function;
  4. Element is rejected, the jawbone at the point of attachment is thoroughly destroyed.

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By deadline

Depending on the time of onset, the disease is characterized by three periods:

  1. Early– the rejection mechanism is launched within the first 30 days after the procedure for installing the structure, the provoking factor in this case is the non-union of the artificial organ with the hard bone tissue fixing it;
  2. medium term- inflammation develops gradually, and actively manifests itself no earlier than 2-3 months after the prosthetics operation. If the probability of mechanical injury is excluded, the main reason is a violation of the integrity and delamination of the bone, which is considered a direct consequence of medical inexperience, as a result of which the maximum allowable load was calculated incorrectly, and the product was selected incorrectly;
  3. Long term peri-implantitis- problems arise only a couple of years after the implantation of the element. In this case, everything happens only through the fault of the patient himself - most often, from poor oral hygiene.

Diagnostics

The disease can be determined using the following diagnostic methods:

  • visual and instrumental inspection- there is hyperemia and swelling;
  • gum probing- detects blood flow;
  • stomatoscopy- gives an internal clinical picture of the anomaly;
  • 3D tomography– determines the degree of bone tissue resorption;
  • periapical x-ray- accurately shows the level of the root after the load;
  • tomographic scanning- the most effective diagnostic method, most accurately determines the degree of damage;
  • clinical analysis- Schiller tests, Russell index, level of structure functioning;
  • pH meter- a fragment of the oral fluid is removed for examination;
  • biochemical and bacteriological laboratory research provides additional information about the course of the disease. Unfortunately, it is this method of diagnosis that doctors most often neglect, which leads to unpleasant consequences.

Treatment

Due to the specifics of the disease, in case of incorrect or incomplete therapy, the risk of relapse is very high. Therefore, a conservative method of treatment is justified only at the initial stage of the development of inflammation, and then, with careful implementation.

In other cases, they resort to surgical intervention, which provides for complex therapy, as an integral part of the overall process of eliminating the pathology.

conservative

The technology of non-surgical treatment of peri-implantitis is as follows:

  • local anesthesia, as needed - a course of antibiotics;
  • removal of the upper, prosthetic component of the structure, its cleaning and modification;
  • the use of disinfectant baths and irrigation of the focus of suppuration;
  • elimination of granulation using ultrasonic, laser or sandblasting (depending on the clinical situation) and subsequent sanitation of the internal bed and the implant itself;
  • fastening of an updated prosthesis, designed after its modernization to reduce the load force on the element.

This method has its drawbacks:

  • inability to adjust the size of the gum pocket;
  • at the time of probing, the inflamed place begins to bleed;
  • often does not have the expected effect. All the manipulations performed either do not eliminate the problem at all, or after a while, the disease relapses.

In addition, the doctor will remove plaque and tartar in those places where it is difficult to reach with a toothbrush, and, if necessary, replace the screws with new fasteners.

Surgical

The task of this method of treating peri-implantitis is to localize the focus of inflammation and stop the process of decomposition of the gum bone tissue. Consists of the following steps:

  • anesthesia;
  • antiseptic measures - disinfection of the oral cavity, sanitation of pockets. The choice of technology is at the discretion of the specialist, mainly with the help of plastic curettage, which protects the rod from mechanical damage;
  • washing with the composition of furacilin;
  • if the disease is accompanied by an accumulation of pus, an autopsy is made along the entire perimeter of the bone crest in a beveled way;
  • high-quality antiseptic treatment of the internal part of the structure, and, if necessary, its major restoration or replacement with a new one;
  • filling the lesion with an anti-inflammatory composition that suppresses the accumulation of pus and reduces inflammation;
  • mandatory drug therapy - the necessary drugs and the course of treatment are selected individually, taking into account the complexity of the situation.

The most commonly prescribed antibiotic is Augmentin or Levaquin. In addition to medicines, disinfecting ointments and rinsing solutions are shown.

In the video, see the surgical method for the treatment of peri-implantitis.

Forecast

This diagnosis can lead to complete rejection of the structure and to a long, expensive rehabilitation.

Risks can be minimized by choosing high-quality restorative prostheses using modern computer innovations in work, and by carefully choosing a clinic where this service will be provided.

Prevention

The main measures aimed at preventing the disease include:

  • strict adherence to all the advice and recommendations of the doctor throughout the recovery period after surgery;
  • constant adherence to the rules of oral hygiene, careful attitude to the design;
  • control of the force exerted on the product, to prevent the use of too hard products that can injure the integrity of the prosthesis and open access to bacteria in the internal part of the organ;
  • to give up smoking;
  • regular, in order to control the situation, visits to the dentist.

About dental hygiene after implantation, see the video.

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