Peri-implantitis – risk factors and implications – Matthieu Dupui TBR

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  Posted by: The Probe      30th May 2019

Peri-implantitis is a serious inflammatory condition that affects the tissues surrounding an osseointegrated dental implant, resulting in the loss of bone. It is believed to affect around 30% of dental implant recipients (though published estimates of the scale of the problem vary considerably from 1% to nearly half).[1],[2]Peri-implantitis is highly destructive, potentially difficult to treat, and can reduce further treatment options for the patient.

Peri-implantitis is commonly compared to periodontitis, and this comparison is appropriate. Both conditions are essentially caused by bacterial colonisation, which ultimately leads to a sustained inflammatory response in the gum tissue. Left untreated, both can result in the loss of bone and connective tissue.[3]It should be noted that a history of periodontitis is considered a significant risk factor towards developing peri-implantitis.[4]While there is a resemblance between peri-implantitis and periodontitis, the two conditions are distinct from one another. Peri-implantitis tends to progress faster and with greater ferocity, in part due to the structural difference caused by the lack of a tooth and its supporting connective tissue. Lesions caused by peri-implantitis are often larger than their periodontitis equivalent, and it is suggested that it is more difficult for the immune system to fight peri-implantitis causing bacteria due to an increase in distance to the target.[5]

Peri-implantitis, thankfully, does not appear spontaneously. It is preceded by peri-implant mucositis (which has a prevalence of around 43%) – an inflammatory lesion of the soft tissues surrounding an endosseous implant (but without the bone loss characteristics of peri-implantitis).[6]The level of inflammation can vary from patient to patient, but bleeding upon probing is typical. Like gingivitis, this condition is triggered by bacterial colonisation and a subsequent failure to remove this bacteria. Peri-implant mucositis is a largely reversible state, although it can take three weeks or more for oral conditions to return to normal. The progression from peri-implant mucositis to a case of peri-implantitis can take considerable time (sometimes years), although in some cases the disease progresses much more quickly.[7]Once peri-implantitis has manifested, non-surgical therapy alone is seldom effective.[8]

Risk factors for peri-implantitis – besides a history of periodontitis – include smoking, overloading of the implant site, and xerostomia. Partially edentulous patients may be at greater risk of developing peri-implantitis, due to differences in the typical bacterial flora between the two groups.[9]Diabetes mellitus has a more controversial status as a risk factor within the literature. The survival rate of implants in those with diabetes is in line with healthy patients over the first six years and in the first year, the risk of developing peri-implantitis is equal to that of patients without diabetes. In the long-term, the odds of developing peri-implantitis are most likely higher for those with diabetes, particularly if the condition is uncontrolled.[10]

Polycystic ovary syndrome (PCOS) is the most commonly occurring endocrine disorder among pre-menopausal women by a significant margin (though it can often go undiagnosed). Among those with PCOS, evidence suggests that between 50-70% have insulin resistance regardless of body mass index values.[11]Due to this and other factors (the effect of oestrogen and progesterone on the gingiva, Vitamin D deficiency, and other comorbidities that PCOS can contribute to), there is reason to believe that patients with PCOS may be at increased risk of developing peri-implantitis (and periodontitis). However, while there are hypothetical means by which PCOS could adversely affect oral health and encourage the development of peri-implantitis, there is currently a decided lack of research and evidence into this.[12]

It has been suggested that tissue engineering may help improve long term implant success, based on the observation that increased keratinised mucosa around implants results in healthier peri-implant tissues and less crestal bone loss. It is proposed that soft-tissue grafting could be used to provide sufficient keratinised mucosa. While promising, research into this area is still at its very early stages.[13]

Ultimately, maintaining oral hygiene is critical to avoiding peri-implantitis. However, good case selection and choice of implant can also help reduce the chances of failure. The design and composition of the implant chosen could potentially play a role in modifying the risk of peri-implantitis.[14]

The intelligently designed Z1 implant from TBR is well suited to all types of prosthetic restorations. The innovative zirconia collar of the Z1 encourages the soft tissues to heal around the implant in a manner that closely resembles natural gingival growth. This helps to protect the crestal bone and the gingiva from iatrogenic inflammation and infection, minimising the risk of patients developing peri-implant complications.

Peri-implantitis is a threat to patients with dental implants. However, with good treatment planning and implant selection, in conjunction with good oral hygiene, peri-implantitis is preventable in the overwhelming majority of cases. Where peri-implantitis is detected, due to its capacity for tissue destruction, it should be treated with all possible haste.

 

For more information on the Z1 implant, visit tbr.dental, email support@denkauk.comor call 0800 707 6212

 

 

References

[1]Schminke B., vom Orde F., Gruber R., Schliephake H., R.Bürgers, Miosge N. The pathology of bone tissue during peri-implantitis. Journal of Dental Research.2015; 94(2): 354-361. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4438728/#!po=71.7391Accessed March 21, 2019.

[2]Salvi G., Cosgarea R., Sculean A. Prevalence and mechanisms of peri-implant diseases. Journal of Dental Research. 2016; 96(1): 31-37. https://journals.sagepub.com/doi/full/10.1177/0022034516667484March 21, 2019.

[3]Delima A., Karatzas S., Amar S., Graves D. Inflammation and tissue loss caused by periodontal pathogens is reduced by interleukin-1 antagonists. The Journal of Infectious Diseases.2002; 186(4): 511-516. https://academic.oup.com/jid/article/186/4/511/806088Accessed March 21, 2019.

[4]Sgolastra F., Petrucci A., Severino M., Gatto R., Monaco A. Periodontitis, implant loss and peri-implantitis. A meta-analysis. Clinical Oral Implants Research. 2013; 26(4): 8-16. https://doi.org/10.1111/clr.12319Accessed March 21, 2019.

[5]Salvi G., Cosgarea R., Sculean A. Prevalence and mechanisms of peri-implant diseases. Journal of Dental Research. 2016; 96(1): 31-37. https://journals.sagepub.com/doi/full/10.1177/0022034516667484March 21, 2019.

[6]Salvi G., Cosgarea R., Sculean A. Prevalence and mechanisms of peri-implant diseases. Journal of Dental Research. 2016; 96(1): 31-37. https://journals.sagepub.com/doi/full/10.1177/0022034516667484March 21, 2019.

[7]Heitz-Mayfield L., Salvi G. Peri-implant mucositis. Journal of Clinical Periodontology.  2018; 45(Suppl. 20). https://onlinelibrary.wiley.com/doi/full/10.1111/jcpe.12953March 21, 2019.

[8]Charalampakis G., Rabe P., Leonhardt A., Dahlen G. A follow-up study of peri-implantitis cases after treatement. Journal of Clinical Periodontology. 2011; 38(9): 864-871. https://www.ncbi.nlm.nih.gov/pubmed/21770994March 21, 2019.

[9]Cortes A., Ferraz P., Tosta M. Influence of etiologic factors in peri-implantitis: literature review and case report. Journal of Oral Implantology. 2012; 38(5): 633-637. https://doi.org/10.1563/AAID-JOI-D-10-00139March 21, 2019.

[10]Naujokat H., Kunzendorf B., Wiltfang J. Dental implants and diabetes mellitus – a systematic review. International Journal of Implant Dentistry. 2016; 2(5). https://journalimplantdent.springeropen.com/articles/10.1186/s40729-016-0038-2March 21, 2019.

[11]Ding T., Baio G., Hardiman P., Petersen I., Sammon C. Diagnosis and management of polycystic ovary syndrome in the UK (2004-2014): a retrospective cohort study. BMJ Open. 2016; 6: e012461. http://discovery.ucl.ac.uk/1504811/1/BMJ%20Open-2016-Ding-.pdfMarch 21, 2019.

[12]Tanguturi S., Nagarakanti S. Polycystic ovary syndrome and periodontal disease: underlying links – a review.Indian Journal of Endocrinology and Metabolism. 2018; 22(2): 267-273. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5972486/March 21, 2019.

[13]Shah R., Shah H., Shetty O., Mistry G. A novel approach to treat peri implantitis with the help of PRF. The Pan Africa Medical Journal. 2017; 27: 256. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5660301/March 21, 2019.

[14]Salvi G., Cosgarea R., Sculean A. Prevalence and mechanisms of peri-implant diseases. Journal of Dental Research. 2016; 96(1): 31-37. https://journals.sagepub.com/doi/full/10.1177/0022034516667484March 21, 2019.

 


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