What is Peri-implantitis and how do we prevent it?
(BChD Dip.Imp.Dent.RCS(Eng) (Adv.Cert))
There is little doubt that the “gold standard” way to replace a missing tooth is with a dental implant. They are very durable and are completely independent of the adjacent teeth, which makes them by far the healthiest option, especially when compared to the more conventional tooth supported bridges. As a means of securing dentures, they come into their own; loose dentures which can barely bite through soft bread can be transformed into teeth which can bite into an apple!
However, recently in the press there have been articles about Peri-implantitis – “the time-bomb in dental implants”. In The Telegraph it was described as “a little-known disease in which bacterial infection causes the loss of the bone supporting the implant”. It is certainly true that the condition exists, but does this mean that we should not consider dental implants – with their considerable advantages – as an alternative to missing teeth or loose dentures? So let’s put this issue into context.
What is peri-implantitis?
Quite simply, peri-implantitis is an inflammatory disease characterised by bacterial infection and the gradual loss of the jaw bone that supports the implant. It can be likened to advanced gum diseasewhereby a natural tooth suffers from the loss of the supporting jaw bone.
Risk factors for the condition are smoking, poor oral hygiene and a previous history of gum disease. Research suggests that up to 20% of implants placed may become affected by the condition at some point.
What are the main concerns with peri-implantitis?
The main issue with peri-implantitis is that it is very difficult to treat. Gum disease is relatively straightforward to treat because a tooth has a smooth surface and is easy for a hygienist to clean. In contrast, the surface of an implant is threaded (like a screw) and is roughened to help it heal to the bone in the first place. This means that when dental plaque clings to the implant surface, it is very difficult to clean off.
So whereas we expect high success rates for the treatment of tooth related gum disease, treatment of peri-implantitis has a success rate of around 50%. Furthermore, there is currently no consensus in the dental community on the best way to manage peri-implantitis – hence the scare stories in the press. In fact the only way forward is to avoid the problem developing in the first place.
How do we prevent peri-implantitis from developing?
The key to preventing peri-implantitis is a strict programme of oral hygiene and implant maintenance, before the implant stage of treatment.
A good quality implant supported tooth (or set of teeth) should be designed so that they are easy to clean at home. Patients should be able to use floss around the implant tooth or at the very least use interdental brushes. It is the responsibility of the implant surgeon to ensure that the teeth are designed correctly to allow them to be cleaned easily and effectively. As peri-implantitis is much easier to treat successfully if caught early, implants should be checked at least once a year by the implant surgeon and visits made to a hygienist twice a year for a thorough cleaning.
Is peri-implantitis a reason not to have implants?
Peri-implantitis does exist and is an issue, but let’s consider the current alternatives for replacing missing teeth, such as dentures or tooth supported bridges. Most patients would not want to consider wearing a denture as a permanent option. Dentures are removable, they need fixative to stay in place, they have to cover the roof of the mouth and they are huge plaque and food traps that can be very uncomfortable to wear.
On the other hand, tooth supported bridges require significant and invasive reduction of the teeth either side of the missing tooth. Research shows that at least 20% of these teeth will subsequently need a root-filling, which will further weaken and ultimately put that tooth at risk. As dental surgeons we regularly see this happening. Unfortunately these patients then often need two implants, when they would only have needed one to fill the space initially.
Patients who wear full dentures benefit perhaps the most from implants, as they can make a hopelessly loose set of dentures feel secure. This has been proven to have nutritional benefits as patients can chew their food properly. There are also huge psychological benefits with patients being able to talk and laugh confidently again.
So is it right to deny these patients dental implants just because they might get peri-implantitis? Of course not. However, we still provide a considered and thorough assessment of what the long term success of treatment is likely to be for that patient. (This is discussed in an earlier blog; “How long do implants last?”)
So are dental implants really a “time bomb” for peri-implantitis?
The fact is, natural teeth can be prone to getting gum disease and other problems, but that doesn’t stop us carrying out dentistry on them. Dental implants can still be placed safely in the vast majority of patients with amazing, long lasting results.
We simply have to remember that they are being placed in an incredibly harsh environment and need to be very carefully maintained. After all, you wouldn’t purchase an expensive car and expect it to run problem free, indefinitely, without booking it in for a regular service, would you?!
Dr. Tim Doswell works exclusively in the field of implant dentistryat The Raglan Suite and is one of only a few implant surgeons in the north of England who has been awarded an Advanced Diploma in Implant Dentistry by the Royal College of Surgeons of England in London. Call 01423 565432 to book your free consultation with Dr. Doswell or contact us through our online enquiry form.