My patient said to me: “I have no pain but I have lost my implants”: how to recognise and prevent peri-implantitis happening to you, in good time!

Did you know that around 130,000 dental implants are placed by dentists in the United Kingdom, annually? Know that most dental implants do heal successfully, but some placements are soon lost due to the onset of peri-implantitis. This development of inflammation around the dental implant is hazardous and it is also one which often remains undetected as the affected patient does not feel any pain as a result. Here we outline just how you can recognise such an inflammation in the first place, plus how to act to prevent it taking hold, at an early stage of its development.

How often does peri-implantitis occur in patients with dental implants?

Rest assured that the success rates of dental implants are exceptionally good, as after ten years, an average of 90-95% of them are still intact. When dental implants are lost, it is often due to a combination of risk factors such as overloading, poor bone quality, poor follow-up care and an insufficient oral hygiene regime practised by the affected patient.

The objectives facts are that if the patient decides not to attend the recommended schedule of regular check-ups, an inflammation around the dental implant can start to develop unnoticed. In fact, 10-16% of patients with dental implants do actually have peri-implantitis. If peri-implantitis is left untreated, eventually it will lead to the loss of the dental implant plus the loss of the professional time taken by the dentist and the financial investment made by the patient, originally.

If the gums are inflamed without affecting the bone, the condition of gingivitis can be said to be present. Gingivitis is not as severe a condition as peri-implantitis which involves the bone, but it can still endanger the stability of the dental implant. Gingivitis can be found in 40-48% of all patients fitted with dental implants.

Exactly how does peri-implantitis develop in my mouth?

Know that with the onset of peri-implantitis, not only is the tissue inflamed, but the bone recedes and it is this bone loss which endangers the stability of the dental implant. Bacteria which attach themselves to the less than smooth dental implant surface can trigger an individually different immune reaction in the body; subsequently destroying the bone which was providing essential anchoring support to the dental implant.

How can I recognise the symptoms of peri-implantitis at an early stage so I can act fast?

Please realise that the symptoms of peri-implantitis are not always easy to interpret. Like periodontitis, this condition hardly causes any discomfort to occur at all. With peri-implantitis, pain is rare, but can present occasionally if the person affected touches the gums at the edge of the dental implant. Please also be advised that pain immediately after implantation, however, often originates due to other causes. If this type of pain concerns you, consult your dentist at your earliest opportunity.

With peri-implantitis, when it is at an advanced stage, bleeding can occur when brushing your teeth. The gums turn dark red, swell, and pus can form under the gums. Some patients will also feel bone pain or start to experience receding gums.

If peri-implantitis happens to me – what can I do?

Peri-implantitis affects everyone differently. Depending on the individual immune system, this condition usually progresses relatively quickly. Our clinical principle remains – the earlier peri-implantitis can be diagnosed, the better the dental implant’s chances of survival.

First of all, your dentist will determine the so-called ‘probing depth’ by checking how deep the gum pockets are. The deeper the gum pocket, the greater the inflammation. Depending on your dentist’s clinical findings after initial examination in clinic, sometimes it is enough to simply remove the plaque, administer antiseptics to the affected area and encourage the individual patient concerned to improve their current level of oral hygiene practised at home. Plaque can be removed with hand instruments or by way of air polishing devices. The latter are more efficient and are known to feel more comfortable for the patient, during treatment.

Please be aware that if this treatment is unsuccessful or if the disease is more severe, surgical intervention may be necessary. It is not clear which currently available form of peri-implantitis treatment is the most effective. We believe more meaningful studies within the professional literature are needed for consultation on this clinical point before such a recommendation can be made.

How can I prevent peri-implantitis happening to me and my dental implants?

Your dentist will ask you to commit to booking a schedule of regular routine check-ups with us, here in clinic – a service which is covered by most private health insurers. We would encourage all our valued patients fitted with dental implants to attend so that we are in the best position to diagnose and treat plaque formation in good time. Know that your follow-up dental care is particularly important if periodontitis was diagnosed before implantation, as the risk of developing peri-implantitis is comparatively higher in these clinical cases. Also know that it is possible and advisable to have a professional dental implant cleaning performed after your routine check-up to remove more bacteria for you.

In conclusion, when you clean your teeth twice daily, always consider paying special attention to the particularly problematic spaces between the teeth and the gum line – the interdental spaces – where bacteria will tend to naturally settle within the mouth. Be aware that biofilm also adheres very well to the less than smooth dental implant surface.

Finally, we would ask all dental implant patients to consider stopping smoking if it is their habit to do so. Know that tobacco consumption increases the risk of losing a dental implant despite the best efforts you make by adopting a thorough oral hygiene regime, as we suggest.

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