Peri-implant mucositis is an inflammatory condition which affects the soft tissues surrounding an implant. It is reversable, and treatable with non-surgical methods. Peri-implantitis, on the other hand, is irreversible and leads to the loss of bone which supports the implant. More invasive intervention is often needed for successful outcomes. Peri-implant diseases are common, with peri-implantitis having a prevalence of around 10 per cent at implant level.
There are a number of risk factors associated with peri-implant diseases, including poor oral health, periodontal disease, smoking, infrequent recalls, diabetes, alcohol, and improper restoration design. Clinicians should work with patients to minimise their effects and protect the long-term health of the peri-implant tissue. It is important to understand the differences between these conditions and how best to treat them, to prevent progression and dental implant loss.
Diagnosing peri-implant diseases
Making an accurate diagnosis is essential when deciding on a treatment pathway. When it comes to peri-implant diseases, speed can also be crucial. Peri-implant disease diagnosis often comes after identifying inflammation in the soft tissues which surround the implant, any mobility caused by loss of soft tissue support and bone loss, and bleeding on probing in the pockets surrounding the restoration – sometimes, this is the only indication of disease.
If peri-implantitis is suspected, it is important to carry out a radiograph to assess the level of bone loss. CBCT scans are ideal for monitoring bone levels and should be carried out as soon as possible. A radiograph is essential for producing an accurate diagnosis, and peri-implantitis can progress very quickly, especially when compared to periodontitis, therefore needing a much quicker response for a good outcome.
Non-surgical and surgical intervention
When treating peri-implantitis, it is important to use a combination of non-surgical and surgical interventions to help minimise disease progression, and limit the risk of implant and bone loss. Thorough cleaning is essential here, removing any contamination from the surface of the implant and restoration. In some cases, a surgical resection may be necessary to ensure complete debridement of the implant.
It is also important to consider the effects that the restoration can have on the health of soft tissues. Providing oral hygiene advice is essential, but it must be specific for each patient, and take into account the restoration type in every case. Ensure that their restoration allows room for thorough cleaning. Show patients how to effectively clean around their restoration, being sure to disrupt the biofilm, as this will help to minimise the progression of peri-implant diseases.
The importance of regular monitoring for all patients
For effective monitoring and prevention of peri-implantitis, regular recalls are essential. Ideally, patients should visit the dentist twice per year. This is because regular monitoring and cleaning will help to reduce the chance of disease developing. During these follow up appointments, it is important to check the patient’s plaque score, and aim to keep plaque levels below 25 per cent to minimise the risk of diseases developing. Regular maintenance appointments should be recommended long term, as patients tend to become less compliant after three years post implant. Patients are still at risk of developing peri-implantitis after this time, so it is crucial that regular monitoring and excellent oral hygiene continue past this point.
Maintaining excellent notes is essential because, by keeping a clear and thorough record of each visit, you can monitor your patient’s dental implants, and risk of peri-implantitis more accurately. Kiroku is the digital note taking platform which is designed to make complete note taking easy. With templates specifically designed for monitoring dental implant patients, you can be sure that you are collecting all of the relevant information needed to monitor them effectively. The dynamic templates even offer helpful prompts, making suggestions relevant to your case, to make sure you never miss a thing. Plus, this convenient system allows you to take your clinical notes 60 per cent faster than before.
By keeping a clear and accurate record of each appointment, you will be able to easily track any changes in your patient’s soft tissue, monitoring for early signs of peri-implantitis. You will also have a comprehensive record of any oral hygiene, and smoking cessation advice you have given your patients, and any record of bleeding on probing and pocket depth to refer back to and compare over time. These are essential markers for decision making, helping you to recognise when is the right time for intervention and/or referral.
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