With greater awareness of the tremendous benefits that dental implant therapy provides, an increasing number of general practitioners and specialists are now providing surgical and restorative implant care. With the increasing number of patients receiving dental implant care, we are seeing an increased number of avoidable complications.
In order minimize the number of avoidable complications, it is imperative that dental professionals who want to provide implant care qualify themselves by obtaining additional education and experience specific to this treatment modality.
This being said, I would like to review the treatment protocol for peri-implant infection.
Peri-implant mucositis is an inflammation that is limited to the soft tissues surrounding a dental implant as a result of accumulation of bacteria. Like gingivitis, this condition results in bleeding gum tissues, but is easily treated by performing proper oral hygiene home care. If ignored, peri-implant mucositis rapidly progresses to peri-implantitis. Like progressive periodontitis, peri-implantitis leads to progressive loss of osseointegration and eventual implant failure.
All dental implant patients should receive periodontal examination and, if indicated, treatment prior to implant placement. After placement, they should maintain good oral hygiene, including professional prophylaxis. They should be examined regularly by their dentist for signs of infection, as well as attend all scheduled follow-up appointments with their dental implant specialist. If peri-implant mucositis or peri-implantitis are identified, they should be treated according to the Cumulative Interceptive Supportive Therapy (CIST) protocol outlined below.
CUMULATIVE INTERCEPTIVE SUPPORTIVE THERAPY (CIST)
Treatment to control the bacteria should be done by a qualified dental implant specialist, typically a periodontist or oral surgeon, with advanced knowledge of the complex microbiology of dental implant sites. Peri-implant mucositis treatment typically starts with a dental examination, including a radiograph to evaluate for absence of bone loss, superficial dental cleaning, reinforcement of oral hygiene measures and instruction on the daily use antiseptics such as Chlorhexadine. A follow-up dental evaluation within two weeks is mandatory to verify the return of healthy tissues around the implant(s).
If bone loss is identified on the radiograph or if dental probing generates bleeding or drainage of infection, additional treatment is needed, as these findings indicate the presence of peri-implantitis.
The treatment of peri-implantitis involves deep cleaning around the implant(s) with specialized instrumentation, including the use of lasers. The gum pockets are flushed with an antiseptic solution, after which time-released antibiotic microspheres are injected directly into the gum pockets surrounding the implant(s). Because peri-implantitis is often caused by bacterial migration from a nearby loose tooth suffering from gum disease, a sick tooth or teeth must be successfully treated or removed to avoid future re-infection of the peri-implant tissues. In addition, an oral antibiotic should be taken for 7-10 days. Follow-up dental examinations are scheduled weekly for 3-6 weeks.
Once the infection is controlled, the dental implant specialist can attempt to restore or reshape the supportive hard and soft tissues around the implant(s), using surgical procedures that may include bone resection, repositioning gum tissue to facilitate oral hygiene procedures, and if there has been major bone loss, guided bone regeneration or bone grafting to regenerate bone anchorage for the implant(s). Alternatively, removal and subsequent replacement of the implants can be considered.
ENHANCED ORAL HYGIENE
Enhanced oral hygiene measures become mandatory as the infected areas are susceptible to re-infection. Best Results are obtained using an electronic tooth brush that is proven by research to improve plaque removal around dental implants, such as the Sonicare brush, and a device that allows convenient daily application of anti-bacterial rinses to the involved areas, such as the Air Floss, both of which are highly rated by patients and implant specialists.
AVOIDING & MANAGING DENTAL IMPLANT COMPLICATIONS
Although, we have not scheduled a Dental Implant Complications immersion course at the Sclar Center for 2012, a major portion of our February 1-5, 2013 ISTM Comprehensive Dental Implant Surgery Training Conference on Miami Beach will be dedicated to avoiding and managing complications. Plan now to attend this conference that is appropriate for clinicians with any prior level of dental implant surgery training and experience.