Dental Implants | Esthetic Dentistry
Periodontology | Dr. George Makris & Co.

What are peri-implant diseases?

These are inflammations that develop around implants. They may affect only the gums surrounding the implants, but they can also extend deeply into the bone, destroying the bone support of the implant. It is similar to periodontal diseases, but they progress much faster, and the inflammation is much more intense and persistent.

What are the symptoms? How common are they?

There may be intense bleeding, swelling of the gums, abscess or fistula, and even severe pain. According to the literature, it affects an average of 10% of implants, usually focusing on certain individuals, which means that for these individuals, it will be a total loss of the implants!

What causes peri-implant diseases?

There are three main causes. The first is neglected oral hygiene, the daily mandatory care of your mouth, which may also relate to the way implants were placed and restored. The second is a history of periodontal disease, meaning a periodontal condition that was not treated by your doctor when the implants were placed, resulting in periodontal bacteria attaching to the surface of the implants. The third factor is the way the restoration was done by the doctor (the type of implant, their position in the arch, i.e., where and how they were placed, and finally, the quality of the peri-implant prosthetics.)

Let’s look at some bad examples of implant restoration that were referred to our clinic for treatment of peri-implant disease.

Even an inexperienced eye could tell:

1. How many implants have been placed without reason, resulting in the corresponding teeth being placed very close together, making it impossible for the patient to clean them effectively, naturally leading to peri-implant infection.
2. How advanced the peri-implant infection is, resulting in extensive bone destruction.
3. How rough the overconstruction of the prosthetic part is.

What is the cause of peri-implant diseases?

Peri-implant diseases are infections, the result of bacterial accumulations around the implants. Therefore, inflammation begins (a reaction of the body to the microbial presence). In the second phase, the inflammation goes deeper and destroys the bone support of the implants.

Is there treatment for peri-implant disease?

Yes!

It requires again a “comprehensive approach.” That is:

1. Treatment of the inflammatory condition of the whole mouth, including the teeth.
2. Teaching proper oral hygiene (indicating where the implants are, how to use interdental brushes, how to use super floss)
3. Modification of the prosthetic restoration. Opening up the spaces between the teeth for easier cleaning of the implants.
4. Surgical opening of implants with extensive bone destruction around them to remove the inflamed tissues and perform mechanical and chemical cleaning of the implants.
5. Application of bone regeneration surgical techniques with bone grafts and membranes, if possible.

What is the best way of prevention?

Depending on the severity of the case and the history, there should be a check-up and maintenance of the peri-implant work 2-3 times a year. Also, repeating the oral health instructions according to each person’s needs.

See sample cases

Case 1

This lady came to our clinic with severe pain and swelling in her upper jaw. She had implants placed 4 years ago. She told us that she had lost an implant in her lower jaw 2 years ago (that’s why there are missing teeth on one side of her lower jaw). Her X-ray showed significant bone destruction around the implants as indicated by arrows 1, 2, 3 photo 1. When we removed her bridge, photo 2 showed that implant No3 came out automatically (without anesthesia). In photo 3, you can see the swelling from implants No1 and No2, which are loose and pus is coming out. These implants have lost their integration and need to be extracted. A tooth that had stayed on the bridge has decayed and shifted towards implant No2. Unfortunately, for this lady, implants No1 and No2 and the decayed tooth need to be removed, and the only prosthetic restoration she can have is a complete denture, unless she opts for a new implant placement procedure.

What went wrong?

1. Poor surgical technique (note how close implants No2 and No3 are to each other)
2. Implant choice (the types of implants are different. She has 4 different types of implants, and she doesn’t know their identities)
3. Poor prosthetic restoration. One can see the rough stumps
4. Absence of follow-up for 4-5 years
5. Her oral hygiene was difficult to maintain because the prosthetic work was poorly made

Conclusion: The success of implant work is technically and biologically very sensitive and requires special attention. It is a shame for every patient to lose so much time, effort, and financial investment due to poor choice of doctor.

Case 2

The perfect destruction!
This lady placed 14 implants 6 years ago (multiply the cost per implant and you’ll understand the total expense). The X-ray shows where the bone is now and the white line where it should be. The result is swelling, pain, antibiotics, and again swelling, pain, and antibiotics.

Many of these implants need to be removed.

What went wrong?

1. It is obvious that the number of implants is excessive. There is minimal bone between them, and any small inflammation will lead to the exposure of the implants due to the loss of their support.
2. Surgical methodology, meaning they were placed haphazardly and without any plan.
3. Problematic prosthetic restoration for systematic cleaning.

Conclusion: It is sad to see such cases with such obvious causes from the surgical and prosthetic approach. In other words, medical responsibility, but also poor choice of treating doctor.

Case 3 and 4

Two different implant cases with the same logic. A large number of implants placed in positions where only one could have been placed. Small spaces between them that are impossible for the patient to clean. It is interesting that in both cases, the bone level is much more advanced around the implants than around the teeth.

Conclusion: Ignorance or profit expectation from the treating doctor has devastating results. The evolution of peri-implant destruction is much faster and more extensive than the corresponding periodontal condition of the patient. Therefore, implant placement can cause much more significant problems than those that can arise with teeth if not given proper attention from the placement of the implant to its restoration. Indeed, bone destruction around implants can be much more extensive due to poor medical intervention. The function of implants is much more sensitive than that of teeth in the same mouth. Unfortunately, these cases are many, and their management is very difficult. And sadly, recently, they end up in court!