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Nov 08, 2023 // 10 min read

The Significance of Early Diagnosis of Peri-implant Diseases and the Importance of Supportive Peri-implant Care

Lisa J.A. Heitz-Mayfield

DOI: 10.3290/iti.fi.45719

prevention peri-implant disease peri-implant mucositis peri-implantitis supportive peri-implant care

Abstract

Peri-implant diseases, including peri-implant mucositis and peri-implantitis are common complications that occur around dental implants. Early detection of peri-implant diseases and timely management are of critical importance for the long-term success of dental implant treatment.

Intraoral radiographs and peri-implant probing measurements should be obtained following completion of implant therapy to establish a baseline. At subsequent examinations, if clinical signs of inflammation or deepening of probing depths are observed, a radiograph should be made to assess the peri-implant bone levels and confirm a diagnosis.

Clinicians should perform peri-implant probing to monitor peri-implant conditions at each recall visit in order to detect changes in health conditions at an early stage. Identification and treatment of peri-implant mucositis is key for the primary prevention of peri-implantitis. Early detection of peri-implant disease favors a more conservative non-surgical treatment approach, while peri-implantitis diagnosed with more advanced bone loss usually requires surgical intervention.

Regular supportive peri-implant care (SPIC) is recommended for all patients with dental implants. A comprehensive approach encompasses various aspects, including monitoring peri-implant/periodontal tissue health, reducing or modifying risk factors, reinforcing individualized oral hygiene practices, and providing professional mechanical plaque removal. SPIC also involves risk assessment to determine the appropriate recall interval for each patient. By implementing SPIC, clinicians can proactively reduce the risk of complications, manage peri-implant diseases and ensure the long-term success of dental implant treatment. Clinicians and patients should be well informed of their role in establishing a preventative program.

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Introduction

As oral health care professionals, our aim is to provide patients receiving dental implant prostheses with successful long-term treatment outcomes by implementing a high standard of care and a preventative approach.

Peri-implant diseases, peri-implant mucositis and peri-implantitis refer to biofilm-associated inflammatory conditions that affect the tissues surrounding dental implants. Peri-implant diseases are frequent complications following implant treatment (Derks & Tomasi 2015). Early detection of these conditions and intervention without delay is crucial to prevent disease progression, preserve implant longevity, and ensure patients' overall satisfaction and quality of life. This article emphasizes the critical role of early diagnosis of peri-implant mucositis and peri-implantitis, and highlights the significance of regular supportive peri-implant care (SPIC) in maintaining peri-implant tissue health (Figs 1a - b).

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Fig. 1a: Healthy peri-implant conditions at implant site 11 following delivery of the implant-supported crown. The peri-implant soft tissues have a similar clinical appearance compared with the healthy gingival tissues surrounding the adjacent teeth. Probing depths are ≤ 3 mm with absence of bleeding on probing

Fig. 1b: Healthy peri-implant soft tissues surrounding two adjacent implants with splinted crowns, following treatment of peri-implantitis and regular 3 - 4 monthly supportive peri-implant care. While the implants are obviously placed in close proximity to each other, the patient was able to maintain good plaque control using a small interdental brush

Fig. 1a Fig. 1b

The importance of early diagnosis of peri-implant diseases should not be underestimated. Peri-implant mucositis is considered the precursor to peri-implantitis, a condition which may progress rapidly, leading to advanced bone loss and eventual loss of the implant. Early detection of peri-implant soft tissue inflammation without loss of supporting peri-implant bone (peri-implant mucositis) and implementation of appropriate treatment is key for the primary prevention of peri-implantitis.

Fig. 1a: Healthy peri-implant conditions at implant site 11 following delivery of the implant-supported crown. The peri-implant soft tissues have a similar clinical appearance compared with the healthy gingival tissues surrounding the adjacent teeth. Probing depths are ≤ 3 mm with absence of bleeding on probing

Fig. 1b: Healthy peri-implant soft tissues surrounding two adjacent implants with splinted crowns, following treatment of peri-implantitis and regular 3 - 4 monthly supportive peri-implant care. While the implants are obviously placed in close proximity to each other, the patient was able to maintain good plaque control using a small interdental brush

Fig. 2a: Peri-implant mucositis. Shallow probing depths of 3 mm with clinical signs of inflammation and bleeding on probing (BOP) at the buccal aspect of the implant

Fig. 2b: A periapical radiograph shows the absence of marginal bone loss

Fig. 3a: Peri-implantitis. Probing depth of 6 mm with clinical signs of inflammation and bleeding on probing. A radiograph (not shown) confirmed progressive bone loss

Fig. 3b: Peri-implantitis. Probing depths > 6 mm with suppuration on probing at all 3 implants. The prosthesis has been disconnected to enable peri-implant probing. A radiograph (not shown) confirmed progressive bone loss at all implants

Fig. 4: Peri-implant probing using a manual periodontal probe (a: plastic probe, b: metal probe) with a light probing force (approximately 0.2N) to assess the presence or absence of BOP, and to monitor changes in PD, and changes in the peri-implant mucosal margin level

Fig. 5a: Progressive bone loss at implant site 36. The bitewing radiograph shows the marginal bone levels at approximately thread 1 - 2

Fig. 5b: Progressive bone loss at implant site 36. The patient did not attend supportive peri-implant care appointments for 6 years. The patient presented with peri-implantitis and progressive bone loss, to the level of thread 7, as seen on the bitewing radiograph

Fig. 6: The implant disease risk assessment tool (IDRA) (Heitz-Mayfield et al. 2020) which includes an assessment of the frequency of and compliance with supportive peri-implant care (SPT) as an important element of risk assessment for peri-implant disease

Fig. 7a: Supportive peri-implant care protocols should be individually tailored for each patient and should include assessment of oral conditions, including peri-implant probing to evaluate tissue health

Fig. 7b: Supportive peri-implant care protocols should be individually tailored for each patient and may include use of disclosing solution to demonstrate to the patient the presence of plaque deposits at the implants and remaining dentition

Fig. 7c: Supportive peri-implant care protocols should be individually tailored for each patient and may include oral hygiene coaching demonstrating the use of an interdental brush for plaque removal

Fig. 7d: Supportive peri-implant care protocols should be individually tailored for each patient and may include professional mechanical plaque removal using an ultrasonic device

Fig. 7e: Supportive peri-implant care protocols should be individually tailored for each patient and may include professional mechanical plaque removal using an air-polishing device with erythritol powder

Fig. 7f: Supportive peri-implant care protocols should be individually tailored for each patient and may include professional mechanical plaque removal using a rubber prophylaxis cup