Peri-implantitis is an inflammation of the tissue around the dental implant. The gums and jawbone adjacent to the implant show various signs of inflammation such as swelling, redness and pain. If peri-implantitis is not treated, implant loss usually occurs.

 

Causes of peri-implantitis


Bacterial flora in the oral cavity

If bacteria are present in the oral cavity that are capable of damaging the gums and bone, peri-implantitis can develop quickly. Such pathogenic bacteria produce, for example, enzymes that degrade the adjacent tissue and destroy the implant anchorage.

If these harmful bacteria increase in number and form biofilms and coatings on the dental implant, peri-implantitis is inevitable.

Elevated levels of a-MMP8

a-MMP8 stands for activated matrix metalloproteinase-8, an enzyme produced by immune cells (mainly granulocytes) when they come into contact with bacterial biofilms.

a-MMP8 is able to degrade peri-implant tissue by enzymatically cleaving the collagen of gingiva and jawbone. Thus, it ensures that more immune cells can get to the biofilms and plaques and provide enhanced defense.

In many people, a-MMP8 is produced in excessive amounts, so that the destructive process is very aggressive and excessive.

The worse the oral bacterial flora, the more a-MMP8 is produced by immune cells and the higher the destruction of gums and bone.

Very interesting is the fact that the a-MMP8 level is a marker for the probability of future periodontitis or peri-implantitis. In this way, effective precautions can be taken before the first signs become apparent.

 

Our dental practice specializes in effectively optimizing oral bacterial flora. Only the harmful germs are eliminated and the healthy and important bacteria remain alive.

In our patients, we can determine the aMMP8 level within a few minutes. In this way, the risk of future periodontitis or periimplantitis can be determined even before the first symptoms appear.

 

Effects on health


Peri-implantitis has the same negative impact on health as periodontitis. Through the inflamed tissue, bacteria can enter the bone and blood vessels in large numbers and lead to various diseases in the body. Thus, peri-implantitis is associated with diseases such as arteriosclerosis (heart attack, stroke), diabetes, osteoporosis, arthritis or rheumatism.

Patients also frequently complain of fatigue and lack of energy. The reason is the continuous activation of the immune system, which needs a lot of energy to fight off the bacterial invasion.

Since periodontitis has comparable effects, please read more about this in the article Holistic dentistry.

Therapy of periimplantitis


In general, the therapy of peri-implantitis should always include the bacterial flora, as this is the origin of the problem. This eliminates the destruction by the problematic bacteria and greatly decreases the production of a-MMP8.

Cleaning of the surface of the affected dental implants can be performed as a supportive measure. It is essential to ensure that no unnecessary titanium particles are released into the environment. The more titanium chips and particles there are in the peri-implant tissue, the more pronounced the inflammatory reaction.

If the degradation of the peri-implant tissue is too advanced, complete healing can no longer take place. In pronounced cases, the implant should be removed.

Peri-implantitis and periodontitis


In peri-implantitis, the inflammation is localized around the implants, and in periodontitis, the tissue around the teeth shows inflammation.

Both clinical pictures are the symptoms of the same cause. In both peri-implantitis and periodontitis, the main cause is pathogenic bacterial flora in the mouth. Consequently, the therapy is also the same: Improvement of the oral flora.

Existing periodontitis increases the risk that peri-implantitis will also develop after implant placement. Patients with periodontitis should improve oral flora and complete periodontitis treatment before placing implants.

Peri-implantitis and titanium implants


Titanium implants have the property of healing stably even though inflammation was left and work was not done cleanly when the implant was placed. Titanium implants can also remain in the jawbone for a long time without implant loosening, despite peri-implantitis.

As a result, massive inflammation can form around the titanium implant and the implant still remains immobile and stable.

This has the disadvantage that peri-implantitis can remain undetected for a long time and place a heavy burden on the body.

Titanium implants may promote peri-implantitis due to the following factors:

  • Titanium implants usually have a gap in the area of the bone edge. This gap can harbor bacterial biofilms and increase local inflammation.
  • Titanium is not rigid, but easily deformable. During chewing, the microscopic movements are transmitted to the jawbone, in the form of pressure. Pressure always leads to tissue breakdown, which automatically promotes an inflammatory process.
  • When titanium implants are placed, titanium particles are always released into the environment. The particles are taken up (phagocytosed) by macrophages in the peri-implant tissue, whereupon these release immune messengers into the environment. If the macrophages react with an increased immune response, the titanium stimulation test is positive.

The macrophages, after uptake of the titanium particles, always react with an inflammatory response. Provided you want to know whether this is mild or severe, you can have a titanium stimulation test performed.

Since titanium also contains elements such as nickel, aluminum or vanadium, it is possible to test whether there is an allergy to these additives. Testing is best done with a lymphocyte transformation test (LTT).

Peri-implantitis and ceramic implants


Peri-implantitis can also occur with ceramic implants. If the implantation is not performed properly and inflammation is not completely removed from the tissue, peri-implantitis will form and the ceramic implant will not heal. The implant will not have stability because it cannot heal bony. Consequently, it must be removed and reset.

Provided that the ceramic implant was inserted cleanly and the wound was completely cleaned and disinfected, ceramic implants heal without inflammation in the jawbone.

Reasons why ceramic implants are rarely affected by peri-implantitis:

  • The design of most ceramic implants has no creases. consequently, bacterial colonies cannot settle there.
  • Both gum and bone readily bond with the zirconia ceramic.
  • Ceramic is rigid and does not exhibit movement under masticatory forces. Consequently, there are no pressure peaks that degrade the jawbone.
  • Ceramics are neutral from the point of view of immunology and toxicology. No immune reaction takes place.

If a healthy oral flora is maintained and daily oral hygiene is performed correctly, ceramic implants can remain in the jaw for many decades, without complications.

FAQ about periimplantitis


What are the symptoms of peri-implantitis?

The symptoms of peri-implantitis can be:

  • Gum bleeding and pocket formation around the implant
  • Gum and bone recession
  • Bad breath
  • Pain or discomfort originating from the implant
  • Implant loosening and implant loss in the final stage
How can peri-implantitis be diagnosed?

The safest diagnostic method is still radiographic imaging. Dental films, panoramic images or 3D digital volume tomographies (DVT) can show the degradation of bone very well.

Is there an early diagnosis for peri-implantitis?

Even before peri-implantitis is visible on X-ray, a-MMP8 testing can provide a meaningful prognosis for peri-implantitis.

How can the production of a-MMP8 be reduced?

The most effective way is to improve the bacterial environment in the mouth.

How often does peri-implantitis occur?

In our practice we see peri-implantitis very rarely, provided that the patient follows the oral hygiene instructions and comes regularly for check-ups and prophylaxis sessions.

According to research, the incidence of inflammation on implants ranges from 10 to 65%.

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