Risk factors of peri-implant disease:
The principal risk factors for peri-implantitis include sub-optimal oral hygiene, a history of periodontal disease and cigarette smoking.
Diagnosis of peri-implant disease:
Early diagnosis is essential. Probing (using a light force – 0.24 N) is imperative for the diagnosis of peri-implant diseases and does not damage the peri-implant tissues. Metal probes can be used. Bleeding on probing indicates presence of inflammation in the peri-implant mucosa and may be used as a predictor for loss of tissue support. An increase in probing depth over time is associated with loss of attachment and bone. Radiographs are essential to evaluate bone levels around implants. However, accurate diagnosis may be challenging as probing implants can be difficult due to their super-structure design (e.g. bulky emergence profiles and long contact points with no embrasure space for oral hygiene) and radiographs only provide a 2D view.
Definitions of peri-implant disease:
Peri-implant mucositis can be defined as an inflammatory process in the soft tissues surrounding an implant. The vast majority of cases are actually irreversible and this condition is far more difficult to treat when compared to gingivitis. Peri-implantitis is an irreversible process and can be diagnosed if there has been 1 mm or more of bone loss after the first year of installation together with bleeding and/or suppuration (Sanz & Chapple 2012).
When are implants an option?
Careful case selection for implant therapy is imperative. Implants are not appropriate for all patients and situations. Several studies demonstrate that periodontally compromised teeth survive longer than new implants when treated and therefore implants are not a replacement for teeth, they are a replacement for missing teeth..
When should we start screening for periodontitis?
Clerehugh (1990) has shown that chronic disease begins in adolescence. As suggested by the BSP guidelines, we need to start screening at the age of 7 to check for any bleeding/calculus deposits. Use a simplified BPE by probing the first molars and central incisors. BPE codes 0, 1 and 2 should be used in those aged 7-11 (mixed dentition stage). The full range of BPE codes can be used for those 12 and over, again just on 1st molars and incisors.
The onset, the biofilm and host factors:
A health promoting biofilm is important in maintaining periodontal health. However, if this biofilm is not disrupted on a regular basis, it becomes dysbiotic and pathogens begin to emerge. Pathogens irritate the lining epithelium and cause inflammation in the connective tissue i.e. gingivitis. Gingivitis is reversible in the vast majority of individuals, but in some cases it will progress to periodontitis. 80% of the tissue damage in periodontitis is caused by the host response. Therefore, if we do not modify/control the host risk factors, we will not successfully manage this disease in high risk individuals.