By Dr. Stacey Matheson
Five million implants are placed every year in the U.S., according to Google. Peri-implant tissues must be inspected regularly and can be diagnosed as healthy, or as having peri-implant mucositis or peri-implantitis. The 2018 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions has established clear case definitions for all of these peri-implant conditions.
- Health: Absence of inflammation, absence of bleeding or suppuration on gentle probing, no increase in probing depths compared to previous examinations, and absence of bone loss beyond the crestal bone level changes resulting from initial bone remodelling. There is an allowance for 1 bleeding point around the tooth.1
- Peri-implant mucositis: A reversible inflammatory state where there is presence of bleeding and/or suppuration on gentle probing with or without increased probing depth compared to previous examinations, and absence of bone loss beyond the crestal bone level changes resulting from initial bone remodelling.
- Peri-implantitis: An irreversible inflammatory state where there is presence of bleeding and/or suppuration on gentle probing, increased probing depths compared to previous examinations, and presence of bone loss beyond crestal bone level changes resulting from initial remodelling.
Peri-implantitis can lead to loss of the dental implant. This state progresses in a non-linear fashion and at a much faster rate than periodontitis. As such, it is critical to pick up peri-implant problems early. Baseline data should be recorded once the implant is restored, including probing depth and radiographic bone height against which all future measurements would be compared.
Moreover, all implant patients should be placed on a maintenance program (every three to six months) immediately upon implant restoration in order to prevent disease around the implant. Patients who comply to regular professional maintenance have a much lower likelihood of developing irreversible problems. Indeed, patients with peri-mucositis who do not have regular professional implant maintenance are 43% more likely to develop peri-implantitis, and only 18% who have regular implant maintenance by a dental professional develop peri-implantitis.2
What should we look for during an implant recall examination? Try this 12-point inspection:
1. Probing depth* ***
2. Bleeding on probing*
3. Suppuration**
4. Keratinized tissue
5. Recession
6. Occlusion
7. Interproximal contacts
8. Embrasure spaces
9. Mobility
10. Condition of the prosthesis
11. Plaque biofilm
12. Radiograph***
* Use a metal or plastic probe with gentle force
** Suppuration on probing or by milking the tissues
*** Compare to baseline
After the 12-point inspection, clean-check-clean, educate, motivate, and book the next recall appointment.
For the next issue of Nova Scotia Dentist, I will focus on profession cleaning and home care of dental implants. Stay tuned!
References
1 Herrera et al. Prevention and treatment of peri-implant diseases — The EFP S3 level clinical practice guideline. J Clin Periodontol. 2023;50(Suppl. 26):4-76.
2 Jepsen et al. Primary prevention of peri-implantitis: managing peri-implant mucositis. J Clin Periodontol. 2015;42 (Suppl. 16):152-7. doi: 10.1111/jcpe.12369
Dr. Stacey Matheson is a board-certified periodontist in Halifax and has enjoyed serving Atlantic Canada for more than 20 years.
