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Fast Facts: Perio Edition – Dental Implants: Peri-Implantitis

Fast Facts: Perio Edition Episode 74
[Andrew Johnston, RDH]
Welcome back everyone! You are listening to another episode of Fast Facts- Perio Edition brought to you by A Tale of Two Hygienists in partnership with DentistRX. And now, please welcome your host, Katrina Sanders.
[Katrina Sanders, RDH]
Hello, and welcome to Fast Facts: Perio Edition. This week, we are probing deeper, pun intended, into peri-implant diseases and today’s program is going to focus on peri-implantitis. Remember, dental implants have now been in the mouth long enough to develop disease around them. And so, in 2017, the American Academy of Periodontology began to describe the definition of peri-implantitis. They describe peri-implantitis as a pathological condition that occurs in the tissues that surround the dental implant, beginning with inflammation around that peri-implant connective tissue, and then, of course, progressing into loss of supportive bone.
Now, this is a tough one because it is acknowledged in several research pieces that we still really don’t understand what constitutes a physiological pocket depth at an implant site. We know that there’s a high degree of variation around a healthy dental implant. When we talk about a vertical mucosal thickness. We know depending on how deep into the tissue and implant is placed or the color of tissue around an abutment, can certainly impact this. And so identifying peri-implantitis in its earliest stages can be a bit difficult.
A few interesting comparisons I found… At the histological level, when we compare peri-implantitis sites to periodontitis sites, we actually find that there are higher inflammatory lesions around peri-implantitis sites. And in fact, we found that patients who have peri-implantitis, that in these sites, we do see higher concentrations of oral bacteria, but also opportunistic pathogens like Pseudomonas aeruginosa and Staphylococcus aureus, even fungal infections like Candida and viruses like cytomegalovirus or Epstein Barr virus, which we know can contribute to and make the management of peri-implant disease a bit more complex.
In the surgical space, we do find that surgically, when a peri-implantitis site is opened up, that pattern of bone loss is actually oftentimes circumferential. Meaning, yes, we can see those opportunities where there are angular defects, but in many cases, that pattern of bone loss is obliterated bone completely circumferential around the neck of the peri-implant site.
We’ve found, of course, as one would imagine, that patients who present with peri-implantitis are oftentimes patients who are not maintaining or sustaining regular maintenance care. In fact, a five year research study found that patients with peri-implantitis are lower in concentration, about 18% of patients who have a regular maintenance program may develop peri-implantitis, versus 43% of patients who do not present with a regular maintenance care.
We see strong evidence that demonstrates an increased risk for peri-implantitis patients when they have a history of previous chronic periodontitis or when they have poor plaque control. We also are starting to look at some of the data around tobacco and diabetes as potential risk factors. Katrina, did you just say potential? Yes, you’re right, because currently, the data around tobacco status and diabetes as risk factors or indicators for peri-implantitis are actually inconclusive. We’ve seen some areas, a number of authors have started to indicate that patients with diabetes could be at a higher risk for peri-implantitis. However, we still do not have definitive data. Again, there’s limited evidence that shows a link between peri-implantitis and tobacco status. So stay tuned as we unpack that a bit more. And there is limited evidence that shows that peri-implantitis can be linked to other factors, things like the presence of submucosal cement. Ugh, how frustrating is that as a hygienist, right? Lack of peri-implant, keratinized mucosa, positioning of the implants, and of course, the degree of ability of our patient to be able to perform oral hygiene and maintenance on the dental implant.
Dental implants, we know are absolutely critical for sustaining masticatory function for our patients, and our ability to ensure that we’re keeping these dental implants maintained and sustained within the periodontium is absolutely critical. Thank you for joining me this week as we unpacked everything there is to know about peri-implantitis from our friends at the AAP. Stay tuned next time as we unpack peri-implant soft and hard tissue deficiencies.
This has been another episode of Fast Facts – Perio Edition with Katrina Sanders, RDH. Please feel free to reach me on Instagram @thedentalwinegenist or on my website Cheers.
[Andrew Johnston, RDH]
Thank you for listening to another episode of Fast Facts – Perio Edition, brought to you in part by DentistRX makers of the InteliSonic line of power brushes. Find out more by visiting their website at We’ll see you next week for another Fast Fact!

Resource: ​​
Renvert, Stefan, G. Rutger Persson, Flavia Q. Pirih, and Paulo M. Camargo. “Peri-implant health, peri-implant mucositis, and peri-implantitis: Case definitions and diagnostic considerations.” Journal of clinical periodontology 45 (2018): S278-S285.

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