Looking after and maintaining dental implants

As discussed above, this condition may be the first sign that the gum or mucosa around the implant is not in perfect health. Inflammation may be present, with bleeding and pocket formation, and the mucosal attachment to the titanium abutment may have become weakened. Typically, when probing around the implant there will be spontaneous bleeding and the mucosa may be tender. The gum is more red/mauve and less pink in colour. However the bone underneath is unaffected and there is no evidence of pus or an infection.

The condition is better treated conservatively with antimicrobial solutions and topical antibiotics. Advice on different ways to clean the area may be needed and alternative technology supplied to produce better levels of oral hygiene. Any possible causes for the inflammation such as excess dental cement may need to be addressed to prevent recurrence. In any event, close monitoring and repeat therapy may be indicated occasionally.

Peri-implantitis is quite similar to periodontal (gum) disease around the teeth. There will be mucositis (see above; peri-implant mucositis) but with underlying infection (pus) and a loss of bone around the implant itself. An X-ray will confirm this. Other relevant factors are smoking, poor oral hygiene and systemic conditions such as diabetes.

The treatment for peri-implantitis is initially similar to that for peri-implant mucositis, i.e. irrigation under the gum with antimicrobial agents but also with the topical application of antibiotic gels below the gum and into the pockets that form deeper down into the bone.

If the more conservative treatment fails to remove the infection or if the disease has progressed too far then surgical decontamination is required. This involves raising the gum, just as at the implant placement stage, to remove the inflamed and infected tissue from around the implant(s) and to decontaminate the surface of the implant(s) which may be compromised. It might be necessary to undertake some form of bone grafting to repair any resultant defects. Local anaesthetic is usually fine, just as with implant placement, but sometimes sedation might be used at the same time.

In cases where the bone loss around the implants renders the area impossible to stabilise then the implants will need to be removed. We can often repair the damage and subsequently replace the implant(s), thus restoring you to full dental health. You would then remain on regular recalls to ensure that the disease is kept at bay and does not affect your new implant(s).