Peri-Implantitis: A Review of the Disease and Report of a Case Treated with Allograft to Achieve Bone Regeneration
DOI:
https://doi.org/10.17140/DOJ-2-117Keywords:
Peri-implantitis, Defect fill, Surgery, Peri-implant mucositis, Bone grafting, Implant failureAbstract
Dental implants offer excellent tooth replacement options however; peri-implantitis can limit their clinical success by causing failure. Peri-implantitis is an inflammatory process around dental implants resulting in bone loss in association with bleeding an suppuration. Dental plaque is at the center of its etiology, and in addition, systemic diseases, smoking, and parafunctional habits are also implicated. The pathogenic species associated with peri-implantitis include, Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, and Tannerella forsythia. The goal in the management of peri-implantitis is the complete resolution of peri-implant infection with function. Therapies using various biomaterials to deliver antibiotics have been used in the treatment of peri-implantitis e.g. fibers, gels, and beads. The use of guided tissue regeneration barrier membranes loaded with antimicrobials has shown success in
re-osseointegrating the infected implants in animal models. Several uncertainties still remain regarding the management of peri-implantitis. The purpose of this article is to present a background of peri-implantitis along with a case of peri-implantitis successfully treated for bone regeneration.
References
Sheikh Z, Sima C, Glogauer M. Bone replacement materi-als and techniques used for achieving vertical alveolar bone augmentation. Materials. 2015; 8(6): 2953-2993. doi: 10.3390/ ma8062953
Sheikh Z, Glogauer M. Successful ridge augmentation: The challenge of periodontal tissue engineering. EC Dent Sci. 2015; 2: 216-218.
Rosenberg ES, Cho SC, Elian N, Jalbout ZN, Froum S, Evian CI. A comparison of characteristics of implant failure and sur-vival in periodontally compromised and periodontally healthy patients: A clinical report. The Int J Oral Max Fac Imp. 2004; 19(6): 873.
Snauwaert K, Duyck J, van Steenberghe D, QuirynenM, Naert I. Time dependent failure rate and marginal bone loss of implant supported prostheses: A 15-year follow-up study. Clinical oral investigations. 2000; 4(1): 13-20.
Esposito M, Hirsch J-M, Lekholm U, Thomsen P. Biological factors contributing to failures of osseointegrated oral implants, (II). Etiopathogenesis. European journal of oral sciences. 1998; 106(3): 721-764. doi: 10.1046/j.0909-8836..t01-6-.x
Klinge B, Hultin M, Berglundh T. Peri-implantitis. Dental Clinics of North America. 2005; 49(3): 661-676.
Berglundh T, Persson L, Klinge B. A systematic review of the incidence of biological and technical complications in implant dentistry reported in prospective longitudinal studies of at least 5 years. Journal of clinical periodontology. 2002; 29(s3): 197- 212. doi: 10.1034/j.1600-051X.29.s3.12.x
O’Mahony A, Spencer P. Osseointegrated implant failures. Journal of the Irish Dental Association. 1998. 45(2): 44-51.
Quirynen M, Vogels R, Peeters W. Dynamics of initial sub-gingival colonization of ‘pristine’peri-implant pockets. Clinical oral implants research. 2006; 17(1): 25-37. doi: 10.1111/j.1600- 0501.2005.01194.x
Quirynen M, De Soete M, Van Steenberghe D. Infectious risks for oral implants: A review of the literature. Clinical oral implants research. 2002; 13(1): 1-19. doi: 10.1034/j.1600- 0501.2002.130101.x
Romeo E, Ghisolfi M, Carmagnola D. Peri-implant diseases: A systematic review of the literature. Minerva stomatologica. 2004; 53(5): 215-230.
Tonetti MS. Determination of the success and failure of root-form osseointegrated dental implants. Advances in den-tal research. 1999; 13(1): 173-180. doi: 10.1177/089593749 90130010801
Piattelli A, Scaranoa A, Dalla Norab A, De Bonab G, Favero GA. Microscopical features in retrieved human Branemark im-plants: A report of 19 cases. Biomaterials. 1998; 19(7): 643-649. doi: 10.1016/S0142-9612(97)00158-0
Quirynen M, et al. The intra-oral translocation of periodon-topathogens jeopardises the outcome of periodontal therapy. Journal of Clinical Periodontology. 2001; 28(6): 499-507. doi: 10.1034/j.1600-051x.2001.028006499.x
Esposito M, Hirsch J, Lekholm U, Thomsen P. Differential diagnosis and treatment strategies for biologic complications and failing oral implants: A review of the literature. Interna-tional Journal of Oral and Maxillofacial Implants. 1999; 14(4): 473-490.
Teughels W, Van Assche N, Sliepen I, Quirynen M. Effect of material characteristics and/or surface topography on biofilm development. Clinical oral implants research. 2006; 17(S2): 68- 81. doi: 10.1111/j.1600-0501.2006.01353.x
Quirynen M, Teughels W. Microbiologically compromised patients and impact on oral implants. Periodontology 2000. 2003; 33(1): 119-128. doi: 10.1046/j.0906-6713.2003.03310.x
Tonetti MS. Risk factors for osseodisintegration. Peri-odontology. 2000; 1998. 17(1): 55-62. doi: 10.1111/j.1600- 0757.1998.tb00123.x
Lang NP, Lindhe J. Clinical periodontology and implant den-tistry. New York, USA: John Wiley & Sons; 2015
Sheikh ZA, Javaid A, Abdallah MA, Bone MN. Replace-ment Graft Materials in Dentistry. In: Khurshid SZ, ed. Dental Biomaterials (Principle and its Application). Karachi, Pakistan: Paramount Publishing Enterprise; 2013.
Zeeshan Sheikh MA. Hamdan N, Javaid MA, Khurshid Z. Barrier membranes for tissue regeneration and bone augmenta-tion techniques in dentistry in Handbook of Oral Biomaterials. In: Matilinna KP, ed. Singapore: Pan Stanford Publishing; 2014.
Tamimi F, Sheikh Z, Barralet J. Dicalcium phosphate ce-ments: brushite and monetite. Acta Biomater. 2012; 8(2): 474- 87.
Misch CE. Contemporary Implant Dentistry. Oxford, UK: Elsevier Health Sciences; 2007.
Mombelli A, Lang N. Antimicrobial treatment of peri-im-plant infections. Clinical oral implants research. 1992; 3(4): 162-168.
Tonetti MS, Schmid J. Pathogenesis of implant failures. Periodontology. 2000. 1994; 4(1): 127-138. doi: 10.1111/j.1600- 0757.1994.tb00013.x
Misch CE. Contemporary implant dentistry. Implant Den-tistry. 1999; 8(1): 90.
Rokn AR, Sajedinejad N, Yousefyfakhr H, Badri S. An un-usual bone loss around implants. Journal of Dentistry (Tehran, Iran). 2013; 10(4): 388.
Roller MB, Li Y, Yuan JJ. Implantable medical devices and methods for making same. 2009; Google Patents.
Costerton J, Montanaro L, Arciola C. Biofilm in implant in-fections: its production and regulation. The International jour-nal of artificial organs. 2005; 28(11): 1062-1068.
Ferreira S, Silva GL, Cortelli JR, Costa JE, Costa FO. Prev-alence and risk variables for peri-implant disease in Brazilian subjects. Journal of Clinical Periodontology. 2006; 33(12): 929- 935.
Ellegaard B, Baelum V, Karring T. Implant therapy in periodontally compromised patients. Clinical Oral Im-plants Research. 1997; 8(3): 180-188. doi: 10.1034/j.1600- 0501.1997.080304.x
Karoussis IK, Salvi GE, Heitz-Mayfield LJ, Brägger U, Hämmerle CH, Lang NP. Long-term implant prognosis in pa-tients with and without a history of chronic periodontitis: A 10 year prospective cohort study of the ITI® Dental Implant Sys-tem. Clinical Oral Implants Research. 2003; 14(3): 329-339. doi: 10.1034/j.1600-0501.000.00934.x
De Bruyn H, Collaert B. The effect of smoking on early im-plant failure. Clinical oral implants research. 1994; 5(4): 260- 264. doi: 10.1034/j.1600-0501.1994.050410.x
Bain CA, Moy PK. The association between the failure of dental implants and cigarette smoking. The International jour-nal of oral & maxillofacial implants. 1992; 8(6): 609-615.
Bain CA. Smoking and implant failure--benefits of a smok-ing cessation protocol. The International journal of oral & max-illofacial implants. 1995; 11(6): 756-759.
Quirynen M, Bollen C. The influence of surface roughness and surfacefree energy on supra and subgingival plaque forma-tion in man. Journal of clinical periodontology. 1995; 22(1): 1-14.
Weyant RJ. Characteristics associated with the loss and peri-implant tissue health of endosseous dental implants. The Inter-national journal of oral & maxillofacial implants. 1993; 9(1): 95-102.
Piattelli A, Cosci F, Scarano A, Trisi P. Localized chronic suppurative bone infection as a sequel of peri-implantitis in a hy-droxyapatite-coated dental implant. Biomaterials. 1995; 16(12): 917-920. doi: 10.1016/0142-9612(95)93116-U
Norowski PA, Bumgardner JD. Biomaterial and antibiotic strategies for periimplantitis: a review. Journal of Biomedical Materials Research Part B: Applied Biomaterials. 2009; 88(2): 530-543. doi: 10.1002/jbm.b.31152
Silverstein LH, Kurtzman D, Garnick JJ, Schuster GS, Steflik DE, Moskowitz ME. The microbiota of the peri-implant region in health and disease. Implant dentistry. 1994; 3(3): 170-175.
Heydenrijk K, Meijer HJ, van der Reijden WA, Raghoebar GM, Vissink A, Stegenga B. Microbiota around root-form en-dosseous implants: a review of the literature. The International journal of oral & maxillofacial implants. 2001; 17(6): 829-838.
Van Houte J. Role of micro-organisms in caries etiol-ogy. Journal of dental research. 1994; 73(3): 672-681. doi: 10.1177/00220345940730031301
Karbach J, Callaway A, Kwon YD, d’Hoedt B, Al-Nawas B. Comparison of five parameters as risk factors for peri-mucosi-tis. The International journal of oral & maxillofacial implants. 2008; 24(3): 491-496.
Takanashi K, Kishi M, Okuda K, Ishihara K. Colonization by Porphyromonas gingivalis and Prevotella intermedia from teeth to osseointegrated implant regions. The Bulletin of Tokyo Dental College. 2004; 45(2): 77-85. doi: 10.2209/tdcpublication.45.77
Heuer W, Elter C, Demling A, et al. Analysis of early biofilm formation on oral implants in man. Journal of oral rehabilita-tion. 2007; 34(5): 377-382.
Broggini N, , McManus LM, Hermann JS, et al. Peri-im-plant inflammation defined by the implant-abutment inter-face. Journal of Dental Research. 2006; 85(5): 473-478. doi: 10.1177/154405910608500515
Meffert R. Periodontitis vs. peri-implantitis: the same disease? The same treatment? Critical Reviews in Oral Biology & Medi-cine. 1996; 7(3): 278-291. doi: 10.1177/10454411960070030501
Listgarten MA. Microorganisms and dental implants. Jour-nal of periodontology, 1999; 70(2): 220-222.
Mombelli A. Microbiology of the dental implant. Advances in dental research, 1993; 7(2): 202-206.
Sbordone L, Bortolaia C. Oral microbial biofilms and plaque-related diseases: microbial communities and their role in the shift from oral health to disease. Clinical oral investigations, 2003; 7(4): 181-188. doi: 10.1007/s00784-003-0236-1
George K, Zafiropoulos GGK, Murat Y, Hubertus S, Nisen-gard RJ. Clinical and microbiological status of osseointegrated implants. Journal of periodontology, 1994; 65(8): 766-770. doi: 10.1902/jop.1994.65.8.766
Mombelli A, an Oosten MA, Schurch E Jr, Land NP. The microbiota associated with successful or failing osseointegrated titanium implants. Oral microbiology and immunology, 1987; 2(4): 145-151.
Wingrove SS. Peri-implant therapy for the dental hygienist: clinical guide to maintenance and disease complications. 2013: John Wiley & Sons.
Mombelli A, Lang NP. The diagnosis and treatment of peri-implantitis. Periodontology 2000. 1998; 17(1): 63-76. doi: 10.1111/j.1600-0757.1998.tb00124.x
Mombelli A. Etiology, diagnosis, and treatment consider-ations in peri-implantitis. Current opinion in Periodontology. 1996; 4: 127-136.
RoosJansåker AM, Almhöjd US, Jansson H. Treatment of peri-implantitis: clinical outcome of chloramine as an adjunctive to non-surgical therapy, a randomized clinical trial. Clinical oral implants research. 2015. doi: 10.1111/clr.12612
Meffert RM, Langer B, Fritz ME. Dental implants: a review. Journal of periodontology. 1992; 63(11): 859-870.
Jepsen S, Berglundh T, Genco R, et al. Primary prevention of peri-implantitis: Managing peri-implant mucositis. Journal of clinical periodontology. 2015; 42(S16): S152-S157. doi: 10.1111/jcpe.12369
Dewan SK, Arora A, Sehgal M, Khullar A. Implant failures: a broader perspective. Journal of Dental Implants. 2015; 5(1): 53-59.
Van Steenberghe D, Naert I, Jacobs R, Quirynen M. Influ-ence of inflammatory reactions vs. occlusal loading on peri-im-plant marginal bone level. Advances in dental research. 1999. 13(1): 130-135. doi: 10.1177/08959374990130010201
Roos-Jansåker AM, Renvert S, Egelberg J. Treatment of peri-implant infections: a literature review. Journal of clinical periodontology. 2003; 30(6): 467-485.
Lang NP, Mombelli A, Tonetti MS, Brägger U, Hämmerle CH. Clinical trials on therapies for peri-implant infections. An-nals of Periodontology. 1997. 2(1): 343-356.
Renvert S, Polyzois IN. Clinical approaches to treat peri-implant mucositis and peri implantitis. Periodontology 2000. 2015; 68(1): 369-404.
Pihlstrom BL, Michalowicz BS, Johnson NW. Periodontal diseases. The Lancet. 2005; 366(9499): 1809-1820.
Matarasso S, Quaremba G, Coraggio F, Vaia E, Cafiero C, Lang NP. Maintenance of implants: an in vitro study of titanium implant surface modifications subsequent to the application of dif-ferent prophylaxis procedures. Clinical oral implants research. 1996; 7(1): 64-72. doi: 10.1034/j.1600-0501.1996.070108.x
McCollum J, O’Neal RB, Brennan WA, Van Dyke TE, Horn-er JA. The effect of titanium implant abutment surface irregular-ities on plaque accumulation in vivo. Journal of periodontology. 1992; 63(10): 802-805. doi: 10.1902/jop.1992.63.10.802
Schenk G, Flemmig TF, Betz T, Reuther J, Klaiber B. Con-trolled local delivery of tetracycline HCl in the treatment of pe-riimplant mucosal hyperplasia and mucositis: A controlled case series. Clinical oral implants research. 1997; 8(5): 427-433.
Garrett S, Adams DF, Bogle G, et al. The effect of locally delivered controlled-release doxycycline or scaling and root planing on periodontal maintenance patients over 9 months. Journal of periodontology. 2000; 71(1): 22-30. doi: 10.1902/ jop.2000.71.1.22
Pedrazzoli V, Kilian M, Karring T. Comparative clinical and microbiological effects of topical subgingival application of metronidazole 25% dental gel and scaling in the treatment of adult periodontitis. Journal of clinical periodontology. 1992; 19(9): 715-722. doi: 10.1111/j.1600-051X.1992.tb02534.x
Hill M, Moore R. Locally acting oral chemotherapeutic agents. Periodontics. Medicine, surgery, and implants. In: Rose L, Mealey B, eds. St. Louis, MO, USA: Elsevier Mosby; 2004: 276-287.
Mombelli A, et al. Treatment of peri-implantitis by local de-livery of tetracycline. Clinical Oral Implants Research. 2001. 12(4): 287-294.
Jeffcoat MK, Bray KS, Ciancio SG, et al. Adjunctive use of a subgingival controlled-release chlorhexidine chip reduces prob-ing depth and improves attachment level compared with scaling and root planing alone. Journal of periodontology. 1998; 69(9): 989-997. doi: 10.1902/jop.1998.69.9.989
Salvi GE, Persson GR, Heitz-Mayfield LJ, Frei M, Lang NP. Adjunctive local antibiotic therapy in the treatment of peri-implantitis II: Clinical and radiographic outcomes. Clinical oral implants research. 2007; 18(3): 281-285. doi: 10.1111/j.1600- 0501.2007.01377.x
Killoy WJ. Chemical treatment of periodontitis: local de-livery of antimicrobials. International dental journal. 1998; 48(S3): 305-315.
Rose LF. Periodontics: medicine, surgery, and implants. 2004: Mosby Incorporated.
Mombelli A, Lehmann B, Tonetti M, Lang NP. Clinical response to local delivery of tetracycline in relation to overall and local periodontal conditions. Journal of clinical periodon-tology. 1997; 24(7): 470-477. doi: 10.1111/j.1600-051X.1997. tb00214.x
Fourmousis I, Tonetti MS, Mombelli A, Lehmann B, Lang NP, Brägger U. Evaluation of tetracycline fiber therapy with digital image analysis. Journal of clinical periodontology. 1998; 25(9): 737-745. doi: 10.1111/j.1600-051X.1998.tb02515.x
Mombelli A. Microbiology and antimicrobial therapy of peri-implantitis. Periodontology 2000. 2002; 28(1): 177-189. doi: 10.1034/j.1600-0757.2002.280107.x
Zybutz MD, Laurell L, Rapoport DA, Persson GR. Treat-ment of intrabony defects with resorbable materials, non-re-sorbable materials and flap debridement. Journal of clinical periodontology, 2000; 27(3): 169-178. doi: 10.1034/j.1600- 051x.2000.027003169.x
Park YJ, Lee YM, Park SN, et al. Enhanced guid-ed bone regeneration by controlled tetracycline re-lease from poly (L lactide) barrier membranes. Jour-nal of biomedical materials research. 2000; 51(3): 391-397. doi: 10.1002/1097-4636(20000905)51:3<391::AID-JBM13>3.0.CO;2-9
Chang CY, Yamada S. Evaluation of the regenerative ef-fect of a 25% doxycycline-loaded biodegradable membrane for guided tissue regeneration. J Periodontol. 2000; 71(7): 1086- 1093. doi: 10.1902/jop.2000.71.7.1086
Chen YT, Hung SL, Lin LW, Chi LY, Ling LJ. Attachment of periodontal ligament cells to chlorhexidine-loaded guided tissue regeneration membranes. J Periodontol. 2003; 74(11): 1652- 1659. doi: 10.1902/jop.2003.74.11.1652
Kurtis B, Unsal B, Cetiner D, et al. Effect of polylactide/ glycolide (PLGA) membranes loaded with metronidazole on periodontal regeneration following guided tissue regeneration in dogs. J Periodontol. 2002; 73(7): 694-700. doi: 10.1902/ jop.2002.73.7.694
Sheikh Z, Zhang YL, Grover L, Merle GE, Tamimi F, Bar-ralet J. In vitro degradation and in vivo resorption of dicalcium phosphate cement based grafts. Acta biomaterialia. 2015; 26: 338-346. doi: 10.1016/j.actbio.2015.08.031
Roos Jansåker AM, Renvert H, Lindahl C, Renvert S. Sur-gical treatment of peri-implantitis using a bone substitute with or without a resorbable membrane: A prospective cohort study. Journal of clinical periodontology. 2007; 34(7): 625-632. doi: 10.1111/j.1600-051X.2007.01102.x
Laurencin C, Khan Y, El-Amin SF. Bone graft substitutes. Expert review of medical devices. 2006; 3(1): 49-57. doi: 10.1586/17434440.3.1.49
Giannoudis PV, Dinopoulos H, Tsiridis E. Bone substitutes: an update. Injury. 2005; 36(3): S20-S27.
Goldberg VM. Natural history of autografts and allografts. Bone implant grafting. 1992; 9-12. doi: 10.1007/978-1-4471- 1934-0_2
Sheikh Z, Javaid MA, Hamdan N, Hashmi R. Bone regen-eration using bone morphogenetic proteins and various bioma-terial carriers. Materials. 2015; 8(4): 1778-1816. doi: 10.3390/ ma8041778
Albrektsson T, Johansson C. Osteoinduction, osteoconduc-tion and osseointegration. European Spine Journal. 2001; 10(2): S96-S101. doi: 10.1007/s005860100282
Buckwalter J, Glimcher MJ, Cooper RR, Recker R. Bone bi-ology. II: formation, form, modeling, remodeling, and regulation of cell function. J Bone Joint Surg Am. 1995; 77(8): 1276-1289.
Linde A, Alberius P, Dahlin C, Bjurstam K, Sundin Y. Os-teopromotion: A Soft-Tissue Exclusion Principle Using a Mem-brane for Bone Healing and Bone Neogenesis. J Periodontol. 1993. 64(11s): 1116-1128. doi: 10.1902/jop.1993.64.11s.1116
Schwartz Z, Mellonig JT, Carnes DL Jr, et al. Ability of commercial demineralized freeze-dried bone allograft to induce new bone formation. J Periodontol. 1996; 67(9): 918-926. doi: 10.1902/jop.1996.67.9.918
Taylor TD, Agar JR. Twenty years of progress in implant prosthodontics. The Journal of prosthetic dentistry. 2002; 88(1): 89-95. doi: 10.1067/mpr.2002.126818
Smith DE, Zarb GA. Criteria for success of osseointegrated endosseous implants. The Journal of prosthetic dentistry. 1989; 62(5): 567-572.
KimYK, Park JY, Kim SG, Lee HJ. Prognosis of the im-plants replaced after removal of failed dental implants. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology. 2010; 110(3): 281-286. doi: 10.1016/j.tri-pleo.2010.01.031
Al-Sabbagh M. Complications in implant dentistry. Dental Clinics. 2015; 59(1): 13-15.
El Askary AS, Meffert RM, Griffin T. Why do dental im-plants fail? Part I. Implant dentistry. 1999; 8(2): 173-185.
Misch CE. Dental Implant Prosthetics. Oxford, UK: Elsevier Health Sciences; 2014.
Duyck J, Naert I. Failure of oral implants: aetiology, symp-toms and influencing factors. Clinical oral investigations. 1998; 2(3): 102-114.
Polizzi G, Grunder U, Goené R, et al. Immediate and de-layed implant placement into extraction sockets: A 5 year report. Clin Implant Dent Relat Res. 2000; 2(2): 93-99.
Bergström J, Eliasson S, Preber H. Cigarette smoking and periodontal bone loss. J Periodontol. 1991; 62(4): 242-246. doi: 10.1902/jop.1991.62.4.242
Norderyd O, Hugoson A, Grusovin G. Risk of severe periodontal disease in a Swedish adult population. J Clin Peri-odontol. 1999; 26(9): 608-615. doi: 10.1111/j.1600-051X.1998. tb02408.x
Papapanou PN. Periodontal diseases: epidemiology. Ann Periodontol. 1996; 1(1): 1-36.
Gorman M, Lambert PM, Morris HF, Ochi S, Winkler S. The effect of smoking on implant survival at second-stage sur-gery: DICRG interim report no. 5. Implant dentistry. 1994; 3(3): 165.
Khoury F, Buchmann R. Surgical therapy of peri-implant disease: a 3-year follow-up study of cases treated with 3 dif-ferent techniques of bone regeneration. J Periodontol. 2001; 72(11): 1498-1508. doi: 10.1902/jop.2001.72.11.1498
Charalampakis G, Rabe P, Leonhardt A, Dahlén G. A followup study of peri-implantitis cases after treatment. J Clin Periodontol. 2011; 38(9): 864-871. doi: 10.1111/j.1600- 051X.2011.01759.x
Downloads
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution 4.0 International License.
All content published in Dentistry (DOJ) is licensed under the Creative Commons Attribution 4.0 International License (CC BY 4.0). This license allows anyone to copy, distribute, transmit, and adapt the work — including for commercial purposes — provided appropriate credit is given to the original author(s) and source.
