Peri-implantitis continues to remain prevalent among implant patients, causing considerable complications to the individual. The advanced inflammation it elicits has been shown to induce pathological changes at the interface between the implant and surrounding tissue, inducing resorption of the alveolar bone in which the implant is anchored and ultimately causing failure. Bacterial accumulation and the rate and extent of destruction it causes is thought to be considerably greater around implants than natural teeth. Therefore, getting your patients to look after their oral health is consequently vital for achieving a successful outcome and avoiding the development of peri-implantitis (Atsuta et al, 2016).

Periodontitis

Peri-implant mucositis is believed to be the precursor to peri-implantitis, as is gingivitis for periodontitis. Likewise, a continuum exists from healthy peri-implant mucosa to peri-implant mucositis and peri-implantitis (Derks et al, 2016). It is characterised by inflammation in peri-implant tissues and a loss of supporting bone. However, as yet there is no established and predictable concepts for its treatment, therefore primary prevention is of key importance (Jepsen et al, 2015).

In the absence of good oral hygiene, dental plaque can accumulate around the teeth and implants, triggering a broad inflammation of the oral mucosa, despite the protection of epithelium-hard tissue interfaces that provide both mechanical and biological defence elements. Research has shown that inflammation of the periodontal and peri-implant tissue occurs in as little as three weeks after plaque deposition and appears to be caused by very similar bacteria. However, pocket formation and bone resorption around the implant seems almost inevitable, as the rate and extent of destruction bacteria accumulation causes is greater around implants than natural teeth. The pockets that form around the implant are the result of epithelial down-growth at the soft tissue-implant interface. They produce an area where anaerobic bacteria can accumulate and be sheltered from mechanical cleaning, thus causing inflammation (Atsuta et al, 2016).

Effective cleaning agents

It is important to recognise the limited sealing capacity of peri-implant tissue and the need to provide patients with regular monitoring of their dental health after implantation. Successful treatment of peri-mucosa requires the effective teaching of oral hygiene skills, very thorough removal of supra- and subgingival biofilms (plaque and calculus) and a supportive care programme4. Recommending effective and easy to use adjuncts, such as the Waterpik Water Flosser, can help to improve compliance. The Waterpik Water Flosser has been proven significantly more effective than string floss for improving gingival health around implants.

The oral cavity is constantly exposed to attack from physical, chemical and bacterial insults. Research has shown that accumulation of bacteria and the rate and extent of destruction it causes is considerably greater around implants than natural teeth. Therefore finding ways to encourage and emphasise meticulous oral hygiene practices among patients is of extreme importance in order to avoid the development of peri-implantitis.


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References

Atsuta I, Ayukawa Y, Kondo R, Oshiro W, Matsuura Y, Furuhashi A, Tsukiyama Y and Koyano K (2016) Soft tissue sealing around dental implants based on histological interpretation. Journal of Prosthodontic Research, 60 (1): 3-11

Derks J, Schaller D, Hâkansson J, Wennström J, Tomasi C and Berglundh T (2016) Peri-implantitis – onset and pattern of progression. J Clin Periodontol 43: 383-8

Jepsen S, Berglundh T, Genco R, Aass A, Demirel K, Derks J, Figuero E, Giovannoli J, Goldstein M, Lambert F, Ortiz-Vigon A, Polyzois I, Salvi G, Schwarz F, Serino G, Tomasi C and Zitzmann N (2015) Primary prevention of peri-implantitis: Managing peri-implant mucositis. J Clin Periodontol 42: S152-7