Dental Implant Infection

Peri-mucositis

This is the less serious condition. The implant is still covered by the bone (i.e. no bone-loss occured) and a very small portion is covered by the gingival tissue (gums).

The gingival sulcus harbors a greater load of microbial species which multiplies and gets adhered to the tissue, causing its destruction by liberating the toxins.

This causes inflammation in the region of the implant around the sulcus initially, which is termed as peri-mucositis.

If left untreated, peri-mucositis might lead to the other, more serious, implant infection: peri-implantitis.

Peri-implantitis

When larger area of the bone covering the implant gets infected, it is called peri-implantitis. This results from peri-mucositis if it is ignored over a period of time.

Peri-implantitis may appear as a painful condition and may even show mobility of the implant. The signs and symptoms depends upon the severity and the grade of the condition.

• Pain and discomfort: Pain and tenderness is seen in almost every case of implant infection. This occurs due to the chemical mediators released at the site of infection. Because of the pain, it even becomes uncomfortable to chew. Loosened implants causes discomfort.
• Swelling and redness: Swelling and redness occurs due to the pathogenic reactions causing the stasis of the blood flow and also the bacterial by-products initiates the microbiological reactions.
• Bleeding: Bleeding from the pockets or gingival sulcus may be seen. It is mostly seen at the initial stages. It becomes more noticeable while brushing or swallowing.
• Pus discharge: Pus discharge from the pockets is seen in later stages. Foul smelling discharge from the site of implant indicates the pus formation and peri-implantitis.
• Mobility of the implant: Loosened implant may or may not be seen in implant infection case. Few cases shows no mobility at all, whereas sometimes implants became so mobile that the implant itself falls off from the mouth.
• Fever: Fever is seen in acute dental implant failure cases. Fever is usually accompanied by redness, swelling and discomfort. Fever alone itself does not point towards implant failure. It is always seen in association with other signs.
• Bone infection: Bony tissue adjacent to the site of the implant infection gets affected. This is the reason which causes the implant to loosen up as the anchorage is lost.

The most important risk factors are:

• Neglected oral hygiene: This can lead to bacteria build-up in the mouth, which might cause the inflammation of the implant.
• No regular check-ups at the dentist: A dentist can spot early signs of implant infections and treat them well before the infection escalates, causing more serious problems.
• Smoking: Smoking is very detrimental not only to your general health, but to your oral health too. Smoking accumulates plaque build-up, which facilitates the grow of harmful bacteria in your mouth.
• Uncontrolled diabetes: Bone growth and osseointegration is always slower and the risk of failure is higher if a diabetes is uncontrolled.

As you'll see below, it's a lot easier (and more successful) to treat simple and mild infections, so it's very important to diagnose a possible infection in time. That is why most dentists require you to go to one or two check-ups each year after a dental implant treatment.

The treatment of tooth implant infection depends upon the severity and the level of infection.

Simple swelling and redness with mild irritation around the implant surface externally with no other signs can be treated by simple cleaning the pocket and irrigating with antibiotic solution.

Chlorhexidine chips are also available which are placed inside the pocket which gets dissolved within 2 weeks. Other sustained releaseantibiotics are also available to maintain the healthy environment.

Mild infections can be treated by simple antibiotic course and mouth-rinses.

Soft tissue attachment loss in the initial stages can be treated by local antibiotics therapy like tetracyline fibers. This has also shown improved attachment levels of the tissue by slowing down the disintegration of the collagen fibers at the site of infection.

Other treatment options include surgical intervention which aims at cleaning the area around the implants. The implant site is explored surgically and the surface is cleaned mechanically with special instruments designed to clean the implant surface without causing any damage to it.

Recently laser therapy has also been used instead of the surgical intervention. The advantage of the laser therapy is that it is less violent and the treatment outcome is the same as in conventional surgical procedure.

Laser beam is directed to the focus on the site, it dissolves the dead tissue and helps the implant to get rid of the pathogenic micro-organisms and toxins.

Severe cases may show bone loss around the implant infection site, which hampers the stability of the implant and it becomes wobbly. These type of implant infection cannot be simply treated by antibiotics and simple debridement.

These cases require bone grafting, as the volume of the bone is not sufficient to firmly hold the implant. The bone graft commonly used is cancellous bone graft which is available in powdered form or chips. It is mixed with the normal saline or blood and is placed only after removing the infected tissue and cleaning the infectious site.

Few variety of grafts has osteogenic potential that can form bone cells which accelerates the bone formation process around the implant thereby increasing the survival rate of previously infected implant..

Rarely, aggressive infections which involves large amount of bone causes osteomyelitis. This often causes the implant to fall off.

Such cases require the treatment of osteomyelitis with aggressive intravenous antibiotic therapy and surgical intervention is required to remove the dead bone. The healing of the tissue and general health becomes the primary target. Implants are placed only after the tissues has completely healed.

Osteomyelitis is seen in patients who are:

• immune depleted
• patients under immuno-suppressive treatment
• patients under radiation therapy in head, neck and face area: Osteoradionecrosis occurs where the healing is greatly affected due to the restricted blood flow

To sum up, dental implant infection treatment depends upon the various factors which comes into play like patient's age, generalized health, previous medical history, oral health and hygiene, habits, socio-economic status etc.

Locally, the stage of implant infection, health of the gums, amount of bone loss, attachment levels of the periodontal tissues, site of the implant are considered. The combination of various therapies may be required to attain the best results, no two cases are the same.

Mild dental implant infections, as in peri-mucositis, can be saved if taken care of and maintained properly.

Peri-implantitis with very little amount of surface area involved can also be saved successfully with the proper treatment plan.

Infection associated with little amount of bone loss can be saved with bone graft but the outcome is questionable. It may work for few patients successfully and few may complain of loosened implant over a period of time.

Severe infection with mobile implants showing greater amount of bone loss should be removed and the replacement of the implant is done only after the tissues have healed completely.

Single implants used to replace single missing tooth shows greater chances of survival with better treatment outcomes.

When the patient has multiple implants supporting bridges or full mouth implant supported dentures, the chance of a successful treatment is smaller. This is because the stresses and load acting on the implants are greatly increased in this case.

It is important to know that deeper the infection is and greater the stresses on the implant are, the smaller the chances are to save the implant.

Implant infection can be prevented by taking care of your oral health.

Proper maintenance of oral hygiene has a direct relation with the outcome of the treatment. Even if any discomfort is encountered, proper treatment in initial stages
can greatly improve the prognosis and success rate of the implant.

Choosing the appropriate implant also affects the success rate. In case a patient has periodontal conditions, zirconia implants should be considered, because zirconia implant is single piece and metal free, it does not retain any plaque on its surface. This helps in maintaining the health of the gingival tissue.

Titanium implants are two pieced and the joint may serve as the retentive site for the plaque and growth of anaerobes. So, they should be kept clean.

Single missing tooth replaced with an implant is easier to maintain as it requires normal oral hygiene practice.

Implant supported bridges and full mouth denture implants requires proper cleaning methods and brushing techniques as the area beneath the artificial crowns may provoke infection.

Professional cleaning and regular dental visits are advised to avoid dental implant infection and treat at early stages.

Can dental implant infection occur years after the surgery?
Yes, implant infection can occur anytime. Whenever the conditions are favorable for the pathogens to multiply, they grow rapidly in the favorable environment and are capable of causing infections even after years of implant placement if oral hygiene is not maintained.

How long does it taken to heal the dental implant infection completely?
Very mild infection with slight irritation due to plaque subsides can be cured within a week after plaque removal. Few cases may take 1 or 2 months.

Dental implant infection treated with bone grafts take longer time as much as 6 months to heal properly.

Is implant infection an emergency?
It is always best to treat infections as soon as possible. If the implant becomes loose, it may fall off and there is a danger of accidental swallowing of its component.

In case of titanium implants, the abutment may fall off while the root portion is still within the jawbone. This causes the gingival tissue to cover the open surface rapidly in few weeks. This makes it compulsory to surgically explore the implant embedded.

So, it is advised to visit your dentist as early as possible to avoid any complication.

Is there a chance of re-infection once the dental implant infection is treated successfully?
Yes, if the implants are still not kept clean, the microbial growth may happen again and cause infection even after the successful completion of the treatment.

It is just like any other normal tooth which we need to take proper care of. Properly restored cavities are still susceptible to secondary caries if the oral health is neglected.

The higher the awareness of your oral health, the higher would be the chance of success of an infection treatment and the duration the implant could serve you!