Dental Implant Infection • Peri-Implantitis

Infections is the most common of the dental implant complications. Implant infection, a condition also referred as peri-implantitis, is characterized by inflammation or swelling around the implantation area. Peri-implantitis is a form of periodontal disease that can lead to bone loss and implant failure if not treated properly.

  Causes | Symptoms | Prevention | Treatment

The most common first symptom of an infected dental implant is the inflammation and swelling of the surrounding tissues. Pus in the mouth close to the surgery area is also a clear sign of peri-implantitis which requires immediate treatment. The infection can result to bone loss and if it continues the implant will become loose and will have to be removed.

Visit your dentist with the first sign of swelling. An infected dental implant may have one or more of the following symptoms:

• Red or swollen gums around the implant
• Gums bleeding when brushing around it
• Bad breath / Bad taste
• Pus drainage from the area
• Throbbing pain or discomfort from the area
• Pain when chewing
• Loose implant - Abnormal mobility
• Exposed fixture threads
• Fever

Although implant infections are usually caused by the presence of bacteria during or immediately after the oral surgery, an infection can also happen months or years after surgery. The most common implant complications related to infection can be caused by:

• Poor sterilization - if the dentist does not follow carefully the proper sterilization procedures, a contaminated tool may infect the surgical site with bacteria during the fixture insertion.
• Poor material quality - low quality implants may not fit precisely leaving a gap between the fixture and the bone that could attract bacteria and get infected.
• Improper placement - an improperly placed dental implant may also leave some space between the fixture and the bone that could allow bacteria to invade and infect it. Premature loading, leading to bone micro-fractures that may trap bacteria, is another potential cause of peri implantitis.
• Restoration problems - if the crown used for the tooth restoration is oversized or has an abnormal contour putting pressure to gingival tissues, it can lead to inflammation and infection.
• Poor oral hygiene - if the patient does not follow the dentist's advice and oral hygiene instructions after the surgery, the accumulation of dental plaque can cause gum disease and infection. Bacteria can infect the jawbone either directly if they can enter between the implant and bone, or by first infecting the surrounding gum tissues. Poor oral hygiene is one of the main causes of late implant failure due to infection even years later.

The following instructions can help to prevent the development of a dental implant infection:

• Pre-emptive prescription of antibiotics for some days prior to surgery can help reduce infection risk.
• Sterile environment during the implant surgery is necessary for avoiding surgery infections.
• After surgery, most dentists will prescribe antibiotics and recommend the use of an antibacterial mouthwash.
• Patients must maintain proper daily oral hygiene (brushing and flossing) in combination with preventive visits to the dentist and periodic dental cleanings.
• Smoking should be avoided because it delays healing and increases the risk of infections.
• For patients of high risk groups, the dentist may recommend periodic x-rays to help diagnose and treat any problem of implant infection as soon as possible.

The goal of peri-implantitis treatment is to arrest the progression of the infection and maintain the implant. The most important part of treatment is to find and treat the cause of the infection. The dentist will clean the area and prescribe antibiotics to fight the infection but if its cause is not treated the problem will appear again after the patient stops the antibiotics.

An inflammation caused by a trauma due to improper crown size or shape, can be treated by removing the abnormal crown restoration. After the inflammation has subsided, a proper crown can be placed on the dental implant to restore the tooth.

If the implant infection was caused due to poor oral hygiene, professional dental cleaning and debridement, antibiotics and careful brushing and flossing are usually enough to treat the condition. But if the cause of infection is a loose implant (due to poor material or improper placement) that allows bacteria to invade between the fixture and the bone, the only way to stop the infection and prevent further damage to the jawbone is to remove the failed implant.