Even though no dental cavities will develop on dental implants, gum disease can occur around dental implants. When gum disease around implants occurs, the function, esthetics and longevity of the dental implant is jeopardized.
Implant gum disease refers the development of gum disease around dental implant. There are two main categories of implant gum disease:
- Implant mucositis: inflammation of the gums around implant, much like gingivitis around natural teeth
- Peri-implantitis: inflammation and loss of gums and bone around implant, much like gum disease (periodontitis) around natural teeth
Similar to gum disease, implant gum disease often goes unnoticed or ignored because many individuals suffering from implant gum disease do not feel any pain or discomfort until the end stage of the disease. When the disease destruction around the dental implant is considerable, patients may then start to experience pus, bleeding, pain, bad breath, bad taste, gum recession around dental implants, and exposure of implant metal thread.
Causes of Implant Gum Diseases
Similar to gum disease, implant gum disease is caused by colonization of hundreds of different bacterial species on the crown, abutment and surface of implant screw. When this occurs, it is usually more difficult to decontaminate dental implant because screw surfaces are intentionally made to be rough to encourage in-growth of jaw bone to provide better integration between implant and jawbone. Risk factors for implant gum disease are as follows:
- patient’s poor oral hygiene
- patient’s lack of regular implant cleaning appointments
- patient’s medical conditions (e.g. uncontrolled diabetes)
- residual cement left on the surface of implant by the restorative dentists during implant crown cementation
Implant mucositis can be treated non-surgically with implant debridement to remove debris collected under the gums responsible for gingival inflammation. Peri-implantitis can also be treated non-surgically; however, the success of such treatment is lower because it is very difficult to thoroughly cleanse the contaminated implant surface without surgically peeling the gums away from the implant. As such, peri-implantitis is mostly treated with surgical intervention. Laser technology has recently been shown to have a positive effect in decontaminating implant surfaces.
Bone Grafting Around Implants
Peri-implantitis is characterized by bone loss around dental implant. When indicated, bone grafting materials can be placed at these bony defects to grow the bone back. Sometimes, removal of implant crown and abutment may be needed to perform bone grafting around implants in peri-implantitis cases.
Gum Grafting Around Implants
Gum recession can be a result of gingival inflammation and bone loss around implants, as well as mal-positioning of implants. When indicated, gum grafting can be performed to grow the lost gums back around dental implants.