What is Peri-implantitis

Peri-implantitis is defined as an inflammatory reaction, with the loss of supporting bone in the tissues surrounding a functioning implant. The features to be observed are 

1. bleeding gums

2. swollen gums

3. shaking implant

4. exposure of implant screw threads

5. Loss of bone in the X- ray

                               

Treatment of peri-implantitis

According to the best available evidence, traditional periodontal infection control including plaque control regimens and mechanical cleaning of the affected areas possessing professional cleaning should be performed. 

It is essential to inform the patient about the need for effective oral hygiene procedures (particularly around implants), and the patient should be carefully instructed in the proper use of necessary additional oral hygiene aids. Oral hygiene procedures should be trained under professional supervision.

Surgical exposure of the lesions was performed, and the affected implants were cleaned using hydrogen peroxide.

Systemic antibiotics were administered according to a susceptibility of bacteria. The applied surgical and antimicrobial treatment strategy was successful in less than 60% of the treated implants. Despite treatment and re-treatment of peri-implantitis–affected areas, additional loss of supporting bone was found in up to 40% of the advanced peri-implant lesions.

LASERS to treat Peri-implantitis

A promising method for decontaminating implant surfaces involves the use of laser energy. Unlike mechanical decontamination methods, which cannot fully adapt to the irregularities on the surface of an implant, lasers can irradiate the whole surface, reaching areas that are too small to receive mechanical instrumentation. Power settings are variable, and the clinician can choose a setting that will effectively disinfect the implant while not damaging the surface. 

Conventional approaches include:

• Systemic administration of

   antibiotics

• Removal of supragingival bacterial plaque

• Removal of granulation tissue

   with plastic curettes

• Debridement of the exposed surface by using mechanical brushing, air powder abrasives, citric acid, disinfectants like chlorhexidine or topical tetracycline, plaque inhibitor like delmopinol, or low-intensity ultraviolet radiation

• Removal ofthe peri-implant pocket

• Regeneration of peri-implant hard tissue by means of guided tissue regeneration

• Plaque control and oral hygiene.

Advantages of Laser in the treatment of Peri-implantitis

• The laser easily vaporizes any existing granulation tissue.
• The implant surface can be debrided by lasing directly on the implant’s exposed screws with a low-energy setting. Both the target tissue and implant surface are disinfected without damage.
• The laser is bactericidal.

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