Jump to content

Peri-implant mucositis

Add links
From Wikipedia, the free encyclopedia

This is an old revision of this page, as edited by Wittyyteeth (talk | contribs) at 00:53, 7 November 2018 (Added possible risk factors). The present address (URL) is a permanent link to this revision, which may differ significantly from the current revision.

Definition

Peri-implant mucositis is defined as an inflammatory lesion of the peri-implant mucosa in the absence of continuing marginal bone loss.[1]

The American Academy of Periodontology defines peri‐implant mucositis as a disease in which inflammation of the soft tissues surrounding a dental implant is present without additional bone loss after the initial bone remodeling that may occur during healing following the surgical placement of the implant.[2][3]

Peri-implant mucositis is largely accepted as the precursor of peri-implantitis and corresponds to gingivitis around natural teeth.[4]

Important criteria to defining peri-implant mucositis are, the inflammation of mucosa surrounding an endosseous implant and the absence of continuing marginal peri-implant bone loss.[1]

Aetiology

A shift in bacterial biofilm composition, from uninterrupted plaque maturation, and the immune system disintegration causes peri-implant mucosa inflammation to occur.

In peri-implant mucositis, there is an increase in proportion of bacteria from the orange complex: F. nucleatum, P. intermedia and Eubacterium species. A decrease in proportion of Streptococci and Actinomoyces species is also observed.[5]

Accumulation of bacteria around osseointegrated dental implants has been proven to be a cause of peri-implant mucositis[6] by demonstrating this under experimental conditions and the development of an inflammatory response due to this has also been shown experimentally.[7] When the surfaces of the implant in the mouth are colonised by pathogenic bacteria, plaque-induced inflammation can go on to cause destruction of the tissues around the implant.[6] The presence of an inflammatory cell infiltrate in the connective tissue lateral to the junctional epithelium has been discovered in this condition, contributing to its development.[1] The bacterial biofilm disrupts the host-microbe homeostasis, creating a dysbiosis which results in an inflammatory lesion.[1] The inflammatory cell infiltrate has been found to increase in size as the peri-implant mucositis develops.[1]

Where peri-implant mucositis has been brought about by the accumulation of bacteria and their formation of a biofilm, it has been shown to be eventually reversible[7] once the biofilm has been brought under control by regular cleaning by both patient and dental professional.[1] This has been shown as studies display a clear reduction in redness, swelling and bleeding on probing in lesions of the peri-implant soft tissue[7] after bacterial load has been minimised.[6] This was shown in an experiment where bacteria were encouraged to accumulate for a period of time in which no oral hygiene was undertaken, allowing all of the patients to develop peri-implant mucositis.[7] When oral hygiene was regularly commenced once again, all of the periodontal tissues eventually became healthy once more.[7] However, the best management of peri-implant mucositis is not reversing it but preventing this from occurring in the first instance.[6]

The presence of excess luting cement has been demonstrated to contribute to causing peri-implant mucositis.[8] One study gleaned results that suggested that in both patients with and without a history of periodontal problems, implants with extracoronal residual cement developed statistically significantly more cases of peri-implant mucositis as well as other periodontal problems.[8] In this study 85% of implants in patients with previous periodontal conditions went on to develop peri-implant mucositis, which then progressed to peri-implantitis.[8] In the group with no previous history of periodontal issues, 65% of implants still developed peri-implant mucositis, but significantly fewer of these implants then developed peri-implantitis.[8] In contrast, the group with no extracoronal residual cement only had 30% of implants develop peri-implant mucositis.[8] Therefore, cement remnants may be more likely to cause patients to develop peri-implant mucositis.[8]

Other causal factors of peri-implant mucositis include radiation and smoking, in addition to accretion of oral bacteria at the site.[1] Other factors that are thought to contribute to the condition include lack of keratinised mucosa and diabetes mellitus, particularly poorly-controlled diabetes which will mean the patient will have a high level of blood glucose over longer periods.[1] Understanding and controlling peri-implant mucositis is essential as it often leads to peri-implantitis.[6]

Signs and Symptoms

Clinical signs and symptoms of peri-implant mucositis involves the localised surrounding gingival tissues (gum tissue) of a dental implant. These include:-[1][2][9]

  1. Bleeding on probing with no supporting bone loss.
  2. Localised swelling
  3. Redness/erythema.
  4. Increased shininess of soft tissue surface.
  5. Soreness

Risk Factors[1]

Risk Factors of PIM are categorised into General and Local Risk Factors

General Risk Factors

  1. Smoking
  2. Radiation Therapy
  3. Poorly controlled Diabetes Mellitus (HbA1c >10.1)

Local Risk Factors

  1. Oral Hygiene
  2. Poor compliance / access to regular supportive implant therapy
  3. Design of Implant-supported prostheses affecting accessibility for plaque removal
  4. Sub-mucosal restorations
  5. Dimension of Keratinized Peri-implant mucosa
  6. Excess Cement

Possible Risk Factors:

Some other possible risk factors may include the location the implant is placed, type of implant placed and the age of the subject, as it was found that these factors had significant influences on bleeding on probing (BOP). [10]

Although it is uncertain whether increased abutment roughness will cause an increase in plaque accumulation and hence increase the risk of peri-implant mucositis, a 12-month comparative analysis in humans found that “a further reduction of the surface roughness, below a certain "threshold R(a)" (0.2 microns), has no major impact on the supra‐ and subgingival microbial composition.”[11]

Implants and abutments made of zirconium dioxide (ZrO2) were claimed to be more bio-compatible compared to those made of titanium but clinical studies show that there were slightly higher BOP scores or no significant difference in BOP scores around ZrO2 compared to titanium abutments.[1]

References

  1. ^ a b c d e f g h i j k Heitz-Mayfield, Lisa J.A.; Salvi, Giovanni E. (2018-06). "Peri-implant mucositis". Journal of Clinical Periodontology. 45: S237–S245. doi:10.1111/jcpe.12953. ISSN 0303-6979. PMID 29926488. {{cite journal}}: Check date values in: |date= (help)
  2. ^ a b Renvert, Stefan; Persson, G. Rutger; Pirih, Flavia Q.; Camargo, Paulo M. (2018-06). "Peri-implant health, peri-implant mucositis, and peri-implantitis: Case definitions and diagnostic considerations". Journal of Clinical Periodontology. 45: S278–S285. doi:10.1111/jcpe.12956. ISSN 0303-6979. PMID 29926496. {{cite journal}}: Check date values in: |date= (help)
  3. ^ "Academy Report: Peri-Implant Mucositis and Peri-Implantitis: A Current Understanding of Their Diagnoses and Clinical Implications". Journal of Periodontology. 84 (4): 436–443. 2013-04. doi:10.1902/jop.2013.134001. ISSN 0022-3492. PMID 23537178. {{cite journal}}: Check date values in: |date= (help)
  4. ^ Lang, NP; et al. Do mucositis lesions around implants differ from gingivitis lesions around teeth? J Clin Perio 2011;38S(11):182–187.
  5. ^ Pokrowiecki, Rafał; Mielczarek, Agnieszka; Zaręba, Tomasz; Tyski, Stefan (2017-11). "Oral microbiome and peri-implant diseases: where are we now?". Therapeutics and Clinical Risk Management. Volume 13: 1529–1542. doi:10.2147/tcrm.s139795. ISSN 1178-203X. PMC 5716316. PMID 29238198. {{cite journal}}: |volume= has extra text (help); Check date values in: |date= (help)CS1 maint: unflagged free DOI (link)
  6. ^ a b c d e al., Khammissa RA , et (2012). "Peri-implant mucositis and peri-implantitis: clinical and histopathological characteristics and treatment. - PubMed - NCBI". Sadj : Journal of the South African Dental Association = Tydskrif van die Suid-Afrikaanse Tandheelkundige Vereniging. 67 (3): 122, 124–6. PMID 23198360.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  7. ^ a b c d e al., Pontoriero R , et (1994). "Experimentally induced peri-implant mucositis. A clinical study in humans. - PubMed - NCBI". Clinical Oral Implants Research. 5 (4): 254–9. PMID 7640340.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  8. ^ a b c d e f al., Linkevicius T , et (2013). "Does residual cement around implant-supported restorations cause peri-implant disease? A retrospective case analysis. - PubMed - NCBI". Clinical Oral Implants Research. 24 (11): 1179–84. doi:10.1111/j.1600-0501.2012.02570.x. PMID 22882700.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  9. ^ Peter Heasman, Zaid Esmail, Craig Barclay (2010). "Peri-Implant Diseases". Dental Update. 37: 511–516.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  10. ^ Ziebolz, Dirk; Klipp, Sandra; Schmalz, Gerhard; Schmickler, Jan; Rinke, Sven; Kottmann, Tanja; Fresmann, Sylvia; Einwag, Johannes (2017-8). "Comparison of different maintenance strategies within supportive implant therapy for prevention of peri-implant inflammation during the first year after implant restoration. A randomized, dental hygiene practice-based multicenter study". American Journal of Dentistry. 30 (4): 190–196. ISSN 0894-8275. PMID 29178700. {{cite journal}}: Check date values in: |date= (help)
  11. ^ Bollen, C. M.; Papaioanno, W.; Van Eldere, J.; Schepers, E.; Quirynen, M.; van Steenberghe, D. (1996-9). "The influence of abutment surface roughness on plaque accumulation and peri-implant mucositis". Clinical Oral Implants Research. 7 (3): 201–211. ISSN 0905-7161. PMID 9151584. {{cite journal}}: Check date values in: |date= (help)
Retrieved from "https://en.wikipedia.org/w/index.php?title=Peri-implant_mucositis&oldid=867637148"