The treatment will strongly depend on the stage of advancement of the peri-implantitis. The greater the resorption, the rougher the surface is external to the bone tissue, the lower the chances of successful implant treatment. the dental implant will often be the preferred solution.
The implant should be cleaned using soft instruments such as polishing with a cup and rubber paste, dental floss, interdental brushes or using plastic scaling instruments. In fact, metallic and ultrasonic scalers can roughen the surface of the implant and increase the adhesion of bacteria.
The Karring & All study demonstrated that submucosal debridement, performed using an ultrasound device or carbon fiber curettes, is not sufficient to decontaminate the surface of implants with peri-implant pockets larger than 5mm when the rough implant surface is already apparent. So, it seems that mechanical or ultrasound debridement alone may be a solution only for primary stage peri-implantitis.
Decontamination of the implant surface
Four methods for decontaminating the surface of implants were compared on guinea pig monkeys:
- Air powder abrasive technique followed by application of citric acid
- Air powder abrasive technique
- A gauze soaked in a saline solution followed by an application of citric acid
- A gauze impregnated alternately with 0.1% chlorhexidine and physiological serum
The results of this study did not reveal any significant difference between the methods used. The results of an in vitro study combining photosensitization to toluidine blue solution and mild laser irradiation indicated that it was possibl eliminate bacteria from different titanium surfaces without modifying the implant surface.
Non-surgical treatment of peri-implantitis lesions using an erbium-doped laser has shown satisfactory results one month after treatment. According to Schwarz et al.
Studies regarding the presence of pathogens are essential in making a decision on antibiotic administration. Although the composition of the subgingival microbial component is important for drug selection, drug profiles oral administration are also important in deciding whether an antibiotic should be administered topically or orally. To make this decision, the doctor should examine the periodontal condition of the residual teeth.
The study by Schwarz showed that the treatment of peri-implant infection by mechanical debridement with plastic curettes combined with antiseptic treatment (0.2% chlorhexidine) could lead to statistically significant improvements bleeding after 6 months A study by Renvert demonstrated that adding antiseptic therapy to mechanical debridement did not confer additional benefit if the peri-implant lesion was greater than 4 mm. Localized implants, in the absence of other infections may be appropriate for local application of antibiotics by the insertion of tetracycline fibers for 10 days.
If peri-implantitis is present in several areas or if it is associated with periodontitis, a microbiological collection must be carried out and antibiotics administered systemically. Prof. Lang and his collaborators recommend: Systemic ornidazole 500 mg per day for 10 days or 250 mg of metronidazole per day for 10 days or a daily combination of metronidazole 500 mg and amoxicillin 375 mg every 10 days.
Surgical treatment is generally limited to implants placed on non-aesthetic areas. The surgical flap technique helps complete debridement and decontamination of the implant affected by peri-implantitis. Surgical treatment is performed using autogenous bone grafts + membranes or membranes alone or even autogenous bone grafts alone.
However, the use of porous membranes can lead to bacterial penetration and lead to infection. Still there are no viable organism-controlled clinical trials to be available on the use of flap surgery. 'Access only (debridement of the open flap) for the treatment of peri-implantitis.
Replacement of a dental implant after a rejection
The loss or the rejection of a dental implant has serious consequences on the bone volume present on the jawbone. Indeed, not only the peri-implantitis will have resulted in a melting of bone tissue but the volume of the (traditional) dental implant itself is substantial. Also, it is necessary to understand the causes of peri-implantitis. If these are not precisely established, replacing the dental implant with the same type of dental implant will present the same risks or even higher risks since in a good number of cases, a bone graft or a sinus lift will have been necessary.
Immediate replacement with the BAx basal implant
Basal implantology is used to treat patients who have suffered a rejection or loss of dental implant. With a basal dental implant, the risk of rejection is close to 0. We can thus in a single step, remove traditional dental implants with peri-implantitis and replace them directly with a BAx, BCS, BOI and KOS basal implant (strategic implant). Thanks to its ultra-smooth titanium structure, and its mechanical retention, the risk of rejection is almost non-existent and it is not necessary to perform a bone graft.