Periodontitis & Peri-Implantitis - What's the Difference?

Peri-Implantitis over 5 yrs in smoker. ( Source: Wikipedia)

Replacement of missing teeth with implant supported restorations has become increasingly common. While implant supported restorations do not share the risk of dental caries that natural teeth are subject to, they are susceptible to peri-implant mucositis and peri-implantitis, just as the natural dentition is subject to gingivitis and periodontitis. It is well established that periodic periodontal maintenance can optimize the long-term prognosis of the natural dentition. Like-wise, successful dental implant therapy must include an appropriate recall program. A major etiologic factor in periodontitis is the formation of a biofilm harboring pathogenic bacteria, and this is also true for peri-implantitis. Bacterial colonization of implant abutments has been found to be similar on both zirconia and titanium abutments.

Peri-implantitis is defined as an inflammatory process affecting the tissues around an osseointegrated implant in function, resulting in loss of supporting bone. Peri-implant mucositis is defined as reversible inflammatory changes of the peri-implant soft tissues in the absence of bone loss. The prevalence of peri-implantitis has been reported to be as low as approximately 10% to as high as 47%; the prevalence of peri-implant mucositis is generally greater, ranging from 32% to 80%.

Periodontal and peri-implant bone turnover is a balanced dynamic process that involves resorption and formation, controlled and influenced by the local production of cytokines, with a wide range of inflammatory, hemopoietic, metabolic and immunomodulatory properties. Peri-implant microbial contamination or infection (bacteria and viruses) elicit an immune response regulated by key cytokines (TNF-a, Interleukin [IL]-1ß, TGF- ß, IL-10) that control the progression and/or suppression of the inflammatory response. Over-production of pro-inflammatory cytokines, released by monocytes / macrophages and T cells in response to a microbial challenge can lead to the breakdown of the periodontal or peri-implant tissues.

The continuous balance that exists between the host immune response and potential subgingival pathogens (bacteria / viruses) determines the clinical condition, not only around teeth, but also around osseointegrated dental implants. On February 21^st, at the Nowzari Symposium, peri-implantitis will be discussed by Drs. Tord Berglundh and Hessam Nowzari: www.nowzarisymposium.com