Peri-implantitis: Associated microbiota and treatment

Abstract

Introduction: Peri-implantitis is a late complication of dental implant treatment, induced by microbiological changes. Since the disorder is frequent, a review is indicated of the microorganisms that influence it and of the existing treatment options. Objective: To conduct a literature review of the microbiota associated to peri-implantitis and the existing treatment options. Material and Method: A PubMed literature search was made of the studies on the microbiota associated to dental implants in healthy patients and patients with peri-implantitis, as well as of the latest treatment developments, using the following key words: "peri-implantitis AND microbiota", "periimplantitis AND microbiota", "periimplantitis AND treatment", and "periimplantitis AND treatment". Only clinical studies in humans were considered. The following criteria were applied for including articles in the analysis: a) for the peri-implant microbiota, the search limits were human studies after the year 2000; and b) for the treatment of peri-implantitis, the search limits were randomized and controlled clinical trials (RCTs) in humans, with a minimum follow-up of 4 months, and publication after the year 2000. Results: A total of 18 articles were selected in relation to peri-implant microbiota, and 13 in relation to the treatment of peri-implantitis (8 involving nonsurgical mechanical treatments and 5 surgical procedures). Conclusions: Evaluation of the literature has shown the microbiota associated to peri-implantitis to be more complex than that found under healthy peri-implant conditions -the main flora consisting of anaerobic gramnegative bacteria. No clear criteria have been identified for the diagnosis and treatment of peri-implantitis.

Bacterial adhesion mechanisms on dental implant surfaces and the influencing factors

“…Gram-positive aerobic bacteria such as Streptococcus mitis, Streptococcus sanguis and Streptococcus oralis were observed on dental implant surfaces surrounded by healthy oral environment [32]. However, it was also possible to find small concentrations of anaerobic Gram-negative bacilli on some implants.…”

“…These subgingival microbiota lead to an increase in pocket depth and alveolar bone loss, which may damage the soft and hard tissue around the implant [29]. The microbiota changes in the periimplantitis sites include an increased total bacterial quantity and the proportion of Aggregatibacter actinomycetemcomitans, Fusobacterium species, Prevotella intermedia and Porphyromonas gingivalis, a decrease in the percentage of cocci, and an important increase in the proportion of mobile organisms and spirochaetes [31][32][33].…”

Treatment of Peri-Implantitis and the Failing Implant

“…Specifically, A actinomycetemcomitans and P gingivalis, which can be found in healthy peri-implant biofilms in small numbers, have been suggested to be the predominant pathogens implicated in peri-implant destruction. 63 A major difference between implants and teeth (in a partially edentulous case) is that with implants, one is introducing a sterile object into an environment of widely variable existing microbiota, so the most important question to answer is whether the existing microbiota influences the progression to peri-implantitis. Quirynen and colleagues 64 showed that colonization of an implant occurs within 2 weeks of healing abutment placement, and that this flora was nearly identical to the adjacent teeth (same quadrant).…”

New approaches to combat Porphyromonas gingivalis biofilms

“…When left untreated, peri-implantitis can result in loss of the dental implant [9,58]. Studies have reported a considerably high prevalence of peri-implantitis, with estimations ranging from 20% to 56% of the patients, depending on the time frame under investigation [59,60]…”