The Painful Dental Implant: Peri-Implantitis

Dental implant with peri-implantitis due to poor implant position and implant surface exposure

Dental implant with peri-implantitis due to poor implant position and implant surface exposure

Post-operative discomfort following placement of dental implants  often resolves within a few days. However, pain persisting weeks or even months after implant placement indicates either inflammation or infection which should be treated as soon as possible. The most common cause of long-term pain around dental implants is peri-implantitis (inflammation around the implant) that develops from plaque around the implant or its surface; the plaque sticks tightly to the implant’s rough surface making its removal impossible. This in-turn results in chronic inflammation or infection that leads to further bone and gum tissue loss and eventual implant failure. Another reason for chronic dental implant pain is non-integration that means the implant has not healed in the bone as expected.

The most common causes of peri-implantitis are:

  1. Insufficient bone with exposure of the implant surface- This is evident by the visible gray color under the gum tissue indicating that the implant is not covered with bone. This can be avoided by bone grafting prior to implant placement to make sure there is sufficient bone covering the implant surface.
  2. Poorly positioned implants that make them difficult to clean- This results in plaque retention and inflammation due to difficult access for effective hygiene.
  3. Placement of implants next to teeth with gum disease- The plaque from teeth with periodontal disease can contaminate the implant at time of placement and lead to persistent inflammation. This can be avoided by either extracting the adjacent teeth with advanced periodontal disease or deep cleaning prior to the implant procedure.
  4. Poor surgical technique by inexperienced dentists- Implant placement is a highly-technically and demanding surgical procedure that is best done by a trained surgeon who understands bone and soft tissue manipulation, when performed by an inexperienced general dentist, the overall rate of complications and implant failure increase.
  5. Poor oral hygiene and irregular professional dental cleaning- Implants can develop ‘gum disease’ similar to natural teeth. Hence, regular professional dental care is crucial for maintaining oral health and implant longevity.

Unfortunately, in most cases there are no treatments available for peri-implantitis and ultimately the implant must be removed (watch video for new technique for implant removal).  Once the site has healed, the surgeon can assess the quality and quantity of the bone and then graft if necessary to accommodate the new implant.