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Whenever I go to an implant meeting these days a lot of what’s being discussed is titanium implant failures and what to do about them. I went to two high level conventions in 2016 and I was surprised at all the case studies presented highlighting failures of titanium implants. Much of the focus was on maintaining these implants in the face of significant inflammation and progressive bone loss. This condition is called peri-implantitis and is similar to periodontal disease or gum disease. The difference is that peri-implantitis is gum disease that happens around implants. Periodontal disease is gum disease that happens around natural teeth. Basically, both result in loss of bone and gum support due to infection from bacteria and the inflammation that results. Eventually the infection starts to drain pus from around the affected tooth or implant resulting in pain, soreness and possibly the loss of the implant altogether. The above graphic is of the annual convention of implantologists, oral surgeons and dentists attending high level lectures on implant techniques.

The graphic on the right was another meeting of periodontists/gum specialists discussing gum procedures and implants. Fully 1/4 to 1/3rd of the lectures had to do with how to manage and try to fix failing implants and what to do with the growing problem of peri-implantitis.

Basically, the case studies presented discussed what treatment options there are to keep the implants in place for as long as possible by slowing down the disease process. At this point there is quite a bit of agreement that once the core of the implant is exposed to the oral cavity bacteria can then start to attach or imbed itself onto the surface of the implant because it is rough. It can also create deposits in the grooves of the implant similar to the build up and plaque on your teeth that your dentist removes every 6 months during your cleaning appointment. The problem is that these deposits on implants result in bone loss with implants much, much faster than with natural teeth, because the strength of the gum and bone attachments to the implant is much weaker than with real teeth.

The recommended treatment is to pull the gum back from the implant so that it can be smoothed and polished as best as possible. This makes it harder for bacteria to continue to attach to the implant and infect the bone around it. This definitely slows down the damage from peri-implantitis, but by that time the metal from the implant usually starts to show as a black band or as a gray halo through the gums. This is a failure by most dentists criteria and cosmetically it is certainly a failure for the patient.

2016 began a sea change in how titanium implants are going to be viewed by the profession and by the public at large. Peri-implantitis is a huge problem because there is no real fix and the number of cases are just going to grow as time goes on as more and more implants are being placed every year. I’ve even heard the word epidemic be thrown out by some practitioners and lecturing implant experts.

So what’s the solution? In my next post I’ll review the causes of peri-implantitis and what to do to avoid them. Hint: stop doing the procedure that causes it.