- Microbiological sensitivity testing, may be clinically relevant when peri-implantitis; evidence is present.
- It is important to stress the importance of accurate surgical procedure, proper oral hygiene instructions and prosthetic constructions that allow accessibility for oral hygiene around implants are key factors to the long term success of dental implants.
- Marginal bone loss can lead to deepened pockets. Superinfection can develop peri-implantitis. Bone maintenance in the long-term perspective are to be expected when adequate levels of oral hygiene are kept.
Following implant insertions in patients with residual dentition, the implant surfaces were colonized by the same bacteria present on the surfaces of the remaining teeth. Plaque accumulation at implants will result in the development of an inflammation at implant sites. Some studies show an increased incidence of peri-implantitis and implant loss in patients with a history of periodontitis, smoking, excess cement, and lack of supportive therapy. Two-piece implants unavoidably present a micro-gap between the implant and the abutment. Bacterial leakage at the interface between abutments and implants, as well as along the abutment screw assemblies was convincingly documented as well. Presence of microbiota vary according to studies. Aggregatibacter actinomycetemcomitans (A. actinomycetemcomitans), Porphyromonas gingivalis (P. gingivalis), and Tannerella forsythia (T. forsythia) are key pathogens in the process of periodontitis and probably also play a significant role in the development and progression of peri-implant mucositis and peri-implantitis.
Antibiotic medication selection
For peri-implantitis the beneficial effects of a systemic antibiotic, as adjunct to mechanical/surgical treatment remain unproven. Whether the composition of submucosal microbiota is a determining factor for the effectiveness of therapy remains unsubstantiated. Microbial testing can help selecting proper antibiotic by detecting resistant species.
Available tests for on an outpatient population:
- phase-contrast microcopy
- latex agglutination test
- checkerboard DNA-DNA hybridization
- polymerase chain reaction
Simple and fast chair-side test which provides proportion of cocci/rods/filaments and motile organisms. Increased % of motile organisms has been associated with aggressively of periodontitis; this relationship is not established for peri-implantitis.
Culturing is technique sensitive and time-consuming. Determines sensitivity towards antibiotics. Paper points are inserted in the peri-implant pocket and transported in a vial to the laboratory.
Consists of beads coated with specific antibodies. When contacting target antigens from the sample, à clumping of beads. Simple and rapid.
Checkerboard DNA-DNA hybridization
Optimal test for complex ecosystems. Allows identification of large numbers of species in many samples. ≥104 bacteria allow detection.
Polymerase chain reaction
Involves amplification of DNA sequence by a primer. If amplification occurs, presence of target species proven. ≥ 10 bacteria can be detected. Biofilm may contain enzymes which inhibit reaction.
In view of these results we should like to stress the importance of giving proper oral hygiene instructions to the patients who are rehabilitated with dental implant and of proper prosthetic constructions that allow accessibility for oral hygiene around implants.