Etiology, diagnosis, and treatment considerations in peri-implantitis.

Peri-implantitis is an inflammatory process affecting the tissues around an osseointegrated implant in function, resulting in loss of supporting bone. A review of the literature currently available leads to the conclusion that microorganisms play a major role in this disease. Gram-negative anaerobic bacteria, particularly fusobacteria, spirochetes, and black-pigmenting organisms such as Prevotella intermedia are often found in diseased sites. Several treatment modalities are presently being evaluated. Treatment aimed at a reduction of the anaerobic bacteria improves clinical conditions. Furthermore, case reports indicate a possibility for successful treatment with guided tissue regeneration procedures. However, to date histologic evidence of true reosseointegration has not been obtained. Incomplete surface decontamination seems to be the major obstacle for regrowth of bone onto previously exposed implants. It appears reasonable to attempt interception of destructive peri-implantitis as early as possible and to stop progression by removal of the bacterial deposits.