Page 73 - EJMO-9-1

Eurasian Journal of Medicine and
Oncology
Microbial profile of peri-implantitis

level of sophistication we see today. Despite the previous around implants not only lack this orientation but also run
centuries’ denial of implantology, the idea was actually parallel to the surface of the implant, without inserting into
proposed in the past, although considered impossible at its structure. Despite these differences, peri-implantitis is
the time. The journey began as early as 600 Anno Domini often considered a “twin” of periodontitis because these
(AD) with the Mayan civilization, which used shells to two diseases share numerous similarities, including their
replace missing teeth. Around 300 AD, the Phoenicians causative factors, pathogenesis passing, microbial profiles,
used gold to treat teeth suffering from mobility. From the and immunological responses.
th
16 to the 19 centuries, Europeans attempted to replant
th
teeth taken from cadavers to replace missing teeth. In 4. Peri-implant diseases
1809, Dr. Maggiolo used gold tubes placed in the socket Peri-implant conditions, including both health and disease
after extraction (a procedure resembling today’s immediate states, are classified into peri-implantitis, peri-implant
surgical techniques). mucositis, and soft- and hard-tissue deficiencies, in
In the 20 century, significant progress was made. addition to peri-implant health. 1
th
In the 1930s, Dr. Moses Strock and Dr. Alvin Strock Criteria for implant health include : (i) No inflammation
1
introduced screws made from vitallium alloy (similar to or any clinical features of inflammation; (ii) absence of
those used by orthopedic surgeons) to replace missing suppuration or bleeding on probing; (iii) no increase in pocket
teeth, achieving notable success. In 1978, Dr. Branemark probing depth (PD) compared to previous examinations; and
– rightfully considered the “godfather” of modern (iv) no osseous resorption, other than the resorption of the
implantology – demonstrated the success of using titanium crest resulting from early osseous remodeling.
fixtures to replace missing teeth and introduced the term Criteria for peri-implant mucositis include all the
“osseointegration.” Today, dental implants have moved criteria that are absent in health, such as suppuration,
beyond a theoretical concept, gaining popularity like never bleeding, and increased PD. However, osseous resorption
before, with a market flooded with various systems, both is not present in mucositis. 1
macro, and micro. What a remarkable journey this field
has undergone! Criteria of peri-implantitis include all the criteria found
in mucositis, such as suppuration, bleeding, and increased
3. From implants to teeth: A distance of a PD. However, osseous resorption, compared to previous
1
thousand feet measurements, is also present in peri-implantitis. When
no previous measurements are available, peri-implantitis
Despite all the industrial revolutions and technical can be diagnosed under the following conditions:
advances, nature remains the ultimate winner. Therefore, (i) Suppuration or bleeding with mild probing; (ii) a PD
comparing implants to natural teeth is inherently unfair, measurement of 6 mm or more; and (iii) a bone crest
as the natural tooth surpasses implants in nearly every measurement that is 3 mm or lower than the most superior
aspect. However, dental implants still represent the most part of the implant in the bone. 1
attractive alternative to natural teeth compared to other The healing process following tooth loss is often
modalities. Implants differ from natural teeth anatomically, associated with a decrease in the proportion of alveolar
physiologically, and structurally. In this sense, comparing bone, resulting in soft and hard tissue defects. Several
them is akin to comparing metal to rubber. While metal factors contribute to large alveolar defects, including root
possesses great strength, it lacks the flexibility found fractures, diminished periodontal support, endodontic
in rubber. Metal may not withstand impact forces and problems, thin buccal bone plates, extraction with
may break, whereas rubber absorbs these forces and additional trauma to the tissues, tooth malposition in the
disperses them. Similarly, osseointegration, if it occurs arch, trauma, medication usage, systemic diseases, and
correctly, provides a more rigid bond than the periodontal poorly designed removable dentures or prostheses. These
ligament’s attachment to natural teeth. However, it lacks conditions may occur alone or in combination.
the shock-absorbing characteristic that the periodontal
ligament provides. The primary difference between The pathological state affecting the structures
implants and natural teeth stems from the absence of surrounding the implants, characterized by bone loss and
the periodontal ligament in dental implants. While the inflammation of the mucosa around the implant, is known
2
implant is surrounded by low vasculature, the natural as peri-implantitis.
teeth are immersed in a rich network of blood vessels. Two mechanisms have been identified as contributing
In addition, natural teeth are surrounded by a three- factors of peri-implantitis – retrograde and classical – with
dimensional network of collagen fibers, while the fibers biomechanical and biological factors acting as effectors. 3-5

Volume 9 Issue 1 (2025) 65 doi: 10.36922/ejmo.6770