Can a Dental Implant Get Infected?

Implant treatments are highly successful, with success rates ranging from 95 to 99%, depending on different studies. However, there are still cases where implants fail, and it’s often hard to pinpoint the exact reasons for these failures. One of the main factors is the role of bacteria, which can lead to dental implant infection during the process and even after the implant is placed in the mouth—a naturally bacteria-filled environment.

This blog will explore infections related to dental implants, divided into the following stages: infections before the implant, infections during surgery, severe infections after surgery, and infections around the implant (peri-implant disease).

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Causes of Implant Failure

Implants can fail at any stage of the treatment, even after they’re in place and functioning.

Studies have shown that there are two main causes of implant failure: infection and too much force on the implant (occlusal overload). Infection is often linked to the period before or during the surgery, while too much force usually becomes a problem after the implant has been fitted with a tooth. This force can cause small cracks in the bone, creating spaces where infections can develop.

To better understand why implants fail, we will look at four types of infection-related failures:

Infection before the implant (Previous Infection )
Infection during surgery (Peri-Surgical Infection)
Severe infection after surgery (Severe Postoperative Infection)
Infection around the implant (peri-implant Infection).

Also, read about tooth implant side effects to get more information on the risks and complications associated with implants beyond infection, such as implant rejection or nerve damage.

Previous Infection

This type of infection refers to two key conditions: an active infection (whether or not it’s linked to remaining tooth roots) and a history of gum disease (periodontal disease).

Active Infection

The presence of an active infection has traditionally been seen as a reason not to place an implant. This is because the infection could spread, leading to complications like bone infections (osteomyelitis) or abscesses around the implant. Additionally, any remaining infected tissue could interfere with the implant’s ability to bond with the bone (osseointegration). Therefore, before placing an implant, the affected area must be thoroughly cleaned and disinfected.

In recent years, lasers have become more commonly used for cleaning these infected areas. Lasers can effectively sterilize the site before placing an implant.

Periodontal Disease

From a bacterial perspective, patients with gum disease in their remaining teeth have more harmful bacteria around their implants compared to patients without any teeth. As a result, people at risk for gum disease are also at risk for infections around implants (peri-implantitis).

The European Association for Osseointegration (EAO) reported that patients with gum disease had a 91–92% implant success rate, while those without gum disease had a success rate of 97%. However, patients with gum disease had a higher chance of experiencing bone loss and infections around their implants.

Peri-Surgical Infection

In implant surgery, the surgical area can be exposed to bacteria from various sources, allowing germs to easily enter the field. However, good blood flow in the area and the absence of prior infections generally help prevent infection during these procedures.

Many contamination sources during surgery come from the instruments used (air, suction, tools) and the presence of saliva in the surgical field, including contact with the face and lips.

Various methods are used to minimize this risk, such as reducing saliva with atropine, using double suction to prevent saliva from contaminating the area, and rinsing the mouth with chlorhexidine, which significantly reduces the number of bacteria. Some researchers also suggest that bacteria from the nose can affect the surgical field, so keeping the area isolated and clean is crucial to prevent infections during implant surgery.

Infections caused by contamination during surgery typically appear as abscesses around the implant and are visible on X-rays as dark areas.

Read our blog on the tooth implant procedure to get more detailed information on the entire process of implant placement, covering steps from initial consultation to aftercare.

Severe Postoperative Infection

Infections after implant surgery can be serious, with aggressive bacteria sometimes causing severe, even life-threatening, infections. These can range from mild to more complicated oral and jaw infections, and treatment often involves removing the implant , surgical cleaning of the area, and antibiotics.

One major concern is infection following bone graft surgery, which may be done alongside or before implant placement. This type of infection is particularly important because it can lead to other complications, such as immune reactions or issues related to the foreign material.

There are several key post-operative guidelines to follow for successful graft healing:

a) Antibiotic therapy.
b) Use of chlorhexidine mouthwash.
c) Apply cold pads locally.
d) If necessary, use anti-inflammatory steroids.
e) Apply chlorhexidine gel after the first week.
f) Maintain excellent oral hygiene.
g) No smoking.
h) Avoid putting pressure on the grafted area.

Graft infections are usually marked by pain, swelling, and the formation of fistulas. This often leads to the graft material being expelled from the body. Treatment involves removing the infected graft material, cleaning the area thoroughly to restore blood flow, and administering antibiotics.

Peri-Implant Infection

Understanding the connection between the gums and the implant is key to understanding peri-implant disease. The soft tissues surrounding implants are similar to those around natural teeth. The soft tissue around implants is called peri-implant mucosa, and it forms a pocket around the implant similar to the gum pocket around a tooth. This tissue has different layers, with the inner part facing the implant and the outer part exposed to the mouth, which may be thicker or regular gum tissue. Beneath this is connective tissue that attaches to the implant surface, called the lamina propria.

Because of this structure, when probing around implants, the probe can go deeper than it would around a natural tooth, causing more compression and movement of the soft tissue. This means that bleeding during probing may not always be a reliable sign of inflammation if too much pressure is applied.

Clinical Signs of Peri-Implant Diseases

A) Peri-Implant Mucositis

This is a reversible infection in the soft tissue around an implant. It is characterized by:

– Presence of bacterial plaque and tartar.

– Swelling, redness, and overgrowth of gum tissue.

– Bleeding when probing the area.

– Sometimes, pus or exudate may be present.

– X-rays show no bone loss.

B) Peri-Implant Osteitis (Peri-Implantitis)

This is a more serious, irreversible infection that affects both the soft tissue and bone around an implant. Without treatment, bone loss will occur. Initially, it shows similar signs as peri-implant mucositis, but as it progresses, additional symptoms develop, including:

– Bacterial plaque and tartar buildup.

– Swelling and redness of the gums.

– Overgrowth of gum tissue, especially in areas without enough thicker gums.

– Deeper probing depths, often reaching the bottom of the implant.

– Bleeding and sometimes pus when probing or pressing on the gums.

– Vertical bone loss seen on X-rays.

– Implant mobility.

– Pain is uncommon but can occur in some cases.

If the implant moves and X-rays show dark areas around the implant, this suggests severe infection and a total loss of bone-implant attachment.

Treatment of Peri-Implant Diseases

Treatment of peri-implant diseases involves several steps:

Professional Cleaning by dentist

– Removing bacterial plaque with mechanical cleaning tools.

– Rinsing the pocket around the implant.

– Removing and disinfecting the prosthetic parts and implant posts.

– Modifying the design of the prosthetic parts if they are hard to clean.

– In some cases, a minor flap surgery is done to rinse with sterile saline and apply tetracycline cream.

– Using laser treatment in difficult cases.

Personal Care

– Patients should use chlorhexidine mouthwash every 12 hours to control plaque (According to dentist’s prescription).

Antibiotics

– Both local and systemic antibiotics are used to fight the infection.

Regular Checkups

– Regular professional monitoring is essential to keep the infection under control.

Diagnosis of Tooth Implant Infections

Recognizing and diagnosing dental implant infections early is crucial for preventing further complications and preserving the implant.

Symptoms of an Infected Dental Implant

The symptoms of a dental implant infection are similar to those of gum disease. Some common signs include:

– Loose or wobbly implant

– Red or swollen gums around the implant

– Bad taste in the mouth

– Bad breath

– Throbbing pain or discomfort in the implant area

– Dull ache when touched

– Pus (exudate) visible near the implant

– Visible implant threads

– Difficulty chewing

– Fever

– Bleeding during brushing

It is important to note that not all infections present with severe pain or discomfort. In some cases, the infection can be painless, which makes regular checkups critical for early diagnosis.

Clinical Examination for Diagnosis

To diagnose an infected dental implant, the dentist will conduct a clinical examination and take radiographs. The first step in this process involves taking a dental X-ray to assess any bone loss around the implant. If bone loss is detected, it usually indicates an advanced infection.

The dentist will also gently probe the tissues around the implant to assess inflammation levels, checking for signs such as bleeding, swelling, or pus. This step helps evaluate the severity of the infection and determine whether the infection is localized to the soft tissue or has spread to the surrounding bone.

Importance of Early Detection

Early detection is crucial for saving the implant and preventing complications. If peri-implantitis is diagnosed in its early stages, less invasive treatments, such as improved oral hygiene and antibiotics, may be effective. However, if significant bone loss has occurred, surgical intervention may be required to clean the affected area and potentially perform bone grafting.

Regular dental checkups, typically every six months, can help detect and address any signs of inflammation or infection before they lead to more severe complications.

Treatment of Tooth Implant Infections

Treating dental implant infections depends on the severity of the infection, ranging from simple oral hygiene adjustments to surgical intervention in more advanced cases.

Preventive Measures

The best way to treat an infection is to prevent it from occurring in the first place. After implant placement surgery, patients should strictly follow their dentist’s post-operative instructions, maintain diligent oral hygiene, and avoid harmful habits like smoking. Regular brushing, flossing, and routine dental checkups are essential in reducing the risk of infection. If you have conditions like diabetes or a compromised immune system, managing them carefully will also help reduce the risk of implant infection.

Non-Surgical Treatments

If an infection is caught early, non-surgical treatments may be sufficient:

Improved Oral Hygiene: Adjusting your oral hygiene routine can significantly help in addressing early-stage infections like peri-implant mucositis. Regular brushing and flossing can help eliminate bacteria around the implant.
Antibiotic Treatment: In cases where the infection is not severe, antibiotics may be prescribed to fight bacterial growth. This is typically the first step in treating peri-implant infections and can be highly effective when combined with good oral hygiene practices.
Mechanical Cleaning: Non-surgical cleaning methods like mechanical debridement are used to remove bacteria, plaque, and debris around the implant. This process may involve ultrasonic devices or carbon fiber curettes, which clean the infected area without damaging the implant. For deeper infections, more thorough scaling and root planning may be necessary.

Surgical Treatments

In more advanced cases where bone loss has occurred or the infection has spread, surgical intervention may be required:

Surgical Debridement: When non-surgical methods are not enough, surgical debridement is used to clean the area around the implant. In this procedure, the gum tissue around the infected implant is surgically lifted to allow better access to the affected area. The contaminated tissue and any pus are carefully removed before the area is stitched back.
Bone Grafting: If the infection has caused significant bone loss, a bone graft may be necessary to restore the lost bone tissue. Bone regeneration techniques can help re-establish a solid foundation for the implant, and in some cases, a new implant can be placed after the area has healed.
Implant Removal: In severe cases, where the infection has progressed to the point that the implant has become loose and cannot be saved, removing the implant may be necessary. The surrounding infected tissue is cleaned, and a bone graft may be placed to allow the area to heal before considering a new implant.

Advanced Treatment Techniques

Laser Therapy (LAPIP): For severe cases of peri-implantitis, advanced treatments like the Laser-Assisted Peri-Implantitis Procedure (LAPIP) may be used. LAPIP involves using laser energy to target and remove bacteria, infected tissue, and harmful proteins without affecting the surrounding healthy tissue. The laser also promotes gum tissue regeneration and can help restore lost bone, offering a less invasive alternative to traditional surgery.

Talk to Dr. Noorbakhsh’s Dental Clinic Today!

The team at Dr. Noorbakhsh’s dental clinic are leading professionals in dental implant. If you’re searching for a specialist in dental implants, book online for a consultation. Additionally, you can contact our team on +98 912 203 9774 to speak about dental implants or any of our other dental services, and find the best solution for you.