|Year : 2013 | Volume
| Issue : 1 | Page : 58-61
Bacteria and dental implants: A review
15640 Redmond Way, Redmond, USA
|Date of Web Publication||10-May-2013|
15640 Redmond Way, Redmond
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Dental implants have been shown to be an excellent method for replacing natural teeth. Dental implants like natural teeth can be affected by microorganisms. Various terms have been proposed to describe inflammation around dental implant. The ones that are commonly used include peri-implantitis and peri-implant mucositis. Studies were conducted that described the bacteriology of dental implants. Most studies reported that the microbiota associated with stable implants is similar to the one seen in periodontal health. Similarly, bacteria associated with failing implants have also been studied. These studies predominantly showed that the bacteria associated with failing implant are similar to the ones seen in periodontal disease. One should be very cautious in placing dental implants in subjects with significant periodontal disease as there is a risk for failure. Implants are not immune for infections. The present review briefly describes the bacteriology associated with stable and failing implants.
Keywords: Bacteria, implants, peri-implantitis
|How to cite this article:|
Buddula A. Bacteria and dental implants: A review. J Dent Implant 2013;3:58-61
| Introduction|| |
Dental implants like natural teeth are colonized by microorganisms. There are various terminologies associated with ailing and failing implants. Terms such as peri-implant disease, peri-implant mucositis, and peri-implantitis have been proposed that describe pathologic conditions around dental implants. Dental implants are being used more frequently to restore partially edentulous or completely edentulous patients. Clinicians now are facing problems that they encountered with natural teeth. Like natural teeth dental implants are susceptible to inflammation of the supporting tissues by colonization of pathogenic bacteria.
Implant failure has been defined as the inadequacy of the host tissue to establish or maintain osseointegration.  Implant failures can be classified based on the time of failure as early or late and based on the etiopathogenesis as infectious or noninfectious. , Early failures are due to failure to establish osseointegration and late failure is due to failure to maintain osseointegration.  Osseointegration is defined as a "direct structural and functional connection between ordered living bone and surface of a load-carrying implant". , Early failures can occur as a result of surgical trauma, premature loading of the implant, and bacterial infection. Late failures can occur following prosthetic rehabilitation.  Late failures can again be divided as "soon" late failures which occur during the first year of loading and as "delayed" late failures occurring in subsequent years. "Soon' late failures can be attributed to overloading of the implant placed in bone that is poor both qualitatively and quantitatively. " Delayed late failures can occur when there are changes in the loading conditions in relation to bone quality and volume and also as a result of peri-implantitis". ,
The present review will focus on the microbiota associated with dental implants in healthy and diseased states.
| Definition and Prevalence of Peri-Implant Disease|| |
European workshop on periodontology proposed the following definitions for inflammatory lesions that develop around implants. 
However, Zitzmann, et al. provided new definitions for these inflammatory lesions.
- Peri-implant disease: The inflammatory lesions that develop in the tissues around the implants
- Peri-implant mucositis: Reversible inflammatory reaction in the soft tissues surrounding a functioning implant
- Peri-implantitis: Inflammatory reactions associated with loss of supporting bone around an implant in function.
Authors in their latest definition eliminated the words reversible and irreversible proposed by the European workshop on periodontology as it might imply that the process cannot be treated. Authors were of the opinion that peri-implantitis is treatable hence it cannot be considered irreversible. Peri-implant mucositis is comparable to gingivitis around natural teeth as there is no loss of supporting structure and peri-implantitis is comparable to periodontitis around natural teeth as there is bone loss associated with it.
- Peri-implant Disease: Inflammatory reactions in the tissues surrounding an implant
- Peri-implant Mucositis: Presence of inflammation in the mucosa at an implant with no signs of loss of supporting bone
- Peri-implantitis: Presence of inflammation and loss of supporting bone.
| Prevalence of Peri-Implant Diseases|| |
There is the scant literature available about the prevalence of peri-implant diseases. Cross-sectional studies on prevalence of implant related disease are rare. Hence, there is a scarcity in the available literature about the prevalence of implant related diseases.
Based on the available literature, peri-implant mucositis occurred in approximately 80% of the subjects and in 50% of the implants. ,
Peri-implantitis was identified in 28% of the subjects and ≥56% of subjects and in 12 and 43% of implant sites, respectively. ,,,,
| Microbiota Around Healthy and Diseased Teeth in the Absence of Implants|| |
Studies have shown that flora associated with healthy implants is similar to the flora in natural teeth and also that the flora associated with ailing/failing implants is similar to the one associated with periodontal disease. ,,, Hence, it is important for the clinician to evaluate the periodontal status of the subject before implant placement.
Samples from healthy gingival sulcus consist of predominantly gram-positive anaerobic cocci and rods. Principally found are A. naeslundii, A. gerencseriae, S oralis, and Peptostreptococcus species which account for more than 50% of the bacteria. ,, With the development of periodontitis, there are a higher proportion of gram-negative rods and decreased gram-positive species. Increased proportions of P. gingivalis, B. forsythus and species of Prevotella, Fusobacterium, Campylobacter, and Treponema have been detected. ,
| Bacteriology of Stable Implants|| |
There are only two longitudinal studies to date that report microbial colonization of stable dental implants. The first study was done by Nakou, et al. in 1987. They found that supragingival plaque in stable implants predominantly consists of gram-positive cocci and subgingival plaque is dominated by Haemophilus spp and Veillonella parula. Second longitudinal study was done by Mombelli, et al. in 1988. They studied microbial colonization of ITI implants in edentulous patients. Samples were taken from peri-implant crevice. They found that the flora was established shortly after installation of the dental implant. Over 85% of the organisms were identified as coccoid cells and over 80% were gram-positive facultative cocci. No, noteworthy, changes were found in the flora in the first 6 months. Spirochetes were never detected and Fusobacteria and black-pigmenting gram-negative rods were found occasionally. Authors' concluded from the study that bacteria around the implants in edentulous patients were similar to that found in the sulci of subjects with healthy periodontium. Mombelli, et al. conducted a follow-up study in which they assess the microbial flora associated with stable osseointegrated dental implants. Majority of the patients were followed to the fifth year of implantation. No significant change was noted in the microbial flora during follow-up examinations.
However, cross-sectional studies are available in the literature that talks about bacteriology of stable implants. Lekholm, et al. studied 20 patients with Brånemark implants. Mean observation time was 7.6 years. Coccoid and nonmotile rods dominated in up to 94% in the samples taken. Similarly, Apse, et al. compared bacteriology of tooth and implant crevices. Microbiology included dark field microscopy and anaerobic culturing. The results were interpreted by the authors as an indication that crevices around teeth may be reservoirs of bacteria for implant colonization. The authors were trying to explain higher percentages of black pigmenting anaerobes on implants in partially edentulous patients as opposed to completely edentulous patients. Rams, et al. compared microbiota associated with osseointegrated hydroxyapatite coated titanium implants to pure titanium implants. No significant differences in the microbiota between the implant types. Strep. sanguis and Strep. mitis were the predominant organisms. Conclusions based on various studies about bacteriology of stable implants are as follows:
Microbiota around failing implants
- Peri-implant microbiota is established soon after implant placement
- Significant shifts in the flora do not occur over time
- Microflora is stable in healthy patients comprising a microbiota in which periodontal pathogens present only at low or below detectable levels.
- Composition of the subgingival microflora around implants in partially edentulous patients is a resultant of the composition of the flora around the teeth.
Most studies reported that microbiota around failing dental implants harbored periodontopathic bacteria. Mombelli, et al. reported data from seven cases with hollow cylinder titanium implants. Implant sites with pocket depth greater than 6 mm with bleeding on probing and suppuration were compared to successfully osseointegrated implants. Failing implants harbored a flora similar to adult periodontitis. Increased proportions of P. intermedia, Fusobacterium spp, and spirochetes were found around failing implants. Quirynen, et al. conducted a retrospective study with four Brånemark implants and four patients. Implants failing due to overload demonstrated flora similar to periodontal health and failing implants due to infection harbored periodontopathic flora. Rosenberg, et al. studied 32 implants in subjects. This was a prospective study. Subjects were followed for 2-18 months. Implants failing due to infection had periodontopathic bacteria and implants failing due to traumatic influences had flora similar to periodontal health. One study reported higher levels of P. gingivalis in failed implants.  Based on the observations from the above-mentioned studies, it can be concluded that implants that fail due to infection have microbiota similar to those associated with periodontal disease. This could possibly be one of the reasons why implants fail more in subjects with periodontal disease compared to implants placed in otherwise healthy mouth.
| Conclusion|| |
A review of the literature so far leads to the conclusion that dental implants are not immune to infections. Like natural teeth, dental implants are colonized by bacteria. However there is a difference in the nature of microorganisms colonizing stable and failing implants. Most studies reported that stable implants have microbiota similar to that found in healthy periodontium. Gram-positive anaerobic cocci and rods are the predominant species colonizing stable implants. In contrast, failing implants have bacteria similar to the ones seen in periodontal disease. This is based on the majority of the studies. Like any topic in periodontics, there are studies that refute these findings. No matter what the studies show, it is wise to be cautious in placing dental implants in subjects with significant periodontal disease. It is important to treat the disease first and then treatment plan for dental implants.
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