Predictable tissue repair around diseased dental implants: The missing step

Although the use of dental implants is a reliable treatment option for replacing missing or hopeless teeth, long-term complications that were not known when implants were first utilized have been reported in the literature.¹ Implant complications have been categorized into two types: mechanical and/or biologic complications that can present in early or late stages of a dental implant’s life span. Biologic problems include inflammation and/or loss of supporting tissue around a dental implant. Many studies have analyzed different treatment methods for tissue repair around diseased implants with varying degrees of success.² Most studies have suggested methods for decontaminating the dental implant fixtures prior to tissue grafting.³ Few studies, however, have acknowledged the importance of decontaminating the tissue flap in contact with the diseased implant prior to tissue grafting. This article will briefly address the rationale behind decontamination of the inner lining of the peri-implant soft-tissue flap prior to grafting and suggest a treatment method that can be used to accomplish this goal.

Peri-implantitis has been commonly described in the literature as a pathological condition occurring in tissues around dental implants, characterized by inflammation in the peri‐implant mucosa and progressive loss of supporting bone.⁴ Plaque/biofilm continues to be the primary etiology of peri-implantitis.⁵ However, newer studies suggest that titanium or metal particles that come from the implant or prosthesis and embed themselves into the peri-implant tissue may play a role in the pathogenesis of peri-implant diseases.⁶ This concept, known as implant tribocorrosion, suggests that these particles can be an inflammatory initiator in addition to the commonly accepted bacterial pathogenesis model.⁷ Tribocorrosion may help explain why many of the treatment efforts around diseased implants that focus solely on detoxification of the implant fixture alone may have failed.

Although the exact mechanism of titanium and metal particles becoming embedded in peri-implant tissue remains unknown, there are a few theories presented in the literature. First, titanium particles might be produced during the insertion of the dental implant into the bone.⁸ Second, there may be dissolution of titanium from the dental implant into the submucosal plaque as a result of the peri-implantitis disease itself.⁹ Third, titanium particles might come from the micromotion present at the abutment-implant interface.¹⁰ Fourth, metal particles might be produced when performing certain professionally administered hygiene procedures around the dental implant.¹¹

In a recent article discussing two case reports, Nd:YAG and 9.3 micron CO₂ lasers were used to detoxify the inner lining of soft tissue surrounding ailing dental implants prior to tissue grafting (figures 1 and 2).¹² Lasers can ablate the soft tissue of this particulate (metal) material while killing some of the residual translocated/invasive bacteria, thereby facilitating soft- and hard-tissue healing.

This video demonstrates laser detoxification of the inner lining of the soft-tissue flap, approximating failed dental implant and showing titanium particles embedded into the soft tissue with sparks flying during ablation:

Both the Nd:YAG and 9.3 micron CO₂ lasers can have an impact on enhancing soft-tissue healing. Their ability to ablate residual titanium and/or cement from the inner soft-tissue flap lining may help enable the ailing implant sites to successfully heal.