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58 Journal of Dental Implants | Jan - Jun 2013 | Vol 3 | Issue 1

Bacteria and dental implants: A review

Aravind Buddula

ABSTRACT

Dental implants have been shown to be an excellent method for replacing natural teeth. Dental implantslike natural teeth can be affected by microorganisms. Various terms have been proposed to describeinflammation around dental implant. The ones that are commonly used include periimplantitis andperiimplant 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 inperiodontal health. Similarly, bacteria associated with failing implants have also been studied. Thesestudies predominantly showed that the bacteria associated with failing implant are similar to the onesseen in periodontal disease. One should be very cautious in placing dental implants in subjects withsignificant 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.

KEY WORDS: Bacteria, implants, periimplantitis

INTRODUCTION

Dental implants like natural teeth are colonized bymicroorganisms. There are various terminologiesassociated with ailing and failing implants. Termssuch as periimplant disease, periimplant mucositis,and periimplantitis have been proposed that describepathologic conditions around dental implants. Dental

implants are being used more frequently to restorepartially edentulous or completely edentulous patients.Clinicians now are facing problems that they encounteredwith natural teeth. Like natural teeth dental implants aresusceptible to inammation of the supporting tissues bycolonization of pathogenic bacteria.

Implant failure has been defined as the inadequacyof the host t i ssue to establ ish or maintainosseointegration. [1] Implant failures can be classied basedon the time of failure as early or late and based on the

etiopathogenesis as infectious or noninfectious.[2,3] Earlyfailures are due to failure to establish osseointegrationand late failure is due to failure to maintainosseointegration. [4] Osseointegration is defined as adirect structural and functional connection betweenordered living bone and surface of a loadcarryingimplant.[5,6] Early failures can occur as a result of surgicaltrauma, premature loading of the implant, and bacterial

infection. Late failures can occur following prostheticrehabilitation.[2] Late failures can again be divided assoon late failures which occur during the rst yearof loading and as delayed late failures occurring insubsequent years. Soon late failures can be attributedto overloading of the implant placed in bone that is poorboth qualitatively and quantitatively. Delayed latefailures can occur when there are changes in the loadingconditions in relation to bone quality and volume andalso as a result of periimplantitis.[2,7]

The present review will focus on the microbiota

associated with dental implants in healthy and diseasedstates.

DEFINITION AND PREVALENCE OF

PERIIMPLANT DISEASE

European workshop on periodontology proposed thefollowing definitions for inflammatory lesions thatdevelop around implants.[8]

Periimplant disease: The inammatory lesions thatdevelop in the tissues around the implants

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Address for correspondence: Dr. Aravind Buddula,15640 Redmond Way, Redmond, USA, E-mail: [email protected]

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DOI:

10.4103/0974-6781.111698

REVIEW ARTICLE


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Buddula: Bacteria and dental implants

Journal of Dental Implants | Jan - Jun 2013 | Vol 3 | Issue 1 59

Periimplant mucositis: Reversible inflammatoryreaction in the soft tissues surrounding a functioningimplant

Periimplantitis: Inammatory reactions associatedwith loss of supporting bone around an implant infunction.

However, Zitzmann, et al.[9]

provided new denitionsfor these inammatory lesions. Periimplant Disease: Inammatory reactions in the

tissues surrounding an implant Periimplant Mucositis: Presence of inammation

in the mucosa at an implant with no signs of loss ofsupporting bone

Periimplantitis: Presence of inammation and lossof supporting bone.

Authors in their latest denition eliminated the wordsreversible and irreversible proposed by the Europeanworkshop on periodontology as it might imply that

the process cannot be treated. Authors were of theopinion that periimplantitis is treatable hence it cannotbe considered irreversible. Periimplant mucositis iscomparable to gingivitis around natural teeth as thereis no loss of supporting structure and periimplantitisis comparable to periodontitis around natural teeth asthere is bone loss associated with it.

PREVALENCE OF PERIIMPLANT DISEASES

There is the scant literature available about theprevalence of periimplant diseases. Crosssectionalstudies on prevalence of implant related disease are rare.

Hence, there is a scarcity in the available literature aboutthe prevalence of implant related diseases.

Based on the available literature, periimplant mucositisoccurred in approximately 80% of the subjects and in50% of the implants.[10,11]

Periimplantitis was identied in 28% of the subjectsand56% of subjects and in 12 and 43% of implant sites,respectively.[1014]

MICROBIOTA AROUND HEALTHY AND

DISEASED TEETH IN THE ABSENCE OFIMPLANTS

Studies have shown that ora associated with healthyimplants is similar to the ora in natural teeth and also thatthe ora associated with ailing/failing implants is similarto the one associated with periodontal disease.[1518] Hence,it is important for the clinician to evaluate the periodontalstatus of the subject before implant placement.

Samples from healthy gingival sulcus consist

of predominantly grampositive anaerobic cocciand rods. Principally found are A. naeslundii,A. gerencseriae, S oralis, and Peptostreptococcus species which account for more than 50% of thebacteria.[1921] With the development of periodontitis,there are a higher proportion of gramnegative rods anddecreased grampositive species. Increased proportions

of P. gingivalis, B. forsythus and species of Prevotella,Fusobacterium, Campylobacter, and Treponema have beendetected.[18,19]

BACTERIOLOGY OF STABLE IMPLANTS

There are only two longitudinal studies to date that reportmicrobial colonization of stable dental implants. The rststudy was done by Nakou, et al.[22] in 1987. They found thatsupragingival plaque in stable implants predominantlyconsists of grampositive cocci and subgingival plaqueis dominated by Haemophilus spp and Veillonella parula.Second longitudinal study was done by Mombelli, et al.[23]

in 1988. They studied microbial colonization of ITIimplants in edentulous patients. Samples were takenfrom periimplant crevice. They found that the orawas established shortly after installation of the dentalimplant. Over 85% of the organisms were identied ascoccoid cells and over 80% were grampositive facultativecocci. No, noteworthy, changes were found in the ora inthe rst 6 months. Spirochetes were never detected andFusobacteria and blackpigmenting gramnegative rodswere found occasionally. Authors concluded from thestudy that bacteria around the implants in edentulouspatients were similar to that found in the sulci of subjectswith healthy periodontium. Mombelli, et al.[24] conducteda followup study in which they assess the microbial oraassociated with stable osseointegrated dental implants.Majority of the patients were followed to the fth yearof implantation. No signicant change was noted in themicrobial ora during followup examinations.

However, crosssectional studies are available in theliterature that talks about bacteriology of stable implants.Lekholm, et al.[25] studied 20 patients with Brnemarkimplants. Mean observation time was 7.6 years. Coccoidand nonmotile rods dominated in up to 94% in the samplestaken. Similarly, Apse, et al.[26] compared bacteriology of

tooth and implant crevices. Microbiology included darkeld microscopy and anaerobic culturing. The resultswere interpreted by the authors as an indication thatcrevices around teeth may be reservoirs of bacteria forimplant colonization. The authors were trying to explainhigher percentages of black pigmenting anaerobes onimplants in partially edentulous patients as opposed tocompletely edentulous patients. Rams, et al.[27] comparedmicrobiota associated with osseointegrated hydroxyapatitecoated titanium implants to pure titanium implants. Nosignificant differences in the microbiota between the


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60 Journal of Dental Implants | Jan - Jun 2013 | Vol 3 | Issue 1

implant types. Strep. sanguis and Strep. mitis were thepredominant organisms. Conclusions based on variousstudies about bacteriology of stable implants are as follows: Periimplant microbiota is established soon after

implant placement Signicant shifts in the ora do not occur over time Microora is stable in healthy patients comprising a

microbiota in which periodontal pathogens presentonly at low or below detectable levels. Composition of the subgingival microora around

implants in partially edentulous patients is a resultantof the composition of the ora around the teeth.

Microbiota around failing implantsMost studies reported that microbiota around failingdental implants harbored periodontopathic bacteria.Mombelli, et al.[17] reported data from seven cases withhollow cylinder titanium implants. Implant sites withpocket depth greater than 6 mm with bleeding onprobing and suppuration were compared to successfully

osseointegrated implants. Failing implants harbored aora similar to adult periodontitis. Increased proportionsof P. intermedia, Fusobacterium spp, and spirochetes werefound around failing implants. Quirynen, et al.[28]conducted a retrospective study with four Brnemarkimplants and four patients. Implants failing due tooverload demonstrated flora similar to periodontalhealth and failing implants due to infection harboredperiodontopathic flora. Rosenberg, et al.[29] studied32 implants in subjects. This was a prospective study.Subjects were followed for 218 months. Implants failingdue to infection had periodontopathic bacteria andimplants failing due to traumatic inuences had orasimilar to periodontal health. One study reported higherlevels of P. gingivalis in failed implants.[30] Based on theobservations from the abovementioned studies, it canbe concluded that implants that fail due to infection havemicrobiota similar to those associated with periodontaldisease. This could possibly be one of the reasons whyimplants fail more in subjects with periodontal diseasecompared 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 bybacteria. However there is a difference in the natureof microorganisms colonizing stable and failingimplants. Most studies reported that stable implantshave microbiota similar to that found in healthyperiodontium. Grampositive anaerobic cocci and rodsare the predominant species colonizing stable implants.In contrast, failing implants have bacteria similar to theones seen in periodontal disease. This is based on themajority of the studies. Like any topic in periodontics,

there are studies that refute these ndings. No matterwhat the studies show, it is wise to be cautious in placingdental implants in subjects with signicant periodontaldisease. It is important to treat the disease rst and thentreatment plan for dental implants.

REFERENCES

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implant sulcus: A comparison of sites in edentulous and partiallyedentulous patients. J Periodont Res 1989;24:96-105.

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26. Apse P, Ellen RP, Overall CM, Zarb GA. Microbiota and

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implant sulcus: A comparison of sites in edentulous and partially

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intra-oral translocations of periodontopathogens jeopardize theoutcome of periodontal therapy. A review of the literature. J Clin

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18. Meffert RM. Periodontitis and periimplantitis: One and the same?Pract Periodont Aesthetic Dent 1993;5:79-82.

19. SlotsJ.Microorainthehealthygingivalsulcusinman.Scand

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Kent RL Jr, Socransky SS. Subgingival microbiota in healthy,well-maintained elder and periodontitis subjects. J ClinPeriodontol 1998;25:346-53.

22. Nakou M, Mikx FH, Oosterwaal PJ, Kruijsen JC. Early microbialcolonization of permucosal implants in edentulous patients.J Dent Res 1987;11:1654-7.

23. Mombelli A, Buser D, Lang NP. Colonization of osseointegratedtitanium implants in edentulous patients. Early results. OralMicrobiol Immunol 1988;3:113-20.

24. Mombelli A, Mericske-Stern R. Microbiological features of stableosseointegrated implants used as abutments for overdentures.Clin Oral Impl Res 1990;1:1-7.

25. Lekholm U, Adell R, Lindhe J, Brnemark P, Eriksson B,Rockler B, et al. Marginal tissue reactions at Osseointegratedtitaniumxtures.Acrosssectionalretrospectivestudy.IntJOral

Maxillofac Surg 1986;15:53-61.

How to cite this article: Buddula A. Bacteria and dental implants:

A review. J Dent Implant 2013;3:58-61.

Source of Support: Nil,Conict of Interest:

None.

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