Management of Acute Dental Problems

Brief description of condition

Inflammation affecting the soft and hard tissues around implants, leading to loss of bone support.

Key signs and symptoms

• Pain (around the implants)
• Swelling
• Bleeding
• Suppuration on applying pressure
• Radiographic evidence of peri-implant bone loss

Initial management

Recommend optimal analgesia.

Do not prescribe antibiotics unless there are signs of spreading infection, systemic infection, or for an immunocompromised patient.

Recommend good oral hygiene.

Advise the patient to seek non-urgent dental care or, if analgesia is ineffective, urgent dental care.

Subsequent Care

Assess the patient's progress including radiographic assessment to evaluate bone loss and monitor the outcome of treatment.

Give appropriate oral hygiene instruction.

Consider non-surgical debridement with carbon fibre or plastic curettes and irrigate the pocket with 0.2% chlorhexidine.

Consider surgical debridement and implant decontamination with saline or 0.2% chlorhexidine.

In severe cases, consider regenerative surgery with barrier membranes with or without autogenous bone grafts or bone substitute or surgical removal of the implant.

Reference

1. Esposito M, Grusovin MG. Interventions for replacing missing teeth: treatment of peri-implantitis. Cochrane Database of Systematic Reviews 2012, Issue 1. Art. No.: CD004970. DOI: 10.1002/14651858.CD004970.pub5