The oral cavity, being an open and dynamic ecosystem, is exposed to numerous factors that regulate the microbial composition. The alteration of the balance of the mouth leads to the possible appearance of diseases of the gums by accumulation of microorganisms that form the oral biofilm (bacterial plaque).
A gum in health conditions should not have inflammation or bleeding. If this condition occurs, it may be due to the patient having gum disease, which can develop on teeth (gingivitis and periodontitis) or dental implants (peri-implant mucositis and peri-implantitis). The main causative agent is the accumulation of bacterial plaque (oral biofilm).
Gingivitis is characterized by inflammation and bleeding of the gum. Generally redness, inflammation and bleeding of the gum is observed, without affecting the tissues that support the tooth (periodontium). This condition is reversible, however, if left untreated it can progress and progress to periodontitis.
Periodontitis is characterized by redness, inflammation, bleeding, recessions of the gum, tooth mobility and loss of the alveolar bone that supports the teeth, and tooth loss can occur.
On the other hand, the mucosa that forms around the implants shares similarities with the gum that forms around the teeth. Like periodontal tissues, soft peri-implant tissues have a protective function against external environmental aggressions, such as microorganisms. The peri-implant mucosa presents a different inflammatory response, such that after the accumulation of oral biofilm the extension of the inflammation may become deeper. Therefore, peri-implant tissues are less responsive to the aggression of oral biofilm compared to periodontal tissues.
The presence of microorganisms on the surface of dental implants occurs quickly after exposure to the oral cavity, which can cause peri-implant diseases (peri-implant mucositis and peri-implantitis). Peri-implant mucositis is an inflammatory lesion that occurs in the mucosa surrounding an implant .
The most common characteristics are edema, redness and hyperplasia of the mucosa, bleeding (Ikeda-Artacho et al., 2007) without loss of the surrounding bone. The continuous presence of bacterial plaque (oral biofilm) on the implants induces this inflammatory reaction and, if not treated correctly, it can evolve to peri-implantitis.
Periimplantitis is an inflammatory lesion of the mucosa that surrounds a functioning implant, associated with the loss of supporting bone (Zitmann and Berglundh 2008). The lesions caused by periimplantitis are poorly encapsulated, extend into the marginal bone tissue and, if they advance, can cause the loss of the implant.
Prevention and treatment
The prevention and treatment of these periodontal and peri-implant pathologies should focus on the application of anti-infective measures. The objective is to achieve the mechanical destructuring of bacterial plaque (oral biofilm) and the reduction of bacteria that cause pathologies at levels compatible with health. For this it is necessary to carry out combined treatments that include a mechanical and chemical treatment. The mechanical treatment breaks down the bacterial plaque (oral biofilm); however, it has certain limitations in non-compliant patients. Therefore, the use of antiseptics, such as Chlorhexidine or Cetilpiridinium Chloride, is essential as a chemical adjuvant to the mechanical treatment in the biofilm control.
That is why efforts should focus on maintaining the health of teeth and implants or, what is the same, in the prevention of the onset of periodontal and peri-implant diseases, whose objective will be to prevent inflammation and infection of the teeth. dental and peri-implant tissues and prevent the formation of a pathogenic biofilm, thus minimizing the risk of failure of periodontal treatments and that of implants.