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Periodontics · patient case question

How does the microflora of peri-implantitis compare with that of periodontitis?

Patient case: Implants, Peri-implantitis, and a Regeneration Question

Patient: 59-year-old male

Chief Complaint: Review of two implants placed four years ago, and assessment of a defect on tooth #6.

Background: Former smoker. History of treated periodontitis. Irregular maintenance attendance.

Medications: None

Vital Signs: BP 130/82 mmHg · HR 74 bpm · RR 16 · T 98.4°F

Findings: Implant at site #19: 6 mm probing depth with bleeding and suppuration, 2 mm of radiographic crestal bone loss. Tooth #6 has a NARROW three-walled intrabony defect on its MESIAL surface, 6 mm deep, with the tooth firm and vital. Posterior mandibular ridge is being assessed for a further implant.

  1. They are broadly similar — both are dominated by anaerobic Gram-negative species
  2. Peri-implantitis flora is substantially more pathogenic
  3. Periodontitis flora is substantially more pathogenic
  4. The two are entirely unrelated
Show answer and explanation

Correct answer: A. They are broadly similar — both are dominated by anaerobic Gram-negative species

  • A. CORRECT. The microbial profiles are BROADLY SIMILAR. Both are dominated by anaerobic Gram-negative organisms, including the red complex — Porphyromonas gingivalis, Tannerella forsythia and Treponema denticola — together with Prevotella intermedia and Fusobacterium. In a partially dentate patient, the remaining teeth act as the reservoir from which the implant surface is colonised, which is precisely why untreated periodontitis is such a strong risk factor for peri-implantitis.
  • B. There are some differences in peri-implantitis lesions — a higher prevalence of staphylococci, particularly S. aureus, and of some enteric species and Candida — but the dominant picture is the same anaerobic Gram-negative flora, not a more pathogenic one.
  • C. There is no basis for regarding periodontal flora as the more pathogenic of the two.
  • D. The two are closely related — the shared flora is the mechanism of the shared risk.

Note: The clinical consequence: periodontal disease must be treated and STABILISED before implants are placed, and lifelong maintenance is mandatory. Peri-implantitis differs from periodontitis in its progression — faster, with a larger inflammatory infiltrate extending closer to the bone, because the implant lacks a periodontal ligament and has only a parallel-fibre attachment with no perpendicular Sharpey fibre insertion.

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