Perimplantite: cos’è ?

La perimplantite è un’infezione batterica che si sviluppa intorno agli impianti dentali ed è una patologia severa che, se non curata, può portare alla perdita dell’impianto.

Le cause della perimplantite sono da ricondursi alla presenza di batteri che si possono palesare sia subito dopo il posizionamento

dell’impianto stesso che dopo qualche tempo.

Una perimplantite che compare dopo poco tempo dal posizionamento dell’impianto dentale indica che il dentista non ha usato tutte le precauzioni di igiene dentale e di sterilizzazione, non solo degli strumenti utilizzati, ma anche dei più elementari accorgimenti, come indossare un paio di guanti igienizzati.

In tal caso si tratta di una perimplantite che si può definire precoce, perché si instaura molto tempo prima che sia avvenuta l’osteointegrazione, cioè la “saldatura” tra l’osso e i perni in titanio, il materiale che meglio si presta alla compatibilità biologica.

Nei casi in cui la perimplantite compaia dopo qualche tempo è realistico pensare che la responsabilità sia da ricondurre a una scarsa o assente e corretta igiene orale quotidiana e ai mancati controlli periodici dal proprio dentista, che si accorgerebbe subito della patologia in atto. I batteri quindi intaccano l’impianto dentale, nel primo caso già mentre questo viene posizionato, e i sintomi della perimplantite sono visibili fin da subito e riguardano sia i tessuti molli che l’osso mandibolare e mascellare.

Le gengive infatti che aderiscono alla protesi fissa cominciano a ritirarsi e a scoprire i colletti. E’ in questa fase che si formano delle sacche (o tasche) molto pericolose per la diffusione dell’infezione batterica, in quanto raccolgono sia depositi di placca che di cibo difficili da rimuovere, se non con una seduta di igiene dentale professionale.

Le sacche infatti possono superare la profondità di 0,5 mm e non sono raggiungibili dallo spazzolino e dal filo interdentale.

Quando l’infezione raggiunge l’osso anche questo si ritira e non è più in grado di dare un sostengo all’impianto che inesorabilmente deve essere rimosso.

I batteri che provocano la perimplantite su un impianto dentale sono identici a quelli della parodontite che colpisce i denti naturali.

Il dentista in questo caso deve porre attenzione a non inserire nessun impianto in un paziente che ha già in atto questo patologia, in quanto è facile che i batteri di un dente possano intaccare l’impianto.

Per riscontrare la presenza di parodontite, e quindi il pericolo di una perimplantite, basta condurre analisi microbiologiche mirate. In tal caso il cavo orale deve essere decontaminato, sia localmente che con una terapia antibiotica.

Allo stesso modo quando viene asportato l’impianto bisogna attendere che sia debellata l’infezione per procedere all’inserimento di uno nuovo, verificando prima la consistenza e la qualità dell’osso mandibolare e mascellare.

Se non fosse sufficiente è sempre possibile eseguire un trapianto osseo per avere un sostegno per il nuovo impianto dentale.

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