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 implants
like natural teeth can be affected by microorganisms. Various terms have been proposed to describe
inflammation around dental implant. The ones that are commonly used include periimplantitis and
periimplant 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 in
periodontal health. Similarly, bacteria associated with failing implants have also been studied. These
studies predominantly showed that the bacteria associated with failing implant are similar to the ones
seen in periodontal disease. One should be very cautious in placing dental implants in subjects with
significant 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 by
microorganisms. There are various terminologies
associated with ailing and failing implants. Terms
such as periimplant disease, periimplant mucositis,
and periimplantitis have been proposed that describe
pathologic conditions around dental implants. Dental
implants are being used more frequently to restore
partially edentulous or completely edentulous patients.
Clinicians now are facing problems that they encountered
with natural teeth. Like natural teeth dental implants are
susceptible to infammation of the supporting tissues by
colonization of pathogenic bacteria.
Implant failure has been defined as the inadequacy
of t he host t i ssue t o est abl i sh or mai nt ai n
osseointegration.
[1]
Implant failures can be classifed based
on the time of failure as early or late and based on the
etiopathogenesis as infectious or noninfectious.
[2,3]
Early
failures are due to failure to establish osseointegration
and late failure is due to failure to maintain
osseointegration.
[4]
Osseointegration is defined as a
direct structural and functional connection between
ordered living bone and surface of a loadcarrying
implant.
[5,6]
Early failures can occur as a result of surgical
trauma, premature loading of the implant, and bacterial
infection. Late failures can occur following prosthetic
rehabilitation.
[2]
Late failures can again be divided as
soon late failures which occur during the frst year
of loading and as delayed late failures occurring in
subsequent years. Soon late failures can be attributed
to overloading of the implant placed in bone that is poor
both qualitatively and quantitatively. Delayed late
failures can occur when there are changes in the loading
conditions in relation to bone quality and volume and
also as a result of periimplantitis.
[2,7]
The present review will focus on the microbiota
associated with dental implants in healthy and diseased
states.
DEFINITION AND PREVALENCE OF
PERIIMPLANT DISEASE
European workshop on periodontology proposed the
following definitions for inflammatory lesions that
develop around implants.
[8]
Periimplant disease: The infammatory lesions that
develop in the tissues around the implants
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Address for correspondence: Dr. Aravind Buddula,
15640 Redmond Way, Redmond, USA, E-mail: arvimayo@yahoo.com
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DOI:
10.4103/0974-6781.111698
REVIEW ARTICLE
Buddula: Bacteria and dental implants
Journal of Dental Implants | Jan - Jun 2013 | Vol 3 | Issue 1 59
Periimplant mucositis: Reversible inflammatory
reaction in the soft tissues surrounding a functioning
implant
Periimplantitis: Infammatory reactions associated
with loss of supporting bone around an implant in
function.
However, Zitzmann, et al.
[9]
provided new defnitions
for these infammatory lesions.
Periimplant Disease: Infammatory reactions in the
tissues surrounding an implant
Periimplant Mucositis: Presence of infammation
in the mucosa at an implant with no signs of loss of
supporting bone
Periimplantitis: Presence of infammation and loss
of supporting bone.
Authors in their latest defnition eliminated the words
reversible and irreversible proposed by the European
workshop on periodontology as it might imply that
the process cannot be treated. Authors were of the
opinion that periimplantitis is treatable hence it cannot
be considered irreversible. Periimplant mucositis is
comparable to gingivitis around natural teeth as there
is no loss of supporting structure and periimplantitis
is comparable to periodontitis around natural teeth as
there is bone loss associated with it.
PREVALENCE OF PERIIMPLANT DISEASES
There is the scant literature available about the
prevalence of periimplant diseases. Crosssectional
studies on prevalence of implant related disease are rare.
Hence, there is a scarcity in the available literature about
the prevalence of implant related diseases.
Based on the available literature, periimplant mucositis
occurred in approximately 80% of the subjects and in
50% of the implants.
[10,11]
Periimplantitis was identifed in 28% of the subjects
and56% of subjects and in 12 and 43% of implant sites,
respectively.
[1014]
MICROBIOTA AROUND HEALTHY AND
DISEASED TEETH IN THE ABSENCE OF
IMPLANTS
Studies have shown that fora associated with healthy
implants is similar to the fora in natural teeth and also that
the fora associated with ailing/failing implants is similar
to the one associated with periodontal disease.
[1518]
Hence,
it is important for the clinician to evaluate the periodontal
status of the subject before implant placement.
Sampl es from heal thy gi ngi val sul cus consi st
of predominantly grampositive anaerobic cocci
and rods. Principally found are A. naeslundii,
A. gerencseriae, S oralis, and Peptostreptococcus
species which account for more than 50% of the
bacteria.
[1921]
With the development of periodontitis,
there are a higher proportion of gramnegative rods and
decreased grampositive species. Increased proportions
of P. gingivalis, B. forsythus and species of Prevotella,
Fusobacterium, Campylobacter, and Treponema have been
detected.
[18,19]
BACTERIOLOGY OF STABLE IMPLANTS
There are only two longitudinal studies to date that report
microbial colonization of stable dental implants. The frst
study was done by Nakou, et al.
[22]
in 1987. They found that
supragingival plaque in stable implants predominantly
consists of grampositive cocci and subgingival plaque
is dominated by Haemophilus spp and Veillonella parula.
Second longitudinal study was done by Mombelli, et al.
[23]

in 1988. They studied microbial colonization of ITI
implants in edentulous patients. Samples were taken
from periimplant crevice. They found that the fora
was established shortly after installation of the dental
implant. Over 85% of the organisms were identifed as
coccoid cells and over 80% were grampositive facultative
cocci. No, noteworthy, changes were found in the fora in
the frst 6 months. Spirochetes were never detected and
Fusobacteria and blackpigmenting gramnegative rods
were found occasionally. Authors concluded from the
study that bacteria around the implants in edentulous
patients were similar to that found in the sulci of subjects
with healthy periodontium. Mombelli, et al.
[24]
conducted
a followup study in which they assess the microbial fora
associated with stable osseointegrated dental implants.
Majority of the patients were followed to the ffth year
of implantation. No signifcant change was noted in the
microbial fora during followup examinations.
However, crosssectional studies are available in the
literature that talks about bacteriology of stable implants.
Lekholm, et al.
[25]
studied 20 patients with Brnemark
implants. Mean observation time was 7.6 years. Coccoid
and nonmotile rods dominated in up to 94% in the samples
taken. Similarly, Apse, et al.
[26]
compared bacteriology of
tooth and implant crevices. Microbiology included dark
feld microscopy and anaerobic culturing. The results
were interpreted by the authors as an indication that
crevices around teeth may be reservoirs of bacteria for
implant colonization. The authors were trying to explain
higher percentages of black pigmenting anaerobes on
implants in partially edentulous patients as opposed to
completely edentulous patients. Rams, et al.
[27]
compared
microbiota associated with osseointegrated hydroxyapatite
coated titanium implants to pure titanium implants. No
significant differences in the microbiota between the
Buddula: Bacteria and dental implants
60 Journal of Dental Implants | Jan - Jun 2013 | Vol 3 | Issue 1
implant types. Strep. sanguis and Strep. mitis were the
predominant organisms. Conclusions based on various
studies about bacteriology of stable implants are as follows:
Periimplant microbiota is established soon after
implant placement
Signifcant shifts in the fora do not occur over time
Microfora is stable in healthy patients comprising a
microbiota in which periodontal pathogens present
only at low or below detectable levels.
Composition of the subgingival microfora around
implants in partially edentulous patients is a resultant
of the composition of the fora around the teeth.
Microbiota around failing implants
Most studies reported that microbiota around failing
dental implants harbored periodontopathic bacteria.
Mombelli, et al.
[17]
reported data from seven cases with
hollow cylinder titanium implants. Implant sites with
pocket depth greater than 6 mm with bleeding on
probing and suppuration were compared to successfully
osseointegrated implants. Failing implants harbored a
fora similar to adult periodontitis. Increased proportions
of P. intermedia, Fusobacterium spp, and spirochetes were
found around failing implants. Quirynen, et al.
[28]

conducted a retrospective study with four Brnemark
implants and four patients. Implants failing due to
overload demonstrated flora similar to periodontal
health and failing implants due to infection harbored
periodontopathic flora. Rosenberg, et al.
[29]
studied
32 implants in subjects. This was a prospective study.
Subjects were followed for 218 months. Implants failing
due to infection had periodontopathic bacteria and
implants failing due to traumatic infuences had fora
similar to periodontal health. One study reported higher
levels of P. gingivalis in failed implants.
[30]
Based on the
observations from the abovementioned studies, it can
be concluded that implants that fail due to infection have
microbiota similar to those associated with periodontal
disease. This could possibly be one of the reasons why
implants fail more in subjects with periodontal disease
compared 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 by
bacteria. However there is a difference in the nature
of microorganisms colonizing stable and failing
implants. Most studies reported that stable implants
have microbiota similar to that found in healthy
periodontium. Grampositive anaerobic cocci and rods
are the predominant species colonizing stable implants.
In contrast, failing implants have bacteria similar to the
ones seen in periodontal disease. This is based on the
majority of the studies. Like any topic in periodontics,
there are studies that refute these fndings. No matter
what the studies show, it is wise to be cautious in placing
dental implants in subjects with signifcant periodontal
disease. It is important to treat the disease frst and then
treatment plan for dental implants.
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How to cite this article: Buddula A. Bacteria and dental implants:
A review. J Dent Implant 2013;3:58-61.
Source of Support: Nil, Confict of Interest: None.
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