Differences periodontitis and peri-implantitis

Periodontitis and peri-implantitis have a number of similarities. However, there are also fundamental differences, which are primarily due to the different anatomy of tooth and implant.

Tooth and implant in comparison

The natural tooth is separated from the alveolar bone by the ligament and suspended in the alveolus via a connective tissue fiber apparatus. The fibers run in different directions, forming a network that is difficult to penetrate. The implant, on the other hand, is anchored directly in the bone and thus the periodontal cleft and Sharpey’s fibers are absent. In addition, the collagen fibers of the implant tissue do not insert on the implant, but are oriented parallel thereto, resulting in less connective tissue attachment. This contributes to the fact that peri-implant inflammations propagate 2-3 times faster and show a faster progressing bone loss than periodontal inflammation.

The implant-surrounding tissue is a scar tissue

The peri-implant tissue also has fewer blood vessels, which means it is worse vascularized compared to the periodontium. Overall, the peri-implant tissue is more like a scar tissue with reduced immunological competence, which also makes the defence against bacterial attacks less efficient. This is also reflected in the increased spread of the inflammatory cell infiltrate (mainly neutrophils and macrophages) on the implant compared to the natural tooth, which can be taken as an indication of a more acute inflammatory process.