Quantification of Subgingival Microflora in a Peri Implantitis Patient Using RTPCR - A Case Report

Background and aims. Peri-implantitis is a chronic progressive marginal infection which is defined as an inflammatory reaction affecting the tissues surrounding osseointegrated dental implants resulting in loss of supporting bone. Microflora of patients with implants who are edentulous mainly consists of gram positive facultative cocci and non motile rods. Predominantly, Streptococcus sanguis, Streptococcus mitis while motile rods, Spirochetes, Fusiforms and filaments are infrequently found in a healthy, stable implant. Microbiota around the failing implant in edentulous patients usually consists of gram negative anaerobic rods. In partially edentulous patients, peri implant microorganisms are increased in proportion of motile rods, Spirochetes and cocci in a stable implant. In a failing implant, in partially edentulous patients high proportions of P. micros, P. intermedia, C. rectus and Fusobacterium species were observed. The concept that the composition of subgingival microflora around implants in partially edentulous patients was said to be resultant of composition of flora around the teeth, based on this principle we set out to identify the presence of putative periodontal pathogens on teeth in a predominantly edentulous arch with a metallic coping with periodontitis and a site in the same mouth with peri implantitis site. Materials and methods. Subgingival plaque samples were collected from a partially edentulous patient using a paper point from the periimplantitis lesion with a probing depth of 8-9 mm and a tooth with deepest pocket with a probing depth of 6mm and we analyzed the five putative periodontal pathogens namely, P. gingivalis, P. intermedia, P. nigrecens, T. denticola and T. forcythia using Real Time Polymerised Chain Reaction (RTPCR) technique. Results. P. Gingivalis and P. Intermedia, P. Nigrecens had a 3 fold increase and T. Denticola had 1 fold increase when compared to the periodontitis (teeth) site, and T. Forsythia was found in trace amounts at the peri implantit is site and was completely absent at the periodontitis (teeth) site. Conclusion. Proper periodontal infection control before the placement of dental implants in partially edentulous individuals may prevent early bacterial complications and also continuous monitoring of partially edentulous teeth site making it infection free will help in the longevity of the implant.