Peri‐implant diseases and conditions: Consensus report of workgroup 4 of the 2017 World Workshop on the Classification of Periodontal and Peri‐Implant Diseases …

Peri-implant health is characterized by the absence of erythema, bleeding on probing, swelling, and suppuration. It is not possible to define a range of probing depths compatible with health; Peri-implant health can exist around implants with reduced bone support.

The main clinical characteristic of peri-implant mucositis is bleeding on gentle probing. Erythema, swelling, and/or suppuration may also be present. An increase in probing depth is often observed in the presence of peri-implant mucositis due to swelling or decrease in probing resistance. There is strong evidence from animal and human experimental studies that plaque is the etiological factor for peri-implant mucositis.Smoking, diabetes mellitus, and radiation therapy may modify the condition.

Peri-implantitis is a plaque-associated pathological condition occurring in tissues around dental implants, characterized by inflammation in the peri-implant mucosa and subsequent progressive loss of supporting bone. Peri-implantitis sites exhibit clinical signs of inflammation, bleeding on probing, and/or suppuration, increased probing depths and/or recession of the mucosal margin in addition to radiographic bone loss.


What are the major risk indicators for peri-implantitis?

There is strong evidence that there is an increased risk of developing peri-implantitis in patients who have a history of severe periodontitis, poor plaque control, and no regular maintenance care after implant therapy. Data identifying smoking and diabetes as potential risk indicators for peri-implantitis are inconclusive.

Implants that have been placed under less than ideal circumstances are often encountered in day-to-day practice. As a result, there may be an increased prevalence of peri-implantitis associated with these situations.

There is some limited evidence linking peri-implantitis to factors such as post-restorative presence of submucosal cement and positioning of implants that does not facilitate oral hygiene and maintenance. The role of peri-implant keratinized mucosa, occlusal overload, titanium particles, bone compression necrosis, overheating, micromotion and biocorrosion as risk indicators for peri-implantitis remains to be determined.

There is a high priority to conduct studies that are designed to develop diagnostic, preventive, and intervention strategies for the management of these peri-implant issues.

How do we define a case of peri-implantitis in day-to-day clinical practice and teaching situations?

Diagnosis of peri-implantitis requires:
- Presence of bleeding and/or suppuration on gentle probing.
- Increased probing depth compared to previous examinations.
- Presence of bone loss beyond crestal bone level changes resulting from initial bone remodeling
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In the absence of previous examination data diagnosis of peri-implantitis can be based on the combination of:
- Presence of bleeding and/or suppuration on gentle probing.
- Probing depths of ≥6 mm.
- Bone levels ≥3 mm apical of the most coronal portion of the intraosseous part of the implant.

It should be noted that visual signs of inflammation can vary and that recession of the mucosal margin should be considered in the probing depth evaluation.