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Peri-Implant Diseases Defnitions

Peri-implant diseases are inflammatory conditions that affect the tissues surrounding dental implants and are primarily categorised into peri-implant mucositis and peri-implantitis.

  • Peri-implant mucositis is defined as a reversible inflammatory condition affecting the soft tissues around a functioning implant, characterised by inflammation without any accompanying bone loss (Berglundh et al., 2018).
  • Peri-implantitis is a more severe condition that involves both inflammation of the peri-implant tissues and progressive loss of supporting bone. This condition poses a significant threat to the stability and longevity of the implant and requires prompt intervention to prevent implant failure (Schwarz et al., 2018; Berglundh et al., 2018).

 

Characteristics of Peri-Implant Health

A healthy peri-implant site is characterised by:

  • Absence of erythema, bleeding on probing (BoP), swelling, and suppuration.
  • Shorter interproximal papillae adjacent to implants compared to natural teeth.
  • The necessity of probing peri-implant tissues to assess BoP, monitor changes in probing depth, and detect any mucosal margin migration.

 

Diagnosis of Peri-Implant Health:

  • No clinical signs of inflammation

  • Absence of bleeding and/or suppuration upon gentle probing
  • No increase in probing pocket depth (PPD) compared to previous examinations
  • No bone loss beyond crestal bone level changes associated with initial bone remodelling (Renvert et al., 2018).

 

Peri-Implant Mucositis

  • Peri-implant mucositis is primarily identified by bleeding on gentle probing. Other clinical signs may include erythema, swelling, and/or suppuration.
  • Increased PPD may be observed, often due to swelling or a decrease in probing resistance.
  • The primary etiological factor is plaque accumulation, which necessitates strict plaque control to resolve the condition.
  • Peri-implant mucositis can be resolved with effective plaque and biofilm management, although resolution may take more than three weeks (Araujo & Lindhe, 2018).

 

Diagnosis of Peri-Implant Mucositis:

  • Presence of bleeding and/or suppuration upon gentle probing, with or without an increase in PPD compared to previous examinations
  • Absence of bone loss beyond the changes associated with initial bone remodelling (Berglundh et al., 2018).

 

Peri-Implantitis

  • Peri-implantitis is a plaque-associated pathological condition that affects the tissues around dental implants, characterised by inflammation in the peri-implant mucosa and progressive bone loss.
  • Clinical signs include inflammation, BoP, suppuration, increased PPD, and/or recession, along with radiographic evidence of bone loss when compared to previous examinations.
  • The depth of PPD at sites with peri-implantitis often correlates with the severity of bone loss, making it a critical indicator of disease progression.
  • Peri-implant mucositis is generally considered to precede peri-implantitis (Renvert et al., 2018; Schwarz et al., 2018).

 

Diagnosis of Peri-Implantitis:

  • Clinical signs of inflammation, including BoP and suppuration
  • Increased PPD and/or recession
  • Radiographic evidence of bone loss beyond initial bone remodelling (Berglundh et al., 2018).

Diagnosis of peri-implantitis requires:

  • Presence of bleeding and/or suppuration on gentle probing
  • ↑PPD compared to previous examinations
  • Presence of BL (beyond crestal bone level changes resulting from initial bone remodelling)

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  (A) of the intraosseous part of the implant

These updated definitions and diagnostic criteria emphasise the importance of regular monitoring and early intervention to prevent the progression of peri-implant diseases, which can have a significant impact on the success and longevity of dental implants.

 

Aetiology

The composition of peri-implant plaque and the development of biofilm around implants are similar to those seen around natural teeth (Berglundh et al., 1992). The primary etiological factor in the initiation and progression of peri-implant diseases is the adherence of plaque biofilm on the implant surface, which mirrors the pathogenic processes of periodontitis in natural teeth (Lang et al., 2011; Quirynen et al., 2006).

However, biofilm accumulation tends to result in a higher incidence of bleeding around implants compared to natural teeth. Experimental models of peri-implantitis have demonstrated that tissue destruction occurs more rapidly and extensively around implants than in periodontitis (Salvi et al., 2017). The microbiota associated with peri-implantitis often includes high levels of motile rods, spirochetes, and fusiform bacteria, similar to those found in periodontal infections. Additionally, other bacteria such as staphylococci, peptostreptococci, and enteric rods may also be present (Mombelli & Decaillet, 2011).

A systematic review has linked the presence of Porphyromonas gingivalis, Treponema denticola, Tannerella forsythia, Prevotella intermedia, and Campylobacter rectus with the aetiology of peri-implantitis (Perez-Chaparro et al., 2016).