Peri-Implantitis - Diagnosis
What is peri-implantitis?
If left untreated, reversible peri-implant mucositis can develop and become peri-implantitis. Peri-implantitis is characterised by inflammatory lesions in peri-implant tissues and associated loss of supporting bone.[i] The overall prevalence of peri-implantitis is estimated to be 15%.[ii
How do we diagnose peri-implantitis?
Clinically, soft tissue inflammation is detected through bleeding on probing, and progressive bone loss is identified on radiographs.[ii Although there are varying parameters for what defines peri-implantitis as opposed to peri-implant mucositis, generally, any bone loss equal to or greater than 2mm is indicative of peri-implantitis.[iv] In order to detect its presence:
- a visual inspection must be carried out, assessing signs and symptoms of inflammation
- a bleeding on probing test must be undertaken to examine changes
- a radiograph must be taken based on clinical judgement to assess bone levels. [iv]
What is the difference between peri-implant mucositis and peri-implantitis?
Peri-implant mucositis is a disease that is characterised by inflammation of the soft tissues around a dental implant, without bone loss outside of what is considered normal. Peri-implantitis is an inflammatory lesion of the mucosa surrounding an implant with progressive loss of supporting bone. If left untreated, peri-implant mucositis can turn into peri-implantitis, and it is widely accepted that both have an infection aetiology through the development of pathogenic biofilm. [iv]
Do you need probing to monitor peri-implant health?
Probing is an essential tool in monitoring the health of peri-implant tissue and in the diagnosis of peri-implant diseases. After fitting the implant-supported prosthesis, it is recommended that clinicians obtain a baseline probing measurement.[vii] It is necessary to probe the peri-implant tissues to assess the presence of bleeding on probing and to continue to monitor probing depth changes and mucosal margin migration. This is a safe and important component of a complete exam. [vii]
Do you need x-rays to monitor peri-implant health?
X-rays are an important tool for monitoring peri-implant health. Images can reveal the loss of bone around the implant, show early signs of peri-implantitis, provide detailed images and help measure bone density. It is recommended that clinicians obtain baseline radiographic measurements following implant-supported prosthesis placement. Further x-rays should then be taken at review appointments to assess changes in bone level based on baseline imaging. [vii]
Further reading
Doornewaard R, Jacquet W, Cosyn J, De Bruyn H. How do peri‐implant biologic parameters correspond with implant survival and peri‐implantitis? A critical review. Clin Oral Impl Res. 2018;29(Suppl. 18):100–123. Source: 5th EAO Consensus Conference 7–10 February 2018, Pfäffikon, Schwyz, Switzerland
Fiorelli JP, WanXin Luan K, Chang Y-C, Kim DM, Sarmiento HL. Peri-implant Mucosal Tissues and Inflammation: Clinical Implications. Int J Oral MaxIllofac Implants 2019;34(suppl):s25–s33. Source: AO 2018 Summit, 8-10 August 2018, Oak Brook, Illinois
Hashim D, Cionca N, Combescure C, Mombelli A. The diagnosis of peri-implantitis: A systematic review on the predictive value of bleeding on probing. Clin Oral Impl Res. 2018;29(Suppl. 16):276–293. Source: 6th ITI Consensus Conference, Amsterdam, 17–19 April 2018
Heitz-Mayfield LJ, Aaboe M, Araujo M, et al. Group 4 ITI Consensus Report: Risks and biologic complications associated with implant dentistry. Clin Oral Impl Res. 2018;29(Suppl. 16):351–358. Source: 6th ITI Consensus Conference, Amsterdam, 17–19 April 2018
Lang NP, Berglundh T on Behalf of Working Group 4 of the Seventh European Workshop on Periodontology: Periimplant diseases: where are we now? – Consensus of the Seventh European Workshop on Periodontology. J Clin Periodontol 2011; 38 (Suppl. 11): 178–181. Source: 7th European Workshop on Periodontology of the European Academy of Periodontology, La Granja, Segovia, Spain
Lindhe J, Meyle J. Peri-implant diseases: Consensus Report of the Sixth European Workshop on Periodontology. J Clin Periodontol 2008; 35 (Suppl. 8): 282–285. Source: 6th European Workshop on Periodontology of the European Academy of Periodontology, Ittingen, Thurgau, Switzerland
Sanz M, Klinge B, Acoforado G, et al. Biological aspects: Summary and consensus statements of group 2. The 5th EAO Consensus Conference 2018. Clin Oral Impl Res. 2018;29(Suppl. 18):152–156. Source: 5th EAO Consensus Conference 7–10 February 2018, Pfäffikon, Schwyz, Switzerland
References:
[i] Berglundh T, Zitzmann NU, Donati M. Are peri-implantitis lesions different from periodontitis lesions? J Clin Periodontol 2011; 38 (Suppl. 11): 188–202.
[ii] Schwarz F, Derks J, Monje A, Wang H-L. Peri-implantitis. J Periodontol. 2018;89(Suppl 1):S267–S290.
[iv] Renvert S, Persson GR, Pirih FQ, Camargo PM. Peri-implant health, peri-implant mucositis, and peri-implantitis: Case definitions and diagnostic considerations. J Periodontol. 2018;89(Suppl 1):S304–S312.
[vi] Renvert S, Persson GR, Pirih FQ, Camargo PM. Peri-implant health, peri-implant mucositis, and peri-implantitis: Case definitions and diagnostic considerations. J Periodontol. 2018;89(Suppl 1):S304–S312.
[vii] Berglundh T, Armitage G, et al. Peri-implant diseases and conditions: Consensus report of workgroup 4 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. J Periodontol. 2018;89(Suppl 1): S313–S318.