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Peri-implantitis: All You Want (or not) To Know

Course Number: 680


Peri-implant mucositis refers to an inflammation that is confined in soft tissue attachment around dental implant fixture. An implant with peri-implant mucositis often demonstrates erythema and edema around peri-implant marginal mucosa in addition to bleeding on gentle probing. In comparison, peri-implantitis refers to an inflammation in supporting alveolar bone as well as soft-tissue attachment, which results in irreversible destruction of alveolar bone.1-4 In addition to the clinical signs of peri-implant mucositis, an implant with peri-implantitis may accompany suppuration, pain, and mobility. The loss of the supporting bone and attachment is irreversible. In the absence of treatment, peri-implantitis progresses in a “non-linear and accelerating pattern”, more rapid than the progression of periodontitis.2,3

The American Academy of Periodontology and European Federation of Periodontology Classification of Periodontal and Peri-implant Diseases and Conditions proposed a new definition of these pathologies, aiming at introducing a uniform classification for peri-implant health, peri-implant mucositis, and peri-implantitis.2-3 Peri-implant tissue health status has been recently defined as an essential outcome domain that should be captured in all implant clinical trials, and the 2018 classification case definitions have been used in the European Federation of Periodontology (EFP) guidelines to drive prevention and treatment of peri-implant diseases.2-3 According to the 2018 classification, the distinction between peri-implant health and peri-implant mucositis is based on the presence or absence of the following: (a) clinical signs of inflammation (e.g., gingival erythema, edema, and changes in soft tissue consistency); (b) bleeding and/or suppuration on gentle probing; and (c) increased probing pocket depth. Peri-implantitis—in addition to the previous clinical signs of inflammation of the mucosa—is characterized by radiographic evidence of progressive bone loss.2-3

Figure 2. Peri-implantitis lesion (radiographic view).

ce680 - Images - Figure 2

Figure 2. Peri-implantitis lesion (radiographic view).