Classification

Classification of periodontal and peri-implant diseases and conditions (2017)

PERI-IMPLANT HEALTH & PERI-IMPLANT DISEASES & CONDITIONS

Previous classification systems did not include implants. However, the latest classification incorporates an implant component to address the rising biological complications associated with implant therapy. This updated system defines implant health and provides clear definitions for the two most common biological complications of implant therapy: peri-implant mucositis and peri-implantitis.

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CLASSIFICATION OF PERI-IMPLANT DISEASES & CONDITIONS

Berglundh, Armitage et al. 2018 Consensus Report link

PERI-IMPLANT HEALTH

Peri-implant health is characterised by the absence of clinical signs of inflammation and is defined by the following criteria:

No erythema (redness of the peri-implant mucosa)
No bleeding on probing (BOP)
No swelling
No suppuration (pus discharge)
Stable bone levels (physiological bone remodeling after implant placement is expected, but no progressive bone loss)

Peri-implant health can exist around implants with normal or reduced bone support, provided there are no signs of inflammation. However, the definition does not establish a specific probing depth threshold, as depth varies based on individual anatomy and implant position.


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PERI-IMPLANT MUCOSITIS

Peri-implant mucositis is a reversible inflammatory disease affecting the peri-implant soft tissues without evidence of bone loss.

It is characterised by:
Erythema (redness) of the peri-implant mucosa
Bleeding on probing (BOP) with or without swelling
Possible suppuration (pus discharge)
Increased probing depths compared to baseline, but without radiographic bone loss

Peri-implant mucositis is primarily caused by biofilm accumulation and can be successfully managed through professional and patient-administered biofilm control. If untreated, it may progress to peri-implantitis.

PERI-IMPLANTITIS

Peri-implantitis is a progressive inflammatory disease affecting both the peri-implant mucosa and the underlying bone, leading to bone loss. It is characterized by:

Erythema, swelling, and/or bleeding on probing (BOP)
Increased probing depths usually with suppuration
Radiographic evidence of progressive bone loss beyond physiological remodeling
Frequently associated with poor plaque control but may be influenced by other factors (e.g., excess cement, history of periodontitis, smoking, systemic conditions)

Peri-implantitis requires active intervention to halt disease progression and may necessitate surgical therapy.


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Implant assessment is crucial for ensuring the long-term success of dental implants. According to the most recent publications, effective monitoring of peri-implant conditions involves a combination of clinical and radiographic evaluations.

Clinical Assessment
Visual Inspection: Evaluating the peri-implant mucosa for signs of inflammation, such as erythema, swelling, or ulceration, can indicate peri-implant diseases.

Probing Depths (PD): Measuring peri-implant probing depths helps assess the health of the peri-implant tissues. However, it’s important to note that peri-implant probing depths may not directly correlate with disease presence, and other clinical signs should be considered.

Bleeding on Probing (BOP): The presence of bleeding upon gentle probing can be a sign of inflammation. However, single spots of bleeding may not necessarily indicate peri-implant disease, as implants can exhibit bleeding related to probing force. Additionally, in smokers, bleeding may lack sensitivity due to decreased angiogenic activity.

Suppuration: The presence of pus upon probing suggests infection and warrants immediate attention.

Radiographic Assessment
Bone Level Evaluation: Radiographs are essential for assessing peri-implant bone level. Progressive bone loss observed radiographically is a definitive indicator distinguishing peri-implant mucositis from peri-implantitis.
Imaging Techniques: Both two-dimensional (e.g., periapical radiographs) and three-dimensional imaging methods (e.g., cone-beam computed tomography) can be utilized to evaluate bone levels and detect any pathological changes.

Regular and comprehensive assessments combining these clinical and radiographic parameters are vital for the early detection and management of peri-implant diseases, thereby enhancing the longevity and success of dental implants.

BASIC IMPLANT ASSESSMENT FLOW CHART

Common risk factors for peri-implantitis

Just as with periodontitis risk, it is essential to evaluate implants after the restorative phase to establish baseline measurements for future monitoring. Additionally, assessing the patient’s risk profile for peri-implant diseases is crucial for devising an effective maintenance plan.

References:

Monje A, Salvi GE. Diagnostic methods/parameters to monitor peri-implant conditions. Periodontol 2000. 2024 Jun;95(1):20-39. doi: 10.1111/prd.12584. Epub 2024 Jun 24. PMID: 38923148.

2017-World-Workshop-on-Disease-Classification-FAQs.pdf

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