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Received: 3 October 2017 Revised: 4 January 2018 Accepted: 1 February 2018
DOI: 10.1002/JPER.17-0588

2017 WORLD WORK SHOP

Peri-implant health, peri-implant mucositis, and peri-implantitis:

Case definitions and diagnostic considerations

Stefan Renvert1,2,3 G. Rutger Persson1,4 Flavia Q. Pirih5 Paulo M. Camargo5

1 School of Health and Society, Department of

Abstract
Oral Health Sciences, Kristianstad University,
Kristianstad, Sweden The objective of this review is to identify case definitions and clinical criteria of peri-
2 School of Dental Science, Trinity College, implant healthy tissues, peri-implant mucositis, and peri-implantitis. The case defi-
Dublin, Ireland nitions were constructed based on a review of the evidence applicable for diagnostic
3 Blekinge Institute of Technology, Karlskrona,
considerations. In summary, the diagnostic definition of peri-implant health is based
Sweden
4 Departments of Periodontics and Oral
on the following criteria: 1) absence of peri-implant signs of soft tissue inflammation
Medicine, School of Dentistry, University (redness, swelling, profuse bleeding on probing), and 2) the absence of further addi-
of Washington, Seattle, WA, USA tional bone loss following initial healing. The diagnostic definition of peri-implant
5 School of Dentistry, Section of Periodontics,
mucositis is based on following criteria: 1) presence of peri-implant signs of inflam-
University of California, Los Angeles, Los
Angeles, CA, USA mation (redness, swelling, line or drop of bleeding within 30 seconds following prob-
Correspondence ing), combined with 2) no additional bone loss following initial healing. The clinical
Prof. Stefan Renvert, Department of Health definition of peri-implantitis is based on following criteria: 1) presence of peri-implant
Sciences, Kristianstad University, 29188
signs of inflammation, 2) radiographic evidence of bone loss following initial healing,
Kristianstad, Sweden.
Email: [email protected] and 3) increasing probing depth as compared to probing depth values collected after
The proceedings of the workshop were placement of the prosthetic reconstruction. In the absence of previous radiographs,
jointly and simultaneously published in the radiographic bone level ≥3 mm in combination with BOP and probing depths ≥6 mm
Journal of Periodontology and Journal of
Clinical Periodontology. is indicative of peri-implantitis.

KEYWORDS
diagnosis, peri-implant health, peri-implant mucositis, peri-implantitis

I N T RO D U C T I O N as implant fractures that may mimic or share certain clinical

features with biofilm-associated peri-implant diseases. With
Osseointegrated dental implants have become an increasingly such context in mind, the reader is to be reminded that this
popular modality of treatment for the replacement of absent manuscript focuses solely on biofilm-induced inflammatory
or lost teeth. Dental implants have high rates of long-term lesions around dental implants.
survival (≥10 years) when used to support various types of Biological complications associated with dental implants
dental prostheses. However, the long-term success of den- are mostly inflammatory conditions of the soft tissues and
tal implants is not the same or as high as their survival, as bone surrounding implants and their restorative compo-
functional implants and their restorations may be subject to nents, which are induced by the accumulation of bacte-
mechanical and biological complications.1 rial biofilm. Such conditions, which have been named peri-
It is recognized that there are also unusual peri-implant implant mucositis and peri-implantitis, need to be clearly
problems (e.g., peri-implant peripheral giant-cell granuloma, defined and differentiated from a state of peri-implant health,
pyogenic granuloma, squamous cell carcinoma, metastatic so that the clinician may assign a proper diagnosis and select
carcinomas, malignant melanoma) or other conditions such a proper treatment modality in cases where disease is present.

© 2018 American Academy of Periodontology and European Federation of Periodontology

S304 wileyonlinelibrary.com/journal/jper J Periodontol. 2018;89(Suppl 1):S304–S312.

 19433670, 2018, S1, Downloaded from https://aap.onlinelibrary.wiley.com/doi/10.1002/JPER.17-0588 by Readcube (Labtiva Inc.), Wiley Online Library on [22/01/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
RENVERT ET AL. S305

In a survey of registered specialists in periodontology in thema and swelling) including no bleeding on probing. This
Australia and the United Kingdom about the etiology, preva- determination is true to evidence from the periodontal liter-
lence, diagnosis and management of peri-implant mucosi- ature that the absence of bleeding on probing is consistent
tis and peri-implantitis, there appears to be no consensus on with periodontal health.4,7 In clinical health, the peri-implant
treatment standards for the management of peri-implant mucosa forms a tight seal around the trans-mucosal compo-
diseases.2 An American survey that examined the practi- nent of the implant itself, the abutment or the restoration. The
tioners’ understanding of the etiology of peri-implant dis- height of the soft tissue around the implant following place-
eases and the management of peri-implant mucositis and peri- ment influences the initial probing depth. In general, however,
implantitis by periodontists in the United States revealed the the probing depth associated with peri-implant health should
absence of a standard therapeutic protocol to treat these condi- be ≤5.0 mm.4 It should also be noted that peri-implant tissue
tions and a significant variation in the empirical use of thera- health can exist following treatment of peri-implantitis with
peutic modalities that result in moderately effective treatment variable levels of bone support.
outcome.3 Accordingly, there is a need to establish applicable It has been proposed that the soft tissue cuff around
clinical guidelines for the diagnosis of peri-implant mucositis, implants exhibits less resistance to probing than the gingiva at
and peri-implantitis. Additionally, there is a need to develop adjacent teeth sites.8,9 This property of the implant mucosal
criteria for peri-implant mucositis and peri-implantitis appli- seal may lead to mechanically induced bleeding on prob-
cable in not only in for clinical practice but also for clinical ing on dental implants that are clinically healthy.9 The clin-
and epidemiological research studies. ical relevance of such phenomenon is that the presence of
The objective of this manuscript is to define peri-implant a local bleeding dot may, therefore, represent a traumatic
health, peri-implant mucositis and peri-implantitis based episode rather than a sign of biofilm-induced inflammation.
on their clinical and radiographic parameters. The case Such trauma-induced bleeding on probing may not only be
definitions herein described were constructed based on a the result of excessive probing forces, but can also be the con-
systematic review of the scientific evidence that currently sequence of clinical difficulties in aiming the dental probe
correlates clinical and radiographic findings with the three at the sulcus/pocket around the implant, which can occur
diagnostic entities. The scientific evidence for peri-implant because of the implant-restoration spatial relationship and
health, peri-implant mucositis and peri-implantitis has been contours. It has been suggested that the absence of a peri-
summarized in other manuscripts in this volume.4–6 The odontal ligament around implants and the prosthetic design
case definitions proposed in this paper are intended to makes assessments of pocket probing depth measurements at
apply to situations in which there are reasons to believe dental implants difficult to perform and interpret.10 Recogniz-
that the presence of biofilm on implant surfaces is the ing the above described issue, a modified bleeding index has
main etiological factor associated with the development of been proposed using a grading scale of the extent of bleeding
peri-implant mucositis and peri-implantitis. It is obvious at dental implants,11 where a score of “0” represents healthy
from previous manuscripts in this volume that there are major conditions, and a score of “1” representing an isolated dot of
patient-specific differences in inflammatory responses to the bleeding.
microbial challenge of bacterial communities that reside on
implants and its restorations.5,6 What clinical and radiographic findings and
what clinical examination steps are necessary to
PERI-IMPLANT HEALTH detect the presence of peri-implant health?
1. Clinical evaluation of the soft tissue conditions around
While peri-implant health shares many common clinical fea- implants should include registration of oral hygiene in gen-
tures with periodontal health around natural teeth, it is clear eral, with specific focus on the presence of biofilm on
that there are major structural differences between the two implants and their restorations;
scenarios, particularly with respect to their relationship with
2. Dental implants should be visually evaluated and probed
surrounding tissues and biological attachment. The review
routinely and periodically (at least once per year) as part
by Araujo and Lindhe4 describes the different anatomical
of comprehensive oral exams, similar to natural teeth;
and histological characteristics associated with the soft and
hard tissues around natural teeth and dental implants and 3. Pocket probing on dental implants should be conducted
the authors further described how such differences may be with a light force (approximately 0.25 N); peri-implant
responsible for the distinct biological mechanisms involved pocket depths should in general be ≤5 mm;
in host response and tissue homeostasis observed between the 4. Bleeding on probing should not occur at implant sites
two entities. defined as being healthy. Bleeding on probing should be
Araujo and Lindhe4 also concluded that peri-implant health assessed carefully using light forces (0.25 N) to avoid
requires the absence of clinical signs of inflammation (i.e. ery- possible effects of trauma caused by the process. It is diffi-
 19433670, 2018, S1, Downloaded from https://aap.onlinelibrary.wiley.com/doi/10.1002/JPER.17-0588 by Readcube (Labtiva Inc.), Wiley Online Library on [22/01/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
S306 RENVERT ET AL.

cult to differentiate between biofilm-induced peri-implant defining clinical and radiographic criteria for the diagnosis of
inflammation and mechanically-induced trauma; bleeding peri-implant mucositis and peri-implantitis (Table 1).
“dots” should be interpreted carefully as this may represent The American Academy of Periodontology has defined
bleeding due to tissue trauma and not bleeding associated peri-implant mucositis as a disease that includes inflamma-
with tissue inflammation; tion of the soft tissues surrounding a dental implant, without
5. Intra-oral radiographic evaluation of changes in bone additional bone loss after the initial bone remodeling that may
levels around implants (preferably using a standardized occur during healing following the surgical placement of the
film holder) is necessary to discriminate between health implant.17 The etiology of peri-implant mucositis is the accu-
and disease states. A prerequisite for the radiographic mulation of a bacterial biofilm around the implant.5
evaluation should be an image taken at baseline (supra- Peri-implantitis has been defined as an inflammatory lesion
structure in place) that clearly allows for identification of of the mucosa surrounding an endosseous implant and with
an implant reference point and distinct visualization of progressive loss of supporting peri-implant bone.6,17–20 It is
implant threads, for future reference as well as assessment generally perceived that following implant installation and
of mesial and distal bone levels in relation to such refer- initial loading, some crestal bone height is lost (between 0.5
ence points; and and 2 mm) in the healing process.12,13 Any additional radio-
graphic evidence of bone loss suggests peri-implant disease.
6. Absence of bone loss beyond bone level changes resulting
The conversion from an inflammatory process identified
from initial bone remodeling. Alveolar bone remodeling
as peri-implant mucositis (without evidence of bone loss) to
following the first year in function may be dependent on
peri-implantitis (with bone loss) remains an enigma. It is,
the type and position of the implant, but change (loss) of
however, generally agreed that both peri-implant mucositis
alveolar bone starting after the implant was placed in func-
and peri-implantitis have an infectious etiology through the
tion should not exceed 2 mm.12–14 Changes ≥2 mm at any
development of biofilm composed of a plethora of bacteria
time point during or after the first year should be consid-
with known pathogenicity.21–24
ered as pathologic.

Peri-implant health: Case definitions PERI-IMPLANT MUCOSITIS

for day-to-day clinical practice
Case definitions of peri-implant mucositis were identified in
The diagnosis of peri-implant health requires:
22 out of 33 articles listed in Table 1. Bleeding on probing
without any other criteria was identified in three out of 22
articles. Bleeding on probing combined with no radiographic
1. Visual inspection demonstrating the absence of peri-
evidence of bone level changes could be identified in seven
implant signs of inflammation: pink as opposed to red, no
out of 22 articles as the definition of peri-implant mucosi-
swelling as opposed to swollen tissues, firm as opposed to
tis. Three of these articles accounted for remodeling of the
soft tissue consistency;
marginal alveolar bone adjacent to the implant as a result of
2. Lack of profuse (line or drop) bleeding on probing; the surgical procedure. The remaining reports also included
3. Probing pocket depths could differ depending on the height probing pocket depths and/or bone loss assessments. In addi-
of the soft tissue at the implant location. An increase tion to bleeding on probing, one study allowed up to 3 mm
in probing depth over time, however, conflicts with peri- of bone loss from the implant platform to define peri-implant
implant health; and mucositis.25
4. Absence of further bone loss following initial healing, The diagnosis of peri-implant mucositis should be based
which should not be ≥2 mm. on clinical signs of inflammatory disease. In routine clini-
cal examinations, signs of inflammation should be screened
for. In addition, radiographic images should be evaluated to
exclude bone level changes consistent with the definition of
PERI-IMPLANT DISEASES
peri-implantitis, as described later in the manuscript.
The scientific literature has provided the evidence to define
the diagnosis of peri-implant conditions and diseases, and the
What clinical and radiographic findings and
reviews by Heitz-Mayfield and Salvi,5 and Schwarz et al.6
what clinical examination steps are necessary to
were used as the basis for the present report. In addi-
detect the presence of peri-implant mucositis?
tion, two recent systematic reviews reporting on the preva- 1. Visually, local swelling, redness, and shininess of the soft
lence of peri-implant mucositis and peri-implantitis were also tissue surface are classical signs of clinical inflammation.
evaluated.15,16 Through these reports, we identified 33 articles A common symptom reported by patients is soreness;
 19433670, 2018, S1, Downloaded from https://aap.onlinelibrary.wiley.com/doi/10.1002/JPER.17-0588 by Readcube (Labtiva Inc.), Wiley Online Library on [22/01/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
RENVERT ET AL. S307

TABLE 1 Criteria used for the case definitions of peri-implantitis and peri-implant mucositis from studies selected in the review
Study Case definition of peri-implantitis Case definition of peri-implant mucositis
Fransson et al. (2005) 29
Bone level change > 3 threads after first year ND
in function
Roos-Jansåker et al. (2006)31 Bone level change > 1.8 mm after first year in BOP + PD > 4 mm + no bone loss after first
function + BOP year on function
Ferreira et al. (2006) 32 PD > 5 mm + BOP and/or suppuration (SUP) BOP
Gatti et al. (2008)33 Bone level change > 2 mm from last ND
radiographic assessment + Pus/ BOP +
PD > 5 mm
Maximo et al. (2008)34 Bone level change ≥3 threads + BOP and/or BOP + absence of radiographic bone loss and
SUP + PD ≥5 mm no SUP
Koldsland et al. (2010)35 Bone level change ≥2 mm from platform + BOP + no bone loss from platform
BOP + PD ≥4 mm
Koldsland et al. (2010)35 Bone level change ≥2 mm from platform + BOP + no bone loss from platform
BOP + PD ≥6 mm
Koldsland et al. (2010)35 Bone level change ≥3 mm from platform + BOP + no bone loss from platform
BOP + PD ≥4 mm
Koldsland et al. (2010)35 Bone level change ≥3 mm from platform + BOP + no bone loss from platform
BOP + PD ≥6 mm
Simonis et al. (2010)36 Bone level change > 2.5 mm (or ≥3 threads) ND
from platform + BOP and/or SUP + PD
≥5 mm
Wahlström et al. (2010)37 Bone level change > 2 mm after first year in BOP + PD < 4 mm + no bone loss after first
function + BOP and/or SUP + PD ≥4 mm year on function
Zetterqvist et al. (2010)38 Bone level change > 5 mm from the platform ND
+ BOP/SUP + PD > 5mm
Pjetursson et al. (2012)39 Bone level change ≥2 mm after bone Level 1: BOP + PD > 5 mm
remodeling equals marginal bone levels of Level 2: BOP + PD > 6 mm
≥5 mm below the implant shoulder
Mir-Mari et al (2012)40 Bone level change > 2 threads from platform BOP + bone level change < two threads from
+ BOP and or suppuration platform
Swierkot et al. (2012)41 Bone level change > 0.2 mm annually after BOP + PD > 5 mm + no bone level change
first year in function, + PD ≥5 mm with or
without BOP
Fardal and Grytten (2013)42 Bone level change > 3 threads after bone ND
remodeling + BOP or suppuration
Marrone et al. (2013)43 Bone level change > 2 mm from the platform BOP + bone level change ≤2 mm from
+ BOP + PD > 5 mm platform. PPD ≤5 mm
Cecchinato et al. (2014)44 Progressive bone loss > 0.5 mm +BOP + PD BOP
≥4 mm
Martens et al. (2014)45 Bone level change > 2 mm from the platform ND
+ PD > 4 mm
Meijer et al. (2014)46 Bone level change ≥2 mm from the platform BOP + bone level change < 2 mm from
+ BOP platform
Passoni et al. (2014)47 Bone level change > 2 + BOP and/or SUP + BOP + no bone level change
PD ≥ 5 mm
Renvert et al. (2014)48 Bone level change ≥2 mm from the platform BOP + bone level change < 2 mm from
+ PD ≥ 4 mm + BOP and or suppuration platform
Aguirre-Zorzano et al. (2015)49 Bone level change > 1.5 mm after 6 months BOP + no bone loss
in function + often associated with
suppuration, increased probing depth and
bleeding on probing
𝐶𝑜𝑛𝑡𝑖𝑛𝑢𝑒𝑑
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S308 RENVERT ET AL.

TABLE 1 Continued.
Study Case definition of peri-implantitis Case definition of peri-implant mucositis
Canullo et al. (2015) 50
Bone level change > 3 mm following implant ND
integration
Daubert et al. (2015)51 Bone level change > 2 mm after remodeling BOP and/or gingival inflammation + no bone
+ BOP and or SUP + PD ≥4 mm level change after remodeling
Ferreira et al. (2015)52 Bone level change > 2 mm after remodeling BOP and no bone loss
+ BOP and/or + PD ≥4 mm
Frisch et al. (2015)53 Bone level change ≥2 mm after remodeling + BOP
BOP +PD ≥5 mm
Konstantinidis et al. (2015)54 Bone level change > 2 mm from the platform BOP
(at tissue level implants > 2 mm from the
polished collar+ BOP + PD > 4 mm
Rinke et al. (2015)55 Bone level change ≥ 3.5 mm from platform ND
Papantonopoulos et al. (2015)56 Bone level change ≥3 mm from platform + ND
BOP and/or SUP +PD ≥5 mm
Trullenque-Eriksson et al. (2015)25 Bone level change ≥3 mm from the platform BOP + bone level change < 3 mm from
+ BOP and/or SUP + PD ≥ 5 mm platform level
van Velzen et al. (2015)57 Bone level change > 1.5 mm after first year in ND
function + BOP
Derks et al. (2016)1 Bone loss > 0.5 mm after up to 24 months + BOP + no bone loss
BOP/suppuration.
In addition, bone level change > 2 mm +
BOP was considered moderate/severe
peri-implantitis

Dalago et al. (2017)58 Bone level change > 2 mm from abutment ND

installation + PD > 5 mm + BOP/SUP
Rokn et al. (2017)59 Bone level change > 2 mm from platform BOP and/or SUP + bone level change ≤2 mm
level + BOP and/or SUP from platform level
Tenenbaum et al. (2017)60 Bone level change > 4.5 mm from platform + BOP + no bone level change from platform
BOP + PD ≥5 mm
BOP = bleeding on probing, PD = probing depth, SUP = suppuration, ND = not defined.

2. A local dot of bleeding resulting from probing may be the erences. Accounting for the remodeling process of alveo-
result of a traumatic (probing) injury that should not be lar bone during the first year after installation, the change
considered, in the absence of other inflammatory changes, in bone level since the placement of the prosthetic supra-
a definitive criterion to characterize a peri-implant soft structure should not be > 2.0 mm. Presence of bone loss
tissue lesion; beyond crestal bone level changes resulting from the intial
3. Any bleeding on probing that is combined with visual remodeling process of alveolar bone after implant instal-
inflammatory changes of the tissues at the site of probing; lation suggests either progressive peri-implant infection,
or other local factors such as excess cement and loose-
4. Clear evidence of bleeding such as a line of bleeding or
ness/fracture of implant components.
drop bleeding should be used as an indication of an inflam-
matory peri-implant soft tissue lesion;
Peri-implant mucositis: Case definitions
5. Suppuration upon clinical examination (e.g., application of
for day-to-day clinical practice
light pressure to the tissues or following probing); and
6. Intra-oral radiographic evaluation of bone levels around The diagnosis of peri-implant mucositis requires:
implants should always be included in the presence of clin-
ical signs of inflammation. In addition, a pre-requisite for 1. Visual inspection demonstrating the presence of peri-
the evaluation is that a radiograph be taken at baseline implant signs of inflammation: red as opposed to pink,
(supra-structure in place) and used for future assessment swollen tissues as opposed to no swelling, soft as opposed
of mesial and distal bone levels in relation to defined ref- to firm tissue consistency;
 19433670, 2018, S1, Downloaded from https://aap.onlinelibrary.wiley.com/doi/10.1002/JPER.17-0588 by Readcube (Labtiva Inc.), Wiley Online Library on [22/01/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
RENVERT ET AL. S309

2. Presence of profuse (line or drop) bleeding and/or suppu- Furthermore, experiences from the knowledge about the
ration on probing; progression of periodontitis can only be extrapolated to peri-
3. An increase in probing depths compared to baseline; and implantitis with extreme care. For decades, it has been rec-
ognized that the progression of periodontitis is unpredictable,
4. Absence of bone loss beyond crestal bone level changes
as lesions alternate phases of dormancy and bursts of disease
resulting from the intial remodeling.
activity, which may be slow or rapid.30 Based on this knowl-
edge and in attempting to extrapolate it to peri-implantitis, any
bone loss greater than the measurement error (≥2 times its
PERI-IMPLANTITIS standard deviation) or approximately 2 mm is indicative of
peri-implantitis.28
To assign a diagnosis of peri-implantitis, most reports listed in
Table 1 (30 out of 33) require bleeding on probing in addition What clinical and radiographic findings and
to bone loss. Following the initial healing, additional bone what clinical examination steps are necessary to
loss 0.5 mm to 5 mm – as assessed from radiographs – was detect the presence of peri-implantitis?
a necessary criterion for the diagnosis of peri-implantitis in
13 reports. 1. The visual inspection with assessment of the presence of
Without accounting for the initial (remodeling-associated) classical signs and symptoms of inflammation, i.e. redness,
bone loss, the remaining articles identified bone loss using the swelling, pain, and bleeding on probing (characteristics of
implant platform level as reference. Bone loss requirements the latter, described for peri-implant mucositis, also apply
varied between 1.8 to 4.5 mm to diagnose the implant as hav- to the diagnosis of peri-implantitis);
ing peri-implantitis. Different cut-off levels for probing pocket 2. The differential diagnosis between peri-implant mucosi-
depth around implants were also required in 20 of the arti- tis and peri-implantitis is based on evidence that alveo-
cles to define a diagnosis of peri-implantitis. It is clear from lar bone loss following initial healing and bone remodel-
the data summarized in Table 1 that there is a large varia- ing has occurred and requires a radiographic evaluation of
tion in the requirements to define a case as having either peri- the bone level around dental implants over time. This is
implant mucositis or peri-implantitis. Such variation in the in addition to the presence of inflammatory changes and
application of individual clinical judgement is confirmed by bleeding on probing on a given site;
Ramanauskaite et al.26 who concluded that there is currently 3. Presence of bone loss beyond crestal bone level changes
no single uniform definition of peri-implantitis, or parameters resulting from the intial remodeling in conjunction with
that could be used to define peri-implant disease entities. BOP after the implant has been placed in function
Understanding the wide heterogeneity in defining peri- should be considered as a marker for peri-implantitis;
implantitis, the most uniform consensus in characterizing and
peri-implantitis is as follows; 1) peri–implantitis lesions 4. Radiographs should be taken based on clinical judge-
present with the same clinical signs of inflammation as peri- ment after findings. Standardized radiographs should be
implant mucositis and 2) the distinctive difference between a taken and compared to reference radiographs when the
diagnosis of peri-implant mucositis and peri-implantitis is the implant(s) was placed in function.
presence of bone loss in peri-implantitis, as identified from
dental radiographs.6
During the last 10 to 15 years, there has been a gen- Peri-implantitis: Case definitions
eral agreement that following the first year in function, for day-to-day clinical practice
bone loss around dental implants ≥2 mm represents peri- The diagnosis of peri-implantitis requires:
implantitis.14,27,28 Recent data suggest that the pattern of bone
loss in general is not linear.1,29 Typically, the development of 1. Evidence of visual inflammatory changes in the peri-
peri-implantitis appears within the first few years after which implant soft tissues combined with bleeding on probing
the implant is in function. This suggests that it is impor- and/or suppuration;
tant to carefully monitor changes that may occur around den-
2. Increasing probing pocket depths as compared to measure-
tal implants in the early post-restorative phase, with focus
ments obtained at placement of the supra-structure; and
on bleeding on probing/suppuration and in combination with
radiographic evidence of bone loss. From the clinical per- 3. Progressive bone loss in relation to the radiographic bone
spective, it is important to recognize that there is no pre- level assessment at 1 year following the delivery of the
dictable model or algorithm to predict the progression of implant-supported prosthetics reconstruction; and
peri-implantitis based on diagnostic methodologies currently 4. In the absence of initial radiographs and probing depths,
available in daily practice. radiographic evidence of bone level ≥3 mm and/or
 19433670, 2018, S1, Downloaded from https://aap.onlinelibrary.wiley.com/doi/10.1002/JPER.17-0588 by Readcube (Labtiva Inc.), Wiley Online Library on [22/01/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
S310 RENVERT ET AL.

probing depths ≥6 mm in conjunction with profuse bleed- 10. Serino G, Turri A, Lang NP. Probing at implants with peri-
ing represents peri-implantitis. implantitis and its relation to clinical peri-implant bone loss. Clin
Oral Implants Res. 2013;24:91–95.

For day to day clinical practice it may be valuable to assess 11. Mombelli A, van Oosten MA, Schurch E, Jr, Land NP. The micro-
biota associated with successful or failing osseointegrated titanium
the yearly rate of bone loss. This can be calculated if it is
implants. Oral Microbiol Immunol. 1987;2:145–151.
known when the implant was placed in function.
12. Lindquist LW, Carlsson GE, Jemt T. A prospective 15-year follow-
up study of mandibular fixed prostheses supported by osseointe-
C R I T E R I A TO B E U S E D I N grated implants. Clinical results and marginal bone loss. Clin Oral
Implants Res. 1996;7:329–336.
EPIDEMIOLOGIC (SURVEILLANCE)
ST U D I E S 13. Cochran DL, Nummikoski PV, Schoolfield JD, Jones AA, Oates
TW. A prospective multicenter 5-year radiographic evaluation of
crestal bone levels over time in 596 dental implants placed in 192
The same criteria used to define peri-implant health and peri- patients. J Periodontol. 2009;80:725–733.
implant mucositis in day-to-day practice should be applied
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