Objectives The aim of the present study was to evaluate the diagnostic accuracy of clinical and radiographic evaluations made at a single time point during follow‐up in identifying (a) a history of peri‐implant bone loss and (b) the presence of peri‐implantitis. Material & Methods 427 patients provided with implant‐supported reconstructions 9 years earlier were evaluated clinically by Probing Pocket Depth, Bleeding or Suppuration on Probing (PPD, BoP & SoP) and radiographically. Bone levels were assessed relative to the most coronal point of the intra‐osseous part of the implant. A history of bone loss and diagnosis of peri‐implantitis was confirmed through baseline documentation (direct evidence). Diagnostic accuracy of radiographic bone levels at 9 years and clinical findings (indirect evidence/secondary case definition) in identifying a history of bone loss and peri‐implantitis were evaluated through correlation and multilevel regression analyses as well as receiver operating characteristic curves. Results were expressed as sensitivity/specificity and area under the curve (AUC). Results Bone levels observed at 9 years were highly accurate in identifying pronounced bone loss (>2 mm; AUC = 0.96; 95% CI 0.95–0.98). In the absence of baseline documentation, a secondary case definition based on the presence of BoP/SoP & bone level ≥ 1 mm (indirect evidence) provided the overall best diagnostic accuracy (AUC = 0.80; 95% CI 0.77–0.82) in identifying peri‐implantitis cases (direct evidence: BoP/SoP & bone loss > 0.5 mm). Moderate/severe peri‐implantitis (BoP/SoP & bone loss > 2 mm) was most accurately identified by the combination of BoP/SoP & bone level ≥ 2 mm (AUC = 0.93; 95% CI 0.91–0.96). Sensitivity of the secondary case definition suggested by the 2017 World Workshop of Periodontology (WWP) (BoP/SoP ≥ 1 site & bone level ≥ 3 mm & PPD ≥ 6 mm) was low. Conclusions The present results underline the importance of baseline documentation for the correct diagnosis of peri‐implantitis, especially in its early/incipient forms. The secondary case definition of peri‐implantitis suggested at the 2017 WWP demonstrated a high level of specificity but low sensitivity. Moderate/severe peri‐implantitis was most accurately identified by the combination of BoP/SoP & bone level ≥ 2 mm.

Objectives To evaluate outcome measures, methods of assessment, and analysis in clinical studies on the prevention and management of peri‐implant mucositis and peri‐implantitis. Methods Systematic electronic searches (CENTRAL/MEDLINE/SCOPUS) up to April 2021 were conducted to identify longitudinal clinical studies with ≥10 patients on either the prevention or management of peri‐implant diseases. Outcome measures of this analysis were the choice of outcome measures, methods of assessment, and analytical methods. Risk of bias was evaluated according to study design. Data were extracted into evidence tables and outcomes were analysed in a descriptive manner. Results The analysis of the 159 selected studies revealed that probing pocket depth (PPD) and bleeding/suppuration on probing (BOP) were reported in 89% and 87% of all studies, respectively. Additional outcome measures included plaque scores (reported in 64% of studies), radiographic outcomes (49%), soft tissue dimensions (34%), and composite outcomes (26%). Adverse events (8%) and patient‐reported outcomes (6%) were only rarely mentioned. A primary outcome measure was clearly defined only in 36% of studies. Data on PPD, radiographic outcomes, and soft tissue dimensions were primarily reported as mean values and rarely as frequency distributions. For radiographic outcomes and soft tissue dimensions, it was frequently unclear how clustered data were handled. Conclusions PPD and BOP were routinely reported in studies on the prevention and management of peri‐implant mucositis and peri‐implantitis, while composite outcomes, adverse events, and patient‐reported outcomes were only infrequently described.

Objectives The aim of the present study was to evaluate whether clinical findings at implant sites are relevant as screening tests for a history of marginal bone loss. Material and Methods 427 patients provided with implant‐supported reconstructions 9 years earlier were evaluated clinically (probing pocket depth (PPD), bleeding on probing (BoP)) and radiographically. A history of bone loss was confirmed through baseline documentation. Diagnostic accuracy was evaluated through receiver operating characteristic curves and multi‐level regression analyses. Results were expressed as sensitivity/specificity, area under the curve, and odds ratios. Results While the sensitivity of PPD in regard to bone loss was low, specificity was generally high. Multi‐level modeling revealed that each additional millimeter of PPD corresponded to an additional bone loss of 0.30 mm (95% CI 0.27; 0.33). The sensitivity of BOP in regard to bone loss >2 mm was 80.9% (95% CI 73.9; 86.7), while the specificity was 42.2% (95% CI 39.6; 44.8). Conclusions Clinical parameters at implant sites obtained at a single time point were associated with a history of marginal bone loss. While BoP demonstrated a high level of sensitivity, the sensitivity of PPD was generally low. The present data suggest that BoP is a relevant screening test for history of bone loss.

Objectives: To evaluate outcome measures, methods of assessment, and analysis in clinical studies on the prevention and management of peri-implant mucositis and peri-implantitis.Methods: Systematic electronic searches (CENTRAL/MEDLINE/SCOPUS) up to April 2021 were conducted to identify longitudinal clinical studies with ≥10 patients on either the prevention or management of peri-implant diseases. Outcome measures of this analysis were the choice of outcome measures, methods of assessment, and analytical methods. Risk of bias was evaluated according to study design. Data were extracted into evidence tables and outcomes were analysed in a descriptive manner. Results:The analysis of the 159 selected studies revealed that probing pocket depth (PPD) and bleeding/suppuration on probing (BOP) were reported in 89% and 87% of all studies, respectively. Additional outcome measures included plaque scores (reported in 64% of studies), radiographic outcomes (49%), soft tissue dimensions (34%), and composite outcomes (26%). Adverse events (8%) and patient-reported outcomes (6%) were only rarely mentioned. A primary outcome measure was clearly defined only in 36% of studies. Data on PPD, radiographic outcomes, and soft tissue dimensions were primarily reported as mean values and rarely as frequency distributions.For radiographic outcomes and soft tissue dimensions, it was frequently unclear how clustered data were handled.Conclusions: PPD and BOP were routinely reported in studies on the prevention and management of peri-implant mucositis and peri-implantitis, while composite outcomes, adverse events, and patient-reported outcomes were only infrequently described.

Background: The 2017 World Workshop Classification highlighted the importance of baseline documentation for adequate diagnosis of periimplantitis. In the absence of baseline data, findings of Bleeding/Suppuration on probing (BoP/SoP), Probing pocket depth (PPD) ≧6 mm together with bone levels ≧3 mm were described to be consistent with peri-implantitis. The validity of the suggested thresholds in the identification of "true" peri-implantitis, however, has not be validated. Aim/Hypothesis: The aim of the present study was to evaluate the accuracy of one-time (no baseline) clinical and radiographic evaluations (or their combinations) in identifiying "true" peri-implantitis (validated by baseline documentation). Materials and Methods: The dataset included 427 patients who had received implant-supported restorative therapy in 2003. Baseline radiographs were available and a clinical and radiographic examination was performed 9 years later. At 9y, PPD, BoP, SoP were recorded at all implant sites. Changes of marginal bone levels from baseline to 9y were measured. A "true" peri-implantitis case was defined as the presence of BoP/SoP together with radiographic bone loss >0.5 mm. One-time assessments from the 9-y examination and different combinations thereof were tested for their accuracy in identifying "true" peri-implantitis cases. Contingency tables were constructed and the sensitivity, specificity and AUC are reported. Results: 1,577 implants were analyzed, with a 25.2% implant-level prevalence of peri-implantitis. The one-time classification suggested at the 2017 World Workshop had a sensitivity of 15.4%, a specificity of 99.5% and an AUC = 0.57 in identifying "true" peri-implantitis cases. The highest accuracy of one-time clinical and radiographic findings was observed for the presence of BoP/SoP together with bone levels ≧1 mm, with a sensitivity of 72.4%, a specificity of 86.8% and an AUC = 0.80. Cases of moderate/severe peri-implantitis (BoP/SoP & true bone loss ≧2 mm) were best identified by the presence of BoP/SoP together with bone levels ≧2 mm, with a sensitivity of 93.0%, a specificity of 93.7% and an AUC = 0.93. Conclusions and Clinical Implications: In the absence of baseline documentation, the presence of BoP and/or SoP together with bone levels ≧1 mm provided the best diagnostic accuracy in identifying "true" peri-implantitis.