Diagnosis and non-surgical treatment of peri-implant diseases and maintenance care of patients with dental implants – Consensus report of working group 3

Abstract

The following consensus report is based on four background reviews. The frequency of maintenance visits is based on patient risk indicators, homecare compliance and prosthetic design. Generally, a 6‐month visit interval or shorter is preferred. At these visits, peri‐implant probing, assessment of bleeding on probing and, if warranted, a radiographic examination is performed. Diagnosis of peri‐implant mucositis requires: (i) bleeding or suppuration on gentle probing with or without increased probing depth compared with previous examinations; and (ii) no bone loss beyond crestal bone level changes resulting from initial bone remodelling. Diagnosis of peri‐implantitis requires: (i) bleeding and/or suppuration on gentle probing; (ii) an increased probing depth compared with previous examinations; and (iii) bone loss beyond crestal bone level changes resulting from initial bone remodelling. If diagnosis of disease is established, the inflammation should be resolved. Non‐surgical therapy is always the first choice. Access and motivation for optimal oral hygiene are key. The patient should have a course of mechanical therapy and, if a smoker, be encouraged not to smoke. Non‐surgical mechanical therapy and oral hygiene reinforcement are useful in treating peri‐implant mucositis. Power‐driven subgingival air‐polishing devices, Er: YAG lasers, metal curettes or ultrasonic curettes with or without plastic sleeves can be used to treat peri‐implantitis. Such treatment usually provides clinical improvements such as reduced bleeding tendency, and in some cases a pocket‐depth reduction of ≤ 1 mm. In advanced cases, however, complete resolution of the disease is unlikely.

Prevalence of Peri-Implantitis: A Multi-Centered Cross-Sectional Study on 248 Patients

“…In this study, peri-implantitis was defined as the combination of bleeding on probing > 0 and/or the presence of exudate/suppuration, peri-implant bone loss greater than expected in accordance with the criteria proposed by Albrektsson et al in 1986 [ 7 ] and increased pocket depth compared with previous examinations. These criteria are in accordance with the findings of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions [ 3 ] and 2019 FDI Peri-implant Diseases Project: Consensus reports from the FDI workshop on prevention, diagnosis and treatment [ 12 ]. Hopefully, in the very near future, by applying these criteria, more homogeneous studies will be performed, and data could be compared in a profitable way.…”

Role of Dental Implant Homecare in Mucositis and Peri-implantitis Prevention: A Literature Overview

“…These data seem to underline the importance of a powered toothbrush in implant-supported rehabilitations homecare but two recent RCTs compared oscillating/rotating and sonic toothbrushes with the traditional manual technique and in both studies, no statistically significant differences in peri-implant inflammatory parameters were noticed [14,21].…”

“…One multicenter CCT analyzed the effect of powered toothbrushes on 2966 implant-supported restorations, showing that this device has a statistically significant higher plaque removal effect than the manual method (p<0.001) [20]. A single blind RCT conduct on 83 patients and 290 implants instead reported no statistically significant differences between groups in BOP, GI, PPD and PI [21]. Also, Grusovin et al found no statistically significant differences between manual and powered toothbrushes [25].…”

Defined clinical entities: implant complications

“…Note that these four summary papers [1][2][3][4] have been distilled from a series of review papers that have been published in Implant Dentistry, following a consensus conference held in May 2018. The topics include diagnosis of peri-implant mucositis and peri-implantitis, local and systemic risk factors, and the management of these conditions, including non-surgical and surgical approaches.…”

“…The topics include diagnosis of peri-implant mucositis and peri-implantitis, local and systemic risk factors, and the management of these conditions, including non-surgical and surgical approaches. Note that these four summary papers [1][2][3][4] have been distilled from a series of review papers that have been published in Implant Dentistry, following a consensus conference held in May 2018.…”