W&H Hovedkvarter
How to correctly diagnose peri-implant mucositis
PD Dr. Kristina Bertl, PhD MSc MBA
Up to what point can an implant and its surrounding tissue be described as healthy? And at what point are caution and appropriate treatment required because the diagnosis of peri-implant mucositis already applies?
As part of the new classification scheme for periodontal and peri-implant diseases that was jointly created by the EFP (European Federation of Periodontology) and AAP (American Academy of Periodontology) in November 2017, peri-implant diseases were included for the first time. Definitions for peri-implant health, peri-implant mucositis and peri-implantitis were established.
How can we now correctly diagnose peri-implant mucositis in everyday clinical practice?
First of all, what constitutes peri-implant health?
- No signs of inflammation in the peri-implant tissue (e.g. no reddening, no swelling, no heavy bleeding on probing). The small amount of trauma associated with probing can cause slight bleeding, but in the absence of other signs of inflammation, it does not constitute peri-implant inflammation.
- Increase in pocket probing depth after baseline examination (see article).
- No bone loss that exceeds normal/anticipated bone remodelling after implantation and implant loading. The best way to assess the extent of bone loss is to compare it with an X-ray taken 1 year after prosthetic restoration or – if such an X-ray is not available – an absence of > 2 mm bone loss can be used as a rough guideline.
And which criteria now define the presence of peri-implant mucositis?
- Signs of inflammation in the peri-implant tissue (e.g. reddening, swelling, heavy bleeding on probing). Occurrence of heavy bleeding or a continuous line of blood (see Figure of patient case).
- Increase in pocket probing depth after baseline examination (see article).
- No bone loss that exceeds normal/anticipated bone remodelling after implantation and implant loading. The best way to assess the extent of bone loss is to compare it with an X-ray taken 1 year after prosthetic restoration or – if such an X-ray is not available – an absence of > 2 mm bone loss can be used as a rough guideline.
Tip
There is a simple rule you can follow to achieve good X-ray images of implants – see the article ‘Taking good implant X-rays made easy!’
Reference
- Renvert S, Persson GR, Pirih FQ, Camargo PM. Peri-implant health, peri-implant mucositis, and peri-implantitis: Case definitions and diagnostic considerations. J Clin Periodontol. 2018 Jun; 45 Suppl 20:S278-S285. doi: 10.1111/jcpe.12956.
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