How to correctly diagnose peri-implantitis

03.01.2022

PD Dr. Kristina Bertl, PhD MSc MBA

The article ‘How to correctly diagnose peri-implant mucositis’ discussed the criteria for peri-implant health and peri-implant mucositis. But how can you tell that the patient’s condition has already reached an advanced stage – in other words, how can I correctly diagnose peri-implantitis?

Based on the results of the 2017 World Workshop on periodontal and peri-implant diseases, peri-implantitis is diagnosed using the following criteria:

Signs of inflammation in the peri-implant tissue (e.g. reddening, swelling, heavy bleeding on probing, suppuration etc.).
Increase in pocket probing depth after baseline examination (see article).
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 that was taken 1 year after prosthetic restoration.
If you are treating a patient with no available baseline status (i.e. no X-ray from the time of prosthetic restoration and/or 1 year after and no pocket probing depths from the time of prosthetic restoration), the following signs can be regarded as a clear indication of the presence of peri-implantitis: 1) Bone loss ≥ 3 mm, 2) pocket probing depths ≥ 6 mm, and 3) signs of inflammation such as bleeding and/or suppuration on probing.

If the patient has these symptoms and is therefore suspected of having peri-implantitis, it is imperative to act quickly! The findings should be reported to the patient’s dentist immediately so that the required treatment can be carried out. It is important to note that treatment should start as soon as possible, because peri-implantitis can progress very quickly, and substantial further bone loss can occur within just a few months.

How to correctly diagnose peri-implantitis (Shutterstock)

Patient with peri-implantitis. The patient has substantially increased pocket probing depths (9–11 mm), and the X-ray confirms the presence of peri-implant bone loss.

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.