How to correctly diagnose peri-implant mucositis

03.01.2022

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?

How to correctly diagnose peri-implant mucositis

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.

Patient with peri-implant mucositis: Clear signs of inflammation can be seen around the implant in region 23 (heavy bleeding on probing – continuous line of blood), but no bone loss that exceeds normal/anticipated bone remodelling after implantation and implant loading.

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.