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BERGLUNDH et al .
Correspondence Prof. Tord Berglundh, Department of Periodontology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, PO Box 450, 405 30 Gothenburg, Sweden. Email: tord.berglundh@odontologi.gu.se Sources of Funding : The workshop was planned and conducted jointly by the American Academy of Periodontology and the European Federation of Periodontology with financial support from the American Academy of Periodontology Foundation, Colgate, Johnson & Johnson Consumer Inc., Geistlich Biomaterials, SUNSTAR, and Procter & Gamble Professional Oral Health. The proceedings of the workshop were jointly and simultaneously published in the Journal of Periodontology and Journal of Clinical Periodontology .
Abstract A classification for peri‐implant diseases and conditions was presented. Focused questions on the characteristics of peri‐implant health, peri‐implant mucositis, peri‐ implantitis, and soft‐ and hard‐tissue deficiencies were addressed. Peri‐implant health is characterized by the absence of erythema, bleeding on prob‐ ing, swelling, and suppuration. It is not possible to define a range of probing depths compatible with health; Peri‐implant health can exist around implants with reduced bone support. The main clinical characteristic of peri‐implant mucositis is bleeding on gentle prob‐ ing. Erythema, swelling, and/or suppuration may also be present. An increase in prob‐ ing depth is often observed in the presence of peri‐implant mucositis due to swelling or decrease in probing resistance. There is strong evidence from animal and human experimental studies that plaque is the etiological factor for peri‐implant mucositis. Peri‐implantitis is a plaque‐associated pathological condition occurring in tissues around dental implants, characterized by inflammation in the peri‐implant mucosa and subsequent progressive loss of supporting bone. Peri‐implantitis sites exhibit clinical signs of inflammation, bleeding on probing, and/or suppuration, increased probing depths and/or recession of the mucosal margin in addition to radiographic bone loss. The evidence is equivocal regarding the effect of keratinized mucosa on the long‐ term health of the peri‐implant tissue. It appears, however, that keratinized mucosa may have advantages regarding patient comfort and ease of plaque removal. Case definitions in day‐to‐day clinical practice and in epidemiological or disease‐ surveillance studies for peri‐implant health, peri‐implant mucositis, and peri‐implanti‐ tis were introduced. The proposed case definitions should be viewed within the context that there is no generic implant and that there are numerous implant designs with different surface characteristics, surgical and loading protocols. It is recom‐ mended that the clinician obtain baseline radiographic and probing measurements following the completion of the implant‐supported prosthesis. KEYWORDS case definition, dental implant, hard tissue deficiencies, peri‐implant mucositis, peri‐implant tissues, peri‐implantitis, soft tissue deficiencies
The objective of Workgroup 4 was to present a classification on peri‐ implant diseases and conditions. Five position papers describing the characteristics of peri‐implant health, 1 peri‐implant mucositis, 2 peri‐ implantitis, 3 soft and hard tissue deficiencies 4 and case definitions and diagnostic considerations 5 were prepared prior to the workshop. In preparing this consensus report regarding the criteria for peri‐implant health and disease it was recognized that there are a number of somewhat unusual peri‐implant problems (e.g., implant fractures) and other conditions that may mimic or share certain clinical features with biofilm‐associated peri‐implant diseases. The following assumptions have been made: 1) complete medical‐dental histories have been obtained including details on implant‐supported
reconstructions; and 2) an appropriate differential diagnostic analy‐ sis has been performed. The following questions and case definitions are intended to apply to situations in which the clinician has reasons to believe that biofilms on implant surfaces are the main etiological expo‐ sures associated with the development of peri‐implant mucositis and peri‐implantitis. It is important to emphasize that there are major patient‐specific differences in inflammatory responses to the microbial challenge of bacterial communities that reside on implants. In addition, it has been assumed that the implants were properly placed and subsequently integrated with soft and hard tissues.
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