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BERGLUNDH et al .
PERI‐IMPLANT HEALTH
8. What are the main histological differences between healthy peri‐im‐ plant and periodontal tissues?
1. What are the clinical characteristics of a healthy peri‐implant site? In health, the peri‐implant site is characterized by absence of erythema, bleeding on probing, swelling and suppuration. 2. What are the main clinical differences between healthy peri‐implant and periodontal tissues? In health, there are no visual differences between peri‐implant and periodontal tissues. However, the probing depths are usually greater at implant versus tooth sites. The papillae at the inter ‐ proximal sites of an implant may be shorter than the papillae at interproximal tooth sites. 3. What clinical methods and instruments should be used to detect the presence or absence of inflammation at an implant site? The clinical methods to detect the presence of inflammation should include visual inspection, probing with a periodontal probe, and digital palpation. 4. Why is it important to probe peri‐implant tissues during a complete oral examination? It is necessary to probe peri‐implant tissues to assess the pres ‐ ence of bleeding on probing, and to monitor probing depth changes and mucosal margin migration. This assessment may alert the clinician to the need for therapeutic intervention. There is evidence that probing of the peri‐implant tissue using a light probing force is a safe and important component of a complete oral examination. 5. What peri‐implant probing depths are compatible with peri‐implant health? It is not possible to define a range of probing depths compatible with health; of more importance are the clinical signs of inflammation. 6. Can peri‐implant health exist around implants with reduced bone support? Yes, peri‐implant tissue health can exist around implants with re ‐ duced bone support. 7. What are the histological characteristics of a healthy peri‐implant site? The histological characteristics of a healthy peri‐implant site are derived mainly from animal studies. The healthy peri‐im ‐ plant mucosa averages 3 to 4 mm in height and is covered by either a keratinized (masticatory mucosa) or non‐keratinized epithelium (lining mucosa). The portion of the peri‐implant mu ‐ cosa that is facing the implant/abutment contains a “coronal” portion that is lined by a sulcular epithelium and a thin junc ‐ tional epithelium, and a more “apical” segment in which the connective tissue is in direct contact with the implant surface. The connective tissue lateral to the sulcular epithelium harbors a small infiltrate of inflammatory cells. Most of the intrabony part of the implant is in contact with mineralized bone, while the remaining portion faces bone marrow, vascular structures, or fibrous tissue.
Compared to the periodontium, the peri‐implant tissues do not have cementum and periodontal ligament. The peri‐implant epi ‐ thelium is often longer and in the connective tissue zone there are no inserting fibers into the implant surface. The peri‐implant tissues are less vascularized in the zone between the bone crest and the junctional epithelium when compared to the connective tissue zone of the periodontium.
PERI‐IMPLANT MUCOSITIS
1. What are the clinical characteristics of peri‐implant mucositis? The main clinical characteristic of peri‐implant mucositis is bleeding on gentle probing. Erythema, swelling and/or suppu ‐ ration may also be present. 2. Does peri‐implant mucositis exist in the absence of clinical signs of inflammation? Clinical signs of inflammation are necessary for a diagnosis of peri‐implant mucositis. 3. How does probing depth relate to the detection of peri‐implant mucositis? An increase in probing depth is often observed in the presence of peri‐implant mucositis due to swelling or decrease in probing resistance. 4. What is the evidence for plaque as the main etiological factor for peri‐ implant mucositis? There is strong evidence from animal and human experimental studies that plaque is the etiological factor for peri‐implant mucositis. 5. Does non–plaque‐induced peri‐implant mucositis exist? There is limited evidence for non–plaque‐induced peri‐implant mucositis. 6. Can peri‐implant mucositis resolve? There is evidence from experimental human studies that peri‐ implant mucositis can resolve. Resolution of the clinical signs of inflammation may take more than 3 weeks following reinstitu ‐ tion of plaque/biofilm control. 7. What are the environmental and patient‐specific risk indicators for peri‐implant mucositis? The major etiological factor is plaque accumulation. Host re ‐ sponse to the bacterial challenge may vary between patients. Smoking, diabetes mellitus, and radiation therapy may modify the condition. 8. What are the histological characteristics of peri‐implant mucositis? Peri‐implant mucositis is characterized by a well‐defined inflam ‐ matory lesion lateral to the junctional/pocket epithelium with an infiltrate rich in vascular structures, plasma cells, and lym ‐ phocytes. The inflammatory infiltrate does not extend “apical” of the junctional/pocket epithelium into the supracrestal con ‐ nective tissue zone.
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