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4. What is the role of the peri‐implant bone in giving form to the peri‐im‐ plant soft tissues? The papilla height between implants and teeth is affected by the level of the periodontal tissues on the teeth adjacent to the im ‐ plants. The height of the papilla between implants is determined by the bone crest between the implants. Results are equivocal whether the buccal bone plate is necessary for supporting the buccal soft tissue of the implant in the long‐term.
examinations. • Absence of bone loss beyond crestal bone level changes resulting from initial bone remodeling. It should be noted that visual signs of inflammation can vary and that peri‐implant mucositis can exist around implants with variable lev‐ els of bone support. How do we define a case of peri‐implantitis in day‐to‐day clinical prac‐ tice and teaching situations? Diagnosis of peri‐implantitis requires: • Presence of bleeding and/or suppuration on gentle probing. • Increased probing depth compared to previous examinations. • Presence of bone loss beyond crestal bone level changes resulting from initial bone remodeling.
CASE DEFINITIONS AND DIAGNOSTIC CONSIDERATIONS
The following case definitions and characteristics of peri‐implant health, peri‐implant mucositis, and peri‐implantitis should be viewed within context of several potential confounding factors. It is known that there is no generic implant and that there are numerous implant designs with different surface characteristics, surgical and loading protocols. The degree of physiological remod‐ eling after implant placement may vary and will determine the cr‐ estal level of bone expected in peri‐implant health. The amount of remodeling will also be influenced by a number of local and systemic factors. Clinicians should be aware that extensive peri‐implant bone loss may also be reflective of the development of peri‐implantitis during the remodeling phase. It is recommended that the clinician obtain baseline radiographic and probing measurements following the completion of the implant‐ supported prosthesis. An additional radiograph after a loading pe‐ riod should be taken to establish a bone level reference following physiological remodeling. If the patient presents for the first time with an implant‐supported prosthesis the clinician should try to obtain clinical records and previous radiographs in order to assess changes in bone levels. How do we define a case of peri‐implant health in day‐to‐day clinical practice and teaching situations? Diagnosis of peri‐implant health requires: • Absence of clinical signs of inflammation. • Absence of bleeding and/or suppuration on gentle probing. • No increase in probing depth compared to previous examinations. • Absence of bone loss beyond crestal bone level changes resulting from initial bone remodeling. It should be noted that probing depths depend on the height of the soft tissue at the location of the implant. Furthermore, peri‐im‐ plant tissue health can exist around implants with variable levels of bone support. How do we define a case of peri‐implant mucositis in day‐to‐day clinical practice and teaching situations? Diagnosis of peri‐implant mucositis requires: • Presence of bleeding and/or suppuration on gentle probing with or without increased probing depth compared to previous
In the absence of previous examination data diagnosis of peri‐im‐ plantitis can be based on the combination of:
• Presence of bleeding and/or suppuration on gentle probing. • Probing depths of ≥6 mm. • Bone levels ≥3 mm apical of the most coronal portion of the in‐ traosseous part of the implant. It should be noted that visual signs of inflammation can vary and that recession of the mucosal margin should be considered in the prob‐ ing depth evaluation. How do we define a case of peri‐implant health and peri‐implant muco‐ sitis in epidemiological or disease surveillance studies? The same criteria used to define peri‐implant health and peri‐im‐ plant mucositis in day‐to‐day practice should be applied in epidemi‐ ological studies. How do we define a case of peri‐implantitis in epidemiological or disease surveillance studies? Diagnosis of peri‐implantitis requires: • Presence of bleeding and/or suppuration on gentle probing. • Increased probing depth compared to previous examinations. • Presence of bone loss beyond crestal bone level changes re‐ sulting from initial bone remodeling. Epidemiological studies need to take into account the error of measurements in rela‐ tion to assessments of bone level changes. Bone loss should be reported using thresholds exceeding the measurement error (mean 0.5 mm). Epidemiological studies should ideally include previous exam‐ inations performed after the first year of loading. In the absence of previous radiographic examinations, bone levels ≥3 mm apical of the most coronal portion of the intra‐osseous part of the implant to‐ gether with bleeding on probing are consistent with the diagnosis of peri‐implantitis.
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