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Assessment, Development and Evaluation process. A rigorous and transparent pro- cess included synthesis of relevant research in 13 specifically commissioned system- atic reviews, evaluation of the quality and strength of evidence, formulation of specific recommendations, and a structured consensus process involving leading experts and a broad base of stakeholders. Results: The S3 level CPG for the prevention and treatment of peri-implant diseases culminated in the recommendation for implementation of various different interven- tions before, during and after implant placement/loading. Prevention of peri-implant diseases should commence when dental implants are planned, surgically placed and prosthetically loaded. Once the implants are loaded and in function, a supportive peri-implant care programme should be structured, including periodical assessment of peri-implant tissue health. If peri-implant mucositis or peri-implantitis are detected, appropriate treatments for their management must be rendered. Conclusion: The present S3 level CPG informs clinical practice, health systems, pol- icymakers and, indirectly, the public on the available and most effective modalities to maintain healthy peri-implant tissues, and to manage peri-implant diseases, according to the available evidence at the time of publication.
KEYWORDS clinical guideline, dental implant, peri-implant diseases, peri-implant mucositis, peri-implantitis
Clinical Relevance Scientific rationale for study : Peri-implant diseases, specifically peri-implant mucositis and peri- implantitis, are highly prevalent and their management is challenging, and are associated with significant morbidity. This clinical practice guideline (CPG) provides guidance on the manage- ment of peri-implant diseases. The recommendations described in this CPG have been formu- lated following a rigorous evidence-based and patient-centred decision-making process. Principal findings : This guideline covers preventive and treatment interventions for peri-implant diseases to be implemented during the planning, execution and long-term follow-up of tooth replacement with dental implants. It identifies specific interventions demonstrated to be effec- tive and structures them in needs-based care pathways. It also examines the current level of sci- entific support for a variety of widely employed approaches and techniques. Practical implications : The application of this S3 level CPG will facilitate a consistent, interdisci- plinary and evidence-based approach to the prevention and treatment of peri-implant diseases.
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INTRODUCTION
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in probing depth (PD) is frequently observed in the presence of peri- implant mucositis due to oedema or a decrease in probing resistance (Berglundh et al., 2018). Peri-implant mucositis is primarily caused by a disruption of host – microbial homeostasis at the implant – mucosa interface and is a reversible condition when assessed indirectly at the host biomarker level (Heitz-Mayfield & Salvi, 2018). Additional factors associated with the onset and progression of peri-implant mucositis include biofilm accumulation, smoking and radiation therapy (Berglundh et al., 2018). Peri-implantitis has been defined as a ‘ peri-implant biofilm- associated pathological condition, occurring in tissues around dental implants, and characterized by inflammation in the peri-implant mucosa and subsequent progressive loss of supporting bone ’ (Berglundh et al., 2018). Clinically, peri-implantitis sites exhibit
1.1
The health problem
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1.1.1 | Definition
Peri-implant diseases are inflammatory conditions that affect the peri- implant tissues and are induced by peri-implant biofilms. There are two distinct conditions: peri-implant mucositis and peri-implantitis. Peri-implant mucositis is ‘ an inflammatory lesion of the peri- implant mucosa, in the absence of continuing marginal bone loss ’ (Heitz-Mayfield & Salvi, 2018). It is characterized clinically by bleeding on gentle probing. Other clinical signs of inflammation may be pre- sent, such as erythema, swelling and/or suppuration, and an increase
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