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4.4
| Specific care pathways according to diagnosis
4.3.1 | Diagnosis of healthy peri-implant tissues
of the peri-implant condition
According to this 2018 classification (Araujo & Lindhe, 2018; Berglundh et al., 2018), a diagnosis of peri-implant health requires:
Almost 25 years ago, at the Food and Drug Administration (FDA)/ AAP consensus conference in 1996, Lang and co-workers (Lang et al., 1997; Lang et al. 2000; Mombelli & Lang, 1998) proposed the Cumu- lative Interceptive Supportive Therapy concept for the management of peri-implant diseases. This protocol was based on a combination of early detection, and implementation of preventive and therapeutic interventions, aimed first to prevent the onset, and then to treat peri- implantitis as early as possible to arrest its progression and thus pre- vent loss of the implant. While the interventions recommended in the current guideline are different, the overall strategy and philosophy are similar. Depending on the clinical diagnosis, distinct care pathways can be followed (Figures 2 and 3). However, the important overarching principle portends that peri-implant mucositis is treatable and leads to the restora- tion of peri-implant tissue health. Therefore, primary prevention of peri- implant diseases and secondary prevention of peri-implant mucositis (after peri-implant mucositis treatment) share identical interventions. Moreover, since the treatment of peri-implant mucositis is the primary intervention in the prevention of peri-implantitis, this treatment should also be considered a preventive strategy. The maintenance of health and function of dental implants and the associated implant-supported pros- theses through prevention and treatment of peri-implantitis is, therefore, the primary aim of this guideline. However, once peri-implantitis has developed, it is well established that treatment will not re-establish intact peri-implant tissue support, even if the inflammation is successfully con- trolled. Therefore, specific clinical definitions following the treatment of peri-implantitis need to be established.
• Absence of clinical signs of inflammation. • Absence of bleeding or suppuration on gentle probing. • No increase in PD compared to previous examinations. • Absence of bone loss beyond crestal bone level changes resulting from initial bone remodelling. The present guideline has also adopted the recent ID-COSM ini- tiative consensus (Tonetti et al., 2023) and the slightly modified defini- tion of peri-implant health, which allows for the presence of a single bleeding spot around the implant.
4.3.2 | Diagnosis of peri-implant mucositis
For a diagnosis of peri-implant mucositis, the 2018 classification requires (Berglundh et al., 2018; Heitz-Mayfield & Salvi, 2018):
• Presence of bleeding and/or suppuration on gentle probing with or without increased PD compared to previous examinations. • Absence of bone loss beyond crestal bone level changes resulting from initial bone remodelling. Following the modification of the ID-COSM initiative consensus (Tonetti et al., 2023), this definition has been updated as follows: pres- ence of bleeding (more than one spot at a location around the implant or presence of a line of bleeding or profuse bleeding at any location) and/or suppuration on gentle probing, in the absence of bone loss beyond crestal bone level changes resulting from initial bone remodelling.
4.4.1 | Specific care pathways in healthy peri- implant tissues
In cases of peri-implant tissue health, interventions for primary pre- vention should be implemented as part of a SPIC programme, includ- ing periodical professional supra-and sub-marginal plaque biofilm removal.
4.3.3 | Diagnosis of peri-implantitis
A diagnosis of peri-implantitis requires (Berglundh et al., 2018; Schwarz et al., 2018):
4.4.2 | Specific care pathways in peri-implant mucositis
• Presence of bleeding and/or suppuration on gentle probing. • Increased PD compared to previous examinations. • Presence of bone loss beyond crestal bone level changes resulting from initial bone remodelling.
Interventions for the management of peri-implant mucositis are detailed in Section 6 and focus on biofilm control, either self- administered or professionally delivered. Treatment outcomes should be evaluated after 2 – 3 months, and if relevant end points have not been achieved, re-treatment is recommended. These endpoints reflect the re-establishment of peri-implant health; if peri-implant health is re-established, then the primary prevention of peri-implant diseases and the secondary prevention of peri-implant mucositis are essentially identical. Furthermore, since the treatment of peri-implant mucositis
However, in the absence of previous examination data, the diag- nosis of peri-implantitis can be based on the combination of:
• Presence of bleeding and/or suppuration on gentle probing. • PDs of ≥ 6mm. • Bone levels ≥ 3 mm apical of the most coronal portion of the intraosseous part of the implant.
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