Periâ implant diseases and conditions: Consensus report of workgroup 4 of the 2017 World Workshop on the Classification of Periodontal and Periâ Implant Diseases and Conditions

Abstract

A classification for periâ implant diseases and conditions was presented. Focused questions on the characteristics of periâ implant health, periâ implant mucositis, periâ implantitis, and softâ and hardâ tissue deficiencies were addressed.Periâ implant health is characterized by the absence of erythema, bleeding on probing, swelling, and suppuration. It is not possible to define a range of probing depths compatible with health; Periâ implant health can exist around implants with reduced bone support.The main clinical characteristic of periâ implant mucositis is bleeding on gentle probing. Erythema, swelling, and/or suppuration may also be present. An increase in probing depth is often observed in the presence of periâ 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 periâ implant mucositis.Periâ implantitis is a plaqueâ associated pathological condition occurring in tissues around dental implants, characterized by inflammation in the periâ implant mucosa and subsequent progressive loss of supporting bone. Periâ 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 longâ term health of the periâ implant tissue. It appears, however, that keratinized mucosa may have advantages regarding patient comfort and ease of plaque removal.Case definitions in dayâ toâ day clinical practice and in epidemiological or diseaseâ surveillance studies for periâ implant health, periâ implant mucositis, and periâ implantitis 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 recommended that the clinician obtain baseline radiographic and probing measurements following the completion of the implantâ supported prosthesis.