Research update: peri-implant disease

perio-implantImplant Dentistry Today presents the latest papers published on peri-implant disease.

Hwang G, Blatz MB, Wolff MS, Steier L (2021)

Diagnosis of biofilm-associated peri-implant disease using a fluorescence-based approach

Dent J (Basel) 9(3): 24

Dental implants have become a routine component of daily dental practice. The demand for dental implants is expected to increase significantly in the future. Despite the high success rates of dental implants, failures do occur. This results in discomfort, rampant destruction of the oral health, or painful and costly surgical replacement of a failed implant.

Peri-implant diseases are inflammatory conditions affecting the soft/hard tissues surrounding a functional dental implant. Plenty of experimental evidence indicates that the accumulation of dental plaque at the soft tissue–implant interface and the subsequent local inflammatory response seems to be key in the pathogenesis of the peri-implant mucositis.

Such peri-implant soft tissue interface is less effective than natural teeth in resisting bacterial invasion. This enhances vulnerability to subsequent peri-implant disease. Furthermore, in certain individuals, it will progress to peri-implantitis, resulting in alveolar bone loss and implant failure.

Although early diagnosis and accurate identification of risk factors are extremely important to effectively prevent peri-implant diseases, current systematic reviews revealed that a uniform classification and diagnostic methodology for peri-implantitis are lacking. Recent progress on fluorescence-based technology enabled rapid diagnosis of the disease and effective removal of plaques.

Here, we briefly review biofilm-associated peri-implant diseases and propose a fluorescence-based approach for more accurate and objective diagnoses. A fluorescence-based diagnosis tool through headlights combined with special-filtered dental loupes may serve as a hands-free solution for both precise diagnosis and effective removal of plaque-biofilms.

Kormas I, Pedercini C, Pedercini A, Raptopoulos M, Alassy H, Wolff LF (2020)

Peri-implant diseases: diagnosis, clinical, histological, microbiological characteristics and treatment strategies. A narrative review

Antibiotics (Basel) 9(11): 835

Since the use of dental implants is continuously increasing, it is imperative for dental practitioners to understand the nature and treatment of peri-implant diseases.

The purpose of this manuscript is to comprehensively review peri-implant diseases, their characteristics, as well as their non-surgical and surgical treatment. To that end, the current literature was searched and a narrative review was conducted.

It is essential that the case definitions described in the 2017 World Workshop on the Classification of Periodontal and Peri-implant Diseases and Conditions are used to diagnose and classify peri-implant health, peri-implant mucositis and peri-implantitis.

While recent epidemiologic studies on peri-implant diseases exist, there is great heterogeneity in the definition of these conditions. Several risk factors and indicators are reported in the literature, with smoking and diabetes being the most universally accepted. In peri-implant mucositis, non-surgical treatment seems to be sufficient. However, for the treatment of peri-implantitis, a surgical approach, which includes open-flap debridement, apically positioned flap and guided bone regeneration, is considered more appropriate.

A great variety of adjuncts to mechanical treatment have been reported with controversial results. Finally, studies comparing results from different peri-implantitis treatments are warranted in randomised controlled clinical trials in order to provide stronger evidence-based approaches.

Coli P, Sennerby L (2019)

Is peri-implant probing causing over-diagnosis and over-treatment of dental implants?

J Clin Med 8(8): 1123

Pocket probing depth (PPD) and bleeding on probing (BOP) measurements are useful indices for the assessment of periodontal conditions. The same periodontal indices are commonly recommended to evaluate the dental implant/tissue interface to identify sites with mucositis and peri-implantitis, which, if not treated, are anticipated to lead to implant failure.

The aim of the present narrative review is to discuss the available literature on the effectiveness of probing at dental implants for identification of peri-implant pathology.

There is substantial clinical evidence that PPD and BOP measurements are very poor indices of peri-implant tissue conditions and are questionable surrogate endpoints for implant failure. On the contrary, the literature suggests that frequent disturbance of the soft tissue barrier at implants may instead induce inflammation and bone resorption.


Moreover, over-diagnosis and subsequent unnecessary treatment may lead to iatrogenic damage to the implant-tissue interface. Despite this, the recommendations from recent consensus meetings are still promoting the use of probing at dental implants.

For evaluation of implants, for instance at annual check-ups, the present authors recommend a clinical examination. This includes (i) a visual inspection of the peri-implant tissues for the assessment of oral hygiene and the detection of potential redness, swelling, (ii) palpation of the peri-implant tissues for assessment of the potential presence of swelling, bleeding, suppuration. In addition, (iii) radiography is recommended for the assessment of crestal bone level for comparison with previous radiographs to evaluate potential progressive bone loss even if there is a need for more scientific evidence of the true value of the first two clinical testing modes.

Chala M, Anagnostaki E, Mylona V, Chalas A, Parker S, Lynch E (2020)

Adjunctive use of lasers in peri-implant mucositis and peri-implantitis treatment: a systematic review

Dent J (Basel) 8(3): 68


The aim of this systematic review is to compare the effectiveness of lasers in the treatment of implant mucositis and peri-implantitis compared to conventional treatment (non-surgical or surgical: resective or regenerative).


Sources of Pubmed, Cochrane and Google Scholar search engines were used on articles published from 1997 to 2020 in English, with selected keyword criteria applied. Nine randomized controlled trials (RCTs) were selected.


All included studies were considered of ‘high quality’ according to the quality assessment scale. The comparative assessment of the RCTs was done twice for each RCT. This was based on the type of treatment and according to wavelength. There is strong scientific evidence that, regarding non-surgical treatment, adjunct laser application can provide better results only in the short term (three months). Regarding the surgical approach, the method of decontamination plays a subordinate role. All wavelengths/applications presented similar results.


Within the limitations of this study, the adjunctive use of lasers in the treatment of peri-implant inflammation is effective for up to three months. There is no strong evidence regarding the long-term benefit compared to conventional treatment.

Ahn DH, Kim HJ, Joo JY, Lee JY (2019)

Prevalence and risk factors of peri-implant mucositis and peri-implantitis after at least seven years of loading

J Periodontal Implant Sci 49(6): 397-405


This study examined the prevalence and risk factors of peri-implant disease after at least seven years of dental implant loading.


A total of 111 patients with 218 dental implants were treated. The follow-up period for all implants was at least seven years. The patients’ dental records were collected and risk factors of peri-implant disease were investigated through logistic regression analysis.


The overall implant survival rate was 95.87%, because nine of the 218 implants failed. The prevalence of peri-implant mucositis and peri-implantitis was 39.7% and 16.7%, respectively. As risk factors, smoking and prosthetic splinting showed significant associations with peri-implantitis (P<0.05).


Within the limits of this study, no significant correlations were found between any risk factors and peri-implant mucositis. However, a significantly elevated risk of peri-implantitis was observed in patients who smoked or had splinted prostheses in two or more implants. 

Search criteria

These abstracts were curated from Pubmed using the keywords peri-implantitis, peri-implant mucositis and peri-implant disease.

This article first appeared in Implant Dentistry Today magazine. You can read the latest issue here.

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