Table 1 Recommendations for the management on peri-implantitis†
Topics | Recommendation | Supporting guidelines | Number of recommendations | Strength of recommendation# | Quality of evidence‡ |
|---|---|---|---|---|---|
Prevention | It is recognized that secondary prevention of peri-implantitis poses unique challenges that may only be partially addressed by routine supportive periodontal care programs. | EWP(2) | 1 | Ungraded | Ungraded |
Self-performed hygiene care or professional maintenance program (e.g. proper plaque control) have positive effect on preventing peri-implant mucositis proceeding into peri-implantitis | ITI, BOA&LUHS(2), BOA&LUHS(3) | 3 | Ungraded | Ungraded | |
Caution should be used for implants in Sjögren’s Patients and diabetic patient which may have an increased risk for peri-implantitis. | EWP(1), BOA&LUHS(1) | 2 | Ungraded | Ungraded | |
Diagnosis | A diagnosis of peri-implantitis is given in the presence of mucositis in conjunction with progressive crestal bone loss | ITI | 1 | Ungraded | Ungraded |
When clinical signs suggest the presence of peri-implantitis, the clinician is advised to take a radiograph of the site to confirm the diagnosis. | EWP(1), BOA&LUHS(3) | 2 | Ungraded | Ungraded | |
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. | AAP&EFP, FDI(2) | 2 | Ungraded | Ungraded | |
In the absence of previous examination data, diagnosis of peri-implantitis can be based on the combination of: • Presence of bleeding and/or suppuration on gentle probing. • Probing depths of ≥ 6 mm(or ≥ 4 mm). • Bone levels ≥ 3 mm (or ≥ 5 mm) mapical of the most coronal portion of the intraosseous part of the implant | AAP&EFP, BOA&LUHS(3) | 2 | Ungraded | Ungraded | |
Treatment | A regular maintenance program may be needed for the long-term management of peri-implantitis lesions. | ITI | 1 | Ungraded | Ungraded |
Pretreatment phase including: i. Thorough assessment and diagnosis ii. Reduction of risk factors for peri-implantitis; in particular poor oral hygiene, prostheses that prevent adequate access for plaque control, to-bacco use, presence of periodontal diseases, and systemic diseases that may predispose to peri-implant disease ii. If required, prosthesis removal and adjustment/replacement | ITI | 1 | Ungraded | Ungraded | |
Nonsurgical debridement focused on maximal removal of biofilm, with or without antimicrobials | ITI, EAO(1) | 2 | Ungraded | Ungraded | |
The clinician should consider implant removal as a treatment option. Factors influencing this decision may include the severity of the peri-implantitis lesion, the position of the implant, the surrounding tissues, or when the treatment outcomes are likely to be unsatisfactory. | ITI, EAO(1), BOA&LUHS(3) | 3 | Ungraded | Ungraded | |
If non-surgical treatment does not resolve the peri-implantitis lesion or arrest progressive bone loss, surgical therapy may be considered. | EAO(1), FDI(2) | 2 | Ungraded | Ungraded | |
Proper pre- and postsurgical hygiene maintenance phases and successful implant surface decontamination are mandatory for successful surgical regenerative procedure. | Albrektsson et al., EWP(1), BOA&LUHS(2) | 3 | Ungraded | Ungraded | |
Surgical augmentative peri-implantitis therapy results in improved clinical and radiographic treatment outcomes, which is considered to be superior to non-surgical therapy in resolving peri-implantitis. | FDI(1), EAO(1), AAP(2), FDI(2), BOA&LUHS(2) | 5 | Ungraded | Ungraded | |
Surgical regenerative treatment might be chosen for intrabony defect reconstruction, whereas non-regenerative approach and implantoplasty of the supracrestal implant component is recommended. | FDI(1), BOA&LUHS(2) | 2 | Ungraded | Ungraded | |
Implant surface scaling plus antimicrobial photodynamic therapy versus implant surface scaling for the treatment of peri-implantitis is recommended compared with scaling and root planing. | AAP(1) | 1 | Weak | Low | |
Others | Monitoring | ||||
Regular assessment of peri-implant health is recommended during support periodontal treatment (SPT) to identify disease at an early stage. | ITI, BOA&LUHS(3) | 3 | Ungraded | Ungraded | |
The presence of purulent exudate in combination with clinically significant progressing Crestal bone loss (CBL) necessitates therapeutic intervention. | Albrektsson et al., EAO(1), EWP(1), EWP(2), AAP&EFP | 5 | Ungraded | Ungraded | |
Evaluate iatrogenic factors that might have caused the disease, including cement remnants, malpositioning of the implant, inadequate restoration-abutment seating, and overcontouring of the reconstruction that disturbs proper plaque control should be evaluated. | BOA&LUHS(3) | 1 | Ungraded | Ungraded | |
Clinical monitoring should be performed on a regular basis and supplemented by appropriate radiographic evaluation as required. | Albrektsson et al., ITI, AAP&EFP | 3 | Ungraded | Ungraded | |
Qualifications | |||||
Training of dental team professionals should include diagnosis and management of peri-implant disease. | ITI | 1 | Ungraded | Ungraded | |
Biomarker | |||||
Evidence regarding biomarkers and enzymes in peri-implant crevicular fluid (PICF) as possible predictors for peri-implantitis are very limited. | BOA&LUHS(3) | 1 | Ungraded | Ungraded |