Signs, Symptoms, and Diagnosis of Peri-implantitis
- Swollen, bleeding, or reddened peri-implant tissue
- Loosening or wobbling of the implant
- Bleeding while brushing teeth
- Swelling around the implant
- Bad breath or foul taste
- Bone loss and soft tissue inflammation
- Pain and gingival hyperplasia
- No sign of bone loss in healthy situations
- Bone loss can take the shape of a crater with surrounding bone walls
- Bone loss may have no surrounding bone walls
- Alveolar bone shape depends on buccal-lingual length
- Bone remodeling at the alveolar crest is normal after implant placement
- Bleeding on probing may indicate inflammation
- Pus, pocket formation, and gum recession may be present during probing
- Swelling and redness of the gums (erythema) may be observed
- Pocket depth around an implant is typically greater than around natural teeth
- Change in pocket depth between appointments is used for diagnosis
- Peri-implant disease includes peri-implantitis and peri-implant mucositis
- Peri-implant mucositis affects the surrounding mucosa, while peri-implantitis affects both mucosa and bone
- Peri-implant mucositis is similar to gingivitis in terms of symptoms and cause
- Diagnosis of peri-implant mucositis involves identifying bleeding upon probing
- Inadequate plaque removal is a common cause of peri-implant mucositis
- Clinical signs of peri-implantitis include bleeding on probing, suppuration, and increased probing depths
- Radiographic examination is essential for diagnosing peri-implantitis and assessing bone loss
- Peri-implant pocket depth and bleeding on probing are commonly used clinical parameters for diagnosis
- The presence of peri-implant mucositis can precede the development of peri-implantitis
- A comprehensive clinical examination, including assessment of soft and hard tissues, is necessary for accurate diagnosis

Risk Factors for Peri-implantitis
- Poor plaque control
- Lack of regular maintenance therapy
- Presence of titanium implant degradation products
- Presence of peri-implant bacterial plaque
- Diabetes mellitus (potential risk factor)
- Excess cement around the implant (potential risk factor)
- Width of keratinised mucosa around the implant (potential risk factor)
- Genetics (potential risk factor)
- Systemic conditions (e.g., cardiovascular disease, rheumatoid arthritis) (potential risk factor)
- Iatrogenic factors (e.g., implant positioning, bone grafting) (potential risk factor)
- Occlusal overloading of the implant (potential risk factor)
- Smoking (debated potential risk factor)

Prevention of Peri-implantitis
- Treat peri-implant mucositis to prevent it from progressing to peri-implantitis.
- Regular plaque removal through tooth-brushing is essential for preventing and treating peri-implant mucositis.
- Dentists should provide oral hygiene instruction to ensure proper plaque removal and calculus removal.
- Smoking negatively affects the prognosis of implants, so patients should be encouraged to quit smoking.
- Dentists should ensure correct sizing of implant elements to prevent bacterial colonization and place restoration margins supra-gingivally.
- Implementing proper oral hygiene practices, including regular brushing and flossing, is essential for preventing peri-implantitis.
- Smoking cessation is strongly recommended to reduce the risk of peri-implantitis.
- Regular professional maintenance visits, including professional cleaning and assessment of implant stability, are important for prevention.
- Patient education on the importance of oral hygiene and the risks associated with peri-implantitis is crucial.
- Early detection and treatment of peri-implant mucositis can help prevent the progression to peri-implantitis.

Treatment of Peri-implantitis
- Non-surgical therapy aims to control infection and detoxify the implant surface.
- Surgical procedures may be necessary to regenerate lost alveolar bone.
- Mechanical debridement alone is ineffective in removing all microorganisms from implant surfaces.
- Antiseptic, antibiotic therapy, and/or surgery can be combined with mechanical debridement for treatment.
- Ultrasonic scalers with non-metallic tips or resin/carbon fiber curettes are used for calculus removal.
- Conventional steel curettes or ultrasonic instruments with metal tips should be avoided to prevent implant surface damage.
- Polishing with rubber cups and polishing paste aids in plaque removal.
- Proper debridement techniques help reduce future plaque accumulation.
- Chlorhexidine digluconate is commonly used as an antiseptic to maintain plaque control around implants.
- Long-term use of chlorhexidine is not recommended due to adverse events.
- Chlorhexidine may slightly improve tissue inflammation.
- Hydrogen peroxide at a 1% concentration can be as effective as chlorhexidine without staining side effects.
- Concerns have been raised about the direct application of chlorhexidine on implant surfaces due to cytotoxic effects.
- Antibiotics targeting gram-negative anaerobic bacteria can be administered during antiseptic treatment.
- Local antibiotic application, such as tetracycline periodontal fibers, can create a sustained high dose at the affected site.
- Minocycline microspheres, in combination with mechanical debridement, can improve probing depths.
- Oral systemic antibiotic intake alone is not a permanent solution.
- Mechanical and/or local application of doxycycline and hydrogen peroxide may be necessary.
- Surgical flap management with resective and/or regenerative approaches can be considered if infection is controlled.
- Guided bone regeneration can restore bony support, while reshaping peri-implant soft tissue can improve aesthetics.
- Surgical treatment allows comprehensive debridement and local decontamination.
- Consideration of peri-implant lesion characteristics is vital for selecting appropriate surgical techniques.
- Successful infection control is a prerequisite for surgical treatment.

Group 5