If the biofilm is removed at this stage,
the peri-implant tissues can return to health.
If the biofilm persists however,
transition to the peri-implantitis,
the final stage of inflammation, is very likely.
Peri-implantitis, the condition where implants
are losing supporting bone due to inflammation
is today a major therapeutical challenge.
As a new disease entity, the prevalence of peri-implantitis
is not easy to define and estimations vary
depending on the sensitivity of the diagnostic indicators used.
Although some authors have estimated peri-implantitis
to affect as many as 40% of the patients
after 10 years with implants,
the majority of studies place peri-implantitis
between 5-20% of patients for the same period.
It is also clear that the occurrence
of plaque-induced inflammation greatly depends on
the oral hygiene and the maintenance of the patients,
and consequently, the prevalence will be very low
in well-maintained patient populations.
The diagnosis of peri-implantitis is mainly clinical.
First, as we discussed previously,
start by continuously assessing the risk of your patients.
Patients with compromised oral hygiene,
smokers, patients with diabetes mellitus,
or history of periodontitis,
are also in higher risk to develop peri-implantitis.
Second, probe around the dental implants
at every maintenance appointment.
Bleeding on probing with light force
is an indication of inflammation.
Unlike teeth however, there is no
definitive pathological probing depth around implants.
As we often place implants rather deep in the tissues,
especially in the aesthetic zone,
probing depths of 4 or 5 mm
are not uncommon around healthy implants.
Therefore, compare the probing depths
at follow up with that at baseline,
when the implant was first restored.
Any increase in probing depth
might indicate initiated peri-implantitis.
