Peri-implant Classifications Revisited

This is a continuation of my September Editor’s Note comments about the new classifications for periodontal and peri-implant diseases issued by the American Academy of Periodontology and European Federation of Periodontology. (The complete proceedings can be found at perio.org/2017wwdc; in addition, you’ll find a continuing education article on the new system here: https://decisionsindentistry.com/ce-sponsored-by-colgate-in-partnership-with-the-american-academy-of-periodontology-overview-of-the-new-peri-implant-and-periodontal-disease-classification-system.) The report examines peri-implant health, peri-implant mucositis and peri-implantitis. It further states that peri-implant health is characterized by an “absence of visual signs of inflammation and bleeding on probing.”¹ It asserts the definition of health can exist around implants with both normal and reduced bone support, and that it is not possible to define the range of probing depth compatible with health.

The new system defines peri-implant mucositis as peri-implant tissues that have visual signs of inflammation and/or bleeding on probing.¹ Peri-implantitis is defined as a “plaque-associated pathological condition occurring in the tissue around dental implants, characterized by inflammation in the peri-implant mucosa and subsequent progressive loss of supporting bone.”¹ The report suggests peri-implantitis may occur early or late following implant placement, and should be monitored with sequential radiographs.

From my perspective, the report mentions peri-implant conditions only briefly — perhaps because scientific understanding of peri-implant disease is at an early stage. When workgroups like this convene, it is necessary to use the preponderance of qualified studies to offer suggestions and conclusions. That noted, the report does not mention newer information concerning the role of foreign bodies — such as cement and titanium — in implant health, or the possible role of occlusion in implant failure. Both omissions are understandable because, at present, there is insufficient data on these possible etiologic or cofactors in implant loss.

The report suggests peri-implantitis may occur early or late following implant placement, and should be monitored with sequential radiographs

So, where does this leave the rank-and-file clinician? If one bases treatment on the suggestions from this report, it would be assumed that plaque is the primary (and possibly only) etiologic factor in these diseases. Therefore, the ideal implant candidate would have tissue as healthy as possible, and optimal oral hygiene before and after implant placement. Based on the new system, it would also seem that periodic bitewing and/or periapical radiographs are appropriate to monitor disease progression. Probing is only mentioned tangentially and is not suggested as one of the diagnostic factors. However, in my experience, one of the ways to diagnose peri-implant mucositis is with the use of probing. Thus, it seems reasonable this data should be recorded at appropriate intervals.

Overall, this update from the previous classifications, issued in 1999, represents a useful clinical tool — especially in that it offers the inaugural system for classifying peri-implant disease. At the same time, the new report underscores how much science still has to learn about the management of peri-implant mucositis and peri-implantitis.

Thomas G. Wilson Jr., DDS

Editor in Chief

twilson@belmontpublications.com

REFERENCE

1. Caton J, Armitage G, Berglund T, et al. A new classification scheme for periodontal and peri-implant diseases and conditions — Introduction and key changes from the 1999 classification. J Periodontol. 2018;89(Suppl 1):S1–S8.

From Decisions in Dentistry. October 2018;4(10):6.