Peri-implantitis

ObjectivesThis narrative review provides an evidence-based overview on peri-implantitis for the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. MethodsA literature review was conducted addressing the following topics: 1) definition of peri-implantitis; 2) conversion from peri-implant mucositis to peri-implantitis, 3) onset and pattern of disease progression, 4) characteristics of peri-implantitis, 5) risk factors/indicators for peri-implantitis, and 6) progressive crestal bone loss in the absence of soft tissue inflammation. Conclusions Peri-implantitis is a pathological condition occurring in tissues around dental implants, characterized by inflammation in the peri-implant connective tissue and progressive loss of supporting bone. The histopathologic and clinical conditions leading to the conversion from peri-implant mucositis to peri-implantitis are not completely understood. The onset of peri-implantitis may occur early during follow-up and the disease progresses in a non-linear and accelerating pattern. Peri-implantitis sites exhibit clinical signs of inflammation and increased probing depths compared to baseline measurements. At the histologic level, compared to periodontitis sites, peri-implantitis sites often have larger inflammatory lesions. Surgical entry at peri-implantitis sites often reveals a circumferential pattern of bone loss. There is strong evidence that there is an increased risk of developing peri-implantitis in patients who have a history of chronic periodontitis, poor plaque control skills, and no regular maintenance care after implant therapy. Data identifying smoking and diabetes as potential risk factors/indicators for peri-implantitis are inconclusive. There is some limited evidence linking peri-implantitis to other factors such as: post-restorative presence of submucosal cement, lack of peri-implant keratinized mucosa and positioning of implants that make it difficult to perform oral hygiene and maintenance. Evidence suggests that progressive crestal bone loss around implants in the absence of clinical signs of soft tissue inflammation is a rare event.