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Professor Tord Berglundh

Peri-implantitis – characteristics, prevalence and implant surface as a risk

Report by David Offord

Prof Berglundh
Prof Berglundh opened by giving the 6th European Workshop on Periodontology definition of peri-implantitis (Lindhe & Meyle 2008) that “peri-implant mucositis was an inflammatory lesion that resides in the mucosa, while peri-implantitis also affects the supporting bone.”

The diagnosis of peri-implantitis requires clinical and radiographic assessments of the tissues around an implant. He strongly advocated clinical assessment using the periodontal probe, arguing that bleeding following probing peri-implant tissues indicates an inflammatory lesion in the mucosa. Radiographs may be taken at prosthesis delivery (baseline) and one year, but he discouraged celebrating each implant birthday with a radiograph! Bleeding or suppuration on probing + bone loss = peri-implantitis.

Peri-implantitis is a generic disease, ie. it affects all implant systems with no exceptions.

So how common is peri-implantitis? Recent cross-sectional studies suggest that mild, moderate or severe forms of peri-implantitis (bleeding on probing + bone loss) occur in 28 – 56% of subjects.

Prof Berglundh went on to offer three risk factors for peri-implantitis:

  1. Susceptibility to periodontal disease. We carry this for life. Just as for periodontal disease patients, at-risk implant patients should have supportive therapy, reviews four times a year and stringent follow-up protocols. Are there certain patients who should not get implants due to their susceptibility to peri-implantitis eg. Papillon-Lefevre syndrome?
  2. Prosthesis design. Some patients have never seen their implants! How can they keep them clean?
  3. Implant surface. In experimental studies in dogs, spontaneous progression of ligature-induced peri-implantitis is more pronounced in rough surface implants than smooth surface. TiUnite implants demonstrate more bone surface loss in ligature-induced peri-implantitis than smooth, SLA or TioBlast surfaces. (Albouy, Abrahamsson, Persson, Berglundh 2008, 2009)

In summary, periodontitis and peri-implantitis have many features in common. Peri-implantitis is more aggressive and progresses faster than periodontitis, and it would appear the implant surface does influence the disease progression.