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The Prevention, Diagnosis and Management of Peri-Implant Diseases - ADI Guidance

Peri-implant mucositis is the commonest form of peri-implant diseases (PID) which affects most of the patients with implant-supported restorations. Although there is conclusive evidence that plaque has a direct cause-effect relationship with mucositis, there is still little consensus on how to monitor or manage this condition in practice.  A variety of surgical and non-surgical techniques have been advocated in the literature but, in absence of controlled prospective studies, there is little evidence to demonstrate which of these interventions are more effective.

In February 2010, the ADI staged a focus meeting on peri-implantitis and gathered four of world’s most eminent periodontologists- Professors Lang, Mombelli, Berglundh and Renvert to explore the primary and secondary aetiological factors surrounding the pathogenesis of peri-implant diseases. Despite much research on the aetiology of this increasingly common condition, there is still no clarity on how to monitor or manage peri-implant disease in practice.

In November 2012, the ADI has hosted an expert panel consensus meeting on diagnosis, monitoring and management of peri-implant diseases. The invited expert panel consisted of Professors Mariano Sanz (Spain), Tord Berglundh (Sweden), Nikos Donos (UK), Nicola West (UK), Dr Maria Retzepi (UK), Simon Wright (UK) and Sally Simpson (Past President of the British Society of Dental Hygienists and Therapists) and the ADI scientific Chairman, Eddie Scher.  

The panel was asked to discuss the pathogenesis, diagnosis and management of peri-implant diseases and reach a consensus based on the best available evidence and their expert opinion. The results of the consensus meeting have been summarised as best practice guidelines by the ADI guidelines committee in two papers; a) ADI guidelines on monitoring and maintenance of peri-implant diseases b) ADI guidelines on treatment of peri-implant diseases.

These papers do not resolve all the controversies and probably raise more questions. However, what is not in dispute is that meticulous plaque control is imperative for the prevention of PID. This is even more critical in patients who present with additional risk factors such as smoking and/or history of periodontal disease.

As early diagnosis will enable more effective prevention and treatment of PID, periodic patient monitoring and evaluation of the condition of the peri-implant hard and soft tissues is of paramount importance to the implant patients.  I therefore commend every dental professional who looks after dental implant patients to update their knowledge, on the aetiology, diagnosis, monitoring and management of peri-implant diseases. I hope the ADI guidelines on PID would be of some help to all members of the dental team in this respect.

I also would like to take this opportunity to thank the invited panel of experts and the authors of the consensus documents for their invaluable contribution the consensus meeting and helping to make it a great success.

I hope you will find the consensus documents useful.

Professor Cemal Ucer
ADI President
February, 2013

NB: These guidelines should be regarded as best practice position papers based on the available evidence as well as expert opinion at the time of writing and are not intended to be prescriptive rules or clinical protocols as such.  It is imperative that clinicians should base their decision making, when managing individual patients, on the most up to date information obtained from different sources.