Peri-Implant Mucositis

Diagnosis

What is peri-implant health?

There are a number of factors that might indicate peri-implant health, or a lack of it. At a microscopic level, healthy peri-implant mucosa is comprised of a core of connective tissue covered by either a keratinised (masticatory) or non-keratinised (lining) epithelium. Healthy peri-implant mucosa averages 3-4 mm high, with an epithelium of 2 mm long facing the implant surface. Usually present in the connective tissue lateral to the barrier epithelium are small clusters of inflammatory cells, and most (60%) of the intrabony part of the implant is in contact with mineralised bone. Some reduction in marginal bone levels may be present due to bone modelling that occurs during healing following implant placement.[i]

What is peri-implant mucositis?

With a prevalence ranging from 19-65%,[ii] peri-implant mucositis is an inflammatory lesion of the soft tissues surrounding a dental implant without the loss of supporting bone or continuing marginal bone loss. It is caused by biofilm accumulation which disrupts the microbiome homeostasis at the implant-mucosa interface, leading to an inflammatory lesion. It is a reversible condition; therefore, optimal biofilm removal is essential for its prevention and management.[iii]

How do we diagnose peri-implant mucositis?

In order to come to a diagnosis of peri-implant mucositis, a clinical examination must be undertaken, and the clinician must look for visual indications and clinical markers of disease. The key clinical characteristic of peri-implant mucositis is bleeding on gentle probing, with erythema, swelling, and suppuration also possible. Often, an increase in probing depth is observed in the presence of peri-implant mucositis due to swelling or a decrease in probing resistance. Radiographic assessment may also indicate peri-implant mucositis. Whilst there may not be significant bone loss, any changes should be notes, as it may be an indicator of problems.[iv]

References:

[i] Araujo, Mauricio G., and Jan Lindhe. "Peri‐implant health." Journal of periodontology 89 (2018): S249-S256.

[ii] Derks, Jan, and Cristiano Tomasi. "Peri‐implant health and disease. A systematic review of current epidemiology." Journal of clinical periodontology 42 (2015): S158-S171.

[iii] Heitz‐Mayfield, Lisa JA, and Giovanni E. Salvi. "Peri‐implant mucositis." Journal of clinical periodontology 45 (2018): S237-S245.

[iv] Berglundh, Tord, et al. "Peri‐implant diseases and conditions: Consensus report of workgroup 4 of the 2017 World Workshop on the Classification of Periodontal and Peri‐Implant Diseases and Conditions." Journal of periodontology 89 (2018): S313-S318.