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Journal of Oral Science & Rehabilitation No. 4, 2016

Journal of Oral Science & Rehabilitation Volume 2 | Issue 4/2016 51 D e f i n i t i o n o f p e r i i m p l a n t i t i s Froum and Rosen proposed a classification sys- tem to determine periimplantitis severity based upon PPD, MBL and clinical signs of BOP and/or SUP,28 but this system remains to be validated. Furthermore, in a series ofstudies byMerli et al., the inter-rater agreement in the diagnosis of pe- riimplant disease was judged as merely good, owing to the unclear definition of periimplantitis and mucositis, with complete agreement ob- tained only in half of the cases (52%).80 The vast majority (45%) of the studies in- cluded in the present review found radiographic MBL > 1–2 mm after prosthetic loading. Hence, the following criteria for defining periimplantitis are proposed: a radiographic MBL > 1 mm after implant prosthesis delivery or 2 mm at least six months after implant prosthesis placement as a good indicator of periimplantitis. BOP does not possessahighpredictivevalueowingtotheweak soft-tissue connection around dental implants. Likewise, PPD largely relies on implant design (bone vs. tissue level), apicocoronal position and biotype.Fromtheextracteddata,itseemslogical to consider radiographic MBL as the most uni- form and accurate indicator of periimplantitis. Although, the cut-offvalue depends on the pati- ent’s inflammatory pattern, the type of surgery, the apicocoronal implant position, the implant’s macrodesignandthecrestalmodule,considering the rapid disease progression over time, strict radiographic controlmust befollowed ifanyclin- ical symptom is detected. Furthermore,the clin- ician must use a combination of the many avai- lable clinical parameters, such as PPD, inflammatorystatus ofthe mucosa, BOPon light probing, radiographic MBL, and possibly bacte- rialand/orperiimplantcrevicularfluidbiomarkers to establish an accurate diagnosis ofperiimplan- titis.28 Unlike in the case of periodontitis, bacte- rial testing may not reliable in diagnosing peri- implantitis.84 This suggests that periodontal and periimplant ecosystems differ significantly and, hence, periimplant disease might not always be approached as an infectious disease. Similarly, such difference has been shown to apply to the pathogenesis.85 Furthermore, no evidence was found that primary infection caused marginal bone resorption.86 Conclusion The available scientific literature suggested an absenceofaunanimousdefinitionofperiimplan- titis. Actual definitions of periimplantitis were based solelyon clinicalparameterswithout con- sideration of other potential related risk factors of the disease. Future studies that apply consis- tent case definitions should be considered. Competing interests The authors declare no conflict of interests. Acknowledgments The authors wish to thank Dr. Mia Rakic for her scientific contribution to this work. References 1. Levignac J. [Periimplantation osteolysis— periimplantosis—periimplantitis]. → Rev Fr Odontostomatol. 1965 Oct;12(8):1251–60. French. 2. Hämmerle CH, Glauser R. Clinical evaluation of dental implant treatment. → Periodontol 2000. 2004 Feb;34:230–9. 3. Schwarz F, Becker K, Sager M. Efficacy of professionally administered plaque removal with or without adjunctive measures for the treatment of peri-implant mucositis. A systematic review and meta-analysis. → J Clin Periodontol. 2015 Apr;42 Suppl 16:S202–13. 4. Atieh MA, Alsabeeha NH, Faggion CM, Duncan WJ. The frequency of peri-implant diseases: a systematic review and meta-analysis. → J Periodontol. 2013 Nov;84(11):1586–98. 5. Zitzmann NU, Margolin MD, Filippi A, Weiger R, Krastl G. Patient assessment and diagnosis in implant treatment. → Aust Dent J. 2008 Jun;53 Suppl 1:S3–10. 6. Sanz M, Chapple IL; Working Group 4 of the VIII European Workshop on Periodontology. Clinical research on peri-implant diseases: consensus report of Working Group 4. → J Clin Periodontol. 2012 Feb;39 Suppl 12:202–6. 7. American Academy of Periodontology. Academy report: peri-implant mucositis and peri-implantitis: a current under- standing of their diagnoses and clinical implications. → J Periodontol. 2013 Apr;84(4):436–43. 8. Lang NP, Berglundh T; Working Group 4 of the Seventh European Workshop on Periodontology. Periimplant diseases: where are we now?—Consensus of the Seventh European Workshop on Periodontology. → J Clin Periodontol. 2011 Mar;38 Suppl 11:178–81. 9. Chan HL, Lin GH, Suarez F, MacEachern M, Wang HL. Surgical management of peri-implantitis: a systematic review and meta-analysis of treatment outcomes. → J Periodontol. 2014 Aug;85(8):1027–41. 10. Lindhe J, Meyle J; Group D of the European Workshop on Periodontology. Peri-implant diseases: consensus report of the Sixth European Workshop on Periodontology. → J Clin Periodontol. 2008 Sep;35(8 Suppl):282–5. 11. Mombelli A, Müller N, Cionca N. The epidemiology of peri-implantitis. → Clin Oral Implants Res. 2012 Oct;23 Suppl 6:67–76. Volume 2 | Issue 4/201651

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