Peri-implant health is defined as the absence of bleeding on gentle probing, absence of suppuration, no increase in probing depth compared with previous assessments, and no bone loss beyond the initial crestal remodeling. Peri-implant mucositis is an inflammatory lesion confined to the soft tissues, marked by bleeding on probing without progressive bone loss. Peri-implantitis is a pathologic, plaque-associated condition characterized by inflammation of the peri-implant mucosa and progressive loss of supporting bone.

Schwarz et al. (2018) emphasized that the histopathology of peri-implantitis differs from periodontitis: lesions are larger, extend closer to the bone crest, and contain a higher density of plasma cells and neutrophils, which contributes to the more rapid disease progression observed clinically.

Prevalence and Risk Indicators

A 2022 systematic review and meta-analysis by Diaz et al. reported the prevalence of peri-implantitis at approximately 19.53 percent at the patient level and 12.53 percent at the implant level. Salvi et al. (2017) and Sanz and Chapple (2012) emphasize that peri-implant diseases are at least as prevalent as periodontal diseases and may progress more rapidly once initiated.

Established risk indicators include a history of treated or untreated periodontitis, poor oral hygiene and absence of supportive maintenance, cigarette smoking, and poorly controlled diabetes mellitus. Monje et al. (2017), in a systematic review and meta-analysis, demonstrated a significant association between hyperglycemia and peri-implant disease severity. Local factors such as residual subgingival cement, malposition relative to the prosthetic envelope, and prosthetic emergence profiles that obstruct hygiene access further elevate risk.

Diagnostic Criteria

Diagnosis of peri-implantitis requires three findings: bleeding on probing or suppuration, increased probing depth compared with baseline (typically reaching or exceeding 6 mm), and progressive radiographic bone loss beyond the initial crestal remodeling. When baseline data are unavailable, a probing depth of 6 mm or greater combined with bleeding on probing and radiographic bone loss of 3 mm or more is generally accepted as diagnostic.

Periapical or bite-wing radiographs are standard for monitoring marginal bone level changes. CBCT may be indicated when buccal or lingual defect morphology is required for surgical planning, although its routine use is not recommended due to radiation dose considerations.

Prevention and Supportive Peri-Implant Therapy

The 2023 EFP S3 Clinical Practice Guideline (Herrera et al.) emphasizes that prevention is the single most consequential element of peri-implant disease management. Patient-level interventions include cessation of smoking, optimization of glycemic control, and individualized oral hygiene instruction. Practitioner-level interventions include prosthetic design that supports cleansability, complete removal of residual cement at the time of cementation, and the establishment of a structured supportive peri-implant therapy (SPT) schedule, typically at 3 to 6 month intervals depending on individual risk.

Roccuzzo et al. (2018), in a systematic review on peri-implantitis treatment and supportive care, demonstrated that patients who adhere to SPT after treatment experience significantly lower rates of disease recurrence and implant loss than those who do not.

 Non-Surgical Treatment

Non-surgical therapy is the universal first step. The 2023 EFP guideline recommends mechanical debridement of the implant surface using instruments that do not damage the implant (titanium curettes, plastic or carbon-fiber tips, ultrasonic devices with implant-safe inserts, glycine or erythritol powder air-polishing). Adjunctive measures with varying levels of supporting evidence include local antiseptics such as chlorhexidine gluconate, topical or systemic antibiotics (for advanced cases or biological complications), and laser-assisted decontamination.

Heitz-Mayfield and Mombelli (2014) and Lang et al. (2019) have emphasized that non-surgical therapy alone rarely achieves complete resolution of peri-implantitis, particularly in moderate to advanced disease. The clinical objective of non-surgical treatment is to reduce inflammation, control the bacterial load, and prepare tissues for surgical access when needed.