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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">A Classification Proposal for Peri-Implant Mucositis and Peri-Implantitis: A Critical Update</title><author><name sortKey="Ata Ali, Javier" sort="Ata Ali, Javier" uniqKey="Ata Ali J" first="Javier" last="Ata-Ali">Javier Ata-Ali</name><affiliation><nlm:aff id="aff1">Public Dental Health Service, Arnau de Vilanova Hospital, European University of Valencia, Spain</nlm:aff></affiliation></author><author><name sortKey="Ata Ali, Fadi" sort="Ata Ali, Fadi" uniqKey="Ata Ali F" first="Fadi" last="Ata-Ali">Fadi Ata-Ali</name><affiliation><nlm:aff id="aff2">Valencia University Medical and Dental School, Spain</nlm:aff></affiliation></author><author><name sortKey="Bagan, Leticia" sort="Bagan, Leticia" uniqKey="Bagan L" first="Leticia" last="Bagan">Leticia Bagan</name><affiliation><nlm:aff id="aff3">Department of Oral Medicine, Valencia University Medical and Dental School, Spain</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">26966463</idno><idno type="pmc">4758051</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4758051</idno><idno type="RBID">PMC:4758051</idno><idno type="doi">10.2174/1874210601509010393</idno><date when="2015">2015</date><idno type="wicri:Area/Pmc/Corpus">000750</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000750</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">A Classification Proposal for Peri-Implant Mucositis and Peri-Implantitis: A Critical Update</title><author><name sortKey="Ata Ali, Javier" sort="Ata Ali, Javier" uniqKey="Ata Ali J" first="Javier" last="Ata-Ali">Javier Ata-Ali</name><affiliation><nlm:aff id="aff1">Public Dental Health Service, Arnau de Vilanova Hospital, European University of Valencia, Spain</nlm:aff></affiliation></author><author><name sortKey="Ata Ali, Fadi" sort="Ata Ali, Fadi" uniqKey="Ata Ali F" first="Fadi" last="Ata-Ali">Fadi Ata-Ali</name><affiliation><nlm:aff id="aff2">Valencia University Medical and Dental School, Spain</nlm:aff></affiliation></author><author><name sortKey="Bagan, Leticia" sort="Bagan, Leticia" uniqKey="Bagan L" first="Leticia" last="Bagan">Leticia Bagan</name><affiliation><nlm:aff id="aff3">Department of Oral Medicine, Valencia University Medical and Dental School, Spain</nlm:aff></affiliation></author></analytic><series><title level="j">The Open Dentistry Journal</title><idno type="eISSN">1874-2106</idno><imprint><date when="2015">2015</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>Definitions of peri-implant mucositis and peri-implantitis vary in the literature, and no clear criteria have been
established for the diagnosis and treatment of such disorders. This study proposes a classification for peri-implant mucositis
and peri-implantitis based on the severity of the disease, using a combination of peri-implant clinical and radiological
parameters to classify severity into several stages (Stage 0A and 0B = peri-implant mucositis, and Stage I to IV = periimplantitis).
Following a review of the literature on the subject and justification of the proposed peri-implant disease classification,
the latter aims to facilitate professional communication and data collection for research and community health
studies.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Albrektsson, T" uniqKey="Albrektsson T">T. Albrektsson</name></author><author><name sortKey="Zarb, G" uniqKey="Zarb G">G. Zarb</name></author><author><name sortKey="Worthington, P" uniqKey="Worthington P">P. Worthington</name></author><author><name sortKey="Eriksson, A R" uniqKey="Eriksson A">A.R. Eriksson</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Oh, T J" uniqKey="Oh T">T.J. Oh</name></author><author><name sortKey="Yoon, J" uniqKey="Yoon J">J. Yoon</name></author><author><name sortKey="Misch, C E" uniqKey="Misch C">C.E. Misch</name></author><author><name sortKey="Wang, H L" uniqKey="Wang H">H.L. Wang</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Jemt, T" uniqKey="Jemt T">T. Jemt</name></author><author><name sortKey="Chai, J" uniqKey="Chai J">J. 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<front><journal-meta><journal-id journal-id-type="nlm-ta">Open Dent J</journal-id><journal-id journal-id-type="iso-abbrev">Open Dent J</journal-id><journal-id journal-id-type="publisher-id">TODENTJ</journal-id><journal-title-group><journal-title>The Open Dentistry Journal</journal-title></journal-title-group><issn pub-type="epub">1874-2106</issn><publisher><publisher-name>Bentham Science Publishers</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">26966463</article-id><article-id pub-id-type="pmc">4758051</article-id><article-id pub-id-type="publisher-id">TODENTJ-9-393</article-id><article-id pub-id-type="doi">10.2174/1874210601509010393</article-id><article-categories><subj-group subj-group-type="heading"><subject>Article</subject></subj-group></article-categories><title-group><article-title>A Classification Proposal for Peri-Implant Mucositis and Peri-Implantitis: A Critical Update</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Ata-Ali</surname><given-names>Javier</given-names></name><xref ref-type="aff" rid="aff1">1</xref><xref ref-type="corresp" rid="cor1">*</xref></contrib><contrib contrib-type="author"><name><surname>Ata-Ali</surname><given-names>Fadi</given-names></name><xref ref-type="aff" rid="aff2">2</xref></contrib><contrib contrib-type="author"><name><surname>Bagan</surname><given-names>Leticia</given-names></name><xref ref-type="aff" rid="aff3">3</xref></contrib></contrib-group><aff id="aff1"><label>1</label>Public Dental Health Service, Arnau de Vilanova Hospital, European University of Valencia, Spain</aff><aff id="aff2"><label>2</label>Valencia University Medical and Dental School, Spain</aff><aff id="aff3"><label>3</label>Department of Oral Medicine, Valencia University Medical and Dental School, Spain</aff><author-notes><corresp id="cor1"><label>*</label>Address correspondence to this author at the Public Dental Health Service. Arnau de Vilanova Hospital, c/ San Clemente 12, 46015-Valencia (Spain); Tel: +0034963868501;
E-mail: <email xlink:href="javiataali@hotmail.com">javiataali@hotmail.com</email></corresp></author-notes><pub-date pub-type="epub"><day>11</day><month>12</month><year>2015</year></pub-date><pub-date pub-type="collection"><year>2015</year></pub-date><volume>9</volume><fpage>393</fpage><lpage>395</lpage><history><date date-type="received"><day>25</day><month>12</month><year>2014</year></date><date date-type="rev-recd"><day>17</day><month>8</month><year>2015</year></date><date date-type="accepted"><day>12</day><month>10</month><year>2015</year></date></history><permissions><copyright-statement>© Ata-Ali <italic>et al.</italic>; Licensee <italic>Bentham Open.</italic></copyright-statement><copyright-year>2015</copyright-year><copyright-holder>Ata-Ali</copyright-holder><license license-type="open-access" xlink:href="https://creativecommons.org/licenses/by/4.0/legalcode"><license-p>This is an open access articles licensed under the terms of the Creative Commons Attribution-Non-Commercial 4.0 International Public License (CC BY-NC 4.0) (<uri xlink:type="simple" xlink:href="https://creativecommons.org/licenses/by-nc/4.0/legalcode">https://creativecommons.org/licenses/by-nc/4.0/legalcode</uri>), which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided that the work is properly cited.</license-p></license></permissions><abstract><p>Definitions of peri-implant mucositis and peri-implantitis vary in the literature, and no clear criteria have been
established for the diagnosis and treatment of such disorders. This study proposes a classification for peri-implant mucositis
and peri-implantitis based on the severity of the disease, using a combination of peri-implant clinical and radiological
parameters to classify severity into several stages (Stage 0A and 0B = peri-implant mucositis, and Stage I to IV = periimplantitis).
Following a review of the literature on the subject and justification of the proposed peri-implant disease classification,
the latter aims to facilitate professional communication and data collection for research and community health
studies.</p></abstract><kwd-group><title>Keywords:</title><kwd>Classification</kwd><kwd>dental implant</kwd><kwd>disease</kwd><kwd>peri-implant mucositis</kwd><kwd>peri-implantitis</kwd><kwd>peri-implant.</kwd></kwd-group></article-meta></front><body><sec><title>INTRODUCTION </title><p>In 1986, Albrektson <italic>et al.</italic> [<xref rid="R1" ref-type="bibr">1</xref>] introduced the widely accepted criteria for implant success, accepting 0.2 mm of bone loss annually after the first year and 85% and 80% success rates after 5 and 10 years, respectively. Various degrees of marginal bone loss are normally seen around dental implants, probably reflecting remodeling / adaptation following surgery and during loading. In general, up to 1.5 mm of bone is lost during the first year of function, followed by a period of minimal annual bone loss [<xref rid="R2" ref-type="bibr">2</xref>].A number of authors [<xref rid="R3" ref-type="bibr">3</xref>-<xref rid="R5" ref-type="bibr">5</xref>] have estimated that peri-implant bone loss occurs progressively over the first three years. Vandeweghe <italic>et al.</italic> [<xref rid="R6" ref-type="bibr">6</xref>], in a prospective study of bone loss in 15 implants, showed bone remodeling to continue for 6 months, after which no further changes were observed, with stabilization of bone loss at 1 mm.</p><p>The Sixth European Workshop on Periodontics 2008 [<xref rid="R7" ref-type="bibr">7</xref>], held in Göteborg (Sweden), defined peri-implant mucositis as the presence of inflammation of the peri-implant mucosa without signs of supporting bone loss, while peri-implantitis was defined as the presence of supporting bone loss in addition to inflammation of the mucosa [<xref rid="R7" ref-type="bibr">7</xref>].In turn, the Seventh European Workshop on Periodontics 2011, held in Segovia (Spain), specified that the key feature of peri-implant mucositis is the presence of bleeding upon probing, while the key feature of peri-implantitis comprises changes in bone crest level associated to bleeding upon probing [<xref rid="R8" ref-type="bibr">8</xref>].According to the latest definition of the American Academy of Periodontology [<xref rid="R9" ref-type="bibr">9</xref>], peri-implant mucositis is a disease in which the presence of inflammation is confined to the softtissues surrounding a dental implant, with no signs of loss of supporting bone following initial bone remodeling during healing, while peri-implantitis is characterized as an inflammatory process around an implant, including both soft tissue inflammation and progressive loss of supporting bone beyond biological bone remodeling [<xref rid="R10" ref-type="bibr">10</xref>].</p><p>Peri-implant probing is essential for establishing a diagnosis of peri-implant disease. Conventional peri-implant probing under appropriate conditions of pressure, such as 0.25 N, does not cause tissue damage [<xref rid="R11" ref-type="bibr">11</xref>]. In addition, parallelized intraoral X-rays should be used in all dental implants to determine possible marginal bone loss, and confirmed bone loss moreover should be quantified. These periapical X-rays must be obtained at implant placement and prosthesis installation in order to allow comparisons with the periapical X-rays obtained on occasion of the periodic patient controls.</p><p>Definitions of peri-implantitis and peri-implant mucositis vary in the literature, and no clear criteria have been established for the diagnosis and treatment of these disorders [<xref rid="R12" ref-type="bibr">12</xref>]. The use of different thresholds referred to probing depth and radiographic bone loss for defining peri-implant diseases gives rise to considerable variability in the reported prevalence of peri-implant diseases. The reported prevalence of peri-implant mucositis varies between 36.3% [<xref rid="R13" ref-type="bibr">13</xref>] and 64.6% [<xref rid="R14" ref-type="bibr">14</xref>], while the prevalence of peri-implantitis ranges from 8.9% [<xref rid="R14" ref-type="bibr">14</xref>] to 47.1% [<xref rid="R15" ref-type="bibr">15</xref>]. According to Hallström <italic>et al.</italic> [<xref rid="R16" ref-type="bibr">16</xref>], the infectious etiology of peri-implant mucositis is well documented [<xref rid="R17" ref-type="bibr">17</xref>-<xref rid="R19" ref-type="bibr">19</xref>]. Peri-implant mucositis has been defined as the presence of bleeding in response to probing [<xref rid="R13" ref-type="bibr">13</xref>-<xref rid="R15" ref-type="bibr">15</xref>,<xref rid="R20" ref-type="bibr"> 20</xref>-<xref rid="R23" ref-type="bibr">23</xref>], while other authors [<xref rid="R14" ref-type="bibr">14</xref>,<xref rid="R20" ref-type="bibr"> 20</xref>,<xref rid="R21" ref-type="bibr"> 21</xref>,<xref rid="R24" ref-type="bibr"> 24</xref>] add the presence of purulent secretion to the definition. The specified probe depth varies between ≥ 4 mm and ≥ 5 mm [<xref rid="R14" ref-type="bibr">14</xref>,<xref rid="R20" ref-type="bibr"> 20</xref>-<xref rid="R22" ref-type="bibr">22</xref>]. Other studies [<xref rid="R15" ref-type="bibr">15</xref>,<xref rid="R23" ref-type="bibr"> 23</xref>,<xref rid="R25" ref-type="bibr"> 25</xref>] have added the condition of no bone loss to the definition of mucositis, while other investigators propose higher defining thresholds such as radiographic bone loss of up to three threads after the first year of loading [<xref rid="R13" ref-type="bibr">13</xref>,<xref rid="R20" ref-type="bibr"> 20</xref>,<xref rid="R21" ref-type="bibr"> 21</xref>].</p><p>Different probing depths have been described in the diagnosis of peri-implant tissues with peri-implant mucositis: 2.07 (range 1-3.16 mm) [<xref rid="R26" ref-type="bibr">26</xref>]; 2.67±0.76 mm [<xref rid="R27" ref-type="bibr">27</xref>]; 2.9±0.7 mm [<xref rid="R28" ref-type="bibr">28</xref>]; 3.42±1.18 mm [<xref rid="R29" ref-type="bibr">29</xref>]; 3.55±0.40 mm [<xref rid="R25" ref-type="bibr">25</xref>]; 5.2±1.3 mm [<xref rid="R30" ref-type="bibr">30</xref>]; and 5.4±1.4 mm [<xref rid="R31" ref-type="bibr">31</xref>]. For this reason, our classification distinguishes between peri-implant mucositis with a probing depth of less than 4 mm and peri-implant mucositis with a greater probing depth.</p><p>Peri-implantitis is defined as the presence of bleeding upon probing and / or pus with concomitant radiographic bone loss [<xref rid="R13" ref-type="bibr">13</xref>-<xref rid="R15" ref-type="bibr">15</xref>,<xref rid="R20" ref-type="bibr"> 20</xref>,<xref rid="R21" ref-type="bibr"> 21</xref>,<xref rid="R23" ref-type="bibr"> 23</xref>,<xref rid="R24" ref-type="bibr"> 24</xref>,<xref rid="R32" ref-type="bibr"> 32</xref>-<xref rid="R36" ref-type="bibr">36</xref>]. The bone loss criteria differ, however: > 0.4 mm after implant loading [<xref rid="R15" ref-type="bibr">15</xref>,<xref rid="R23" ref-type="bibr"> 23</xref>]; detectable bone loss from the one-year examination and bone level ≥ 1.8 mm [<xref rid="R32" ref-type="bibr">32</xref>,<xref rid="R33" ref-type="bibr"> 33</xref>]; ≥ 2 mm after implant loading [<xref rid="R23" ref-type="bibr">23</xref>]; ≥ 1.8 mm from the one-year examination [<xref rid="R13" ref-type="bibr">13</xref>,<xref rid="R20" ref-type="bibr"> 20</xref>,<xref rid="R21" ref-type="bibr"> 21</xref>,<xref rid="R34" ref-type="bibr"> 34</xref>]; > 2 mm after the last radiological control [<xref rid="R35" ref-type="bibr">35</xref>]; ≥ 3 mm of radiological bone loss after abutment placement [<xref rid="R37" ref-type="bibr">37</xref>]; ≥ 3 mm after implant loading [<xref rid="R36" ref-type="bibr">36</xref>]; or > 5 mm of bone loss [<xref rid="R24" ref-type="bibr">24</xref>]. Ferreira <italic>et al.</italic> [<xref rid="R14" ref-type="bibr">14</xref>] in turn define peri-implantitis as the presence of a probing pocket depth of ≥ 5 mm, without mentioning bone loss. A number of studies [<xref rid="R38" ref-type="bibr">38</xref>,<xref rid="R39" ref-type="bibr"> 39</xref>] have offered no clear definition of peri-implantitis, while another publication [<xref rid="R37" ref-type="bibr">37</xref>] defined it as radiological bone loss > 3 mm, without taking the clinical parameters into account. As commented by Tomasi <italic>et al.</italic> [<xref rid="R40" ref-type="bibr">40</xref>], the multitude of different disease criteria, the diagnostic and methodological inconsistencies, as well as the variable quality of the reports have so far hampered attempts to draw firm conclusions in the field of peri-implant diseases.</p><p>Although there is a classification contemplating three peri-implantitis stages [<xref rid="R41" ref-type="bibr">41</xref>] based on the Seventh European Workshop on Periodontics 2011 [<xref rid="R8" ref-type="bibr">8</xref>], we consider it necessary to unify the concepts of peri-implant mucositis and peri-implantitis within one same classification, since both form part of what we know as peri-implant diseases. A more exhaustive and precise classification of peri-implant diseases is needed with the aim of facilitating communication among investigators and comparison of the different clinical studies.</p><p>A recent consensus conference defined peri-implantitis as “infection with suppuration associated to clinically significant progressing crestal bone loss” [<xref rid="R42" ref-type="bibr">42</xref>]. Based on this definition, recent 10-year clinical reports on modern implant surfaces have shown low incidences of peri-implantitis. With this definition, the disease incidence according to recent longitudinal studies on modern implant surfaces is < 5% after 10 years of function [<xref rid="R43" ref-type="bibr">43</xref>]. We do not consider suppuration to be a necessary condition for diagnosing peri-implantitis, since in the same way that some cases of moderate and advanced periodontitis can develop without suppuration, certain cases of peri-implantitis may also show no suppuration.</p><p>Since there is no clear consensus on peri-implant diseases, we offer the following unified approach to the classification of peri-implant mucositis (Table <bold><xref ref-type="table" rid="T1">1</xref></bold>) and peri-implantitis (Table <bold><xref ref-type="table" rid="T2">2</xref></bold>).</p></sec></body><back><ack><title>ACKNOWLEDGEMENTS</title><p>Declared none.</p></ack><sec><title>CONFLICT OF INTEREST</title><p>The authors confirm that this article content has no conflict of interest.</p></sec><ref-list><title>REFERENCES</title><ref id="R1"><label>1</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Albrektsson</surname><given-names>T.</given-names></name><name><surname>Zarb</surname><given-names>G.</given-names></name><name><surname>Worthington</surname><given-names>P.</given-names></name><name><surname>Eriksson</surname><given-names>A.R.</given-names></name></person-group><article-title>The long-term efficacy of currently used dental implants: a review and proposed criteria of success.</article-title><source>Int. 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Prosthodont.</source><year>2012</year><volume>25</volume><issue>4</issue><fpage>320</fpage><lpage>322</lpage><pub-id pub-id-type="pmid">22720281</pub-id></element-citation></ref><ref id="R43"><label>43</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>De Bruyn</surname><given-names>H.</given-names></name><name><surname>Vandeweghe</surname><given-names>S.</given-names></name><name><surname>Ruyffelaert</surname><given-names>C.</given-names></name><name><surname>Cosyn</surname><given-names>J.</given-names></name><name><surname>Sennerby</surname><given-names>L.</given-names></name></person-group><article-title>Radiographic evaluation of modern oral implants with emphasis on crestal bone level and relevance to peri-implant health.</article-title><source>Periodontol. 2000</source><year>2013</year><volume>62</volume><issue>1</issue><fpage>256</fpage><lpage>270</lpage><pub-id pub-id-type="doi">10.1111/prd.12004</pub-id><pub-id pub-id-type="pmid">23574471</pub-id></element-citation></ref></ref-list></back><floats-group><table-wrap id="T1" position="float"><label>Table 1.</label><caption><p>Proposed classification of peri-implant mucositis.</p></caption><table frame="border" rules="all" width="100%"><thead><tr><th align="center" rowspan="1" colspan="1">Staging</th><th align="center" rowspan="1" colspan="1">Definition</th></tr></thead><tbody><tr><td align="center" rowspan="1" colspan="1">Stage 0A</td><td align="center" rowspan="1" colspan="1">PPD ≤ 4 mm and BoP and/or SUP, with no signs of loss of supporting bone following initial bone remodeling during healing</td></tr><tr><td align="center" rowspan="1" colspan="1">Stage 0B</td><td align="center" rowspan="1" colspan="1">PPD > 4 mm and BoP and/or SUP, with no signs of loss of supporting bone following initial bone remodeling during healing</td></tr></tbody></table><table-wrap-foot><fn id="T1F1"><p>PPD = probing pocket depth; BoP = bleeding on probing; SUP = suppuration</p></fn></table-wrap-foot></table-wrap><table-wrap id="T2" position="float"><label>Table 2.</label><caption><p>Proposed classification of peri-implantitis.</p></caption><table frame="border" rules="all" width="100%"><thead><tr><th align="center" rowspan="1" colspan="1">Staging</th><th align="center" rowspan="1" colspan="1">Definition</th></tr></thead><tbody><tr><td align="center" rowspan="1" colspan="1">Stage I</td><td align="center" rowspan="1" colspan="1">BoP and/or SUP and bone loss ≤ 3 mm beyond biological bone remodeling</td></tr><tr><td align="center" rowspan="1" colspan="1">Stage II</td><td align="center" rowspan="1" colspan="1">BoP and/or SUP and bone loss > 3 mm and < 5 mm beyond biological bone remodeling</td></tr><tr><td align="center" rowspan="1" colspan="1">Stage III</td><td align="center" rowspan="1" colspan="1">BoP and/or SUP and bone loss ≥ 5 mm beyond biological bone remodeling</td></tr><tr><td align="center" rowspan="1" colspan="1">Stage IV</td><td align="center" rowspan="1" colspan="1">BoP and/or SUP and bone loss ≥ 50% of the implant length<xref ref-type="table-fn" rid="T2F1">*</xref> beyond biological bone remodeling</td></tr></tbody></table><table-wrap-foot><fn id="T2F1"><p>BoP = bleeding on probing; SUP = suppuration </p><p>* Depending on implant length, if peri-implantitis can be classified as simultaneously corresponding to more than one stage, the most advanced stage should be chosen.</p></fn></table-wrap-foot></table-wrap></floats-group></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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