Peri-Implantitis vs. Peri-Implant Mucositis
A 61-year-old woman had an implant placed at tooth 36 three years ago. She presents with bleeding on probing around the implant, a probing depth of 6 mm on the mesial aspect, and no suppuration. Radiographs show 2.5 mm of bone loss compared with the 1-year post-loading radiograph, with a saucer-shaped defect. The implant is a tissue-level design with a machined collar. Her plaque score is 30%, and she has a history of treated periodontitis with stable pocket depths elsewhere. She reports no pain and the implant is not mobile. She asks whether the implant is 'failing' and whether she needs surgery.
1. Distinguish peri-implant mucositis from peri-implantitis in this case and explain the significance of the radiographic change.
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Peri-implant mucositis is reversible inflammation limited to the soft tissues with bleeding on probing but no progressive bone loss. Peri-implantitis involves progressive bone loss beyond initial remodeling, often with bleeding and sometimes suppuration. Here there is bleeding, a 6 mm pocket, and 2.5 mm of bone loss compared with the 1-year radiograph, which indicates progression and supports peri-implantitis rather than mucositis. The saucer-shaped defect suggests a crateriform pattern that may be amenable to surgical access. The absence of suppuration and mobility does not rule out peri-implantitis; these are severity markers, not diagnostic requirements. The history of treated periodontitis is a known risk factor, and the plaque score of 30% suggests hygiene is a contributing factor. The key judgment is that this is not just mucositis and should not be managed with hygiene alone without reassessment.
2. What is your management plan, and when would you consider surgical intervention?
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Initial management should be non-surgical: reinforce hygiene, perform submucosal debridement, and reassess at 4-6 weeks. If bleeding and pocket depth persist with continued bone loss, surgical intervention is reasonable. Surgery may include flap elevation, debridement, and consideration of implantoplasty or resection of the suprastructure if the defect is not reconstructable. Because the defect is saucer-shaped and 2.5 mm, regenerative approaches are possible but less predictable around a machined collar. I would also check occlusion and the prosthesis for cleansability. The decision for surgery should be based on persistence after non-surgical therapy and documented progression, not on the single radiograph alone. I would tell the patient the implant is not necessarily failing but has peri-implantitis that requires active management, and that surgery may be needed if non-surgical care does not control the inflammation.