Implantology and Peri-Implant Diseases
What this domain tests
Implant biology, diagnosis of peri-implant mucositis and peri-implantitis, and evidence-based management.
Core concepts
- Osseointegration is direct bone-to-implant contact without intervening fibrous tissue; primary stability and controlled loading matter.
- Peri-implant mucosa lacks a periodontal ligament; the epithelial attachment is hemidesmosomal and the connective tissue fibers are largely parallel to the implant.
- Probing around implants is acceptable with light force; bleeding and suppuration are key signs.
- Peri-implant mucositis: bleeding and/or suppuration, with no bone loss beyond initial remodeling; reversible.
- Peri-implantitis: bleeding and/or suppuration, increased probing depth, and bone loss 3 mm or more apical to the most coronal intraosseous portion of the implant.
- Risk factors: history of periodontitis, smoking, poor plaque control, lack of maintenance, and uncontrolled diabetes.
Worked example
A 60-year-old with a mandibular implant reports bleeding. Probing depth is 7 mm, with bleeding and suppuration; radiograph shows bone loss 4 mm below the platform, compared with a 1-mm baseline. This meets peri-implantitis criteria. Management: nonsurgical debridement and oral hygiene first, then surgical access with decontamination, consideration of implantoplasty, and grafting if the defect is suitable. If bone loss were 1.5 mm with bleeding only, the diagnosis would be peri-implant mucositis.
Traps
- Calling any bone loss peri-implantitis; crestal remodeling occurs early.
- Assuming lack of keratinized mucosa alone causes implant loss.
- Using a periodontal diagnosis for an implant.
- Overlooking a history of periodontitis as the strongest risk factor.