volume 36  |  No. 2  |  2025

Peri-implant diseases, including peri-implant mucositis and peri-implantitis, affect a substantial number of patients with dental implants. Peri-implant mucositis is a reversible inflammatory lesion of the peri-implant mucosa, while peri-implantitis involves inflammation and the loss of supporting bone, posing a threat to implant stability and long-term success. The rising use of dental implants has increased the prevalence of these diseases, emphasizing the critical need for effective prevention and management strategies. Notably, the dental community has recognized the need for standardized treatment protocols due to the
variability in treatment outcomes and the lack of consensus on management in traditional dental education.

The Academy of Osseointegration (AO) and the American Academy of Periodontology (AAP) convened a summit to review the scientific evidence on peri-implant diseases and establish a unified framework for their prevention and management. The resulting publications provide valuable insights, including:

• Prevalence: The prevalence of peri-implant diseases increased over time. Peri-implant mucositis prevalence ranged from 7% to 85% at the implant level. Meta analyses of the included randomized controlled trials revealed a weighted mean of 20% after a mean loading time of 1–5 years for peri-implantitis.
• Risk Factors: While dysbiotic plaque or biofilm is a primary etiologic factor for peri-implant diseases, there are various categories of risk factors that were reported in following 4 major groups:

1. Patient-Related: Systemic diseases and conditions such as smoking, diabetes (uncontrolled), depression (and certain antidepressant medications) and obesity
   are significant risk factors. Smoking for instance, negatively affects mucosal barriers, immune function, and the peri-implant sulcus microbiota.
2. Surgical and Implant Related Factors: Implant malposition, implant micro- and macro-design were among surgical and implant factors that could significantly influence the pathogenesis of peri-implantitis.
3. Prosthetic Design Related Factors: Poor prosthetic design and residual cement play a significant role in the etiology of peri-implant diseases.
4. Soft Tissue Related Factors: Vertical and/or horizontal deficiencies in the mucogingival complex around implants with is associated with the onset and progression of peri-implant diseases.

• Multifactorial Nature: The etiology of peri-implantitis is multifaceted, with various factors showing different degrees of association with the condition. Odds ratios, which measure the association between an exposure and an outcome, help quantify these risks. For example, the odds ratio for developing peri-implantitis in diabetics is 2.31, for smokers is 2.27, and for patients with active periodontitis is 4.05. This suggests smokers, diabetics, and patients with active periodontitis are 2 to 4 times more likely to develop peri-implantitis.
• Expert Consensus: The AO/AAP summit reports explicitly differentiate between findings based solely on scientific evidence and expert opinions in areas where data is incomplete or inconclusive. For instance, there was a high level of agreement among experts (93%) that implant macro- and micro-design influenced the risk of peri-implantitis onset/progression.
• Clinical Translation: Recognizing the existing gaps and inconsistencies in the evidence base, the summit opted for the term “clinical translation” instead of prescribing rigid guidelines. The reports utilize tables and decision tree algorithms to guide clinicians in developing individualized treatment strategies for their patients, emphasizing evidence-based management of peri-implant diseases. Early identification of risk factors, tailored treatment protocols, and continued maintenance are highlighted as crucial for optimizing long-term implant therapy outcomes.

For more information on the AO/AAP consensus on prevention and management of peri-implant diseases and conditions HERE.