Clinical signs, symptoms, perceptions and impact on quality of life of patients suffering peri-implant diseases: a university-representative cross-sectional study

Clinical Oral Implants Res

Berglundh

Derks

et al. 2021

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Objectives The aim of the present study was to evaluate the diagnostic accuracy of clinical and radiographic evaluations made at a single time point during follow‐up in identifying (a) a history of peri‐implant bone loss and (b) the presence of peri‐implantitis. Material & Methods 427 patients provided with implant‐supported reconstructions 9 years earlier were evaluated clinically by Probing Pocket Depth, Bleeding or Suppuration on Probing (PPD, BoP & SoP) and radiographically. Bone levels were assessed relative to the most coronal point of the intra‐osseous part of the implant. A history of bone loss and diagnosis of peri‐implantitis was confirmed through baseline documentation (direct evidence). Diagnostic accuracy of radiographic bone levels at 9 years and clinical findings (indirect evidence/secondary case definition) in identifying a history of bone loss and peri‐implantitis were evaluated through correlation and multilevel regression analyses as well as receiver operating characteristic curves. Results were expressed as sensitivity/specificity and area under the curve (AUC). Results Bone levels observed at 9 years were highly accurate in identifying pronounced bone loss (>2 mm; AUC = 0.96; 95% CI 0.95–0.98). In the absence of baseline documentation, a secondary case definition based on the presence of BoP/SoP & bone level ≥ 1 mm (indirect evidence) provided the overall best diagnostic accuracy (AUC = 0.80; 95% CI 0.77–0.82) in identifying peri‐implantitis cases (direct evidence: BoP/SoP & bone loss > 0.5 mm). Moderate/severe peri‐implantitis (BoP/SoP & bone loss > 2 mm) was most accurately identified by the combination of BoP/SoP & bone level ≥ 2 mm (AUC = 0.93; 95% CI 0.91–0.96). Sensitivity of the secondary case definition suggested by the 2017 World Workshop of Periodontology (WWP) (BoP/SoP ≥ 1 site & bone level ≥ 3 mm & PPD ≥ 6 mm) was low. Conclusions The present results underline the importance of baseline documentation for the correct diagnosis of peri‐implantitis, especially in its early/incipient forms. The secondary case definition of peri‐implantitis suggested at the 2017 WWP demonstrated a high level of specificity but low sensitivity. Moderate/severe peri‐implantitis was most accurately identified by the combination of BoP/SoP & bone level ≥ 2 mm.

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Diagnosis of peri‐implantitis in the absence of baseline data: A diagnostic accuracy study

Clinical Oral Implants Res

Berglundh

Derks

et al. 2021

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“…There is preliminary evidence that PISTD, similarly to localized gingival recessions around teeth, may represent a localized condition characterized by the apical shift of the buccal peri‐implant mucosa in healthy or peri‐implant mucositis implants. However, this condition can also be present at implants affected by peri‐implantitis (Romandini et al, 2021a). Its diagnosis, however, lacks a fixed reference, such as the cemento‐enamel junction for gingival recessions.…”

Section: Introductionmentioning

confidence: 99%

Prevalence and risk/protective indicators of buccal soft tissue dehiscence around dental implants

J Clinic Periodontology

Pedrinaci

Lima

et al. 2021

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Aim To evaluate the prevalence of buccal peri‐implant soft tissue dehiscence (PISTD) in anterior implants and to identify the risk/protective indicators of PISTD in implants not suffering peri‐implantitis. Materials and methods 240 randomly selected patients from a university clinic database were invited to participate in the present cross‐sectional study. Those who accepted, after the evaluation of their medical and dental records, were clinically examined to assess the prevalence of buccal PISTD in non‐molar implants. Multilevel multivariate logistic regression analyses were then carried out to identify those factors associated either positively (risk) or negatively (protective) with buccal PISTD in implants without peri‐implantitis. Results 92 patients with a total of 272 dental implants were analysed. At implant‐level, the prevalence of buccal PISTD was 16.9%, while when selecting only implants without peri‐implantitis it was 12.0%. Buccal PISTD was present in 26.7% of the implants diagnosed with peri‐implantitis. The following factors were identified as risk/protective indicators of buccal PISTD in implants without peri‐implantitis: malposition (too buccal vs. correct: OR=14.67), thin peri‐implant phenotype (OR=8.31), presence of at least one adjacent tooth (OR=0.08) and presence of abutment (OR=0.12). Conclusions PISTD are highly prevalent among patients with dental implants in this university‐based population, and several factors were identified as risk and protective indicators of PISTD in implants not suffering peri‐implantitis.

“…It may be speculated that the low sensitivity of PPD in identifying bone loss was explained by mucosal recession (Monje et al., 2018; Romandini et al, 2020a), a parameter that was not assessed in the present study, and by the fact that supraconstructions were not removed prior to probing (Serino et al., 2013). The present data analysis also revealed that additional parameters may confound the relationship between PPD and history of bone loss.…”

Section: Discussionmentioning

confidence: 88%

Clinical findings and history of bone loss at implant sites

Berglundh

Clinical Oral Implants Res

Derks

et al. 2021

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Objectives The aim of the present study was to evaluate whether clinical findings at implant sites are relevant as screening tests for a history of marginal bone loss. Material and Methods 427 patients provided with implant‐supported reconstructions 9 years earlier were evaluated clinically (probing pocket depth (PPD), bleeding on probing (BoP)) and radiographically. A history of bone loss was confirmed through baseline documentation. Diagnostic accuracy was evaluated through receiver operating characteristic curves and multi‐level regression analyses. Results were expressed as sensitivity/specificity, area under the curve, and odds ratios. Results While the sensitivity of PPD in regard to bone loss was low, specificity was generally high. Multi‐level modeling revealed that each additional millimeter of PPD corresponded to an additional bone loss of 0.30 mm (95% CI 0.27; 0.33). The sensitivity of BOP in regard to bone loss >2 mm was 80.9% (95% CI 73.9; 86.7), while the specificity was 42.2% (95% CI 39.6; 44.8). Conclusions Clinical parameters at implant sites obtained at a single time point were associated with a history of marginal bone loss. While BoP demonstrated a high level of sensitivity, the sensitivity of PPD was generally low. The present data suggest that BoP is a relevant screening test for history of bone loss.