First things first: define the difference between Peri-Implantitis and Peri-Mucositis. Generally peri-implant mucositis is a precursor to peri-implantitis. Evidence suggests that peri-implant mucositis may be successfully treated and is reversible if caught early⁴.

Peri-Mucositis: This is essentially the less concerning, yet still very concerning, condition of the two. It may present with signs similar to gingivitis.

1. Any visual signs of red, swollen, and potentially soft/flabby tissues around the implant
2. Bleeding upon probing, brushing, or flossing.
3. Increased probing depths compared to baseline
4. And of course, suppuration around the implant
5. An important distinction between peri-mucositis and peri-implantitis: less than 2mm of bone loss since placement¹.

Peri-Implantitis: This condition is a progression from peri-mucositis resulting in potentially irreversible bone loss, similar to how gingivitis can turn into periodontitis².

1. The signs of peri-mucositis will be present as listed above (redness, swelling, bleeding, suppuration)
2. Increased pocket depths on probing
3. Progressive bone loss
4. Two millimeters of bone loss following the first year after placement
5. “In the absence of initial radiographs and probing depths, radiographic evidence of bone level ≥3 mm and/or probing depths ≥6 mm in conjunction with profuse bleeding represents peri‐implantitis.”¹

Avoidance of Peri-Mucositis: PREVENTION

Poor plaque control, poor adherence to cleaning/maintenance protocol, history of or active periodontitis, and diabetes, are all risk factors for peri-mucositis and peri-implantitis². This is not an exclusive list as there are many factors that may be at play. But, all of these conditions may be regulated/can be controlled by the patient and he/she should understand just so.

What to do if Signs and Symptoms of Peri-Mucositis/Implantitis present: Get rid of the plaque biofilm.

1. Individualized risk assessments for each implant patient should have already been completed, and the patient made aware (informed consent) of the complications if they do not do their part in at-home-hygiene.
2. If signs do begin to present, a thorough reiteration of at home care is a must and-
3. A decrease in the time between professional recall appointments.
4. Increased and more thorough charting of progression or regression of mucositis³.
5. With pocket depths less than or equal to 3mm:
   • Titanium hand scaling instruments or ultrasonics
   • Lasers may be an option to help clean the roughened surfaces of implants
   • The main goal is to get as much decontamination of the implant surface as possible⁵.
   • Improved and increased homecare
6. Locally administered Chlorhexidine gluconate rinses and gels that can be placed around an implant⁵.
7. For pockets that are greater than 3mm:
   • Supersaturated Citric acid placed around the implant
   • Topical tetracyclines
   • Use of cetylpyridinum chloride mouth rinses
   • Mechanical debridement⁵.
   • and of course improved and increased home care

All of this and more can and probably should be used to prevent Peri-Mucositis from making its way toward the Peri-Implantitis stage.

Summary: Researchers don’t currently know the exact how’s and why’s of peri-mucositis/implantitis, more research needs to be completed as there definitely seems to be multiple concomitant causes. Prevention, prevention, prevention is the best take home message. If signs start to show of Peri-Mucositis, attacking the problem as soon as possible with some, or all, of the strategies above are crucial. Enforcing strict home hygiene before implants are even placed is also a must. Finally, keep the plaque down as much as possible.

1. Renvert, S., Persson, G. R., Pirih, F. Q., & Camargo, P. M. (2018). Peri-implant health, peri-implant mucositis, and peri-implantitis: Case definitions and diagnostic considerations. Journal of periodontology, 89 Suppl 1, S304–S312. https://doi.org/10.1002/JPER.17-0588
2. Fu, J. H., & Wang, H. L. (2020). Breaking the wave of peri-implantitis. Periodontology 2000, 84(1), 145–160. https://doi.org/10.1111/prd.12335
3. Jepsen, S., Berglundh, T., Genco, R., Aass, A. M., Demirel, K., Derks, J., Figuero, E., Giovannoli, J. L., Goldstein, M., Lambert, F., Ortiz-Vigon, A., Polyzois, I., Salvi, G. E., Schwarz, F., Serino, G., Tomasi, C., & Zitzmann, N. U. (2015). Primary prevention of peri-implantitis: managing peri-implant mucositis. Journal of clinical periodontology, 42 Suppl 16, S152–S157. https://doi.org/10.1111/jcpe.12369\
4. American Academy of Periodontology. (2021). Implant diseases. Retrieved March 04, 2021, from https://www.perio.org/consumer/peri-implant-disease
5. Ephros, H., Kim, S., & DeFalco, R. (2020). Peri-implantitis: Evaluation and Management. Dental clinics of North America, 64(2), 305–313. https://doi.org/10.1016/j.cden.2019.11.002

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