Differential diagnosis and treatment strategies for peri-implant diseases

The aim of this article is to discuss the requirements to prevent, intercept and treat the peri-implant diseases at different stages. The ethiology and pathogenesis of peri-implant disease is presented, followed by definition and characteristics of the two main entites: peri-implant mucositis and peri-implantitis. Data and concepts regarding various evaluation parameters, such as pocket probing depth, bleeding on probing, gingival and plaque scores, radiographic and mobility which should be used to assess the clinical status of the peri-implant environment are discussed. The detection and treatment of early pathogenic changes during regular recall maintenance visits can prevent peri-implant soft tissue inflammation and progressive bone loss. The biologic rationale and guidelines for therapeutic procedures aimed to prevent and arrest the Peri-implant Disease according to a maintenance system termed Comulative Interceptive Supportive Therapy (CIST) is presented. The CIST protocol includes as a first sequence mechanical antiseptic and antibiotic treatment to control ongoing infection. Following this, peri-implant bony lesion may be corrected by regenerative or resective surgical techniques. IN CONCLUSION: By continuing diagnosis during maintenance, developing peri-implant infections can be controlled successfully by providing mechanical, antiseptic, antibiotic and surgical supportive therapy, individually or combined.