Peri‐implant diseases and conditions: Consensus report of workgroup 4 of the 2017 World Workshop on the Classification of Periodontal and Peri‐Implant Diseases and Conditions
Open accessAbstract
A classification for peri‐implant diseases and conditions was presented. Focused questions on the characteristics of peri‐implant health, peri‐implant mucositis, peri‐implantitis, and soft‐ and hard‐tissue deficiencies were addressed. Peri‐implant health is characterized by the absence of erythema, bleeding on probing, swelling, and suppuration. It is not possible to define a range of probing depths compatible with health; Peri‐implant health can exist around implants with reduced bone support. The main clinical characteristic of peri‐implant mucositis is bleeding on gentle probing. Erythema, swelling, and/or suppuration may also be present. An increase in probing depth is often observed in the presence of peri‐implant mucositis due to swelling or decrease in probing resistance. There is strong evidence from animal and human experimental studies that plaque is the etiological factor for peri‐implant mucositis. Peri‐implantitis is a plaque‐associated pathological condition occurring in tissues around dental implants, characterized by inflammation in the peri‐implant mucosa and subsequent progressive loss of supporting bone. Peri‐implantitis sites exhibit clinical signs of inflammation, bleeding on probing, and/or suppuration, increased probing depths and/or recession of the mucosal margin in addition to radiographic bone loss. The evidence is equivocal regarding the effect of keratinized mucosa on the long‐term health of the peri‐implant tissue. It appears, however, that keratinized mucosa may have advantages regarding patient comfort and ease of plaque removal. Case definitions in day‐to‐day clinical practice and in epidemiological or disease‐surveillance studies for peri‐implant health, peri‐implant mucositis, and peri‐implantitis were introduced. The proposed case definitions should be viewed within the context that there is no generic implant and that there are numerous implant designs with different surface characteristics, surgical and loading protocols. It is recommended that the clinician obtain baseline radiographic and probing measurements following the completion of the implant‐supported prosthesis.
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Peri-implant mucositis is an important risk factor for peri-implantitis, an irreversible destructive condition associated with progressive crestal bone loss.
“Peri-implant mucositis, characterised by reversible mucosal inflammation around an implant, is an important risk factor for peri-implantitis, an irreversible destructive condition associated with progressive crestal bone loss [10, 11].”
From Confidence of primary care dental practitioners in the assessment, referral and maintenance of dental implants: a cross-sectional survey in Yorkshire (2026) · cites this paper as [10]
The section on mucositis as a precursor (page not provided) says mucositis is assumed to precede peri-implantitis and that affected patients may develop it, especially without regular maintenance care. That is weaker than calling mucositis an established important risk factor. The clinical-characteristics and diagnostic sections (pages not provided) support the association with bone loss, but do not establish that peri-implantitis is irreversible. (LLM, conf=0.84)
Experimental — accuracy not yet measuredThe assessment of tissue health status was performed using case definitions agreed upon in an international consensus conference (Berglundh et al., 2018).
“On one side of the spectrum, the assessment of tissue health status was performed using case definitions agreed upon in an international consensus conference (Berglundh et al., 2018).”
From Relevant domains, core outcome sets and measurements for implant dentistry clinical trials: The Implant Dentistry Core Outcome Set and Measurement ( <scp>ID‐COSM)</scp> international consensus report (2023) · cites this paper as Berglundh et al., 2018
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Cites
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Self-citationRenvert, S., Persson, G. R., Pirih, F. Q. M., & Camargo, P. M. (2018) · Journal Of Clinical Periodontology · doi:10.1111/jcpe.12956 · Cited by 589 · see citing works
Self-citationHeitz‐Mayfield, L. J. A., & Salvi, G. E. (2018) · Journal Of Clinical Periodontology · doi:10.1111/jcpe.12953 · Cited by 409 · see citing works
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Self-citationHeitz‐Mayfield, L. J. A., & Salvi, G. E. (2018) · Journal of Periodontology · doi:10.1002/jper.16-0488 · Cited by 307 · see citing works
Self-citationAraújo, M. G., & Lindhe, J. (2018) · Journal of Periodontology · doi:10.1002/jper.16-0424 · Cited by 172 · see citing works
The etiology of hard‐ and soft‐tissue deficiencies at dental implants: A narrative review
Hämmerle, C. H. F., & Tarnow, D. (2018) · Journal of Periodontology · doi:10.1002/jper.16-0810 · Cited by 164 · see citing works
Self-citationAraújo, M. G., & Lindhe, J. (2018) · Journal Of Clinical Periodontology · doi:10.1111/jcpe.12952 · Cited by 128 · see citing works
The etiology of hard‐ and soft‐tissue deficiencies at dental implants: A narrative review
Hämmerle, C. H. F., & Tarnow, D. P. (2018) · Journal Of Clinical Periodontology · doi:10.1111/jcpe.12955 · Cited by 108 · see citing works
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Research works printed but not linked: 1
- Berglundh T, Armitage G, et al. Peri- implant diseases and conditions: Consensus report of workgroup 4 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. J Clin Periodontol. 2018;45(Suppl 20):S286-
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Caton, J. G., Armitage, G., Berglundh, T., Chapple, I. L. C., Jepsen, S., Kornman, K. S., Mealey, B. L., Papapanou, P. N., Sanz, M., & Tonetti, M. S. (2018) · Journal of Periodontology · doi:10.1002/jper.18-0157 · Cited by 1,845 · see citing works
Self-citationMicrobial Community-Driven Etiopathogenesis of Peri-Implantitis
Belibasakis, G. N., & Manoil, D. (2021) · Journal of Dental Research · doi:10.1177/0022034520949851 · Cited by 244 · see citing works
Tonetti, M. S., Sanz, M., Avila‐Ortiz, G., Berglundh, T., Cairo, F., Derks, J., Figuero, E., Graziani, F., Guerra, F., Heitz‐Mayfield, L., et al. (2023) · Clinical Oral Implants Research · doi:10.1111/clr.14074 · Cited by 89 · see citing works
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Is Peri-Implant Probing Causing Over-Diagnosis and Over-Treatment of Dental Implants?
Coli, P., & Sennerby, L. (2019) · Journal of Clinical Medicine · doi:10.3390/jcm8081123 · Cited by 55 · see citing works
Relevance of Biofilm Models in Periodontal Research: From Static to Dynamic Systems
Sánchez, M. C., Alonso-Español, A., Ribeiro-Vidal, H., Alonso, B., Herrera, D., & Sanz, M. (2021) · Microorganisms · doi:10.3390/microorganisms9020428 · Cited by 39 · see citing works
Patel, J., & Ramsdale, M. (2026) · BDJ Open · doi:10.1038/s41405-026-00456-7
- Authors
- Berglundh, T., Armitage, G., Araujo, M. G., Avila‐Ortiz, G., Blanco, J., Camargo, P. M., Chen, S., Cochran, D., Derks, J., Figuero, E., Hämmerle, C. H. F., Heitz‐Mayfield, L. J. A., Huynh‐Ba, G., Iacono, V., Koo, K., Lambert, F., McCauley, L., Quirynen, M., Renvert, S., Salvi, G. E., Schwarz, F., Tarnow, D., Tomasi, C., Wang, H., & Zitzmann, N.
- Affiliations
- University of Gothenburg (SE)
- University of California, San Francisco (US)
- State University of Maringa Parana Brazil
- University of Iowa Iowa City IA USA
- Universidade de Santiago de Compostela (ES)
- University of California, Los Angeles (US)
- The University of Melbourne (AU)
- The University of Texas at San Antonio Health Science Center (US)
- Universidad Complutense de Madrid (ES)
- University of Zurich (CH)
- The University of Sydney (AU)
- Stony Brook University (US)
- Seoul National University (KR)
- University of Liège (BE)
- University of Michigan (US)
- KU Leuven (BE)
- Kristianstad University (SE)
- University of Bern (CH)
- Goethe University Frankfurt (DE)
- Columbia University (US)
- University of Basel (CH)
- Corresponding author
- Berglundh, Tord
- ORCID
- Venue
- Journal of Clinical Periodontology
- Publisher
- Wiley
- Published
- 2018-06
- Volume
- 45
- Issue
- S20
- Pages
- S286-S291
- ISSN
- 0303-6979 (ISSN-L)
- 1600-051X
- OpenAlex
- W2809593437
- Cited by
- 1,755
- References
- 9
- Citations by year
- 2026: 209 · 2025: 236 · 2024: 277 · 2023: 256 · 2022: 250 · 2021: 208 · 2020: 208 · 2019: 87 · 2018: 16 · 2015: 2
- FWCI
- 158.05
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal Of Clinical Periodontology (publishedVersion)
- PubMed (publishedVersion)
- Lirias (KU Leuven) (submittedVersion, other-oa)
- BORIS (University Library Bern) (submittedVersion)
- Bern Open Repository and Information System (University of Bern) (submittedVersion)
- Deep Blue (University of Michigan) (submittedVersion)
- Minerva Access (University of Melbourne) (submittedVersion)
- ORBi (University of Liège) (submittedVersion)
- Funders
- American Academy of Periodontology Foundation
- Johnson and Johnson
- Topics
- Health Sciences › Dentistry › Oral Surgery › Dental Implant Techniques and Outcomes
- Health Sciences › Dentistry › Periodontics › Oral microbiology and periodontitis research
- Health Sciences › Medicine › Urology › Periodontal Regeneration and Treatments
- Keywords
- peri-implant disease, peri-implantitis, peri-implant mucositis, peri-implant health, dental implants, plaque, probing depth, keratinized mucosa, case definition, bone loss
- MeSH terms
- Animals, Dental Plaque, Humans, Stomatitis, Dental Implants, Peri-Implantitis
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