Peri-Implantitis and Peri-implant Mucositis

Dental implants have become, over recent decades, one of the most effective and predictable therapeutic options for replacing missing teeth. Due to their high survival rates and their ability to restore both function and aesthetics, implants are now a fundamental component of modern restorative dentistry. However, despite their widely documented success, implant-supported rehabilitations are not exempt from complications, especially biological ones, which may compromise long-term prognosis. Understanding these events and the factors that influence them represents a significant clinical and scientific need. Among the most frequent biological complications are peri-implant mucositis and peri-implantitis, inflammatory conditions that affect the soft and hard tissues surrounding the implant. Their onset is closely related to the formation and accumulation of bacterial biofilm on the prosthetic and implant surfaces, triggering an inflammatory response that, in advanced cases, can lead to progressive marginal bone loss. The literature suggests that the prevalence of these pathologies has increased as implant treatments have become more common, reinforcing the importance of evaluating the biological behavior of implants in various clinical contexts. In this regard, microbiological assessment is a cornerstone for understanding the etiology and progression of peri-implant complications. The structural characteristics of biofilm around implants differ partially from those observed around natural teeth, which may influence the virulence of the microorganisms involved and their ability to induce inflammation. Moreover, patient-related factors-such as systemic health status, habits like smoking, or oral biofilm control-as well as implant-related variables-such as surface characteristics, macro-geometry, and prosthetic design-can modify microbial composition and tissue response. Therefore, microbiological evaluation not only identifies predominant pathogens but also provides essential information for developing individualized preventive and therapeutic strategies. Alongside biological and microbiological assessment, radiographic evaluation has become an indispensable method for assessing bone stability around dental implants. Conventional and digital radiographic techniques allow clinicians to objectively monitor marginal bone loss, considered one of the most important parameters for determining the long-term success or failure of implants. Correlating radiographic findings with clinical indicators of inflammation provides a comprehensive understanding of implant health and enables early detection of potential complications. Additionally, radiographic interpretation helps identify surgical and prosthetic factors associated with bone remodeling, such as the three-dimensional position of the implant, crown-to-implant ratio, abutment design, or the patient's bone quality. Despite the extensive knowledge available on implant therapy, uncertainties remain regarding the interplay between biological, microbiological, and radiographic factors in the development and progression of peri-implant complications. Evidence suggests that these elements do not act independently but rather form an integrated system where biofilm, immune response, and bone stability influence one another. For this reason, research that combines these three dimensions is essential to achieving a more complete understanding of implant behavior in real clinical scenarios. The present research project aims to evaluate the behavior of dental implants in relation to biological complications, microbiological findings, and radiographic outcomes, with the goal of identifying patterns, associations, and potential risk factors that may affect treatment success. This multidimensional approach will allow the analysis not only of inflammation or bone loss but also of the microbial composition associated with these conditions and its relationship with clinical and radiographic findings. By integrating these components, the study seeks to generate evidence that contributes to improving diagnostic, maintenance, and treatment protocols for patients rehabilitated with dental implants. The importance of this investigation lies in the need to optimize the long-term predictability of implant-supported treatments. Early detection of complications, identification of key microorganisms involved in peri-implant diseases, and precise evaluation of bone stability are essential tools for ensuring successful outcomes. Furthermore, the results of this study may support patient education regarding biofilm control and enhance clinical strategies aimed at preventing peri-implant pathology. Taken together, the simultaneous analysis of biological, microbiological, and radiographic aspects will provide a comprehensive perspective on peri-implant conditions and a deeper understanding of the factors that determine the performance of dental implants. Ultimately, the study intends to genera

This is an interventional clinical study on the peri-implant treatment necessary to improve the clinical conditions surrounding dental implants registered with peri-implant inflammation. The focus of this double-armed, examiner blinded, controlled, randomized clinical trial is to examine the effect of short-term increased frequency of a SPiT (supportive peri-implant treatment) protocol on implants diagnosed with peri-implant mucositis. The study is a part of a project assessing the frequency of supportive peri-implant therapy. The current is on treatment of peri-implant mucositis (inflammation and no attachment loss at the implants) and secondary prevention of peri-implant mucositis. The other study is a RCT on non-surgical treatment of peri-implantitis (inflammation and exposed implant surface) (REK 790240). Exposure of rough surface may dramatically change the frequency of maintenance needed to improve the inflammatory condition. Thus, a segregation between adequate and low bone level at the implant is necessary. Subjects with more than one implant and both diagnoses, may be enrolled in both studies, following the frequency of treatment randomized in the peri-implant mucositis study.

This is an interventional clinical study on the peri-implant treatment necessary to improve the clinical conditions surrounding dental implants registered with peri-implant inflammation. The focus of this double-armed, examiner blinded, controlled, randomized clinical trial is to examine the effect of short-term increased frequency of a Non-surgical protocol on implants diagnosed with peri-implantitis. The study is a part of a project assessing the frequency of supportive peri-implant therapy. The current is on non-surgical treatment of peri-implantitis (inflammation and exposed implant surface). The other study is a RCT on treatment of peri-implant mucositis (inflammation and no attachment loss at the implants) and secondary prevention of peri-implant mucositis (REK 790097). Exposure of rough surface may dramatically change the frequency of maintenance needed to improve the inflammatory condition. Thus, a segregation between adequate and low bone level at the implant is necessary. Subjects with more than one implant and both diagnoses, may be enrolled in both studies, following the frequency of treatment randomized in the peri-implant mucositis study

This clinical trial is being conducted to study peri-implant mucositis (inflammation in the gums around dental implant that does not extend into the implant-supporting bone). There are currently no available treatment options able to provide long-term resolution of implant gum inflammation even with our current gold standard treatment of non-surgical cleanings and oral hygiene instructions. The purpose of the study is to compare the effect of crown glaze removal and subsequent polishing in addition to mechanical debridement compared to only mechanical debridement on the implant affected by implant gum inflammation. In this study, participants will be randomized (put into a group by chance) into one of 2 study groups, groups A and B. Group A: The implant crown will be cleaned with titanium scaling instruments and powered instruments. The screw-retained crown will be removed and the remaining build-up on the crown will be photographed. The crown will then be sent to a lab technician who will remove the glaze and polish the crown only in the areas that sit under the gums. Group B: The implant crown will be cleaned with titanium scaling instruments and powered instruments. The screw-retained crown will be removed and the remaining build-up on the crown will be photographed. The crown will then be sent to a lab technician to perform a superficial cleaning only. In both groups, the crown will be placed back on the implant and customized oral hygiene instructions will be provided. The study will require four appointment. Appointment #1 is the screening appointment and will take 30-60 minutes. Appointment #2 is when treatment is delivered and will occur within 4 weeks of appointment #1. Appointment #3 is for the short-term follow-up and will occur within 60-70 days of appointment #2. Appointment #4 is for the long-term follow-up and will occur within 12-13 months of appointment #2. All these appointment will be in an outpatient setting at the institutional graduate periodontics clinic. A total of 2 x-rays will be taken of the implant. One will be taken during appointment #1 to assess the bone around the implant. One will be taken during appointment #2 to ensure that the crown is fully seated when the crown is re-inserted. The following information will be collected in appointment #1: gum measurements around the implants, how tight the implant contacts adjacent teeth, when the crown was delivered, previous cleanings around the implant, age, sex, gender, previous systemic antibiotic use in the last 2 weeks, smoking habits, presence of diabetes and HbA1C values. At appointments #2, 3, and 4, the following information will be collected: plaque around implant, gum measurements around implants, previous systemic antibiotic use in the last 2 weeks, smoking habits, presence of diabetes and HbA1C values, gum fluid samples around the implant crown. In appointment #4, additionally, information on how the implant has been cleaned throughout the year will be collected.

In this study, we collected and analysed the review results of 100 patients over 18 years of age who received implant fixed restorations in the Department of Stomatology of the First Hospital of Nanjing, China. The aim was to investigate the incidence of loss of contact between implant restorations and adjacent teeth and its influencing factors. Our findings may provide better insights for treatment planning and prevention of PCL.

Patients included in the study will be recruited after arriving at the Faculty of Dentistry of the University of Zagreb. During the clinical examination, the patient's periodontal status (bleeding during probing, and the depth of the pockets around the implant) and a control x-ray will be taken to check bone loss. Saliva sampling will occur at 3-time points, when establishing the diagnosis of periimplantitis, before the start of therapy, and at the first control after treatment.