What are the clinical characteristics of a healthy peri‐implant site?

In health, the peri‐implant site is characterized by absence of erythema, bleeding on probing, swelling and suppuration.

What are the main clinical differences between healthy peri‐implant and periodontal tissues?

In health, there are no visual differences between peri‐implant and periodontal tissues. However, the probing depths are usually greater at implant versus tooth sites. The papillae at the interproximal sites of an implant may be shorter than the papillae at interproximal tooth sites.

What clinical methods and instruments should be used to detect the presence or absence of inflammation at an implant site?

The clinical methods to detect the presence of inflammation should include visual inspection, probing with a periodontal probe, and digital palpation.

Why is it important to probe peri‐implant tissues during a complete oral examination?

It is necessary to probe peri‐implant tissues to assess the presence of bleeding on probing, and to monitor probing depth changes and mucosal margin migration. This assessment may alert the clinician to the need for therapeutic intervention. There is evidence that probing of the peri‐implant tissue using a light probing force is a safe and important component of a complete oral examination.

What peri‐implant probing depths are compatible with peri‐implant health?

It is not possible to define a range of probing depths compatible with health; of more importance are the clinical signs of inflammation.

Can peri‐implant health exist around implants with reduced bone support?

Yes, peri‐implant tissue health can exist around implants with reduced bone support.

What are the histological characteristics of a healthy peri‐implant site?

The histological characteristics of a healthy peri‐implant site are derived mainly from animal studies. The healthy peri‐implant mucosa averages 3 to 4 mm in height and is covered by either a keratinized (masticatory mucosa) or non‐keratinized epithelium (lining mucosa). The portion of the peri‐implant mucosa that is facing the implant/abutment contains a “coronal” portion that is lined by a sulcular epithelium and a thin junctional epithelium, and a more “apical” segment in which the connective tissue is in direct contact with the implant surface. The connective tissue lateral to the sulcular epithelium harbors a small infiltrate of inflammatory cells. Most of the intrabony part of the implant is in contact with mineralized bone, while the remaining portion faces bone marrow, vascular structures, or fibrous tissue.

What are the main histological differences between healthy peri‐implant and periodontal tissues?

Compared to the periodontium, the peri‐implant tissues do not have cementum and periodontal ligament. The peri‐implant epithelium is often longer and in the connective tissue zone there are no inserting fibers into the implant surface. The peri‐implant tissues are less vascularized in the zone between the bone crest and the junctional epithelium when compared to the connective tissue zone of the periodontium.