Implant probing plays a key role in diagnosing peri-implant disease, as does a radiological check, in which bone changes should be compared with baseline radiographs from the time of reconstruction.
Probing peri-implant soft tissue
A periodontal probe made of plastic or metal should be used to explore four to six sites around the implant. No probing should be done for the first six to eight weeks after implantation, while the soft tissues are healing. The probing pocket depth should be compared with the baseline following reconstruction.
The probing pressure should not exceed 0.2–0.25 N. An increasing probing pocket depth is an alarm requiring further investigation. In the case of implants that are set deeply in the esthetic zone, 5–6 mm probing depths are possible in the approximal region, even in non-inflamed conditions.
Signs of inflammation and bleeding
Clinical changes in the peri-implant mucosa, such as reddening and swelling, should be examined regularly. The absence of bleeding in response to probing is an indication of peri-implant health. A two-year observation period has shown that peri-implantitis progresses if bleeding on probing occurs in more than half of the follow-up sessions.1
The radiographic depiction of the implant should always be linked to the clinical diagnosis. Intraoral dental imaging, orthopantomography (OPT) and, for special indications, cone-beam computed tomography (CBCT) have been shown to be successful in radiographic diagnosis. The distance should be measured from a fixed reference point, for example the implant shoulder, to the crestal bone. The bone level at the time of reconstruction serves as a radiological reference (baseline).
Implant mobility is an indication of a complete loss of osseointegration, and therefore implant mobility cannot be used for early diagnosis of peri-implantitis. Implant mobility, when there are no signs of bleeding on probing, increased probing pocket depths, suppuration or crestal bone loss, can indicate improper loading.
A purulent secretion with or without formation of fistulae is the consequence of advanced inflammation. Suppuration is therefore also not suited for early diagnosis of peri-implantitis.