CIT Peri-Implant Disease & Long-Term Maintenance — Questions and Answers
Question 1: What is the primary distinguishing feature that differentiates peri-implantitis from peri-implant mucositis?
- Peri-implantitis involves bone loss beyond the initial remodeling, while peri-implant mucositis is limited to soft tissue inflammation (Correct answer)
- Peri-implantitis only occurs within the first year after placement, while peri-implant mucositis is a chronic condition
- Peri-implant mucositis always requires surgical intervention, while peri-implantitis can be resolved with antibiotics alone
- Peri-implantitis affects the gingiva only, while peri-implant mucositis affects the alveolar bone
Correct answer: Peri-implantitis involves bone loss beyond the initial remodeling, while peri-implant mucositis is limited to soft tissue inflammation
Peri-implant mucositis is a reversible inflammatory lesion confined to the soft tissues (analogous to gingivitis). Peri-implantitis is characterized by inflammation AND progressive bone loss beyond normal crestal remodeling, making it more serious and harder to reverse.
Question 2: Which of the following is considered the most significant modifiable risk factor for developing peri-implantitis?
- Patient age over 60
- Poor oral hygiene and plaque accumulation (Correct answer)
- The brand of implant system used
- Implant placement in the posterior mandible
Correct answer: Poor oral hygiene and plaque accumulation
Poor oral hygiene leading to plaque biofilm accumulation is the primary modifiable risk factor for peri-implant disease, just as it is for periodontal disease. Smoking and a history of periodontitis are also significant risk factors, but oral hygiene is the most actionable.
Question 3: When probing around a dental implant during a maintenance visit, which finding would most strongly suggest the presence of active peri-implantitis?
- Probing depth of 3 mm with no bleeding
- Probing depth of 6 mm with bleeding on probing and suppuration (Correct answer)
- Slight discomfort during probing with probing depth of 2 mm
- Probing depth of 4 mm with healthy pink keratinized tissue
Correct answer: Probing depth of 6 mm with bleeding on probing and suppuration
A probing depth of 6 mm combined with bleeding on probing (BOP) and suppuration (pus) are hallmark clinical signs of active peri-implantitis. Bleeding and suppuration indicate active infection and inflammation, while increased probing depth suggests bone loss has occurred.
Question 4: Which decontamination method is most commonly recommended for implant surface debridement during non-surgical treatment of peri-implant mucositis?
- Ultrasonic scalers with standard steel tips
- Titanium or carbon fiber curettes and air-polishing with glycine powder (Correct answer)
- Stainless steel hand scalers
- High-speed burs under irrigation
Correct answer: Titanium or carbon fiber curettes and air-polishing with glycine powder
Titanium or carbon fiber curettes and glycine powder air-polishing are recommended because they effectively remove biofilm without scratching the implant surface. Standard steel instruments and ultrasonic tips with metal tips can damage the titanium surface, creating roughness that promotes future bacterial adhesion.
Question 5: What is the recommended minimum frequency for supportive implant therapy (maintenance recall) for a patient with a history of peri-implant mucositis who now has stable implants?
- Every 12 months
- Every 6 months
- Every 3 to 4 months (Correct answer)
- Every 18 months
Correct answer: Every 3 to 4 months
Patients with a history of peri-implant disease are at elevated risk and typically require more frequent recall intervals of every 3–4 months to monitor for disease recurrence and reinforce home care. Annual or semi-annual intervals are insufficient for high-risk patients.
Question 6: Radiographic bone loss is used to help diagnose peri-implantitis. Beyond normal initial crestal remodeling, what threshold of bone loss around an implant is generally considered indicative of peri-implantitis?
- 0.2 mm per year over any period
- Greater than 2 mm of marginal bone loss after the first year of loading (Correct answer)
- Any bone loss visible on a periapical radiograph
- Greater than 5 mm of bone loss from the implant platform
Correct answer: Greater than 2 mm of marginal bone loss after the first year of loading
The widely cited threshold for peri-implantitis diagnosis is marginal bone loss greater than 2 mm measured from the baseline radiograph taken at implant loading, combined with clinical signs of inflammation. Some initial bone remodeling (up to ~1–1.5 mm) in the first year is considered normal.
CIT Peri-Implant Disease & Long-Term Maintenance
What is the primary distinguishing feature that differentiates peri-implantitis from peri-implant mucositis?