Abstract
As far as the periimplant anatomy is considered, the question raised is whether or not healthy periimplant tissues present bleeding on probing (BOP). AIM: To assess if the criterion BOP is strictly related to periimplant disease (PID). METHODS: 134 patients were included in this study. All periimplant regions were clinically and radiographically evaluated. Patients were assigned to 3 groups based on radiographic and clinical aspects in the periimplant region: Group A (healthy-sites) - no signs of mucosal inflammation or bone loss; Group B (mucositis) - red and swollen mucosa, but no radiographic bone loss; Group C (periimplantitis) - radiographically confirmed pathological bone loss. After this classification, all periimplant sulci were probed at 4 sites (mesial, distal, buccal, lingual/palatal). Patients' mean age was 51.7±12.4 years, 77 women and 57 men, with a total of 486 osseointegrated endosseous implants. RESULTS: Groups A and C showed significant difference in age and implant region distribution (p=0.009 and p=0.008, respectively). After initial clinical and radiographic diagnosis of periimplant status, 33 (20.1%) regions showed BOP in group A. All regions in Group B presented BOP. In Group C, 41 (19.9%) regions showed no BOP. All groups differed significantly considering BOP as diagnosis parameter (p<0.0001). CONCLUSIONS: BOP was always present in inflamed mucosa, but it was not always absent in healthy mucosa. Not all periimplantitis regions showed BOP. Clinical and radiographic aspects must always be considered together for diagnosis of PID, even if BOP is absent.
Highlights
The soft and hard tissues around endosseous implants share some similarities with the periodontium
In Group A, 131 (19.1%) periimplant regions were characterized by the absence of bleeding on probing (BOP) while 33 (20.1%) regions showed BOP with no clinical or radiographic signs of inflammation
This study evaluated the presence of BOP in periimplant regions clinically and radiographically characterized as healthy, mucositis and periimplantitis, excluding BOP as the initial diagnostic factor
Summary
The soft and hard tissues around endosseous implants share some similarities with the periodontium Differences such as the absence of cementum and periodontal ligament in the periimplant region, orientation of the collagen fibers in the periimplant soft tissue, which is parallel to the implant surface and not inserted in the implant surface and periimplant vascularization must be taken into consideration to provide reliable prognosis[1]. Of the periodontal sulcus against the penetration of chemical pathogens and bacterial substances[2] Rupture of this sealing or lysis of connective tissue fibers attached to the apical cementum to the junctional epithelium, lead to rapid migration of the sulcular epithelium and consequent pathological pocket formation. Since cementum or fiber attachment is not seen around the titanium surface, mucosal seal provides the main barrier against the dissemination of pathological aggressions in the deep periimplant tissues. The destruction of the mucosal integrity around the titanium leads to the direct extension of the pathological pocket to the bone tissue, which may result in loss of the endosseous implant[1,2,3]
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