Abstract
† The great majority of well-documented oralimplants show very good long-term clinical results.† A limited amount of crestal bone loss (CBL) ormarginal bone loss may be a biologic response toimplant placement.† CBL may occur for reasons other than infection.† CBL may occur around implants and can have along-termimpactontheoutcomeof thoseimplants.† Some implants can demonstrate substantial boneloss, but a steady state may be reached and nofurther clinically significant bone loss observed.† There is an adaptive change of the crestal bone levelafter placement and restoration.† Peri-implantitis is an unsuitable term to describe allCBL.† The term peri-implantitis is here defined as aninfection with suppuration associated with clini-cally significant progressing CBL after the adaptivephase.† In contrast, peri-implant mucositis is defined asinflammation of the peri-implant mucosa withoutdiscernibly progressing CBL.† Bone remodeling including CBL is influenced byinflammation.† Implant-, clinician-, and patient-related factors aswell as foreign body reactions may contribute toCBL. Implant factors: material, surface properties,and design (e.g., ease of plaque removal); clinicianfactors: surgical and prosthodontic experience,skills, and ethics; patient factors: systemic diseaseand medication, oral disease (e.g., untreated orrefractory periodontal disease, local infections),behavior (e.g., patient compliance with oral hygieneand maintenance, smoking), and site-related factors(e.g., bone volume and density, soft tissue quality);and foreign body reactions (e.g., corrosion by-products, excess cement in soft tissues).† A radiograph does not give an absolutely accuratepicture of the bone-implant contact or the crestalbone situation. However, the periapical radiographis an important clinical tool to be used at im-plant placement, implant loading, and repeatedlythereafter.† Radiographs taken longitudinally may assist the cli-nician to monitor changes in crestal bone levels.† Peri-implant examinations that include bleedingon probing and probing depths do not by
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