Reviewed By: Melissa Obrotka, RDH, ICP and Shavonne Healy, RDH, ICP

Date: April 15, 2019


In June, 2018, the American Academy of Periodontology (AAP) and European Federation of Periodontology (EFP) released the results of their 2017 conference and subsequent workgroup reports. The following definitions are from these reports, as printed in the Journal of Periodontology Number 89, Journal S1, June 2018. (It is available online, click here). Page numbers are identified below.


Peri implant mucositis: “Peri-implant mucosal inflammation in absence of continuous marginal peri-implant bone loss” (S259)

​Peri implantitis: “A pathological condition occurring in tissues around dental implants, characterized by inflammation in the peri-implant mucosa and progressive loss of supporting bone.”  (S268) Radiographs are necessary in the diagnosis of bone loss)

​Cementitis: Not recognized or defined as a term, however, the report states that “excess cement has been associated with clinical signs of peri-implant mucositis” (page S263)

​Implant Crown: final restoration, can be either cemented or screw retained. Recommendation per report “Restoration margins should be located at or above the peri-implant mucosal margin or restorations should be cemented on individualized abutments allowing proper cement removal.” (S263)

​Abutment: attaches the implant to the crown, can either be stock or customized


Visual assessment Firm, pink, no swelling Red, edematous
Probing and palpation* lack of profuse bleeding, no exudate, generally ≤ to 6mm >6mm, profuse bleeding/exudate
Identify calculus with a lasso flossing technique No calculus or cement Calculus or cement
Evaluate mobility None Mobility
Radiographic evaluation (1x/yr) Bone height stable (note thread) Bone loss (CBCT is recommended)
Tapping the crown No pain Tenderness or pain
Checking occlusion/contacts Not too heavy, good IP contacts Heavy or open contacts


Bleeding may be caused by trauma from probing, or biofilm-induced inflammation. It may be difficult to differentiate between trauma-induced bleeding and biofilm induced bleeding. “Bleeding ‘dots’ should be interpreted carefully as this may represent bleeding due to tissue trauma and not bleeding associated with tissue inflammation” (S306).

If bleeding is profuse/visual inflammation, it is probably biofilm-induced bleeding.

Reference: Revert S, Persson GR, Girih FQ, Camargo PM. Peri-implant health, peri-implant mucositis, and peri-implantitis: Case definitions and diagnostic considerations. J Periodontal. 2018;89 (Suppl 1):S304-s312.


The following definitions are from these reports, as printed in the Journal of Periodontology Number 89, Journal S1, June 2018. (It is available online, click here). Page numbers are identified below.

Cigarette smoking

Radiation therapy

Diabetes mellitus “HbA1c levels >10.1 are associated with greater BOP around implants” (S261)

Cardiovascular disease “while a history of cardiovascular disease has been associated with an increased risk of peri-implantitis, there is no evidence for an association with peri-implant mucositis” (S261)




“Mechanical biofilm control should be considered the standard of care of management of peri-implant mucositis administered either by the patient or the oral healthcare professional” (S261). See product recommendations below.

“Peri-Implant mucositis may take longer than 3 weeks for clinical reversibility” (S259).


Heitz-Mayfield LJA, Salvi EG. Peri-imlant mucositis. J Periodontal 2018;89(Suppl1):S257-266.


May improve Implant success // Beta Blockers

May increase failure rates // Heartburn medication and antidepressants

Article “These two drugs help or hinder dental implants” 10/26/16

Article “Antidepressants linked to tooth implant failure, new study finds” 3/7/16






Subgingival Powder Streaming with glycine powder (Hu Friedy Air Flow Master Piezon Combo, Hu Friedy Air Flow Handy, Acteon’s Air-N-Go easy)

*When using APS, you must use HVE. ReLeaf is the product Ms Healy recommends!

As of June 2018, Erythritol is now available to use in the US! (This powder cannot be used with Acteon’s device).

Note: Sodium Bicarbonate is not appropriate for sub gingival use (Particles are too large)

Flossing with a lasso technique is not recommended by RDH Innovations  because floss may leave remnants behind, leading to peri implant disease.

Rubber cup polishing with non-abrasive paste (not for sub gingival biofilm disruption) is not necessary in the opinion of RDH Innovations.

Diode laser can reduce pathogens around an implant; it has bactericidal effects. Decontaminates the implant surface and can be used for pocket reduction in periodontal pockets.

Periodontal Endoscopy is recommended by RDH Innovations, as it shows you the surface of the tooth and sulcus, allowing for better cleaning and healing.


It is important to remove biofilm, and stimulate the tissue (which increases the blood supply to heal and remove toxins)

Tepe interdental brushes // With plastic coated wires, they are safe and effective for interproximal cleaning of dental implants. Purchase your first Tepe Practice Box and get 40% off with code RDHINNO40

Hydromagnetic oral irrigator // Hydro Floss

Soft bristled brush with low abrasive toothpaste // Ms Healy recommends Radius for her full arch patients as well as their Organic toothpaste, and the Implant Sulcus brush by Stop White Spots.

Rinse // A chlorine dioxide rinse is preferred, since it has a neutral pH and is alcohol free (alcohol may dry out the seal around the implant)

Ms Healy has incorporated StellaLife products into her practice. Check out their line of home care products.


Medical grade titanium instruments generally recommended over plastic (which can leave particles).

Cold treated rather than heat treated is generally recommended (cold treated can be used on both new and old implants). Hardness rating of 28-30. But according to RDH Innovations, this really isn’t important.

USE HORIZONTAL STROKES with instrumentation (following the threads of the implant)

  • PDT Wingrove Titanium
  • Brassler Titanium (Cold treated)
  • Hu Friedy Titanium (Heat treated)
  • American Eagle Titanium
  • LM Dental Implant Series
  • Deppler Titanium (tips can be changed)

Ultrasonic tips still tend to be bulky and may leave particles behind, but there are a couple of newer ones that are good!

  • ULTRASONIC: Acteon’s Pizeo Implant Protect or Periosoft tips or Hu-friedy PEEK tip
  • ULTRASONIC: Premier’s PEEK 30K (for Cavitron) with the blue tip, should only be used on small supra gingival areas.

If you have a deep pocket around an implant, an endoscope will simplify your life. With sub gingival illumination and magnification, you will see the calculus and cement!


Can a Natural tooth and implant be used to support a bridge?

It is not recommended. Implants lack the PDL that a natural tooth has, so research shows that when an implant and natural tooth are both used to support a bridge, the natural tooth generally does not fare well.

Probing an Implant, what is the recommendation?

Yes, probe, but gently. Wait 6 months after clearance from the surgeon. Understand that this is one assessment, and the angulation of the abutment and crown may make it a challenge (and less reliable).  Perhaps more important than the number, is if there is any bleeding or pus, and the overall look of the tissue around the implant.


​An Implant Care Practitioner is a Registered Dental Hygienist who has received further training in all aspects of Implant Dentistry. An ICP is knowledgeable about the entire process of preparing bone for an implant to caring for an aging implant. They may work closely with the surgeon and restoring Dentist to make sure the patient is equipped with knowledge and the right tools for success.

An Implant Care Practitioner has the hands-on training to be comfortable treating peri-implant disease. He/She may provide more advanced treatment options (Laser, periodontal endoscopy, Aqueous Powder Streaming) depending on their State’s Scope of Practice Act.


Read // Nonsurgical Periodontal Therapy
Indications, Limits, and Clinical Protocols with the Adjunctive Use of a Diode Laser (2017)

Attend an Implant Care Practitioner Training (See our events page) and become a Certified Implant Care Practitioner!


The use of CBCT technology is revealing cracked roots that used to be treated by RCT, but are now being extracted and replaced with implants.

Fluoride, oral pH and implant corrosion – corrosion seems to occur from fluoride in an acidic environment