Peri-implant pathology risk assessment

Use the below tool to assess the risk of peri-implant pathology

This test, developed by a research group from Portugal, is designed to help predict the risk of peri-implant pathology and provide recall recommendations for a particular case. This assessment should be performed after one year of follow-up in order to exclude early implant failure, and can be repeated at follow-up visits for a continuous evaluation of peri-implant pathology risk.

8 questions
  • Does the patient have a history of periodontitis?

    Multiple choice question
    Does the patient have a history of periodontitis?
    Explanation to the question: 
    • A history of periodontitis is a potential predisposing factor for peri-implant pathology.1
    • Because its suppression isn’t possible, whenever it is present it becomes crucial to efficiently control/suppress the remaining risk factors.2

     

    de Araújo Nobre M, Mano Azul A, Rocha E, Maló P. Risk factors of peri-implant pathology. Eur J Oral Sci. 2015 Jun;123(3):131-9. 
    de Araújo Nobre M, Mano Azul A, Rocha E, Maló P, Salvado F. Attributable fractions, modifiable risk factors and risk stratification using a risk score for peri-implant pathology. J Prosthodont Res. 2016 Mar 28. pii: S1883-1958(16)30003-2.

  • Is bacterial plaque present?

    Multiple choice question
    Is bacterial plaque present?
    Explanation to the question: 
    • Bacterial plaque is a possible precipitating or reinforcing factor of peri-implant pathology.1
    • It’s suppression could lead to reduction of 31% of cases of peri-implant disease.2
    • Daily effective oral hygiene is crucial in these patients.2

     

     

    de Araújo Nobre M, Mano Azul A, Rocha E, Maló P. Risk factors of peri-implant pathology. Eur J Oral Sci. 2015 Jun;123(3):131-9.
    de Araújo Nobre M, Mano Azul A, Rocha E, Maló P, Salvado F. Attributable fractions, modifiable risk factors and risk stratification using a risk score for peri implant pathology. J Prosthodont Res. 2016 Mar 28. pii: S1883-1958(16)30003-2.

  • Is there bleeding?*

    Multiple choice question
    Is there bleeding upon insertion of a probe?
    Explanation to the question: 
    • *Bleeding upon insertion of a probe 1 mm in the sulcus and running a circle around the abutment. 
    • Bleeding is a possible precipitating or reinforcing factor for peri-implant pathology.1
    • Its suppression could lead to a reduction of 18% of cases of peri-implant disease.2
    • Daily effective oral hygiene is crucial in these patients.2

     

     

    de Araújo Nobre M, Mano Azul A, Rocha E, Maló P. Risk factors of peri-implant pathology. Eur J Oral Sci. 2015 Jun;123(3):131-9
    de Araújo Nobre M, Mano Azul A, Rocha E, Maló P, Salvado F. Attributable fractions, modifiable risk factors and risk stratification using a risk score for peri-implant pathology. J Prosthodont Res. 2016 Mar 28. pii: S1883-1958(16)30003-2. 

  • Is the implant close to other teeth or implants?

    Multiple choice question
    Is the implant close to other teeth or implants?
    Explanation to the question: 
    • This variable exerts a protective effect when independent, reducing risk of peri-implant pathology (due to an effect of biomechanical protection), or a possible risk factor when in combination with bacterial plaque.1
    • In combination with plaque, the proximity of implants to other implants or teeth could create a bacteria reservoir.1
    • The suppression of these factors could lead to a potential reduction of 15% of peri-implant pathology cases.2
    • Daily effective oral hygiene is crucial in these patients.2

     

     

    de Araújo Nobre M, Mano Azul A, Rocha E, Maló P. Risk factors of peri-implant pathology. Eur J Oral Sci. 2015 Jun;123(3):131-9.
    de Araújo Nobre M, Mano Azul A, Rocha E, Maló P, Salvado F. Attributable fractions, modifiable risk factors and risk stratification using a risk score for peri-implant pathology. J Prosthodont Res. 2016 Mar 28. pii: S1883-1958(16)30003-2.

  • Tick all that apply.

    Multiple choice question

    Tick all that apply.

     What type of materials are present in the implant-supported prostheses?
    Explanation to the question: 
    • The type of prostheses may impact the risk of peri-implant pathology in different ways, in a trade-off between the degree of shock absorption provided by the material (biomechanical protection)1 and the degree of surface roughness of the same material (facilitating bacterial plaque accumulation).1,2
    • Occlusion should be assessed on a regular basis (at least once every two years) in order to provide a stable biomechanical condition for the implant-supported rehabilitation.3

     

     

    de Araújo Nobre M, Mano Azul A, Rocha E, Maló P. Risk factors of peri-implant pathology. Eur J Oral Sci. 2015 Jun;123(3):131-9.
    Maló P, de Araújo Nobre M, Borges J, Almeida R. Retrievable metal ceramic implant-supported fixed prostheses with milled titanium frameworks and all-ceramic crowns: retrospective clinical study with up to 10 years of follow-up. J Prosthodont. 2012 Jun;21(4):256-64.

    de Araújo Nobre M, Mano Azul A, Rocha E, Maló P, Salvado F. Attributable fractions, modifiable risk factors and risk stratification using a risk score for peri-implant pathology. J Prosthodont Res. 2016 Mar 28. pii: S1883-1958(16)30003-2.

  • Is there lack of passive fit or prosthetic component loosening?

    Multiple choice question
    Is there lack of passive fit or prosthetic component loosening?
    Explanation to the question: 
    • Lack of passive fit and non-optimal screw-tightening influences disease development by both increasing the load transmitted to bone,  which may lead to bone loss, and through bacterial colonization of the gaps between prosthetic components.1,2
    • Suppression of these factors could decrease incidence of peri-implant disease by 5%.3

     

    Strub JR, Jurdzik BA, Tuna T. Prognosis of immediately loaded implants and their restorations: a systematic literature review. J Oral Rehabil. 2012 Sep;39(9):704-17.
    Sahin S, Cehreli MC. The significance of passive framework fit in implant prosthodontics: current status.Implant Dent. 2001;10(2):85-92.

    de Araújo Nobre M, Mano Azul A, Rocha E, Maló P, Salvado F. Attributable fractions, modifiable risk factors and risk stratification using a risk score for peri-implant pathology. J Prosthodont Res. 2016 Mar 28. pii: S1883-1958(16)30003-2.

  • Is bone level located on implant’s medium third?

    Multiple choice question
    Is bone level located on implant’s medium third?
    Explanation to the question: 
    • Bone level at the implant’s medium third (either caused by bone loss or present since implant placement) is a potential biomechanical and/or biological risk factor.1
    • As bone level progresses apically, the implant loses bone support and stability.2 This reduces its ability to support occlusal forces and increases the risk of biomechanically-influenced peri-implant pathology.1
    • Occlusion should be assessed on a regular basis (at least once every two years) in order to provide a stable biomechanical condition for the implant-supported rehabilitation.3



    de Araújo Nobre M, Mano Azul A, Rocha E, Maló P. Risk factors of peri-implant pathology. Eur J Oral Sci. 2015 Jun;123(3):131-9.
    Chong L1, Khocht A, Suzuki JB, Gaughan J. Effect of implant design on initial stability of tapered implants. J Oral Implantol. 2009;35(3):130-5.

    de Araújo Nobre M, Mano Azul A, Rocha E, Maló P, Salvado F. Attributable fractions, modifiable risk factors and risk stratification using a risk score for peri-implant pathology. J Prosthodont Res. 2016 Mar 28. pii:S1883-1958(16)30003-2.

  • Does the patient currently smoke?

    Multiple choice question
    Does the patient currently smoke?
    Explanation to the question: 
    • Smoking habit is a risk factor for implant failure1, and a possible confounder2 or risk factor for peri-implant pathology.3
    • Smoking cessation counseling is recommended for these patients.

     

    Chrcanovic B, Albrektsson T, Wennerberg A. Smoking and dental implants: A systematic review and meta-analysis. J Dent. 2015 May;43(5):487-98.
    de Araújo Nobre M, Mano Azul A, Rocha E, Maló P. Risk factors of peri-implant pathology. Eur J Oral Sci. 2015 Jun;123(3):131-9.

    Sgolastra F, Petrucci A, Severino M, Gatto R, Monaco A. Smoking and the risk of peri-implantitis. A systematic review and meta-analysis. Clin Oral Implants Res. 2015 Apr;26(4):e62-7.

About Peri-implant pathology

Peri-implant pathology is defined as ‘the term for inflammatory reactions with loss of supporting bone tissue surrounding the implant in function’.1 It is the leading cause of dental implant failure after osseointegration.2 From an epidemiological perspective, it is a group of multifactorial situations with several non-sufficient, non-necessary causes.3

 


Albrektsson T. Consensus report on session IV. In: Lang NP, ed. Proceedings of the First European Workshop on Periodontology. London, UK: Quintessence, 1984: 365-369.

Kourtis SG1, Sotiriadou S, Voliotis S, Challas A. Private practice results of dental implants. Part I: survival and evaluation of risk factors--Part II: surgical and prosthetic complications. Implant Dent. 2004 Dec;13(4):373-85.

de Araújo Nobre M, Mano Azul A, Rocha E, Maló P. Risk factors of peri-implant pathology. Eur J Oral Sci. 2015 Jun;123(3):131-9.

The algorithm for this test has been developed by one research group. In addition, recommendations for recall and maintenance are based on the MALO CLINIC protocol. This test can be used as an additional tool by trained clinicians but shall not substitute appropriate clinical assessment, planning, medical care or verification. FOR shall not assume any liability and does not warrant the test, the results or the use of the results thereof.