Diederik Hentenaar

10 Chapter 1 i.e. how to assess the condition. Hence, the current classification is described with the following disease definitions: peri-implant health is characterised by the absence of clinical signs of inflammation, such as swelling, redness, and bleeding on probing (BoP) (Araujo & Lindhe 2018). Peri-implant mucositis is characterised by an inflammatory lesion in the soft tissues surrounding an implant in the absence of loss of supporting bone (Heitz-Mayfield & Salvi 2018) and peri-implantitis is a plaque-associated pathological condition that occurs in tissues around dental implants. Peri-implantitis is characterised by inflammation in the peri-implant mucosa and loss of supporting bone (Schwarz et al. 2018). Subsequently, the currently used case definitions in day-to-day clinical practice are: Peri-implant health • absence of clinical signs of inflammation; • absence of bleeding/suppuration on gentle probing; • no increase in probing depth compared to previous examinations; • no bone loss. Peri-implant mucositis • bleeding and/or suppuration on gentle probing; • no bone loss. Peri-implantitis • bleeding and/or suppuration on gentle probing; • increased probing depth compared to previous examinations; • bone loss. Importantly, if previous diagnostic data are not available, the diagnosis of peri-implantitis can be made based on the presence of bleeding and/or suppuration on gentle probing, probing depths ≥6 mm, and bone levels ≥3 mm apical to the most coronal portion of the intraosseous part of the implant. Etiopathogenesis Peri-implant soft tissue inflammatory reactions can be initiated by several factors such as excess cement remnants, inadequate/loose restoration-abutment connections, implant malposition, and fracture of implant components (Atieh et al. 2020). However, a major etiological role is reserved for bacteria as trigger of the host defence mechanism (Belibasakis et al. 2015, Belibasakis & Manoil 2021). Embedded in a self-produced matrix, these microbial communities form a biofilm which adheres to the surface of the implant and implant supported restoration (Lee & Wang 2010). These biofilms represent a