Peri-Implantitis Finally Gets a Flowchart
Fiorellini and colleagues translate the 2024 AO/AAP peri-implant disease consensus into clinical flowcharts for mucositis, peri-implantitis, risk assessment, maintenance, surgery, regeneration, and implant removal.
Flowchart the inflammation
Source Paper
Clinical Translation of the 2024 AO/AAP Consensus on Prevention and Management of Peri-implant Diseases and Conditions
Peri-implant disease has always had a faintly bureaucratic cruelty about it. First it asks you to diagnose inflammation around a threaded object with microscopic topography and a suprastructure designed by optimism. Then it asks you to decide whether the answer is hygiene, antibiotics, lasers, flap surgery, regeneration, explantation, or a long stare at the original treatment plan. Fiorellini and colleagues’ Clinical Translation of the 2024 AO/AAP Consensus on Prevention and Management of Peri-implant Diseases and Conditions does the sensible thing: it turns the chaos into flowcharts.
That sounds administrative. It is actually the paper’s main clinical virtue. Peri-implant mucositis and peri-implantitis are not one disease at one stage needing one heroic gadget; they are risk-shaped conditions needing diagnosis, debridement, maintenance, escalation, and sometimes retreat.
The Data Anchor
This paper is not a trial. It is a clinical translation of the 2024 AO/AAP Consensus on Prevention and Management of Peri-implant Diseases and Conditions, built around recommendations and reference flowcharts for prevention, mucositis therapy, nonsurgical peri-implantitis therapy, surgical management, soft tissue procedures, reconstructive treatment, supportive peri-implant therapy, and implant removal.
The diagnostic distinctions matter. Peri-implant mucositis is inflammation confined to soft tissue, often with increased probing depths generally < 5 mm, bleeding on probing, and no radiographic bone loss beyond physiological remodelling. Peri-implantitis adds progressive bone loss; when previous records are unavailable, diagnosis can rest on bleeding and/or suppuration, probing depths ≥ 6 mm, and bone levels ≥ 3 mm apical to the most coronal intraosseous implant portion.
Management is deliberately staged: implant-safe mechanical debridement, oral hygiene instruction, risk modification, adjunctive therapy where justified, and supportive peri-implant therapy every 3 to 4 months.
Key Findings
- Mucositis is the warning light. The goal is biofilm disruption, risk control, and close maintenance before soft-tissue inflammation becomes bone loss.
- Adjuncts are not the main character. Chlorhexidine, hydrogen peroxide, saline, local antimicrobials, lasers, photodynamic therapy, and probiotics may be considered, but the paper repeatedly notes variable or limited evidence.
- Peri-implantitis starts with access to the contaminated surface. Nonsurgical therapy can help mild to moderate cases, but persistent disease needs surgical access when debridement and patient-level control are insufficient.
- Defect morphology guides the operation. Contained defects may suit regenerative therapy; non-contained defects often push the plan toward resective surgery and cleansability.
- Removal is a treatment, not a failure of vocabulary. Severe bone loss, recurrent infection, nonregenerable defects, or compromised implant stability can justify explantation.
💡 The Clinical Bottom Line
The gold standard here is not a product. It is a staged decision process: diagnose the disease level, identify the risk profile, clean what can be cleaned, maintain what can be maintained, and escalate when the defect has stopped pretending to be manageable.
For clinicians, the most useful move may be psychological. Once peri-implantitis is in flowchart form, it becomes less like a shameful surprise and more like a complication with branches, thresholds, and next steps. That is not glamorous, but it is how difficult clinical problems become treatable.
Dr Samuel Rosehill is a general dentist with a prosthodontic focus, practising at Ethical Dental in Coffs Harbour, NSW. He holds a BDSc (Hons) from the University of Queensland, an MBA, an MMktg, and an MClinDent in Fixed & Removable Prosthodontics (Distinction) from King’s College London.
Clinical Relevance
This consensus translation gives clinicians a practical framework for peri-implant disease rather than a single magic intervention. Mucositis management centres on biofilm disruption, risk control, and 3- to 4-month supportive peri-implant therapy. Peri-implantitis requires escalation from nonsurgical debridement to surgery, regeneration, resection, or removal depending on defect morphology, bone loss, cleansability, and patient risk.
Disclosure: The author has no financial conflicts of interest related to the products or topics discussed in this review. This is an independent summary prepared for educational purposes.
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