AO/AAP consensus on prevention and management of peri-implant diseases and conditions: Summary report

IF 3.8 2区医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of periodontology Pub Date : 2025-06-12 DOI:10.1002/JPER.25-0270

Hom-Lay Wang, Gustavo Avila-Ortiz, Alberto Monje, Purnima Kumar, Javier Calatrava, Tara Aghaloo, Shayan Barootchi, Joseph P. Fiorellini, Maria Elisa Galarraga-Vinueza, Joseph Kan, Guo-Hao Lin, Andrea Ravida, Muhammad H. A. Saleh, Lorenzo Tavelli, AO/AAP Consensus Participants, Paul S. Rosen

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Abstract

Background

The exponential increase in dental implant use has led to a parallel rise in peri-implant diseases (PID), adversely affecting implant therapy success and patient quality of life. Efforts have been made by the dental community to understand systemic, behavioral, and site-level risk factors involved in the etiologies and pathogenesis of PID and conditions and to develop standardized treatment protocols for the management of these clinical entities. The 2024 Academy of Osseointegration/American Academy of Periodontology (AO/AAP) consensus aimed to integrate the best available evidence and expert opinion into a unified framework for the prevention and management of PID and conditions.

Methods

Focused questions were previously addressed in eight systematic reviews that were grouped into two main topics. Group 1 evaluated systemic and local risk factors/indicators for the development of peri-implant mucositis and peri-implantitis, peri-implant soft tissue deformities, as well as prosthetic factors associated with peri-implant marginal bone loss. Group 2 focused on therapeutic strategies for the management of PID, encompassing nonsurgical debridement, implant surface decontamination methods, and surgical interventions (both nonreconstructive and reconstructive). Structured consensus discussions were held during an on-site meeting in Oak Brook, Illinois (August 14–16, 2024) to inform evidence-based recommendations.

Results

A plethora of systemic, behavioral, and local factors may play a pivotal role in the onset and progression of PID and conditions. Key systemic and behavioral risk factors include history of periodontitis, smoking, uncontrolled diabetes, poor microbial biofilm control, and obesity, while implant malposition, unfavorable prosthetic factors, and suboptimal peri-implant soft tissue phenotypical features are relevant site-related factors. Peri-implant mucositis may be effectively managed with nonsurgical debridement and control of risk factors. This possibly represents the first step of treatment of peri-implantitis, whereas more advanced cases require individualized surgical approaches, ranging from flap-for-access, resective, reconstructive, or soft tissue augmentation procedures. Supportive peri-implant maintenance is essential for long-term peri-implant tissue stability and health.

Conclusions

An evidence-based flow diagram combined with expert opinion was generated for clinicians to manage PID and conditions, emphasizing early risk factor identification, tailored treatment protocols, and continued maintenance to optimize long-term implant therapy outcomes.

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AO/AAP关于种植体周围疾病和病症预防和管理的共识：总结报告。

背景：种植体使用的指数增长导致种植体周围疾病（PID）的平行上升，对种植体治疗的成功和患者的生活质量产生不利影响。牙科社区已经努力了解与PID病因和发病机制有关的系统、行为和部位水平的风险因素，并为这些临床实体的管理制定标准化的治疗方案。2024年骨整合学会/美国牙周病学会（AO/AAP）达成共识，旨在将现有的最佳证据和专家意见整合到一个统一的框架中，以预防和管理PID和病症。方法：先前在8个系统综述中解决了重点问题，这些综述分为两个主要主题。组1评估种植体周围粘膜炎和种植体周围炎、种植体周围软组织畸形以及与种植体周围边缘骨丢失相关的假体因素发展的全身和局部危险因素/指标。第2组侧重于PID的治疗策略，包括非手术清创、种植体表面净化方法和手术干预（非重建和重建）。2024年8月14日至16日在伊利诺伊州奥克布鲁克举行的现场会议上进行了结构化的共识讨论，以提供基于证据的建议。结果：大量的系统、行为和局部因素可能在PID的发生和进展中起关键作用。关键的系统和行为危险因素包括牙周炎史、吸烟、未控制的糖尿病、微生物生物膜控制不良和肥胖，而种植体错位、不利的假体因素和种植体周围软组织表型不佳的特征是相关的部位相关因素。种植体周围粘膜炎可以通过非手术清创和控制危险因素有效地治疗。这可能是治疗种植体周围炎的第一步，而更晚期的病例需要个性化的手术方法，包括皮瓣移植、切除、重建或软组织增强手术。支持性种植体周围维持对于种植体周围组织的长期稳定和健康至关重要。结论：结合专家意见，生成了一个循证流程图，供临床医生管理PID和病情，强调早期风险因素识别，量身定制的治疗方案，并持续维护，以优化长期种植体治疗效果。

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