Diagnosis of Peri-Implantitis: A Systematic Review on the Predictive Value of Bleeding on Probing

Consensus Statement 1: The positive predictive value of Bleeding on Probing (BOP) for the diagnosis of periimplantitis for each implant ranges from about 7%–58%

The positive predictive value of BOP alone for the diagnosis of periimplantitis for each implant ranges from about 7%–58%, depending on the prevalence in the population. This means, if 100 implants present with BOP, between 7 and 58 implants may have peri-implantitis. This statement is based upon the prediction interval of 6.9%–57.8% bounding the weighted mean (24.1%) calculated across 29 studies identified as part of this review.

Consensus Statement 2: The positive predictive value of BOP increases with time after loading

The positive predictive value of BOP alone increases with time after loading. This probably indicates that the prevalence of peri-implantitis increases with time after loading. Shorter observation periods have lower rates of peri-implantitis, while longer observation periods have higher rates of peri-implantitis. This statement is based on the reduced positive predictive value of BOP identified across two studies with 1- to 3-year mean follow-up compared with 27 studies with more than a 3-year mean follow-up.

What are the key criteria to diagnose the presence of peri-implantitis?

BOP alone is insufficient for the diagnosis of peri-implantitis. The diagnosis of peri-implantitis requires the evaluation of inflammation/infection and progressive bone loss that can vary between implants and patients.

What does the predictive value of a diagnostic test mean in clinical practice?

If a site bleeds after probing, there is a chance that the implant may have peri-implantitis. The probability that this is the case is called the positive predictive value. Clinicians should be aware that the positive predictive value of a diagnostic test may vary and is related to the prevalence of the disease within the specific patient population. In specific patient populations where the prevalence of peri-implantitis may be increased, the predictive value may be higher than in a general patient population.