Diagnosis of Peri-Implantitis: A Systematic Review on the Predictive Value of Bleeding on Probing
Amsterdam 2018
Risks and Biologic Complications Associated with Implant Dentistry
Consensus Statement
Structured Assessment and Treatment Planning

Bleeding on probing has been proposed as one of the signs of mucositis and/or peri-implantitis. This review aimed to systematically evaluate the predictive value of the presence or absence of bleeding on probing (BOP) alone for the diagnosis of peri-implantitis.

Thirty-one clinical studies reporting on the prevalence of peri-implantitis, BOP and/or suppuration (SUP) after at least 1 year of functional loading were selected. Meta-analyses were conducted to combine the proportions of peri-implantitis among BOP and/or SUP-positive subjects and implants across studies up to 18 years. Subgroups were created and compared to investigate potential sources of heterogeneity.

For BOP-positive patients, there was a 34% probability to be diagnosed with peri-implantitis (prediction interval 10% to 69%). On average, 24% of implants which presented with BOP across these studies were diagnosed with peri-implantitis. The prediction interval ranged from 7% to 58%. Thus, we can assume that the effect size varied across populations. Longer observation periods were significantly associated with higher proportions of peri-implantitis among BOP-positive implants, reflecting increasing prevalence with time.

This review was limited in its analysis by the heterogeneity of the populations and the variable definitions of peri-implantitis.

Consensus Statements
  • 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.
  • 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.
Clinical Recommendations
  • 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.
Review Paper
Classification Tags
Assessment & Diagnosis
Biological Complications
Consensus Statement
Diagnostic Tools