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

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.

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.

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.

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.