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A Stage- and Grade-Based Classification of Peri-Implantitis
Eswar Kandaswamy, Vinayak Joshi, Guo-Hao Lin, Giacomo Baima, Mario Aimetti, Harlan Shiau, Hom-Lay Wang, Vivek Math
Background: Peri-implantitis binary classification (present/absent) overlooks disease severity, progression rate, and patient-specific risk factors, undermining diagnostic accuracy and outcome measurement. To address these limitations, a new classification is proposed integrating radiographic bone loss (RBL), clinical parameters, and risk modifiers.
Results: Classification combines staging (disease severity) and grading (future progression risk). Staging is determined by pathologic RBL, BoP, and suppuration, with implant malpositioning serving as a stage modifier. Stage I (Mild): RBL <25% (coronal-third), Stage II (Moderate): RBL 25–50% (middle-third), Stage III (Severe): RBL >50% (apical-third) or severely malpositioned implants. Grading incorporates direct (serial RBL change) or indirect evidence of bone loss (%RBL per years in function), refined by patient-level risk factors. Grade A (low risk) RBL <0.5 mm, Grade B (moderate risk) 0.5–2.0 mm RBL over 5 years, Grade C (high risk) >2 mm RBL over 5 years or rapid deterioration within a short interval. Risk predictors (history of periodontitis, smoking, poor plaque control, prior implant failure at the same site) can further modify grade within each stage.
Conclusion: This stage–grade model provides a biologically grounded and clinically structured framework to characterize peri-implantitis severity, management complexity, and progression risk.