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

Amsterdam 2018


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.


Publication date: Nov 16, 2018 Last review date: Nov 9, 2018 Next review date: Nov 9, 2021
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