Bleeding when brushing around an implant years later: what should be checked first?｜證據鏈

Bleeding when brushing around a dental implant means that the area needs to be examined, but bleeding alone cannot distinguish peri-implant mucositis from peri-implantitis, nor can it directly establish implant failure. A more complete assessment considers bleeding after gentle probing, probing depth, the presence of suppuration or pain, any mobility of the restoration or implant, and changes in bone height on imaging together. Research also cautions that different case definitions and probing-depth thresholds can markedly change the estimated proportion of disease. A single probing measurement or one episode of bleeding should therefore not be interpreted without reference to previous records. Another systematic review compared sites with an ‘adequate’ (≥ 2 mm) and an ‘inadequate’ (< 2 mm) width of keratinised mucosa: where oral hygiene is good, the amount of keratinised mucosa has a limited effect on soft-tissue inflammation, but in areas of minimal keratinised mucosa, where difficulty of access for plaque control makes hygiene suboptimal, tissue damage may be greater, and the review therefore still holds that an appropriate amount of keratinised gingiva is required. It is also worth checking whether cleaning aids can reach around the implant crown and whether there are inaccessible areas where plaque can readily accumulate (a checking framework compiled by this site, not a conclusion of the cited literature).