AO/AAP consensus on peri-implant diseases (2025): the risk factors that matter, debridement first for mucositis, surgery when peri-implantitis does not respond, and a recall every 3 to 6 months

What it says#

The summary report comes out of a consensus meeting the American Academy of Periodontology and the Academy of Osseointegration organized jointly in Oak Brook, Illinois, from August 14 to 16, 2024. Eight systematic reviews were commissioned first and sorted into two groups. Group 1 covered systemic, behavioral and patient-related risk factors for peri-implant mucositis and peri-implantitis, surgical and implant-related factors, prosthetic design and marginal bone loss, and soft tissue dehiscences in the absence of disease. Group 2 covered nonsurgical debridement, implant surface decontamination, and nonreconstructive and reconstructive surgery. The panel voted on statements and reported each result as unanimous (100%), strong consensus (over 95%), consensus (75% to 95%), simple majority (50% to 74%) or no consensus (under 50%).

Two definitions frame the report. Peri-implant mucositis is a reversible inflammatory lesion of the peri-implant mucosa, in the absence of marginal bone loss beyond the initial biological bone remodeling. Peri-implantitis is a persistent inflammation of the peri-implant mucosa with subsequent loss of supporting bone that can jeopardize implant stability and long-term success; its bone loss, the report says, tends to follow a nonlinear, accelerating pattern. The epidemiologic studies the panel cites put mucositis at about 43% to 47% of implant patients and peri-implantitis at 20% to 22%. The pooled patient-level incidence of peri-implantitis was 12% at 5 years, 14% at 10 and 22% at 20; for mucositis, 46%, 61% and 53%.

On risk, the meta-analyses give odds ratios for peri-implantitis: current or former smoking, OR 2.27 (95% CI 1.68 to 3.06); history of periodontitis, OR 2.92 (2.05 to 4.13); active periodontitis, OR 4.05 (3.06 to 6.35); diabetes, OR 2.31 (1.59 to 3.32), with 95% of the panel agreeing that uncontrolled or poorly controlled diabetes carries higher risk. Obesity or metabolic syndrome was rated a moderate risk. Among site factors, implant malposition was high risk with consensus; an interimplant distance under 3 mm and a platform more than 6 mm apical to the adjacent tooth's midfacial CEJ were moderate; residual submucosal cement was rated high risk without consensus. On the prosthesis, a transmucosal abutment height of 2 mm or more decreases the risk of marginal bone loss (85% agreed) and a transmucosal angle over 30 degrees increases it (92% agreed). Keratinized mucosa under 2 mm was high risk with consensus.

On treatment, mucositis should be managed through an etiology-based approach that is primarily, though not exclusively, nonsurgical debridement with implant-safe instruments, together with control of risk factors; the abstract adds that this possibly represents the first step in treating peri-implantitis. For peri-implantitis, nonsurgical, minimally invasive therapy is the first line, to reduce microbial load and inflammation while preserving the implant and bone; surgical intervention may be required if the condition does not improve or the disease recurs. When feasible, reconstructive surgery is preferable to nonreconstructive approaches (79% agreed), and it should be performed wherever the lesion morphology favors it, with multiple bony walls, infraosseous compartments and defects 3 mm or more in depth (strong consensus, 97%). The pooled probing depth reduction after reconstructive surgery was 2.88 mm (95% CI 2.49 to 3.28). No gold-standard surface decontamination method has been identified. Supportive peri-implant therapy (SPiT) intervals of 3 to 4 months are recommended for mucositis patients under active surveillance (88% agreed) and for patients treated for peri-implantitis (94%); 5 to 6 months for mucositis patients who need less active surveillance (88%).

The AAP's flowcharts, drawn from the clinical translation paper, add the timing: re-evaluate after 6 weeks or more of nonsurgical therapy and 4 months or more after surgery, keep a 3 to 4 month recall, and at one year reassess the risk profile, moving a low-risk patient to 5 to 6 months and keeping a high-risk patient at 3 to 4.

Who it applies to#

Every patient with an implant, because the framework begins before disease: the risk section is written for treatment planning (position, spacing, abutment height, emergence angle, keratinized tissue, cement) as much as for diagnosis, and the maintenance section has no end date. The treatment sections apply to mucositis and to peri-implantitis at every stage, including the surgical decisions a general practice usually refers.

The report does not set its own numeric case definitions; it describes the two diseases and relies on the 2018 classification for thresholds. It names no single decontamination method as standard, and it did not support systemic antibiotics as a routine adjunct for mucositis. The disclosure on the PubMed record lists consulting and lecture fees from implant and biomaterial companies among the participants, which a reader weighing the surgical recommendations should know.

What changed#

The 2018 classification defined peri-implant health, mucositis and peri-implantitis but did not say how to treat them. This is the first joint AO/AAP consensus on prevention and management, and its contribution is the sequence: risk identification, then debridement, then a staged move to surgery, then maintenance, with agreement percentages attached to each step. It also moves risk upstream into the prosthetic and surgical plan, rating abutment height, emergence angle, platform depth and cement as risk factors in their own right. In the panel's words, implant therapy should be substantiated on a preventive mindset, and it notes lower predictability of success in treating peri-implant disease than periodontal disease.

Where the source is#

The document is Wang and colleagues, AO/AAP consensus on prevention and management of peri-implant diseases and conditions: Summary report, Journal of Periodontology 2025, volume 96, issue 6, pages 519 to 541, doi 10.1002/JPER.25-0270, published open access by Wiley for the American Academy of Periodontology. The Wiley site refused automated access when this entry was written, so the full text was read in PubMed Central (PMC12273748), which the link under the title opens; the abstract and disclosures were read on PubMed. The eight systematic reviews are in the same June 2025 issue of the Journal of Periodontology and in the International Journal of Oral and Maxillofacial Implants, and the workgroup reports in Clinical Advances in Periodontics and the International Journal of Periodontics and Restorative Dentistry, all linked from the AAP page listed above; the AAP flowcharts PDF is free.