Clinical Appearance, Probing, Bleeding, and/or Suppuration

Signs of peri-implant mucositis are similar to those of gingival disease. In mucositis, soft tissue color changes from pale pink to more red, or may even appear bluish or cyanotic (FIG 5A). Edema of the gingival margin may present as rolled or thickened instead of knife-edged (FIG 5B Interdental papilla may look blunted (FIG 5C). Spontaneous bleeding or bleeding upon probing and/or suppuration may be noted.

Figure 5A.
Image: Note cyanotic gingiva.
Note cyanotic gingiva.
Figure 5B.
Image: Note thickened rolled margin around implant.
Note thickened rolled margin around implant.
Figure 5C.
Image: Note bulbous, red, papilla with spontaneous bleeding, distal to #8 implant.
Note bulbous, red, papilla with spontaneous bleeding, distal to #8 implant.

Probing with traditional light force (0.25N) protects adjacent soft tissues. Using a plastic probe protects the implant surface from scratches. Increasing probing depths, especially with bleeding and or suppuration, when compared to baseline probing (when the final restoration was placed) can be helpful in early diagnosis. However, increasing probing depths and the presence of bleeding and/or suppuration do not distinguish between peri-implant mucositis and peri-implantitis.8