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. 2025 Jun;96(6):519-541.
doi: 10.1002/JPER.25-0270. Epub 2025 Jun 12.

AO/AAP consensus on prevention and management of peri-implant diseases and conditions: Summary report

Hom-Lay Wang  1 , Gustavo Avila-Ortiz  2   3 , Alberto Monje  1   4   5 , Purnima Kumar  1 , Javier Calatrava  1   2 , Tara Aghaloo  6 , Shayan Barootchi  1   3   7 , Joseph P Fiorellini  8 , Maria Elisa Galarraga-Vinueza  3   9 , Joseph Kan  10 , Guo-Hao Lin  1   11 , Andrea Ravida  12 , Muhammad H A Saleh  1 , Lorenzo Tavelli  3   7   13 ; AO/AAP Consensus Participants; Paul S Rosen  14   15
Collaborators, Affiliations

AO/AAP consensus on prevention and management of peri-implant diseases and conditions: Summary report

Hom-Lay Wang et al. J Periodontol. 2025 Jun.

Abstract

Background: The exponential increase in dental implant use has led to a parallel rise in peri-implant diseases (PID), adversely affecting implant therapy success and patient quality of life. Efforts have been made by the dental community to understand systemic, behavioral, and site-level risk factors involved in the etiologies and pathogenesis of PID and conditions and to develop standardized treatment protocols for the management of these clinical entities. The 2024 Academy of Osseointegration/American Academy of Periodontology (AO/AAP) consensus aimed to integrate the best available evidence and expert opinion into a unified framework for the prevention and management of PID and conditions.

Methods: Focused questions were previously addressed in eight systematic reviews that were grouped into two main topics. Group 1 evaluated systemic and local risk factors/indicators for the development of peri-implant mucositis and peri-implantitis, peri-implant soft tissue deformities, as well as prosthetic factors associated with peri-implant marginal bone loss. Group 2 focused on therapeutic strategies for the management of PID, encompassing nonsurgical debridement, implant surface decontamination methods, and surgical interventions (both nonreconstructive and reconstructive). Structured consensus discussions were held during an on-site meeting in Oak Brook, Illinois (August 14-16, 2024) to inform evidence-based recommendations.

Results: A plethora of systemic, behavioral, and local factors may play a pivotal role in the onset and progression of PID and conditions. Key systemic and behavioral risk factors include history of periodontitis, smoking, uncontrolled diabetes, poor microbial biofilm control, and obesity, while implant malposition, unfavorable prosthetic factors, and suboptimal peri-implant soft tissue phenotypical features are relevant site-related factors. Peri-implant mucositis may be effectively managed with nonsurgical debridement and control of risk factors. This possibly represents the first step of treatment of peri-implantitis, whereas more advanced cases require individualized surgical approaches, ranging from flap-for-access, resective, reconstructive, or soft tissue augmentation procedures. Supportive peri-implant maintenance is essential for long-term peri-implant tissue stability and health.

Conclusions: An evidence-based flow diagram combined with expert opinion was generated for clinicians to manage PID and conditions, emphasizing early risk factor identification, tailored treatment protocols, and continued maintenance to optimize long-term implant therapy outcomes.

Keywords: dental implant prosthetics; dental implants; peri‐implant diseases; peri‐implant mucositis; peri‐implant soft tissue dehiscence; peri‐implantitis; supportive peri‐implant therapy.

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Conflict of interest statement

Participants filed detailed disclosure of potential conflicts of interest relevant to the meeting topic, and these are kept on file. The authors receive, or have received, consulting fees and/or lecture compensation from the following companies: BioHorizons, Brasseler USA, Bredent Medical, Camlog, Dentsply Sirona, Geistlich, ITI, Nobel Biocare, Novabone LLC, Osteogenics, Osteology Foundation, Straumann, W&H, and ZimVie. Dr. Ioannidou is the editor‐in‐chief of the Journal of Periodontology. Dr. Kotsakis holds a patent for a dental irrigator (US‐2024390122‐A1) and is an associate editor of the Journal of Periodontology. Dr. Levine is currently employed by Geistlich Pharma North America. Dr. Pirih is an associate editor of the Journal of Periodontology. Dr. Schwarz is an executive board member of the Osteology Foundation. Dr. Stanford is the editor‐in‐chief of the International Journal of Oral & Maxillofacial Implants.

Figures

FIGURE 1
FIGURE 1
Flow diagram for nonsurgical treatment of peri‐implant mucositis (without flap elevation). BOP, bleeding on probing; CPC, cetylpyridinium chloride; OTC, over the counter; PD, probing depth. Reprinted with permission from Quintessence Publishing and the International Journal of Periodontics & Restorative Dentistry.
FIGURE 2
FIGURE 2
Flow diagram for adjunctive therapies (antibiotics or probiotics) to nonsurgical treatment of peri‐implant mucositis. Reprinted with permission from Quintessence Publishing and the International Journal of Periodontics & Restorative Dentistry.
FIGURE 3
FIGURE 3
Flow diagram for nonsurgical treatment of peri‐implantitis (without flap elevation). BOP, bleeding on probing; CHX, chlorhexidine; CPC, cetylpyridinium chloride; OTC, over the counter; PD, probing depth. Reprinted with permission from Quintessence Publishing and the International Journal of Periodontics & Restorative Dentistry.
FIGURE 4
FIGURE 4
Flow diagram for adjunctive methods (antibiotics or probiotics) to nonsurgical treatment of peri‐implantitis. PD, probing depth. Reprinted with permission from Quintessence Publishing and the International Journal of Periodontics & Restorative Dentistry.
FIGURE 5
FIGURE 5
Flow diagram for surgical treatment options of peri‐implantitis. OFD, open flap debridement; PD, probing depth; SRP, scaling and root planing. Reprinted with permission from Quintessence Publishing and the International Journal of Periodontics & Restorative Dentistry.
FIGURE 6
FIGURE 6
Flow diagram illustrating key considerations regarding soft tissue reconstruction procedures for prevention and management of peri‐implantitis. CAL, clinical attachment level; CBCT, cone‐beam computed tomography. Reprinted with permission from Quintessence Publishing and the International Journal of Periodontics & Restorative Dentistry.
FIGURE 7
FIGURE 7
Flow diagram for supportive peri‐implant therapy after treatment of peri‐implant mucositis. Reprinted with permission from Quintessence Publishing and the International Journal of Periodontics & Restorative Dentistry.
FIGURE 8
FIGURE 8
Clinical flow diagram for supportive peri‐implant therapy after treatment of peri‐implantitis. SPiT, supportive peri‐implant maintenance therapy. Reprinted with permission from Quintessence Publishing and the International Journal of Periodontics & Restorative Dentistry.
See this image and copyright information in PMC

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