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Journal of Oral Science & Rehabilitation Volume 2 | Issue 4/2016 43 D e f i n i t i o n o f p e r i i m p l a n t i t i s Introduction The term “periimplantitis” was introduced in the early 1960s to describe infectious pathological conditions of the periimplant tissue.1 Today, periimplantitis isthe mostfrequent complication of dental implants and occurs with a frequency ranging from 1% to 47% at implant level.2–9 Dif- ferentfromperiimplantmucositis(definedasthe presence of reversible inflammatory soft-tissue infiltrate, without additional bone loss beyond the initial physiological bone remodeling),10 periimplantitishasbeendescribed asbeingchar- acterized by an inflammatory process around an implant, including both soft-tissue inflammation and progressive loss of supporting bone beyond thephysiologicalcrestalboneremodeling.10 How- ever, as highlighted in recent literature reviews and consensus conferences, different definitions of periimplantitis have been reported.5–8, 11 This may be due in part to the lack of consensus on terminology, etiology, diagnosis and prognosis systems.4, 5, 12 Periimplantitis has been described as a disea- se with an infectious component that is similarto chronicperiodontitis.13 The8th EuropeanWorkshop on Periodontologyhas agreedthatthe definitions publishedin200810 and20118 shouldbeadopted. Thesuggesteddefinitionshouldincludethefollo- wing:changesinthelevelofcrestalbone,positive bleeding on probing (BOP) and/or suppuration (SUP), with or without concomitant periimplant pockets(probingpocketdepth,PPD).8 Nowadays, although plaque accumulation is still considered themainetiologicalfactor,14 ithasbeenshownthat there are otherpotentialrelated riskfactors ofthe disease, including patient, surgical and prosthetic factors that may certainly contribute to its de- velopment.15–22 IntheMeSH(MedicalSubjectHeadings)data- base,theterm “periimplantitis”was introduced in 2011anddefinedasaninflammatoryprocesswith loss of supporting bone in the tissue surrounding functioning dental implants.23 Despite this very clearandcomprehensivediseasedefinition,incon- sistencies and confusion emerge in applying the terminologyclinically.Allofthesefactorstogether haveledtodifferentinterpretationsanddefinitions ofthiscommonemergingdisease.Besides,recent- ly, the noninfectious foreign-body reaction hypo- thesis hasfurthercomplicatedthe understanding of this issue.22 The aim of the present systematic review was to present the different definitions of periimplantitis proposed in the literature. Materials and methods The present paperwas prepared in partial fulfill- ment of a consensus statement held in Rome, Italy, in January 2016. This systematic review waswritten accordingtothe PRISMA(Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines (http://www.prisma- statement.org/PRISMAStatement/PRISMA- Statement.aspx). The focused question was: Is there an unani- mous definition of periimplantitis, including clinical diagnosis. The research question was adapted to the PICO format: P = population: human patients derived from clinical studies, systematic reviews, narrative reviews,consensusesstatements,commentaries or editorials, who presented with at least one dental implant in function for a minimum of one year, affected by periimplantitis; I = intervention: clinical data collected with the aimofestablishingtheseverityoftheperiimplant disease and ofdefining novelcriteria bywhichto classify periimplant diseases; C = comparator/control: clinical outcomes of periimplantitis compared with clinical signs of periodontitis, as well as with healthy patients; O = outcomes: clinical parameters and radio- graphicassessmentofperiimplantitis:BOP,PPD, bleeding index, presence of SUP and marginal bone loss (MBL). S e a r c h s t r a t e g y An initial search strategy encompassing the En- glishliteraturefrom1967uptoOctober2015was performedonlinetoidentifyrelevantstudiesthat mettheinclusioncriteria.Thefollowingelectron- ic databases were consulted: PubMed database ofthe U.S. National Libraryof Medicine, Embase (Excerpta Medica dataBASE) and the Cochrane Library. According to the AMSTAR (A Measure- mentTooltoAssess Systematic Reviews) check- list, the Grey Literature Database was screened in the New York Academy of Medicine Grey Lit- erature Report in order to find possible unpub- lished works. Screening was performed inde- pendentlyand simultaneouslybytwo examiners (MT and AM). A third reviewer (LC) reassessed the included and excluded studies.The electron- Volume 2 | Issue 4/201643