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Journal of Oral Science & Rehabilitation Volume 2 | Issue 4/2016 45 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 ic databaseswere searched using a combination of boolean keywords, including MeSH and sev- eral free-text terms (Table 1). E l i g i b i l i t y c r i t e r i a The following inclusion criteria were defined for the selection of articles: – written in English; – entailing clinical examination of human patients; – randomized controlled clinical trials of implants of ≥ 1 year in function; – prospective and retrospective cohort studies of implants of ≥ 1 year in function; – cross-sectional studies of ≥ 1 year in function; and – systematic reviews, narrative reviews, consensus statements, commentaries or editorials. Articles were excluded if they were – animal studies; – in vitro studies; – reports of locally or systemically compro- mised sites and/or conditions; – reports with < 15 cases; – reports involving mini-implants, one-piece implants or blade implants; or – reports on implants < 1 year in function. Papers without abstracts, but with titles related to the objectives of this review were selected so that the full text could be screened for eligibility. Full-text papers were obtained for all abstracts and titles that appeared to meet the inclusion criteria and were assessed for inclusion by the same two examiners. The reference lists of the selected studies was screened for additional pa- pers that may have met the eligibility criteria of the study. Additionally, manual searches of the reference lists of selected systematic reviews wereconducted,limitedtothefollowingjournals: Clinical Implant Dentistry and Related Research, Clinical Oral Implants Research, International Journal of Oral and Maxillofacial Implants, Jour- nalofClinicalPeriodontology and JournalofPeri- odontology. Any disagreement between the two reviewers was resolved after an additional dis- cussion. Furthermore, inter-investigator agree- ment was calculated in the second stage. A final reviewer(LC) evaluated possible inconsistencies between the two reviewers. All of the full texts oftheselectedpaperswerestoredinsharedfold- ers accessible to all of the reviewers. Q u a l i t a t i v e a s s e s s m e n t o f p a r a m e t e r s t o d e f i n e p e r i i m p l a n t i t i s A descriptive evaluation was performed to ana- lyze qualitatively the range of parameters con- sideredtodefineperiimplantitisasanirreversible inflammatory condition that results in hard- tissue breakdown. Accordingly, the following common parameterswere appraised: PPD, BOP, SUP and radiographic MBL. Such parameters from the various articles were pooled to analyze the variance or uniformity among the reported case definitions of periimplantitis. Graphs for presenting the variance were generated. While PPD was classified into three different groups (< 3 mm, 3–5 mm and > 5 mm), radiographic MBL was categorized into four main ranges, dependingonthe mainreferencetakingprosthe- sis delivery as the baseline: ≤ 1 mm, > 1–2 mm, > 3–4 mm and ≥ 5 mm. Results S c r e e n i n g p r o c e s s The combinations of search terms and a manual search of references in selected articles resulted in a list of1,061titles. Ofthese, 976 articleswere excluded on the basis of the evaluation of the title and abstract, leaving 85 articles eligible for inclusion (ˁ = 0.84). After application of the eli- gibilitycriteria, atotalof49 articleswere consid- ered for review. After full-text article selection and reading, the relevant information from each article was extracted. A diagram of the search strategy is shown in Figure 1. D e f i n i t i o n s o f “ p e r i i m p l a n t i t i s ” Eighteen manuscripts, including narrative and systematic reviews, consensus statements and original papers, were selected and data were ex- tracted. In 1965, Levignac reported a periimplant soft-tissue inflammation with subsequent de- struction ofbone and labeled it “periimplantitis.”1 Inthe1987,Mombellietal.describedperiimplan- titis as an infectious diseasethat sharesfeatures with chronic periodontitis.13 The same author emphasized the infectious nature of this patho- Volume 2 | Issue 4/201645