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Treatment Algorithm · Module
Survival is not success: grading implant health
An implant still in the mouth is not necessarily a healthy one. This module separates survival from success, sets the marginal-bone-loss thresholds, and grades a case across the ICOI Pisa health scale from optimum health to failure.
Use: Outcome & prognosis reference
Driver: Clinical + radiographic findings
Framework: Albrektsson · ICOI Pisa
01 — Definitions
Survival, success, and the bone-loss thresholds
"Survival" only asks whether the implant is still in place. "Success" is a higher bar requiring health of the implant and surrounding tissues. The two are reported separately because survival rates flatter outcomes that include diseased but retained implants.
Concept
Survival
- Implant still present and not removed
- Says nothing about tissue health or bone loss
- May include ailing / failing implants
- Usually the highest reported figure
Concept
Success
- Implant and tissues are healthy
- No mobility, pain, or peri-implant radiolucency
- Bone loss within accepted thresholds
- A stricter, more meaningful endpoint than survival
Classic criteria
Albrektsson (1986)
- No clinical mobility when tested
- No peri-implant radiolucency
- No persistent pain, discomfort, or infection
- Bone loss < 1.5 mm first year, then < 0.2 mm/yr
Bone-loss view
Thresholds in context
- Historic benchmark: < 1.5 mm yr 1, then < 0.2 mm/yr
- Contemporary view: little remodeling expected with platform-switched / bone-level designs
- Progressive loss + BOP/suppuration ⇒ peri-implantitis, not normal remodeling
- Always interpret against a baseline radiograph
02 — Decision Pathway
Interactive health-grade selector
Combine pain/mobility, bone loss vs. baseline, probing depth and BOP/exudate, then classify the implant on the ICOI Pisa Quality of Health Scale. Thresholds below follow Misch et al. (2008).
Tap the finding set that best matches the implant.
Step 1 — What do the clinical and radiographic findings show?
GROUP I
No pain · no mobility · bone loss < 2 mm · no exudate
Optimum health, stable tissues.
GROUP II
No pain · no mobility · bone loss 2–4 mm · stable
Reduced but stable support.
GROUP III
Bone loss > 4 mm (< 50%) · deepening pockets · BOP/exudate
Active peri-implantitis, no mobility.
GROUP IV
Mobility · pain on function · > 50% bone loss · uncontrolled exudate
Clinical or absolute failure.
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03 — Quick Reference
Parameter → success vs. failing thresholds
A side-by-side of the parameters used to grade implant health. A healthy/successful implant satisfies all columns on the left; a failing implant shows one or more findings on the right.
| Parameter | Success / health | Failing / failed |
|---|
| Mobility | None on clinical testing | Clinically detectable mobility |
| Pain / function | None on percussion or function | Pain on function (absolute failure) |
| Marginal bone loss | < 1.5 mm yr 1, then < 0.2 mm/yr (Albrektsson); < 2 mm total (Pisa success) | > 4 mm, or > 50% of implant length |
| Probing depth | Stable vs. baseline | Increased to half the implant length |
| BOP / suppuration | Absent | Persistent bleeding; exudate > 2 weeks |
| Radiolucency | No peri-implant radiolucency | Peri-implant radiolucency present |
Reference
Sources & clinical disclaimer
For licensed clinicians — educational use only. This algorithm summarizes published consensus and is not a substitute for individual clinical judgment, examination, or the standard of care in your jurisdiction. Health-scale grading requires a baseline radiograph and full peri-implant assessment; classification guides — but does not replace — definitive diagnosis and treatment planning.
- Albrektsson T, Zarb G, Worthington P, Eriksson AR. The long-term efficacy of currently used dental implants: a review and proposed criteria of success. Int J Oral Maxillofac Implants. 1986;1(1):11–25.
- Misch CE, Perel ML, Wang HL, et al. Implant success, survival, and failure: the International Congress of Oral Implantologists (ICOI) Pisa Consensus Conference. Implant Dent. 2008;17(1):5–15.
- Buser D, Janner SFM, Wittneben JG, et al. 10-year survival and success rates of 511 titanium implants with a sandblasted and acid-etched surface: a retrospective study. Clin Implant Dent Relat Res. 2012;14(6):839–851.
Last reviewed: June 2026 · Next review due: June 2027 · Version 1.0