Is bleeding on probing a reliable clinical indicator of peri‐implant diseases?

Bleeding on probing (BOP) is regarded as an indispensable diagnostic tool for evaluating periodontal disease activity; however, its role in peri‐implant disease is more intricate. Much of the confusion about the interpretation originates from drawing parallels between periodontal and peri‐implant conditions. BOP can originate from two forms of probing in implants: traumatic or pathologic induction. This, in addition to the dichotomous scale of BOP can complicate diagnosis. The objective of this commentary is to discuss the following: 1) the value of BOP as a diagnostic tool for peri‐implant diseases; 2) the reasons it should be distinct from value for diagnosing periodontal and peri‐implant diseases; and 3) the current best evidence on how to implement it in daily clinical practice. A comprehensive bleeding index is proposed for evaluating and monitoring peri‐implant conditions. BOP should be used in addition to other parameters such as visual signs of inflammation, probing depth, and progressive bone loss before a peri‐implant diagnosis is established.