Epidemiology and risk factors of peri‐implantitis: A systematic review

Abstract

The purpose of this systematic review and meta-analysis was to assess the prevalence, incidence and risk factors of peri-implantitis in the current literature. An electronic search was performed to identify publications from January 1980 until March 2016 on 9 databases. The prevalence and incidence of peri-implantitis were assessed in different subgroups of patients and the prevalences were adjusted for sample size (SSA) of studies. For 12 of 111 identified putative risk factors and risk indicators, forest plots were created. Heterogeneity analysis and random effect meta-analysis were performed for selected potential risk factors of peri-implantitis. The search retrieved 8357 potentially relevant studies. Fifty-seven studies were included in the systematic review. Overall, the prevalence of peri-implantitis on implant level ranged from 1.1% to 85.0% and the incidence from 0.4% within 3 years, to 43.9% within 5 years, respectively. The median prevalence of peri-implantitis was 9.0% (SSA 10.9%) for regular participants of a prophylaxis program, 18.8% (SSA 8.8%) for patients without regular preventive maintenance, 11.0% (SSA 7.4%) for non-smokers, 7.0% (SSA 7.0%) among patients representing the general population, 9.6% (SSA 9.6%) for patients provided with fixed partial dentures, 14.3% (SSA 9.8%) for subjects with a history of periodontitis, 26.0% (SSA 28.8%) for patients with implant function time ≥5 years and 21.2% (SSA 38.4%) for ≥10 years. On a medium and medium-high level of evidence, smoking (effect summary OR 1.7, 95% CI 1.25-2.3), diabetes mellitus (effect summary OR 2.5; 95% CI 1.4-4.5), lack of prophylaxis and history or presence of periodontitis were identified as risk factors of peri-implantitis. There is medium-high evidence that patient's age (effect summary OR 1.0, 95% CI 0.87-1.16), gender and maxillary implants are not related to peri-implantitis. Currently, there is no convincing or low evidence available that identifies osteoporosis, absence of keratinized mucosa, implant surface characteristics or edentulism as risk factors for peri-implantitis. Based on the data analyzed in this systematic review, insufficient high-quality evidence is available to the research question. Future studies of prospective, randomized and controlled type including sufficient sample sizes are needed. The application of consistent diagnostic criteria (eg, according to the latest definition by the European Workshop on Periodontology) is particularly important. Very few studies evaluated the incidence of peri-implantitis; however, this study design may contribute to examine further the potential risk factors.

A nomogram prediction of peri‐implantitis in treated severe periodontitis patients: A 1–5‐year prospective cohort study

“…The incidence of peri‐implantitis at patient‐level and implant level were 16% and 11.2%, respectively, for 1 to 5 years' function. The incidence was within the incidence range from 0.4% within 3 years, to 43.9% within 5 years reported by previous systematic reviews . And the incidence was relatively low when compared with that of 28.6% within 10 years and 26% within 3–16 years in previous study among periodontally healthy patients .…”

“…As the global number of individuals that undergo restorative therapy through dental implants increases, peri‐implantitis is considered to be a major and growing problem in dentistry . According to a meta‐analysis with 57 studies, the incidence of peri‐implantitis is up to 43.9% within 5 years . As we all know, the inflammatory process that occurs in peri‐implantitis lesions is irreversible .…”

The impact of diabetes on periodontal diseases

“…Peri‐implant tissues exhibit a more pronounced inflammatory response compared with teeth with the same amount of plaque, and reversal of this inflammation takes longer in peri‐implant tissues . Risk factors for peri‐implantitis include a history of periodontitis, poor oral hygiene, smoking, genetic traits, and systemic disease such as diabetes . Although less is known about the pathogenesis of peri‐implantitis, there are a number of studies which indicate that diabetes increases the probability of developing peri‐implantitis .…”

Effect of high glucose levels and lipopolysaccharides‐induced inflammation on osteoblast mineralization over sandblasted/acid‐etched titanium surface

“…Therefore, we conclude from our data, in diabetic patients with periodontitis, once the periodontal pathogen has been removed and inflammation subsides, osteoblast lineage can differentiate, which assists in bone regeneration. Intensive periodontal therapy can significantly reduce biofilm levels and average blood glucose levels in diabetic patients with moderate periodontitis . Naturally, in vitro experiments have always certain limitations that can only be addressed by in vivo studies and our results must be still interpreted with some caution.…”