Smoking and the risk of peri-implantitis. A systematic review and meta-analysis

Survival analysis of implants placed simultaneously with lateral sinus floor elevation in severely atrophic maxilla: A 3- to 12-year retrospective cohort study

OBJECTIVES

To retrospectively evaluate whether implants placed simultaneously with lateral sinus floor elevation (LSFE) in severely atrophic maxilla (residual bone height [RBH] ≤3 mm) could achieve long-term survival and comprehensively analyze the factors influencing their survival rates.

MATERIALS AND METHODS

A total of 123 patients receiving LSFE and simultaneous implant placement from 2010 to 2019 and their 123 implants in sites with RBH ≤3 mm were included in this study. Basic characteristics of patients and implants were collected from the medical record system and cone-beam computed tomography (CBCT) images. Kaplan-Meier survival curves were applied to estimate cumulative survival rates (CSRs) and Cox proportional hazards regression models were used to detect factors influencing implant survival.

RESULTS

The 6-year and 12-year CSR of implants placed in sites with RBH ≤3 mm were 95.7% (95% confidence interval [CI]: 92.1%-99.5%) and 76.6% (95% CI: 58.1%-100%), respectively. Eight patients presented late implant failure. Univariate and multivariate Cox regression analyses demonstrated that RBH ≤2 mm (hazard ratio [HR]: 20.63, p = 0.000) and smoking habit (HR: 6.055, p = 0.024) were significantly associated with long-term implant survival. Specifically, the 10-year CSR of implants in sites with RBH ≤2 mm (53.3%, 95% CI: 27.5%-100%) was dramatically lower than those in sites with RBH >2 mm (92.9%, 95% CI: 81.7%-100%, p = 0.000).

CONCLUSIONS

Implants placed simultaneously with LSFE in sites with RBH ≤3 mm can achieve long-term survival. However, caution is required especially for implantation in sites with RBH ≤2 mm. Besides, the smoking habit is also considered a risk factor jeopardizing long-term implant survival.

Analyzing the Causes and Frequency of Early Dental Implant Failure among Iranians: An Epidemiological Study

Aim

The rate of early dental implant failure (DIF) has increased in recent years, though the risk factors associated with this primary failure remain unclear. This study aimed to determine the rate of early implant failure and identify contributing factors. It was conducted from March 2018 to 2020 in Mashhad, Iran.

Method

This observational study examined the records of 983 implants from the Implant Department of Mashhad Dental School. Variables considered included age, gender, systemic diseases, smoking habits, implant type and size, and surgery-related factors. Data were analyzed using Chi-square, Mann-Whitney U, and Fisher exact tests in SPSS V22, with a p-value of 0.05 or less considered statistically significant.

Result

Of the 983 implants, 42 (4.3%) experienced early failure. The study population consisted of 555 (56.5%) females and 428 (43.5%) males, with an average age of 49.34 ± 13.67 years. A significant correlation was found between surgical complications (e.g., fracture of implant fixtures and inferior alveolar nerve exposure) and implant loading time (Yes or No) with early DIF (p=0.05 and p < 0.01, respectively). However, no significant correlation was observed between early failure and factors such as age, gender, smoking habits, systemic diseases, implant dimensions, or manufacturer.

Conclusion

Surgical complications and loading time may be the most critical factors contributing to early implant failure. Therefore, we suggest dentists pay attention to the mentioned factors in the surgical protocols and their relationship. Further prospective studies on risk factors that could affect early implant failure are needed.

SMOKING MAY BE STRONGLY ASSOCIATED WITH PERI‑IMPLANTITIS

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION

Reis INRD, do Amaral GCLS, Hassan MA, Villar CC, Romito GA, Spin-Neto R, Pannuti CM. The influence of smoking on the incidence of peri‑implantitis: A systematic review and meta-analysis. Clin Oral Implants Res. 2023 Mar 20. doi:10.1111/clr.14066. Epub ahead of print. PMID: 36,939,434.

SOURCE OF FUNDING

None reported.

TYPE OF STUDY/DESIGN

Systematic review with meta-analysis.

Influence of Periodontal Status and Prosthetic Treatment on Survival and Success Rates in Implant Therapy: A 5-Year Retrospective Follow-Up Study

The objective of the present study was to evaluate the 5-year outcome of dental implant therapy and assess the survival, success, and biological and technical complications. A periodontal and prosthetic-oriented evaluation was conducted on the variables that can influence the long-term predictability of implant therapy. A total of 615 patients and 1427 dental implants from a private clinic (MedArtis Dent, Cluj-Napoca, Romania) were enrolled in the study. The study was a longitudinal cohort with data collected retrospectively from physical/digital dental records in combination with a cross-sectional clinical/radiological examination. Results showed that periodontal diagnosis at baseline had a significant impact on the marginal bone loss prediction. Data showed that the cylindrical implant with an internal 45° medium taper connection experienced a higher rate of bone resorption compared to the tapered implant with the 5° internal connection. Screw-retained restorations and overdentures showed a statistical decrease in the marginal bone level height when compared to the cemented restorations. Data from our study suggest that not only is there a powerful association between recall visits and the rate of complications in dental implant treatment, but a lack of professional maintenance predicts a higher bone level loss during the 5-year interval.

The influence of smoking on the incidence of peri-implantitis: A systematic review and meta-analysis

OBJECTIVE

The aim of this study was to systematically analyze the influence of smoking on the incidence of peri-implantitis.

MATERIALS AND METHODS

The search was performed in the National Library of Medicine (MEDLINE-PubMed), SCOPUS, EMBASE, and ISI Web of Science databases (finished on November 30, 2022). Systematic review and meta-analysis were conducted according to PRISMA statement. Prospective cohort studies that evaluate the incidence of peri-implantitis in smokers and non-smokers were included. Two authors independently searched for eligible studies, screened titles, and abstracts, did the full-text analysis, extracted data, and performed the risk-of-bias assessment. The results were summarized through random-effects meta-analyses. The GRADE method was used to determine the certainty of evidence.

RESULTS

A total of 7 studies with 702 patients and 1959 implants were included for analysis. The meta-analysis revealed a significant difference between smokers and non-smokers for the risk of peri-implantitis in the implant-based (p < .0001) and patient-based analysis (p = .003). A strong association between smoking and the risk for peri-implantitis was verified at the implant level (RR: 2.04, 95% CI: 1.46-1.85) and the patient level (RR: 2.79, 95% CI: 1.42-5.50).

CONCLUSIONS

Moderate certainty evidence suggests that smoking is associated with peri-implantitis compared to non-smoking at the patient and implant levels.

Avoiding implant-related complications in medically compromised patients with or without unhealthy lifestyle/Elevated oxidative stress

Increased human life expectancy broadens the alternatives for missing teeth and played a role in the widespread use of dental implants and related augmentation procedures for the aging population. Though, many of these patients may have one or more diseases. These systemic conditions may directly lead to surgical complications, compromise implant/bone healing, or influence long-term peri-implant health and its response to biologic nuisances. Offering patients credible expectations regarding intra- and postoperative complications and therapeutic prognosis is an ethical and legal obligation. Clear identification of potential types of adverse effects, complications, or errors is important for decision-making processes as they may be related to different local, systemic, and technical aspects. Therefore, the present review structures the underlying biological mechanisms, clinical evidence, and clinical recommendations for the most common systemic risk factors for implant-related complications.

Influence of Smoking on Periodontal and Implant Therapy: A Narrative Review

BACKGROUND

smoking is considered the most modifiable risk factor for periodontal disease.

OBJECTIVE

the aim of this narrative review is to emphasize the effect of smoking on periodontal and implant therapy.

METHODS

The authors reviewed the literature reporting the clinical outcomes of smoking on periodontal surgical and nonsurgical treatment. The impact of smoking on implant therapy and sinus lifting procedures were also reviewed.

RESULTS

Periodontal and implant therapy outcomes are adversely affected by smoking. Smokers respond less favorably to periodontal therapy and periodontal flap procedures as compared to nonsmokers. Clinical outcomes for smokers are 50-75% worse than for nonsmokers. Studies reveal that smokers experience a significantly lower reduction in pocket depth compared to nonsmokers as well as less bone growth after treating infra-bony defects with guided tissue regeneration. The relative risk of implant failure is significantly higher in patients who smoke 20 cigarettes or more per day compared to nonsmokers. Additionally, smoking has also been shown to increase postoperative wound dehiscence and infection rates following sinus floor elevation. Longitudinal studies on smoke cessation have shown a reduction in bone loss and probing depths for periodontitis patients after cessation compared to those who smoke.

CONCLUSION

Smoking cessation can reduce probing depths and improve clinical attachment after nonsurgical periodontal therapy. There is insufficient evidence regarding the effect of smoking on peri-implantitis, as well as the loss of implants in the long-term.

A Randomized Clinical Trial Comparing Implants Placed in Two Different Biomaterials Used for Maxillary Sinus Augmentation

The objective of this study was to compare marginal bone loss, surgical and clinical complications, and dental implant survival rate in bilateral maxillary sinus augmented by autologous or porcine xenograft. A randomized controlled clinical trial using split-mouth design enrolled 12 consent adult patients (59.7 ± 8.7 years), who received bilateral maxillary sinus floor augmentation for oral rehabilitation with implant-supported prosthesis. Each patient received both the autologous bone from the mandible (control) or porcine xenograft (test) during the random bilateral sinus lift surgery. A total of 39 dental implants were placed in the posterior maxilla of the 12 patients after 6 months, being rehabilitated after the respective osseointegration period. Both graft materials demonstrated a high implant survival rate at 12 months: 95% for the xenograft side, only 1 implant without osseointegration, and 100% for the autologous side. Radiographic bone loss was low and similar for both groups: control group with a mean of 0.063 ± 0.126, and test group with a mean of 0.092 ± 0.163. No major surgical-related complications have occurred. Only one patient had several prosthetic complications due to fractures of prosthetic components. The maxillary sinus augmentation procedure, both with autologous bone and porcine xenograft materials, is an excellent clinical option procedure for the prosthetic rehabilitation of atrophic maxillae, with low marginal bone loss after one year follow-up, few clinical complications, and a high implant survival rate.

Association of Peri-Implant Health Status With COVID-19

OBJECTIVE

The aim of this research was to evaluate peri-implant health status in patients infected with COVID-19 and control patients (individuals without COVID-19).

METHODS

This observational investigation was performed in adults with (test group) and without (control group) COVID-19 infection having at least 1 functional dental implant. Self-reported education status and daily frequency of toothbrushing and flossing was determined. A questionnaire was administered to record demographic data, brushing/flossing frequency, and education status. Periodontal examination comprised full-mouth assessment of clinical attachment loss (CAL), plaque index (PI), probing depth (PD), and gingival index (GI). Peri-implant PD, modified PI, and modified gingival index were recorded. Loss of marginal and crestal bone around teeth and implants was also measured. Significance level was established for P < .05.

RESULTS

Seventy-three (41 males) and 71 (44 males) individuals were included in the test and control groups, respectively. Average ages of patients and controls were 44.6 ± 5.2 and 40.1 ± 3.1 years, respectively. University-level education was attained by 52 (75.3%) and 50 (70.4%) individuals in the test and control groups, respectively. Seventy (95.9%) and 68 (95.7%) patients and controls were brushing twice a day. Once-daily interproximal flossing was reported by 44 (60.3%) and 48 (67.6%) individuals in test and control groups. All participants had healthy periodontal and peri-implant tissues.

CONCLUSIONS

The study indicated that there are no short-term adverse effects on the peri-implant tissues due to acute COVID-19 infection, and further well-controlled longitudinal studies are needed to evaluate the long-term effect of the infection on these tissues.

Novel use of chloro-aluminum phthalocyanine assisted photodynamic therapy helps in periimplant healing among smoking patients

AIMS

To evaluate the clinical and biochemical peri‑implant parameters using chloro‑aluminum phthalocyanine-(CAP) mediated antimicrobial photodynamic therapy (PDT) as an adjunct to non-surgical mechanical debridement (NSD) in cigarette smokers (CS) and never-smokers (NS) with peri‑implantitis.

MATERIALS AND METHODS

Thirty-two patients with peri‑implantitis [Group CS - 16 and Group NS - 16] were recruited for the trial. The study participants underwent two therapies: PDT + NSD and NSD alone. The clinical peri‑implant parameters assessed in this clinical trial were bleeding on probing (BP), crestal bone loss (CBL) peri‑implant pocket depth (PD), and peri‑implant plaque scores (PS), respectively. Peri-implant crevicular fluid was sampled and the quantification of interleukin (IL)-1β and tumor necrosis factor-alpha (TNF-α) was performed using enzyme linked immunosorbent assay (ELISA).

RESULTS

BP was significantly reduced at 6 months after PDT+NSD in CS groups. Mean PD significantly reduced after both PDT+NSD and NSD subgroups within both NS and CS groups. Only at 6 months did PDT+NSD showed statistically significantly reduced IL-1β levels in the NS group. TNF-α levels significantly reduced in CS group with PDT+NSD and NSD alone at both 3 months and 6 months follow up.

CONCLUSION

CAP-assisted PDT helped to improve the clinical and cytokine levels after non-surgical peri‑implant mechanical debridement in treating peri‑implantitis patients in smokers.

Photodynamic Therapy for Peri-Implant Diseases

Peri-implant diseases are frequently presented in patients with dental implants. This category of inflammatory infections includes peri-implant mucositis and peri-implantitis that are primarily caused by the oral bacteria that colonize the implant and the supporting soft and hard tissues. Other factors also contribute to the pathogenesis of peri-implant diseases. Based on established microbial etiology, mechanical debridement has been the standard management approach for peri-implant diseases. To enhance the improvement of therapeutic outcomes, adjunctive treatment in the form of antibiotics, probiotics, lasers, etc. have been reported in the literature. Recently, the use of photodynamic therapy (PDT)/antimicrobial photodynamic therapy (aPDT) centered on the premise that a photoactive substance offers benefits in the resolution of peri-implant diseases has gained attention. Herein, the reported role of PDT in peri-implant diseases, as well as existing observations and opinions regarding PDT, are discussed.

Does Ultraviolet Radiation Exhibit Antimicrobial Effect against Oral Pathogens Attached on Various Dental Implant Surfaces? A Systematic Review

Background: Dental implant therapy is currently identified as the most effective treatment for edentulous patient. However, peri-implant inflammations were found to be one of the most common complications that leads to the loss and failure of dental implantation. Ultraviolet (UV) radiation has been proposed to enhance bone integration and reduce bacterial attachment. In this study, we aimed to systematically review the current evidence regarding the antimicrobial effect of UV on different dental implant surfaces. Methods: Five databases including PubMed, Scopus, Web of science, VHL, and Cochran Library were searched to retrieve relevant articles. All original reports that examined the effect of the application of UV radiation on dental implants were included in our study. Results: A total of 16 in vitro studies were included in this systematic review. Polymethyl methacrylate UV radiation has induced a significant decrease in bacterial survival in PMMA materials, with an increased effect by modification with 2.5% and 5% TiO₂ nanotubes. UV-C showed a superior effect to UV-A in reducing bacterial attachment and accumulation. UV wavelength of 265 and 285 nm showed powerful bactericidal effects. UV of 365 nm for 24 h had the highest inhibition of bacterial growth in ZnO coated magnesium alloys. In UV-irradiated commercially pure titanium surfaces treated with plasma electrolytic oxidation, silver ion application, heat or alkali had shown significant higher bactericidal effect vs non-irradiated treated surfaces than the treatment with any of them alone. UVC and gamma-ray irradiation increased the hydrophilicity of zirconia surface, compared to the dry heat. Conclusion: UV radiation on Ti surfaces exhibited significant antibacterial effects demonstrated through the reduction in bacterial attachment and biofilm formation with suppression of bacterial cells growth. Combination of UV and treated surfaces with alkali, plasma electrolytic oxidation, silver ion application or heat enhance the overall photocatalytic antimicrobial effect.

Association between cumulative smoking exposure, span since smoking cessation, and peri-implantitis: a cross-sectional study

OBJECTIVES

To investigate the association of cumulative smoking exposure and span since smoking cessation with the occurrence of peri-implantitis.

METHODS

A sample of 350 individuals aged ≥ 35 years, with the presence of at least one osseointegrated implant functioning for > 5 years, were enrolled in the study. According to smoking habits, participants were categorized into 3 groups: non-smokers (NS; n = 212), former smokers (FC; n = 66), and current smokers (CS; n = 72). Complete peri-implant and periodontal examinations were evaluated. Associations between the occurrence of peri-implantitis and smoking habits, as well as potential confounders, were evaluated through univariate and multivariate analyses.

RESULTS

The occurrence of peri-implantitis in the NS, FS, and CS groups was 18.2%, 19.7%, and 30.5%, respectively. A high prevalence of the overall number of cases with periodontitis (54.2%) was observed in the CS group when compared to the FS and NS groups. After adjusting for confounders, the odds ratio (OR) for the occurrence of peri-implantitis was 2.63 (1.39-6.77; p < 0.001) for CS compared to NS. There was a significant dose-response relationship between pack/year of smoking and the occurrence of peri-implantitis, as well as a significant decrease in the risk as the years of smoking cessation increased.

CONCLUSIONS

The occurrence of peri-implantitis among CS was high. The cumulative smoking exposure in an incremental manner and the shorter smoking cessation span was directly associated with a higher risk for peri-implantitis.

CLINICAL RELEVANCE

Educational and preventive strategies in general health services must attempt to reduce the adverse effects of cumulative smoking exposure and to explore the beneficial effects of smoking cessation on peri-implant status.

Pilot Study of Use of Nitric Oxide in Monitoring Multiple Dental Foci in Oral Cavity—A Case Report

Background: The most common cause of implant loss and deteriorating restoration aesthetics is infection and chronic inflammation of the tissues around the implants. Inflammation in the oral cavity, confirmed by clinical and histopathological examination and determination of exhaled nitric oxide, is a situation which may cause the complications on the whole human body. Elimination of the patology in the oral cavity in some cases is the only resonable treatment. The aims and objectives of our work is to present a gradual treatment of advanced infalmmation and present huge reduction stamp of inflammation measured with marker nitric oxide (NO) in exhaled air. Materials and Methods: Simple treatment containing elimantion of pathology in the oral cavity was conducted. Patient that came to the dental practice suffered from the inflammation caused by lack of proper hygiene. First aid in this situation was to eliminate the inflammation which may affect negatively for general health. At first visit full hygienization was performed, at the second visit roots of abutment teeth and implants were removed under local anesthesia along with cystic changes. Results: The hygiene precedures and extraction of the unsteady inflammationprosthetic restorations significantly decreased the level of NO in exhaled air. Conclusions: During the examination of the patient coming to the dental practice great attention should be paid to the coexistence of pathologies related to the oral cavity. Omission of a dental examination and possible elimination of odontogenic foci may affect the implication of the results of general diagnostics and subsequent treatment. Measuring the level of NO on exhaled air seems to be useful diagnostic method.

Five-Year Prospective Study on Implant Failure and Marginal Bone Remodeling Expected Using Bone Level Implants with Sandblasted/Acid-Etched Surface and Conical Connection

OBJECTIVE

 The purpose of the present prospective, case-series study was to report implant survival rate and marginal bone remodeling expected 5 years after loading using dental implants placed in daily practice.

MATERIALS AND METHODS

 This research was designed as an open-cohort, prospective, case-series evaluation. Any partially or completely edentulous patient, scheduled to receive at least one bone level implant, was considered eligible for this study. Primary outcome measurements were: implant and prosthetic cumulative survival rate and any complications experienced up to the 5-year follow-up. Secondary outcome measures were: thickness of gingival biotype, implant insertion torque, implant stability quotient, and marginal bone loss (MBL).

RESULTS

 Ninety consecutive patients (34 males and 56 females, aged between 24 and 81 years old [mean: 53.2 ± 15.4]) with 243 inserted implants were followed for at least 5 years after loading (mean: 65.4 ± 3.1 months; range from 60 to 72). At the 1-year follow-up, no drop-outs were recorded, but 17 patients (18.9%) with 18 restorations (12.6%) delivered on 34 implants (14%) were lost at the 5-year examination. At the 5-year follow-up examination, six implants lost osseointegration (97.5%). In the same period, four prostheses failed (97.2%). Five complications were reported in five different patients (prosthetic success rate was 96.5%, at patient level). Five years after loading, the mean MBL was 0.41 ± 0.30 mm. The difference from the 1-year data was 0.04 ± 0.19 mm. A statistically significant higher MBL was found for smokers, and patients with thin gingival biotype. The mean implant insertion torque was 42.9 ± 4.8 Ncm (range from 15 to 45 Ncm). Two-hundred and three implants (83.5%) were inserted with an insertion torque ≥35 and ≤45 Ncm.

CONCLUSIONS

 High implant survival and success rate could be expected with stable marginal bone remodeling up to 5 years after loading. Smoking and thin tissue biotype were the most important variabilities associated with higher MBL. Further research studies are needed to confirm these results.

Long-term outcomes after peri-implantitis treatment and their influencing factors: a retrospective study

Purpose

This study aimed to determine the long-term outcomes after peri-implantitis treatment and the factors affecting these outcomes.

Methods

This study included 92 implants in 45 patients who had been treated for peri-implantitis. Clinical data on the characteristics of patients and their implants were collected retrospectively. The change in the marginal bone level was calculated by comparing the baseline and the most recently obtained (≥3 years after treatment) radiographs. The primary outcome variable was progression of the disease after the treatment at the implant level, which was defined as further bone loss of >1.0 mm or implant removal. A 2-level binary logistic regression analysis was used to identify the effects of possible factors on the primary outcome.

Results

The mean age of the patients was 58.7 years (range, 22–79 years). Progression of peri-implantitis was observed in 64.4% of patients and 63.0% of implants during an observation period of 6.4±2.7 years (mean±standard deviation). Multivariable regression analysis revealed that full compliance to recall visits (P=0.019), smoking (P=0.023), placement of 4 or more implants (P=0.022), and marginal bone loss ≥4 mm at baseline (P=0.027) significantly influenced the treatment outcome.

Conclusions

The long-term results of peri-implantitis treatment can be improved by full compliance on the part of patients, whereas it is impaired by smoking, placement of multiple implants, and severe bone loss at baseline. Encouraging patients to stop smoking and to receive supportive care is recommended before treatment.

Radiographic peri-implant bone loss after a function time up to 15 years

OBJECTIVE

The aim was to assess the degree of radiographic peri-implant bone loss over a follow-up period up to 15 years. In addition, another aim was to identify risk indicators for peri-implant bone loss and for moderate-severe peri-implantitis at patient- and implant level.

MATERIALS AND METHODS

This is a cross-sectional clinical and radiological study of 147 patients with a total of 425 implants in combination with data collected retrospectively for baseline variables. To calculate the peri-implant bone loss (primary outcome variable), the radiographic bone level measurements from baseline were compared to the radiographic bone level measurements at the final radiographic measurement. Multilevel analyses were adopted with peri-implant bone loss and peri-implantitis as outcome variables.

RESULTS

The mean follow-up time was 12.5 years (range 10-15) and the mean age of the patients was 63 years (range 29-83). The mean peri-implant bone loss was 0.94 mm (S.D. 1.3). The prevalence of moderate-severe peri-implantitis at patient level was 17% and 8.9% at implant level. The peri-implant bone loss was significantly more pronounced in healthy implants if moderate-severe peri-implantitis was present in at least one implant within the same patient. The presence of moderate-severe peri-implantitis was significantly associated with general periodontitis Stages III or IV at follow-up and smoking.

CONCLUSION

The presence of moderate-severe peri-implantitis at patient level was found to be a risk indicator of peri-implant bone loss in healthy implants, while smoking and general periodontitis Stages III and IV were risk indicators of moderate-severe peri-implantitis.

Antineoplastic agents aggravate the damages caused by nicotine on the peri-implant bone: an in vivo histomorphometric and immunohistochemical study in rats

OBJECTIVE

To assess the interaction between chemotherapy and normal tissues is critical to assure quality of life during and after the treatment of cancer. This study evaluated the influence of cisplatin (CIS) and 5-fluorouracil (5-FU) over the peri-implant tissues around osseointegrated titanium implants in animals previously exposed to nicotine. Materials and methods One hundred twenty male rats were divided into two groups, receiving via subcutaneous injection, either physiological saline solution (PSS) (n = 30) or nicotine hemissulfate (NIC) (n = 90) for 30 days prior to implants' placement. One titanium implant (4.0 × 2.2 mm) was installed in each tibia of all animals. PSS and NIC were continued for 30 days after surgery. Five days after cessation, rats were subdivided into three subgroups in accordance with systemic treatments with either PSS, CIS, or 5-FU. Euthanasia was performed at 50, 65, and 95 days post-surgery. Histometric, histopathological, and immunohistochemical analyses were performed.

RESULTS

NIC-CIS and NIC-5FU presented lower BIC (50, 65, and 95 days) and bone area fraction occupancy (BAFO) (65 and 95 days) than group NIC. Intense inflammatory infiltration, severe tissue breakdown, reduced expression of bone formation biomarkers, and upregulation of TRAP were observed in NIC-CIS and NIC-5FU when compared with group NIC. TRAP expression was significantly higher in NIC-5FU as compared with NIC-CIS at 50 and 95 days. Groups NIC, NIC-CIS, and NIC-5FU presented statistically significant negative impact in all outcome parameters than group PSS.

CONCLUSION

CIS and 5-FU severely disrupted the peri-implant tissues around osseointegrated implants in animals previously exposed to nicotine.

CLINICAL RELEVANCE

Assessing the interaction between chemotherapy and normal tissues is critical to assure quality of life during and after the cancer treatment.

Prevalence of early and late oral implant loss among smokers: a nationwide survey in Japan

A cross-sectional, nationwide survey was conducted in Japan to examine the relationship between tobacco smoking and oral diseases including implant failure. A questionnaire survey was sent to designated facilities by post, and 158 answered questions regarding implant loss. Smoking status, number of implant failures, and other related variables were collected from the participating dentists as secondary data. A total of 1966 patients who were treated with dental implants by participating dentists during the survey period were analysed. Among the total sample, 90 (5%) had early implant loss (≤12 months) and 153 (8%) had late implant loss (>12 months and ≤120 months). The number of pack-years was significantly higher in the total (early and late) implant loss group (31.2±15.9) than in the group with no implant loss (26.1±18.1) (P=0.026). In the multivariate analysis, the number of implants installed, smoking, and pack-years were significant factors for total implant loss. The adjusted odds ratio for implant failure for current smokers compared with never smokers was 2.07 (95% CI 1.19-3.62) for early implant loss and 1.48 (95% CI 0.92-2.37) for late implant loss. This study reaffirms that current smoking is associated with an increased risk of early implant loss, irrespective of the duration of smoking exposure.

Ultrashort Implants, Alternative Prosthetic Rehabilitation in Mandibular Atrophies in Fragile Subjects: A Retrospective Study

This study aimed to evaluate the effectiveness of using ultrashort implants in the rehabilitation of jaws of fragile patients. The aim of the study was to retrospectively evaluate the survival rate of full-arch prosthetic rehabilitation on ultrashort implants, length 4 mm, 4 mm in diameter in the premolar and canine area and 4.5 mm in diameter in the molar area, with the insertion torque of 60 Nw and immediate loading. Nineteen patients were evaluated for 3 years clinically and radiographically. The significant majority of the patients at the 3 year follow-up (T4) presented a stable and functional implant-supported prothesis, and the survival rate of the implants was 85%, with a loss of 16 implants on 114 implants. The combination of the innovative implant surfaces and the correct project of the prostheses, with the related implant connection, determined a different timing in the therapy, allowing to obtain an immediate loading, which is currently demanded by patients. This and recent reports on short and ultrashort implant usage in atrophic jaws offer a good solution in critical cases. In conclusion, within the limits of the study, the full-arch rehabilitation with immediate loading on ultrashort implants showed good results with few postoperative complications and related low biological cost.

The impact of a change in classification criteria on the prevalence of peri-implantitis: A cross-sectional analysis

BACKGROUND

Peri-implantitis is a frequent finding but estimates of its prevalence vary widely. This may be due to the wide variety of disease definitions. In 2017 the World Workshop on Periodontal and Peri-implant Diseases and Conditions established new criteria for disease definitions. The aim of this study is to assess the potential impact of a new definition on the future reporting of peri-implant disease.

METHODS

Data from a 2015 report of peri-implant prevalence were examined using the new diagnostic criteria. This cross-sectional study was performed on 95 patients with 220 implants who had their implants placed between 1998 and 2003. An examiner masked to the previous diagnosis examined the radiographs and patient data to make a diagnosis based on 3 mm of bone loss from the expected level of bone. This reanalysis was used to calculate the prevalence of peri-implant disease and generate new relative risk indicators.

RESULTS

The mean follow-up time for the patients was 10.9 years. Using the 2017 criteria, peri-implant mucositis was found in 35.3% of the implants and 52.2% of the subjects, and peri-implantitis occurred in 8.7% of the implants and 15.2% of the subjects. This constituted a drop in peri-implantitis at both patient and implant level of nearly 50% from the prior analysis. Smoking at time of implant placement emerged as a new risk factor in this analysis that was not identified in the prior analysis.

CONCLUSIONS

The new diagnostic criteria significantly reduce the reported prevalence of peri-implantitis and bring new risk factors into focus.

Factors influencing the prevalence of peri-implantitis in implants inserted in augmented maxillary sinuses: A multicenter cross-sectional study

BACKGROUND

Peri-implantitis is widely recognized as a major cause of late implant failure, both in pristine and regenerated bone. The present study aims to evaluate the prevalence of peri-implantitis in implants inserted in augmented maxillary sinuses and to analyze possible risk factors.

METHODS

A cross-sectional study was conducted in four centers including patients who underwent lateral or transcrestal sinus augmentation and received dental implants. Clinical and anamnestic data were collected using a standardized form. Univariate and multivariate logistic regression analyses have been performed for both implant-level and patient-level variables. Subsequently, a multilevel logistic mixed-effect model was built to analyze variables correlated with the occurrence of peri-implantitis.

RESULTS

A total of 156 patients (61 males and 95 females; mean age: 60.9 ± 11.6 years) with 315 implants inserted into augmented maxillary sinuses with a follow-up ranging from 1 to 18 years were evaluated. Seven implants in seven patients were previously lost for peri-implantitis (2.2% and 4.5% at implant- and patient-level, respectively); 250 implants showed no signs of peri-implant diseases (79.4%), 34 implants presented mucositis (10.8%), and 24 implants exhibited peri-implantitis (7.6%). Corresponding data evaluated at patient-level were 125 (80.1%), 17 (10.9%), and 14 (9.0%), respectively. At the multilevel analysis, history of periodontitis, sinus elevation with lateral approach, and one-stage sinus floor elevation significantly correlated with the occurrence of peri-implantitis (P <0.001).

CONCLUSIONS

History of periodontitis confirmed its well-known role as a risk factor for peri-implant pathologies. In addition, both lateral window technique and one-stage sinus floor elevation seemed to represent significant risk factors for peri-implantitis.

Peri-Implant Diseases: Diagnosis, Clinical, Histological, Microbiological Characteristics and Treatment Strategies. A Narrative Review

Since the use of dental implants is continuously increasing, it is imperative for dental practitioners to understand the nature and treatment of peri-implant diseases. The purpose of this manuscript is to comprehensively review peri-implant diseases, their characteristics, as well as their non-surgical and surgical treatment. To that end, the current literature was searched and a narrative review was conducted. It is essential that the case definitions described in the 2017 World Workshop on the Classification of Periodontal and Peri-implant Diseases and Conditions are used to diagnose and classify peri-implant health, peri-implant mucositis and peri-implantitis. While recent epidemiologic studies on peri-implant diseases exist, there is great heterogeneity in the definition of these conditions. Several risk factors and indicators are reported in the literature, with smoking and diabetes being the most universally accepted. In peri-implant mucositis, non-surgical treatment seems to be sufficient. However, for the treatment of peri-implantitis, a surgical approach, which includes open-flap debridement, apically positioned flap and guided bone regeneration, is considered more appropriate. A great variety of adjuncts to mechanical treatment have been reported with controversial results. Finally, studies comparing results from different peri-implantitis treatments are warranted in randomized controlled clinical trials in order to provide stronger evidence-based approaches.

Breaking the wave of peri-implantitis

Peri-implant diseases are prevalent with a weighted mean prevalence rate of 43% across Europe and 22% across South and North America. Although the main etiologic agent is bacterial biofilm, a myriad of factors influence the initiation and progression of the disease. Unfortunately, the treatment of peri-implant diseases is at best favorable in the short term with a high rate of persistent inflammation and recurrence. Therefore, it is sensible to consider and control all potential factors that may predispose an implant to peri-implant tissue inflammation in an attempt to avoid the disease. This paper reviews recent evidence on factors that may predispose implants to peri-implantitis and measures that can be taken to prevent it.

Risk indicators for mucositis and peri-implantitis: results from a practice-based cross-sectional study

Purpose

This practice-based cross-sectional study aimed to investigate whether common risk indicators for peri-implant diseases were associated with peri-implant mucositis and peri-implantitis in patients undergoing supportive implant therapy (SIT) at least 5 years after implant restoration.

Methods

Patients exclusively restored with a single implant type were included. Probing pocket depth (PPD), bleeding on probing (BOP), suppuration, and radiographic bone loss (RBL) were assessed around implants. The case definitions were as follows: peri-implant mucositis: PPD ≥4 mm, BOP, no RBL; and peri-implantitis: PPD ≥5 mm, BOP, RBL ≥3.5 mm. Possible risk indicators were compared between patients with and without mucositis and peri-implantitis using the Fisher exact test and the Wilcoxon rank-sum test, as well as a multiple logistic regression model for variables showing significance (P<0.05).

Results

Eighty-four patients with 169 implants (observational period: 5.8±0.86 years) were included. A patient-based prevalence of 52% for peri-implant mucositis and 18% for peri-implantitis was detected. The presence of 3 or more implants (odds ratio [OR], 4.43; 95 confidence interval [CI], 1.36-15.05; P=0.0136) was significantly associated with an increased risk for mucositis. Smoking was significantly associated with an increased risk for peri-implantitis (OR, 5.89; 95% CI, 1.27-24.58; P=0.0231), while the presence of keratinized mucosa around implants was associated with a lower risk for peri-implantitis (OR, 0.05; 95% CI, 0.01-0.25; P<0.001).

Conclusions

The number of implants should be considered in strategies to prevent mucositis. Furthermore, smoking and the absence of keratinized mucosa were the strongest risk indicators for peri-implantitis in patients undergoing SIT in the present study.

Influence of margin location and luting material on the amount of undetected cement excess on CAD/CAM implant abutments and cement-retained zirconia crowns: an in-vitro study

Background

The flexibility in designing the submucosal part of CAD/CAM customized implant abutments and the individual positioning of its shoulder line has been suggested to reduce the risk of leaving undetected cement residues, thus preventing adverse effects on peri-implant tissues. A high correlation between excess cement left in the soft tissues and the occurrence of increased biofilm accumulation with sulcular bleeding and/ or suppuration has been reported. This in turn may cause peri-implant inflammation and peri-implant marginal bone loss. The aim of this study was to assess the frequency of cement remnants after the luting of zirconia crowns on CAD/CAM custom molar abutments with different margin levels and to evaluate the impact of the luting material.

Material and methods

A total of 20 titanium molar CAD/CAM implant abutments (BEGO Medical GmbH) with internal taper connection/ internal hex anti-rotation protection, and a convex emergence profile with different margin positions (0, 1, 2 and 3 mm below the mucosa), were virtually designed (Implant Studio, 3Shape) and manufactured. A master cast was scanned, duplicated by a 3D printer and individual gingival masks were produced to simulate peri-implant soft tissues. 20 corresponding zirconia crowns were designed (Cerec 3D, Dentsply Sirona), produced and cemented to the abutments with two different luting materials; a zinc oxide non-eugenol cement (Temp Bond NE) or a methacrylate cement (Panavia V5). To ensure retrievability of the crown/abutment connection, occlusal openings providing access to the abutment screws were designed. Excess cement was thoroughly removed and the crown/abutment units were unscrewed to evaluate the occurrence of cement residues. All the quadrants of each specimen were evaluated for calculation of the ratio between the cement remnant area and the total specimen area using Adobe Photoshop. Spearman analysis was performed to detect correlations between different variables. A two-sided t-test, ANOVA, Mann–Whitney, and Kruskal–Wallis tests were applied to detect differences between the groups.

Results

Cement remnants were found in every depth of the crown abutment complex and in almost every area investigated. The amount of cement residues increased as the crown-abutment margin was located more submucosally. Lingual areas were more prone to cement remnants than other surface areas (p = 0.0291). Excess cement was not only found at the margins of the crown-abutment complex, but also underneath (basal) the abutment itself, where cleaning was impossible. No statistical difference in the effect of zinc oxide non-eugenol- and methacrylate cement on the frequency of excess material at the lateral abutment surfaces could be demonstrated in vitro. The proportion of basal abutment aspects covered with cement residues was, however, significantly smaller in Panavia V5 samples with an average of 4.9 ± 3.7% compared to Temp Bond samples with an average of 8.6 ± 5.5%.

Conclusions

Given the results obtained in the present investigation the margin of CAD/CAM molar abutments should be located as coronally as possible to minimize the amount of cement remnants. If an epigingival or supragingival margin location is not feasible due to esthetic concerns, it cannot be recommended to place the margin of molar CAD/CAM abutments deeper than 1.5 mm in the proximal and oral regions.

Understanding Peri-Implantitis as a Plaque-Associated and Site-Specific Entity: On the Local Predisposing Factors

The prevalence of implant biological complications has grown enormously over the last decade, in concordance with the impact of biofilm and its byproducts upon disease development. Deleterious habits and systemic conditions have been regarded as risk factors for peri-implantitis. However, little is known about the influence of local confounders upon the onset and progression of the disease. The present narrative review therefore describes the emerging local predisposing factors that place dental implants/patients at risk of developing peri-implantitis. A review is also made of the triggering factors capable of inducing peri-implantitis and of the accelerating factors capable of interfering with the progression of the disease.

Proinflammatory cytokine levels and peri-implant parameters among cigarette smokers, individuals vaping electronic cigarettes, and non-smokers

BACKGROUND

Tobacco smoking compromises the prognosis of dental implant treatment and is associated with increased risk of peri-implant bone loss and increased implant failure rate. There is a dearth of studies that have compared clinical, radiographic, and immunological peri-implant parameters among cigarette smokers (CS), individuals vaping e-cigarettes (e-cigs), and non-smokers (NS). This study aimed to compare clinical and radiographic peri-implant parameters and levels of matrix metalloproteinase (MMP)-9 and interleukin (IL)-1β levels among CS, individuals' vaping e-cigs, and NS.

METHODS

Thirty-two CS (group 1), 31 individuals vaping e-cigs (group 2), and 32 NS (group 3) were included. Demographic- and implant-related data were collected using a structured baseline questionnaire. Peri-implant plaque index (PI), bleeding on probing (BOP), and probing depth (PD) were recorded and marginal bone loss (MBL) were assessed using standardized digital radiographs. Enzyme-linked immunosorbent assay was used to assess levels of MMP-9 and IL-1β in peri-implant sulcular fluid. Pearson correlation coefficient was used to analyze for correlations of MMP-9 and IL-1β levels with peri-implant parameters.

RESULTS

BOP showed significantly higher values in group 3 as compared with groups 1 and 2 (P < 0.01). PI (P < 0.01), PD ≥ 4 mm (P < 0.01), and mean concentrations of MMP-9 (P < 0.001) and IL-1β (P < 0.01) were significantly higher in groups 1 and 2 than group 3. MBL was significantly higher in group 1 as compared with group 2 and group 3 (P < 0.01). Significant positive correlations were found between MMP-9 (P = 0.0198) and IL-1β (P = 0.0047) levels and MBL in group 1; and a significant positive correlation between IL-1β and MBL in group 2 (P = 0.0031).

CONCLUSIONS

Peri-implant health was compromised among CS than vaping individuals and NS. Increased levels of proinflammatory cytokines in CS and vaping individuals may suggest greater peri-implant inflammatory response.

Peri-implantitis: A Comprehensive Overview of Systematic Reviews

The objective of this systematic review was to perform a comprehensive overview of systematic reviews and meta-analyses pertaining to peri-implantitis in humans, including the prevalence and incidence, the diagnostic findings, microbial findings, effects of systemic diseases, and treatment of peri-implantitis. Electronic databases were searched for systematic reviews and meta-analyses of peri-implantitis. In view of the limitations of the included systematic reviews, the outcome of this overview suggested that (1) occurrence of peri-implantitis was higher in patients with periodontitis, in patients who smoke, and after 5 years of implant function; (2) the microbial profile of peri-implantitis was different from periodontitis; (3) risk for peri-implantitis was higher in patients with uncontrolled diabetes and cardiovascular disease; (4) there was no strong evidence to suggest the most effective treatment intervention for peri-implantitis, although most peri-implantitis treatments can produce successful outcomes; and (5) postimplant maintenance may be crucial in patients with a high risk of peri-implantitis.

Risk Factors for Peri-Implantitis: Effect of History of Periodontal Disease and Smoking Habits. A Systematic Review and Meta-Analysis

Objectives

The purpose of this review was to evaluate whether history of periodontitis and smoking habits could represent a risk factor for peri-implantitis and implant loss.

Material and Methods

This systematic review followed PRISMA guidelines and was registered at the PROSPERO database [registration numbers CRD42016034160 (effect of history of periodontitis) and CRD42016033676 (effect of smoking)]. Broad electronic (MEDLINE) and manual searches were conducted among articles published from January 1^st 1990 up to December 31^st 2015, resulting in 49332 records for history of periodontitis and 3199 for smoking habits. Selection criteria included prospective studies comparing two cohorts of patients, with and without the investigated risk factor, with a minimum follow-up period of three years, and reporting data on peri-implantitis and implant loss occurrence. Considering that only prospective studies were included, dichotomous data were expressed as risk ratios and 95% confidence intervals.

Results

Three studies evaluating history of periodontitis (on which quantitative analysis was performed) and one study on smoking effect were included. Both implant and patient-based meta-analyses revealed a significantly higher risk of developing peri-implantitis in patients with a history of periodontitis compared with periodontally healthy subjects, but not a statistically significant increased risk for implant loss.

Conclusions

The outcomes of this systematic review indicate history of periodontitis as a possible risk factor for peri-implantitis, while insufficient data are present in literature to evaluate the role of smoking. However, available evidence is still weak and immature, and sound epidemiological studies are needed to analyse the specific contribution of these potential risk factors.

Peri-implant disease: what we know and what we need to know

Peri-implant disease is a serious problem that plagues today's dentistry, both in terms of therapy and epidemiology. With the expansion of the practice of implantology and an increasing number of implants placed annually, the frequency of peri-implant disease has greatly expanded. Its clinical manifestations, in the absence of a globally established classification, are peri-implant mucositis and peri-implantitis, the counterparts of gingivitis and periodontitis, respectively.

However, many doubts remain about its features. Official diagnostic criteria, globally recognized by the dental community, have not yet been introduced. The latest studies using metagenomic methods are casting doubt on the assumption of microbial equivalence between periodontal and peri-implant crevices. Research on most of the features of peri-implant disease remains at an early stage; moreover, there is not a commonly accepted treatment for it. In any case, although the evidence so far collected is limited, we need to be aware of the current state of the science regarding this topic to better understand and ultimately prevent this disease.

Risk Factors for Implant Failure and Peri-Implant Pathology in Systemic Compromised Patients

PURPOSE

To identify the possible risk factors for implant failure and peri-implant pathology in a population of systemically compromised patients.

MATERIALS AND METHODS

This retrospective clinical study included a total of 721 systemically compromised patients (422 women, 299 men), with an average age of 51 years (range: 20 to 87) rehabilitated with dental implants. The average follow-up time was 7.3 years. The patients' demographic variables (age and gender) and clinical variables (implant location, type of implant surface, and systemic conditions) were recorded. Outcome measures were implant failure and peri-implant pathology. Binary logistic regression models were performed to investigate the effect of the patients' demographic and clinical characteristics on the dependent variables implant failure and peri-implant pathology. A linear regression model was performed to correlate the patient's characteristics with the number of failed implants. Odds ratios (OR) with 95% confidence intervals and corresponding levels of significance were estimated for each variable.

RESULTS

Multivariate logistic regression disclosed increased age (patients over 40 years of age) as a risk factor for implant failure (OR = 2.63) and hepatitis as a risk factor for peri-implant pathology (OR = 3.74). Multivariate linear regression disclosed rheumatologic and cardiac diseases to be correlated with a higher number of failed implants.

CONCLUSIONS

Within the limitations of this study, the results suggest no absolute contraindications for implant rehabilitation in a population of systemically compromised patients. Nevertheless, this study suggests that increasing age, rheumatological condition, cardiovascular condition, and hepatitis should be considered when performing implant-supported rehabilitations due to their negative influence on the outcome.

Attributable fractions, modifiable risk factors and risk stratification using a risk score for peri-implant pathology

PURPOSE

This study aimed to estimate the impact of risk factors for peri-implant pathology, to identify potentially modifiable factors, and to evaluate the accuracy of the risk algorithm, risk scores and risk stratification.

METHODS

This retrospective case-control study with 1275 patients (255 cases; 1020 controls) retrieved a model according to the predictors: history of Periodontitis, bacterial plaque, bleeding, bone level, lack of passive fit or non-optimal screw joint, metal-ceramic restoration, proximity to other implants/teeth, and smoking habits. Outcome measures were the attributable fraction; the positive and negative likelihood ratios at different disease cut-off points illustrated by the area under the curve statistic.

RESULTS

Six predictors may be modified or controlled directly by either the patient or the clinician, accounting for a reduction in up to 95% of the peri-implant pathology cases. The positive and negative likelihood ratios were 9.69 and 0.13, respectively; the area under the curve was 0.96; a risk score was developed, making the complex statistical model useful to clinicians.

CONCLUSIONS

Based on the results, six predictors for the incidence of peri-implant pathology can be modified to significantly improve the outcome. It was possible to stratify patients per risk category according to the risk score, providing a tool for clinicians to support their decision-making process.

Factors affecting peri-implant bone resorption in four Implant supported mandibular full-arch restorations: a 3-year prospective study

BACKGROUND

Peri-implant marginal bone-level (MBL) alteration represents one of the parameters included in the criteria for determining implant health.

OBJECTIVE

Factors affecting peri-implant MBL alteration for 4-implant-supported fixed mandibular prostheses (4-ISFMP) were assessed.

MATERIAL & METHODS

A 3-year prospective, cohort study was conducted on 44 mandibularly edentulous patients treated with 4-ISFMP. Peri-implant MBL alteration was evaluated radiographically at the 12-, 24- and 36-month follow-ups considering to patient-related risk factors [age, gender, diabetes mellitus, smoking, cardiovascular disease (CVD), rheumatic disorders (RD)] and implant/prosthesis-related features (implant location, keratinized gingiva, denture cantilever length, prosthesis supporting zone, opposing dentition) as well as to peri-implant biological parameters (plaque-, bleeding-, calculus index).

RESULTS

148/176 implants (37 patients, drop-out: 15%) were followed for 3 years showing significant (p < 0.001) annual differences of MBL alterations over time. The univariate analysis demonstrated differences of MBL alterations for smokers (p = 0.014), for patients with CVD (p = 0.001) and RD (p = 0.011). In the 3-year multivariate analysis, MBL alteration was influenced by time (p < 0.001) and showed relationship with risk factors as smoking (p < 0.002; OR = 18.965), CVD (p < 0.021; OR = 5.172), RD (p < 0.006; OR = 50.171) and plaque-index (p = 0.034; OR = 3.252).

CONCLUSIONS

Although peri-implant MBL alteration increased annually, significant odds ratios, were found for patients-related risk factors identifying them potentiating the alterations.

Can Periimplantitis Be Treated?

Over the past few decades, dental implants have been found to have high predictability and survival rates because of improvements in knowledge, clinical expertise, and implant designs. As such, dental implants are frequently integrated in the clinical management of fully or partially edentulous patients. It is prudent to realize that despite the high early survival rates, dental implants do have their fair share of long-term esthetic, biological, and mechanical complications. Therefore, this paper aims to review the current evidence on the management of peri-implant diseases in an attempt to answer the following question: Can periimplantitis be treated?

Prevalence and Possible Risk Factors of Peri-implantitis: A Concept Review

AIM

The purpose of this review is to estimate the prevalence of peri-implantitis, as well as to determine possible risk factors associated with its development in patients treated with oral implants.

BACKGROUND

Although implant therapy has been identified as a successful and predictable treatment for partially and fully edentulous patients, complications and failures can occur. Peri-implantitis is considered a biologic complication that results in bone loss around implants and may lead to implant treatment failure.

RESULTS

A great variation has been observed in the literature regarding the prevalence of peri-implantitis according to the diagnostic criteria used to define peri-implantitis. The prevalence ranges from 4.7 to 43% at implant level, and from 8.9 to > 56% at patient level. Many risk factors that may lead to the establishment and progression of peri-implantitis have been suggested. There is strong evidence that presence and history of periodontitis are potential risk factors for peri-implantitis. Cigarette smoking has not yet been conclusively established as a risk factor for peri-implantitis, although extra care should be taken with dental implant in smokers. Other risk factors, such as diabetes, genetic traits, implant surface roughness and presence of keratinized mucosa still require further investigation.

CONCLUSION

Peri-implantitis is not an uncommon complication following implant therapy. A higher prevalence of peri-implantitis has been identified for patients with presence or history of periodontal disease and for smokers. Until now, a true risk factor for peri-implantitis has not been established. Supportive maintenance program is essential for the long-term success of treatments with oral implants.

CLINICAL SIGNIFICANCE

The knowledge of the real impact of peri-implantitis on the outcome of treatments with oral implants as well as the identification of risk factors associated to this inflammatory condition are essential for the development of supportive maintenance programs and the establishment of prevention protocols.