AIM To evaluate the prevalence of peri-implant diseases and to identify risk/protective indicators of peri-implantitis. MATERIALS AND METHODS Two hundred and forty randomly selected patients from a university clinic database were invited to participate. Those who accepted, once data from their medical and dental history were collected, were examined clinically and radiographically to assess the prevalence of peri-implant health and diseases. Peri-implantitis was defined as the presence of BoP/SoP together with radiographic bone levels (BL) ≧2 mm. An intermediate peri-implant health category between peri-implant mucositis and peri-implantitis was also identified, defined by the presence of BoP/SoP together with 1 mm ≦BL < 2 mm. A multilevel multivariate logistic regression analysis was carried out to identify those factors associated either positively (risk) or negatively (protective) with peri-implantitis. RESULTS Ninety-nine patients with a total of 458 dental implants were analyzed. The prevalences of pre-periimplantitis and of peri-implantitis were, respectively, 31.3% and 56.6% at patient-level, while 31.7% and 27.9% at implant level. The following factors were identified as risk indicators for peri-implantitis: smoking (OR = 3.59; 95% CI: 1.52-8.45), moderate/severe periodontitis (OR = 2.77; 95% CI: 1.20-6.36), <16 remaining teeth (OR = 2.23; 95% CI: 1.05-4.73), plaque (OR = 3.49; 95% CI: 1.13-10.75), implant malposition (too vestibular: OR = 2.85; 95% CI: 1.17-6.93), implant brand (Nobel vs. Straumann: OR = 4.41;95% CI: 1.76-11.09), restoration type (bridge vs. single crown: OR = 2.47; 95% CI: 1.19-5.12), and trauma as reason of tooth loss (vs. caries: OR = 6.51; 95% CI: 1.45-29.26). Conversely, the following factors were identified as protective indicators: interproximal flossing/brushing (OR = 0.27; 95% CI: 0.11-0.68), proton pump inhibitors (OR = 0.08; 95% CI: 0.01-0.90), and anticoagulants (OR = 0.08; 95% CI: 0.01-0.56). CONCLUSIONS Peri-implant diseases are highly prevalent among patients with dental implants in this university-based population. Several factors were identified as risk- and protective- indicators of peri-implantitis.

Prevalence and risk/protective indicators of peri‐implant diseases: A university‐representative cross‐sectional study

BACKGROUND Peri-implant defect morphology has shown to potentially impact upon the reconstructive outcomes for the management of peri-implantitis. Given the role that defect morphology plays upon the decision-making in the treatment of peri-implantitis, the present study aimed at assessing the morphology and severity of peri-implantitis bone defects and to insight on the patient-, implant- and site-related variables associated to these. MATERIAL AND METHODS A cone-beam computed tomography study was carried out to classify peri-implantitis defects according to the type of defect, number of remaining bony walls and severity according to the extension of vertical bone loss. Three major defect categories were proposed: class I-infraosseous; class II-horizontal; class III-combined of class I and II. These were then subclassified into: (a) dehiscence; (b) 2/3-wall; and (c) circumferential-type defect. According to the severity the defects were further subclassified into: A: advanced; M: moderate; and S: slight. In addition, 20 site-, implant-, and patient-related variables were analyzed by generalized estimating equations (GEEs) of multilevel logistic regression models. RESULTS Based on an a priori power calculation, 332 implants were screened in 47 peri-implantitis patients. Of these, 158 peri-implantitis implants were eligible. The most prevalent defect morphology type was class Ib (55%) followed by class Ia (16.5%), and class IIIb (13.9%). On the contrary, the less frequent defect was class II (1.9%). The most frequent degree of severity was M (50.6%) with S (10.1%) being the least prevalent. Buccal bone loss was significantly greater compared to the other bony walls in class I and class III defects. Age was associated with the type of defect. Age and smoking habit were associated with the morphology of the defects, while smoking habit, type of prosthesis and distance to adjacent implant were associated with the severity of the defects (vertical bone loss). CONCLUSION Peri-implantitis defects frequently course with an infraosseous component and often with buccal bone loss. Certain patient-, implant-, and site-specific variables are related with defect morphology and severity. However, morphological patterns for peri-implantitis bone defects could not be proven (NCT NCT03777449).

/pdf/morphology-and-severity-of-peri-implantitis-bone-defects-2av9ldl9f8.pdf

Morphology and severity of peri-implantitis bone defects.

PURPOSE To evaluate the efficacy of alternative or adjunctive measures to conventional non-surgical or surgical treatment of peri-implant mucositis and peri-implantitis. MATERIAL AND METHODS Prospective randomized and nonrandomized controlled studies comparing alternative or adjunctive measures, and reporting on changes in bleeding scores (i.e., bleed0ing index (BI) or bleeding on probing (BOP)), probing depth (PD) values or suppuration (SUPP) were searched. RESULTS Peri-implant mucositis: adjunctive use of local antiseptics lead to greater PD reduction (weighted mean difference (WMD) = - 0.23 mm; p = 0.03, respectively), whereas changes in BOP were comparable (WMD = - 5.30%; p = 0.29). Non-surgical treatment of peri-implantitis: alternative measures for biofilm removal and systemic antibiotics yielded higher BOP reduction (WMD = - 28.09%; p = 0.01 and WMD = - 17.35%; p = 0.01, respectively). Surgical non-reconstructive peri-implantitis treatment: WMD in PD amounted to - 1.11 mm favoring adjunctive implantoplasty (p = 0.02). Adjunctive reconstructive measures lead to significantly higher radiographic bone defect fill/reduction (WMD = 56.46%; p = 0.01 and WMD = - 1.47 mm; p = 0.01), PD (- 0.51 mm; p = 0.01) and lower soft-tissue recession (WMD = - 0.63 mm; p = 0.01), while changes in BOP were not significant (WMD = - 11.11%; p = 0.11). CONCLUSIONS Alternative and adjunctive measures provided no beneficial effect in resolving peri-implant mucositis, while alternative measures were superior in reducing BOP values following non-surgical treatment of peri-implantitis. Adjunctive reconstructive measures were beneficial regarding radiographic bone-defect fill/reduction, PD reduction and lower soft-tissue recession, although they did not improve the resolution of mucosal inflammation.

Efficacy of alternative or adjunctive measures to conventional non-surgical and surgical treatment of peri-implant mucositis and peri-implantitis: a systematic review and meta-analysis.

Peri-implantitis is a usual finding but estimates of its prevalence fluctuate very much. This may be due to the wide variety of disease definitions. This systematic review aims to estimate the overall prevalence of peri-implantitis and the effect of different study designs, function times and use of probing depth on prevalence rate.Following electronic and manual searches of the literature published from January 2005 to December 2021, data were extracted from the studies fitting the study criteria. Fifty-seven articles were included in this study.Prevalence of peri-implantitis was 19.53% (95% CI 12.87-26.19) at the patient-level, and 12.53% (95% CI 11.67-13.39) at the implant-level and it remains highly variable even following restriction to the clinical case definition. The use of probing depth like diagnostic criteria affected the prevalence data.The results indicate that it remains essential the identification of the diagnostic markers for more accurate disease classification. 

/pdf/what-is-the-prevalence-of-peri-implantitis-a-systematic-2xhvdxjq.pdf

What is the prevalence of peri-implantitis? A systematic review and meta-analysis

To assess the clinical and radiographic outcomes of implants treated by means of non-surgical debridement with systemic antibiotic therapy. A prospective case series study evaluating the 12-month clinical and radiographic outcomes of peri-implantitis lesions treated with ultrasonic scaler debridement, a glycine air abrasive, and metronidazole followed by supportive maintenance. Clinical and radiographic variables and success criteria were defined a priori. Overall, 21 patients were included. One implant failed during the study period (implant survival rate 95.24%). Substantial changes occurred at 12 months in all the clinical and radiographic variables, reaching strong statistical significance in the majority of them. According to the success criteria applied, 40.90% of the peri-implantitis were arrested and resolved, while 59.1% presented with at least one probed site with bleeding on probing (BoP). Moreover, 95.45% exhibited peri-implant pocket depth (PPD) < 5 mm at the end of the study. None of the implants presented with progressive bone loss. Non-surgical therapy of peri-implantitis is effective to arrest progressive bone loss, reduce PPD and suppuration, and achieve radiographic bone fill in the majority of cases. Nevertheless, it failed to be completely efficacious in the achievement of successful therapeutic outcomes as BoP remained frequently present. Non-surgical therapy achieved significant clinical and radiological improvements.

Non-surgical therapeutic outcomes of peri-implantitis: 12-month results

AIM To evaluate the prevalence of peri-implant diseases in Spain, as well as the associated risk indicators. MATERIAL AND METHODS This is a cross-sectional study using a network of sentinel dentists, who randomly selected 10 patients with implants (placed, at least, 5 years before), which were clinically and radiographically evaluated. Case definitions were established for peri-implant mucositis [bleeding on probing (BOP) and no bone level ≥2 mm] and peri-implantitis (BOP plus bone level ≥2 mm). Potential predictor variables, at univariate and multivariate levels, were explored by means of binary logistic regression. RESULTS A total of 49 sentinel dentists provided complete data from 474 implants in 275 patients. At implant level, prevalences for peri-implant mucositis and peri-implantitis were 27% (95% confidence interval [CI] 22-32) and 20% (95% CI: 15-24), respectively, with 17% of implants (14-21) with bone level ≥2 mm without BOP. At patient level, prevalences were 27% (22-32), 24% (19-29) and 18% (13-22), respectively. In the multiple regression analysis, statistically significant associations for peri-implantitis (p < 0.10) were found for gender, peri-implant supportive therapy, implant location, diameter and surface, type of prosthesis and access to interproximal hygiene. CONCLUSIONS In this representative subject sample across Spain, the prevalence of peri-implant diseases was high (51%).

Prevalence and risk indicators of peri-implant diseases in Spain.

Objectives To evaluate radiographic bone level (RxBL) at dental implants and its associated factors in Spain. Material and methods This cross-sectional study was performed by a network of sentinel dentists from regions of Spain. RxBL was defined as the distance from the implant shoulder to the first clearly visible contact between the implant surface and the bone. Radiographic measurements were performed by two trained and experienced periodontists. Implant and patient data were also collected. Descriptive, bivariate, discriminative and multivariate analyses were done. Results A total of 49 sentinel dentists provided data 275 patients. Mean RxBL from 474 implants (5-13 years) was 1.87 mm (range: 0.00-13.17 mm). Statistically significant associations between RxBL and clinical output variables (bleeding on probing, oedema, plaque, probing depth, suppuration, keratinized tissue) were found. In the multiple regression analysis, statistically significant associations for RxBL were found for smoking habit, implant diameter, years of follow-up and type of prosthesis (p Conclusions Peri-implant RxBL ranged from 0 to 13.17 mm. It was significantly associated with clinical output variables and with some potentially predictor variables, at patient- (smoking >10 cigarettes/day) and implant- (diameter, years of follow-up, Toronto bridge) levels.

Peri‐implant radiographic bone level and associated factors in Spain

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Prevalence and risk indicators of peri-implant diseases in Spain.

Peri‐implant radiographic bone level and associated factors in Spain