Prevalence and risk indicators of peri‐implantitis: an university‐representative cross‐sectional study

Abstract

Background: Despite some epidemiological studies are available on the prevalence and risk indicators of peri-implant diseases, there is still a need of studies in different settings since the role of some risk factors is still putative. To minimize selection bias, representative samples should be used. However, only two epidemiological studies have analysed the epidemiology of peri-implantitis using representative samples so far, both referring to private settings and not to university clinics. Aim/Hypothesis: The aim of this cross-sectional study was to analyse the prevalence of peri-implantitis and its risk indicators in a university-based representative sample. Materials and Methods: 240 patients who received at least one dental implant in an EFP Program in Periodontology between the years 2000 and 2017 and in function by at least 1 year were randomly selected. Those who accepted to participate received a detailed medical and dental history assessment, a clinical examination and a standardized peri-apical radiograph. Peri-implantitis was both defined according to the 2018 World Workshop (bone levels≧3 mm & BoP/SoP) and according to the case definitions of Sanz & Chapple 2012 (bone levels≧2 mm & BoP/SoP). The prevalence of peri-implantitis was then calculated, as well as a multilevel multivariate logistic regression analysis was carried out to identify the risk indicators associated with peri-implantitis. Results: 109 patients with a total of 508 implants accepted to participate. The prevalence of peri-implantitis according to the definition of the 2018 World Workshop was 6.52% at implant-level and 16.19% at patient-level. The prevalence of peri-implantitis according to the Sanz & Chapple 2012 case definition was 33.86% at implant-level and 60.75% at patient level. The following factors were identified as risk indicators for peri-implantitis (Sanz & Chapple 2012 case definition): - smoking (OR = 3.3; 95% CI: 1.2–8.9); - diabetes (OR = 12.66; 95% CI: 1.78–90.16); - moderate/severe periodontitis (AAP) (OR = 3.7; 95% CI: 1–40–9.74); - use of interproximal brushes (OR = 0.18; 95% CI: 0.06–0.62); - implant brand (Nb vs. S: OR = 5.12; 95% CI: 1.90 – 13.90); - type of super-structure (multi-unit restorations vs. single crown: OR = 2.37; 95% CI: 1.22–4.60); - plaque (six sites vs. 0 sites: OR = 3.4; 95% CI: 1.02–11.32). Conclusions and Clinical Implications: According to the present study, peri-implantitis is a highly prevalent disease at patient-level. Diabetes, smoking, moderate/severe periodontitis, implant brand, multi-unit restorations and plaque were identified as risk indicators for peri-implantitis, while the use of interproximal brushes was inversely associated. Randomized clinical studies or, when not possible for ethical reasons prospective cohort studies, are needed to demonstrate true causality of the identified risk indicators. Keywords: peri-implantitis, cross-sectional, risk indicators, risk factor, prevalence.