Risk Of Peri-implantitis Research Articles

Are partially edentulous patients with a history of severe periodontitis more prone to develop peri-implantitis over the long term?

Aim This study aimed to compare the long-term outcome of implant therapy in partially edentulous patients with severe periodontitis compared to those with no history of periodontitis.Design Retrospective cohort study.Cohort selection Eighty-eight patients (34 men and 54 women; age ranging from 28 to 45 years) with severe periodontitis (47 patients with 108 implants) and no history of periodontitis (41 patients with 78 implants) were included in this institutional study. All these cohorts had received implants 6-8 years previously.Data analysis Probing pocket depth, radiographic marginal bone level and peri-implantitis were the primary outcomes, while bleeding on probing was the secondary outcome. The effect of variables was measured by odds ratio with 95% confidence interval. Both patient-level and implant-level analyses were used to evaluate the association between peri-implantitis and potential risk factors. In addition, the association between probing pocket depth and radiographic marginal bone level with potential risk factors was assessed at implant-level analyses. In contrast, for patient-level data, a positive relationship was assessed with the Chi-square test.Results Patients with a history of severe periodontitis (OR = 11.13; p = 0.045), implants with a lack (<2 mm) of peri-implant keratinised mucosa (OR = 14.94; p <0.001) and implants placed in bone-grafted sites (OR = 4.93; p = 0.047) were associated with greater risk of peri-implantitis, at 6-8 years post-implant placement. The risk of developing radiographic marginal bone level ≥3 mm was significantly greater (OR = 1.20; p <0.001) in patients with higher full-mouth bleeding scores. The chance of peri-implant bleeding on probing was independently and especially higher in patients who brushed their teeth at most once per day (OR = 3.20; p = 0.04), with higher full-mouth bleeding score values (OR = 1.16; p <0.001) and irregular recall visits (OR = 15.34; p = 0.001).Conclusion This retrospective cohort study concluded that partially edentulous patients with a history of severe periodontitis were more prone to develop peri-implantitis at 6-8 years post-implant placement.

The long-term impact of alveolar ridge preservation with xenograft bone mineral on peri-implant health after 5 years in function: A retrospective cohort study of 108 patients assessed clinically and radiologically.

ObjectivesWhen teeth are lost, dental implants contribute to improved oral function and quality of life. Limitations in dental implant placement arising from poor bone anatomy may be circumvented via alveolar ridge preservation (ARP). The aim is to evaluate the long‐term impact of ARP on peri‐implant health and the relationship with common risk indicators such as smoking and history of periodontitis.Materials and MethodsOne hundred and eight patients were enrolled in this retrospective cohort study with 308 implants. Of these, ∼41% were placed in bone sites that had previously received ARP with deproteinized bovine bone mineral xenograft. Association between baseline variables: ARP, age, gender, number of implants per patient, anatomical site, smoking, and previous history of grade III/IV periodontitis, and outcome variables: mucositis, peri‐implantitis, implant loss, full‐mouth plaque score (FMPS), full‐mouth bleeding score, and marginal bone loss (MBL) was evaluated using both univariate and multivariate models.ResultsAfter 5 years, the overall survival rate was 93.7%. The occurrence of peri‐implantitis was 21.3% and the extent of MBL was ~2.2 mm. Both peri‐implantitis occurrence and MBL were comparable between ARP+ and ARP−. Smoking is associated with higher FMPS and MBL.ConclusionsThe findings indicate that peri‐implant health can be maintained around dental implants for up to 5 years in ARP+ sites using Bio‐Oss®. Smoking is a major risk indicator for peri‐implantitis, whereas the association between history of periodontitis and the risk of peri‐implantitis, based on this specific, well‐maintained cohort and the specific implants used, remains inconclusive.

PERI-IMPLANTITIS IN DENTAL IMPLANTS PLACED IN AUGMENTED BONE: A CASE REPORT.

Introduction: Periimplantitis is a disease most commonly affecting dental implants placed in patients with a history of periodontal disease. It is still questionable if native bone is more resistant to periimplantitis than regenerated bone. Case presentation: A case of dental implant placed in regenerated bone in a patient with treated periodontal disease is presented. The patient is a male healthy adult, who lost the tooth #11 due to advanced periodontal disease. 4 weeks after tooth extraction, the alveolar ridge was augmented and the dental implant was placed 5 months after the guided bone regeneration. The dental implant was restored 3 months after placement. The patient was compliant with the periodontal recall appointments for 2 years. After a personal crisis, the patient neglected his oral hygiene and failed to follow his periodontal recall visits for 7 years. When he finally presented for a dental examination, the dental implant #11 showed significant bone loss and periodontal tissue inflammation. The site was treated conservatively and surgically treated and augmented-with a combination of xenograft, allograft and a collagen membrane-in order to achieve re-osseintegration. Conclusions: Patients with periodontal disease are at high risk for peri-implantitis. Regular recall visits are essential for maintenance of dental tooth and implant health, since treatment of peri-implantitis is a very demanding procedure.

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

To investigate the association of cumulative smoking exposure and span since smoking cessation with the occurrence of peri-implantitis. A sample of 350 individuals aged ≥ 35years, with the presence of at least one osseointegrated implant functioning for > 5years, 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. 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. 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. 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.

Comparison of Two Risk Assessment Scores in Predicting Peri-Implantitis Occurrence during Implant Maintenance in Patients Treated for Periodontal Diseases: A Long-Term Retrospective Study.

Background: There is a need for reliable risk assessment tools to better predict peri-implantitis occurrence. This study compared the long-term prognosis value of two models of risk assessment scoring in predicting peri-implantitis. Methods: Seventy-three patients with treated periodontitis representing 232 implants and attending long-term implant maintenance were evaluated. The Periodontal Risk Assessment (PRA) score, which combines only periodontal risk factors/indicators, and the Implant Risk Assessment (IRA) score, which combines both periodontal and implant risk factors/indicators, were calculated during implant maintenance. Peri-implantitis was defined by the presence of probing depth ≥6 mm with bleeding on probing/suppuration and bone level ≥3 mm. Analyses were performed at the patient level. Results: The mean implant follow-up was 6.5 years. Peri-implantitis incidence was 17.8%, and high-risk PRA and IRA percentages were 36.9% and 27.3%, respectively. High-risk PRA and IRA were significantly associated with peri-implantitis incidence, with hazard ratio (HR) = 4.8 and 3.65, respectively. Risk factors/indicators considered separately showed reduced associations with peri-implantitis. Conclusions: The PRA score combining periodontal parameters and IRA score combining both periodontal and implant parameters have comparable value in predicting peri-implantitis. These scores could allow practicians to intercept the risk of peri-implantitis and to manage follow-up modalities in patients with treated periodontitis.

The role of systemic diseases and local conditions as risk factors.

The role of systemic diseases and local conditions as risk factors.

Management of Fixed Rehabilitation of Single Implants in the Aesthetic Sector: A Systematic Review

Introduction When dental implants are installed and subjected to functional loads, marginal bone resorption is frequent, also in sites not affected by peri-implantitis, and it can be a critical factor that will affect the aesthetics and longevity of the implant because it is associated with an increased risk of peri-implantitis and soft tissue collapse. Objective To assess the peri-implant marginal bone loss and the survival percentage of implant restorations that present internal and external prosthetic connections. Material and methods A systematic review of the literature was carried out. Various information sources were consulted such as PubMed, Embase, Ovid, Scopus databases. For the search process, the methodology approved by the PRISMA Guide was followed. Results 5 articles were found that met the established criteria. In these articles, 2,866 patients rehabilitated by means of 6,455 implants were registered, of which 3,057 were restored with an external hexagonal prosthetic connection and 3,398 with an internal connection of the hexagonal or conometric type. The 3,057 implants prosthetized by connection to an external hexagon showed a mean peri-implant marginal bone loss of 0.986 ± 0.58mm. The 3,398 implants prosthetized by means of an internal hexagon or conometric type connection highlighted a mean peri-implant marginal bone loss of 0.86 + - 0.43mm. Conclusion Taking into consideration the individual characteristics of each patient and each situation, the literature seems to indicate that on the intensity of the mechanical stress and the tensions emitted to the peri-implant region, the conical connection and the cylindrical design of the implant transmit less stress to the cortical bone. Bone with respect to the external hexagonal connection and the conical design of the implant, which transmit less stress and tension to the trabecular bone and more to the cortical bone.

A retrospective comparison of clinical outcomes of implant restorations for posterior edentulous area: 3-unit bridge supported by 2 implants vs 3 splinted implant-supported crowns.

PURPOSETo compare the clinical outcomes of two types of implant restoration for posterior edentulous area, 3-unit bridge supported by 2 implants and 3 implant-supported splinted crowns.MATERIALS AND METHODSThe data included 127 implant-supported fixed restorations in 85 patients: 37 restorations of 3-unit bridge supported by 2 implants (2-IB), 37 restorations of 3 implant-supported splinted crowns (3-IC), and 53 single restorations (S) as controls. Peri-implantitis and mechanical complications that occurred for 14 years were analyzed by multivariable Cox regression model. Kaplan-Meier curves and the multivariable Cox regression model were used to analyze the success and survival of implants.RESULTSPeri-implantitis occurred in 28.4% of 2-IB group, 37.8% of 3-IC group, and 28.3% of S control group with no significant difference. According to the implant position, middle implants (P2) of the 3-IC group had the highest risk of peri-implantitis. The 3-IC group showed a lower mechanical complication rate (7.2%) than the 2-IB (16.2%) and S control group (20.8%). The cumulative success rate was 52.8% in S (control) group, 62.2% in 2-IB group, and 60.4% in 3-IC group. The cumulative survival rate was 98.1% in S (control) group, 98.6% in 2-IB group, and 95.5% in 3-IC group. There was no significant difference in the success and survival rate according to the restoration type.CONCLUSIONThe restoration type was not associated with the success and survival of implants. The risk of mechanical complications was reduced in 3 implant-supported splinted crowns. However, the middle implants of the 3 implant-supported splinted crowns had a higher risk of peri-implantitis.

Interleukin-16 rs4072111 Polymorphism is Associated with the Risk of Peri-Implantitis in the Chinese Population.

PurposePeri-implantitis (PI) is a major contributor to dental implant failure. Genetic predisposition plays an essential role in the development of PI. The purpose of this study was to investigate the correlation of IL-16 gene single nucleotide polymorphisms (SNPs), rs11556218 and rs4072111, with PI at the gene level.Patients and MethodsA total of 162 patients with PI and 162 cases with healthy implants were recruited as the case and control groups, respectively. The genotypes were analysed using direct sequencing. The genotype and allele proportion between the case and control groups were compared using the chi-square test. The periodontal status of patients carrying different genotypes was analysed, including gingival index, plaque index, calculus index, peri-implant pocket depth (PPD), and clinical attachment level (CAL).ResultsThe case and control groups were age- and gender-matched. In the case group, the rs4072111 CT genotype was majorly observed, and the T allele carriers showed a high PI risk. Patients with the rs4072111 CT genotype had worse periodontal status, which was reflected by the higher levels of the gingival index, plaque index, calculus index, PPD and CAL. The distribution of the rs11556218 genotype and T allele showed no significant difference between the case and control groups (P > 0.05).ConclusionThe CT genotype of IL-16 gene rs4072111 SNP can be used as a factor assessing PI risk. Therefore, IL-16 genetic variation may be related to PI susceptibility in the Chinese Han population.

Effectiveness of implant-supported fixed partial denture in patients with history of periodontitis: A systematic review and meta-analysis.

This systematic review investigates the effectiveness of implant-supported fixed partial denture (IS-FPD) in patients with history of periodontitis (HP) vs. patients with no history of periodontitis (NHP). A literature search was performed on different databases on May 2020. Prospective and retrospective studies assessing survival (primary outcome), success and biological/mechanical complications of IS-FPDs in HP vs. NHP patients at ≥1year after implant loading were evaluated. Meta-analyses were conducted by estimating hazard ratio (HR), risk ratio (RR) and standardized mean differences (SMD) with 95% confidence intervals (CI) using random effect models. Of the initially identified 4096 articles, 349 underwent a full-text evaluation. Finally, 17 were included. Pooled data analyses showed that overall implant survival was significantly higher in the NHP than the HP group (HR=2.06; 95% CI=1.37-3.09; I2 =0%). This difference was noted when follow-up ≥5years. The risk of peri-implantitis was higher in HP than NHP patients (RR=3.3; 95% CI=1.31-8.3; I2 =0%), whereas the mean marginal bone level change over time was not different between the groups (SMD=-0.16mm; 95% CI=-1.04-0.73; I2 =98%). In partially edentulous patients receiving IS-FPDs, a history of periodontitis is associated with poorer survival rate and higher risk of peri-implantitis during a 5-10years period after implant loading.

Screw-retained restoration of a facially shifted postextraction implant in the esthetic zone with immediate provisionalization

Aim The aim of this article is to describe an alternative rehabilitation of a facially shifted postextraction implant with immediate provisionalization of a screw-retained restoration. Case report Immediate postextraction implant placement may pose significant challenges. A case is described where, despite proper risk assessment and planning, an implant shifted from the position of the prosthetic driven restoration. This resulted in different positions of immediate postextraction implants in the sites of the upper central incisors. The provisional was constructed with different access holes. The use of an angulated screw channel compensated the access holes from the original implant axis, thus making a screw-retained restoration on the palatal side feasible. Result The use of angulated screw-retained crowns might benefit periimplant condition in the long-term by eliminating the use of cements. Although the mechanical complications are underreported, this approach is likely to yield good results and allow shifted implant in the anterior region. Conclusions Angulated screw crowns could correct facially shifted implants in the esthetic zone. The system compensates the natural angulation of maxillary teeth, allows easy application of screw retained crowns, eliminates the risk of cement-related periimplantitis and preserves esthetics.

Impact of design elements of the implant supracrestal complex (ISC) on the risk of peri-implant mucositis and peri-implantitis: A critical review.

The aim of this review was to investigate the evidence correlating the emergence profile (EP) and emergence angle (EA), peri-implant tissue height, implant neck design, abutment and/or prosthesis material, retention and connection types with risk of peri-implant mucositis and peri-implantitis. Seven focus questions were identified, and seven electronic search queries were conducted in PubMed. Human studies reporting on bleeding on probing, probing depth or case definitions of peri-implant mucositis and peri-implantitis were included. Emerging evidence with bone-level implants suggests a link between EA combined with convex EP and peri-implantitis. Depth of the peri-implant sulcus of ≥3mm is shown to be reducing the effectiveness of treatment of established peri-implant mucositis. Modification of the prosthesis contour is shown to be an effective supplement of the anti-infective treatment of peri-implant mucositis. Limited evidence points to no difference with regard to the risk for peri-implant mucositis between tissue- and bone-level implants, as well as the material of the abutment or the prosthesis. Limited evidence suggests the use or not of prosthetic abutments in external connections and does not change the risk for peri-implantitis. Literature with regard to prosthesis retention type and risk for peri-implantitis is inconclusive. Limited evidence indicates the involvement of EA, EP, sulcus depth and restricted accessibility to oral hygiene in the manifestation and/or management of peri-implant mucositis/peri-implantitis. Conclusions are limited by the lack of consensus definitions and validated outcomes measures, as well as diverse methodological approaches. Purpose-designed studies are required to clarify current observations.

Peri-implantitis: Summary and consensus statements of group 3. The 6th EAO Consensus Conference 2021.

To evaluate the influence of implant and prosthetic components on peri-implant tissue health. A further aim was to evaluate peri-implant soft-tissue changes following surgical peri-implantitis treatment. Group discussions based on two systematic reviews (SR) and one critical review (CR) addressed (i) the influence of implant material and surface characteristics on the incidence and progression of peri-implantitis, (ii) implant and restorative design elements and the associated risk for peri-implant diseases, and (iii) peri-implant soft-tissue level changes and patient-reported outcomes following peri-implantitis treatment. Consensus statements, clinical recommendations, and implications for future research were discussed within the group and approved during plenary sessions. Data from preclinical in vivo studies demonstrated significantly greater radiographic bone loss and increased area of inflammatory infiltrate at modified compared to non-modified surface implants. Limited clinical data did not show differences between modified and non-modified implant surfaces in incidence or progression of peri-implantitis (SR). There is some evidence that restricted accessibility for oral hygiene and an emergence angle of >30combined with a convex emergence profile of the abutment/prosthesis are associated with an increased risk for peri-implantitis (CR). Reconstructive therapy for peri-implantitis resulted in significantly less soft-tissue recession, when compared with access flap. Implantoplasty or the adjunctive use of a barrier membrane had no influence on the extent of peri-implant mucosal recession following peri-implantitis treatment (SR). Prosthesis overcontouring and impaired access to oral hygiene procedures increases risk for peri-implantitis. When indicated, reconstructive peri-implantitis treatment may facilitate the maintenance of post-operative peri-implant soft-tissue levels.

Is Immunosuppression a Risk Factor for Development of Peri-implantitis? A Retrospective Cohort Analysis

The present study aims to identify if immunosuppression is a risk factor for the development of peri-implantitis. A retrospective cohort study design was conducted on patients presenting to the Philadelphia Veterans Affairs (VA) Medical Center for dental implant placement from 2006 to 2013. Medical encounter notes within 3 months of implant placement were used to collect information about patients’ health status, including evaluations of immune system function. Implant status was assessed using dental encounter notes and radiographs from follow-up appointments at 1, 3, 5, and 10 years. Peri-implantitis was defined as radiographic evidence of change in crestal bone level, clinical evidence of bleeding on probing, with or without suppuration.1Electronic medical records of 884 implants were retrospectively analyzed. Descriptive statistics were calculated using the SAS System (SAS Institute Version 9.4, 2002-2012, Cary, NC). The primary predictor variable was immunosuppression. The primary outcome variable was the presence of peri-implantitis. Other study variables assessed included graft at the time of implant placement, diabetes, smoking, gender, and age over 60. Descriptive, univariate, and multivariate regression analyses were performed to measure the association between predictive variables and development of peri-implantitis.Of the 884 implants placed, 205 (23.1%) developed peri-implantitis. Following a multivariate analysis that controlled for diabetes, smoking, gender, and age over 60, immunosuppression was shown to be significantly associated with an increased risk in the presence of peri-implantitis (P = .0071) when compared to implants placed in immunocompetent subjects. The data from this study show that implants placed in immunosuppressed patients were 29.78% more likely to develop peri-implantitis compared to implants placed in immunocompetent patients (OR = 2.229, 95% CI 1.243-3.996). To the best of the authors’ knowledge, no existing literature has demonstrated this significant risk relationship.Following surgical implant placement, adequate function of the immune system's inflammatory response is imperative to target infections and orchestrates wound healing to allow for successful osseointegration of implants. Few studies, however, have directly investigated this nexus at a mechanistic level. In vivo studies in rabbits have indicated that titanium implant placement may up-regulate the immune system's type 2 inflammatory response to inhibit bone resorption markers and promote healing.2 Therefore, in conjunction with the authors' results, immunosuppression could play a significant role in increasing risk of peri-implantitis.Analysis of implants placed at the Philadelphia VA Medical Center revealed an important association between immunosuppression and the development of peri-implantitis. This study shows that immunosuppression may play a role in increasing the development of peri-implantitis. Along with need for further exploration regarding the pathophysiology of this relationship, additional observational and randomized controlled studies are necessary to validate the authors' findings. As implant restoration of edentulous areas is becoming the new standard of care, identification and understanding of associated risks factors are critical to ensure successful implant outcomes.

Treatment planning considerations in the older adult with periodontal disease.

Periodontal health in the elderly is influenced by numerous factors, including systemic conditions, patient compliance, age-associated changes, and restorative procedures. The numerous comorbidities seen in the elderly necessitate individualized approaches for treatment planning. In this paper, we review how age, comorbidities, oral hygiene, and restorative dental procedures collectively influence the treatment and management of the periodontium in the elderly. The elderly population is predicted to double in 30years, which will have an economic impact the dental profession needs to plan for. Preventative and noninvasive treatment, supportive periodontal therapy, and patient-specific maintenance plans are imperative to maintaining oral health in the older population. Multiple coexisting changes, including xerostomia, altered wound healing, altered bone physiology, altered microbiome, and diminished plaque control, can add complexity to periodontal management. Considerations of the patient's general health, the selected periodontal treatment plan, and the selected completed restorative procedures need to be considered. The influence of caries, fixed prosthodontics, partial dentures, shortened dental arch, and implant therapy can have unintended impacts on periodontal health in the elderly. Adverse periodontal outcomes in the elderly can be minimized by carefully assessing the patient's medical history, impact of medications, functional needs, properly finishing and contouring restorations to avoid plaque accumulation, and designing restorations to allow access for hygiene. Partial dentures can be a source of plaque accumulation leading to periodontal disease, caries, and recession around abutment teeth. A shortened dental arch should be considered as a functional and cost-effective alternative to partial dentures. With dental implants, the patient's tissue phenotype, keratinized tissue quantity, risk of peri-implantitis, and patient access for maintaining adequate oral hygiene are all important to consider. Implant risk-assessment tools show promise by providing a systematic approach for early diagnosis to avoid future complications.

Early peri-implant bone loss as a predictor for peri-implantitis: A 10-year prospective cohort study.

To evaluate the effect of early bone loss (EBL), on long-term bone stability and future peri-implantitis development. Patients referred for implant placement between 2005 and 2009 were consecutively treated and followed for 10 years. After 10 years, patients were invited for a scientific diagnostic visit to evaluate implant survival and bone loss. Bone level changes were compared with baseline. Non-parametric testing was performed in cross-tabs (Pearson Chi-square and Fishers's exact test). Kaplan-Meier-estimated survival curves were plotted for different thresholds for EBL at different timepoints. Generalized linear mixed models with binomial distribution and logit link for peri-implantitis were fitted. An adjusted logistic mixed model was made to evaluate peri-implantitis, in relation with smoking status, history of periodontitis, and EBL > 0.5 mm. Four hundred and seven patients (mean age of 64.86 years [range 28-92, SD 10.11]), with 1482 implants, responded to the 10-year recall invitation. After an average follow-up time of 10.66 years (range 10-14, SD 0.87), implant survival was 94.74%. Mean crestal bone loss after 10 years was 0.81 mm (SD 1.58, range 0.00-17.00). One hundred and seventy five implants in 76 patients had peri-implantitis (11.8% on implant level, 18.7% on patient level). EBL of 0.5, 1, and 2 mm were significant predictors for peri-implantitis and implant loss after 10 years. Implants with EBL ≥0.5 mm during the first year of function showed a 5.43 times higher odds for future peri-implantitis development. Probability in developing peri-implantitis was 52.06% when smoking, Periodontal history and EBL of >0.5 mm was combined. The present study suggests that EBL is a predictor for long-term peri-implant pathology, with a significant higher risk for peri-implantitis when early bone loss exceeds the thresholds of 0.5 and 1 mm, especially when additional risk factors such as smoking or susceptibility for periodontal disease prior to implant treatment are present. Clinical trial registration number B670201524796.

Predictive modeling for peri-implantitis by using machine learning techniques

The purpose of this retrospective cohort study was to create a model for predicting the onset of peri-implantitis by using machine learning methods and to clarify interactions between risk indicators. This study evaluated 254 implants, 127 with and 127 without peri-implantitis, from among 1408 implants with at least 4 years in function. Demographic data and parameters known to be risk factors for the development of peri-implantitis were analyzed with three models: logistic regression, support vector machines, and random forests (RF). As the results, RF had the highest performance in predicting the onset of peri-implantitis (AUC: 0.71, accuracy: 0.70, precision: 0.72, recall: 0.66, and f1-score: 0.69). The factor that had the most influence on prediction was implant functional time, followed by oral hygiene. In addition, PCR of more than 50% to 60%, smoking more than 3 cigarettes/day, KMW less than 2 mm, and the presence of less than two occlusal supports tended to be associated with an increased risk of peri-implantitis. Moreover, these risk indicators were not independent and had complex effects on each other. The results of this study suggest that peri-implantitis onset was predicted in 70% of cases, by RF which allows consideration of nonlinear relational data with complex interactions.

Tobacco Use and Oral Health.

This review outlines the important oral implications of tobacco use. The lining of the mouth (oral mucosa), if exposed to tobacco and its products in a susceptible individual, can develop benign, potentially malignant, and malignant tumours. Treatment and prognosis depend on tumour type, how early it is detected, its size and site in the oral cavity and whether it has spread. Advanced oral squamous cell carcinoma (OSCC) has a 20% 5-year survival rate. Tobacco use also increases the risk of periodontitis, peri-implantitis, caries, alveolar osteitis and halitosis. Although less life threatening than OSCC, these tobacco related conditions create a substantial financial and health burden for individuals and society. Dental practitioners routinely examine the oral cavity for signs of mucosal and tooth changes, are experienced in recognising variations from normal and have established management and referral pathways. They are also ideally positioned to provide brief interventions to assist their patients to quit smoking.

SECONDARY ETIOLOGICAL FACTORS IN THE DEVELOPMENT OF PERI-IMPLANTITIS

Purpose: The aim of this review was to investigate the potential impact of secondary etiological factors on the development of peri-implant infections. Results: During the review process we found sufficient evidence to define the following factors as secondary etiological factors for the development of peri-implantitis: a history of periodontitis; implant surface characteristics; suprastructure characteristics; cemented restorations; implant-abutment connection; smoking; diabetes and peri-implant mucosa characteristics. Conclusion: To reduce the risk of peri-implantitis, the following recommendations should be considered: (1) in partially edentulous patients, implant treatment should start after elimination of the periodontal infection and after the establishment of a stable periodontal status; (2) implants should be placed in areas where there is a minimum of 2 mm of keratinized mucosa; (3) an internal implant-abutment connection and screw-retained suprastructures are preferred; (4) supra structures should be planned carefully to facilitate good oral hygiene; and (5) smoking cessation should be promoted and (6) only patients with controlled diabetes should undergo implant placement.

Experimental peri-implantitis around titanium implants with a chemically modified surface with a monolayer of multi-phosphonate molecules: a preclinical in vivo investigation.

The purpose of this experimental in vivo investigation was to evaluate the influence of modifying the implant surface by adding a monolayer of multi-phosphonate molecules on the development of experimental peri-implantitis. Eight beagle dogs received 5 tests and 5 control implants each following a split-mouth design 3months after premolar and molar extraction. On the most mesial implant of each side, a 3-mm buccal dehiscence was artificially created. Experimental peri-implantitis was induced by silk ligatures over a 4-month period; after ligature removal, peri-implantitis was left to progress for another 4months without plaque control. Clinical, histological, and radiographic outcomes were evaluated. Radiographically, both implant groups showed a similar bone loss (BL) at the end of the induction and progression phases. BL measured on the histological sections of the test and control groups was 3.14 ± 0.42mm and 3.26 ± 0.28mm, respectively; the difference was not statistically significant (p > 0.05). The remaining buccal bone to implant contact (bBIC) percentage of the test and control groups was 59.38 ± 18.62 and 47.44 ± 20.46%, respectively; the difference, however, was not statistically significant (p > 0.05). Bone loss observed at dehiscent sites compared to non-dehiscent ones showed no statistically significant difference (p > 0.05). Addition of a monophosphonate layer to a moderately rough implant surface did not affect development of experimental peri-implantitis. Influence of implant surface on peri-implantitis may condition implant selection by the clinician, especially on patients with disease risk factors. In that sense, monophosphate layer implants do not show higher peri-implantitis risk than control implants.