1. Int J Oral Maxillofac Implants. 2016 Jan-Feb;31(1):111-8.

doi:
10.11607/jomi.4149.

Prevalence of Peri-implantitis in Medically Compromised Patients and Smokers: A

Systematic Review.

Turri A, Rossetti PH, Canullo L, Grusovin MG, Dahlin C.

PURPOSE: To verify whether the diversity of systemic medical conditions and

smoking act as biologic associated factors for peri-implantitis.
MATERIALS AND METHODS: The PICO question was: "In patients with osseointegrated
dental implants, does the presence of smoking habits or a compromised medical
status influence the occurrence of peri-implantitis compared with the presence of
good general health?" Smoking and systemic conditions such as type 2 diabetes
mellitus, cardiovascular diseases, rheumatoid arthritis, lung diseases, obesity,
cancer, deep depression, and osteoporosis were screened. Selection criteria
included at least 10 patients per condition, 1 year of follow-up after implant
loading, and strict cutoff levels (probing pocket depth [PPD], bleeding on
probing [BOP] and/or pus, marginal bone loss) to define peri-implantitis.
RESULTS: From the 1,136 records initially retrieved, 57 were selected after title
and abstract analyses. However, only six papers were considered for qualitative
evaluation. No randomized controlled clinical trial was found. Smoking was
associated with peri-implantitis in only one out of four studies. Poorly
controlled type 2 diabetes accentuated only PPD and radiographic marginal bone
level prevalence rates in peri-implant patients (one study). Cardiovascular
disease was considered a risk (one out of two studies). The chance of
peri-implant patients harboring the Epstein-Barr virus was threefold in one
report. No associations were found for rheumatoid arthritis.
CONCLUSION: Data from existing studies point to smoking and diabetes as biologic
associated factors for peri-implantitis. However, the body of evidence is still
immature, and the specific contribution of general health problems to
peri-implantitis requires additional robust epidemiologic and clinical
investigations.

PMID: 26800167 [Indexed for MEDLINE]

2. Eur J Oral Implantol. 2015 Winter;8(4):405-10.

Dramatic course of osteomyelitis in a patient treated with immediately placed

dental implants suffering from uncontrolled diabetes: A case report.

Doll C, Hartwig S, Nack C, Nahles S, Nelson K, Raguse JD.

PURPOSE: To report a rare and dramatic complication following immediate dental

implant placement in a heavy smoker, who had a delayed diagnosis of uncontrolled
diabetes.
MATERIALS AND METHODS: In this case report we present the dramatic course of a
64-year old female patient treated with five immediate post-extractive dental
implants in the mandible, who developed osteomyelitis, which manifested initially
as local peri-implant inflammation and progressed into a spontaneous jaw
fracture, despite repeated surgical interventions and antibiotic courses over a
3-year period, until diabetes was diagnosed.
RESULTS: A symptom-free status could be achieved only after partial
mandibulectomy, treatment of diabetes and reconstruction with a microvascular
fibula free flap.
CONCLUSION: In the presence of mandibular osteomyelitis refractory to therapy,
yet undiagnosed underlying pathologies, such as diabetes, should be investigated
and treated urgently.

PMID: 26669550 [Indexed for MEDLINE]

3. J Contemp Dent Pract. 2015 Sep 1;16(9):750-7.

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

Marcantonio C(1), Nicoli LG(1), Marcantonio Junior E(1), Zandim-Barcelos DL(2).

Author information:
(1)Department of Diagnosis and Surgery, School of Dentistry at Araraquara,
Universidade Estadual Paulista, UNESP, Sao Paulo, Brazil.
(2)Assistant Professor, Department of Diagnosis and Surgery, School of Dentistry
at Araraquara, Universidade Estadual Paulista, UNESP, Humaita, 1680, Zipcode:
14801-903 Araraquara/Sao Paulo, Brazil, Phone: +55 16 33016508 e-mail:
danielalzandim@foar.unesp.br.

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.

PMID: 26522602 [Indexed for MEDLINE]

4. Clin Oral Implants Res. 2015 Sep;26 Suppl 11:15-44. doi: 10.1111/clr.12636.

Risk indicators for peri-implantitis. A narrative review.

Renvert S(1)(2)(3), Quirynen M(4).

Author information:
(1)Department of Oral Health Sciences, Kristianstad University, Kristianstad,
Sweden.
(2)School of Dental Sciences, Trinity College, Dublin, Ireland.
(3)Blekinge Institute of Technology, Karlskrona, Sweden.
(4)Department of Oral Health Sciences, Katholieke Universiteit Leuven, University
Hospitals Leuven, Leuven, Belgium.

AIM: To examine the existing evidence in identifying risk indicators in the

etiology of peri-implantitis.
MATERIAL AND METHODS: A literature search was performed in MEDLINE via PubMed
database of the US National Library of Medicine, for articles published until
October 2014 using Medical Subject Heading search terms + free text terms and in
different combinations.
RESULTS: The microbiota associated with peri-implantitis is complex,
demonstrating differences and similarities to the one seen at periodontitis
sites. Plaque accumulation at dental implants triggers the inflammatory response
leading to peri-implant mucositis/peri-implantitis. Individuals with a history of
periodontal disease and smokers have an increased risk of developing
peri-implantitis. There is some evidence to support the role of genetic
polymorphism, diabetes, and excess cement as risk indicators for the development
of peri-implantitis. There is also evidence to support that individuals on
regular maintenance are less likely to develop peri-implantitis and that
successful treatment of periodontitis prior to implant placement lowers the risk
of peri-implantitis.
CONCLUSIONS: Plaque accumulation at implants will result in the development of an
inflammation at implants. A history of periodontal disease, smoking, excess
cement, and lack of supportive therapy should be considered as risk indicators
for the development of peri-implantitis.

2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

DOI: 10.1111/clr.12636
PMID: 26385619 [Indexed for MEDLINE]

5. J Periodontol. 2016 Jan;87(1):14-20. doi: 10.1902/jop.2015.150229. Epub 2015 Sep

3.

Relationship Between Osteoporosis and Marginal Bone Loss in Osseointegrated

Implants: A 2-Year Retrospective Study.

Corcuera-Flores JR(1), Alonso-Domnguez AM(1), Serrera-Figallo M(1),

Torres-Lagares D(1), Castellanos-Cosano L(1), Machuca-Portillo G(1).

Author information:
(1)Faculty of Odontology, University of Seville, Seville, Spain.

BACKGROUND: Fitting implants in osteoporotic patients has traditionally been

controversial, and there is little scientific evidence relating osteoporosis to
marginal bone loss (MBL). The aims of this study are as follows: 1) to evaluate
the possibility of a correlation between osteoporosis, as measured by the
mandibular cortical index (MCI), and MBL and 2) to assess how various systemic
diseases, periodontitis, and placement of implants in regenerated bone are
correlated with MBL and MCI.
METHODS: This retrospective study examines 212 implants inserted in 67 patients.
To take a possible cluster failure into account, an implant for each patient was
selected (n = 67 implants). MBL was assessed. Osteoporosis was evaluated using
the MCI. Both MBL and MCI were assessed from panoramic radiographs. (2) test was
performed (Haberman post hoc test). Significance was P <0.05.
RESULTS: When the total sample implant (N = 212) was evaluated, a significant
association was found between the presence of osteoporosis and MCI (P <0.001) and
between the presence of diabetes mellitus and MCI (P <0.01). Significant
associations were also found between MBL and placement of implants in regenerated
sites (P <0.001) and between MBL and a previous history of periodontitis (P
<0.05). When the sample is evaluated only in selected implants (one per patient,
n = 67), significant differences appear to relate only to the MBL with the
placement of implants in regenerated bone sites (P <0.001).
CONCLUSIONS: Osteoporosis (as evaluated by MCI) does not pose a risk for the
development of greater MBL. Parameters adversely affecting the development of
increased MBL are a previous history of periodontitis and especially the
placement of implants at sites of bone regeneration.

DOI: 10.1902/jop.2015.150229
PMID: 26334497 [Indexed for MEDLINE]

6. Aust Dent J. 2015 Mar;60 Suppl 1:14-9. doi: 10.1111/adj.12280.

Periodontal considerations in older individuals.

Darby I(1).

Author information:
(1)Melbourne Dental School, The University of Melbourne, Victoria, Australia.

In the next few years there will be a great increase in the percentage of the
population aged over 65. Not only will they have more teeth than previous
generations, but also a large number of implants. The increase in age is
accompanied by an increase in the prevalence and incidence of periodontal
diseases. In addition, there is a decrease in manual dexterity and an increase in
co-morbidity and medications affecting the oral cavity. Dental care in aged care
facilities can be poor and access to dental professionals difficult. This article
discusses these issues.

2015 Australian Dental Association.

DOI: 10.1111/adj.12280
PMID: 25762038 [Indexed for MEDLINE]

7. Eur J Oral Implantol. 2015 Spring;8(1):75-88.

Cross-sectional study on the prevalence and risk indicators of peri-implant

diseases.

Konstantinidis IK, Kotsakis GA, Gerdes S, Walter MH.

PURPOSE: To evaluate the prevalence of peri-implant diseases in a university

patient sample and to analyse possible risk variables associated with their
occurrence.
MATERIALS AND METHODS: One hundred and eighty-six patients with 597 implants were
examined clinically and radiographically. The mean period of function was 5.5
years (range 1 to 16.5 years). A subgroup analysis was performed for implants
with a minimum function time of 5 years. Outcome measures were implant failures,
prevalence and risk indicators of peri-implant diseases. In order to identify
statistically significant risk indicators of peri-implant mucositis and
peri-implantitis multi-level logistic regression models were constructed.
RESULTS: The prevalence of peri-implantitis and peri-implant mucositis on patient
levels were 12.9% (13.3% for 5 years) and 64.5% (64.4% for 5 years),
respectively. Multi-level analysis showed that a high plaque score (OR = 1.365;
95% CI: 1.18 to 1.57, P < 0.001) was a risk indicator for periimplant mucositis,
while augmentation of the hard or soft tissue at implant sites had a protective
effect (OR = 0.878 95% CI: 0.79 to 0.97, P = 0.01). It was also shown that the
odds ratio for having peri-implant mucositis increased with the increase of
plaque score in a dose-dependent manner. With respect to peri-implantitis, loss
of the last tooth due to periodontitis (OR = 1.063; 95% CI: 1.00 to 1.12, P =
0.03) and location of the implants in the maxilla (OR = 1.052, 95% CI: 1.00 to
1.09, P = 0.02) were identified as statistically significant risk indicators.
CONCLUSIONS: Within the limitations of this study, the history of periodontal
disease was the most significant risk indicator for peri-implantitis and the
level of oral hygiene was significantly associated with peri-implant mucositis.

PMID: 25738181 [Indexed for MEDLINE]

8. Clin Oral Implants Res. 2016 Feb;27(2):156-61. doi: 10.1111/clr.12552. Epub 2015

Jan 26.

Peri-implant evaluation of immediately loaded implants placed in esthetic zone in

patients with diabetes mellitus type 2: a two-year study.

Aguilar-Salvatierra A(1), Calvo-Guirado JL(2), Gonzlez-Jaranay M(3), Moreu G(3),

Delgado-Ruiz RA(4), Gmez-Moreno G(5).

Author information:
(1)Department of Pharmacological Research in Dentistry, Faculty of Dentistry,
University of Granada, Granada, Spain.
(2)Department of Implant Dentistry, Master of Implant Dentistry and Biomaterials,
School of Medicine and Dentistry, University of Murcia, Murcia, Spain.
(3)Department of Periodontology, Master of Periodontology and Implant Dentistry,
Faculty of Dentistry, University of Granada, Granada, Spain.
(4)School of Dental Medicine, Stony Brook University, Stony Brook, NY, USA.
(5)Department of Special Care in Dentistry, Pharmacological Research in
Dentistry, Master of Periodontology and Implant Dentistry, Faculty of Dentistry,
University of Granada, Granada, Spain.

OBJECTIVES: The aim of this study was to evaluate implant survival and primary
stability parameters in patients with diabetes with different levels of
glycosylated hemoglobin Alc (HbA1c) treated with immediate placement and
provisionalization of implant-supported, single-tooth replacements over 2 years.
MATERIALS AND METHODS: Eighty-five patients were divided into three groups
according to their HbA1c levels: 33 patients in Group 1 (<6, control group); 30
patients in Group 2 (6.1-8); and 22 patients in Group 3 (8.1-10). Each patient
received one-one-piece implant in the anterior zone of the upper maxillary. The
implant survival rate was analyzed for each group, together with three variables
to evaluate the general state of peri-implant health: probe depth, bleeding on
probing, marginal bone loss.
RESULTS: Marginal bone loss increased in relation with higher HbA1c levels. For
marginal bone loss in Group 1, mean resorption values ranged from 0.51 after
6 months to 0.72 after 2 years in comparison with respective values of 1.33 and
1.92 in Group 3. This pattern was repeated for bleeding on probing, both
parameters showing significant differences between groups. For bleeding on
probing, mean bleeding levels varied from 0.36 in Group I at 6 months after
implant placement, to 0.59 in Group 3 (P = 0.041 between the three groups).
Peri-implant pocket depth showed the same tendency to increase in relation to
HbA1C but differences between groups did not reach statistical significance.
CONCLUSIONS: Patients with diabetes can receive implant-based treatments with
immediate loading safely, providing they present moderate HbA1c values.

2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

DOI: 10.1111/clr.12552
PMID: 25623884 [Indexed for MEDLINE]

9. J Periodontol. 2015 Mar;86(3):337-47. doi: 10.1902/jop.2014.140438. Epub 2014

Nov
21.

Prevalence and predictive factors for peri-implant disease and implant failure: a
cross-sectional analysis.

Daubert DM(1), Weinstein BF, Bordin S, Leroux BG, Flemming TF.

Author information:
(1)Department of Periodontics, University of Washington, Seattle, Washington.

BACKGROUND: Long-term studies worldwide indicate that peri-implant inflammation

is a frequent finding and that the prevalence of peri-implantitis correlates with
loading time. Implant loss, although less frequent, has serious oral health and
economic consequences. An understanding of predictive factors for peri-implant
disease and implant loss would help providers and patients make informed
decisions.
METHODS: A cross-sectional study was performed on 96 patients with 225 implants
that were placed between 1998 and 2003. Implant placement data were collected
from patient records, and patients presented for a clinical and radiographic
follow-up examination. Implant status and periodontal status were determined, the
data were analyzed to determine the prevalence of peri-implant disease or implant
loss, and a predictive model was tested.
RESULTS: The mean follow-up time for the patients was 10.9 years. The implant
survival rate was 91.6%. Peri-implant mucositis was found in 33% of the implants
and 48% of the patients, and peri-implantitis occurred in 16% of the implants and
26% of the patients. Individuals with peri-implantitis were twice as likely to
report a problem with an implant as individuals with healthy implants.
Peri-implantitis is associated with younger ages and diabetes at the time of
placement and with periodontal status at the time of follow-up. Implant loss is
associated with diabetes, immediate placement, and larger-diameter implants.
CONCLUSIONS: One in four patients and one in six implants have peri-implantitis
after 11 years. The data suggest that periodontal and diabetes status of the
patient may be useful for predicting implant outcomes.

DOI: 10.1902/jop.2014.140438
PMID: 25415249 [Indexed for MEDLINE]

10. J Clin Periodontol. 2014 Oct;41(10):1007-14. doi: 10.1111/jcpe.12298. Epub 2014

Sep 12.

Supportive post-implant therapy: patient compliance rates and impacting factors:

3-year follow-up.

Frisch E(1), Ziebolz D, Vach K, Ratka-Krger P.

Author information:
(1)Northern Hessia Implant Center, Hofgeismar, Germany.

AIM: To evaluate patient compliance rates and influential factors regarding a

systematic SIT program.
MATERIALS AND METHODS: Between 2005 and 2008, we identified all patients who were
provided with implant-supported restorations in the study centre. They had been
recommended to attend a SIT program with a 3-month recall. In 2012, a clinical
retrospective cohort study on compliance rates over the first 3 years was
performed different data were assessed in a regression analysis to identify
potential influential factors.
RESULTS: The inclusion criteria were met by 236 patients with 540 implants.
Non-compliance rates increased over the 3 years (5.37%/7.78%/13.33%). Total
non-compliance was observed in four patients (1.69%). No correlation to patient
compliance was detected for "Age," "Gender," "Cardiovascular disease,"
"Pus/suppuration," or "Surgical case complexity." No decreasing effect of higher
compliance rates on the patients' bleeding on probing (BOP+) values was found,
but a statistical significance between lower compliance rates and increased
pocket probing depth (PPD) was detected. The correlation between the presence of
plaque and compliance did not reach statistical significance.
CONCLUSIONS: When patients with implant-supported restorations are strongly
recommended to comply with a SIT program with a 3-month recall, considerably high
rates of compliance can be achieved.

2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

DOI: 10.1111/jcpe.12298
PMID: 25138992 [Indexed for MEDLINE]

11. Clin Oral Implants Res. 2015 Sep;26(9):1031-5. doi: 10.1111/clr.12391. Epub
2014
Mar 31.

Peri-implant evaluation in type 2 diabetes mellitus patients: a 3-year study.

Gmez-Moreno G(1), Aguilar-Salvatierra A(2), Rubio Roldn J(3), Guardia J(2),

Gargallo J(4), Calvo-Guirado JL(5).

Author information:
(1)Department of Special Care in Dentistry, Pharmacological Research in
Dentistry, Periodontology and Implant Dentistry, Faculty of Dentistry, University
of Granada, Granada, Spain.
(2)Department of Pharmacological Research in Dentistry, Faculty of Dentistry,
University of Granada, Granada, Spain.
(3)Periodontology and Implant Dentistry, Faculty of Dentistry, Universidad de
Granada, Granada, Spain.
(4)Department of Dentistry, Faculty of Dentistry, Universitat Internacional de
Catalunya, Barcelona, Spain.
(5)Department of Implant Dentistry, Implant Dentistry and Biomaterials, School of
Medicine and Dentistry, University of Murcia, Murcia, Spain.

OBJECTIVE: The aim of this study was to analyze the changes produced in
peri-implant tissues in type 2 diabetes mellitus patients with different glycemia
levels, measured by monitoring glycated hemoglobin A1c (HbA1c), over a period of
3 years following dental implant placement.
MATERIALS AND METHODS: Sixty-seven patients were divided into four groups
according to their HbA1c levels: 21 patients in Group 1 (<6); 24 patients in
Group 2 (6.1-8); and 11 patients in Group 3 (8.1-10) and Group 4 (>10.1). Each
patient received one implant. All implants were placed in the anterior zone of
the maxilla. The variables selected to assess the general state of patients'
peri-implant health were as follows: probing depth, bleeding on probing, and
marginal bone loss.
RESULTS: Marginal bone loss was found to increase in relation to increases in
HbA1c levels. Bleeding on probing showed statistically significant differences
between groups. When the peri-implant area was probed, mean levels of bleeding
varied from 0.43 in Group 1 at 1 year after implant surgery to 0.62 in Group 4
(P = 0.042 between the four study groups). After the second year, greater
bleeding on probing was observed in Group 4 (0.63) in comparison with groups with
lower HbA1c levels. Peri-implant pocket depths presented values that were too low
to be considered pathological and without statistically significant differences
between the study groups.
CONCLUSION: Implant therapies for diabetic patients can be predictable, providing
these patients fall within controlled ranges of glycemia over time, assessed by
monitoring HbA1c levels.

2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

DOI: 10.1111/clr.12391
PMID: 24684438 [Indexed for MEDLINE]

12. J Periodontol. 2013 Apr;84(4):436-43. doi: 10.1902/jop.2013.134001.

Peri-implant mucositis and peri-implantitis: a current understanding of their

diagnoses and clinical implications.

[No authors listed]

DOI: 10.1902/jop.2013.134001
PMID: 23537178 [Indexed for MEDLINE]