Risk factors for peri-implantitis and implant loss
Näytönastekatsaukset
11.2.2025
Level of evidence: A
Smoking, irregular supportive periodontal treatment (maintenance) and presence of periodontitis or periodontitis with poor response to treatment are significant risk factors for peri-implantitis and implant loss.
The evidence is mainly supported by cross-sectional and retrospective studies and systematic reviews/meta-analysis. In most studies, serious biases were not detected, but some heterogenity and impresicion were detected mainly due to differences in diagnostic criteria and follow-up time. The risk among previously treated and well-maintained periodontitis patients remains unclear.
| Reference | Study type | Population | Intervention and comparison | Outcomes | Risk of bias |
|---|---|---|---|---|---|
| RCT=randomized controlled trial; SR=systematic review; MA=meta-analysis | |||||
| «Carra MC, Blanc-Sylvestre N, Courtet A, ym. Primordial and primary prevention of peri-implant diseases: A systematic review and meta-analysis. J Clin Periodontol 2023;50 Suppl 26():77-112 »1 | SR/MA | The efficacy of risk factor control to prevent the occurrence of peri-implant diseases (PIDs) in adult patients Interventional and observational studies up to 8/2022 with at least 6 months of follow-up, overall 48 studies included | Preventive factors studied: Glycemic control Smoking cessation Supportive periodontal/peri-implant protocol and compliance Soft tissue augmentation Oral hygiene Bruxism control | Occurrence of peri-implant mucositis and/or peri-implantitis at implant or patient level For SPT also implant survival | Imprecision in results (wide confidence-intervals) concerning DM/glycemic control |
| «Costa FO, Lages EJP, Cortelli SC, ym. Association between cumulative smoking exposure, span since smoking cessation, and peri-implantitis: a cross-sectional study. Clin Oral Investig 2022;26(7):4835-4»2 | Cross-sectional study | 350 participants having at least one osseointegrated implant functioning for > 5 years, patient age ≥ 35 years 3 Public Health Centres from the Western region of Belo Horizonte city, Brazil | CS (current smokers)—those who had smoked ≥ 100 cigarettes over their lifetime and smoked at the time of the examination (n = 72) FS (former smokers)— those who had smoked ≥ 100 cigarettes over their lifetime but did not currently smoke (n = 66); NS (never smokers)—those who had not smoked ≥ 100 cigarettes in their lifetime (n = 212). | Occurrence of peri-implantitis | Measurement of exposure, smoking status was self-reported |
| «Dreyer H, Grischke J, Tiede C, ym. Epidemiology and risk factors of peri-implantitis: A systematic review. J Periodontal Res 2018;53(5):657-681 »3 | SR/MA | publications from January 1980 until March 2016 on 9 databases: 32 cross-sectional studies, 10 case-control studies, 7 prospective cohort studies, 3 cohort studies, 2 cross-sectional retrospective studies, 1 randomized controlled trial, 1 non-randomized controlled trial and 1 retrospective cohort study. Peri-implantits prevalence/incidence and risk factors reported | Smokers and former smokers compared to non-smokers DM patients compared to non-diabetics Patients participating/not participating prophylaxis program Patients having/not having periodontitis or history of periodontitis | Prevalece of peri-implantitis | Imprecision in results in DM patients (wide confidence-intervals) Indirectness related maintenance treatment Heterogenity in studies related to periodontitis or history of periodontitis prevented meta-analysis |
| «Ferreira SD, Martins CC, Amaral SA, ym. Periodontitis as a risk factor for peri-implantitis: Systematic review and meta-analysis of observational studies. J Dent 2018;79():1-10 »4 | SR/MA | Systemic literature search for articles published until March 2018 in Pubmed and Cochrane library: 5 cohort studies, 2 case- control studies, 12 cross sectional studies | Patients rehabilitated with dental implants and diagnosed with history/presence of periodontitis, compared to periodontally healthy patients with no history of periodontitis | Risk of developing/having peri-implantitis | Low risk of bias in 18 studies, high risk in 1. |
| «Kordbacheh Changi K, Finkelstein J, Papapanou PN. Peri-implantitis prevalence, incidence rate, and risk factors: A study of electronic health records at a U.S. dental school. Clin Oral Implants Res 20»5 | Cohort study | Random subset (236 patients, 633 implants) of all patients receiving dental implants at the Clinics of the Columbia University College of Dental Medicine in 6/2011-12/2014 A total of 2,127 patients received 6,129 dental implants over the above 3.5-year period. 215/ 540 analyzed. | gender, implant brand, prosthetic design, history of periodontitis were studied | Frequency of peri-implantitis | |
| «Lin CY, Chen Z, Pan WL, ym. The effect of supportive care in preventing peri-implant diseases and implant loss: A systematic review and meta-analysis. Clin Oral Implants Res 2019;30(8):714-724 »6 | SR/MA | Systemic literature search for studies published up to June 2018 Clinical controlled trials (CCT) involved in SPT protocol with more than 1-year follow-up were included | influence of supportive treatment (SPT) or lack of SPT during a maintenance period after implant placement on . | implant survival rate (SR) and incidence of peri‐implant diseases | |
| «Reis INRD, do Amaral GCLS, Hassan MA, ym. The influence of smoking on the incidence of peri-implantitis: A systematic review and meta-analysis. Clin Oral Implants Res 2023;34(6):543-554 »7 | SR/MA | Four electronic databases were last searched on November 30, 2022, Studies that reported results related to the effect of smoking on the incidence of peri-implant diseases. Adult patients excluded patients with immunological conditions | smokers compared to non-smokers | incidence of peri-implantitis at patient and implant level | Serious bias were not detected, strong association |
| «Romandini M, Lima C, Pedrinaci I, ym. Prevalence and risk/protective indicators of peri-implant diseases: A university-representative cross-sectional study. Clin Oral Implants Res 2021;32(1):112-122 »8 | Cross-sectional study | 240 implantpatients randomly selected from a university clinic (Madrid) database were invited, 99 patients and 458 implants analysed | studied factors: smoking moderate/severe periodontitis < 16 remaining teeth plaque implant malposition implant brand restoration type previous trauma interproximal cleaning proton pump inhibitors anticoagulants | prevalence of preperi-implantitis (bone loss 1-2 mm) and peri-implantitis (bone loss ≥ 2 mm) and associated risk or protective factors | |
| «Sgolastra F, Petrucci A, Severino M, ym. Periodontitis, implant loss and peri-implantitis. A meta-analysis. Clin Oral Implants Res 2015;26(4):e8-e16 »9 | SR/MA | Six electronic database and a manual search until 6/2013, 16 /13 relevant studies included in SR/MA | Periodontitis as a risk factor for implant loss, peri-implantitis and implant-bone loss. | peri-implant bone loss at implant level peri-implantitis at patient level implant loss at implant level | |
| «Tsaousoglou P, Chatzopoulos GS, Tsalikis L, ym. Prevalence and risk indicators of peri-implantitis: a university based cross-sectional study. Quintessence Int 2023;54(7):558-568 »10 | Retrospective cohort | Randomly selected patients from Aristotele university clinic, Theassaloniki, treated with implants 2005 – 2017 | risk and protective indicators for peri-implantitis | peri-implantitis | |
| Reference | Comments |
|---|---|
| «Carra MC, Blanc-Sylvestre N, Courtet A, ym. Primordial and primary prevention of peri-implant diseases: A systematic review and meta-analysis. J Clin Periodontol 2023;50 Suppl 26():77-112 »1 | Glycemic control was considered poor with HbA1c >8 %. Mean implant survival rate may be considered as acceptable in both (unstable and stable DM) groups; 95.6% and 99%, respectively. However, follow-up times were as short as 1-3 y in 5 of the included studies, including 1 study in meta-analysis. Irregular SPT decreased implant survival OR 3.76 (1.5 – 9.45). The role of a long term unstable DM is difficult/unethical to study, because the goal of DM treatment is stable glycemic status. |
| «Costa FO, Lages EJP, Cortelli SC, ym. Association between cumulative smoking exposure, span since smoking cessation, and peri-implantitis: a cross-sectional study. Clin Oral Investig 2022;26(7):4835-4»2 | Follow up was a minimum of 5 years, dose-response was reported |
| «Dreyer H, Grischke J, Tiede C, ym. Epidemiology and risk factors of peri-implantitis: A systematic review. J Periodontal Res 2018;53(5):657-681 »3 | Meta-analysis focused on smoking, included one study of former smokers, in which OR was 0,34 (0,01-9,95), No meta-analysis performed on profylaxis program because of heterogenity among studies. Lack of professional maintenance was the primary outcome only in 1 included study, others used indirect outcomes such as presence plaque/plaque index No meta-analysis performed on periodontitis/history of periodontitis |
| «Ferreira SD, Martins CC, Amaral SA, ym. Periodontitis as a risk factor for peri-implantitis: Systematic review and meta-analysis of observational studies. J Dent 2018;79():1-10 »4 | Significant heterogenity, publication bias reported by the authors. Wide confidence intervals may be partly explained by wide range of follow-up time (1-16 years) |
Results
| Reference | Number of studies and number of patients (I/C) | Follow-up time | Absolute number of events (%) I | Absolute number of events (%) C | Relative effect (95% CI) |
|---|---|---|---|---|---|
| I=intervention; C=comparison; CI=confidence interval CS=current smoker, FS=former smoker, NS=non-smoker | |||||
| «Costa FO, Lages EJP, Cortelli SC, ym. Association between cumulative smoking exposure, span since smoking cessation, and peri-implantitis: a cross-sectional study. Clin Oral Investig 2022;26(7):4835-4»2 | CS 72, FS 66, NS 212 | Minimum of 5 y | FS 13, CS 22 | NS 39 | FS 1.31 (1.18–2.34) CS 2.63 (1.39–6.77) heavy smoking (> 40 pack years) 2.88 (1.28–12.27) |
| «Dreyer H, Grischke J, Tiede C, ym. Epidemiology and risk factors of peri-implantitis: A systematic review. J Periodontal Res 2018;53(5):657-681 »3 | 8 studies, 1618 participants | not reported for studies on smoking, overall from 6 months to 16 years | OR 1.7, 95% CI 1.25-2.3) | ||
| «Reis INRD, do Amaral GCLS, Hassan MA, ym. The influence of smoking on the incidence of peri-implantitis: A systematic review and meta-analysis. Clin Oral Implants Res 2023;34(6):543-554 »7 | 6 studies, 689 participants | 1 to 10 years | implant level 109/342 patient level 49/153 | implant level 200/1617 patient level 95/609 | implant level 2,04 (1,46-2,85) patient level 2,08 (1,17-3,71) |
| «Romandini M, Lima C, Pedrinaci I, ym. Prevalence and risk/protective indicators of peri-implant diseases: A university-representative cross-sectional study. Clin Oral Implants Res 2021;32(1):112-122 »8 | 99 patients, 458 implants | minimum of 1 y after loading | current smoker OR 3.59; 95% CI: 1.52–8.45 former smoker OR 1.89; 95% CI: 0.90–3.98 | ||
| Level of evidence: high (A) Assess the risk of bias and delete irrelevant sources of bias: The quality of evidence is upgraded due to strong association, dose-response, consistency of results across studies | |||||
| Reference | Number of studies and number of patients (I/C) | Follow-up time | Absolute number of events (%) I | Absolute number of events (%) C | Relative effect (95% CI) |
|---|---|---|---|---|---|
| I= intervention; C=comparison; CI=confidence interval; SR= survival rate | |||||
| «Carra MC, Blanc-Sylvestre N, Courtet A, ym. Primordial and primary prevention of peri-implant diseases: A systematic review and meta-analysis. J Clin Periodontol 2023;50 Suppl 26():77-112 »1 | 6 studies 416/320 | from 6 months up to 20 y | 69/416 | 72/320 | Regular SPT compared to irregular SPT OR 0.45 (0.30 – 0.68) |
| «Dreyer H, Grischke J, Tiede C, ym. Epidemiology and risk factors of peri-implantitis: A systematic review. J Periodontal Res 2018;53(5):657-681 »3 | 11 studies, 1898 participants | 5-10 y | No meta-analysis on prevalence of peri-implantitis 9.0% for regular participants of a prophylaxis programme, 18.8%, for patients without regular preventive maintenance | ||
| «Lin CY, Chen Z, Pan WL, ym. The effect of supportive care in preventing peri-implant diseases and implant loss: A systematic review and meta-analysis. Clin Oral Implants Res 2019;30(8):714-724 »6 | 9 studies, of which six (SR), three (peri-implantitis) and three (peri-implant mucositis) were included in further meta-analysis, | 1 – 20 y | Regular SPT compared to irregular SPT | ||
| SR (SPT) 683/723 | SR (no/irregular SPT) 910/1048 | SR 1.10 (1.07 – 1.14) | |||
| peri-implant mucositis (SPT) 42/124 | peri-implant mucositis (no/irregular SPT) 57/94 | RR 0.57 (0.43 – 0.76) | |||
| peri-implantitis 9/124 | peri-implantitis 32/94 | RR 0.25 (0.13 – 0.48) | |||
| Level of evidence: high (A) Assess the risk of bias and delete irrelevant sources of bias: The quality of evidence is upgraded due to strong effect and consistent results across studies. | |||||
| Reference | Number of studies and number of patients (I/C) | Follow-up time | Absolute number of events (%) I, periodontitis | Absolute number of events (%) C healthy | Relative effect (95% CI) |
|---|---|---|---|---|---|
| I=intervention; C=comparison; CI=confidence interval | |||||
| «Dreyer H, Grischke J, Tiede C, ym. Epidemiology and risk factors of peri-implantitis: A systematic review. J Periodontal Res 2018;53(5):657-681 »3 | Forest plot showed a strong tendency favouring patients with periodontitis/history of periodontitis as more susceptible to peri-implantitis | ||||
| «Ferreira SD, Martins CC, Amaral SA, ym. Periodontitis as a risk factor for peri-implantitis: Systematic review and meta-analysis of observational studies. J Dent 2018;79():1-10 »4 | 4222 patients 10075 implants | 1 – 16 y | Risk for peri-implantitis at patient level 2,29 (1,34 – 3,24) at implant level 2,15 (1,10 – 3,21) | ||
| «Kordbacheh Changi K, Finkelstein J, Papapanou PN. Peri-implantitis prevalence, incidence rate, and risk factors: A study of electronic health records at a U.S. dental school. Clin Oral Implants Res 20»5 | 215 patients 540 implants | 2,5 y | History/radiographic evidence of periodontitis (OR = 3.63; 95% CI: 1.73–7.64 at implant level | ||
| «Romandini M, Lima C, Pedrinaci I, ym. Prevalence and risk/protective indicators of peri-implant diseases: A university-representative cross-sectional study. Clin Oral Implants Res 2021;32(1):112-122 »8 | 99 patients 458 implants | minimum of 1 y after loading | OR = 2.77; 95% CI: 1.20–6.36 | ||
| «Sgolastra F, Petrucci A, Severino M, ym. Periodontitis, implant loss and peri-implantitis. A meta-analysis. Clin Oral Implants Res 2015;26(4):e8-e16 »9 | 3 studies, 505 implants 5 studies, 810 patients 11 studies, 4372 implants | peri-implantitis 132/402 implant loss 136/2812 | peri-implantitis 62/408 implant loss 42/1560 | SMD for peri-implant bone loss 0,44 (0,19 – 0,69) peri-implantitis RR 2,21 (1,42 – 3,43) implant loss RR 1,89 (1,35 – 2,66) | |
| «Tsaousoglou P, Chatzopoulos GS, Tsalikis L, ym. Prevalence and risk indicators of peri-implantitis: a university based cross-sectional study. Quintessence Int 2023;54(7):558-568 »10 | 108 patients 355 implants | Peri-implantitis OR periodontal status: health in reduced periodontium 0,39 (0,09 – 1,69) recurrent periodontitis 3,11 (1,02 – 9,45) | |||
| Level of evidence: high (A) for presence of periodontitis or periodontitis with poor response to treatment, the risk for previously treated and well maintained periodontitis remains unclear. Assess the risk of bias and delete irrelevant sources of bias: The quality of evidence is upgraded due to strong effect and consistency of the results. | |||||
References
- Carra MC, Blanc-Sylvestre N, Courtet A, ym. Primordial and primary prevention of peri-implant diseases: A systematic review and meta-analysis. J Clin Periodontol 2023;50 Suppl 26():77-112 «PMID: 36807599»PubMed
- Costa FO, Lages EJP, Cortelli SC, ym. Association between cumulative smoking exposure, span since smoking cessation, and peri-implantitis: a cross-sectional study. Clin Oral Investig 2022;26(7):4835-4846 «PMID: 35316410»PubMed
- Dreyer H, Grischke J, Tiede C, ym. Epidemiology and risk factors of peri-implantitis: A systematic review. J Periodontal Res 2018;53(5):657-681 «PMID: 29882313»PubMed
- Ferreira SD, Martins CC, Amaral SA, ym. Periodontitis as a risk factor for peri-implantitis: Systematic review and meta-analysis of observational studies. J Dent 2018;79():1-10 «PMID: 30391683»PubMed
- Kordbacheh Changi K, Finkelstein J, Papapanou PN. Peri-implantitis prevalence, incidence rate, and risk factors: A study of electronic health records at a U.S. dental school. Clin Oral Implants Res 2019;30(4):306-314 «PMID: 30768875»PubMed
- Lin CY, Chen Z, Pan WL, ym. The effect of supportive care in preventing peri-implant diseases and implant loss: A systematic review and meta-analysis. Clin Oral Implants Res 2019;30(8):714-724 «PMID: 31231883»PubMed
- Reis INRD, do Amaral GCLS, Hassan MA, ym. The influence of smoking on the incidence of peri-implantitis: A systematic review and meta-analysis. Clin Oral Implants Res 2023;34(6):543-554 «PMID: 36939434»PubMed
- Romandini M, Lima C, Pedrinaci I, ym. Prevalence and risk/protective indicators of peri-implant diseases: A university-representative cross-sectional study. Clin Oral Implants Res 2021;32(1):112-122 «PMID: 33210772»PubMed
- Sgolastra F, Petrucci A, Severino M, ym. Periodontitis, implant loss and peri-implantitis. A meta-analysis. Clin Oral Implants Res 2015;26(4):e8-e16 «PMID: 24382358»PubMed
- Tsaousoglou P, Chatzopoulos GS, Tsalikis L, ym. Prevalence and risk indicators of peri-implantitis: a university based cross-sectional study. Quintessence Int 2023;54(7):558-568 «PMID: 37139954»PubMed