Prevalence of peri-implant diseases - a critical review on the current evidence

Abstract The objective of this paper was to evaluate the current evidence reporting on the prevalence of peri-implantitis and to determine the influencing factors. An electronic search for articles published until February 2019 reporting on the prevalence of peri-implantitis was performed in MEDLINE. Included criteria were published in international peer-reviewed journals, written in English language, reported on the prevalence of peri-implantitis, included implants with a minimum follow-up of one year after functional loading and used a clear definition for peri-implantitis and/or peri-implant mucositis with a clear cutoff for bone level changes according to the case definitions of Sanz and Chapple and Berglundh et al. 2018. Included papers were anaylized for factors affecting the reported prevalences for peri-implantitis. Twenty-five papers were included in the present review and a wide range for the reported prevalence of peri-implantitis was seen. Case definitions for peri-implantitis with various thresholds for bone loss together with the type of reporting on patient- or implant-level were the most significant factors that lead to a large variety of the occurrence of the disease. Additionally, follow-up time and the evaluation in a certain "convenience" population may have influenced the prevalence values. In conclusion, it can be stated that a wide range for reporting the prevalence of peri-implantitis can be found and no real estimation of the global burden of the disease can be made. Applying accurate case definitions for peri-implantitis is the most important factor for reporting the prevalence and should be strictly followed in future reports.

Prevalencia y caracterización de hallazgos asociados con implantes en radiografías panorámicas / Prevalence and characterization of findings associated with implants in panoramic radiographs

Introducción: en Colombia, el último estudio de salud bucal evidenció que cerca del 70 por ciento de la población presenta edentulismo parcial mientras que el 5,2 por ciento habrá perdido todos los dientes entre los 65 y 79 años. La rehabilitación con implantes es una opción cada vez más utilizada, que requiere seguimiento clínico y radiográfico, siendo la radiografía panorámica una opción de bajo costo, en la que es posible observar zonas de pérdida ósea, angulación mesodistal del implante, relación con estructuras anatómicas y lesiones sugerentes de periimplantitis. Se requieren reportes y análisis de datos relevantes sobre los hallazgos en radiografías asociados a implantes dentales para determinar los factores de riesgo para su éxito, en los pacientes que los usan. Objetivo: determinar la prevalencia y caracterizar los hallazgos asociados a los implantes de oseointegración en radiografías panorámicas. Métodos: se realizó un estudio observacional descriptivo de corte transversal, con 10 000 radiografías panorámicas digitales seleccionadas por conveniencia de centros radiológicos en la ciudad de Bogotá, Colombia, de las cuales 543 correspondieron a la muestra analizada por la presencia de implantes. Se evaluó para cada implante: localización, posición, angulación y distancias con las estructuras adyacentes, utilizando el programa Clínicalview® (Orthopantomograph OP200D, Instrumentarium, USA). Resultados: La frecuencia de radiografías con implantes fue del 5,43 por ciento con un total de 1 791 implantes, con un promedio 3,2 por radiografía. Se encontraron en mayor proporción en el maxilar superior con una localización supracrestal y una angulación de 10,3 grados. El 32 por ciento presentaba distancias implante/diente o implante/implante inferiores a las óptimas. El 40,9 por ciento estaban restaurados y 1,2 por ciento mostraban lesiones compatibles con periimplantitis. Conclusiones: un alto porcentaje de los implantes revisados tiene un factor de riesgo que afecta su viabilidad a largo plazo ya sea por angulación, posición supracrestal o crestal, vecindad con dientes u otros implantes o bien por no ser restaurable(AU)

Introduction: the most recent survey about oral health conducted in Colombia revealed that nearly 70 percent of the population is partially edentulous, whereas 5.2 percent will have lost all their teeth by the time they are 65-79 years old. Implant rehabilitation is an ever more common alternative which requires clinical and radiographic follow-up, panoramic radiography being a low-cost option to observe areas of bone loss, mesiodistal angulation of the implant, relationship to anatomical structures and lesions suggesting peri-implantitis. Relevant data analyses and reports are needed about radiographic findings associated with dental implants to determine the risk factors for their success in patients wearing them. Objective: determine the prevalence of and characterize the findings associated to osseointegration implants in panoramic radiographs. Methods: a cross-sectional observational descriptive study was conducted of 10 000 digital panoramic radiographs chosen by convenience sampling at radiology centers from the city of Bogotá, Colombia, of which 543 made up the study sample, due to the presence of implants. Each implant was evaluated for location, position, angulation and distance from adjacent structures, using the software Clínicalview® (Orthopantomograph OP200D, Instrumentarium, USA). Results: the frequency of radiographs with implants was 5.43 percent with a total 1 791 implants and an average 3.2 per radiograph. Implants were more common on the upper maxilla with a supracrestal location and an angulation of 10.3 degrees. In 32 percent implant-tooth or implant-implant distances were below optimum values. 40.9 percent had been restored and 1.2 percent showed lesions compatible with peri-implantitis. Conclusions: a large proportion of the implants examined exhibit a risk factor affecting their long-term viability, namely angulation, supracrestal or crestal position, proximity to teeth or other implants, or not being restorable(AU)

Doença peri-implantar follow-up microbiológico de 5 anos e revisão sistemática com meta-análise / Peri-implant disease: Microbiological 5-year follow-up and systematic review with meta-analysis

Objetivos: Avaliar, em um estudo longitudinal de 5 anos, a associação entre o diagnóstico da doença peri-implantar (DPi) e a contagem de patógenos na presença e ausência de terapia de manutenção periodontal/peri-implantar (TMPP). Realizar uma revisão sistemática de estudos observacionais para avaliar se dados presentes na literatura indicam uma maior prevalência de peri-implantite (PI) em indivíduos com diagnóstico ou histórico de periodontite (PE). Métodos: O estudo longitudinal microbiológico foi realizado avaliando-se, através da técnica da reação em cadeia da polimerase em tempo real, as seguintes espécies bacterianas: T. forsythia, T. denticola, P. gingivalis, P. intermedia, F. nucleatum e A. naeslundii em 80 indivíduos com mucosite peri-implantar (MP) que realizavam consultas para manutenção periodontal/peri-implantar regular (GTP, n = 39) comparados aos que não realizavam (GNTP, n = 41). Para a revisão sistemática uma busca eletrônica foi conduzida até março de 2016. Foram encontrados 1330 estudos, 17 artigos foram incluídos na análise final (PROSPERO CRD42015009518). A meta-análise foi realizada para presença ou ausência de PI. Medidas de efeito sumário e taxas de razão de chances (OR) com 95% IC foram calculadas. Resultados: Os resultados do estudo longitudinal mostraram que, após 5 anos, houve uma diminuição da carga bacteriana total (CBT), na frequência das bactérias analisadas do complexo laranja (p = 0.013) e nas frequências isoladas de T. forsythia (p = 0.000), P. gingivalis (p = 0.003) e P. intermedia (p = 0.013) no GTP. Indivíduos com PI apresentaram maiores frequências de P. gingivalis (GNTP: p = 0,030; GTP: p = 0,000), T. denticola (GNTP: p = 0,017) e F. nucleatum (GTP e GNTP; p = 0.002) comparados aos com MP. Indivíduos que desenvolveram PI apresentaram um aumento na CBT (GTP: p = 0.047; GNTP: p = 0,055) e na frequência isolada de P. gingivalis (GNTP: p = 0,002) e F. nucleatum (GTP e GNTP; p = 0.000). Não houve diferenças estatisticamente significativas intergrupos em relação aos patógenos do complexo vermelho (p > 0,05). Tanto nos indivíduos com MP (T1 e T2: p = 0,000), quanto nos indivíduos com PI (T2: p = 0,000), a frequência do complexo laranja foi significativamente menor no GTP. A meta-análise dos estudos coorte mostrou que indivíduos (OR = 7.22), e implantes (OR = 5.63) apresentaram maior risco de desenvolver PI. Nos estudos transversais, em análises não ajustadas, indivíduos com PE apresentaram maior chance de ter PI (OR = 3.18). Quando a análise foi ajustada para tabagismo e diabetes não houve aumento estatisticamente significativo no risco para PI (OR = 1.73; IC 95% 0.86- 3.45). Conclusões: Pôde-se concluir que a ausência de consultas regulares para manutenção periodontal/peri-implantar foi associada com pior condição clínica periimplantar, maior incidência de PI e um aumento significativo na CBT. Adicionalmente, indivíduos com diagnóstico de PI apresentaram maiores frequências de P. gingivalis, T. denticola e F. nucleatum e maior CBT. A revisão sistemática permitiu concluir que indivíduos com diagnóstico ou histórico de PE podem apresentar um risco aumentado para PI. Mais estudos prospectivos são necessários para confirmar a evidência, principalmente os ensaios clínicos controlados randomizados

Aims: Evaluate, in a 5-year longitudinal study, the association between peri-implant disease's (DPi) diagnosis and the count of pathogens in the presence and absence of periodontal/peri-implant maintenance therapy. Conduct a systematic review of observational studies to evaluate whether data in the literature indicates a higher prevalence of peri-implantitis (PI) in subjects with diagnosis or history of periodontitis (PE). Methods: the microbiologic study was performed evaluating, through polymerase chain reaction in real time technique, the following bacterial species: T. forsythia, T. denticola, P. gingivalis, P. intermedia, F. nucleatum and A. naeslundii in 80 patients with peri-implant mucositis (PM) that were queries for periodontal/periimplant regular maintenance (GTP, n = 39) compared to those who were not (GNTP, n = 41). For the systematic review an electronic search was conducted until March 2016. It was found 1330 studies, 19 articles were included in the final analysis (PROSPERO CRD42015009518). The meta-analysis was performed for presence or absence of PI. Summary measures and odds ratio (OR) with 95% IC were calculated. Results: the results of the longitudinal study showed that, after 5 years, there was a decrease in the total bacterial load (TBL), the frequency of bacteria analyzed in the orange complex (p = 0.013) and in the frequencies of T. forsythia (p = 0.000), P. gingivalis (p = 0.003) and P. intermedia (p = 0.013) in the GTP. Individuals with PI had higher frequencies of P. gingivalis (GNTP: p = 0.030; GTP: p = 0.000), T. denticola (GNTP: p = 0.017) and T. nucleatum (GTP and GNTP; p = 0.002) compared to those with PM diagnosis. Individuals who have developed PI showed an increase in TBL (GTP: p = 0047; GNTP: p = 0.055) and in the isolated frequencies of P. gingivalis (GNTP: p = 0.002) and F. nucleatum (GTP and GNTP; p = 0.000). There were no statistically significant differences intergroups in relation to red complex pathogens (p > 0.05). Both in individuals with PM (T1 and T2: p = 0.000), as in individuals with PI (T2: p = 0.000), the frequency of orange complex was significantly lower in the GTP. The meta-analysis of cohort studies showed that individuals (OR = 7.22), and implants (OR = 5.63) presented a higher risk of developing PI. In the cross-sectional studies, in unadjusted analyses, individuals with PE presented a higher chance of having PI (OR = 3.18). When the analysis was adjusted for smoking and diabetes, there was no statistically significant increase in risk for PI (OR = 1.73; 95% CI 0.86-3.45). Conclusions: it might be concluded that the absence of regular periodontal/peri-implant maintenance was associated with worse peri-implant clinical condition, higher incidence of PI and a significant increase in TBL. Additionally, individuals diagnosed with PI showed greater frequencies of P. gingivalis, T. denticola and F. nucleatum and largest TBL. The systematic review showed that individuals diagnosed or with PE's history may have an increased risk for PI. More prospective studies are needed to confirm this evidence, especially the randomized controlled clinical trials

Prevalence of peri-implant disease on platform switching implants: a cross-sectional pilot study

The objective of this study was to assess the prevalence of mucositis and peri-implantitis associated with the use of two types of implants—conventional versus platform switching after one year of loading. A longitudinal study of 64 implants in 25 patients was performed. Clinical variables, such as clinical pocket depth and bleeding upon probing, plaque, mobility, gingival recession, clinical attachment loss, and radiographic bone loss, were analyzed. The case definition for peri-implantitis was established as pockets of ≥ 5 mm with bleeding and bone loss ≥ 2 mm. One year after implant loading, the prevalence of mucositis and peri-implantitis with conventional implants (CIs) was 81.2% and 15.6%, respectively. For platform switching implants (PSIs) the prevalence was 90% and 6.6%, respectively. These differences were not statistically significant (p = 0.5375). However, there was a trend towards a lower prevalence of peri-implantitis with platform switching Implants.

Factores de riesgo y periimplantitis en la terapia implantológica: revisión narrativa / Risk factors and periimplantitis in implant therapy: narrative review

Las enfermedades que involucran a los tejidos que rodean a los dientes y a los implantes osteointegrados son el resultado de una interacción entre algún tipo de agente patológico (bacteriano, viral, etc.) y la respuesta inmunitaria del huésped. Estas interacciones se pueden dar tanto en los tejidos dentarios como en aquellos biomateriales que se introducen para tratar de corregir algún tipo de patología periodontal; los implantes al ser sustitutos biocompatibles de las piezas dentarias no están exentas de este tipo de interacciones que muchas veces cursan con patologías periodontales y periimplantarias. La periimplantitis es un tipo de patología que resulta de dicha interacción; los factores de riesgo e indicadores de riesgo de la periimplantitis son amplios y complejos. El presente artículo resume las múltiples fuentes de información de la literatura científica para abordar al detalle los aspectos de los principales factores de riesgo y la periimplantitis en la terapia implantológica.

Diseases involving tissue around the teeth and osseo integrated implants are the result of an interaction between some type of pathological agent (bacterial, viral, etc.) and host immune response. These interactions can occur both in the dental tissues as those biomaterials which are introduced to attempt to correct some type of periodontal disease, the implant being a biocompatible substitute of the teeth is not free from this type of interaction often enrolled periodontal and peri-implant pathology. The peri-implantitisis a type of disease that results from this interaction, the risk factors and risk indicators of peri-implantitis are broad and complex. This article summarizes the multiple sources of information in the scientific literature to address in detail the aspects of the main risk factors and the peri-implantitis in the peri implant therapy.