Takaisin

Risk factors for peri-implantitis and implant loss

Näytönastekatsaukset
Marja Pöllänen and Heidi Kuula
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.

Table 1. Description of the included studies
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. Primor...»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 ...»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 an...»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. Periodonti...»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. ...»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 supporti...»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 infl...»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 a...»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. Periodont...»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. Pr...»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
Table 2. Additional comments for included studies
Reference Comments
«Carra MC, Blanc-Sylvestre N, Courtet A, ym. Primor...»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 ...»2 Follow up was a minimum of 5 years, dose-response was reported
«Dreyer H, Grischke J, Tiede C, ym. Epidemiology an...»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. Periodonti...»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

Table 3. Outcome: Smoking as a risk factor for peri-implantitis
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 ...»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 an...»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 infl...»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 a...»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
Table 4. Outcome: irregular SPT as a risk factor for peri-implantitis
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
«Carra MC, Blanc-Sylvestre N, Courtet A, ym. Primor...»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 an...»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 supporti...»6 9 studies, of which six (SR), three (peri-implantitis) and three (peri-implant mucositis) were included in further meta-analysis, 1 – 20 y


SR (SPT) 683/723


peri-implant mucositis (SPT) 42/124


peri-implantitis
9/124



SR (no/irregular SPT) 910/1048

peri-implant mucositis
(no/irregular SPT) 57/94

peri-implantitis
32/94
Regular SPT compared to irregular SPT
SR 1.10 (1.07 – 1.14)


RR 0.57 (0.43 – 0.76)



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.
Table 5. Outcome: history/presence of periodontitis as a risk factor
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 an...»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. Periodonti...»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. ...»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 a...»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. Periodont...»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. Pr...»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

  1. 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
  2. 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
  3. 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
  4. 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
  5. 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
  6. 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
  7. 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
  8. 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
  9. 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
  10. 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