Peri-implantitis is a biological complication that can occur after a dental implant is placed. It encompasses inflammatory reactions around the implant, such as peri-implant mucositis and peri-implantitis itself. As dental implants become more widely used, complications associated with them are also becoming more common. Several risk factors can contribute to the development of peri-implantitis. These include placing an implant when there is an existing periodontal infection in the remaining teeth, as well as when there is inadequate width of attached gingiva. Poor oral hygiene is another significant risk factor. Additional factors include the presence of an endodontic infection near where the implant is placed, improper implant positioning in terms of prosthetic and/or biological alignment, the implant design itself, incorrect abutment choice, and unremoved cement in cement-retained prosthetic devices. Systemic and genetic factors can also play a role in modifying the risk of peri-implantitis. Peri-implant inflammatory diseases are diagnosed through both clinical and paraclinical testing methods. This involves assessing the risks associated with the implant, such as whether plaque is present, whether there is bleeding on probing, edema, erythema, increased probing depths, exudation, bone loss around the implant, and implant mobility. The treatment for peri-implant inflammation involves CIST therapy.
Perussolo J, Donos N. Maintenance of peri-implant health in general dental practice. Br Dent J. 2024 May;236(10):781-9. doi: 10.1038/s41415-024-7406-8.
Lanza A, Scognamiglio F, Femiano F, Lanza M. Immediate, early, and conventional implant placement in a patient with history of periodontitis. Case Rep Dent. 2015;2015:217895. doi: 10.1155/2015/217895.
Ahuja S, Wicks R, Selecman A. Fabrication of new restorations with a consideration of oral hygiene. J Indian Prosthodont Soc. 2016 Jul-Sep;16(3):307-10. doi: 10.4103/0972-4052.158084.
Berglundh T, Armitage G, Araujo MG, Avila-Ortiz G, Blanco J, Camargo PM, et al. Peri-implant diseases and conditions: Consensus report of workgroup 4 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. J Clin Periodontol. 2018 Jun;45 Suppl 20:S286-S291. doi: 10.1111/jcpe.12957.
Peev S. Dental implantology. City Center; 2023. (in Bulgarian).
Buonocunto N, Cinquini C, Mijiritsky E, Tagger-Green N, Porreca A, Di Nicola M, et al. Effect of alveolar ridge preservation on peri-implant mucositis and peri-implantitis prevalence: A multicenter, cross-sectional study. Clin Implant Dent Relat Res. 2023 Dec;25(6):1044-55. doi: 10.1111/cid.13240.
Heitz-Mayfield LJA, Salvi GE. Peri-implant mucositis. J Clin Periodontol. 2018 Jun;45 Suppl 20:S237-S245. doi: 10.1111/jcpe.12953.
Jayesh RS, Dhinakarsamy V. Osseointegration. J Pharm Bioallied Sci. 2015 Apr;7(Suppl 1):S226-9. doi: 10.4103/0975-7406.155917.
Parithimarkalaignan S, Padmanabhan TV. Osseointegration: an update. J Indian Prosthodont Soc. 2013 Mar;13(1):2-6. doi: 10.1007/s13191-013-0252-z.
Anitua E, Alkhraisat MH, Eguia A. On Peri-Implant Bone Loss Theories: Trying To Piece Together the Jigsaw. Cureus. 2023 Jan 1;15(1):e33237. doi: 10.7759/cureus.33237.
Chan HL, Rodriguez Betancourt A, Liu CC, Chiang YC, Schmidlin PR. A conceptual review on reconstructive peri-implantitis therapy: Challenges and opportunities. Clin Exp Dent Res. 2023 Oct;9(5):735-745. doi: 10.1002/cre2.788.
Achanur M, Aldhuwayhi S, Parihar AS, Bhardwaj A, Das R, Anad KS. Assessment of correlation of periodontitis in teeth adjacent to implant and peri- implantitis. J Family Med Prim Care. 2020 Jan 28;9(1):243-6. doi: 10.4103/jfmpc.jfmpc_726_19.
van Winkelhoff AJ, Goené RJ, Benschop C, Folmer T. Early colonization of dental implants by putative periodontal pathogens in partially edentulous patients. Clin Oral Implants Res. 2000 Dec;11(6):511-20. doi: 10.1034/j.1600-0501.2000.011006511.x.
Cortelli SC, Cortelli JR, Romeiro RL, Costa FO, Aquino DR, Orzechowski PR, et al. Frequency of periodontal pathogens in equivalent peri-implant and periodontal clinical statuses. Arch Oral Biol. 2013 Jan;58(1):67-74. doi: 10.1016/j.archoralbio.2012.09.004.
Corsalini M, Montagnani M, Charitos IA, Bottalico L, Barile G, Santacroce L. Non-Surgical Therapy and Oral Microbiota Features in Peri-Implant Complications: A Brief Narrative Review. Healthcare (Basel). 2023 Feb 23;11(5):652. doi: 10.3390/healthcare11050652.
Iușan SAL, Lucaciu OP, Petrescu NB, Mirică IC, Toc DA, Albu S, et al. The Main Bacterial Communities Identified in the Sites Affected by Periimplantitis: A Systematic Review. Microorganisms. 2022 Jun 16;10(6):1232. doi: 10.3390/microorganisms10061232.
Fragkioudakis I, Tseleki G, Doufexi AE, Sakellari D. Current Concepts on the Pathogenesis of Peri-implantitis: A Narrative Review. Eur J Dent. 2021 May;15(2):379-87. doi: 10.1055/s-0040-1721903.
Edgerton M, Lo SE, Scannapieco FA. Experimental salivary pellicles formed on titanium surfaces mediate adhesion of streptococci. Int J Oral Maxillofac Implants. 1996 Jul-Aug;11(4):443-9.
Sedghi L, DiMassa V, Harrington A, Lynch SV, Kapila YL. The oral microbiome: Role of key organisms and complex networks in oral health and disease. Periodontol 2000. 2021 Oct;87(1):107-31. doi: 10.1111/prd.12393.
Sahrmann P, Gilli F, Wiedemeier DB, Attin T, Schmidlin PR, Karygianni L. The Microbiome of Peri-Implantitis: A Systematic Review and Meta-Analysis. Microorganisms. 2020 May 1;8(5):661. doi: 10.3390/microorganisms8050661.
Kotsakis GA, Olmedo DG. Peri-implantitis is not periodontitis: scientific discoveries shed light on microbiome-biomaterial interactions that may determine disease phenotype. Periodontol 2000. 2021;86(1):231–40. doi: 10.1111/prd.12372.
Tamura N, Ochi M, Miyakawa H, Nakazawa F. Analysis of bacterial flora associated with peri-implantitis using obligate anaerobic culture technique and 16S rDNA gene sequence. The Int J Oral Maxillofac Implants. 2013;28(6):1521–9. doi: 10.11607/jomi.2570.
Berglundh T, Zitzmann NU, Donati M. Are peri-implantitis lesions different from periodontitis lesions? J Clin Periodontol. 2011 Mar;38 Suppl 11:188-202. doi: 10.1111/j.1600-051X.2010.01672.x.
Radaelli K, Alberti A, Corbella S, Francetti L. The Impact of Peri-Implantitis on Systemic Diseases and Conditions: A Review of the Literature. Int J Dent. 2021 May 15;2021:5536566. doi: 10.1155/2021/5536566.
Berglundh T, Armitage G, Araujo MG, Avila-Ortiz G, Blanco J, Camargo PM, et al. Peri-implant diseases and conditions: Consensus report of workgroup 4 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. J Periodontol. 2018 Jun;89 Suppl 1:S313-8. doi: 10.1002/JPER.17-0739.
Ata-Ali J, Flichy-Fernández AJ, Alegre-Domingo T, Ata-Ali F, Palacio J, Peñarrocha-Diago M. Clinical, microbiological, and immunological aspects of healthy versus peri-implantitis tissue in full arch reconstruction patients: a prospective cross-sectional study. BMC Oral Health. 2015 Apr 1;15:43. doi: 10.1186/s12903-015-0031-9.
Banu Raza F, Vijayaragavalu S, Kandasamy R, Krishnaswami V, Kumar VA. Microbiome and the inflammatory pathway in peri-implant health and disease with an updated review on treatment strategies. J Oral Biol Craniofac Res. 2023 Mar-Apr;13(2):84-91. doi: 10.1016/j.jobcr.2022.11.005.
Yakar N, Guncu GN, Akman AC, Pınar A, Karabulut E, Nohutcu RM. Evaluation of gingival crevicular fluid and peri-implant crevicular fluid levels of sclerostin, TWEAK, RANKL and OPG. Cytokine. 2019 Jan;113:433-439. doi: 10.1016/j.cyto.2018.10.021.
Arikan F, Buduneli N, Kütükçüler N. Osteoprotegerin levels in peri-implant crevicular fluid. Clin Oral Implants Res. 2008 Mar;19(3):283-8. doi: 10.1111/j.1600-0501.2007.01463.x.
Boyce BF, Xing L. The RANKL/RANK/OPG pathway. Curr Osteoporos Rep. 2007 Sep;5(3):98-104. doi: 10.1007/s11914-007-0024-y.
Strbac GD, Monov G, Cei S, Kandler B, Watzek G, Gruber R. Cathepsin K levels in the crevicular fluid of dental implants: a pilot study. J Clin Periodontol. 2006 Apr;33(4):302-8. doi: 10.1111/j.1600-051X.2006.00904.x.
van Bezooijen RL, Roelen BA, Visser A, van der Wee-Pals L, de Wilt E, Karperien M, et al. Sclerostin is an osteocyte-expressed negative regulator of bone formation, but not a classical BMP antagonist. J Exp Med. 2004 Mar 15;199(6):805-14. doi: 10.1084/jem.20031454.
Lira-Junior R, Teixeira MKS, Lourenço EJV, Telles DM, Figueredo CM, Boström EA. CSF-1 and IL-34 levels in peri-implant crevicular fluid and saliva from patients having peri-implant diseases. Clin Oral Investig. 2020 Jan;24(1):309-15. doi: 10.1007/s00784-019-02935-8.
Kitaura H, Marahleh A, Ohori F, Noguchi T, Shen WR, Qi J, et al. Osteocyte-Related Cytokines Regulate Osteoclast Formation and Bone Resorption. Int J Mol Sci. 2020 Jul 21;21(14):5169. doi: 10.3390/ijms21145169.
Ellen RP, Apse P. Periimplant Infections of the Oral Cavity. In: Wadström T, Eliasson I, Holder I, Ljungh Å, editors. Pathogenesis of Wound and Biomaterial-Associated Infections. Springer, London; 1990. pp .217-8.
Gong J, Al-Sosowa AA, Zhao R, Li J, Mei M. Successful Management of Peri-Implant Infection from the Endodontic Lesion of Adjacent Natural Tooth. Case Rep Dent. 2023 Mar 14;2023:5034582. doi: 10.1155/2023/5034582.
Asensio G, Vázquez-Lasa B, Rojo L. Achievements in the Topographic Design of Commercial Titanium Dental Implants: Towards Anti-Peri-Implantitis Surfaces. J Clin Med. 2019 Nov 14;8(11):1982. doi: 10.3390/jcm8111982.
Inchingolo AM, Malcangi G, Ferrante L, Del Vecchio G, Viapiano F, Inchingolo AD, et al. Surface Coatings of Dental Implants: A Review. J Funct Biomater. 2023 May 22;14(5):287. doi: 10.3390/jfb14050287.
Choi S, Kang YS, Yeo ISL. Influence of Implant–Abutment Connection Biomechanics on Biological Response: A Literature Review on Interfaces between Implants and Abutments of Titanium and Zirconia. Prosthesis. 2023;5:527-38. doi: 10.3390/prosthesis5020036.
Meijndert CM, Raghoebar GM, Vissink A, Delli K, Meijer HJA. The effect of implant-abutment connections on peri-implant bone levels around single implants in the aesthetic zone: A systematic review and a meta-analysis. Clin Exp Dent Res. 2021 Dec;7(6):1025-36. doi: 10.1002/cre2.471.
Hamed MT, Abdullah Mously H, Khalid Alamoudi S, Hossam Hashem AB, Hussein Naguib G. A Systematic Review of Screw versus Cement-Retained Fixed Implant Supported Reconstructions. Clin Cosmet Investig Dent. 2020 Jan 14;12:9-16. doi: 10.2147/CCIDE.S231070.
Rungtanakiat P, Thitaphanich N, Chengprapakorn W, Janda M, Arksornnukit M, Mattheos N. Association of prosthetic angles of the Implant Supracrestal Complex with peri-implant tissue mucositis. Clin Exp Dent Res. 2023 Jun;9(3):425-436. doi: 10.1002/cre2.750.
Ravidà A, Arena C, Tattan M, Caponio VCA, Saleh MHA, Wang HL, et al. The role of keratinized mucosa width as a risk factor for peri-implant disease: A systematic review, meta-analysis, and trial sequential analysis. Clin Implant Dent Relat Res. 2022 Jun;24(3):287-300. doi: 10.1111/cid.13080.
Farronato D, Azzi L, Giboli L, Maurino V, Tartaglia GM, Farronato M. Impact of Smoking Habit on Peri-Implant Indicators following Different Therapies: A Systematic Review. Bioengineering (Basel). 2022 Oct 18;9(10):569. doi: 10.3390/bioengineering9100569.
Nibali L, Gkranias N, Mainas G, Di Pino A. Periodontitis and implant complications in diabetes. Periodontol 2000. 2022 Oct;90(1):88-105. doi: 10.1111/prd.12451.
D'Ambrosio F, Amato A, Chiacchio A, Sisalli L, Giordano F. Do Systemic Diseases and Medications Influence Dental Implant Osseointegration and Dental Implant Health? An Umbrella Review. Dent J (Basel). 2023 Jun 5;11(6):146. doi: 10.3390/dj11060146.
Lee S, Kim JY, Hwang J, Kim S, Lee JH, Han DH. Investigation of pathogenic genes in peri-implantitis from implant clustering failure patients: a whole-exome sequencing pilot study. PLoS One. 2014 Jun 12;9(6):e99360. doi: 10.1371/journal.pone.0099360.
Tavakoli M, Yaghini J, Abed AM, Malekzadeh M, Maleki D. Evaluation of Effect of Low-Dose Methotrexate on Osseointegration of Implants: A Biomechanical Study on Dogs. Open Dent J. 2018 Jul 31;12:546-54. doi: 10.2174/1874210601812010546.
Tallarico M, Scrascia R, Annucci M, Meloni SM, Lumbau AI, Koshovari A, et al. Errors in Implant Positioning Due to Lack of Planning: A Clinical Case Report of New Prosthetic Materials and Solutions. Materials (Basel). 2020 Apr 16;13(8):1883. doi: 10.3390/ma13081883.
Heitz-Mayfield LJA. Peri-implant mucositis and peri-implantitis: key features and differences. Br Dent J. 2024 May;236(10):791-4. doi: 10.1038/s41415-024-7402-z.
Sato J, Gomi K, Makino T, Kawasaki F, Yashima A, Ozawa T, et al. The evaluation of bacterial flora in progress of peri-implant disease. Aust Dent J. 2011 Jun;56(2):201-6. doi: 10.1111/j.1834-7819.2011.01324.x.
Kormas I, Pedercini C, Pedercini A, Raptopoulos M, Alassy H, Wolff LF. Peri-Implant Diseases: Diagnosis, Clinical, Histological, Microbiological Characteristics and Treatment Strategies. A Narrative Review. Antibiotics (Basel). 2020 Nov 22;9(11):835. doi: 10.3390/antibiotics9110835..
Heitz-Mayfield LJA, Salvi GE. Peri-implant mucositis. J Clin Periodontol. 2018 Jun;45 Suppl 20:S237-S245. doi: 10.1111/jcpe.12953. PMID: 29926488.
Ahn DH, Kim HJ, Joo JY, Lee JY. Prevalence and risk factors of peri-implant mucositis and peri-implantitis after at least 7 years of loading. J Periodontal Implant Sci. 2019 Nov 18;49(6):397-405. doi: 10.5051/jpis.2019.49.6.397.
John V, Shin D, Marlow A, Hamada Y. Peri-Implant Bone Loss and Peri-Implantitis: A Report of Three Cases and Review of the Literature. Case Rep Dent. 2016;2016:2491714. doi: 10.1155/2016/2491714.
Email this article (Login required) 
