Emerging risk factors influencing the occurrence of peri-implantitis

The objective of the present review is to explore the evidence and biological plausibility of factors that may expose dental implants to a greater likelihood of developing peri-implantitis.

An electronic screening on the PubMed library the was carried out to identify potential emerging factors that influence the onset/progression of peri-implantitis. These factors were explored and are presented in a narrative review.

Seven major emerging factors were pinpointed as emerging risk factors influencing the onset/progression of peri-implantitis. Concerning (1) anatomy-related risk factors, it seems that crestal soft tissue thickness and the dimension of the mucosal attachment are factors worth being assessed in order to understand the susceptibility of implants to peri-implantitis. In turn, concerning (2) prosthesis-related factors, certain implant-abutment connections may be more prone to peri-implantitis. Moreover, (3) surgery-related factors, in particular as regards inadequate bucco-lingual and mesio-distal positioning, were seen to be contributors to peri-implantitis, while apico-coronal implant positioning might be dictated by the emergence profile and the crestal connective tissue height. Inconclusive findings were obtained concerning (4) the type and materials of implant-supportive restorations. However, a lack of cleansability and the convexity of the emergence profile were suggested to be key elements in promoting inflammation. Implant-supported fixed restorations, in contrast to implant-retained overdentures, may increase the likelihood of developing peri-implantitis in high-risk individuals, since monitoring and plaque control are often jeopardized. Furthermore, (5) the regular intake of certain medication may increase the susceptibility to disease by interrupting regular homeostasis and tissue repair. In turn, (6) non-controlled systemic disorders or a history of peri-implantitis were seen to be strongly associated with peri-implantitis. Lastly, (7) operator-related factors, including the level of training in implant surgery and implant prosthodontics, were also regarded as risk factors for peri-implantitis.

Emerging factors are yet to be validated by scientific data. However, aiming at preventing disease onset and progression, clinicians are encouraged to apply all measures known to affect hard and soft tissue breakdown and plaque accumulation in the pursuit of long-term peri-implant health. Moreover, patient-related factors must be identified for proper patient selection in implant therapy. Education and training in implant surgery and implant prosthodontics are needed to prevent peri-implantitis.