Recommended by Dr. med. dent. Konrad Meyenberg and Dr. med. dent. Karin Wolleb Torrisi
Insights from this study for clinical practice
Insights from this study for clinical practice
Use implants with machined collars and sandblasted, acid-etched intraosseous surfaces to lower peri-implantitis risk
Screen for periodontitis and smoking and provide tailored maintenance for at-risk patients
Ensure >1.5 mm prosthetic margin-to-bone distance
Peri-implantitis is a major and growing problem in dentistry, necessitating inconvenient and uncomfortable treatment for the patient and using valuable dentists’ resources. However, information on prevalence of peri-implantitis is limited, with many studies looking only at small patient groups. To counter this, a group of experts from Gothenburg, Sweden, report their findings from a large, real-world population.
The authors performed a retrospective analysis of 2,765 randomly selected patient files from a Swedish registry, and clinical and radiological examination of patients at a mean of 9 years after implant-supported restorative therapy. The final analysis included 588 patients and 2,277 implants. Peri-implantitis was defined as bleeding on probing/suppuration and detectable bone loss >0.5 mm, with moderate/severe peri-implantitis showing bone loss >2 mm.
The authors found that nearly half of patients undergoing implant-supported restorative therapy suffered from peri-implantitis 9 years after the procedure.
This classic, unique study conducted by renowned authors examined various design parameters of implant systems commonly used today for their influence on risk of peri-implantitis.
Dr. med. dent. Konrad Meyenberg
Of the 427 patients with baseline radiographs, 192 (45.0%) had peri-implantitis, including moderate/severe peri-implantitis in 62 patients (14.5%). Patients with moderate/severe peri-implantitis experienced a bone loss corresponding to 29.4% of the intraosseous portion of the implant.
The authors investigated risk factors for moderate/severe peri-implantitis, and found significantly higher odds ratios associated with periodontitis, having ≥4 implants, general practitioner-delivered therapy, and implant type/characteristics (referred to as implant brand in the original publication). Furthermore, multilevel analysis found significantly higher risk of peri-implantitis with mandible implants and with a prosthetic margin to crestal bone distance of ≤1.5 mm.
A history of periodontitis affects the success of implant treatment.
Dr. med. dent. Karin Wolleb Torrisi
In addition to patient-related factors, the design of the implant itself plays a critical role in peri-implantitis risk. A detailed review of implant types and characteristics from the different brands revealed that the lowest risk was associated with a gold standard design, characterized by a machined (smooth) supraosseous implant collar combined with an intraosseous sandblasted and acid-etched surface. These designs are commonly referred to as “soft tissue level” or “hybrid designs.”
Conversely, implants with rough or porous collar surfaces (e.g., anodized) were associated with a three-fold higher risk of peri-implantitis (Implant brands NB and AT versus S: ORs 3.8, 3.6 versus 1, respectively). Notably, this elevated risk persisted regardless of other implant features, such as connection type or vertical positioning.
These findings emphasize that selecting an implant with a smooth, machined collar can significantly reduce peri-implantitis risk, independent of the surgical or prosthetic protocol.
The lowest risk of peri-implantitis is associated with the gold standard supraosseous machined implant collar in combination with intraosseous sandblasted and acid-etched surface.
Dr. med. dent. Konrad Meyenberg
Much of the information on implant outcomes comes from limited samples and focuses on implants rather than patients. The current study, with its patient group randomly selected from a real-world population, therefore adds considerable value to the field. The findings that patient- and implant-related factors influence the risk of moderate/severe peri-implantitis could inspire future work to investigate the reasons for this. With peri-implantitis potentially leading to loss of implant and entailing inconvenient and uncomfortable treatment, this work could have a valuable impact on the lives of patients.
