Kontakt

Academy Literature Review

Introduction:

Every 6 – 8 weeks we highlight a specific surgical topic from implantology or periodontology and present the latest scientific publications in a concise format. Our aim is to bridge the gap between research and clinical application – providing referring dentists and colleagues with clear, practice-oriented insights based on current evidence.

Etiology and Prevention of Peri-implantitis – An Evidence-based Literature Review

Author: Dr. Leyli Behfar, Hamburg

Abstract

Peri-implantitis is an inflammatory disease of the peri-implant tissues characterized by progressive bone loss. With a prevalence affecting approximately 20 % of patients and 10 % of implants, it has become one of the most significant complications in implant dentistry. The purpose of this review is to present the current evidence on the etiology and prevention of peri-implantitis and to translate these findings into practical recommendations. The available literature demonstrates a multifactorial pathogenesis: biofilm-induced inflammation is the primary cause, whereas patient-related risk factors such as a history of periodontitis, smoking, and diabetes significantly increase susceptibility. Local iatrogenic influences including excess cement, unfavorable prosthetic designs, and a lack of keratinized mucosa further contribute to disease development. Prevention therefore requires a combination of systemic risk management, optimized surgical-prosthetic strategies, soft tissue management, and structured supportive peri-implant care (SPIC).

Introduction

Since the introduction of dental implants as a standard treatment modality, their use has continuously increased. In parallel, peri-implant diseases have emerged as a major clinical concern. While peri-implant mucositis is considered a reversible condition, peri-implantitis is characterized by irreversible bone loss that can eventually lead to implant failure. Systematic reviews estimate the prevalence of peri-implantitis at around 20 % of patients and 10 % of implants (Derks & Tomasi 2015). This underlines the critical importance of preventive strategies.

Etiology

The etiology of peri-implantitis is multifactorial. At its core, the disease is biofilm-driven: microbial colonization triggers an inflammatory host response that results in bone resorption (Berglundh et al. 2018). Without bacterial biofilm, peri-implantitis does not occur.

Patient-related risk factors are of particular importance. A history of periodontitis is the strongest predictor for peri-implantitis (Sanz et al. 2020). Smoking is associated with significantly higher prevalence rates and faster progression (Heitz-Mayfield & Salvi 2022). Uncontrolled diabetes further compromises immune defense and wound healing, thereby increasing susceptibility (Monje et al. 2017).

Local factors play a crucial role as well. Strong evidence links residual cement to peri-implant inflammation (Wilson 2009; Linkevicius 2013). Insufficient keratinized mucosa (< 2 mm) is correlated with greater plaque accumulation, more pronounced inflammation, and higher prevalence of peri-implantitis (Roccuzzo et al. 2022). Prosthetic designs with convex emergence profiles or restricted cleansability also predispose to disease development (Doornewaard et al. 2022).

Modifying factors such as occlusal overload remain controversial. While some studies associate overloading with marginal bone loss (Isidor 2006), a direct causal relationship to peri-implantitis has not been firmly established.

Prevention

Preventive strategies can be structured into three levels.

“Primary prevention” focuses on the identification and control of systemic risk factors. Periodontal disease must be stabilized prior to implant placement (Tonetti & Sanz 2023). Smoking cessation and glycemic control are critical measures. On the surgical-prosthetic level, cleansable emergence profiles, polished surfaces, and strict cement control are mandatory. Screw-retained restorations are preferred whenever possible. Soft tissue management to ensure sufficient keratinized mucosa has also been shown to improve peri-implant tissue stability (Roccuzzo et al. 2022).

“Secondary prevention” aims to detect and intercept peri-implant mucositis before it progresses to peri-implantitis. Risk-based supportive care with recall intervals of 3–6 months, professional biofilm removal with air polishing or PEEK curettes, and standardized probing and radiographic monitoring are essential. Patient compliance is critical: lack of supportive care is strongly associated with higher prevalence of peri-implantitis (Monje et al. 2021).

“Tertiary prevention” applies after successful peri-implantitis treatment. Close supportive care significantly reduces the risk of recurrence.

Conclusion

The prevention of peri-implantitis requires a multifactorial approach. While biofilm is the primary etiological factor, systemic, local, and iatrogenic risks must all be considered. Effective prevention depends on comprehensive risk management, careful prosthetic planning, adequate soft tissue management, and structured supportive peri-implant care. Only through this integrated strategy can implants remain functional and esthetically stable in the long term.

References (selection)

  • Berglundh T, Armitage G, Araujo M, et al. (2018). Peri-implant diseases and conditions: Consensus report. J Clin Periodontol.
  • Derks J, Tomasi C. (2015). Peri-implant health in Europe – prevalence, incidence and risk factors. J Clin Periodontol.
  • Sanz M, Schwarz F, et al. (2020). Peri-implantitis: Consensus and S3 Guideline. J Clin Periodontol.
  • Heitz-Mayfield L, Salvi G. (2022). Peri-implant mucositis and peri-implantitis. Periodontol 2000.
  • Monje A, Caton JG. (2017). Risk indicators for peri-implantitis: Diabetes and glycemic control. J Dent Res.
  • Wilson TG. (2009). The positive relationship between excess cement and peri-implant disease. J Periodontol.
  • Linkevicius T, et al. (2013). Prevention of cement-induced peri-implant disease. Clin Oral Implants Res.
  • Roccuzzo A, et al. (2022). The role of keratinized mucosa in peri-implant health. Clin Oral Implants Res.
  • Doornewaard R, et al. (2022). Implant surface roughness and peri-implantitis. Periodontol 2000.
  • Tonetti M, Sanz M. (2023). EFP S3 Guideline: Prevention and treatment of peri-implant diseases. J Clin Periodontol.
  • Monje A, et al. (2021). Supportive care after peri-implantitis treatment. Clin Oral Implants Res.
  • Isidor F. (2006). Influence of forces on peri-implant bone. Clin Oral Implants Res.