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Background:There are no studies that have investigated the presence of Candida species in the subgingival oral biofilm (OB) of patients with peri-implantitis.Purpose: The aim was to assess the presence of Candida species in the subgingival OB of patients with peri-implantitis.Materials and Methods: Individuals with (group A) and without (group B) peri-implantitis were included. Life style related and demographic data were collected using a questionnaire. In both groups, peri-implant plaque-index (PI), bleeding-on-probing (BOP), and probing-depth (PD) were evaluated and crestal bone loss (CBL) were measured on digital bitewing radiographs. In both groups, subgingival OB samples were collected using sterile paper points. Identification of Candida species was performed using ChromAgar medium and colony forming units per milliliter (CFU/mL) were determined. Statistical analysis was performed, and level of significance was set at P < 0.05. Results:The mean age of individuals in groups A (n = 43) and B (n = 41) were 52.2 ± 4.4 and 55.1 ± 2.3 years, respectively. All participants were male. In groups A and B, implants were in function for 7.4 ± 1.3 and 6.8 ± 0.6 years, respectively. Scores of peri-implant PI (P < 0.001), BOP (P < 0.001), PD (P < 0.001), and CBL (P < 0.001) were significantly higher in group A than group B. Subgingival Candida was isolated from the OB of 33 (76.7%) patients in group A and 5 (12.2%) individuals in group B. The most common yeast species was Candida albicans, which was isolated from 67.4% to 60% individuals in groups A and B, respectively. The number of subgingival oral yeasts CFU/mL were significantly higher in group A (3147.54 ± 1052.6 CFU/mL) compared with group B (496.68 ± 100.2 CFU/mL; P < 0.01).Conclusion: Candida species (predominantly C. albicans) are present in the subgingival OB of patients with peri-implantitis. Community-based efforts toward routine oral hygiene maintenance are needed to improve oral health and minimize the risks of peri-implant diseases in populations. K E Y W O R D Salveolar bone loss, dental implant, probing depth, yeast Oral Candida species are commensal oral fungi and are often isolated from the oral cavity of healthy patients. 8,9 It has also been reported that the subgingival environment may serve as a haven for various Candida species. 9 In a recent observational cross-sectional study, Matic Petrovic et al. 9 compared the prevalence of Candida species in the subgingival areas with the dorsal surface of tongue. Although the dorsum of the tongue often harbors oral Candida species 8 ; in the study by Matic Petrovic et al. 9 Candida species was present in the subgingival area of nearly 16% individuals and were absent on the tongue.Moreover, besides adherence to teeth and oral mucosal surfaces, yeasts can also adhere to nonbiological surfaces, such as dental materials, for example, titanium implants. 7,10 Results from an experimental study 10 showed Candida albicans biofilm thicker on the body surfaces of the tissue-and bone-level implants compared with other...

Orthodontic extrusion is being implemented as a treatment alternative to enhance hard and soft tissue prior to implant placement. While the current literature does not provide clear guidelines, the decision making for a specific approach seems to be based on the clinician's preferences. Clinical studies are needed to verify the validity of this treatment option.