Peri-Implant Diseases: Diagnosis, Clinical, Histological, Microbiological Characteristics and Treatment Strategies. A Narrative Review

Abstract

Since the use of dental implants is continuously increasing, it is imperative for dental practitioners to understand the nature and treatment of peri-implant diseases. The purpose of this manuscript is to comprehensively review peri-implant diseases, their characteristics, as well as their non-surgical and surgical treatment. To that end, the current literature was searched and a narrative review was conducted. It is essential that the case definitions described in the 2017 World Workshop on the Classification of Periodontal and Peri-implant Diseases and Conditions are used to diagnose and classify peri-implant health, peri-implant mucositis and peri-implantitis. While recent epidemiologic studies on peri-implant diseases exist, there is great heterogeneity in the definition of these conditions. Several risk factors and indicators are reported in the literature, with smoking and diabetes being the most universally accepted. In peri-implant mucositis, non-surgical treatment seems to be sufficient. However, for the treatment of peri-implantitis, a surgical approach, which includes open-flap debridement, apically positioned flap and guided bone regeneration, is considered more appropriate. A great variety of adjuncts to mechanical treatment have been reported with controversial results. Finally, studies comparing results from different peri-implantitis treatments are warranted in randomized controlled clinical trials in order to provide stronger evidence-based approaches.

Inflammasomes in Alveolar Bone Loss

“…Peri-implantitis, with a prevalence ranging from 1.1% to 85% at the implant level and a higher early failure rate in maxillary implants than mandibular implants, occurs in the peri-implant region and often leads to inflammatory loss of supporting bone (188,271,272). Radiographic bone loss greater than or equal to 2 mm beyond the crestal bone level from the initial surgery, or greater than or equal to 3 mm apical to the most coronal part of the intraosseous portion of the implant is observed in periimplantitis, with even greater progression than that in periodontitis (273). Similar to periodontitis, peri-implantitis exhibits higher IL-1b levels in diseased tissues, and these changes may persist despite nonsurgical therapy (274)(275)(276).…”

Epstein–Barr Virus and Peri-Implantitis: A Systematic Review and Meta-Analysis

“…According to the scientific literature, dental implants show survival rates of up to 98% at 10 years [4][5][6]. However, the higher use of dental implants has been accompanied by an increase in the prevalence of peri-implant pathology [7]. A recent systematic review and meta-analysis reported an incidence of peri-implantitis ranging from 0.4% over 3 years, to 43.9% within 5 years after implant restoration [8].…”

“…Besides minor prosthetic complications (such as crown loosening or ceramic chipping), which are easy to solve, peri-implantitis is the most frequent complication and its resolution is a real challenge, the reason why so much has been published in recent years on this topic [9]. This pathology is defined clinically as the presence of signs of bleeding and/or suppuration in the peri-implant tissues on probing, increased probing depth and loss of 2 or more millimetres of marginal bone compared to previous radiographic recordings [7,10]. Its appearance is the result of a discrepancy between the bacterial challenge and the host response [11].…”

“…A large number of risk factors and indicators have been associated with peri-implant disease, like smoking or diabetes mellitus [12][13][14][15], but bacterial infection plays the most important role in its development [8,16,17]. Among the strains most frequently related to peri-implant disease there can be found Aggregatibacter actinomycetemcomitans, Prevotella intermedia, Tannerella forsythia, Treponema denticola, Campylobacter rectus, Treponema socranskii, Porphyromonas gingivalis, Staphylococcus aureus, and Campylobacter gracilis [7,9,18]. However, it has been observed that other pathogens such as Candida spp.…”

“…However, it has been observed that other pathogens such as Candida spp. or some viruses have an important pathogenic potential in the appearance and evolution of peri-implant disease [7,19,20]. Growing evidence suggests that Epstein-Barr virus (EBV) plays a role in the pathogenesis of periodontitis and peri-implantitis [21].…”