Peri-implant pathology: The prevalence(s) of the condition, the risk model(s) of the condition

Abstract

Dental implants long term success rely on the establishment of a stable condition. This stability may be negatively influenced by the coexistence of peri-implant pathology, provoking loss of the supporting bone tissue around the implant. A large range in the prevalence of this condition is observed when analyzing different reports in the literature given the different definitions for peri-implant pathology. The background for this investigation was the assumption that peri-implant pathology is a group of multifactorial situations with several potential non-sufficient, non-necessary causes and the absence of risk models to aid the decision process in the maintenance of implant supported restorations. We explored these important aspects and investigated potential risk factors and statistical models for peri-implant pathology based on a model of sufficient and component causes. We found that biological and biomechanical factors can be involved as causal mechanisms of peri-implant pathology. Our study established three different statistical models based on binary conditional regression analysis, with the representative model presenting high sensitivity, specificity and accuracy, providing high positive and negative likelihood ratios. This model will represent a valid tool for the clinician in the maintenance of implant-supported fixed prosthetic rehabilitations.

A Peri-Implant Disease Risk Score for Patients with Dental Implants: Validation and the Influence of the Interval between Maintenance Appointments

“…The use of this definition is supported by recent genetic investigations that have revealed differences in gene expression between patients with peri-implant disease and those with periodontitis [21,22]. The etiology, which is considered to be a pathology largely produced by a bacterial infection of plaque accumulation [23], was previously refuted [4,16,23,24,25,26,27] after several factors aside from bacterial plaque emerged as potential risk factors in a multivariable analysis [16,23]. Aside from the risk model from which the present risk scores were derived [16], Konstantinidis et al [25] also conducted a cross-sectional study of 168 patients with 597 implants to evaluate the prevalence of and possible risk indicators for peri-implant diseases.…”

“…The foreign implant would then lead to immunological and inflammatory responses [28]. Additionally, different causal models have been proposed that do not include bacterial plaque as a component cause [4,26], such as the Sander Greenland component causal model [29]. This model states chronic diseases are generally multifactorial and thus more than one causal mechanism may induce the condition, with each causal mechanism being a product of the impacts of several component causes (risk factors).…”