Clinical Characteristics and Factors Associated with Peri-Implantitis: A Comparative Analysis

Background. The clinical condition of the tissues surrounding a dental implant reflects the interplay of the microbial biofilm, soft-tissue characteristics, patient hygiene behavior, implant function time, and local conditions of the implant rehabilitation. Quantitative characterization of these parameters is important for objectifying the clinical phenotype of peri-implantitis and for the early detection of adverse changes [1–6].

Aim. To assess the differences in clinical and implant-related parameters between patients with and without peri-implantitis.

Methods. The study included 414 patients with dental implants, of whom 330 had no signs of peri-implantitis and 84 had a documented diagnosis of peri-implantitis. The following parameters were assessed: the Simplified Oral Hygiene Index (OHI-S), the peri-implant plaque index (PI), bleeding on probing, suppuration, probing depth (PD), the width of keratinized mucosa, marginal bone loss, implant function time, the number of implants, and the number of implants with signs of mucositis. Quantitative variables were compared between groups using non-parametric methods, and categorical variables using the chi-squared test. Multivariable logistic regression was used to identify the clinical characteristics independently associated with peri-implantitis. PD and marginal bone loss (mm) were treated primarily as characteristics of the clinical phenotype and were not used as independent aetiological predictors of the disease.

Results. Patients with peri-implantitis showed poorer oral hygiene, higher plaque index and probing depth (PD 3.76 ± 0.96 vs 1.46 ± 0.66), greater marginal bone loss, and a narrower zone of keratinized mucosa. The mean OHI-S score was 4.69 ± 0.57 versus 1.92 ± 0.98 in the group without peri-implantitis, and the peri-implant plaque index was 2.86 ± 0.35 versus 1.41 ± 0.87. Marginal bone loss was 3.52 ± 0.61 versus 1.22 ± 0.56 mm, whereas the width of keratinized mucosa was smaller in the peri-implantitis group (1.89 ± 0.66 vs 3.39 ± 0.95 mm). All these differences were statistically significant (p < 0.001).

Implant function time was longer in patients with peri-implantitis: 7.52 ± 1.21 versus 4.82 ± 1.70 years (p < 0.001). These patients also had a larger number of placed implants and of implants showing signs of peri-implant mucositis.

Conclusions. In the study cohort, peri-implantitis was characterized by a complex of clinical changes, including poorer oral hygiene, more pronounced signs of inflammation, increased peri-implant probing depth, greater bone loss, and a reduced width of keratinized mucosa. The combination of local parameters and implant function time may be used for the clinical stratification of an adverse peri-implant status.

Peri-implantitis, peri-implant tissues, dental implants

Bekzhanova O., Belenova I., Zaitkhanov A. Faktory riska pri vypolnenii dental'noy implantatsii [Risk factors in dental implantation]. Aktual'nye problemy stomatologii i chelyustno-litsevoy khirurgii [Actual Problems of Dentistry and Maxillofacial Surgery]. 2022;4(1):93–94. doi:10.71337/inlibrary.uz.problems-dentistry.14806. (In Russian).

Rizaev Zh.A., Shodmonov A.A., Olimzhonov K.Ya. Periimplantity — rannie oslozhneniya pri dental'noy implantatsii [Peri-implantitis as an early complication of dental implantation]. Zhurnal biomeditsiny i praktiki [Journal of Biomedicine and Practice]. 2021;6(1):28–33. doi:10.26739/2181-9300-2021-1-4. (In Russian).

Iminzhanova G.R., Mel'kumyan T.V., Dadamova A.D. Sovremennye podkhody v diagnostike i lechenii periimplantitov [Current approaches to the diagnosis and treatment of peri-implantitis]. Zhurnal biomeditsiny i praktiki [Journal of Biomedicine and Practice]. 2021;6(4):28–35. doi:10.26739/2181-9300-2021-4-4. (In Russian).

Mukimov O.A., Olimov A.B. Primenenie metoda perio-flow® dlya lecheniya periimplantita [Use of the perio-flow® technique in the treatment of peri-implantitis]. Stomatologiya [Dentistry]. 2018;1(2):29–32. doi:10.71337/inlibrary.uz.stomatologiya.1716. (In Russian).

Sultanov A.A., Pervov Yu.Yu., Yatsenko A.K., Sultanova M.A., Nikitin S.G. Strukturnye osobennosti myagkikh tkaney, okruzhayushchikh implantat, i faktory, vliyayushchie na razvitie vospaleniya v periimplantatsionnom prostranstve [Structural features of the soft tissues surrounding the implant and factors affecting the development of inflammation in the peri-implant space]. Problemy stomatologii [Problems in Dentistry]. 2019;15(2):11–16. doi:10.18481/2077-7566-2019-15-2-11-16. (In Russian).

Gevorkyan A.A., Ivanov A.S. Varianty snizheniya riska vozniknoveniya periimplantita, vyzvannogo tsementom dlya fiksatsii restavratsiy [Options for reducing the risk of cement-related peri-implantitis]. Glavnyy vrach Yuga Rossii [Chief Physician of Southern Russia]. 2018. (In Russian).

Zitzmann NU, Berglundh T. Definition and prevalence of peri-implant diseases. J Clin Periodontol. 2008;35(Suppl 8):286–291. doi:10.1111/j.1600-051X.2008.01274.x.

Derks J, Tomasi C. Peri-implant health and disease. A systematic review of current epidemiology. J Clin Periodontol. 2015;42(Suppl 16):S158–S171. doi:10.1111/jcpe.12334.

Berglundh T, Armitage G, Araujo MG, et al. Peri-implant diseases and conditions: Consensus report of Workgroup 4 of the 2017 World Workshop. J Periodontol. 2018;89(Suppl 1):S313–S318. doi:10.1002/JPER.17-0739.

Schwarz F, Derks J, Monje A, Wang HL. Peri-implantitis. J Periodontol. 2018;89(Suppl 1):S290–S293. doi:10.1002/JPER.16-0350.

Renvert S, Quirynen M. Risk indicators for peri-implantitis. A narrative review. Clin Oral Implants Res. 2015;26(Suppl 11):15–44. doi:10.1111/clr.12636.

Renvert S, Polyzois I, Maguire R. Risk indicators for peri-implantitis: a cross-sectional study with 916 implants. Clin Oral Implants Res. 2018;29(2):134–142. doi:10.1111/clr.12772.

Monje A, Caballé-Serrano J, Nart J, Peñarrocha D, Wang HL, Rakic M. Diagnostic accuracy of clinical parameters to monitor peri-implant conditions: a matched case-control study. J Periodontol. 2018;89(4):407–417. doi:10.1002/JPER.17-0454.

Diaz P, Gonzalo E, Gil Villagra LJ, Miegimolle B, Suarez MJ. What is the prevalence of peri-implantitis? A systematic review and meta-analysis. BMC Oral Health. 2022;22:449. doi:10.1186/s12903-022-02493-8.

Herrera D, Berglundh T, Schwarz F, et al. Prevention and treatment of peri-implant diseases—The EFP S3 level clinical practice guideline. J Clin Periodontol. 2023;50(Suppl 26):4–76. doi:10.1111/jcpe.13823.

Salvi GE, Aglietta M, Eick S, Sculean A, Lang NP, Ramseier CA. Reversibility of experimental peri-implant mucositis compared with experimental gingivitis in humans. Clin Oral Implants Res. 2012;23(2):182–190.

Mahardawi B, Jiaranuchart S, Damrongsirirat N, et al. The lack of keratinized mucosa as a risk factor for peri-implantitis: a systematic review and meta-analysis. Sci Rep. 2023;13:3778. doi:10.1038/s41598-023-30890-8.

Amerio E, Mainas G, Petrova D, Giner Tarrida L, Nart J, Monje A. Compliance with supportive periodontal/peri-implant therapy: a systematic review. J Clin Periodontol. 2020;47(1):81–100. doi:10.1111/jcpe.13204.

Stiesch M, et al. Supportive care for the prevention of disease recurrence/progression following peri-implantitis treatment: a systematic review. J Clin Periodontol. 2023;50(Suppl 26):113–134. doi:10.1111/jcpe.13822.

Cortellini S, Favril C, De Nutte M, Teughels W, Quirynen M. Patient compliance as a risk factor for the outcome of implant treatment. Periodontol 2000. 2019;81(1):209–225. doi:10.1111/prd.12293.

Schwarz F, Derks J, Monje A, Wang HL. Peri-implantitis. J Clin Periodontol. 2018;45(Suppl 20):S266–S274. doi:10.1111/jcpe.12954.

Koay Chun Giok K, et al. Risk factors for peri-implantitis: an umbrella review of meta-analyses of observational studies and assessment of biases. J Dent. 2024;144:104916. doi:10.1016/j.jdent.2024.104916.

Serroni M, Borgnakke WS, Romano L, et al. History of periodontitis as a risk factor for implant failure and incidence of peri-implantitis. Clin Implant Dent Relat Res. 2024;26(3):482–508. doi:10.1111/cid.13330.

Reis INRD, Amaral GCLSA, Hassan MA, et al. The influence of smoking on the incidence of peri-implantitis: a systematic review and meta-analysis. Clin Oral Implants Res. 2023;34(6):543–554. doi:10.1111/clr.14066.

Shang R, Gao L. Impact of hyperglycemia on the rate of implant failure and peri-implant parameters in patients with type 2 diabetes mellitus: systematic review and meta-analysis. J Am Dent Assoc. 2021;152(3):189–201.e1. doi:10.1016/j.adaj.2020.11.015.

Stacchi C, Berton F, Perinetti G, et al. Risk factors for peri-implantitis: effect of history of periodontal disease and smoking habits. J Oral Maxillofac Res. 2016;7(3):e3. doi:10.5037/jomr.2016.7303.

Esteves RA, et al. Periodontitis as a risk factor for peri-implantitis: systematic review and meta-analysis of observational studies. J Dent. 2019;79:1–10. doi:10.1016/j.jdent.2018.09.010.

Sgolastra F, Petrucci A, Severino M, Gatto R, Monaco A. Periodontitis, implant loss and peri-implantitis: a meta-analysis. Clin Oral Implants Res. 2015;26(4):e16–e25. doi:10.1111/clr.12319.

Stavropoulos A, Bertl K, Winning L, Polyzois I. What is the influence of implant surface characteristics and/or implant material on the incidence and progression of peri-implantitis? A systematic literature review. Clin Oral Implants Res. 2021;32(Suppl 21):203–229. doi:10.1111/clr.13859.

Monje A, et al. Significance of peri-implant keratinized mucosa on implant health: an umbrella systematic review with evidence mapping and quantitative meta-meta-analysis. Clin Oral Implants Res. 2025.