Page 33 - Peri-implant health: the effect of implant design and surgical procedure on bone and soft tissue stability

HOW DO PERI-IMPLANT BIOLOGIC PARAMETERS CORRESPOND WITH IMPLANT SURVIVAL AND PERI-IMPLANTITIS? A CRITICAL REVIEW
of a peri‐implant site to bleed upon probing is associated with PD, implant position, and gender.63 A paper by Jepsen and colleagues revealed no difference in BoP between sites with progressive bone loss or stable sites.64 They pointed out that probing might also provoke a nonspecific bleeding that is unrelated to the amount of inflammation and most probably related to the presence of the microgap between implants and abutments or reconstruction. Indeed, studies comparing teeth and implants, with respect to soft tissue healing, revealed that peri‐implant healing as determined by crevicular molecular composition differs from periodontal healing. It is suggested that peri‐implant tissues represent a higher pro‐inflammatory state.65 An analysis of 987 implants followed for 9–14 years demonstrates that signs of mucositis (BoP) are evenly distributed among implants with or without peri‐implantitis. There was actually no difference in the proportion of implants with the absence or presence of bleeding/suppuration in relation to bone loss, bone gain, or bone stability.66 Another large cohort study, including 4,591 implants from 2,060 subjects, indicated that minimal bleeding did not correlate with bone loss but multipoint bleeding, profuse bleeding, or suppuration did.67 The use of a dichotomous diagnostic criterion (bleeding yes or no) is probably the reason why often high figures of mucositis are reported. Dierens revealed 80% of BoP‐positive implants after 16–22 years of follow‐up despite a prevalence of peri‐implantitis as low as 5% and found no correlation between BoP and peri‐implantitis.8 Renvert, Lindahl and Persson evaluated 86 individuals at an examination after 9–14 years and furthermore after 21–26 years of function; 58% of the individuals with no bone loss during the interval had been diagnosed with mucositis during the first examination. On the other hand, nearly 22% of the patients without any sign of mucositis after 9–14 years had developed peri‐implantitis at a later stage.68 Data analysis failed to show that a diagnosis of mucositis after 9–14 years was predictive for development of peri‐implantitis after 21–26 years. This recent paper is in contradiction with the suggestion of Jepsen and colleagues that mucositis is a precursor for peri‐implantitis.69 This contradiction does not imply that one should become negligent and should not strive for the prevention of mucositis with good oral hygiene.
Prevalence of peri‐implantitis
The prevalence of peri‐implant diseases significantly varies among clinical studies due to the inconsistent definitions, reporting methods and study characteristics. One of the first publications on the prevalence of peri‐implant diseases by
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