Prevalence and risk factors of periimplantitis: A retrospective study

Sae-Eun Lee; Dae-Yeob Kim; Jong-Bin Lee; Eun-Kyoung Pang

doi:10.4047/jkap.2019.57.1.8

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Lee, Kim, Lee, and Pang: Prevalence and risk factors of periimplantitis: A retrospective study

ORIGINAL ARTICLE

J Korean Acad Prosthodont 2019;57(1):8-17.

Published online: NaN January 2019

DOI: https://doi.org/10.4047/jkap.2019.57.1.8

Prevalence and risk factors of periimplantitis: A retrospective study

Sae-Eun Lee¹, Dae-Yeob Kim², Jong-Bin Lee², Eun-Kyoung Pang^1,^2,^3,^∗

^¹Department of Clinical Oral Health Science, Graduate School of Clinical Dentistry, Ewha Womans University, Seoul, Republic of Korea

^²Department of Periodontology, Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea

^³Department of Periodontology, College of Medicine, Ewha Womans University, Seoul, Republic of Korea

∗Corresponding Author: Eun-Kyoung Pang Department of Periodontology, College of Medicine, Ewha Womans University 1071 Anyancheon-ro, Yangcheon-gu, Seoul 07985, Republic of Korea +82 (0)2 2650 2725: e-mail, ekpang@ewha.ac.kr

δ These authors contributed equally to this work.

Received 3 September 201822 October 2018 Accepted 6 November 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The study analyzed the prevalence of periimplantitis and factors which may have affected the disease.

Materials and methods

This study based on medical records and radiographs of 422 patients (853 implant cases) who visited Ewha Womans University Mokdong Hospital Dental Center from January 1, 2012 to December 31, 2016. Generalized estimation equations (GEE) was utilized to determine the statistical relationship between periimplantitis and each element, and the cumulative prevalence of periimplantitis during the observation period was obtained by using the Kaplan Meier Method.

Results

The prevalence rate of periimplantitis at the patient level resulted in 7.3% (31 patients out of a total of 422 patients), and at the implant level 5.5% (47 implants out of a total of 853 implants). Sex, GBR, guided bone regeneration (GBR) and functional loading periods had statistical significance with the occurrence of periimplantitis. Upon analysis of the cumulative prevalence of periimplantitis in terms of implant follow-up period, the first case of periimplantitis occurred at 9 months after the placement of an implant, and the prevalence of peri-implantitis showed a non-linear rise over time without a hint of a critical point.

Conclusion

The prevalence of peri-implantitis at the patient level and the implant were 7.3% and 5.5%, respectively. Male, implant installed with GBR and longer Functional Loading Periods were related with the risk of peri-implantitis. (J Korean Acad Prosthodont 2019;57:8-17)

Keywords: Peri-implantitis, Prevalence, Retrospective study

REFERENCES

1.Albrektsson T., Donos N., Thoma D., Pjetursson B., Eugenio R., Brägger U., Esposito M., Kohal R., Nähri T., Storeilli S., Tomasi C., Watzek G., Zwahlen R., Kapos T., Zwahlen M., Lustenberger F., Holmes N. Implant survival and complications. The Third EAO consensus conference 2012. Clin Oral Implants Res. 2012. 23:63–5.

2.Bränemark PI., Adell R., Breine U., Hansson BO., Lindström J., Ohlsson A. Intra-osseous anchorage of dental prostheses. I. Experimental studies. Scand J Plast Reconstr Surg. 1969. 3:81–100.

3.Brånemark PI. Osseointegration and its experimental background. J Prosthet Dent. 1983. 50:399–410.

4.Saadoun AP., LeGall ML. Clinical results and guidelines on Steri-Oss endosseous implants. Int J Periodontics Restorative Dent. 1992. 12:486–95.

5.Gotfredsen K., Nimb L., Hjörting-Hansen E., Jensen JS., Hol-mén A. Histomorphometric and removal torque analysis for TiO2-blasted titanium implants. An experimental study on dogs. Clin Oral Implants Res. 1992. 3:77–84.

6.Cordioli G., Majzoub Z., Piattelli A., Scarano A. Removal torque and histomorphometric investigation of 4 different titanium surfaces: an experimental study in the rabbit tibia. Int J Oral Maxillofac Implants. 2000. 15:668–74.

7.Berglundh T., Lindhe J., Marinello C., Ericsson I., Liljenberg B. Soft tissue reaction to de novo plaque formation on implants and teeth. An experimental study in the dog. Clin Oral Implants Res. 1992. 3:1–8.

8.Pontoriero R., Tonelli MP., Carnevale G., Mombelli A., Ny-man SR., Lang NP. Experimentally induced peri-implant mucositis. A clinical study in humans. Clin Oral Implants Res. 1994. 5:254–9.

9.Albektsson T., Isidor F. Consensus report of session IV. Lang NP, Karring T, editors. Proceedings of the 1st European Workshop on Periodontology. London: Quintessence Publishing;1994. p. 365–9.

10.Ong CT., Ivanovski S., Needleman IG., Retzepi M., Moles DR., Tonetti MS., Donos N. Systematic review of implant outcomes in treated periodontitis subjects. J Clin Periodontol. 2008. 35:438–62.

11.Heitz-Mayfield LJ. Peri-implant diseases: diagnosis and risk indicators. J Clin Periodontol. 2008. 35:292–304.

12.Esposito M., Murray-Curtis L., Grusovin MG., Coulthard P., Worthington HV. Interventions for replacing missing teeth: different types of dental implants. Cochrane Database Syst Rev. 2007. CD003815.

13.Lang NP., Berglundh T., Heitz-Mayfield LJ., Pjetursson BE., Salvi GE., Sanz M. Consensus statements and recommended clinical procedures regarding implant survival and complications. Int J Oral Maxillofac Implants. 2004. 19:150–4.

14.Roos-Jansåker AM., Lindahl C., Renvert H., Renvert S. Nine-to fourteen-year follow-up of implant treatment. Part II: presence of peri-implant lesions. J Clin Periodontol. 2006. 33:290–5.

15.Zitzmann NU., Berglundh T. Definition and prevalence of peri-implant diseases. J Clin Periodontol. 2008. 35:286–91.

16.Jung RE., Pjetursson BE., Glauser R., Zembic A., Zwahlen M., Lang NP. A systematic review of the 5-year survival and complication rates of implant-supported single crowns. Clin Oral Implants Res. 2008. 19:119–30.

17.Park WK., Lee JK., Chang BS., Um HS. A retrospective study on patients' compliance with supportive periodontal therapy. J Korean Acad Periodontol. 2009. 39:59–70.

18.McDermott NE., Chuang SK., Woo VV., Dodson TB. Complications of dental implants: identification, frequency, and associated risk factors. Int J Oral Maxillofac Implants. 2003. 18:848–55.

19.Pjetursson BE., Tan K., Lang NP., Brägger U., Egger M., Zwahlen M. A systematic review of the survival and complication rates of fixed partial dentures (FPDs) after an observation period of at least 5 years. Clin Oral Implants Res. 2004. 15:667–76.

20.Berglundh T., Persson L., Klinge B. A systematic review of the incidence of biological and technical complications in implant dentistry reported in prospective longitudinal studies of at least 5 years. J Clin Periodontol. 2002. 29:197–212.

21.Renvert S., Polyzois I., Claffey N. How do implant surface characteristics influence peri-implant disease? J Clin Periodontol. 2011. 38:214–22.

22.Quirynen M., De Soete M., van Steenberghe D. Infectious risks for oral implants: a review of the literature. Clin Oral Implants Res. 2002. 13:1–19.

23.Greenstein G., Cavallaro J. Failed dental implants: diagnosis, removal and survival of reimplantations. J Am Dent Assoc. 2014. 145:835–42.

24.Qian J., Wennerberg A., Albrektsson T. Reasons for marginal bone loss around oral implants. Clin Implant Dent Relat Res. 2012. 14:792–807.

25.Padial-Molina M., Suarez F., Rios HF., Galindo-Moreno P., Wang HL. Guidelines for the diagnosis and treatment of peri-implant diseases. Int J Periodontic Restor Dent. 2014. 34:e102–11.

26.Atieh MA., Alsabeeha NH., Faggion CM Jr., Duncan WJ. The frequency of peri-implant diseases: a systematic review and meta-analysis. J Periodontol. 2013. 84:1586–98.

27.Ferreira SD., Silva GL., Cortelli JR., Costa JE., Costa FO. Prevalence and risk variables for peri-implant disease in Brazilian subjects. J Clin Periodontol. 2006. 33:929–35.

28.Higuchi KW., Folmer T., Kultje C. Implant survival rates in partially edentulous patients: a 3-year prospective multicenter study. J Oral Maxillofac Surg. 1995. 53:264–8.

29.Rinke S., Ohl S., Ziebolz D., Lange K., Eickholz P. Prevalence of periimplant disease in partially edentulous patients: a practice-based cross-sectional study. Clin Oral Implants Res. 2011. 22:826–33.

30.Marcantonio C., Nicoli LG., Marcantonio Junior E., Zandim-Barcelos DL. Prevalence and possible risk factors of peri-implantitis: A concept review. J Contemp Dent Pract. 2015. 16:750–7.

31.Vouros ID., Kalpidis CD., Horvath A., Petrie A., Donos N. Systematic assessment of clinical outcomes in bone-level and tissue-level endosseous dental implants. Int J Oral Maxillofac Implants. 2012. 27:1359–74.

32.Fransson C., Tomasi C., Pikner SS., Gröndahl K., Wennström JL., Leyland AH., Berglundh T. Severity and pattern of peri-implantitis-associated bone loss. J Clin Periodontol. 2010. 37:442–8.

33.van der Weijden GA., van Bemmel KM., Renvert S. Implant therapy in partially edentulous, periodontally compromised patients: a review. J Clin Periodontol. 2005. 32:506–11.

34.Schou S., Holmstrup P., Worthington HV., Esposito M. Outcome of implant therapy in patients with previous tooth loss due to periodontitis. Clin Oral Implants Res. 2006. 17:104–23.

35.Karoussis IK., Kotsovilis S., Fourmousis I. A comprehensive and critical review of dental implant prognosis in periodontally compromised partially edentulous patients. Clin Oral Implants Res. 2007. 18:669–79.

36.Quirynen M., Abarca M., Van Assche N., Nevins M., van Steenberghe D. Impact of supportive periodontal therapy and implant surface roughness on implant outcome in patients with a history of periodontitis. J Clin Periodontol. 2007. 34:805–15.

37.Lindhe J, Meyle J, Group D of European Workshop on Periodontology. Peri-implant diseases: Consensus Report of the Sixth European Workshop on Periodontology. J Clin Periodontol. 2008. 35:282–5.

38.Zitzmann NU., Schärer P., Marinello CP. Long-term results of implants treated with guided bone regeneration: a 5-year prospective study. Int J Oral Maxillofac Implants. 2001. 16:355–66.

39.Schmitt A., Zarb GA. The longitudinal clinical effectiveness of osseointegrated dental implants for single-tooth replacement. Int J Prosthodont. 1993. 6:197–202.

40.Krennmair G., Waldenberger O. Clinical analysis of wide-diameter frialit-2 implants. Int J Oral Maxillofac Implants. 2004. 19:710–5.

41.Peñarrocha-Diago MA., Flichy-Fernández AJ., Alonso-González R., Peñarrocha-Oltra D., Balaguer-Martínez J., Peñarrocha-Diago M. Influence of implant neck design and implant-abutment connection type on peri-implant health. Radiological study. Clin Oral Implants Res. 2013. 24:1192–200.

42.Lee SY., Piao CM., Koak JY., Kim SK., Kim YS., Ku Y., Rhyu IC., Han CH., Heo SJ. A 3-year prospective radiographic evaluation of marginal bone level around different implant systems. J Oral Rehabil. 2010. 37:538–44.

43.Gotfredsen K., Rostrup E., Hjörting-Hansen E., Stoltze K., Budtz-Jörgensen E. Histological and histomorphometrical evaluation of tissue reactions adjacent to endosteal implants in monkeys. Clin Oral Implants Res. 1991. 2:30–7.

44.Hermann JS., Cochran DL., Nummikoski PV., Buser D. Crestal bone changes around titanium implants. A radiographic evaluation of unloaded nonsubmerged and submerged implants in the canine mandible. J Periodontol. 1997. 68:1117–30.

45.Derks J., Schaller D., Håkansson J., Wennström JL., Tomasi C., Berglundh T. Peri-implantitis - onset and pattern of progression. J Clin Periodontol. 2016. 43:383–8.

Fig. 1.

Risk factors of implant according to follow-up period using Kaplan Meier method.

Table 1.

Patient-related risk variables for peri-implantitis

Variable	Range	Patient numbers	Percentage (%)
Age (years)	< 20	9	2.1
	21 - 30	17	4.0
	31 - 40	33	7.8
	41 - 50	84	20.0
	51 - 60	124	29.4
	61 - 70	101	23.9
	71 - 80	45	10.7
	> 80	9	2.1
Gender	Male	202	47.9
Gender	Female	220	52.1
Smoking	Yes	47	11.1
Smoking	No	375	88.9
Periodontitis	Yes	395	93.6
history	No	27	6.4
Compliance	Complete	37	8.7
	Excellent	227	53.7
	Erratic	89	21.1
	Non	69	16.5
Total		422	100.0

Table 2.

Implant-related risk variables for peri-implantitis

Variable	Range	Patient numbers	Percentage (%)
Implant position	Maxilla	216	51.2
	Mandible	206	48.8
	Non-molar	90	21.3
	Molar	332	78.7
Edentulism	Full	9	2.1
Edentulism	Partial	413	97.9
Implant diameter (mm)	< 3.75	41	9.7
	3.75 - 4.5	171	40.5
	3.75 - 4.5	171	40.5
	> 4.5	210	49.8
Implant length (mm)	< 10	21	5.0
	10 - 15	401	95.0
	> 15	0	0
Staging	1-stage	299	70.9
Staging	2-stage	123	29.1
GBR	Yes	203	48.1
GBR	No	219	51.9
Connection type	Screw	48	11.4
	Cemented	57	13.5
	SCRP	317	75.1
Prosthetic type	Fixed	406	96.2
Prosthetic type	Removable	16	3.8
Opposite tooth	Natural	354	83.9
	Implant	45	10.7
	Denture	23	5.4
Existence of Adjacent	Yes	138	32.7
Implant	No	284	67.3
Total		422	100.0

GBR: guided bone regeneration, SCRP: screw-cement retained prosthesis

Table 3.

Prevalence of peri-implantitis

Variables		Numbers	Prevalence (%)
Patient level	Patients with peri-implantitis	31	7.3%
Patient level	Total patients	422
Implant level	Implants with peri-implantitis	47	5.5%
Implant level	Total implants	853

Table 4.

Prevalence of peri-implantitis according to patient-related risk variables

Variable	Range	Implant numbers	Prevalence (%)
Age (years)	< 20	0	0
	21 - 30	0	0
	31 - 40	4	0.5
	41 - 50	10	1.2
	51 - 60	25	2.9
	61 - 70	6	0.7
	71 - 80	2	0.2
	> 80	0	0
Gender	Male	31	3.6
Gender	Female	16	1.9
Smoking	Yes	10	1.2
Smoking	No	37	4.3
Periodontitis	Yes	47	5.5
history	No	0	0
Compliance	Complete	2	0.2
	Excellent	28	3.3
	Erratic	6	0.7
	Non	11	1.3
Total		47	5.5

Table 5.

Prevalence of peri-implantitis according to patient-related risk variables

Variable	Range	Implant numbers	Prevalence (%)
Implant position	Maxilla	33	3.9
	Mandible	14	1.6
	Non-molar	9	1.9
	Molar	38	3.6
Edentulism	Full	6	0.7
Edentulism	Partial	41	4.8
Implant diameter (mm)	< 3.75	2	0.2
	3.75 - 4.5	16	1.9
	> 4.5	29	3.4
Implant length (mm)	< 10	3	0.4
	10 - 15	44	5.1
	> 15	0	0
Staging	1-stage	31	3.6
Staging	2-stage	16	1.9
GBR	Yes	32	3.8
GBR	No	15	1.7
Connection type	Screw	10	1.2
	Cemented	2	0.2
	SCRP	35	4.1
Prosthetic type	Fixed	42	4.9
Prosthetic type	Removable	5	0.6
Opposite tooth	Natural	36	4.2
	Implant	6	0.7
	Denture	5	0.6
Existence of Adjacent	Yes	23	2.8
Implant	No	24	2.7
Total		47	5.5

GBR: guided bone regeneration, SCRP: screw-cement retained prosthesis

Table 6.

Univariate GEE analysis for patient-related variables associated with the occurrence of peri-implantitis

Variables		OR	95% CI		P value
Variables		OR	Lower	Upper	P value
Age		0.9801	0.9625	0.9980	0.0298
Gender	Male/Female	1.8621	0.8553	4.0541	0.1173
Smoking	Yes/No	1.6406	0.5649	4.7648	0.3628
Periodontitis history∗	Yes/No	NA	NA	NA	NA
Compliance	Excellent/Complete	2.4743	0.3122	19.6090	0.3910
	Erratic/Complete	1.4906	0.1616	13.7455	0.7247
	Non/Complete	3.5909	0.4197	30.7220	0.2431

GEE: generalized estimation equations, CI: confidence interval, OR: odds ratio, NA: not appropriate ∗The distribution of the number of subjects is not appropriate and the OR is not calculated.

Table 7.

Univariate GEE analysis for implant-related variables associated with the occurrence of peri-implantitis

Variables		OR	95% CI		P value
Variables		OR	Lower	Upper	P value
Implant position	Mandible/Maxilla	0.4900	0.2221	1.0812	0.0773
	Molar/Non-molar	1.0951	0.4039	2.9692	0.8583
Edentulism	Partial/Full	0.2917	0.0747	1.1396	0.0764
Implant diameter (mm)		1.5696	0.7746	3.1801	0.2109
Implant length (mm)		0.9082	0.2908	2.8363	0.8684
Staging	2-stage/1-stage	1.0478	0.4443	2.4708	0.9151
GBR	Yes/No	2.2756	1.0853	4.7714	0.0295
Connection type	Cemented/Screw	0.1793	0.0363	0.8865	0.0351
	SCRP/Screw	0.6212	0.2283	1.6897	0.3510
Prosthetic type	Fixed/Removable	2.0617	0.3932	10.8107	0.3921
Functional loading periods (month)		1.0568	1.0403	1.0735	< 0.0001
Opposite tooth	Implant/Natural	0.5282	0.1892	1.4748	0.2231
	Denture/Natural	1.8734	0.3637	9.6498	0.4529
Existence of adjacent Implant	No/Yes	0.8593	0.3928	1.8799	0.7043

GEE: generalized estimation equations, CI: confidence interval, GBR: guided bone regeneration, OR: odds ratio, SCRP: screw-cement retained prosthesis

Table 8.

Multivariate GEE analysis for variables associated with the occurrence of peri-implantitis

Variables		OR	95% CI		P value
Variables		OR	Lower	Upper	P value
Age		0.9844	0.9614	1.0080	0.1947
Gender	Male/Female	2.7306	1.1292	6.6029	0.0258
Implant position	Mandible/Maxilla	0.5973	0.2547	1.4011	0.2362
Edentulism	Partial/Full	0.2815	0.0534	1.4842	0.1351
GBR	Yes/No	2.9335	1.3306	6.4672	0.0076
Connection type	Cemented/Screw	0.4305	0.0970	1.9105	0.2677
	SCRP/Screw	1.2198	0.4195	3.5467	0.7152
Functional loading periods (month)		1.0647	1.0419	1.0882	< 0.0001

GEE: generalized estimation equations, CI: confidence interval, GBR: guided bone regeneration, OR: odds ratio, SCRP: screw-cement retained prosthesis

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