With the increasing burden of peri-implantitis worldwide, interest in the management of this pathology has flourished. However, there is a lack of consensus in the search for a predictable therapy. Different therapeutic modalities have been advocated. Non-surgical therapy as a sole modality is often insufficient to resolve inflammation. Surgical interventions have demonstrated more favorable results. Among these, evidence supported the application of resective, reconstructive or combined approaches to limit progressive bone loss and achieve soft tissue health. However, to date, the most appropriate modality is unknown and the decision-making process derives from the understanding gained in the management of periodontitis.

A very relevant aspect of peri-implantitis is that the prevalence tends to be higher at the patient level than at the implant level. This indicates that it is a pathology in which there are localized factors that may contribute to the onset and/or perpetuation of the pathology. Some of the factors that have been demonstrated in the literature point to the characteristics of the peri-implant soft tissues, as well as the position of the dental implants. However, the role of each local factor in the predisposition or protection of peri-implant disease or health is still largely unknown. The objective of this study is therefore to evaluate, in partially edentulous patients with multiple implants, the localized factors associated with peri-implantitis.

Variables to explore:

Patient-related variables:

• Periodontal health (health, pathology)
• Periodontal status classification (stage, grade)
• Smoker (S, NS, FS)
• Compliance (NC, C, CE)
• Age (y)
• Time since implants (y)
• Pathology (DM, CVD, OP, other)
• Medication
• Anticoagulant (y/n)
• Plaque control (<20%, >20%, >50%)

Clinical variables:

• Keratinized mucosa (narrow, wide, lack)
• Vestibule (Deep ≥4mm, shallow <4mm, lack)
• Number of implants supporting the prosthesis (n)
• Implant location in the fixed prosthesis (mesial, distal, medial)
• Interproximal access with a 0.5mm brush between implants (IP-i)
• Interproximal access with a 0.5mm brush between implants implant-tooth (IP-t)
• Prosthesis type (SC, FPD)
• Cemented or screw-retained (C, S)
• Ceramic to connection (Y/N)
• Prosthesis material (Zr, Cr-Co)
• Implant (NB, ST, TC, DT, BTI, other)
• Implant diameter (mm)
• Implant length (mm)
• Position (M, PM, A, a, pm, m)

Radiographic variables:

• Distance between implants (m-d)
• Distance to adjacent tooth (m-d)
• Occlusal deviation towards buccal-lingual (b-l)
• Apico-coronal position with respect to adjacent tooth (a-c) with respect to LAC
• Apico-coronal position with respect to adjacent implant (a-c) with respect to coronal
• Inclination (implant deviation º) (m-d), (b-l) and º
• Defect configuration (Monje et al. 2019)
• Implant type (BL, TL)
• Transmucosal abutment (Y, N, short <2mm, long ≥2mm)
• Inadequate implant-prosthesis connection (Ill-fitting)

Inclusion Criteria:

• Partially edentulous patients
• Peri-implantitis and non-peri-implantitis implants
• Readable x-ray and clinical signs of inflammation/health

Exclusion Criteria:

• Complete edentulous patients
• Inconsistent definition of peri-implantitis

Partially edentulous patients with dental implants exhibiting peri-implantitis

Publication in a journal in dentistry