Peri-Implant Mucositis

- Prevelance and Risk Factors

 

How common is peri-implant mucositis?

Research suggests that, overall, peri-implantitis has a prevalence of 19-65%.[i] However, it is important to note that its likelihood is often dependant on a number of factors. It has a prevalence of 48% when patients do not adhere to regular supportive implant therapy, whereas when patients receive treatment for periodontal conditions and adhere to supportive implant therapy, peri-implant mucositis has a prevalence of 20%.[ii]

 

What are the risk factors for peri-implant mucositis?

There are a number of factors that are thought to increase the risk of peri-implant mucositis occurring. These include poor oral hygiene, a history of periodontal disease, smoking, uncontrolled diabetes, excessive biomechanical loading of implants, implant design and surface characteristics, insufficient keratinised tissue, prosthetic factors, and infrequent professional cleaning and maintenance.

 

Are patient compliance and oral hygiene risk factors for peri-implant mucositis?

Both patient compliance and oral hygiene are considered to be significant risk factors for peri-implant mucositis. Patient compliance is essential for successful outcomes. If patients do not comply with recommendations from their clinicians – for example, attending regular follow up appointments, effective maintenance and cleaning, recommended treatment plans – this can result in insufficient monitoring and management of oral health, in turn increasing the risk of peri-implant mucositis. Similarly, poor oral hygiene has an impact due to the build-up of plaque around the dental implant, leading to inflammation. It is important that patients who have dental implants understand how to prevent this by regularly brushing and cleaning interdentally.

Is smoking a risk factor for peri-implant mucositis?

Smoking is a significant risk factor for peri-implant mucositis, and smoking cessation is therefore recommended for those undergoing dental implant treatment to help improve overall outcomes. There are a number of reasons why smoking may increase a patient’s risk of developing peri-implant mucositis. These include impaired healing due to reduced blood flow and oxygen delivery to the tissues around implants, increased plaque leading to inflammation, an impaired immune response making it harder to fight infections, and a higher risk of bone loss which may contribute to the development of peri-implant mucositis.

 

Are systemic diseases a risk factor for peri-implant mucositis?

Whilst, at current, the relationship between systemic diseases and peri-implant mucositis is unclear, some studies do suggest that systemic disease is associated with peri-implant disease. Associated systemic factors may include diabetes mellitus, hormonal changes, menopause, chemotherapy, thyroid alterations, cardiac problems, and alcohol use.[ii]Further research is needed in the field to better inform clinical practice.

 

Is abutment surface and design a risk factor for peri-implant mucositis?

Characteristics of abutment surfaces have been studied to assess the impacts that design may have on the peri-implant mucosa. Two implant abutments with different surface typography (acid etched and turned) harboured large amounts of plaque and calculus, resulting in significant inflammation of peri-implant tissues. However, significant differences between the two groups regarding quantity of plaque formed and amount of inflammation was not identified.[iv] An additional study assessing machined titanium abutments and highly polished ceramic abutments also found no difference in bleeding on probing scores. Another study investigated the impact of abutment roughness on inflammation, finding no association after an observation period of four weeks.[v] However, one report found that, although marginal bone levels were not influenced by abutment material, rough collar implants had a positive impact when compared to machined collar implants. Further, it found that titanium abutments were associated with increased bleeding on probing compared with zirconia.[vi]

 

Is keratinised mucosa a risk factor for peri-implant mucositis?

A lack of keratinised mucosa heightens the risk of developing peri-implant mucositis. As such, clinicians must consider the presence and width of keratinised mucosa prior to placing a dental implant, and whether soft tissue grafting is an appropriate option to improve the clinical situation. Soft tissue grafting, which aims to increase the width of keratinised tissue around implants, is associated with reduced plaque build-up when compared to sites which have not undergone augmentation.[vii] It is important to note that some research does not come to the same conclusion, finding no association between keratinised tissue and peri-implant mucositis, and does not deem soft tissue grafting essential. [ii]

 

Is excess cement a risk factor for peri-implant mucositis?

Excess cement is considered to be a potential risk factor for peri-implant mucositis, with one study identifying it as a risk indicator.[iv] Similarly, research has found that patients restored with single-unit crowns displayed more signs of peri-implant mucositis where excess cement was identified. Further research supported this, finding that peri-implant mucositis was more prevalent in cemented prostheses compared to screw-retained prostheses. As such, excess cement must be avoided at all costs.[ii]

 

Is titanium corrosion a risk factor for peri-implant mucositis?

Titanium particles can be released from the surfaces of dental implants through a number of processes including mechanical wear, contact with chemical agents, or the effects of biofilm adhesion and inflammatory conditions. However, there is not a simple cause and effect relationship between titanium particles and peri-implant mucositis.[xi]

 

Further reading

Doornewaard R, Jacquet W, Cosyn J, De Bruyn H. How do peri‐implant biologic parameters correspond with implant survival and peri‐implantitis? A critical review. Clin Oral Impl Res. 2018;29(Suppl. 18):100–123. Source: 5th EAO Consensus Conference 7–10 February 2018, Pfäffikon, Schwyz, Switzerland

Fiorelli JP, WanXin Luan K, Chang Y-C, Kim DM, Sarmiento HL. Peri-implant Mucosal Tissues and Inflammation: Clinical Implications. Int J Oral MaxIllofac Implants 2019;34(suppl):s25–s33. Source: AO 2018 Summit, 8-10 August 2018, Oak Brook, Illinois

Hashim D, Cionca N, Combescure C, Mombelli A. The diagnosis of peri-implantitis: A systematic review on the predictive value of bleeding on probing. Clin Oral Impl Res. 2018;29(Suppl. 16):276–293. Source: 6th ITI Consensus Conference, Amsterdam, 17–19 April 2018

Jepsen S, Berglundh T, Genco R, Aass AM, Demirel K, Derks J, Figuero E, Giovannoli JL, Goldstein M, Lambert F, Ortiz-Vigon A, Polyzois I, Salvi GE, Schwarz F, Serino G, Tomasi C, Zitzmann NU. Primary prevention of peri- implantitis: managing peri-implant mucositis. J Clin Periodontol 2015; 42 (Suppl. 16): S152–S157. Source: 11th European Workshop on Periodontology

Renvert S, Quirynen M. Risk indicators for peri-implantitis. A narrative review. Clin. Oral Impl. Res. 26 (Suppl. 11), 2015, 15–44. Source: 4th EAO Consensus Conference 11–14 February 2015, Pfaffikon, Schwyz, Switzerland

Salvi GE, Monje A, Tomasi C. Long-term biological complications of dental implants placed either in pristine or in augmented sites: A systematic review and meta-analysis. Clin Oral Impl Res. 2018;29(Suppl. 16):294–310. Source: 6th ITI Consensus Conference, Amsterdam, 17–19 April 2018

Schwarz F, Derks J, Monje A, Wang H-L. Peri-implantitis. J Periodontol. 2018;89(Suppl 1):S267–S290. Source: 2017 World Workshop, 9-11 November 2017, Chicago

Thoma DS, Naenni N, Figuero E, et al. Effects of soft tissue augmentation procedures on peri-implant health or disease: A systematic review and meta-analysis. Clin Oral Impl Res. 2018;29(Suppl. 15):32–49. Source: 2nd Consensus Meeting of the Osteology Foundation, Weggis, Switzerland

 

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