Prevalence of Peri-implant Diseases - Part 1

Research Article

Austin J Dent. 2014;1(1): 1003.

Prevalence of Peri-implant Diseases - Part 1

André R Buttendorf1, Cimara Fortes Ferreira2*, João Gustavo Oliveira de Souza1, Haline Dalago1 and Marco Antonio Bianchini1

1Department of Periodontology, Federal University of Santa Catarina, Brazil

2Department of Periodontology, University of Tennessee Health Sciences Center, USA

*Corresponding author: Cimara Fortes Ferreira, Department of Periodontology, UTHSC College of Dentistry - Dunn Building, Suite S502, 875 Union Ave. Memphis TN 38163, USA

Received: April 10, 2014; Accepted: May 26, 2014; Published: May 30, 2014


Aim: Determine the prevalence of peri–implant diseases; mucositis and periodontitis, of patients from the Center of Studies of Continuing Education in Implant Dentistry of the Federal University of Santa Catarina. In addition to the extension of the disease, the proportion of affected implants was studied.

Materials and Methods: A cross-sectional study was carried out in 200 patients presenting 760 external–hexed cylindrical dental implant supported prosthesis with at least 1 year of loading time (range: 1–9 years). Probing depth, bleeding on probing and suppuration data were collected. Radiographs wererequired to evaluate supporting bone levels around implants.

Results: One hundred and thirty–nine (69%) patients presented all healthy implants, 46 (23%) patients presented peri–implant mucositis and 15 (8%) presented peri–implantitis. The overall outcome was 547 (72%) healthy implants, 161(21%) with peri–implant mucostitis and 62 (7%) with peri–implantitis.

Conclusion: According to the results, it is concluded that the prevalence of peri–implant mucositis was 23% and peri–implantitis to 8%.

Keywords: Diagnostics; Infectious diseases; Peri–implant diseases; Periimplantitis; Peri–implant mucositis; Prevalence

Clinical Relevance

Scientific rationale for study

The prevalence of peri–implant diseases has not yet been presented with absolute values due to insufficient studies [1].

Principal findings

The peri–implant mucositis prevalence in this study was significantly lower than the results presented in the literature. However, peri–implantitis prevalence concurs and other time diverges with the literature.

Practical implications

Excessive force applied in the BOP exam could have resulted in false positive findings for the peri–implant diseases. Care is necessary to adequately diagnose the disease.


Peri–implant mucositis is clinically described as the inflammation of the peri–implant mucosa without bone loss; being the most important clinical diagnosis the presence of Bleeding on Probing (BOP) [2]. Peri–implantitis is associated with clinical characteristics of mucositis in combination with radiographic presence of bone loss [3,4].

The prevalence of peri–implant diseases has not yet been presented with absolute values due to insufficient number of studies [1]. The absence of this information may be attributed to the lack of standardization of the scientific methodology; as well as, to the different definitions for peri–implant diseases [5–7]. It has been reported that peri–implant diseases are present in 28% to 56% [1] of individuals that present dental implants. Retrospective studies [8–15], with dental implant loaded for 5 or more years, revealed that peri–implant diseases were a frequent finding; however, they showed very variable results. In 2008, the Council of the 6th European Workshop on Periodontology expressed the need for more studies to provide sufficient information in regards to the prevalence of peri–implant diseases [4].

This study aims to determine the prevalence of peri–implant diseases; such as, peri–implant mucositis and peri–implantitis, of patients from the Center of Continuing Education in Implant Dentistry (CEPID) of the Federal University of Santa Catarina (UFSC). In addition, the extension (the proportion of affected implants) of the disease was studied.

Materials and Methods

The present study was approved by the Human Ethics Committee of the Federal University of Santa Catarina and an informed consent was obtained from each participant.

Sample selection

This was a retrospective study of which 357 subjects from the CEPID–UFSC database were explained of the study by phone and at a consultation visit. These subjects showed to have received externalhexed cylindrical implants supporting prosthesis (es) which were placed for more than 1 year between the years of 2001 to 2010. These subjects were contacted by phone to participate on this study. If the patient agreed upon his or her participation in the study, the patient was scheduled for the evaluations and a consent form was signed. Of the 357 subjects contacted, 41 declined its ability to participate in the study for various reasons. Of the remaining subjects, only 200 (n=760 implants) completed all the follow–up visits and therefore had their data compiled for this study. Of the 760 implants placed, 33% were maxillary teeth and 67% were mandibular. More than 80% of the implant were placed to substitute molars and pre–molars. Details of the sampling are shown in Table 1. The suprastructures evaluated in this study were crowns (65%), 3 (28%) unit bridges and full–arch prostheses (9%).

Surgical protocol

A consensus report from the 3rd European Workshop on Periodontology used the bone level at implant loading as the baseline [16]. All the implants placed were machined surface Master Screw® (Conexão, São Paulo) SP, Brazil). They were placed with the platform at the level of the alveolar crest. The crest or the edentulous ridge was reduced when the implant was planned to be placed at a lower level from the existing bony ridge. The platform–crest level surgical protocol used by the institution allowed an expected saucerization of < 2 mm for reaching the biological width [17]. Therefore, a bone loss of ≥ 2mm was considered peri–implantitis [14,18] when associated with presence of Probing Depth (PD) > 4 mm and⁄or bleeding⁄ suppuration upon probing [19,20].

Data collection

After each prosthesis was removed, the following data was collected:

BOP index: Presence or absence was registered after the introduction of 1 mm of the periodontal probe (PCV12PT Hu–Friedy Inc., Chicago, IL, USA) into the gingival sulcus with a gingival “sweep” movement [2]. Data was analyzed after removal of the periodontal probe and time elapsed for 30 seconds.

PD: PD measurements were collected on the mesial, mid–buccal, distal and the deepest site on the palatal⁄lingual, after calibration of the examiner for a probing pressure of 0.25 N [4].

Suppuration: Visible presence or absence of suppuration was registered after probing the peri–implant sulcus.

Radiographic analysis

Bone level was measured around the dental implants using the parallel cone technique in order to obtain radiographic images (Kodak Insight film, Carestream, INC., New York, EUA) for analyses. The radiographs were digitalized by and image analysis program (Digimizer® version 3.7.0, Medical Software Brolkstraat, Belgium). The values were obtained by measuring the distance from the implant platform to the first radiographic bone contact on the Mesial (MBL); and, on the Distal (DBL). The measurements were made at baseline (T0) by only one calibrated examiner, different from the clinical examiner; and, repeated after 7 days (T7). The mean bone loss value obtained from both measurements (T0 and T7) was used as the final measurement of each site. For the final measurement for each implant, a mean bone loss value was established by adding the mesial mean with the distal mean values and dividing the sum by 2.

Group analysis and division

The following criteria were used as the definition for the clinical and radiographic analyses. Peri–implant mucositis was considered when the probing depth was of ≤ 4mm with presence of BOP around an implant presenting < 2 mm of bone loss. Data was compiled according to each implant and 4 sites (mesial, distal, mid–buccal and palatal⁄lingual). Peri–implantitis was defined when showing PD of > 4mm, associated with BOP and⁄or suppuration, and bone loss ≥ 2mm [6]. Bone loss was evaluated from the data compiled in 2 sites (mesial and distal) only, due to the inability to evaluate the mid–buccal and lingual⁄palatal implant sites in an x–ray.

In the prevalence analyses, patients were divided into 3 groups: 1) Healthy; 2) presenting mucositis (at least 1 implant with mucositis); and, 3) presenting peri–implantitis (at least 1 implant with periimplantitis). While analyzing the results when all the implants were taken into consideration, they were divided into 4 groups; implants without bleeding and with less than 2 mm of bone loss; implants without bleeding and with ≥ 2mm of bone loss; implants with mucositis; and, implants with peri–implantitis. The division of the healthy implants (without bleeding) into 2 groups aimed to optimize the evaluation of the subjects presenting peri–implant bone loss of ≥ 2mm, even in the absence of bleeding, which may suggest a history of peri–implantitis [7].

Statistical analyses

All data were compiled and compared between groups. The extraexaminer reproducibility of the MBL and DBL measurements was tested with the Intra–class Correction Coefficient (ICC).

Binary logistic regression analysis was applied for the comparison amongst the groups of the presence of mucositis and peri–implantitis. The assumed confidence interval was of 95%. The Microsoft Excel (Microsoft Office XP) and Statistical Package for Social Science (SPSS) programs for Windows (version 13.0) were used for value data tab and data analyses. Statistical significance was considered significantwhen P was less than 0.05.


The sample size was composed of 200 patients that summed a total amount of 760 dental implants. Regarding the time the implant upported prostheses were in function, 162 patients (611 implants) had the prostheses for up to 5 years, and 38 patients (149 implants) for more than 5 years. The mean time interval with the prostheses in function was of 4.02 years (standard deviation of 1.67 years). The patient age ranged from 21 to 86 years, with an average of 50.6 years (standard deviation of 11.22). Gender was distributed as 64% females. Sample details are presented in Table 1.