What is the influence of implant surface characteristics and/or implant material on the incidence and progression of peri‐implantitis? A systematic literature review
Andreas Stavropoulos, Kristina Bertl, Lewis Winning, Ioannis Polyzois
Abstract
Abstract Objectives To answer the focused question, ‘In animals or patients with dental implants, does implant surface characteristics and/or implant material have an effect on incidence and progression of peri‐implantitis?’ Material and Methods Pre‐clinical in vivo experiments on experimental peri‐implantitis and clinical trials with any aim and design, and ≥5 years follow‐up, where the effect of ≥2 different type of implant material and/or surface characteristics on peri‐implantitis incidence or severity, and/or progression, implant survival or losses due to peri‐implantitis, and/or marginal bone levels/loss was assessed. Results Meta‐analyses based on data of pre‐clinical experiments, using the ligature induced peri‐implantitis model in the dog, indicated that after the spontaneous progression phase implants with a modified surface showed significantly greater radiographic bone loss (effect size 0.44 mm; 95%CI 0.10–0.79; p = .012; 8 publications) and area of infiltrated connective tissue (effect size 0.75 mm 2 ; 95%CI 0.15–1.34; p = .014; 5 publications) compared to non‐modified surfaces. However, in 9 out of the 18 included experiments, reported in 25 publications, no significant differences were shown among the different implant surface types assessed. Clinical and/or radiographic data from 7605 patients with 26,188 implants, reported in 31 publications (20 RCTs, 3 CTs, 4 prospective cohort, and 4 retrospective studies; 12 with follow‐up ≥10 years), overall did not show significant differences in the incidence of peri‐implantitis, when this was reported or could be inferred, among the various implant surfaces. In general, high survival rates (90–100%) up to 30 years and no clinically relevant differences in marginal bone loss/levels, merely compatible with crestal remodelling, were presented for the various implant types. Conclusion Pre‐clinical in vivo experiments indicate that surface characteristics of modified implants may have a significant negative impact on peri‐implantitis progression, while clinical studies do not support the notion that there is a difference in peri‐implantitis incidence among the various types of implant surfaces. No assumptions can be made regarding the possible impact of implant material on incidence and/or peri‐implantitis progression due to limited information.