Peri-implant pathology risk assessment

• A history of periodontitis is a potential predisposing factor for peri-implant pathology.¹
• Because its suppression isn’t possible, whenever it is present it becomes crucial to efficiently control/suppress the remaining risk factors.²

¹ de Araújo Nobre M, Mano Azul A, Rocha E, Maló P. Risk factors of peri-implant pathology. Eur J Oral Sci. 2015 Jun;123(3):131-9. 
² de Araújo Nobre M, Mano Azul A, Rocha E, Maló P, Salvado F. Attributable fractions, modifiable risk factors and risk stratification using a risk score for peri-implant pathology. J Prosthodont Res. 2016 Mar 28. pii: S1883-1958(16)30003-2.

• Bacterial plaque is a possible precipitating or reinforcing factor of peri-implant pathology.¹
• It’s suppression could lead to reduction of 31% of cases of peri-implant disease.²
• Daily effective oral hygiene is crucial in these patients.²

¹ de Araújo Nobre M, Mano Azul A, Rocha E, Maló P. Risk factors of peri-implant pathology. Eur J Oral Sci. 2015 Jun;123(3):131-9.
² de Araújo Nobre M, Mano Azul A, Rocha E, Maló P, Salvado F. Attributable fractions, modifiable risk factors and risk stratification using a risk score for peri implant pathology. J Prosthodont Res. 2016 Mar 28. pii: S1883-1958(16)30003-2.

• * Bleeding upon insertion of a probe 1 mm in the sulcus and running a circle around the abutment. 
• Bleeding is a possible precipitating or reinforcing factor for peri-implant pathology.¹
• Its suppression could lead to a reduction of 18% of cases of peri-implant disease.²
• Daily effective oral hygiene is crucial in these patients.²

¹ de Araújo Nobre M, Mano Azul A, Rocha E, Maló P. Risk factors of peri-implant pathology. Eur J Oral Sci. 2015 Jun;123(3):131-9
² de Araújo Nobre M, Mano Azul A, Rocha E, Maló P, Salvado F. Attributable fractions, modifiable risk factors and risk stratification using a risk score for peri-implant pathology. J Prosthodont Res. 2016 Mar 28. pii: S1883-1958(16)30003-2.

• This variable exerts a protective effect when independent, reducing risk of peri-implant pathology (due to an effect of biomechanical protection), or a possible risk factor when in combination with bacterial plaque.¹
• In combination with plaque, the proximity of implants to other implants or teeth could create a bacteria reservoir.¹
• The suppression of these factors could lead to a potential reduction of 15% of peri-implant pathology cases.²
• Daily effective oral hygiene is crucial in these patients.²

¹ de Araújo Nobre M, Mano Azul A, Rocha E, Maló P. Risk factors of peri-implant pathology. Eur J Oral Sci. 2015 Jun;123(3):131-9.
² de Araújo Nobre M, Mano Azul A, Rocha E, Maló P, Salvado F. Attributable fractions, modifiable risk factors and risk stratification using a risk score for peri-implant pathology. J Prosthodont Res. 2016 Mar 28. pii: S1883-1958(16)30003-2.

• The type of prostheses may impact the risk of peri-implant pathology in different ways, in a trade-off between the degree of shock absorption provided by the material (biomechanical protection)¹ and the degree of surface roughness of the same material (facilitating bacterial plaque accumulation).^1,2
• Occlusion should be assessed on a regular basis (at least once every two years) in order to provide a stable biomechanical condition for the implant-supported rehabilitation.³

¹ de Araújo Nobre M, Mano Azul A, Rocha E, Maló P. Risk factors of peri-implant pathology. Eur J Oral Sci. 2015 Jun;123(3):131-9.
² Maló P, de Araújo Nobre M, Borges J, Almeida R. Retrievable metal ceramic implant-supported fixed prostheses with milled titanium frameworks and all-ceramic crowns: retrospective clinical study with up to 10 years of follow-up. J Prosthodont. 2012 Jun;21(4):256-64.
³ de Araújo Nobre M, Mano Azul A, Rocha E, Maló P, Salvado F. Attributable fractions, modifiable risk factors and risk stratification using a risk score for peri-implant pathology. J Prosthodont Res. 2016 Mar 28. pii: S1883-1958(16)30003-2.

• Lack of passive fit and non-optimal screw-tightening influences disease development by both increasing the load transmitted to bone,  which may lead to bone loss, and through bacterial colonization of the gaps between prosthetic components.^1,2
• Suppression of these factors could decrease incidence of peri-implant disease by 5%.³

¹ Strub JR, Jurdzik BA, Tuna T. Prognosis of immediately loaded implants and their restorations: a systematic literature review. J Oral Rehabil. 2012 Sep;39(9):704-17.
² Sahin S, Cehreli MC. The significance of passive framework fit in implant prosthodontics: current status.Implant Dent. 2001;10(2):85-92.
³ de Araújo Nobre M, Mano Azul A, Rocha E, Maló P, Salvado F. Attributable fractions, modifiable risk factors and risk stratification using a risk score for peri-implant pathology. J Prosthodont Res. 2016 Mar 28. pii: S1883-1958(16)30003-2.

• Bone level at the implant’s medium third (either caused by bone loss or present since implant placement) is a potential biomechanical and/or biological risk factor.¹
• As bone level progresses apically, the implant loses bone support and stability.² This reduces its ability to support occlusal forces and increases the risk of biomechanically-influenced peri-implant pathology.¹
• Occlusion should be assessed on a regular basis (at least once every two years) in order to provide a stable biomechanical condition for the implant-supported rehabilitation.³

¹ de Araújo Nobre M, Mano Azul A, Rocha E, Maló P. Risk factors of peri-implant pathology. Eur J Oral Sci. 2015 Jun;123(3):131-9.
² Chong L1, Khocht A, Suzuki JB, Gaughan J. Effect of implant design on initial stability of tapered implants. J Oral Implantol. 2009;35(3):130-5.
³ de Araújo Nobre M, Mano Azul A, Rocha E, Maló P, Salvado F. Attributable fractions, modifiable risk factors and risk stratification using a risk score for peri-implant pathology. J Prosthodont Res. 2016 Mar 28. pii:S1883-1958(16)30003-2.

• Smoking habit is a risk factor for implant failure¹, and a possible confounder² or risk factor for peri-implant pathology.³
• Smoking cessation counseling is recommended for these patients.

¹ Chrcanovic B, Albrektsson T, Wennerberg A. Smoking and dental implants: A systematic review and meta-analysis. J Dent. 2015 May;43(5):487-98.
² de Araújo Nobre M, Mano Azul A, Rocha E, Maló P. Risk factors of peri-implant pathology. Eur J Oral Sci. 2015 Jun;123(3):131-9.
³ Sgolastra F, Petrucci A, Severino M, Gatto R, Monaco A. Smoking and the risk of peri-implantitis. A systematic review and meta-analysis. Clin Oral Implants Res. 2015 Apr;26(4):e62-7.