Risk Factors for Peri-implantitis

This manuscript reviews the literature concerning risk factors associated with the development and/or progression peri-implantitis, focusing on studies published within the last 3 years (2017–2020). For the purpose of this review, all factors that can potentially contribute to the development of peri-implantitis will be considered “risk factors.” Recent studies have focused on evaluating various risk factors associated with the development of peri-implantitis. Research shows that peri-implantitis lesions are associated with complex microbial biofilms consisting of not only periodontal pathogens, but also certain unique bacteria and other microorganisms such as viruses, yeasts, and parasites. Recent evidence reinforces the role of previously well-established risk factors in the pathogenesis of peri-implantitis such as smoking, diabetes, lack of oral hygiene and maintenance, history of periodontitis, and poor peri-implant soft tissue quality. Bone quality, obesity, metabolic syndrome, implant surface characteristics, and placement depth have also been reported to be predisposing factors for the development of peri-implantitis. Few studies suggest that factors like certain medications, age, gender, vitamin D, and autoimmune diseases also play a role, but are currently not well-understood. The role of genetics is still unclear, but studies show that certain polymorphisms may be associated with peri-implantitis. Prosthetic risk factors such as improper restorative design, occlusal overload, microgap, and residual cement are significant as well. A recently emerging risk factor for peri-implantitis is the presence of peri-implant tissue-bound titanium particles. Several risk factors have been associated with peri-implantitis in the literature published over the past 3 years. While some risk factors such as smoking, diabetes, history of periodontitis, and some restorative factors are well-recognized, there is still a need for well-designed randomized controlled trials and longitudinal studies in order to establish the association of some other more recently emerging risk factors for peri-implantitis.