A COMPREHENSIVE REVIEW OF THE LOCAL RISK-FACTORS ASSOCIATED WITH THE ETIOLOGY OF PERI-IMPLANT DISEASES
3 . Results Local risk-factors associated with the etiology of peri-implant diseases are summarized in Figure 2 . 3.1 . Bone quality Studies have reported that peri-implant bone loss is more often manifested in the maxilla , which is composed of less dense bone as compared to the mandible . It has also been suggested that compromised bone density is the most critical factor associated with peri-implant bone loss 25 ; whereas others suggest that both poor bone density and volume are associated with the etiology of peri-implant diseases and bone loss 26-27 . 3.2 . Poor oral hygiene Studies from human biopsies 28 , 29 have shown that peri-implantitis and periodontitis lesions have several features in common . One of such features is poor oral hygiene maintenance . The dental plaque is the core etiological factor that causes the development of oral biofilm around the teeth and dental implant surfaces 30-34 . In the study by Serino and Ström 35 , most of the implants with a diagnosis of peri-implantitis were associated with no accessibility and / or capability for appropriate oral hygiene measures . This study 35 concluded that oral hygiene at the implant sites is most likely associated with the presence or absence of peri-implantitis . Moreover , studies 36-42 have also reported that microbes residing in the oral biofilm such as Aggregatibacter actinomycetemcomitans , Enterococcus fecalis , Porphyromonas gingivalis , and Staphylococcus aureus ( which are also associated with the etiology of periodontitis ) play a role in the initiation of peri-implantitis . It is therefore predictable to find a significant relationship between peri-implant bone loss and poor oral hygiene . In this regard , it is imperative for oral healthcare providers to educate patients regarding the significance of regular oral hygiene maintenance and routine dental checkups towards the establishment of peri-implant and periodontal maintenance .
Figure 1 . A diagrammatic presentation of the local risk factors associated with the etiology of peri-implant diseases
3.3 . History of periodontitis It has been claimed that peri-implantitis is a common finding in patients with a history of periodontitis 43-44 . Results from a systematic review and meta-analysis showed that the relative risk for peri-implantitis was significantly higher in patients with a previous history of periodontitis compared to peri-implantitis patients without a history of periodontal disease 43 . However , in a recent study , Meyle et al . 45 investigated the longterm clinical and radiographic parameters of osseointegrated implants in non-smoking patients with a previous history of chronic periodontitis . The results showed that patients with a previous history of periodontitis regularly attending an oral hygiene maintenance program displayed implant survival rates up to 100 % after 5 and 10 years . Similarly , in a systematic review , Pesce et al . 46 concluded that there is a lack of consensus regarding the role of periodontitis in the etiology of peri-implantitis . Nevertheless , since several periodontopathogens ( such as Aggregatibacter actinomycetemcomitans , Prevotella intermedia and Porphyromonas gingivalis ) associated with the etiology of periodontitis have also been isolated from peri-implant sulci of patients with periimplantitis 47-50 . In a recent study , Jorand et al . 30 reported that Desulfovibrio fairfieldensis is one of the most relevant sulphate-reducing bacteria of the human oral cavity suspected to be involved in peri-implantitis and implant corrosion . It is arduous to disregard the hypothesis that peri-implantitis is more common in patients with a history of periodontitis . 3.4 . Smoking It is well-established that periodontal inflammation and marginal bone loss are more often manifested in tobacco smokers as compared to individuals not using tobacco in any form 51-54 12 , 55-57
. Studies have also reported that cigarette smokers are more susceptible to develop peri-implantitis as
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