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Limited evidence suggests that patients with a history of periodontitis receiving implants might have greater risk of peri-implantitis

Susan Parker RDH, B.S., MEd, MBA; Heeje Lee D.D.S. .


Systematic Review Conclusion

Patients with a history of periodontitis receiving implants may have a higher risk of peri-implantitis than those without a history of periodontitis.

Critical Summary Assessment

Although this systematic review followed accepted methods for evidence-based reviews, there were only three heterogeneous studies finally included with very small sample sizes.

Evidence Quality Rating

Limited Evidence

Structured Abstract

Clinical Questions:

For patients receiving implants, is there a higher risk of developing peri-implantitis in those with a history of periodontitis compared to those without such a history?

Review Methods:

The authors searched Medline and then conducted a hand-search of implant-related journals up to January 31, 2008. For studies to be included, the authors required a 5-year follow-up, prospective or retrospective study design, and publication in English. Factors such as evaluation period, disease definition, general health status, numbers of patients included, age of patients, implant system used, and smoking habits were recorded to investigate heterogeneity among the studies. General principles for conducting evidence-based systematic reviews were followed.

Main Results:

Although an initial screening yielded almost 1,000 potential publications, the authors selected only 3 articles for inclusion. In those studies, the total number of patients with previous history of periodontitis was 38 and the total number of patients without the history of periodontal disease was 75. Combining data through a meta-analysis was not possible because the three selected articles were substantially heterogeneous. Implant patients with the history of periodontitis showed lower implant survival rates (91% ~ 94%) as compared with implant patients without this history (97% ~ 100%).


Patients with the history of periodontitis might be at a greater risk for peri-implantitis, but the supporting data were not robust. The 3 included studies each reported dissimilar variables, were of different study designs and offered different definitions of periodontitis.

Source of Funding:

Johnson & Johnson (for meeting presentation and manuscript preparation).


Importance and Context:

In the past decades there has been a widespread acceptance and increased use of dental implants with reported great success/survival rates, yet the incidence of peri-implantitis should not be considered insignificant. The same types of bacteria play major roles in the development of both periodontitis and peri-implantitis, leading to speculation that a significant association may exist between incidences of the two diseases.1 If the evidence supported existence of such an association, then similar preventive and treatment factors could be considered for both diseases.

Strengths and Weaknesses of the Systematic Review:

The current systematic review showed some weaknesses: 1) the authors searched only 1 electronic database; 2) the authors did not assess the scientific quality of the included studies; and 3) possible publication bias was not assessed statistically.

Strengths and Weaknesses of the Evidence:

The current systematic review was based on 3 studies which comprised a limited number of patients with substantial variations in study design, definitions of periodontitis and no consideration for confounding variables like smoking. Thus, even with the somehow consistent findings from the 3 studies, the current systematic review only provides limited evidence about the relationship between the risk for peri-implantitis and a history of periodontitis.

Implications for Dental Practice:

Very few studies have investigated the possible association between periodontitis and peri-implantitis. This systematic review reported that the survival rate of dental implants placed in patients with a history of periodontitis was lower than the survival rate of dental implant patients without a history of the disease suggesting that patient selection may play a role in implant success. More well-designed clinical trials are necessary to provide stronger evidence before clear cut practice decisions can be supported.

Critical Summary Publication Date:


These summaries are not intended to, and do not, express, imply, or summarize standards of care, but rather provide a concise reference for dentists to aid in understanding and applying evidence from the referenced systematic review in making clinically sound decisions as guided by their clinical judgment and by patient needs. American Dental Association © 2018