Peri‐implantitis susceptibility as it relates to periodontal therapy and supportive care

Abstract Objective To assess the long‐term survival of implants inserted in periodontally susceptible patients and to investigate the influence of residual pockets on the incidence of peri‐implantitis and implant loss. Materials and methods For 70 patients, comprehensive periodontal treatment was followed by installation of 165 Straumann ® Dental implants. Subsequently, 58 patients entered a University supportive periodontal therapy ( SPT ) program and 12 had SPT in a private practice. The follow‐up time ranged from 3 to 23 years (mean 7.9 years). Bleeding on probing ( BOP ), clinical attachment level ( CAL ), and peri‐implant probing depths ( PPD ) were evaluated at baseline (T0), completion of active treatment (T1), and at follow‐up (T2). Peri‐implant bone levels were assessed on radiographs at T2. Patients were categorized as having implants not affected by peri‐implantitis (non‐ PIP ), or affected by peri‐implantitis ( PIP ). Results From 165 implants inserted, six implants were lost, translating into a cumulative survival rate of 95.8%. Solid screw implants yielded significantly higher survival rates than the hollow cylinder and hollow screw implants (99.1% vs. 89.7%). Implants lost due to peri‐implant infection were included in the PIP groups. When peri‐implantitis ( PPD ≥ 5 mm, BOP +) was analyzed, 22.2% of the implants and 38.6% of patients had one or more implants affected by peri‐implantitis. Using the peri‐implantitis definition ( PPD ≥6 mm, BOP +), the prevalence was reduced to 8.8% and 17.1%, respectively. Moreover, all these implants demonstrated significant (≥2 mm) bone loss at T2. At T1, the non‐ PIP group had significantly ( P = 0.011) fewer residual pockets (≥5 mm) per patient than the PIP group (1.9 vs. 4.1). At T2, the PIP group displayed an increased number of residual pockets compared to T1, whereas in the non‐ PIP group, the number remained similar to T1. At T2, mean PPD , mean CAL and BOP were significantly higher in the PIP group compared with the non‐ PIP group. The prevalence of peri‐implantitis was lower in the group that was in a well organized SPT at the University. Conclusions In periodontitis susceptible patients, residual pockets ( PPD ≥5 mm) at the end of active periodontal therapy represent a significant risk for the development of peri‐implantitis and implant loss. Moreover, patients in SPT developing re‐infections are at greater risk for peri‐implantitis and implant loss than periodontally stable patients.