Peri-implantitis: Causation and Treatment

  • Michael L. Schmerman
  • Salvador NaresEmail author


The continued increase in the placement of dental implants, while modifying the course of and improving treatment, has spawned a set of problems endemic to the therapy. This chapter explores peri-implantitis including its prevalence and histologic features. Identification of the etiology and microbiology of the entity are traced. Periodontitis has been found to play an important role in susceptibility. The differences between ailing and failing implants are defined. Finally, the history, evolution, and methods of treatment of these problems by various researchers and clinicians are explored. These citations include techniques discussed by Meffert, Lang, and Froum. The complexity of peri-implantitis, as expected, will require much in further study. Of paramount clinical importance is the maintenance phase of implant restoration. By vigilant monitoring, both early detection and interventions can enhance outcomes.


Dental implants Peri-implantitis Treatment protocols Meffert Lang Froum Maintenance 


  1. Achermann G (2012) How will dentistry look in 2020? Paper presented at the Capital Markets Day, Straumann, Inc., Amsterdam, 16 May 2012Google Scholar
  2. Adell R, Lekholm U, Rockler B, Brånemark PI (1981) A 15-year study of osseointegrated implants in the treatment of the edentulous jaw. Int J Oral Surg 10(6):387–416CrossRefGoogle Scholar
  3. Alani A, Kelleher M, Bishop K (2014) Peri-implantitis. Part 1: scope of the problem. Br Dent J 217(6):281–287CrossRefGoogle Scholar
  4. Atieh MA, Alsabeeha NH, Faggion CM Jr, Duncan WJ (2013) The frequency of peri-implant diseases: a systematic review and meta-analysis. J Periodontol 84(11):1586–98Google Scholar
  5. Berglundh T, Gotfredsen K, Zitzmann NU, Lang NP, Lindhe J (2007) Spontaneous progression of ligature induced peri-implantitis at implants with different surface roughness: an experimental study in dogs. Clin Oral Implants Res 18(5):655–661CrossRefGoogle Scholar
  6. Berglundh T, Zitzmann NU, Donati M (2011) Are peri-implantitis lesions different from periodontitis lesions? J Clin Periodontol 38(S11):188–202CrossRefGoogle Scholar
  7. Carcuac O, Berglundh T (2014) Composition of human peri-implantitis and periodontitis lesions. J Dent Res 93(11):1083–1088CrossRefGoogle Scholar
  8. Casado PL, Pereira MC, Duarte ME, Granjeiro JM (2013) History of chronic periodontitis is a high risk indicator for peri-implant disease. Braz Dent J 24(2):136–141CrossRefGoogle Scholar
  9. Cecchinato D, Parpaiola A, Lindhe J (2014) Mucosal inflammation and incidence of crestal bone loss among implant patients: a 10-year study. Clin Oral Implants Res 25:791–796CrossRefGoogle Scholar
  10. Charalampakis G, Belibasakis GN (2015) Microbiome of peri-implant infections: lessons from conventional, molecular and metagenomic analyses. Virulence 6(3):183–187CrossRefGoogle Scholar
  11. Chrcanovic BR, Albrektsson T, Wennerberg A (2015) Smoking and dental implants: a systematic review and meta-analysis. J Dent 43(5):487–498CrossRefGoogle Scholar
  12. Derks J, Tomasi C (2015) Peri-implant health and disease. A systematic review of current epidemiology. J Clin Periodontol 42(S16):S158–S171CrossRefGoogle Scholar
  13. Dvorak G, Arnhart C, Heuberer S, Huber CD, Watzek G, Gruber R (2011) Peri-implantitis and late implant failures in postmenopausal women: a cross-sectional study. J Clin Periodontol 38(10):950–955CrossRefGoogle Scholar
  14. Emecen-Huja P, Eubank TD, Shapiro V, Yildiz V, Tatakis DN, Leblebicioglu B (2013) Peri-implant versus periodontal wound healing. J Clin Periodontol 40(8):816–824CrossRefGoogle Scholar
  15. Eskow RN, Smith VS (2010) Implant complications related to maintenance therapy. In: Froum S (ed) Dental implant complications: etiology, prevention and treatment, 1st edn. Wiley, Hoboken, pp 422–424Google Scholar
  16. Esposito M, Hirsh J, Lekholm U, Thomson P (1999) Differential diagnosis and treatment strategies for biologic complications and failing oral implants: a review of the literature. Int J Oral Maxillofac Implants 14(4):473–490PubMedGoogle Scholar
  17. Froum SJ, Rosen PS (2012) A proposed classification for peri-implantitis. Int J Periodontics Restor Dent 32(5):533–540Google Scholar
  18. Gallucci GO, Grütter L, Chuang SK, Belser UC (2011) Dimensional changes of peri-implant soft tissue over 2 years with single-implant crowns in the anterior maxilla. J Clin Periodontol 38(3):293–299CrossRefGoogle Scholar
  19. Hämmerle CH, Brägger U, Bürgin W, Lang NP (1996) The effect of subcrestal placement of the polished surface of ITI implants on marginal soft and hard tissues. Clin Oral Implants Res 7(2):111–119CrossRefGoogle Scholar
  20. Heitz-Mayfield LJ, Lang NP (2010) Comparative biology of chronic and aggressive periodontitis vs. peri-implantitis. Periodontol 2000;53:167–181Google Scholar
  21. Judgar R, Giro G, Zenobio E, Coelho PG, Feres M, Rodrigues JA, Mangano C, Iezzi G, Piattelli A, Shibli JA (2014) Biological width around one- and two-piece implants retrieved from human jaws. Biomed Res Int. doi: 10.1155/2014/850120 CrossRefPubMedPubMedCentralGoogle Scholar
  22. Koldsland OC, Scheie AA, Aass, AM (2010) Prevalence of peri-implantitis related to severity of the disease with different degrees of bone loss. J Periodontol 81:231–238CrossRefGoogle Scholar
  23. Koyanagi T, Sakamoto M, Takeuchi Y, Maruyama N, Ohkuma M, Izumi Y (2013) Comprehensive microbiological findings in peri-implantitis and periodontitis. J Clin Periodontol 40(3):218–226CrossRefGoogle Scholar
  24. Kutlu B, Genc T, Tozum T (2016) Treatment of refractory apical peri-implantitis: a case report. J Oral Implantol 42(1):104–109CrossRefGoogle Scholar
  25. Lang N (2000) Biologic complications with dental implants: their prevention, diagnosis and treatment. Clin Oral Implants Res 11(S1):146–155CrossRefGoogle Scholar
  26. Lang NP, Berglundh T (2011) Periimplant diseases: where are we now? Consensus of the Seventh European Workshop on Periodontology. Working Group 4 of Seventh European Workshop on Periodontology. J Clin Periodontol 38(S11):178–181CrossRefGoogle Scholar
  27. Lin HY, Liu Y, Wismeijer D, Crielaard W, Deng DM (2013) Effects of oral implant surface roughness on bacterial biofilm formation and treatment efficacy. Int J Oral Maxillofac Implants 28(5):1226–1231CrossRefGoogle Scholar
  28. Linkevicius T, Apse P, Grybauskas S, Puisys A (2009) The influence of soft tissue thickness on crestal bone changes around implants: a 1-year prospective controlled clinical trial. Int J Oral Maxillofac Implants 24(4):712–719Google Scholar
  29. Machtei EE, Mahler D, Oettinger-Barak O, Zuabi O, Horwitz J (2008) Dental implants placed in previously failed sites: survival rate and factors affecting the outcome. Clin Oral Implants Res 19(3):259–264CrossRefGoogle Scholar
  30. Marrone A, Lasserre J, Bercy P,Brecx MC (2013) Prevalence and risk factors for periimplant disease in Belgian adults. Clinl Oral Implants Res 24: 934–940CrossRefGoogle Scholar
  31. Maruyama N, Maruyama F, Takeuchi Y, Aikawa C, Izumi Y, Nakagawa I (2014) Intraindividual variation in core microbiota in peri-implantitis and periodontitis. Sci Report. doi: 10.1038/srep06602 CrossRefGoogle Scholar
  32. McCallister BS, Masters D, Meffert RM (1992) Treatment of implants demonstrating periapical radiolucencies. Pract Periodontics Aesthet Dent 4(9):37–41Google Scholar
  33. Meffert R (1992) How to treat ailing and failing implants. Implant Dent 1(1):25–33CrossRefGoogle Scholar
  34. Mir-Mari J, Mir-Orfila P, Figueiredo R, Valmaseda-Castellón E, Gay-Escoda C (2012) Prevalence of peri-implant diseases: a cross-sectional study based on a private practice environment. J Clin Periodontol 39: 490–494CrossRefGoogle Scholar
  35. Mombelli A, Lang H (1992) Anti-microbial treatment of implant infections. Clin Oral Implants Res 3(4):162–168CrossRefGoogle Scholar
  36. Mombelli A, van Oosten MA, Schurch E Jr, Land NP (1987) The microbiota associated with successful or failing osseointegrated titanium implants. Oral Microbiol Immunol 2(4):145–151CrossRefGoogle Scholar
  37. Mombelli A, Mühle T, Brägger U, Lang NP, Bürgin WB (1997) Comparison of periodontal and peri-implant probing by depth-force pattern analysis. Clin Oral Implants Res 8(6):448–454CrossRefGoogle Scholar
  38. Mombelli A, Müller N, Cionca N (2012) The epidemiology of peri-implantitis. Clin Oral Implants Res 23(S6):67–76CrossRefGoogle Scholar
  39. Muthukuru M, Zainvi A, Esplugues EO, Flemmig TF (2012) Non-surgical therapy for management of peri-implantitis: a systematic review. Clin Oral Implants Res 23(S6):77–83CrossRefGoogle Scholar
  40. Reiser GM, Nevins M (1995) The Implant periapical lesion: etiology prevention and treatment. Comp Cont Educ Dent 16(8):768 770, 772 passimGoogle Scholar
  41. Robitaille N, Reed DN, Walters JD, Kumar PS (2015) Periodontal and peri-implant diseases: identical or fraternal infections. Mol Oral Microbiol 31(4):285–301CrossRefGoogle Scholar
  42. Saaby M, Karring E, Schou S, Isidor F (2014) Factors influencing severity of peri-implantitis. Clin Oral Implants Res 27(1):7–12CrossRefGoogle Scholar
  43. Sculean A, Gruber R, Bosshardt DD (2014) Soft tissue wound healing around teeth and dental implants. J Clin Periodontol 41(S15):S6–S22CrossRefGoogle Scholar
  44. Stern IB (1981) Current concepts of the dentogingival junction: the epithelial and connective tissue attachments to the tooth. J Periodontol 52(9):465–476CrossRefGoogle Scholar
  45. Tamura N, Ochi M, Miyakawa H, Nakazawa F (2013) Analysis of bacterial flora associated with peri-implantitis using obligate anaerobic culture technique and 16S rDNA gene sequence. Int J Oral Maxillofac Implants 28(6):1521–1529CrossRefGoogle Scholar
  46. Tarnow DP, Cho SC, Wallace SS (2000) The effect of inter-implant distance on the height of inter-implant bone crest. J Periodontol 71(4):546–549CrossRefGoogle Scholar
  47. Teughels W, Van Assche N, Sliepen I, Quirynen M (2006) Effect of material characteristics and/or surface topography on biofilm development. Clin Oral Implants Res 17(S2):68–81CrossRefGoogle Scholar
  48. Tözüm TF, Sençimen M, Ortakoğlu K, Ozdemir A, Aydin OC, Keleş M (2006) Diagnosis and treatment of a large periapical implant lesion associated with adjacent natural tooth: a case report. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 101(6):e132–e138CrossRefGoogle Scholar
  49. Tsao YP, Wang HL (2003) Periodontal considerations in implant therapy. Int Chin J Dent 3:13–30Google Scholar
  50. Valero (2013) Decontamination of dental implants. Med Oral Path 18(6):e869–e876CrossRefGoogle Scholar
  51. Zangrando MS, Damante CA, Sant'Ana AC, Rubo de Rezende ML, Greghi SL, Chambrone L (2015) Long-term evaluation of periodontal parameters and implant outcomes in periodontally compromised patients: a systematic review. J Periodontol 86(2):201–221CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  1. 1.Department of Periodontics, College of DentistryUniversity of Illinois at ChicagoChicagoUSA
  2. 2.Illinois Masonic HospitalChicagoUSA

Personalised recommendations