Microbial Characteristics of Peri-Implantitis: A Case-Control Study

• Autores: Y.C. de Waal, H.V. Eijsbouts, E.G. Winkel, A.J. van Winkelhoff
• Localización: Journal of periodontology, ISSN 0022-3492, Vol. 88, Nº. 2, 2017, págs. 209-217
• Idioma: inglés
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• Resumen

  • Background: The aim of this case-control study is to compare oral microbiologic characteristics of patients with healthy peri-implant conditions and patients with peri-implantitis and to explore the influence of various patient- and implant-related factors on microbiologic characteristics.

    Methods: Peri-implant submucosal microbial samples were collected from 85 patients with peri-implantitis (cases) and from 69 patients with only implants with healthy peri-implant conditions (controls). Samples were analyzed using culturing techniques. Multivariable logistic regression was used to explore the association of disease status and various patient- and implant-related factors (sex, patient age, smoking, number of remaining teeth, percentage of teeth with bone loss, implant function time, implant surface, and presence of plaque) with microbiologic characteristics.

    Results: Peri-implant disease status was significantly associated with the submucosal presence of Porphyromonas gingivalis (Pg), Prevotella intermedia (Pi), Tannerella forsythia (Tf), and Fusobacterium nucleatum (Fn). The association with disease status was most obvious for Pi (odds ratio [OR]: 15.1; 95% confidence interval [CI]: 5.1 to 45.3) and Tf (OR: 13.3; 95% CI: 5.4 to 32.5). The prevalence of Aggregatibacter actinomycetemcomitans and Staphylococcus species was very low.

    Conclusions: The periodontal pathogens Pg, Pi, Tf, and Fn are associated with peri-implantitis. A. actinomycetemcomitans and Staphylococcus species do not seem to play an important role in peri-implantitis.

    Peri-implant infection may result from a disturbance of the balance between the microbiologic challenge and host response.1 Infection limited to the peri-implant mucosa is called peri-implant mucositis. Peri-implantitis is characterized by loss of supporting bone.2 It has been suggested that initiation of the disease is the result of a multifactorial process, in which iatrogenic, mechanical, anatomic, genetic, immunologic, environmental, and microbiologic factors can all play a role.

    Notwithstanding the multifactorial etiology of peri-implantitis, it is very important to understand the microbiologic factors involved in the disease process. This can contribute to disease prevention and assist in increasing the effectiveness of peri-implantitis treatment, which is often antimicrobial based, including the use of antibiotics and antiseptics. The polymicrobial nature of peri-implant disease and the complex interactions of micro-organisms limit the establishment of true causative relationships between micro-organisms and peri-implant disease development/progression. However, studies have clearly shown that the submucosal biofilm in peri-implantitis differs substantially from that of implants with healthy conditions.3-15 To describe the association between disease status and bacterial composition, one has to take into account the influence of possible biofilm-modifying factors such as implant function time, smoking, and periodontal status of remaining teeth.15-18 However, most studies have not evaluated the role of these factors and have included only limited numbers of patients.

    Therefore, the aim of the present case-control study was to compare microbiologic characteristics of implants with healthy peri-implant conditions and implants with peri-implantitis and to explore the influence of various patient-related and implant-related factors.