Patient Related Risk Factors

Risk factors for peri-implant diseases need to be addressed prior to treatment and even prior to the initial implant treatment planning. This is often referred to as “primordial prevention”. When risk factors are identified, the patient and the dental professional can either eliminate or manage them in order to ensure better implant success rates. Since bacteria is the main culprit of the disease, poor oral hygiene is accordingly a very important risk factor.^2,3,5 Patients who incur difficulty maneuvering a toothbrush or an interdental cleaning aid may be unable to clean effectively also putting them at higher risk for implant failure. Poor oral hygiene was found to be associated with peri-implant disease with an odds ratio of 14.3.^5-7 This emphasizes the importance oral hygiene has in maintaining dental implants and thus should be a central portion involved in implant consultations.

Dementia and other systemic diseases that decrease a patient’s ability to clean their mouth are at a higher risk for developing peri-implant diseases. Moreover, patients with uncontrolled diabetes and several other systemic conditions and medications are also at a higher risk. Smoking is another patient related risk factor that is associated with peri-implant diseases as it enables the colonization of bacteria and has been evidenced to double the marginal bone loss around implants.⁶

Periodontal disease also has an ability to influence the incidence of peri-implant disease and therefore also needs to be considered a risk factor. The pathogens in periodontal disease are hypothesized to move from the periodontal pocket to the susceptible implant and initiate inflammation leading to bone loss. Therefore, if an implant candidate has previous or current periodontal disease, the disease itself should be controlled first and in only after getting to a stable condition during the maintenance phase and the patient is able to demonstrate their ability to remain in this phase, an implant can be considered.⁷

Figure 4: Extremely poor oral hygiene.

Figure 4: Extremely poor oral hygiene.