The most notable risk factor for peri-implant disease is poor plaque control. This may reflect a patient’s inability or unwillingness to maintain optimal oral hygiene. Other impediments may include prosthesis design, adjacent restoration contour and margins, and/or loose or broken restorative components, which interfere with oral hygiene. Some of these problems may be avoided by designing removable superstructures, such as screw retained crowns.

It has also been shown that maxillary soft tissues adjacent to implants are at increased risk for plaque-induced inflammation when compared to the gingivae of natural dentition.18 Biofilm associated with peri-implant disease is also more complex than that with periodontitis. Common periopathogenic bacteria show low prevalence, and several bacteria, such as S. aureus, Fusobacterium, and Streptococcus species, have been identified as candidate pathogens in peri-implantitis.19