Peri-implantitis Risk Assessment (PiRA) Part 1: Umbrella review of a Multifactorial Disease With Many Risk Factors.

Abstract

Aim: An objective pre-operative assessment of patients' susceptibility to peri-implantitis could reduce the incidence of the disease and may be helpful in convincing patients to change their lifestyle, thereby reducing risk factors, or to forgo implant therapy in high-risk conditions.

Material & methods: An umbrella review was performed to identify patientrelated risk factors, together with their relative impact (odds ratio/relative risk). Potential treatment-related confounders for the development of peri-implantitis were also searched for.

Results: Ten relevant patient-related risk factors for peri-implantitis were identified. While some of them are modifiable (smoking, bleeding on probing, plaque control, number of sites with PPD ≥ 5 mm, recall frequency, occlusal overload), others are not (history of periodontitis, implant location, number of teeth lost, systemic diseases). The relative impact of these factors differed largely between systematic reviews, most of which unfortunately limited their analysis to one or only a few factors, without taking other factors into consideration, with the potential risk of misinterpretation/overrating. Moreover, patients' susceptibility might change due to a number of confounders (iatrogenic factors, surgical protocol, implant and implant site characteristics, etc.), and these factors should also be considered.

Conclusions: The number of risk factors and potential confounders underline the complexity and multi-factorial etiology of peri-implantitis.