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Dental Tribune Middle East & Africa Edition | January-February 2016 25 implant Tribune Trusted market leader since 1967. Representing some International major companies such as: ABU DHABI SHOWROOM TEL. (02) 673 0790 FAX. (02) 673 1995 SHARJAH INDUSTRIAL AREA OFFICE TEL. (06) 535 5575 FAX. (06) 5350839 SHARJAH BUHAIRAH SHOWROOM TEL. (06) 555 3922 FAX. (06) 555 1300 practice have been confused. Studies evaluating the preva- lence of peri-implantitis used so-called case definitions. While there is consensus con- cerning the use of bleeding on probing as a clinical criterion, the use of at least seven differ- ent radiographic thresholds of bone loss has been suggested to determine peri-implantitis (Tomasi et Derks 2012). Following a meta-analysis of data from different stud- ies, Derks and Tomasi (2015) recently reported that about 22% of patients with dental implants suffered from peri- implantitis. Similar results have been presented in other literature reviews (Mombelli et al 2012). In a recently pub- lished nation-wide project, data from 596 patients were used to study the prevalence of peri-implantitis (Derks et al 2015). While about 45% of the patients presented with signs of peri-implantitis, 14.5% had moderate/severe forms of the disease (bleeding on probing and >2mm bone loss) at ≥1 im- plants. Risk factors for peri-implan- titis Susceptibility to periodonti- tis is one of the strongest risk factors for peri-implantitis. Several studies have dem- onstrated that such patients are overrepresented among those suffering from peri-im- plantitis. It should be kept in mind, however, that adequate supportive measures prevent peri-implantitis also in peri- odontally susceptible individu- als. Thus, provided that peri- odontal therapy is successful and that patient compliance is maintained on a high level im- plants have a favourable prog- nosis with little risk of peri- implantitis. An additional potential risk factor for peri-implantitis is the design of the prosthetic re- construction. Without proper access for self-performed oral hygiene, the risk of peri-im- plantitis is increased. Thus, when designing the prosthetic reconstruction, it is imperative to satisfy the requirement of access for self-performed in- fection control. A more controversial risk fac- tor for peri-implantitis is the surface characteristics of the implant. While convincing pre-clinical data are available, we lack clinical documenta- tion and comparative clinical trials, in particular. In a se- ries of experimental studies it was demonstrated that spon- taneous progression of peri- implantitis at implants with modified surfaces was more pronounced than at implants with non-modified surfaces (Berglundh et al 2007, Albouy et al 2012). Results from pre- clinical research should be interpreted with caution. This is the case for studies demon- strating potentially negative outcomes but also for studies revealing positive effects of implant surface modifications. Results from clinical reports including patient groups with different types of implants indicated that patients with rough-surface implants expe- rienced more problems than those carrying implants with less rough surfaces (Baelum et Ellegaard 2004, Marrone et al 2013). Data presented in a Spanish study suggested dif- ferences not only in the oc- currence of peri-implantitis at different implants, but also differences regarding the time of onset (Mir-Mari et al 2012). In order to identify risk factors related to patients, clinicians, and/or implants, large and randomly selected patient co- horts are required. The nation- wide project aforementioned includes such an evaluation of effectiveness (Derks et al 2015). Results of the different regression analyses revealed that several of the clinician-, patient-, and therapy-related factors were associated with moderate/severe peri-im- plantitis. Patients presenting with periodontitis were more likely to suffer from moderate/ severe peri-implantitis. Fac- tors related to clinicians were associated with moderate/ severe peri-implantitis: pa- tients provided with prosthetic therapy performed by general practitioners presented with a higher odds ratio (4.3). In ad- dition, certain implant brands were associated with a higher risk for peri-implantitis: Strau- mann implants show the low- est rates of moderate/severe peri-implantitis when com- pared to Nobel Biocare, Astra Tech and the other implants represented in this observa- tional study (including Biomet 3i, CrescoTi, Xive, Frialit, Lifecore, Implamed and API). Finally, a higher odds ratio (2.3) for moderate/severe peri- implantitis was observed for implants with a reduced dis- tance (≤1.5 mm) from the pros- thetic margin to the crestal bone as measured in baseline radiographs. References 1. Lang N, Bosshardt DD, Lu- lic M (2011). Do mucositis le- sions around implants differ from gingivitis lesions around teeth? J Clin Periodontol 38 Suppl 11:182–187. 2. Berglundh T, Zitzmann NU, Donati M (2011). Are peri-im- plantitis lesions different from periodontitis lesions? J Clin Periodontol 38 Suppl 11:188– 202 Editorial note: The full list of references is available from the publisher. Dr. Olivier Carcuac (1)DDS, Specialist in Periodontics My Dental Clinic Al Thanya Road, Villa 61A Umm Suqeim 2, Dubai, UAE (2)Odont. Dr. (PhD) Department of Periodontology Institute of Odontology Sahlgrenska Academy University of Gothenburg Sweden Specialist in Periodontics and Implant Dentistry at My Dental Clinic T: + 971 43388939 E: olivier@mydentalclinic.ae About the Author < Page 24 Dental Tribune Middle East & Africa Edition | January-February 201625 TEL. (02) 6730790 FAX. (02) 6731995 TEL. (06) 5355575 TEL. (06) 5553922 FAX. (06) 5551300 T: + 97143388939