“Peri-Implantitis”: A Complication of a Foreign Body or a Man-Made “Disease”. Facts and Fiction

Background: The discrepancy between some scientific views and the daily clinical experience with dental implants hasmade the topic of “periimplantitis” highly controversial, especially the discussion whether “periimplantitis” should evenbe considered a “disease” or whether marginal bone loss instead would represent a complication of having a foreignbody placed in the oral cavity.Purpose: The aim of the present paper was to present the outcomes from a consensus meeting on “peri-implantitis” inRome, Italy (January 8–10, 2016).Materials and Methods: Seventeen clinical scientists were invited to, based on prepared reviews of the literature, discusstopics related to “periimplantitis.”Results and conclusions: Oral implants may lose bone or even display clinical failure. However, progressive bone lossthreatening implant survival is rare and limited to a percent or two of all implants followed up over 10 years or more,provided that controlled implant systems are being used by properly trained clinicians. There is very little evidencepointing to implants suffering from a defined disease entity entitled “peri-implantitis.” Marginal bone loss aroundimplants is in the great majority of cases associated with immune-osteolytic reactions. Complicating factors includepatient genetic disorders, patient smoking, cement or impression material remnants in the peri-implant sulcus, bacterialcontamination of the implant components and technical issues such as loose screws, mobile components or fracturedmaterials. These reactions combine to result in cellular responses with the end result being a shift in the delicate balancebetween the osteoblast and the osteoclast resulting in bone resorption. However, the great majority of controlled implantsdisplay a foreign body equilibrium resulting in very high survival rates of the implants over long term of follow-up