Prevalence of peri-implantitis in medically compromised patients and smokers: A systematic review

Purpose: To verify whether the diversity of systemic medical conditions and smoking act as biologicassociated factors for peri-implantitis. Materials and Methods: The PICO question was: “In patients withosseointegrated dental implants, does the presence of smoking habits or a compromised medical statusinfluence the occurrence of peri-implantitis compared with the presence of good general health?” Smokingand systemic conditions such as type 2 diabetes mellitus, cardiovascular diseases, rheumatoid arthritis, lungdiseases, obesity, cancer, deep depression, and osteoporosis were screened. Selection criteria included atleast 10 patients per condition, 1 year of follow-up after implant loading, and strict cutoff levels (probingpocket depth [PPD], bleeding on probing [BOP] and/or pus, marginal bone loss) to define peri-implantitis.Results: From the 1,136 records initially retrieved, 57 were selected after title and abstract analyses.However, only six papers were considered for qualitative evaluation. No randomized controlled clinical trialwas found. Smoking was associated with peri-implantitis in only one out of four studies. Poorly controlledtype 2 diabetes accentuated only PPD and radiographic marginal bone level prevalence rates in peri-implantpatients (one study). Cardiovascular disease was considered a risk (one out of two studies). The chance ofperi-implant patients harboring the Epstein-Barr virus was threefold in one report. No associations werefound for rheumatoid arthritis. Conclusion: Data from existing studies point to smoking and diabetes asbiologic associated factors for peri-implantitis. However, the body of evidence is still immature, and thespecific contribution of general health problems to peri-implantitis requires additional robust epidemiologicand clinical investigations