Peri‐implantitis prevalence, incidence rate and risk factors: A study of electronic health records at a U.S. dental school

Abstract

Objectives

We assessed peri‐implantitis prevalence, incidence rate and associated risk factors by analyzing electronic oral health records (EHRs) in an educational institution.

Methods

We used a validated reference cohort comprising all patients receiving dental implants over a 3.5‐year period (2,127 patients and 6,129 implants). EHRs of a random 10% subset were examined for an additional follow‐up of ≥2.5 years to assess presence of radiographic bone loss, defined as >2mm longitudinal increase in the distance between the implant shoulder and the supporting peri‐implant bone level (PBL) between time of placement and follow‐up. "Intact" implants had no or ≤2mm PBL increase from baseline. EHR notes were reviewed to corroborate a definitive peri‐implantitis diagnosis at implants with progressive bone loss. A nested case‐control analysis of peri‐implantitis‐affected implants randomly matched by age with "intact" implants from peri‐implantitis‐free individuals identified putative risk factors.

Results

The prevalence of peri‐implantitis over an average follow‐up of _˜2 years was 34% on the patient‐ and 21% on the implant level. Corresponding incidence rates were 0.16 and 0.10 per patient‐year and implant‐year, respectively. Multiple conditional logistic regression identified ill‐fitting fixed prosthesis (OR=5.9; 95%CI 1.6‐21.1), cement‐retained prosthesis (OR=4.5; 2.1‐9.5), and radiographic evidence of periodontitis (OR=3.6; 1.7‐7.6) as statistically associated with peri‐implantitis. Implant location in the mandible (OR=0.02; 0.003‐0.2) and use of antibiotics in conjunction with implant surgery (OR=0.19; 0.05‐0.7) emerged as protective exposures.

Conclusions

Approximately 1/3 of the patients and 1/5 of all implants experienced peri‐implantitis. Ill‐fitting/ill‐designed fixed and cement‐retained restorations, and history of periodontitis emerged as the principal risk factors for peri‐implantitis.

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