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Year : 2020  |  Volume : 31  |  Issue : 1  |  Page : 1-2
Peri-implantitis: Is it the surface or the alloy that's important?

1 Department of Periodontology and Implantology, School of Oral Health and Dentistry, Griffith University, Gold Coast, Australia
2 School of Oral Health and Dentistry, Griffith University, Gold Coast, Australia

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Date of Submission16-Jan-2020
Date of Acceptance13-Feb-2020
Date of Web Publication02-Apr-2020

How to cite this article:
Sharma A, Sharma LA. Peri-implantitis: Is it the surface or the alloy that's important?. Indian J Dent Res 2020;31:1-2

How to cite this URL:
Sharma A, Sharma LA. Peri-implantitis: Is it the surface or the alloy that's important?. Indian J Dent Res [serial online] 2020 [cited 2022 Dec 4];31:1-2. Available from:
The increasing lifetime of the population on a worldwide scale over the last decades has led to a significant growth in the use of titanium oral implants to replace missing teeth. Longitudinal studies have reported high survival rates of the implants in function, ranging from 90% to 95% over a period up to 20 years.[1],[2] This also includes the increase in revision rate of implant prosthesis after the failure due to various factors. The most prominent and insidious complication around dental implants, emerging at a later stage is peri-implantitis.[3] A recent meta-analysis revealed a weighted mean prevalence of 22% for peri-implantitis.[4] Peri-implantitis is one of the main causes of failure in implant dentistry that affects 14%-30% of the implants.[4],[5] The 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions stated that peri-implantitis is an inflammatory process from a microbial origin.[6] By definition, it is a complex multifactorial infectious disease and the inflammatory lesion in the surrounding tissues develops as a result of accumulation of bacteria on implant surfaces resulting in a biofilm.[7] Peri-mucositis and Peri-implantitis analogous to gingivitis and periodontitis respectively. They have similar pathogical events but differ in extent and rapidity of tissue destruction. Experimental peri-implantitis induced by sub marginal placement of ligatures using animal models such as dogs and monkeys showed inflammatory lesions, bone loss and implant failures.[8],[9] Though the microbial taxa identified in peri-implantitis is predominantly similar to periodontitis, several studies have indicated the presence of additional strains like Staphylococcus aureus,Staphylococcus epidermidis and Candida spp.[3],[10],[11]Microorganisms colonize implant surfaces and contribute to the biofilm associated infections in a manner similar to teeth.[3],[12]

The physio-chemical characteristics of specific material surfaces are known to significantly influence the bacterial adhesion process. In general, surface modification of Ti implant surfaces are done to enhance osseointegration. These surface modifications lead to increased roughness, changes in surface free energy that influence the adhesion of microbes on exposed transmucosal surface. Berglundh et al. (2007),[13] studied the tissue reaction to custom-made implants with polished (Sa = 0.35 um) or roughened sandblasted, large-grit, acid-etched (SLA, Sa = 2.29 um) surfaces. The results showed spontaneous progression of peri-implantitis, more pronounced on rough surface compared to smooth surface. In a series of papers published by Albouy et al. (2008, 2009, 2012),[14],[15],[16] commercially available implant systems turned (Biomet 3i), TiOblast (Astra Tech AB), SLA (Straumann AG) and TiUnite (Nobel Biocare AB) was used. The surface roughness (Sa), varied between 1.0 and 2.0 mm for the implants of TiOblast, SLA and TiUnite, and between 0.5 and 1.0 mm for the turned surface. Though there was minimal difference in surface roughness between the four implant types, spontaneous progression of experimental peri-implantitis was most pronounced at TiUnite compared to SLA and TiOblast. The reason for this difference is not fully understood, but it may be related to other characteristics of the implant surface modifications than presented in Sa values. In addition, most published studies report the influence of modified Titanium (Ti) implant surfaces rather than newer alloys that are commercially available as an alternative. Studies to evaluate the presence of new elements in alloy composition with or without surface modification and their affinity for microbial colonization will be worth the exploration.

   References Top

Kim DM, Badovinac RL, Lorenz RL, Fiorellini JP, Weber HP. A 10-year prospective clinical and radiographic study of one-stage dental implants. Clin Oral Implants Res 2008;19:254-8.  Back to cited text no. 1
Šstrand P, Ahlqvist J, Gunne J, Nilson H. Implant treatment of patients with edentulous jaws: A 20-year follow-up. Clin Implant Dent Relat Res 2008;10:207-17.  Back to cited text no. 2
Charalampakis G, Leonhardt Š, Rabe P, Dahlén G. Clinical and microbiological characteristics of peri-implantitis cases: A retrospective multicentre study. Clin Oral Implants Rese 2012;23:1045-54.  Back to cited text no. 3
Derks J, Tomasi C. Peri-implant health and disease. A systematic review of current epidemiology. J Clin Periodontol 2015;42:S158-71.  Back to cited text no. 4
Jung RE, Zembic A, Pjetursson BE, Zwahlen M, Thoma DS. Systematic review of the survival rate and the incidence of biological, technical, and aesthetic complications of single crowns on implants reported in longitudinal studies with a mean follow-up of 5 years. Clin Oral Implants Res 2012;23:2-21.  Back to cited text no. 5
Berglundh T, Armitage G, Araujo MG, Avila-Ortiz G, Blanco J, Camargo PM, et al. Peri-implant diseases and conditions: Consensus report of workgroup 4 of the 2017 World workshop on the classification of periodontal and peri-implant diseases and conditions. J Periodontol 2018;89:S313-8.  Back to cited text no. 6
Mombelli A, Lang NP. The diagnosis and treatment of peri-implantitis. Periodontology 2000 1998;17:63-76.  Back to cited text no. 7
Hämmerle CHF, Schou S, Holmstrup P, Hjørting-Hansen E, Lang NP. Plaque-induced marginal tissue reactions of osseointegrated oral implants: A review of the literature. Clin Oral Implants Res 1992;3:149-61.  Back to cited text no. 8
Lindhe J, Berglundh T, Ericsson I, Liljenberg B, Marinello C. Experimental breakdown of peri-implant and periodontal tissues. A study in the beagle dog. Clin Oral Implants Res 1992;3:9-16.  Back to cited text no. 9
Rams TE, Roberts TW, Feik D, MoIzan AK, Slots J. Clinical and microbiological findings on newly inserted hydroxyapatite-coated and pure- titanium human dental implants. Clin Oral Implants Res 1991;2:121-7.  Back to cited text no. 10
Persson GR, Renvert S. Cluster of bacteria associated with peri-implantitis. Clin Implant Dent Relat Res 2014;16:783-93.  Back to cited text no. 11
Thurnheer T, Belibasakis GN. Incorporation of staphylococci into titanium-grown biofilms: An in vitro “submucosal” biofilm model for peri-implantitis. Clin Oral Implants Res 2016;27:890-5.  Back to cited text no. 12
Berglundh T, Gotfredsen K, Zitzmann NU, Lang NP, Lindhe J. Spontaneous progression of ligature induced peri-implantitis at implants with different surface roughness: An experimental study in dogs. Clin Oral Implants Res 2007;18:655-61.  Back to cited text no. 13
Albouy JP, Abrahamsson I, Berglundh T. Spontaneous progression of experimental peri-implantitis at implants with different surface characteristics: An experimental study in dogs. J Clin Periodontol 2012;39:182-7.  Back to cited text no. 14
Albouy JP, Abrahamsson I, Persson LG, Berglundh T. Spontaneous progression of peri-implantitis at different types of implants. An experimental study in dogs. I: Clinical and radiographic observations. Clin Oral Implants Res 2008;19:997-1002.  Back to cited text no. 15
Albouy JP, Abrahamsson I, Persson LG, Berglundh T. Spontaneous progression of ligatured induced peri-implantitis at implants with different surface characteristics. An experimental study in dogs II: Histological observations. Clin Oral Implants Res 2009;20:366-71.  Back to cited text no. 16

   Authors Top

Correspondence Address:
Ajay Sharma
Department of Periodontology and Implantology, School of Oral Health and Dentistry, Griffith University, Gold Coast
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijdr.IJDR_50_20

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