Surgical- and implant-related factors and onset/progression of peri-implant diseases: An AO/AAP systematic review.

Background
The objective of this systematic review was to shed light on the importance of surgical- and implant-related factors on the onset/progression of peri-implant diseases. This systematic review provides an evidence-based overview on the prevention of peri-implant diseases for the Academy of Osseointegration (AO)/American Academy of Periodontology (AAP) Consensus Conference held in August 14-16, 2024 in Oakbrook, IL, USA.
Methods
Systematic screening of electronic sources was performed to identify clinical studies reporting on the impact of surgical- and implant-related factors on peri-implant diseases. To fulfil the inclusion criteria, a composite clinical and radiographic case definition for peri-implant mucositis and/or peri-implantitis had to be reported. Prevalence or incidence (%) of peri-implant diseases was extracted at patient- and implant-level. Moreover, odds/hazard ratios were collected to explore potential associations.
Results
Overall, 34 articles were included in the qualitative synthesis. Of these, 21 explored surgical-related factors (Npatients = 2752, Nimplants = 7591), while 13 reported implant-related factors (Npatients = 1192, Nimplants = 4072). Given the high heterogeneity across the studies, only qualitative assessment was performed. Clinical evidence proved that surgical-related factors, in particular inadequate implant position and, to a lower extent, implants placed in regenerated bone, are more prone to exhibit peri-implantitis, but not peri-implant mucositis. With regards to specific implant-related factors, insufficient evidence, did not allow for exploring specific associations with the onset/progression of peri-implant diseases. However, it was found that a short distance from the prosthetic margin to crestal bone during implant placement may be a predisposing factor for peri-implantitis.
Conclusion
Clinical evidence linking surgical- and implant-related factors and peri-implant diseases is sparsely reported in the literature. Nevertheless, it appears that implant malposition plays a crucial role on the onset/progression of peri-implantitis.

Plain Language Summary
The objective of this systematic review was to shed light on the importance of surgical-and implant-related factors on the onset/progression of peri-implant diseases. Overall, 33 articles were included in the qualitative synthesis. Of these, 21 explored surgical-related factors. Given the high heterogeneity across the studies, only qualitative assessment was performed. Clinical evidence proved that surgical-related factors, in particular inadequate implant position and, to a lower extent, implants placed in regenerated bone, are more prone to exhibit peri-implantitis, but not peri-implant mucositis. With regards to specific implant-related factors, insufficient evidence, did not allow for exploring specific associations with the onset/progression of peri-implant diseases. However, it was found that a short distance from the prosthetic margin to crestal bone during implant placement may be a predisposing factor for peri-implantitis. All in all, implant malposition plays a crucial role on the onset/progression of peri-implantitis.