Page 74 - EJMO-9-1

Eurasian Journal of Medicine and
Oncology
Microbial profile of peri-implantitis

A previous study criticized the use of the term “peri- attachment of secondary colonizers. Over time, the biofilm
implantitis,” suggesting that the knowledge gap regarding becomes more stable, forming a protective condition
the host-implant interface should not be filled by knowledge against host defenses and antimicrobial agents, supported
from the natural tooth-host relationship. This concept of by a complex population of organisms, a composite
6
isolating natural teeth and implants with distinct disease structure, and a glycocalyx matrix. 19-21 Notable, a “brush
pathogenesis was proposed several years ago and has been form” configuration has been observed around failing
7
further supported by genetic studies. 8,9 implants, while a “corn cob” morphology is seen around
The traditional understanding of peri-implantitis healthy implants. 22,23
pathogenesis has also been influenced by concepts 6. Implant surface, type, and loading
explaining marginal bone resorption. One theory posits a
foreign body reaction, where immunological factors lead The surface features of the implant/abutment and
to a rejection process. 10,11 Another theory focuses on the restorative components, including surface roughness and
role of the operator’s performance (prosthodontic and chemical composition (e.g., titanium nanoparticles and
surgical perspectives). The exact factors responsible for released ions), can influence biofilm development. 24,25
12
peri-implant pathology remain questionable. Higher surface roughness of implants results in
A study by Rosenberg et al. sought to classify implant increased bacterial growth and biofilm formation and
13
failure as either “infectious” or “traumatic,” depending may even affect the immune response, as shown by
on the presence of pathogenic microorganisms around several studies. 24,25 Various implant types and surface
the failed implant. Late failures are more often linked to roughness levels may also affect the aggregation of both
improper prosthetic design, plaque accumulation, or sub- and supra-gingival plaque biofilms. The material of
26
inadequate supportive therapy, while early failures are the implant, such as titanium or zirconia, may also have
typically associated with surgical issues. The most relevant significant consequences on bacterial colonization. 27
14
factors include a history of peri-implant and periodontal As marginal bone supporting the implant is reduced,
diseases, with infections caused by red and orange microbial implant surfaces become exposed to the oral cavity, and
complexes predominating. This similarity is one of the the roughened surface may increase biofilm buildup. It
15
key features linking peri-implantitis to periodontitis. has been recognized that rough implant surfaces are more
16
While prosthetic features, surgical techniques, and timing
of implant insertion have some impact, they have a minor likely to promote peri-implantitis than smooth surfaces.
effect on the microbial profile. However, there is no strong evidence that the roughness of
the surface of a properly integrated implant directly affects
5. Biofilm formation the progression of peri-implant complications. 2

When an implant is placed, the endosseous part should The implant design type has also been shown to
ideally be surrounded by bone and not exposed to biofilm. significantly influence the microbial profile. The interface
In contrast, the transmucosal part of the implant/abutment between the abutment and the implant represents a
is quickly colonized by microorganisms once exposed to potential site for microorganism accumulation due to
the oral environment. These microorganisms bind to microleakage. Gaps of approximately 20 – 49 μm are
17
salivary peptides and proteins in the pellicle. However, sufficient to allow microleakage into the internal parts of
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enamel and titanium pellicles are not identical. In vitro, the dental implant. One study has demonstrated that the
titanium surfaces covered by salivary pellicles do not screw-retained abutments of dental implants are associated
include molecules typically found on tooth enamel, such as with a higher probability of colonizing anaerobic bacteria
cystatins and low molecular weight mucins. Nevertheless, compared to cemented abutments, which consequently
18
titanium pellicles do contain molecules such as secretory leads to a greater likelihood of developing peri-implantitis
immunoglobulin A, high molecular weight mucins, with screw-retained abutments. However, the same study
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proline-rich proteins, and α-amylase. found that both types of abutments are at high risk for
peri-implantitis.
Due to the similar ecologic environment, the sequence
and principles of biofilm development on implants and On the other hand, Penarrocha-Oltra et al. presented a
30
natural teeth are comparable. Biofilm development different perspective. They investigated the microorganisms
2
progresses with the binding of primary colonizers, such as in peri-implant structures with different implant types and
Streptococcus sanguinis and Actinomyces naeslundii, which reported that cemented implants were associated with a
bind to the titanium pellicle. Through co-aggregation, these significantly higher microbial count compared to screw-
primary colonizers alter the environment and facilitate the retained implants. This finding is one of the reasons why

Volume 9 Issue 1 (2025) 66 doi: 10.36922/ejmo.6770