Page 77 - EJMO-9-1

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

enough to establish a significant relationship between peri- because both share similar clinical features, pathogenesis,
implant diseases and viruses. 74 and risk factors. Patients with a host susceptibility to
Despite the success of osseointegrated implants periodontitis remain vulnerable to biofilm infections at
functioning for months or even years, different implant sites. The persistence of periodontal pathogens
microbiologic and clinical findings have been documented. following full-mouth extraction and implant placement
59
Darkfield microscopic analysis revealed that the extent of supports this notion.
all morphotypes was extremely low, not exceeding 5%, It has been shown that a history of periodontal diseases
while coccoid forms predominated (88.5%), suggesting plays an important role in determining the microbial
that the microflora associated with peri-implant health is signature. Quirynen et al. found that in patients with
81
comparable to that found on healthy natural teeth. 75 a history of periodontal diseases, peri-implant surfaces
Anaerobic, asaccharolytic, Gram-positive rods (e.g., became populated by red complex microorganisms just
Filifactor alocis, Slackia exigua, Parascardovia denticolens, 1 week after abutment insertion. 81
and Eubacterium spp.) have been linked to peri-implantitis. Some studies have found that delaying implant
These microorganisms are either non-cultivable or very placement after the extraction of periodontally involved
difficult to cultivate, and have been identified only through teeth leads to a significant reduction in the number of
specific gene clonal methods. 76 periodontal pathogens. However, once the implant is
In a comparative study, microbial profiles in peri- inserted, periodontal pathogens repopulate the area and
implantitis and non-peri-implantitis patients were examined subsequently multiply. 59
at both subgingival and supragingival levels. Elevated levels Danser et al. recommended waiting at least 1 month
56
of T. forsythia, T. denticola, and P. gingivalis were observed in after extraction to allow for the eradication of P. gingivalis
patients with peri-implantitis at both levels. 64 and A. actinomycetemcomitans from the extraction socket.
Prevotella intermedia (P. intermedia) was present in The principal risk factors associated with these
33% of periodontal sites and 30% of peri-implant sites, considerations include smoking – particularly when
while Porphyromonas gingivalis was found in only one combined with poor oral hygiene – poorly designed
peri-implant site and in 10% of periodontal sites. No fixed and cement-retained restorations, and a history of
A. actinomycetemcomitans was detected in either peri- periodontitis. 82,83
implant or dental sites. 64
A recent study has shown that the likelihood of peri-
84
9.3 Fungal effects implant diseases increases with a history of smoking.
Moreover, the same study found that quitting smoking for
The most significant fungal infection associated with up to 21 years is associated with a decreased risk of peri-
periodontal diseases is candidiasis. Candida is highly implant diseases, comparable to that of non-smokers.
heterogeneous, with numerous species, but the most
common is Candida albicans (C. albicans), which has been 11. Bone versus bacteria
found to play a significant role in the pathogenesis of peri-
implantitis. However, its role is more pronounced in the Once a dental implant is inserted into its site, bacteria
85
advanced stages of peri-implantitis. 77 begin their race toward the surface of the implant. The
competitor in this race is the bone cell, which ultimately
In peri-implant pockets, the aerobic environment (often aims for osseointegration. This competition is not an easy
referred to as “mud damping”) is favorable for C. albicans. one; when bacteria win the race, peri-implant diseases
It had been shown that this environment was related to become the consequence. 86
an increase in the aspartyle proteinases activity which
consequently leads to an increase in the C. albican virulence 12. Diagnosis
78.
In addition, it has been found that metallopeptidases
produced by C. albicans have destructive effects on laminin, With the increasing predominance of dental implant
fibronectin, and both Type I and Type IV collagen. 79,80 treatments and associated implant diseases, the need
for effective diagnostic tools is also growing. Similar to
Despite these findings, further studies are needed to confirm periodontal diseases, diagnosing peri-implant diseases is
the exact role of Candida species in peri-implant diseases. challenging because most clinical peri-implant parameters
10. Risk factors are subjective and not reproducible. As a result, several
attempts have been made to identify alternatives to these
One key consideration is that peri-implantitis is closely clinical parameters. One such alternative is laboratory
related to periodontitis. This strong relation is evident investigation. Saliva represents an easily accessible

Volume 9 Issue 1 (2025) 69 doi: 10.36922/ejmo.6770