Impact of local predisposing/precipitating factors and systemic drivers on peri‐implant diseases

Background Strong evidence suggests the infectious nature of peri‐implant diseases occurring in susceptible hosts. Epidemiological reports, though, indicate that peri‐implantitis is a site‐specific entity. Hence, the significance of local factors that may predispose/precipitate plaque accumulation and the impact of systemic drivers that alter the immune response are relevant in the prevention and management of peri‐implant disorders. Purpose The purpose of the present review is to shed light on the significance of local and systemic factors on peri‐implant diseases, making special emphasis on the associations with peri‐implantitis. Methods The biologic plausibility and supporting evidence aiming at providing a concluding remark were explored in the recent scientific literature for local predisposing/precipitating factors and systemic drivers related to peri‐implant diseases. Results Local predisposing factors such as soft tissue characteristics, implant position and prosthetic design proved being strongly associated with the occurrence of peri‐implant diseases. Hard tissue characteristics, however, failed to demonstrate having a direct association with peri‐implant diseases. Robust data points toward the strong link between residual sub‐mucosal cement and peri‐implant diseases, while limited data suggests the impact of residual sub‐mucosal floss and peri‐implantitis. Systemic drivers/habits such as hyperglycemia and smoking showed a strong negative impact on peri‐implantitis. However, there is insufficient evidence to claim for any link between metabolic syndrome, atherosclerotic cardiovascular disease, and obesity and peri‐implant diseases. Conclusion Local predisposing/precipitating factors and systemic drivers may increase the risk of peri‐implant diseases. Therefore, comprehensive anamnesis of the patients, educational/motivational programs and exhaustive prosthetically‐driven treatment planning must be fostered aiming at reducing the rate of biological complications in implant dentistry.