Is there a correlation between peri-implantitis and systemic inflammation?

BACKGROUND: This systematic review investigates the association between peri-implantitis, an infectious/inflammatory disease sharing clinical and radiographic characteristics with periodontitis, and systemic inflammation.

DATA SOURCES: This study, adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, systematically reviewed available evidence up to February 9, 2023. Searches were carried out across eight electronic databases (Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, Web of Science, Dentistry & Oral Sciences Source, Scopus, LILACS, and China Online), ClinicalTrials.gov, WHO International Clinical Trials Registry Platform (ICTRP), and gray literature.

STUDY SELECTION: The review encompasses human studies, including randomised controlled trials, non-randomised intervention studies, cohort studies, case-control, and cross-sectional studies, yielded 27 full-text articles, with 11 clinical studies meeting inclusion criteria, and 9 articles included in the meta-analysis.

DATA EXTRACTION AND SYNTHESIS: Two independent reviewers carried out data extraction using the PECOS /PICOS tool (Patients, Exposure, Comparison, Outcomes, Study designs). The evaluation of the quality and risk of bias in observational studies, randomised controlled trials, and non-randomised studies of interventions was conducted utilising the Newcastle-Ottawa Scale (NOS), the revised Cochrane tool (RoB 2), and the ROBINS-I tool, respectively. Qualitative and quantitative analyses, including weighted mean differences (WMDs) and standard mean differences (SMD), were conducted using Stata/MP 17.0. Heterogeneity was assessed with the Q-statistic method. Pooled estimates, addressing potential inter-study heterogeneity, were calculated with random effects models. Significance criteria were set at p < 0.05. Publication bias was examined via funnel plot and Egger's test. Sensitivity analyses were predefined. Meta-analyses adhered to GRADE approach for inflammatory biomarkers/outcomes evaluation.

RESULTS: Patients with peri-implantitis exhibited elevated levels of serum C-reactive protein (CRP) (standard mean difference (SMD): 4.68, 98.7% CI: 2.12 to 7.25), interleukin-6 (IL-6) (weighted mean difference (WMD): 6.27 pg/mL, 0% CI: 5.01 to 7.54), and white blood cell counts (WMD: 1.16 * 103/mL, 0% CI: 0.61 to 1.70) compared to those without peri-implantitis.

CONCLUSIONS: The findings underscore a significant link between peri-implantitis and heightened systemic inflammation, emphasising the need for further research to elucidate the precise nature of this association.