The Microbiome of Peri-Implantitis: A Systematic Review and Meta-Analysis

Abstract

This review aimed to systematically compare microbial profiles of peri-implantitis to those of periodontitis and healthy implants. Therefore, an electronic search in five databases was conducted. For inclusion, studies assessing the microbiome of peri-implantitis in otherwise healthy patients were considered. Literature was assessed for consistent evidence of exclusive or predominant peri-implantitis microbiota. Of 158 potentially eligible articles, data of 64 studies on 3730 samples from peri-implant sites were included in this study. Different assessment methods were described in the studies, namely bacterial culture, PCR-based assessment, hybridization techniques, pyrosequencing, and transcriptomic analyses. After analysis of 13 selected culture-dependent studies, no microbial species were found to be specific for peri-implantitis. After assessment of 28 studies using PCR-based methods and a meta-analysis on 19 studies, a higher prevalence of Aggregatibacter actinomycetemcomitans and Prevotella intermedia (log-odds ratio 4.04 and 2.28, respectively) was detected in peri-implantitis biofilms compared with healthy implants. Actinomyces spp., Porphyromonas spp. and Rothia spp. were found in all five pyrosequencing studies in healthy-, periodontitis-, and peri-implantitis samples. In conclusion, the body of evidence does not show a consistent specific profile. Future studies should focus on the assessment of sites with different diagnosis for the same patient, and investigate the complex host-biofilm interaction.

Keywords: PCR; culture-dependent techniques; hybridization; oral pathogens; pyrosequencing.

Figure 1

Search strategy.

Figure 2

Frequency of positive detection in studies performing culture-based assessment. Weighted percentages of positive assessment in samples from healthy and peri-implantitis sites (bars = means, whiskers = standard deviation).

Figure 3

Frequency of positive detection in studies performing hybridization-based assessment. Weighted percentages of positive assessment in samples from healthy and peri-implantitis sites (bars = means, whiskers = standard deviation).

Figure 4

Meta-analysis for the presence of Aggregatibacter actinomycetemcomitans in either healthy sites or peri-implantitis sites (studies performing PCR-based analysis). HI—healthy implants, PI—implants with peri-implantitis, Q—Cochrane’s Q, df—degrees of freedom, p—level of significance, I²—proportion of observed variance (heterogeneity).

Figure 5

Meta-analysis for the presence of Porphyromonas gingivalis in either healthy sites or peri-implantitis sites (studies performing PCR-based analysis). HI—healthy implants, PI—implants with peri-implantitis, Q—Cochrane’s Q, df—degrees of freedom, p—level of significance, I²—proportion of observed variance (heterogeneity).

Figure 6

Meta-analysis for the presence of Tannerella forsythia in either healthy sites or peri-implantitis sites (studies performing PCR-based analysis). HI—healthy implants, PI—implants with peri-implantitis, Q—Cochrane’s Q, df—degrees of freedom, p—level of significance, I²—proportion of observed variance (heterogeneity).

Figure 7

Frequency of positive detection in studies performing PCR-based assessment. Weighted percentages of positive assessment in samples from healthy and peri-implantitis sites (bars = means, whiskers = standard deviation).