Evidence for the association between psychological stress and peri-implant health among middle-aged and elderly adults: A systemic review

Abstract

Background: Chronic psychological stress (CPS) is increasingly recognized for its detrimental effects on systemic and oral health, yet its impact on peri-implantitis remains underexplored.

Aim: To evaluate the evidence linking CPS to peri-implantitis.

Methods: This systematic review was conducted according to the PRISMA guidelines. Publications searching PubMed, EMBASE, MEDLINE, Cochrane Library, and ClinicalTrials.gov for human studies published in English from 1983 to December 2024. Additionally, quality assessment of selected full-text articles were performed using the modified Newcastle-Ottawa Scale.

Results: From an initial total of 3964 studies, 4 cross-sectional studies comprising 432 participants met the inclusion criteria and consistently demonstrated a positive association between CPS and peri-implantitis. However, the findings are compromised by small sample sizes, study design limitations, methodological heterogeneity, and inadequate adjustment for critical confounders such as smoking and prior periodontitis.

Conclusion: Cortisol levels in peri-implant sulcus fluid were linearly correlated with probing depth, with evidence suggesting this relationship may be independent of hyperglycemia. Depression emerged as the most significant CPS subtype associated with peri-implantitis. Additionally, CPS may amplify peri-implantitis inflammation by modulating cytokine expression effects. Long-term studies with larger, more diverse patient populations and careful control of confounding variables are needed to establish causality and understand the underlying mechanisms. Including psychological evaluations and stress management techniques in peri-implant care protocols could improve treatment outcomes and patient health.

Keywords: Chronic psychological stress; Cortisol; Peri-implantitis; Periodontitis; Systemic review.

Figure 1

Flow diagram of the study.