05/22/2026
Same bone. Same titanium. Different patient. Different outcome.
The 2025 AO and AAP systematic review and meta-analysis pooled 102 studies, 13,030 patients, and 39,991 dental implants (Galarraga-Vinueza et al., J Periodontol, 2025).
The numbers, at the patient level.
Peri-implant mucositis prevalence: 46 percent (95% CI 41 to 51).
Peri-implantitis prevalence: 21 percent (95% CI 17 to 24).
Cumulative incidence at the patient level.
Within 5 years: peri-implantitis 12 percent (95% CI 7 to 19), mucositis 46 percent.
Within 10 years: peri-implantitis 14 percent (95% CI 9 to 20), mucositis 61 percent.
Within 20 years: peri-implantitis 22 percent (95% CI 11 to 36), mucositis 53 percent.
History of periodontitis: peri-implantitis OR 2.92 (95% CI 2.05 to 4.13).
Smoking: peri-implantitis OR 2.27 (95% CI 1.68 to 3.06).
Diabetes mellitus: peri-implantitis OR 2.31 (95% CI 1.59 to 3.32).
Alcohol consumption: peri-implantitis OR 2.07 (95% CI 1.49 to 2.85).
Obesity: mucositis OR 3.29 (95% CI 1.75 to 6.17).
Edentulous arch subgroup carries the highest disease burden. Peri-implantitis prevalence 33 percent (95% CI 3 to 73, very wide heterogeneity).
The honest caveats.
Heterogeneity is high. I-squared values reach 94 to 95 percent. Different case definitions, different protocols. These are risk indicators, not proven causal factors. Most data come from university clinics, where maintenance compliance is higher than in many real-world settings.
The clinical implication is uncomfortable but clear. The strongest predictors of peri-implant disease are not surgical and they are not prosthetic. They are at the patient level. The implant matters. The technique matters. But the patient matters more.
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Where Healthy Smiles Run in the Family.
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