The challenge of patient perception regarding peri-implantitis

Peri-implantitis currently represents the primary challenge to the longevity of implant restorations. According to the data reported in this study, this pathology affects approximately two out of ten implants and nearly one in five patients. However, a stark discrepancy remains between clinical reality and patient perception: approximately 70% of them still consider this disease to be rare and view implants as devices guaranteed for life.

This cross-sectional study, conducted at the International University of Catalonia (UIC) among 100 patients treated for peri-implantitis, aims to explore their understanding of the pathology and the impact of therapeutic outcomes on their overall satisfaction. The objective is to refine communication strategies to dispel unrealistic expectations prior to the start of treatment.

The researchers tested three key hypotheses: firstly, that patients' knowledge of the aetiology and risk factors is very limited; secondly, that the disease is associated with aesthetic or phonetic sequelae altering well-being; and finally, that the treatment outcome directly influences patient perception and satisfaction regarding implant therapy.

A design combining a population-based survey and radiographic follow-up

This cross-sectional study, conducted at the International University of Catalonia (Barcelona), recruited 100 patients to ensure a statistical power of 88.2%. The objective was to correlate the patients' subjective experience with objective clinical outcomes following the treatment of peri-implantitis.

The protocol was based on a dual approach:

• Multidimensional survey: A 30-item questionnaire assessed patient literacy regarding the pathology, perception of risk factors (smoking, hygiene, diabetes), symptoms experienced and the level of post-operative satisfaction.
• Radiographic evaluation: A retrospective analysis of the periapical radiographs was performed between the initial diagnosis and the last follow-up (minimum 3 months after treatment).

Implants were classified into two categories based on bone changes: stabilised bone loss (defined by the absence of progression ≥ 1 mm compared to the baseline radiograph) or progressive bone loss/implant failure (implant removal). Data were analysed using Chi-squared tests for categorical variables, supplemented by Mann-Whitney tests and Pearson correlation coefficients to measure the relationship between satisfaction and therapeutic outcomes.

Results: Cohort and evaluation parameters

The recruitment process identified an initial sample of 140 patients approached to evaluate their perception of peri-implantitis and its treatment outcomes. To ensure statistical robustness, the sample size was set to a minimum of 100 participants, allowing the estimation of a proportion with a maximum error of 10% (95% CI, p=0.5). The study achieved a statistical power of 88.2% to detect a medium to large effect size (d=0.65).

Success criteria and radiographic analysis

The evaluation of therapeutic efficacy was based on a retrospective analysis of periapical radiographs, comparing the bone status at the time of diagnosis (baseline) and at the last follow-up. The authors defined success as the arrest of bone lysis progression based on a 1 mm threshold:

• Bone stabilisation: No progression of bone loss (threshold set at 1 mm according to the protocol).
• Pathological progression: Continued bone lysis (≥ 1 mm) or need for explantation of the implant.

Structure of patient assessment

Data were collected via a structured 30-item questionnaire, targeting adult patients (≥ 18 years) who had received treatment for peri-implantitis at least 3 months prior to the survey. The analysis focused on the following domains:

Clinical analysis and patient perception

The results of this cross-sectional study conducted on 100 patients highlight a significant gap between the clinical reality of peri-implantitis and patient perception. The study confirms the initial hypotheses: oral health literacy regarding implant complications is limited, even in subjects who have already undergone treatment. Clinically, this means that overall satisfaction does not depend solely on the arrest of radiographic bone loss, but is strongly influenced by perceived aesthetic and phonetic sequelae, often ignored by the patient prior to the intervention.

In comparison with the literature data cited by the authors (where 70% of patients consider peri-implantitis to be rare), this study demonstrates that the lack of knowledge regarding the aetiology and risk factors (smoking, diabetes, hygiene) persists. Notably: the quality of information provided at the time of implant placement is correlated with the perception of the disease upon its subsequent diagnosis. This highlights the importance of the informed consent phase not only for the surgical procedure, but also for the management of long-term expectations.

The limitations of the study lie in its single-centre design within a university and the retrospective analysis of the radiographs. The heterogeneity of the examiners did not allow the inclusion of longitudinal clinical parameters (bleeding, pocket depth), which could have refined the correlation between biological success and subjective satisfaction.

Synthèse des résultats

Cette étude transversale menée auprès de 100 patients révèle un décalage critique entre la réalité épidémiologique et la perception clinique : alors que la péri-implantite touche environ 20 % des implants (1 patient sur 5), près de 70 % des sondés considèrent encore cette pathologie comme rare. L'enquête démontre que cette méconnaissance des facteurs de risque et de la prévalence réelle alimente des attentes irréalistes quant à la pérennité des implants et accroît significativement l'anxiété lors de l'annonce du diagnostic.

Concrètement, pour le praticien :

• Réajuster le consentement éclairé : Présentez systématiquement le taux de complication de 20 % dès la pose pour briser le mythe du dispositif « à vie » et limiter les déceptions post-opératoires.
• Renforcer la communication sur les signes d'alerte : Puisque les patients ignorent souvent les symptômes (saignements, œdèmes), fournissez-leur une fiche de suivi simple pour favoriser une détection précoce avant la perte osseuse.
• Responsabiliser par l'éducation : Rappelez explicitement que le contrôle de la maladie dépend autant de l'hygiène du patient que de l'acte chirurgical, la majorité des patients sous-estimant leur rôle dans la prévention des récidives.

Lexique technique de l'étude

Péri-implantite : Pathologie caractérisée par une dégradation des tissus (tissue breakdown), survenant souvent après une mucosite non traitée et constituant la cause principale d'échec implantaire.

Mucosite péri-implantaire : État inflammatoire précurseur confiné exclusivement aux tissus mous entourant l'implant, sans perte osseuse associée à ce stade.

État dysbiotique : Altération pathologique du microbiome péri-implantaire. Cette rupture d'équilibre est l'un des deux leviers majeurs de la maladie, avec l'inflammation floride non résolue.

Récession post-chirurgicale : Migration apicale de la marge muqueuse suite aux mesures thérapeutiques (chirurgicales ou non). Les auteurs l'identifient comme une complication fréquente pouvant altérer les résultats rapportés par les patients.

Littératie de la maladie (Disease literacy) : Mesure du niveau de compréhension du patient concernant son diagnostic, les facteurs de risque et les mesures préventives. Une faible littératie est corrélée à une anxiété accrue lors de l'annonce du diagnostic.

Perte osseuse stabilisée (Arrested bone loss) : Critère de succès radiographique défini dans l'étude par l'absence de progression de la lyse osseuse entre le diagnostic initial de la péri-implantite et le dernier suivi post-thérapeutique.

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