Prevalence of Peri-implantitis and Mechanical Failure Risk Factors in Long-term Dental Implants

UDC 616.716-089.844:615.468

DOI: 10.32471/umj.1680-3051.282046

Introduction

While dental implants are highly predictable and a well-established treatment for missing teeth with predictable success, there are two types of late complications that threaten the long-term success of dental implants: biological/inflammatory peri-implantitis affecting the peri-implant tissues and mechanical or technical failure of the implant, abutment or prosthesis. Peri-implantitis and mechanical failures tend to only be apparent after years of successful function; early failures are indicative of early lack of osseointegration and therefore long-term follow-up is necessary to assess the real burden of each of these conditions [1–3].

Peri-implantitis is a condition characterised by inflammation of the soft tissue around the implant and the presence of bone loss, which is associated with the presence of a plaque in the peri-implant tissues and is distinct from peri-implant mucositis, which is an inflammatory lesion of the soft tissue without loss of supporting bone [4, 5]. Mechanical failure, on the other hand, is a diverse group of technical complications including loosening of screws, fracture of screws or abutments, fracture of the prosthesis, and the most serious complication, fracture of the implant body, that occur over the years of function due to biomechanical forces acting on the implant [6, 7].

This review collates existing knowledge about the prevalence of peri-implantitis and peri-implant mucositis, risk factors for peri-implant disease in general and iatrogenic risk factors in particular, and the risk factors associated with mechanical failure of long-term dental implants. It also reviews the importance of supportive maintenance therapy in disease prevention and finally attempts an intuitive synthesis to guide long-term implant maintenance and risk assessment.

Diagnostic Criteria and Classification

Consensus case definitions, summarized in Table 1, are now the standard reference for clinical care and epidemiologic studies, developed in the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. The health status of the peri-implant tissues is characterized by the absence of erythema, BOP, swelling and suppuration, and can be maintained around an implant with reduced bone support as long as the tissues are not inflamed. Peri-implant mucositis is inflammation of the soft tissues around the implant, featuring bleeding and/or suppuration when the implant is gently probed, and possibly a deeper probing depth with no additional bone loss compared to the normal remodeling which takes place after initial healing. Other features of peri-implantitis include bleeding and/or suppuration when the implant is probed, or radiographic evidence of bone loss beyond the initial physiological remodeling, or, if baseline radiographs are not available, a probing depth of 6 mm or more accompanied by a bone level at least 3 mm apical to the most coronal portion of the intraosseous implant surface [5].

Table 1. Case definitions of peri-implant health, mucositis, and peri-implantitis per the 2017 World Workshop consensus criteria

Despite this consensus, before and after 2018 there were very different case definitions used in epidemiological studies, especially the probing depths and bone loss thresholds applied, which it is well known is a key factor contributing to the great differences in reported prevalence estimates in the literature [1, 8]. In particular, the use of probing depth as an explicit diagnostic criterion has been demonstrated to increase the prevalence estimates compared to those based on bone loss and bleeding alone without having been found to be statistically different in direct comparison, making cross-study synthesis more complex [1].

Prevalence of Peri-implant Diseases

The prevalence of peri-implant mucositis is high, with weighte­d mean prevalences at the patient level ranging from around 43 percent to 63 percent as reported in a set of meta-analyses depending on the case definition and population studie­d [2–4]. Although less prevalent, it is significant: A large meta-analysis of 57 studies provided the patient-level prevalence of peri-implantitis as 19.53 percent and the implant-level prevalence as 12.53 percent, and other meta-analyses, based on different inclusion criteria, have reported patient-level prevalence ranging from around 18 to 22 percent, as shown in Fig. 1 [1, 2, 3, 8].

Figure 1. Representative prevalence of peri-implant mucositis and peri-implantitis at patient and implant levels

This variation in reported prevalence is not entirely explained by biological variation, but is apparently a result of several other factors. Functional loading time has a variable relationship with prevalence; in one large meta-regression there was a significant positive correlation between prevalence and mean functional loading time within 3–9 years, but not beyond that, and other analyses indicated that there was no significant difference in prevalence between 5–9 years and >9 years, suggesting that prevalence may plateau relatively early after an initial period of risk [1, 2]. Study design, as well as the type of population sample (convenience versus random population samples), and the implant-to-subject ratio have been shown to also affect reported prevalence in the absence of any disease burden difference [1, 2].

Biological Risk Factors for Peri-implantitis

In recent years, many patient and site based risk factors have been studied at an individual level and at a group level, as detailed in Table 2. The results of an umbrella review of meta-analyses of 41 separate risk-factor associations revealed that only a history of periodontitis (OR 3.84) and cigarette smoking (RR 2.07) were found to be associated with the implant failure with «highly suggestive» evidence; eight additional associations, such as diabetes mellitus, hyperglycemia, lack of regular maintenance, and implant location in the anterior jaw, showed statistically significant associations but were ranked as only «suggestive» evidence [9]. A large systematic review, limited to prospective cohort studies, also showed a significantly increased risk of peri-implantitis in patients with a history of periodontitis versus periodontally healthy patients, in one 10-year prospective study, patients with a history of periodontitis experienced 29 percent incidence of peri-implantitis versus 6 percent for those without periodontitis [8, 10].

Table 2. Summary of principal biological and genetic risk factors for peri-implantitis and their reported effect sizes

Smoking has been repeatedly established as a risk factor, although inconsistently between analyses on the implant level (relative risk approximately 2.0 to 2.1 in smokers) and at the patient level (higher relative risks were not found, perhaps due to lower sample size or residual confounding because of the patients’ periodontal history) [11–13]. The risk of peri-implantitis has also been consistently linked to diabetes mellitus and to hyperglycemia, but not to smoking, as there is a tendency towards convergence of several meta-analyses, with an odds ratio of approximately 1.9 to 2.3, depending on the degree of glycemic control, with poorly controlled diabetes (HbA1c >8 percent) having a much higher risk than well controlled diabetes [14–17]. There has been no consistent link between diabetes and peri-implant mucositis, and only a link with the more destructive form of peri-implant disease, which involves bone loss [14].

Genetic susceptibility also has been studied, specifically inflammatory cytokine gene polymorphisms. Meta-analysis of IL-1 gene polymorphisms in several studies have yielded inconsistent results in relation to each of the polymorphisms, but a trend to a higher risk for peri-implant disease with the presence of the IL-1B (+3954) polymorphism, and the composite IL-1A(-889)/IL-1Bv(+3953) genotype, has been consistently reported, indicating a modest but real genetic predisposition for individual susceptibility beyond that of behavioral and systemic risk factors [18]. Lastly, a cross-sectional meta-analysis of 16 independent studies showed that peri-implantitis was significantly more prevalent in cases with a lack of keratinized mucosa around the implant (OR 2.78), which supports the hypothesis that adequate keratinized tissue width will promote good oral hygiene and decrease the chances of mucosal sensitivity to inflammatory changes caused by plaque [19].

Iatrogenic and Local Risk Factors

In addition to patient-level factors, several factors are directly under the clinician’s control, and are involved in peri-implant disease: iatrogenic and prosthetic factors. A systematic review of 26 publications revealed that excess or residual subgingival cement after cementation of the implant restoration is a potential risk factor for the development of peri-implant disease; this excess cement was present in 33 to 100 percent of the peri-implant disease cases in the cemented restorations, especially when the soft tissue healing period prior to cementation was less than four weeks [20]. A more recent meta-analysis, however, directly compared cement-retained and screw-retained restorations and did not find any statistically significant difference in the incidence of peri-implant mucositis or peri-implantitis between them, indicating that careful removal of the cements can significantly reduce this risk, if necessary [21].

The same restoration contour is also suspected to be a risk factor for peri-implantitis around bone level implants: A cross-sectional radiographic study of 225 implants with a mean follow-up of nearly 11 years showed that implants restored with an emergence angle >30° had a peri-implantitis prevalence rate of 31.3 percent versus 15.1 percent for the implants restored at an angle of <30°, and convex emergence contours had an even higher rate of peri-implantitis compared with straight or concave contours [22]. The surface characteristics of implants have also been well investigated, with inconsistent results, with some pooled retrospective studies showing that the rough surfaces were up to 5 times more likely to develop peri-implantitis than the machined surfaces [26–30] and some systematic reviews limited to prevalence data showing no difference overall between turned vs rough surfaces [31, 32] and some surgical studies reporting higher recurrence rate of peri-implantitis after rough (modified) implant surfaces compared to machined surfaces [33–37]. Last but not least, the recall interval for maintenance therapy for peri-implant disease has been consistently associated with a decrease in peri-implant disease and implant loss; meta-analyses have suggested that the optimum recall interval for peri-implant maintenance therapy is around 5–6 months; and reviews have reported that mechanical debridement alone, without any other chemical adjuncts, is usually sufficient to have a positive clinical effect when performed at the proper time [26–28].

Mechanical Failure: Prevalence and Risk Factors

Mechanical and technical issues are more common in long-term functional life of an implant-supported restoration but are not as common as the biological issues in total. A short review of prospective studies gave an overall prevalence of mechanical complications around 5.6–6.5%, with abutment screw loosening the most common (followed by screw fracture), and the molar region of the mandible being the most affected, likely due to increased occlusal forces in this region [6, 29]. Biomechanical, prosthetic, occlusal, and patient-related factors have been suggested to contribute to screw loosening and, in cases of complete breakage of the screws, retrieval of the fractured part is possible in most cases either by using manufacturer rescue screws, ultrasonic instruments, or fine hand instruments, but there is a recognized risk of compromise of the implant internal connection [30, 31]. A fracture of the implant body is extremely uncommon, as it occurs in 2–3 percent of long-term retrospective series, but is the most serious mechanical complication as retrieval is usually only possible if the implant is removed [7, 32].

Other technical complication data are summarized with bruxism and occlusal overload, which have been most consistently identified as predisposing factors for mechanical failu­re. In addition to other technical complication data (Table 3), bruxism and occlusal overload are the two most consistently identified risk factors for mechanical failure. The same study revealed that higher bruxism grades would significantly increase the risk of implant failure, whereas increasing the grade of titanium would significantly decrease the risk of failure; bru­xism, cantilevered prostheses, and the presence of a cantilever near the implant would also significantly increase the risk of fracture [32]. A larger retrospective cohort of 2,670 patients with over 10,000 implants showed implant failure rates of 13.0 percent in bruxing patients compared with 4.6 percent in non-bruxers, with bruxism being a significant independent predictor of failure; higher grades of titanium decreased implant failure, whereas bruxism, cantilevered prostheses, and adjacency to a cantilever each significantly increased the likelihood of failure. In a dedicated meta-analysis of mechanical complications associated with bruxism, the odds ratios of all these types of complications were significantly higher in bruxers versus non-bruxers, with an overall unspecific mechanical failure odds ratio of 6.10 in bruxers (Fig. 2) [33–35].

Table 3. Representative prevalence of mechanical/technical complications in long-term implant-supported restorations

Figure 2. Odds ratios for mechanical complications in patients with bruxism compared with non-bruxers

A retrospective analysis of implant-supported fixed prostheses also revealed that age over 60 years, smoking and a history of periodontal disease were each independently associated with a greater risk of developing technical complications, with bruxism independently being associated with over 20 fold greater risk of developing technical complications in univariate analysis, and poor oral hygiene and bruxism were the most important factors associated with the risk of developing the biological complication (peri-implantitis) in the same cohort [36, 37]. In addition, occlusal overload has been suggested as another cause of peri-implant marginal bone loss by the synergistic effect of occlusal overload and bacterial biofilms, though the evidence for an effect of overload on bone loss, apart from the effect of the bacterial film and inflammation, is less clear than its role in purely mechanical complications [36].

Long term survival and combined outcomes

Although the total incidence of biological and mechanical complications is relatively high, long-term implant survival is still high. A systematic review and sensitivity meta-analysis of studies with follow-up of 10 years or more found the implant-level survival to be 96.4 percent, but after accounting for missing data, the survival estimate was lowered to 93.2 percent (where older age of patient [ages 65 years or older] was reported to be a significant negative predictor of survival) [38]. A separate 10- to 16-year follow-up of non-submerged implants showed a lower cumulative survival rate of 82.94 percent, a biological complication prevalence of 16.94 percent, and a technical complication prevalence of 31.09 percent, demonstrating that complication-free survival is much less frequent than just implant retention [39].

When looking at the prosthesis, not the implant, as the unit under evaluation, the prognosis is similar: a systematic review of studies with ≥5 years of follow-up found that 95.4 percent of implants had a fixed prosthesis at 5 years and 80.1 percent at 10 years, with 66.4 percent of patients having no complications at 5 years [40]. These numbers should be combined to suggest that in the long-term the hazard of catastrophic implant failure is quite low, but the hazard of having at least one biological or mechanical complication within 10 years or more of implant function is not.

Clinical Implications and Limitations

Combining this evidence, a number of practical suggestions arise as to how to manage long-term implants. The patients at high biological risk (e.g., those with a history of periodontitis, uncontrolled diabetes, and active smoking) are discussion points to consider and should be addressed prior to implant placement if possible, as these factors have among the strongest and most well-documented relationships with peri-implantitis in the available evidence base, and they should be discussed with the patient [9, 14]. The biological and mechanical outcomes of a cement removal protocol, the emergence angle and profile of the restoration, and avoiding unsupported cantilevers are issues that the clinician is able to modify and are directly related to the outcome of the cement removal protocol. Patients with clinical or historical indications of bruxism should be especially monitored, and occlusal design, splint therapy, and increased technical monitoring should be considered, as there is an extremely high odds ratio for almost all mechanical failure types noted in these patients [33, 35]. In conclusion, structured supportive maintenance, with a personalized recall schedule of about 5 to 6 months should be considered a fundamental part of the long-term maintenance of implants and not just an additional service, as it has been shown to be successful for reducing the incidence of peri-implant disease and loss of implants [26, 28].

However, evidence base has some important limitations. Previously, there have been many different case definitions for peri-implantitis in the literature, especially prior to the introduction of the 2017 World Workshop criteria, which does not allow for direct comparability of prevalence estimates and risk factor effect sizes between studies [1, 5]. The majority of risk-factor associations (such as smoking, diabetes and cement retention) are not supported by randomized controlled trials, and the causal inference that can be made is limited; additionally, the umbrella review included in this paper deemed that none of the 41 risk-factor associations had «convincing» evidence [9]. There are relatively few long-term (>10 years) implant data available and a significant amount of mechanical-failure data come from single-center retrospective studies in which multiple implant systems were used, which makes conclusions difficult to extrapolate to today’s implant designs or surfaces [7, 38, 39].

Conclusions

Pooled estimates suggest that peri-implantitis affects 10% of implants after 10 years or more in function, and peri-implant mucositis affects almost half of all patients, while mechanical complications, such as screw loosening (most common) and implant or component fracture (least common), affect a further significant minority of implants, again after 10 years or more in function. Currently, a history of periodontitis and the presence of cigarette smoking are the strongest biological risk factors for peri-implantitis, whereas diabetes mellitus, genetic susceptibility, lack of keratinized mucosa, and a few iatrogenic prosthetic factors add more, generally moderate, risk. The most prevalent risk factors for mechanical failure are bruxism and occlusal overload, which significantly increase the risk of screw loosening, component fracture and implant fracture, respectively. Nevertheless, the total burden of complications is high with long-term implant survival nevertheless being high but complication free survival being significantly less common than survival alone highlighting that implant therapy should be considered as a long-term maintenance operation rather than a single event. The continued evolution of standardizing definitions for cases, prospective studies of risk factors and risk-stratified maintenance protocols will be critical for further reducing the burden of both the biological and mechanical complications of implants in the long-term.

References

• 1. Díaz P., Gonzalo E., Villagrá L.J.G. et al. (2022) What is the prevalence of peri-implantitis? A systematic review and meta-analysis. BMC Oral Health, 22: 449.
• 2. Lee C.T., Huang Y.W., Zhu L., Weltman R. (2017) Prevalences of peri-implantitis and peri-implant mucositis: systematic review and meta-analysis. J. Dent., 62: 1–12.
• 3. Derks J., Tomasi C. (2015) Peri-implant health and disease. A systematic review of current epidemiology. J. Clin. Periodontol., 42(Suppl. 16): S158–S171.
• 4. dos Reis I.N.R., Huamán-Mendoza A.A., Ramadan D. et al. (2025) The prevalence of peri-implant mucositis and peri-implantitis based on the 2017 World Workshop criteria: A systematic review and meta-analysis. J. Dent., 160: 105914. https://doi.org/10.1016/j.jdent.2025.105914.
• 5. Berglundh T., Armitage G., Araujo M.G. et al. (2018) Peri-implant diseases and conditions: Consensus report of workgroup 4 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. J. Periodontol., 89(Suppl. 1): S313–S318.
• 6. Verma A., Singh S.V., Arya D. et al. (2023) Mechanical failures of dental implants and supported prostheses: A systematic review. J. Oral Biol. Craniofacial Res., 13(2): 306–314. https://doi.org/10.1016/j.jobcr.2023.02.009.
• 7. Manfredini M., Poli P.P., Giboli L. et al. (2024) Clinical Factors on Dental Implant Fractures: A Systematic Review. Dent. J., 12: 200. https://doi.org/10.3390/dj12070200.
• 8. Rakic M., Galindo-Moreno P., Monje A. et al. (2018) Epidemiology and risk factors of peri-implantitis: A systematic review. Clin. Oral Implants Res., 29(Suppl. 18): 18–40.
• 9. Giok K.C., Veettil S.K., Menon R.K. (2024) Risk factors for Peri-implantitis: An umbrella review of meta-analyses of observational studies and assessment of biases. J. Dent., 146: 105065. doi: 10.1016/j.jdent.2024.105065.
• 10. Sgolastra F., Petrucci A., Severino M. et al. (2015) Risk factors for peri-implantitis: effect of history of periodontal disease and smoking habits. A systematic review and meta-analysis. Clin. Oral Implants Res., 26(4): e8–e16.
• 11. Sgolastra F., Petrucci A., Severino M. et al. (2015) Smoking and the risk of peri-implantitis. A systematic review and meta-analysis. Clin. Oral Implants Res., 26(4): e62–e67.
• 12. Reis I.N.R.d., do Amaral G.C.L.S., Hassan M.A. al. (2023) Influence of smoking on the incidence of peri-implantitis: a systematic review and meta-analysis of cohort studies. Clin. Oral Implants Res., 34: 543–554. https://doi.org/10.1111/clr.14066.
• 13. Calciolari E., Corbella S., Dourou M. et al. (2026) Tobacco Smoking and Smoke-Free Products as Risk Factors for Dental Implants: A Systematic Review. Clin. Oral Implants Res., 37: 262–286. https://doi.org/10.1111/clr.70108.
• 14. Monje A., Catena A., Borgnakke W.S. (2017) Association between diabetes mellitus/hyperglycaemia and peri-implant diseases: Systematic review and meta-analysis. J. Clin. Periodontol., 44(6): 636–648.
• 15. Li Y., Lu Z., Sun H. (2023) Impact of diabetes mellitus on the poor prognosis in patients with osseointegrated dental implants: a meta-analysis of observational studies. Biotechnol. Genet. Eng. Rev., 473–491.
• 16. Dioguardi M., Cantore S., Scacco S. et al. (2022) From Bench to Bedside in Precision Medicine: Diabetes Mellitus and Peri-Implantitis Clinical Indices with a Short-Term Follow-Up: A Systematic Review and Meta-Analysis. J. Pers. Med., 12(2): 235. doi: 10.3390/jpm12020235.
• 17. Galarraga-Vinueza M.E., Pagni S., Finkelman M. et al. (2025) Prevalence, incidence, systemic, behavioral, and patient-related risk factors and indicators for peri-implant diseases: An AO/AAP systematic review and meta-analysis. J. Periodontol., 96(6): 587–633. doi: 10.1002/JPER.24-0154.
• 18. Mohammadi H., Roochi M.M., Sadeghi M. et al. (2021) Association between Interleukin-1 Polymorphisms and Susceptibility to Dental Peri-Implant Disease: A Meta-Analysis. Pathogens, 10(12): 1600. doi: 10.3390/pathogens10121600.
• 19. Mahardawi B., Jiaranuchart S., Damrongsirirat N. et al. (2023) The lack of keratinized mucosa as a risk factor for peri-implantitis: a systematic review and meta-analysis. Sci. Rep., 13(1): 3778. doi: 10.1038/s41598-023-30890-8.
• 20. Staubli N., Walter C., Schmidt J.C. et al. (2017) Excess cement and the risk of peri-implant disease — a systematic review. Clin. Oral Implants Res., 28(10): 1278–1290.
• 21. dos Reis I.N.R., Fukuoka G.L., Nagay B.E. et al. (2025) Incidence of peri-implant disease associated with cement- and screw-retained implant-supported prostheses: A systematic review and meta-analysis. J. Prosthetic Dentistry, 134(1): 100–108. https://doi.org/10.1016/j.prosdent.2023.08.030.
• 22. Katafuchi M., Weinstein B.F., Leroux B.G. et al. (2018) Restoration contour is a risk indicator for peri-implantitis: A cross-sectional radiographic analysis. J. Clin. Periodontol., 45(2): 225–232.
• 23. Ferrantino L., Simion M., Zanetti A., Zambon A. (2022) Association between implant surface roughness, smoking habits and implant site location on the occurrence of peri-implantitis: a pooled retrospective cohort study. Front. Oral Maxillofacial Med., 4. https://fomm.amegroups.org/article/view/65239
• 24. Saulacic N., Schaller B. (2019) Prevalence of Peri-Implantitis in Implants with Turned and Rough Surfaces: a Systematic Review. J. Oral Maxillofac. Res., 10(1): e1. doi: 10.5037/jomr.2019.10101.
• 25. Gardelis P., Giannopoulou C., Stavropoulos A., Zekeridou A. (2025) Impact of implant surface modifications on long-term outcome of surgical peri-implantitis treatment: a systematic review. Front. Dent. Med., 6: 1661369. doi: 10.3389/fdmed.2025.1661369.
• 26. Ramanauskaite A., Tervonen T. (2016) The Efficacy of Supportive Peri-Implant Therapies in Preventing Peri-Implantitis and Implant Loss: a Systematic Review of the Literature. J. Oral Maxillofacial Res., 7(3): DOI: 10.5037/jomr.2016.7312.
• 27. Lin C.Y., Chen Z., Pan W.L., Wang H.L. (2019) The effect of supportive care in preventing peri-implant diseases and implant loss: A systematic review and meta-analysis. Clin. Oral Implants Res., 30(8): 714–724. doi: 10.1111/clr.13496.
• 28. Monje A., Aranda L., Diaz K.T. et al. (2016) Impact of maintenance therapy for the prevention of peri-implant diseases: A systematic review and meta-analysis. J. Dent. Res., 95(4): 372–379.
• 29. Theocharidou A., Petridis H., Tzannas K., Garefis P.D. (2007) Abutment screw loosening in single-implant restorations: a systematic review. Int. J. Oral Maxillofac. Implants, 23(4): 681–690.
• 30. Thomaidis S., Diamantopoulou S., Papazoglou E. (2026) Implant Screw Loosening: A Narrative Review of Medium- and Long-Term Clinical Evidence. Appl. Sci., 16(12): 6253.
• 31. Arshad M.,  Mohammadi M.D., Habibzadeh S. et al. (2026) The efficacy of techniques for managing fractured dental implant abutment screws: a systematic review and meta-analysis. J. Evidence-Based Dental Practice, 26(2): 102226. https://doi.org/10.1016/j.jebdp.2025.102226.
• 32. Chrcanovic B.R., Kisch J., Albrektsson T., Wennerberg A. (2018) Factors influencing the fracture of dental implants. Clin. Implant Dent. Relat. Res., 20: 58–67. https://doi.org/10.1111/cid.12572.
• 33. Ionfrida J.A., Stiller H.L., Kämmerer P.W., Walter C. (2024) Dental Implant Failure Risk in Patients with Bruxism-A Systematic Review and Meta-Analysis of the Literature. Dent. J. (Basel), 13(1): 11. doi: 10.3390/dj13010011.
• 34. Häggman-Henrikson B., Ali D., Aljamal M., Chrcanovic B.R. (2024) Bruxism and dental implants: A systematic review and meta-analysis. J. Oral Rehabil., 51: 202–217. doi:10.1111/joor.13567.
• 35. Vidal R.D.A., Martins V.C., de Figueiredo E.Z. et al. (2025) Relationship between bruxism and different types of mechanical complications in implant-supported prosthesis: A systematic review with meta-analysis. J. Prosthodont., e70046. https://doi.org/10.1111/jopr.70046.
• 36. Mojaver S., Patel N., Sarmiento H., Fiorellini J.P. (2025) Under pressure: Unraveling the impact of occlusal overload on peri-implant health — A systematic review. J. Prosthodont., 34: 784–795. https://doi.org/10.1111/jopr.14088.
• 37. Bardis D., Agop-Forna D., Pelekanos S. et al. (2023) Assessment of Various Risk Factors for Biological and Mechanical/Technical Complications in Fixed Implant Prosthetic Therapy: A Retrospective Study. Diagnostics (Basel), 13(14): 2341. doi: 10.3390/diagnostics13142341.
• 38. Howe M.S., Keys W., Richards D. (2019) Long-term (10-year) dental implant survival: A systematic review and sensitivity meta-analysis. J. Dent., 84: 9–21.
• 39. Simonis P., Dufour T., Tenenbaum H. (2010) Long-term implant survival and success: a 10–16-year follow-up of non-submerged dental implants. Clin. Oral Implants Res., 21: 772–777. https://doi.org/10.1111/j.1600-0501.2010.01912.x.
• 40. Pjetursson B.E., Thoma D., Jung R. et al. (2012) A systematic review of the survival and complication rates of implant-supported fixed dental prostheses (FDPs) after a mean observation period of at least 5 years. Clin. Oral Implants Res., 23(Suppl. 6): 22–38.

Надійшла до редакції/Received: 25.10.2026
Прийнято до друку/Accepted: 28.10.2026