Is Bone Grafting During Implant Placement a Protective Factor Against the Development of Peri-Implantitis? A Retrospective Cohort Analysis

Peter Rekawek

Rekawek, Peter1, Rogoszinski, Tamar1, Carr, Brian1, Coburn, John F.2, Swanson, Derek1, Chuang, Sung-Kiang1, Panchal, Neeraj1
Faculty / Advisor: Ford, Brian P.1
1University of Pennsylvania School of Dental Medicine, Department of Oral & Maxillofacial Surgery/Pharmacology
2Louisiana State University Health Sciences Center, Department of Oral & Maxillofacial Surgery/Pharmacology


This study aims to identify if the use of bone grafting at time of implant placement is a protective factor against the development of peri-implantitis.


A retrospective cohort study was conducted at the Philadelphia Veterans Affairs Medical Center from 2006 to 2013. Physician encounter notes within three months of implant placement were used to gather data about patients’ health status. Operative report notes were used to assess the use of bone grafting at time of implant placement. Implant status was assessed using dental encounter notes and radiographs from follow-up appointments at one, three, five, and ten years. Peri-implantitis was defined as radiographic evidence of changes in the crestal bone level, clinical evidence of bleeding on probing, with or without suppuration. Electronic medical records of 797 implants were retrospectively analyzed. Statistics were computed using the SAS System (SAS Institute Version 9.4, 2002-2012, Cary, NC). The primary predictor variable was bone grafting at time of implant placement (xenograft, allograft, or autograft). The primary outcome variable was the presence of peri-implantitis. Other study variables assessed were diabetes, smoking, gender, and age. Descriptive, univariate, and multivariate regression analyses were performed to measure the association between predictive variables and development of peri-implantitis.


Of the 797 implants placed, 168 (21%) developed peri-implantitis. Following a multivariate analysis which controlled for diabetes, smoking, gender, and age, placement of bone graft at implant placement was shown to be associated with a decreased risk in the presence of peri-implantitis (p = 0.050) when compared to implants that did not receive bone graft. The data from this study show that implants placed with simultaneous bone graft were 44.7% less likely to develop peri-implantitis compared to implants placed without bone graft (OR = 0.553, 95% Cl 0.303-1.000). To our knowledge, no existing literature demonstrates this significant, protective relationship.


Analysis of implants placed at the Philadelphia VA Medical Center revealed an important association between use of bone grafting at implant placement and the development of peri-implantitis. Our study shows that the supplemental placement of bone graft may play a role in decreasing the development of peri-implantitis. As the restoration of edentulous areas with dental implants is becoming the new standard of care, identifying protective factors, such as use of bone grafting during implant placement, will be critical in ensuring successful outcomes. In addition to completing prospective studies, identification of other implant protective and risk factors is a necessity.