How do you define failure?

Is failure situation where the implant is no longer in the jaw? That would be absolute failure.

Do we instead consider failure to be the absence of "success?"

There certainly are many implants that are providing the patient with satisfactory functional outcomes where the implant itself could not be considered to be successful but could be considered to be surviving. Look at the success criteria from Albrektsson et al. In order to determine success you have to know where the bone was relative to the coronal aspect of the implant at two different points in time. If you see a patient who has an implant where the bone is 3 mm from the restorative platform of the implant would you say that that implant has failed to achieve success? The reality is that that implant may well have been placed 2 mm above the level of the bone crest (for some reason that is known to the clinician who placed the implant) and if that bone stays in that position that implant could well be a success using the criteria that are described by Albrektsson and colleagues. Those success criteria also talk about an annualized about of bone loss of 0.2 mm that would still be compatible with "success". Actually this is bone loss of less than 0.2 mm but our ability to measure at that level of precision is so compromised that whether we are talking about less than, equal to or greater than is almost a moot point.

Periimplantitis is a distinct entity with an indistinct definition. What I mean by that is that the definition of this entity has been described in many different ways relative to the amount of bone loss that is allowed before one would consider accepting this disease entity is having occurred. We know that it is an inflammatory process that is associated with suppuration and bone loss. Most of the definitions agree on those three factors. The amount of bone loss though can vary depending upon the author/investigator. Some describe this disease entity is occurring with as little as 1 mm of change in bone height and others will describe it as occurring with as much as three or 4 mm of bone loss. Once again you have to differentiate between implants that were placed above the level of the osseous crest and those that were placed level with the osseous crest and perhaps even with those that were placed below the osseous crest. Likewise you have to be able to differentiate between situations where you are looking at progressive bone loss, bone loss that occurs relentlessly over time or whether you are looking at situations where you observe a bone level that remains relatively constant over time regardless of where that bone level is relative to the platform of the implant.

Certainly a surviving implant that has demonstrated 3 mm of bone loss (creating a scenario here) but has demonstrated no progressive bone loss after that initial 3 mm may well be described as an implant that has remodeled but then remained stable. Using the criteria described above if that patient started with 2 mm of bone remodeling during the first year, assuming that the implant was placed level with the bone crest, and then experienced acceptable bone loss for the next 20 years of 0.2 mm per year this would mean that at 20 years that implant would have bone 6 mm below the platform but may still be Osseo integrated and would still be considered to be successful even though it would look awful on an x-ray. Conversely you could have an implant that started out on the day of implant placement with bone level with the restorative platform and then over that first year of clinical service lost 3 mm of bone but then stabilized and never lost bone after that point. At the end of year one that implant would be a failure but at the end of year five, accepting 0.2 mm of change per year, that implant could fall into the success category.

Getting back to the original topic I think that the question is one that is asking if there is a relationship between Periimplantitis and success rate. And I guess my main point in my responses that you can't answer that question until you define periimplantitis. you can have an inflammatory disease surrounding an implant that can result in suppuration and bone loss that may, with some sort of treatment probably being administered, stabilize and not demonstrate any more progressive bone loss. In that situation the patient did have the disease process but now no longer has the disease as an active entity. In that situation prognosis is unaffected.

Unfortunately in medicine and dentistry absolute answers are rare.

I only told about implant complication. Keystone pathogens we usually directed to bacteria, but recently some evidence showed that as periodontitis, HSV-I and CMV may also influenced the course of disease, especially the HSV-I. Few patients would be lip herpes recurrence after implantology surgery, maybe high pressure, maybe insuffient immune function. At this situation, treatment should be suspended.

Periodontitis, implant loss and peri-implantitis. A meta-analysis.

Review article

Sgolastra F, et al. Clin Oral Implants Res. 2015.

This article may be helpful

Dear Prof. Sunil Kumar Mishra

Thank you for suggestion containing an important meta-analysis study.

Dear Andrea Chen

Thank you for your comments. I agree with your regarding the specific conditions including HSV-1 and CMV.

Dear Dr. Steven E. Eckert

Firstly, I apologize for the delay in thanking for your comments.

Despite the high success rates, failures during or after osseointegration can occur. The clinical indices established by the Pisa Consensus Conference include pain, mobility, bone crest loss, probing depth, and peri-implantitis. Peri-implantitis can be defined as an inflammatory process that affects the tissue surrounding an implant and results in the loss of the support bone. The bacteria involved in peri-implantitis are often secondary to the main etiological agents, such as excessive load on the implant-bone interface. Genetic factors such as polymorphisms in interleukin-1 genes can be used to monitor the status of the implant site and minimize the chances of failure.

Long-term stability of dental implants also depends on the health professionals who work in the fields of implant dentistry and oral rehabilitation, since the success of the implant is related to the integration of these specialties.

I agree with you regarding the rarity of the absolute answers in medicine and dentistry. The concept of science is envolved.