Patient knowledge, home care practices, and peri-implant disease: a preliminary survey analysis of awareness gaps and cleaning behaviors.

Abstract

Dental implants longevity depends on proper maintenance and home care. Understanding patients' knowledge, practices, and barriers to optimal care is essential for developing effective educational strategies and improving long-term implant outcomes. This cross-sectional study evaluated adult patients with at least one restored dental implant at the University of Michigan School of Dentistry. Peri-implant health status was determined using pre-established diagnostic criteria. Participants completed a 13-item survey assessing home care behaviors (cleaning frequency, duration, methods, confidence, challenges) and knowledge regarding implant infection risk and systemic links. Associations between survey variables and disease status were analyzed using Fisher's exact test and chi-square tests ( p < 0.05). Thirty-four subjects (17 males, 17 females) and 71 implants were assessed (20 peri-implant health, 43 peri-implant mucositis, 8 peri-implantitis). Despite 88.2% reporting daily cleaning, disease prevalence was 70.4%. At the implant level, retention method ( p = 0.011), and plaque index ( p < 0.001) were significantly associated with disease. At the patient level, all peri-implantitis patients had a history of periodontitis (Fisher's exact p = 0.029). Facial keratinized mucosa width (KMW) did not show a significant association with peri-implant diagnosis, although lingual KMW did between peri-implant health and peri-implantitis ( p = 0.01), and peri-implantitis and peri-implant mucositis ( p = 0.04). Thin mucosal tissue showed a non-significant trend toward association with more severe disease, progressing from health to peri-implantitis ( p = 0.172). Cleaning frequency was the strongest predictor ( p = 0.035) of peri-implant health. Nearly one-third of patients received no professional implant care instruction. Interdental brushes were least utilized (8.8%), while string floss was most common (82.4%). Knowledge regarding implant disease showed no significant associations with disease status. Most patients reported moderate to high confidence regarding their home care abilities, regardless of disease status ( p = 0.22). High disease prevalence despite daily home care and confidence levels reveals a critical gap between patient effort and effective prevention. Cement-retained restorations emerged as the strongest implant-level risk factor. Nearly one-third lacking professional instruction and minimal interdental brush adoption suggests targets for intervention. Future research should evaluate whether targeted educational interventions emphasizing infection risk and proper cleaning techniques can improve both patient knowledge and clinical outcomes, focusing on primary prevention of peri-implant disease.