LONG-TERM PREDICTIVE VALUE OF BLEEDING ON PROBING IN PERI‑IMPLANTITIS DIAGNOSIS: A SYSTEMATIC REVIEW AND META-ANALYSIS.

OBJECTIVE: This systematic review and meta-analysis aimed to evaluate the diagnostic value of bleeding on probing (BOP) for peri‑implantitis detection on implant- and patient-levels, as reported in prospective and retrospective studies with at least 5 years of follow-up. MATERIALS AND METHODS: A systematic search of 3 electronic databases was conducted and supplemented with a hand-search to identify clinical studies that reported the prevalence of peri‑implantitis and BOP after at least 5 years of functional loading. Random-effects meta-analyses were conducted to combine the proportions of peri‑implantitis among BOP positive implants and patients across studies. Heterogeneity was explored with subgroup analyses. RESULTS: 5826 patients and 17,198 implants were included in this review. Definitions of peri‑implantitis varied between studies. Thirty studies were included for assessment. Implant-level meta-analysis was conducted in 24 studies and patient-level meta-analysis in 19 studies. Overall proportion of peri‑implantitis in BOP-positive implants was 26.5% (95% CI, 21.2 to 32.1) and 35.1% (95% CI, 27.4 to 43.1) in BOP-positive patients. Substantial heterogeneity was present, and prediction intervals were 5.2%-56% and 6.4%-71.5% at the implant- and patient-level, respectively. CONCLUSION: Within the limitations, prevalence of peri‑implantitis was found to be around 1 third in both BOP-positive implants and patients. Prevalence varied between studies. Although a guiding clinical factor in the diagnosis of peri‑implantitis, clinicians should be aware of the significant false-positive rates of BOP.