*Review* **Ligature-Induced Experimental Peri-Implantitis—A Systematic Review**

**David Reinedahl 1,\*, Bruno Chrcanovic 2, Tomas Albrektsson 2,3, Pentti Tengvall <sup>3</sup> and Ann Wennerberg <sup>1</sup>**


Received: 4 November 2018; Accepted: 26 November 2018; Published: 28 November 2018

**Abstract:** This systematic review sought to analyze different experimental peri-implantitis models, their potential to induce marginal bone resorption (MBR) and the necessity of bacteria for bone loss to occur in these models. An electronic search in PubMed/Medline, Web of Science, and ScienceDirect was undertaken. A total of 133 studies were analyzed. Most studies induced peri-implantitis with ligatures that had formed a biofilm, sometimes in combination with inoculation of specific bacteria but never in a sterile environment. Most vertical MBR resulted from new ligatures periodically packed above old ones, followed by periodically exchanged ligatures and ligatures that were not exchanged. Cotton ligatures produced the most MBR, followed by steel, "dental floss" (not further specified in the studies) and silk. The amount of MBR varied significantly between different animal types and implant surfaces. None of the analyzed ligature studies aimed to validate that bacteria are necessary for the inducement of MBR. It cannot be excluded that bone loss can be achieved by other factors of the model, such as an immunological reaction to the ligature itself or trauma from repeated ligature insertions. Because all the included trials allowed plaque accumulation on the ligatures, bone resorbing capacity due to other factors could not be excluded or evaluated here.

**Keywords:** osseointegration; dental implant; peri-implantitis; ligature-induced peri-implantitis; aseptic loosening; systematic review
