Systematic Reviews
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 16, 2025; 13(23): 105762
Published online Aug 16, 2025. doi: 10.12998/wjcc.v13.i23.105762
Evidence for the association between psychological stress and peri-implant health among middle-aged and elderly adults: A systemic review
Yen-Lan Chang, Gen-Min Lin, Shih-Ying Lin, Ren-Yeong Huang, Po-Jan Kuo, Nancy Nei-Shiuh Chang, Kun-Zhe Tsai
Yen-Lan Chang, Department of Stomatology, Mackay Memorial Hospital, Taipei 104217, Taiwan
Gen-Min Lin, Kun-Zhe Tsai, Department of Medicine, Hualien Armed Forces General Hospital, Hualien 970, Taiwan
Gen-Min Lin, Department of Medicine, Tri-Service General Hospital and National Defense Medical Center, Taipei 104, Taiwan
Shih-Ying Lin, Department of Stomatology, MacKay Memorial Hospital, Taipei 104217, Taiwan
Ren-Yeong Huang, Nancy Nei-Shiuh Chang, Kun-Zhe Tsai, Department of Periodontology and School of Dentistry, Tri-Service General Hospital and National Defense Medical Center, Taipei 104, Taiwan
Po-Jan Kuo, School of Dentistry, Department of Periodontology, National Defense Medical Center and Tri-Service General Hospital, Taipei 104, Taiwan
Po-Jan Kuo, Nancy Nei-Shiuh Chang, Department of Periodontology, Lin’s Orthodontic Clinic, Taipei 104, Taiwan
Kun-Zhe Tsai, Department of Stomatology of Periodontology, Mackay Memorial Hospital, Taipei 104217, Taiwan
Author contributions: The study design was conceptualized and developed by Tsai KZ; Data collection, project administration, and data curation were carried out by Chang YL and Lin SY; Formal data analysis was conducted by Tsai KZ and Lin GM; Yen-Lan Chang prepared the initial draft of the manuscript, while Kuo PJ, Chang NNS, and Huang RY critically reviewed and provided editorial revisions; Lin GM assisted with the final English proofreading and editing of the article; All authors contributed to the final manuscript and approved its submission.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Kun-Zhe Tsai, DDS, Department of Stomatology of Periodontology, Mackay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Zhongshan District, Taipei 104217, Taiwan. stupidgrandpa@yahoo.com.tw
Received: February 6, 2025
Revised: April 9, 2025
Accepted: May 7, 2025
Published online: August 16, 2025
Processing time: 118 Days and 3.2 Hours
Abstract
BACKGROUND

Chronic psychological stress (CPS) is increasingly recognized for its detrimental effects on systemic and oral health, yet its impact on peri-implantitis remains underexplored.

AIM

To evaluate the evidence linking CPS to peri-implantitis.

METHODS

This systematic review was conducted according to the PRISMA guidelines. Publications searching PubMed, EMBASE, MEDLINE, Cochrane Library, and ClinicalTrials.gov for human studies published in English from 1983 to December 2024. Additionally, quality assessment of selected full-text articles were performed using the modified Newcastle–Ottawa Scale.

RESULTS

From an initial total of 3964 studies, 4 cross-sectional studies comprising 432 participants met the inclusion criteria and consistently demonstrated a positive association between CPS and peri-implantitis. However, the findings are compromised by small sample sizes, study design limitations, methodological heterogeneity, and inadequate adjustment for critical confounders such as smoking and prior periodontitis.

CONCLUSION

Cortisol levels in peri-implant sulcus fluid were linearly correlated with probing depth, with evidence suggesting this relationship may be independent of hyperglycemia. Depression emerged as the most significant CPS subtype associated with peri-implantitis. Additionally, CPS may amplify peri-implantitis inflammation by modulating cytokine expression effects. Long-term studies with larger, more diverse patient populations and careful control of confounding variables are needed to establish causality and understand the underlying mechanisms. Including psychological evaluations and stress management techniques in peri-implant care protocols could improve treatment outcomes and patient health.

Keywords: Chronic psychological stress; Cortisol; Peri-implantitis; Periodontitis; Systemic review

Core Tip: The bidirectional oral-brain axis has been recently proposed. Numerous contemporary studies have highlighted the association between psychological distress and periodontitis. However, the relationship between psychological distress and peri-implantitis remains unclear. Although the current evidence is limited, all human studies to date suggest that psychological distress increases the risk of peri-implantitis, similar to its impact on periodontitis.