Evidence for the association between psychological stress and peri-implant health among middle-aged and elderly adults: A systemic review

Table 1 Modified Newcastle–Ottawa Scale for included studies

Ref.	ROB	Selection		Study design				Outcome assessment		Confounding factor assessment		Data analysis		Study results
		Representative sample	Adequate sample size	Accuracy of exposure/risk factors	Data quality control	Definition of cases and controls	Selection of control group	Accuracy of outcome	Timing of outcome assessment	Control of confounding factors	Stratification or multivariate analysis	Appropriateness of statistical methods	Reporting of results	Consistency of results	Openness and reproducibility
Soysal et al[21], 2024	Medium				+	+	+	+	+				+	+	+
Strooker et al[20], 2022	Low			+	+	+	+	+		+	+	+	+	+	+
Ali et al[19], 2022	High							+						+
Alresayes et al[18], 2021	Medium				+	+	+	+				+		+	+

ROB: Risk of bias.

Table 2 Characteristics of the included studies

Ref.	Country	Design	Participants	Study groups and age (mean ± SD)	Smoker	Psychological health assessment	Antipsychotic drugs	Definition of peri-implantitis
Soysal et al[21], 2024	Turkey	Cross-sectional	50 (F 16/M 34)	Healthy implant & high stress: 53.06 ± 11.44 years; Healthy implant & low stress: 52.11 ± 16.70 years; Peri-implantitis & high stress: 56.00 ± 6.71 years; Peri-implantitis & low stress: 59.80 ± 7.24 years	No	HAD and STAI questionnaires; GR-α levels of saliva	No use	PD ≥ 6 mm, BoP/suppuration, and BL ≥ 3 mm
Strooker et al[20], 2022	Netherlands	Cross-sectional	230 (F 137/M 93)	No peri-implantitis: 64.4 ± 11.3 years; Peri-implantitis: 62.9 ± 10.8 years	10%	SCL-90 questionnaire	Not available	PD ≥ 4 mm, BoP/suppuration, and BL ≥ 2 mm
Ali et al[19], 2022	Kuwait	Cross-sectional	64	T2DM with peri-implantitis: 53.8 ± 5.6 years; T2DM without peri-implantitis: 52.5 ± 3.2 years; Non-DM with peri-implantitis: 52.7 ± 1.6 years; Non-DM without peri-implantitis: 52.2 ± 1.2 years	No	Cortisol level in peri-implant sulcular fluid	Not available	Not available
Alresayes et al[18], 2021	Saudi Arabia	Cross-sectional	88 (F 42/M 46)	Peri-implantitis: 65.3 ± 5.6 years; No peri-implantitis: 63.8 ± 4.4 years	No	Cortisol level in peri-implant sulcular fluid	Not available	PD ≥ 6 mm, BoP/suppuration, and BL ≥ 3 mm

HAD: Hospital anxiety and depression scale; STAI: State-trait anxiety inventory; GRα: Glucocorticoid receptor-α; PD: Probing depth; BoP: Bleeding on probing; BL: Bone loss; SCL-90: Symptom checklist-90; T2DM: Type 2 diabetes mellitus.