Comparative Severity of Coronary Artery Disease in Patients With Peri-Implantitis Versus Periodontitis: A Prospective Observational Study

Introduction Peri-implant mucositis and peri-implantitis are driven by the same periodontal pathogens implicated in atherosclerosis. Whether peri-implant infection influences coronary artery disease is uncertain. We compared subgingival microbial profiles and coronary stenosis in patients with dental implants versus dentate controls undergoing coronary angiography. Methods In this prospective cross-sectional study (December 6, 2021, to January 24, 2024), we enrolled 88 men (45-64 years) referred for elective or emergency coronary arteriography at a tertiary center. Thirty-seven patients with at least one implant (Group 1) and 51 dentate patients (Group 2) underwent standardized periodontal examination, subgingival sampling for real-time polymerase chain reaction quantification of <i>Aggregatibacter actinomycetemcomitans</i> and red-complex species (<i>Porphyromonas gingivalis, Treponema denticola, Tannerella forsythia</i>), and assessment of systemic risk factors. Coronary stenosis was graded angiographically and summarized by vessel-specific percent narrowing and the SYNTAX I score. Group differences were analyzed with Mann-Whitney U, χ², or Fisher's exact tests (α = 0.05). Results The cohorts were similar in body mass index, lipid profile, diabetes prevalence, and hypertension control. Implant carriers were older (median 60 vs. 55 years, p = 0.001) and more often received statins (75.7% vs. 54.9%, p = 0.046). Median counts of <i>T. denticola</i> (210 × 10³ vs. 100 × 10³ genomes) and <i>P. gingivalis</i> (32 × 10³ vs. 31 × 10³ genomes) were higher in Group 1, whereas total bacterial load was greater in Group 2 (p = 0.026). Implant carriers exhibited more severe stenosis of the circumflex (80% vs. 20%, p = 0.006) and right coronary arteries (75% vs. 20%, p = 0.025); SYNTAX I scores did not differ. Conclusions Peri-implant inflammatory disease was associated with higher concentrations of virulent red-complex bacteria and with marked stenosis of the circumflex and right coronary arteries, independent of traditional cardiovascular risk factors. Routine periodontal surveillance and early management of peri-implant mucositis may represent adjunctive strategies to mitigate coronary artery disease progression in implant recipients.