This proposal aims to establish a prevalence for peri-implant disease in different regions of the United States along with identifying different risk factors that may increase the incidence and progression of this disease. Peri-implantitis is defined as mucosal inflammation and deep pocket depths surrounding the implant along with 2 mm or more of bone loss after restoration (implant loading), whereas peri-mucositis consists of mucosal inflammation without the bone loss. As more and more implant supported restorations are placed as a therapy for partial or complete edentulism, the incidence of this disease is on the rise. Therefore, developing a model for collective risk factors associated with peri-implantitis is imperative in preventing loss of implants and the restorations they support. The objective of this research project is to determine prevalence of the disease in private dental settings, etiologic bacteria, patient-specific factors, implant characteristics and prosthetic designs which may contribute to the occurrence of peri-implantitis disease. The long-term goal of this research is to develop preventive and specific patient-tailored treatment strategies for early diagnosis and to control progression of peri-implantitis. We will test the central hypothesis that there are unique etiologic bacteria, patient specific, local and material-related factors which influence the occurrence of peri-implant diseases. In order to achieve this goal, we will evaluate peri-implant and periodontal microbiota and local and environmental factors in individuals with and without peri-implant disease. This study plans to utilize the National Dental PBRN, thereby making this study unique, comprehensive and the largest research on analysis of prevalence and etiology of peri-implant disease. We plan to recruit 1000 participants who have had their implants placed and restored for at least 60 months. The dental PBRN practitioners will conduct a thorough dental, periodontal and radiographic exam to determine the periodontal and peri-implant status of the participants. Through plaque and saliva samples collected, we plan to determine differences in the microbiome environment between peri-implant and periodontal health and disease. We propose the following specific aims to test our central hypothesis: Aim 1: To determine the prevalence of peri-implantitis in different regions of the United States; Aim 2: To test the hypotheses that there are specific bacterial species and specific inflammatory markers associated with peri-implant disease; Aim 3: To test the hypothesis that local risk factors are associated with an increased susceptibility to peri-implant disease development such as: a) the presence of Ti and other metallic ions locally; (b) cement retained implant supported prosthetic restorations; (c) the presence of metallic alloys (amalgam, gold or nickel) in the oral environment which could precipitate a galvanic reaction; Aim 4: To develop a model for patient r...