REVIEW Current weight of evidence of viruses associated with peri‐ implantitis and peri‐implant health: A systematic review and meta‐analysis Zohaib Akram 1 | Khulud Abdulrahman Al‐Aali 2 | Mohammed Alrabiah 3 | Faisal Abdullah Alonaizan 4 | Tariq Abduljabbar 3 | Fatemah AlAhmari 5 | Fawad Javed 6 | Fahim Vohra 3 1 Department of Oral Restorative and Rehabilitative Sciences, UWA Dental School, The University of Western Australia (M512), Perth, Western Australia, Australia 2 Department of Prosthodontics, College of Dentistry, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia 3 Department of Prosthetic Dental Science, College of Dentistry, King Saud University, Riyadh, Saudi Arabia 4 Department of Restorative Dental Sciences, College Of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia 5 Department of Periodontics and Community Dentistry, College of Dentistry, King Saud University, Riyadh, Saudi Arabia 6 Department of Periodontology, School of Dental Medicine, Stony Brook University, Stony Brook, New York, USA Correspondence Dr Zohaib Akram, Department of Oral Restorative and Rehabilitative Sciences, UWA Dental School, The University of Western Australia (M512), 17 Monash Avenue, Perth, WA 6009,Australia. Email: drzohaibakram@gmail.com Summary The pathological role of human herpesviruses (HHVs) (Epstein‐Barr virus [EBV], Human cytomegalovirus [CMV], and Herpes simplex virus [HSV]) in peri‐implant health needs clarification quantitatively. To determine the weight of evidence for HHVs in patients with peri‐implantitis (PI) and substantiate the significance of HHVs in peri‐implant inflammation, electronic databases including EMBASE, MEDLINE, Cochrane Oral Health Group Trials Register, and Cochrane Central Register of Controlled Trials were searched from 1964 up to and including November 2018. Meta‐analyses were conducted for prevalence of HHVs in PI and healthy controls. Forest plots were generated that recorded risk difference (RD) of outcomes and 95% confidence intervals (CI). Five clinical studies were considered and included. Four clinical studies reported data on EBV while three clinical studies reported data on CMV. Considering the risk of these viruses in PI, significant heterogeneity for CMV (χ 2 = 53.37, p < 0.0001, I 2 = 96.25%) and EBV (χ 2 = 14.14, p = 0.002, I 2 = 78.79%) prevalence was noticed between PI and healthy control sites. The overall RD for only EBV (RD = 0.20, 95% CI, 0.01‐0.40, p = 0.03) was statistically significant between both groups. Frequencies of the viruses were increased in patients with PI compared with healthy nondiseased sites. However, the findings of the present study should be interpreted with caution because of significant heterogeneity and small number of included studies. KEYWORDS cytomegalovirus, Epstein‐Barr virus, herpes simplex virus, literature review as topic, peri‐implantitis 1 | INTRODUCTION Dental implant therapy is a well‐recognized treatment strategy to restore missing teeth. Although dental implants have a long survival period (survival rates ranging from 94% to 100%), 1,2 peri‐implant dis- eases may still occur that may lead to implant failure. There are a List of abbreviations: CI, Confidence interval; CMV, Cytomegalovirus; DNA, Deoxyribonucleic acid; EBV, Epstein‐Barr virus; HHVs, Human herpes viruses; HSV, Herpes simplex virus; MeSH, Medical Subject Headings; MHC, Major histocompatibility complex; NOS, Newcastle Ottawa Scale; PCR, Polymerase chain reaction; PD, Probing depth; PECO, Patients, Exposure, Comparator, Outcome; PI, Peri‐implantitis; PRISMA, Preferred Reporting Items for Systematic Review and Meta‐Analysis; RD, Risk difference Received: 13 December 2018 Revised: 24 January 2019 Accepted: 28 January 2019 DOI: 10.1002/rmv.2042 Rev Med Virol. 2019;e2042. https://doi.org/10.1002/rmv.2042 © 2019 John Wiley & Sons, Ltd. wileyonlinelibrary.com/journal/rmv 1 of 8