## 4 Discussion  
Approximately 10% of titanium implants present with premature failure, mainly due to bacterial infection within the first year of placement [14]. [PERSON] et al., in 2003, evaluated the microflora in peri-implant lesions and demonstrated that facultative anaerobic periodontal pathogens and opportunistic species, such as _Staphylococcus_ spp., _Enterococcus_ spp., _Candida_ spp. and _P. aeruginosa_, were also found around compromised implants [15]. A recent study also found significantly higher levels of _P. aeruginosa_ in oral epithelial cells of individuals with periodontitis compared to those with a healthy periodontium [11]. In our study, when we correlated the number of CFU/mL of _E. faecalis_ with peri-implant health, peri-implant mucositis and peri-implantitis, the median values were higher in peri-implant mucositis than in peri-implantitis, although these differences were not statistically significant. However, it should be noted that undiagnosed and untreated peri-implant mucositis can progress to peri-implantitis. Based on the Consensus Report of the Sixth European Workshop on Periodontology, [PERSON] and [PERSON] reported an incidence of peri-implant mucositis of up to 80% and incidence of peri-implantitis between 28% and 56% [13]. Several studies have quantified the incidence of peri-implantitis development in patients with a history of periodontitis, indicating that it is about six times more prevalent in patients with periodontitis than in patients without a history of periodontal disease. Other research indicates that teeth can be a source of bacteria in partially edentulous patients who have been rehabilitated with dental implants [16; 17]. Regarding our study, we found that the majority of individuals diagnosed with periodontal disease (gingivitis and periodontitis) also had a diagnosis of peri-implant disease in the selected implant (peri-implant mucositis and peri-implantitis). In our study, when we analysed the number of CFU/mL of _Candida_ spp. among individuals who used an irrigator and those who did not; we found that those who did not use an irrigator had higher median values compared to the individual who used an irrigator, and these differences were statistically significant. These data, although requiring further investigation regarding the usefulness of the irrigator in reducing the colonisation of peri-implant tissues, particularly by _Candida_ species, may indicate an effect of this hygiene method, such as the cleansing action of saliva, preventing the presence of yeast in peri-implant plaque formation. [PERSON] et al. reported that the subgingival environment can serve as a refuge for various _Candida_ species [8]. In addition to adhering to teeth and oral mucosal surfaces, yeast can also adhere to non-biological surfaces such as titanium implants. While the presence of oral _Candida_ species in the subgingival region plays a role in the aetiopathogenesis  
Figure 3: Distribution of results regarding the type of oral rehabilitation/connection type with peri-implant diagnosis. of periodontal diseases (such as chronic periodontitis and aggressive periodontitis), the contribution of oral yeast to the occurrence and progression of peri-implant diseases remains uncertain [18]. As in the study by [PERSON] et al., a higher presence of _Candida_ was found in individuals with peri-implantitis compared to those without peri-implantitis. In our study, all cases of peri-implantitis revealed the presence of _Candida_ spp. Some risk factors associated with an increased oral presence of _Candida_ include smoking and compromised oral hygiene status. These are the same risk factors that have been shown to increase the risk of peri-implant diseases. The results of the present study are in line with the study by [PERSON] et al., which showed a significantly higher presence of _Candida_ in patients with poor oral hygiene [19]. According to [PERSON] et al., _E.