Effect of periodontitis history on implant success: a long-term evaluation during supportive periodontal therapy in a university setting

The Influence of History of Severe Periodontitis on Estimated Long-Term Marginal Bone Loss around Implants Restored with Fixed Segmented Full-Arch Rehabilitation

The aim of this study was to analyze the long-term marginal bone level (MBL) of implants supporting fixed full-arch restoration in patients who had previously lost their dentition due to severe periodontitis. This retrospective study included 35 patients in whom 342 implants with internal tapered conical connections were placed. MBL was analyzed radiographically over time and a long-term estimation of MBL was calculated. A mixed linear model with abutment height, graft, diameter and location (maxilla/mandible) as factors and gender, age, implant length and prosthetic variables as covariates was used to evaluate the influence on MBL. MBL in these patients showed an estimator of predictions at 4108 days after loading of -0.307 mm, SE = 0.042. Only 0.15% of implants were radiographically affected with MBL of 3 mm or more. The mixed linear model results showed a main effect of the type of opposing dentition, gender, implant diameter, and abutment height. Particularly, an abutment height of 1 mm had associated larger MBL than the remaining heights. Thus, it can be concluded that dental implants restored with fixed segmented full-arch rehabilitation in patients with a history of severe periodontal disease do not suffer important marginal bone loss if some specific factors are considered, mainly the use of long transmucosal abutments (≥2 mm).

Clinical outcomes of dental implants in patients with and without history of periodontitis: A 20-year prospective study

AIM

To present the 20-year clinical outcomes of tissue-level implants in partially edentulous patients previously treated for periodontitis and in periodontally healthy patients (PHP).

MATERIAL AND METHODS

The original population consisted of 149 partially edentulous patients consecutively enrolled in a private specialist practice and divided into three groups: PHP, moderately periodontally compromised patients (mPCP) and severely PCP (sPCP). After successful completion of periodontal/implant therapy, patients were enrolled in an individualized supportive periodontal care (SPC) programme.

RESULTS

Eighty-four patients rehabilitated with 172 implants reached the 20-year examination. During the observation time, 12 implants were removed (i.e., 11 due to biological complications and 1 due to implant fracture), leading to an overall implant survival rate of 93% (i.e., 94.9% for PHP, 91.8% for mPCP and 93.1% for sPCP [p = .29]). At 20 years, PCP compliant with SPC did not present with significantly higher odds of implant loss compared with PHP compliant with SPC (p > .05). Conversely, PCP not compliant with SPC experienced implant loss with odds ratio of 14.59 (1.30-164.29, p = .03).

CONCLUSIONS

Tissue-level implants, placed after comprehensive periodontal therapy and SPC, yield favourable long-term results. However, patients with a history of periodontitis and non-compliant with SPC are at higher risk of biological complications and implant loss.

Tooth preservation vs. extraction and implant placement in periodontally compromised patients: A systematic review and analysis of studies

PURPOSE

The aim of this systematic review was to identify studies with a minimum of 5-years follow-up, reporting on the management of periodontally compromised teeth with either extraction and subsequent implant placement or teeth preservation with conventional periodontal treatment and application of regenerative procedures. The outcomes of these two approaches, based on clinical and radiographic data and the incidence of tooth- and implant-loss, were also investigated.

MATERIAL AND METHODS

A systematic search for studies reporting on clinical and radiographic outcomes of periodontal treatment or replacement of periodontally compromised teeth with implants was conducted in 3 electronic databases, followed by a hand-search in 8 journals. Only randomized controlled trials (RCTs), cohort studies, and case series with prospective design were included.

RESULTS

The initial search resulted in 1080 papers. After the first two screenings, 24 publications were selected for inclusion in this systematic review. The treatment protocols for the teeth preservation group contained nonsurgical and/or surgical periodontal treatment with or without regeneration procedures. The implant studies included extraction of periodontally involved teeth and implant placement with or without bone and soft tissue augmentation, followed by restoration with fixed dental prostheses (FDPs). Survival rates ranged between 81.8% and 100% in the tooth retention group, and between 94.8% and 100% in the implant group. In the extraction group, no complications were reported for 76.09% of the implants. Similarly, no complications were reported for 86.83% of the tooth retention group. The lack of standardized comparable studies prohibited conduction of a metaanalysis.

CONCLUSION

Both treatment approaches, treatment of periodontally compromised teeth, or tooth extraction followed by implant placement, present high survival rates. The application of bone regeneration techniques improves the long-term prognosis of periodontally involved teeth. Hence, treatment of periodontally involved teeth with subsequent application of a rigorous maintenance protocol can be a viable alternative for a number of years, before proceeding to extraction and replacement with dental implants. More well-designed randomized controlled trials are needed in order to draw definite conclusions on the subject.

The Effect of Photodynamic Therapy on the Early Outcome of Implants Placed on Patients with Periodontitis

Background: Immediate implant is a subtype of implant that is placed following tooth extraction within the socket without further delay. These implants are known to preserve the alveolar bone and minimize the total number of surgical interventions in a patient. 4 Photodynamic therapy (PDT) augments nonsurgical periodontal therapy using antibacterial mechanisms. PTD can be more effective in conjunction with scaling and root planing (SRP). The aim of this study is to assess the effects of PDT on the early outcomes of implants placed on patients with periodontitis with and without SRP at 9 months of follow-up. Materials and methods: A total of 23 implants were placed in 14 patients, with 11 in the test group and 12 in the control group. SRP was carried out prior to immediate implant placement in control sites, and PDT adjunctive to SRP (SRP + PDT) was performed in test sites before immediate implant placement. Plaque index, gingival index, probing pocket depth, clinical attachment level, and radiovisiographs were procured at baseline, 3 months, 6 months, and 9 months. Primary stability was examined at the time of implant placement, and the healing index was recorded a week later. Results: At the end of the 9 months of the study period, (SRP + PDT) group had a mean marginal bone loss of 0.95 mm, and the control group had 1.08 mm. Clinical parameters such as plaque index, gingival index, clinical attachment level, and probing depth showed definitive improvement after 9 months, compared with the baseline, but when the test and control groups were compared, the difference was statistically significant for plaque index and probing depth. The implants in both groups were followed up for a period of 9 months. There was an improvement in marginal bone loss but was not statistically significant. The survival of immediate implants in the PDT group was not different from those in the scaling and root planing group. Conclusion: The effect of PTD can be beneficially used as an adjunct to SRP. However, the effects were not significant. Photodynamic therapy can be effectively used as an adjunct to SRP owing to the better outcomes using PDT.

lncRNA FGD5-AS1 and miR-130a Can Be Used for Prognosis Analysis of Patients with Chronic Periodontitis

Background

lncRNA and microRNA affect the occurrence and development of many diseases, so they are expected to become diagnostic or predictive indicators. But the relationship between lncRNA FGD5-AS1 and miR-130a and the prognosis of chronic periodontitis is still unclear. The purpose of this study is to explore the prognostic value of the two in chronic periodontitis.

Objective

This study set out to investigate the prognostic value of lncRNA FGD5-AS1 and miR-130a in chronic periodontitis.

Methods

Eighty-seven patients with chronic periodontitis who visited our hospital from March 2016 to August 2017 were collected as an observation group (OG), and 72 subjects with periodontal health who underwent physical examination at the same time were collected as a control group (CG). The FGD5-AS1 and miR-130a expression levels of subjects in the two groups were compared, and prognosis of 87 patients who were reviewed one year later was counted. The expression levels of patients with different prognoses were compared when they were admitted to our hospital. We drew the ROC curve and explored the prognostic value of FGD5-AS1 and miR-130a. The risk factors for adverse prognosis were analyzed through logistic regression.

Results

FGD5-AS1 was lowly expressed in patients, while miR-130a was highly expressed. FGD5-AS1 and miR-130a had certain diagnostic and predictive value in chronic periodontitis and patient prognosis. The higher the periodontal pocket, the higher the attachment loss. Lower FGD5-AS1 and higher miR-130a levels were independent prognostic risk factors.

Conclusion

lncRNA FGD5-AS1 is lowly expressed in patients with chronic periodontitis, while miR-130a is highly expressed. Both of them have certain diagnostic and prognostic value in chronic periodontitis and may be potential diagnostic and prognostic indicators.

Effectiveness of implant-supported fixed partial denture in patients with history of periodontitis: A systematic review and meta-analysis

AIM

This systematic review investigates the effectiveness of implant-supported fixed partial denture (IS-FPD) in patients with history of periodontitis (HP) vs. patients with no history of periodontitis (NHP).

METHODS

A literature search was performed on different databases on May 2020. Prospective and retrospective studies assessing survival (primary outcome), success and biological/mechanical complications of IS-FPDs in HP vs. NHP patients at ≥1 year after implant loading were evaluated. Meta-analyses were conducted by estimating hazard ratio (HR), risk ratio (RR) and standardized mean differences (SMD) with 95% confidence intervals (CI) using random effect models.

RESULTS

Of the initially identified 4096 articles, 349 underwent a full-text evaluation. Finally, 17 were included. Pooled data analyses showed that overall implant survival was significantly higher in the NHP than the HP group (HR = 2.06; 95% CI = 1.37-3.09; I²  = 0%). This difference was noted when follow-up ≥5 years. The risk of peri-implantitis was higher in HP than NHP patients (RR = 3.3; 95% CI = 1.31-8.3; I²  = 0%), whereas the mean marginal bone level change over time was not different between the groups (SMD = -0.16 mm; 95% CI = -1.04-0.73; I²  = 98%).

CONCLUSIONS

In partially edentulous patients receiving IS-FPDs, a history of periodontitis is associated with poorer survival rate and higher risk of peri-implantitis during a 5-10 years period after implant loading.

Survival rate and potential risk indicators of implant loss in non-smokers and systemically healthy periodontitis patients: An up to 9-year retrospective study

BACKGROUND

An increasing number of patients with chronic periodontitis (CP) have received implant restoration. However, very few studies have evaluated the probable risk indicators of implant loss in patients with CP.

OBJECTIVE

The aim of this study is to evaluate implant long-term survival rates in patients with CP. The results are analyzed to discern potential risk indicators of implant loss.

METHODS

A total of 1549 implants were inserted in 827 non-smokers and systemically healthy CP patients between March 2011 and March 2019. Clinical variables (age; sex; implant location; implant diameter; implant length; implant type; bone quality; bone graft, periodontal disease status, and insertion torque) were recorded. Kaplan-Meier survival curves illustrated the cumulative survival rate. The relationship between variables and implant loss was discerned by univariate analysis. Further multivariate Cox proportional hazard regression analysis was carried out for the variables with P < 0.2.

RESULTS

The cumulative survival rates were 98.8% after 3 months, 97.9% after 6 months, 97.7% after 1 year, and 97.4% after 2 to 9 years. After adjusting possible confounders, the multivariable Cox regression model revealed statistically significant influences of implant location, history of bone graft, and insertion torque on implant loss. Implants with history of bone graft were more likely to loss. Implants inserted in the anterior area had a higher implant loss risk; insertion torque of <15 Newton-centimeter (Ncm) showed a relatively high risk of being lost.

CONCLUSIONS

The study represented public hospital insight into long-term implant results of patients with CP. Under the premise of strict periodontal control, patients with the history of CP exhibited relatively high implant survival rate. Anterior implant location, history of bone graft, and insertion torque <15 Ncm are associated with a lower implant survival rate and could be considered at a higher risk of implant failure in patients with CP.

Evaluation of peri-implant tissues condition after 10-15 years of loading in treated chronic periodontitis patients attending a private practice setting: A retrospective study

OBJECTIVES

To retrospectively evaluate the conditions of the peri-implant tissues in treated patients with chronic periodontitis (CP) and in patients without chronic periodontitis (noCP).

MATERIALS AND METHODS

A chart review was used to evaluate 267 implants, 134 placed in 42 CP treated patients and 133 placed in 46 noCP patients. The primary outcome was to evaluate the condition of the peri-implant tissues (health, peri-mucositis, and peri-implantitis). The secondary outcome was to evaluate the possible association of some variables, such as, Plaque Index (PI), Bleeding Index (BI), probing pocket depth (PD), bleeding on probing (BoP), bone level (BL), loading time, type of implant placement and loading protocol, type of prosthesis, type of bone, implant manufacturer, and implant diameter and length, with the implant health condition.

RESULTS

The analysis of patient files revealed that after 10-15 years of loading (mean loading time 13.4 ± 2.07 years), six noCP patients (13%) experienced implant loss with a total of nine implants (6.7%) lost. The remaining 124 implants were classified: 54 (43.5%) as healthy, 45 (36.3%) with peri-implant mucositis, and 25 (20.2%) with peri-implantitis. Twelve CP subjects (28.5%) experienced implant loss with a total of 19 implants (14.1%) lost. The remaining 115 implants were classified: 34 (29.5%) as healthy, 40 (34.7%) with peri-implant mucositis and 41 (35.6%) with peri-implantitis. Compared with noCP subjects, only treated CP subjects with recurrent periodontal disease (RPD) showed differences statistically significant (p < .05).

CONCLUSIONS

After 10-15 years of loading, in CP patients treated in a private practice setting, most implants (70.1%) were classified with some type of peri-implant inflammation. In patients with RPD, a higher tendency for implant loss and peri-implant biologic complications was found.

Changes of clinical parameters at implants: A retrospective comparison of implants versus natural teeth over 5 years of supportive periodontal therapy

OBJECTIVES

To compare clinical parameters of implants versus natural teeth over a period of 5 years during supportive periodontal therapy (SPT).

MATERIAL AND METHODS

A total of 421 SPT patients were screened for implants (I) and corresponding control teeth (C). Data (patient level [_P ]: sex, age, smoking status, systemic diseases, adherence, oral hygiene indices, mean probing depth [PD]_P , bleeding on probing [BOP]_P , periodontal risk profile; implant/control tooth level [_I/C ]: PD_I/C , BOP_I/C ; site level at implants [_SITE ]: position, dental arch, aspect, BOP_SITE ) were assessed at the first SPT session where the implant was probed (T1) and 5 years later (T2). The influence of patient and implant/control-related factors on PD_I/C /BOP_I/C was tested (linear mixed model) as well as the influence of site-specific factors on the PD_SITE change (multilevel regression).

RESULTS

A total of 70 patients (151 implants) were included. Mean PD_I was 2.75 ± 0.85 mm (T1) and 2.87 ± 0.79 mm (T2). Mean PD_C was 2.42 ± 0.66 mm (T1) and 2.49 ± 0.71 mm (T2). BOP_I increased from 8.62 ± 15.01% (T1) to 24.06 ± 26.79% (T2) and BOP_C from 9.97 ± 17.78% (T1) to 15.52 ± 22.69% (T2). The differences between implants and controls were significant for BOP (p = .0032). At T2, BOP_I/C was associated with periodontal risk (p = .0351). The site-specific analysis revealed an association of BOP_SITE at T1 with the progression of PD_SITE (p = .0058).

CONCLUSIONS

Probing depths of implants and controls seem to change similarly during SPT but retention of inflammation-free conditions at implants appears to be more difficult compared to natural teeth. Patients with a high-risk profile appear to have an increased susceptibility for BOP around implants, and BOP at implants seems to be a predictor for further PD increase.

Impact of history of periodontitis on gene expression of bone-related factors in young patients

Although dental implants and bone regenerative procedures are important approaches for the reestablishment of esthetics and function in young patients with a history of generalized aggressive periodontitis (GAP), no predictable outcomes have been reported, and the host osteo-immunoinflammatory response may play a relevant role in this context. In view of the lack of molecular investigations into the bone tissue condition of young patients with periodontitis, the aim of this study was to evaluate the gene expression of bone-related factors in this population. Bone biopsies were obtained from the posterior mandible in 16 individuals previously diagnosed with GAP and on periodontal support therapy and from 17 periodontally healthy (PH) patients. The gene expression of tumor necrosis factor (TNF)-α, transforming growth factor (TGF)-β, receptor activator of the NF-κB ligand (RANKL), osteoprotegerin (OPG), osteocalcin (OC), bone sialoprotein (BSP), and type I collagen (COL-I), important biomarkers of bone turnover, was evaluated by qRT-PCR. Lower TGF-β and OPG mRNA levels were observed in GAP patients compared to PH individuals (p ≤ 0.05). There were no between-group differences in levels of TNF-α, BSP, RANKL, OC, or COL-I mRNA (p>0.05). In young adults, a history of periodontal disease can negatively modulate the gene expression of important bone-related factors in alveolar bone tissue. These molecular outcomes may contribute to the future development of therapeutic approaches to benefit bone healing in young patients with history of periodontitis via modulation of osteo-immuno-inflammatory biomarkers.

Evaluation of peri-implant marginal tissues around tissue-level and bone-level implants in patients with a history of chronic periodontitis

OBJECTIVE

To evaluate clinical and radiographic characteristics in peri-implant marginal tissues in patients with a history of chronic periodontitis, rehabilitated using tissue-level or bone-level implants.

MATERIAL AND METHODS

Using a split-mouth design, 20 patients with a history of chronic periodontitis were selected and received two different implants, tissue-level group (n = 20) and the bone-level group (n = 20). Peri-implant probing depth, relative peri-implant mucosal margin position, relative peri-implant clinical attachment level, peri-implant plaque index and peri-implant bleeding on probing were evaluated at prosthesis installation, 1, 3, 6, 12 and 24 months after implant loading. Radiographic marginal bone level was evaluated at implant insertion, prosthesis installation, 6 and 24 months after implant loading.

RESULTS

The mean difference of peri-implant marginal bone resorption from implant installation to 24 months in function was 0.75 ± 1.12 mm for the tissue-level group and 0.70 ± 0.72 mm for the bone-level group. No statistically significant difference was found between groups at all assessment periods for clinical and radiographic peri-implant evaluation.

CONCLUSION

Under a rigid supportive therapy, both approaches performed likewise regarding clinical and radiographic parameters for rehabilitation of patients with a history of chronic periodontitis.

Immediately Loaded Bicortical Implants Inserted in Fresh Extraction and Healed Sites in Patients with and Without a History of Periodontal Disease

Background

Bicortical screw implants may be used in both healed bone and fresh extraction sockets and loaded immediately. To date, there have not been too many studies reporting clinical results of such screws used in periodontally involved sites. This study aimed to assess many aspects of bicortical screw implants used to retain full-arch and segmental cemented prostheses in the rehabilitation of the mandible and maxilla in patients with or without a history of periodontal disease.

Materials and Methods

This retrospective review involved 87 patients, of whom 77 had a history of periodontitis diagnosed before implant placement and 10 did not. They were treated following the same surgical procedure and received a total of 1019 implants which were immediately loaded with fixed prosthetic works.

Results

A total of 1019 polished surface, one-piece, bicortical screw implants were used in 87 patients who underwent the same surgical treatment, i.e., tooth extraction and immediate implant placement were investigated, of which 526 were placed in the healed bone and 493 in fresh extraction sockets with the mean follow-up time of 22.2 ± 7.3 months. Results were analyzed using log-rank test, the Kaplan-Meier method, Chi-square test, and t-test. Cumulative survival at 12, 24, and 35 months after placement was 99.3%, 98.6%, and 97.0%, respectively.

Conclusion

Bicortical smooth surface implant concept with immediate loading protocol provided predictable outcomes and survival rate of 99% in patients with and without a history of periodontitis. More studies are needed to further support the clinical advantages of bicortical anchoraged smooth surface implants.