Comparison of clinical and radiographic peri-implant parameters among obese and non-obese patients: A 5-year study

Comparison of Peri-Implant Health Parameters among Obese and Non-Obese South Indian Population

Implant therapy is gaining immense importance in people presenting with missing teeth due to its increased life expectancy. There is a high concern regarding the link between obesity and peri-implant diseases. The aim of this study was to assess the peri-implant health parameters among the obese and non-obese South Indian population. The cross-sectional study was conducted in Department of Implantology, Saveetha Dental College and Hospitals Chennai, India among 859 patients who reported between January 2022-November 2022 and had a minimum of single implant in function for at least 1 year after crown cementation. Among 859 patients, 428 were non-obese (Group A) and 431 were obese (Group B). Patient's data including the menopausal status was recorded. Clinical parameters including peri-implant probing depth (PPD), clinical attachment level (CAL) and radiographic parameter including alveolar bone level (ABL) was recorded and compared between both the groups using independent t-test. The mean PPD among non-obese and obese population were 2.58 ± 0.03 and 4.09 ± 0.04, respectively. The mean CAL among non-obese and obese population were 2.87 ± 0.02 and 4.19 ± 0.01, respectively. The mean ABL among non-obese and obese population were 2.06 ± 0.01 and 3.17 ± 0.03, respectively. Independent t-test revealed there was statistically significant difference in PPD (P = 0.04), CAL (P = 0.05) and ABL (P = 0.04). The present study suggests that the obese individuals demonstrated high peri-implant probing depth, clinical attachment loss and alveolar bone loss as compared to non-obese individuals.

Systemic Diseases and Biological Dental Implant Complications: A Narrative Review

The relationship between periodontitis and such systemic disorders as diabetes, cardiovascular disease and obesity has been extensively investigated. There is less scientific evidence available, however, regarding the influence of systemic diseases on the risk of late failure of dental implant rehabilitation due to peri-implantitis. The aim of the present study was to review the literature on the role of several common systemic disorders (diabetes, obesity, cardiovascular disease, hypertension and osteoporosis) in the onset of peri-implantitis. A database search initially yielded 2787 studies of potential interest published up to 1 March 2022 (993 in PubMed; 908 in Web of Science; and 886 in Scopus). After removing 1190 duplicate articles and checking the titles, abstracts and full texts for relevance, 70 articles were selected for the present analysis. Only cohort, case-control studies and clinical case series were considered. Most of the literature concludes for no association between diabetes, cardiovascular disease, hypertension or osteoporosis and the risk of peri-implantitis. On the other hand, almost all the studies that investigated obesity as a risk factor for implant rehabilitation found a positive association between the two. Further longitudinal studies are needed to better understand the effects of systemic diseases on rehabilitation with dental implants.

Impact of local predisposing/precipitating factors and systemic drivers on peri‐implant diseases

BACKGROUND

Strong evidence suggests the infectious nature of peri-implant diseases occurring in susceptible hosts. Epidemiological reports, though, indicate that peri-implantitis is a site-specific entity. Hence, the significance of local factors that may predispose/precipitate plaque accumulation and the impact of systemic drivers that alter the immune response are relevant in the prevention and management of peri-implant disorders.

PURPOSE

The purpose of the present review is to shed light on the significance of local and systemic factors on peri-implant diseases, making special emphasis on the associations with peri-implantitis.

METHODS

The biologic plausibility and supporting evidence aiming at providing a concluding remark were explored in the recent scientific literature for local predisposing/precipitating factors and systemic drivers related to peri-implant diseases.

RESULTS

Local predisposing factors such as soft tissue characteristics, implant position and prosthetic design proved being strongly associated with the occurrence of peri-implant diseases. Hard tissue characteristics, however, failed to demonstrate having a direct association with peri-implant diseases. Robust data points toward the strong link between residual sub-mucosal cement and peri-implant diseases, while limited data suggests the impact of residual sub-mucosal floss and peri-implantitis. Systemic drivers/habits such as hyperglycemia and smoking showed a strong negative impact on peri-implantitis. However, there is insufficient evidence to claim for any link between metabolic syndrome, atherosclerotic cardiovascular disease, and obesity and peri-implant diseases.

CONCLUSION

Local predisposing/precipitating factors and systemic drivers may increase the risk of peri-implant diseases. Therefore, comprehensive anamnesis of the patients, educational/motivational programs and exhaustive prosthetically-driven treatment planning must be fostered aiming at reducing the rate of biological complications in implant dentistry.

Evaluation of health screening data for factors associated with peri-implant bone loss

PURPOSE

Systemic health has a profound effect on dental treatment. The aim of this study was to evaluate peri-implant bone loss and health screening data to discover factors that may influence peri-implant diseases.

METHODS

This study analyzed the panoramic X-rays of patients undergoing health screenings at the Health Promotion Center at Seoul St. Mary's Hospital in 2018, to investigate the relationship between laboratory test results and dental data. The patients' physical data, such as height, weight, blood pressure, hematological and urine analysis data, smoking habits, number of remaining teeth, alveolar bone level, number of implants, and degree of bone loss around the implant, were analyzed for correlations. Their associations with glycated hemoglobin, glucose, blood urea nitrogen (BUN), creatinine, and severity of periodontitis were evaluated using univariate and multivariate regression analysis.

RESULTS

In total, 2,264 patients opted in for dental health examinations, of whom 752 (33.2%) had undergone dental implant treatment. These 752 patients had a total of 2,658 implants, and 129 (17.1%) had 1 or more implants with peri-implant bone loss of 2 mm or more. The number of these implants was 204 (7%). Body mass index and smoking were not correlated with peri-implant bone loss. Stepwise multivariate regression analysis revealed that the severity of periodontal bone loss (moderate bone loss: odds ratio [OR], 3.154; 95% confidence interval [CI], 1.175-8.475 and severe bone loss: OR, 7.751; 95% CI, 3.003-20) and BUN (OR, 1.082; 95% CI, 1.027-1.141) showed statistically significant predictive value. The severity of periodontitis showed greater predictive value than the biochemical parameters of blood glucose, renal function, and liver function.

CONCLUSIONS

The results of this study showed that periodontal bone loss was a predictor of peri-implant bone loss, suggesting that periodontal disease should be controlled before dental treatment. Diligent maintenance care is recommended for patients with moderate to severe periodontal bone loss.

Clinical outcomes of different implant types in mandibular bar-retained overdentures: a retrospective analysis with up to 20 years follow-up

PURPOSE

To determine the clinical and radiological outcomes of hybrid-design- (HD) and bone-level (BL) implants for bar-retained mandibular implant-overdentures (IODs).

METHODS

For this retrospective study, edentulous patients who had received maxillary complete dentures and mandibular bar-retained IODs were invited for a follow-up assessment. Implant survival, implant success and health of peri-implant tissues were assessed on an implant level-based analysis. Patient-based parameters served to identify risk factors for peri-implant bone loss, presence of peri-implantitis and success.

RESULTS

Eighty patients (median age 72.72 [67.03; 78.81] years, 46 females) with 180 implants (median follow-up 12.01 [10.82; 21.04] years) were assessed. There was no difference concerning the rate of implant failure (p = 0.26), or peri-implantitis (p = 0.97) between HD and BL implants. Solely in one study group, there was the presence of peri-implant pus. Implant success was higher in BL implants with one group being notably higher than the comparing groups (p = 0.045). For bone loss, a width of keratinized mucosa (KM) ≤ 1 mm (p = 0.0006) and the presence of xerostomia (p = 0.09) were identified as risk factors. Smoking (p = 0.013) and a higher body mass index (BMI) (p = 0.03) were a risk factor for peri-implantitis. As risk factors for reduced implant success, a small width of KM (p = 0.003) and the presence of xerostomia (p = 0.007) were identified.

CONCLUSIONS

For mandibular bar-retained IODs, both BL and HD implants are mostly successful. A minimum of 1 mm KM around implants and normal salivary flow are relevant factors for implant success and stable peri-implant bone levels. Smoking and a high BMI are potential risk factors for peri-implantitis.

Assessment of peri-implant parameters clinical and radiographic in obese and non-obese along with destructive pro-inflammatory cytokines IL-1β - and IL-6 treated with Photodynamic therapy

AIM

The present study aims to compare and evaluate radiographic and clinical parameters along with salivary proinflammatory cytokine profiles (IL-1β - and IL-6) in obese with peri-implantitis.

MATERIAL AND METHODS

Obese and non-obese participants in the present study were 80. The nonobese and obese participants were scrutinized based on inclusion and exclusion criteria. All participants both obese and non-obese were subjected to full mouth mechanical debridement (MD). A single session of Photodynamic therapy (PDT) was provided to all obese participants. Clinical peri-implant parameters peri-implant plaque index (PIPI), Peri-implant bleeding on probing (PIBoP), peri-implant probing depth (PIPD) were assessed at baseline, three months, and six months. Marginal bone loss (MBL) was also assessed. Enzyme-linked immunosorbent assay (ELISA) was used to check the levels of IL-1β - and IL-6 in unstimulated whole saliva samples. All the parameters were assessed using the Kruskal Wallis test and analysis of variance (ANOVA). Overall characteristics were assessed using descriptive statistics. SPSS software was used for statistical analysis.

RESULTS

Clinical baseline periodontal parameters PIPI, PIBoP, PIPD, and MBL in non-obese participants were significantly lower compared to group I obese participants at baseline (p < 0.05). At 3 months follow-up PDT adjunct to MD in group 1 obese participants PIPI and PIPD were significantly lower compared to MD alone in non-obese participants PIP1 and PIPD. At 6 months follow up, non-obese participants with peri-implantitis treated with MD demonstrated PIPI and PIPD significantly lower compared to obese participants treated with PDT adjunct to MD CONCLUSION: : PDT adjunctive to MD enhanced periodontal parameters i.e., peri-implant probing depth, peri-implant plaque index, and peri-implant bleeding on probing in obese with peri-implantitis. Moreover, obese individuals with peri-implantitis demonstrated high levels of proinflammatory cytokines IL-1β and IL-6 than control.

Influence of adjunctive non-surgical peri‑implant therapy on clinical and salivary cytokine profile in obese patients

AIM

The present study aimed to evaluate the impact of Photodynamic therapy (PDT) and Er,Cr:YSGG laser (ECL) adjunct to nonsurgical mechanical debridement (NSMD) in comparison to conventional NSMD in overweight individuals with peri‑implant disease on peri‑implant inflammatory parameters and cytokine levels of IL-6 and TNF-α in Peri-implant crevicular fluid (PICF) MATERIALS AND METHODS: Recruitment of volunteers was performed from the outpatient department according to predefined inclusion and exclusion criteria. Group 1 consisted of obese participants who underwent peri‑implant mechanical debridement (MD); group 2, obese participants who experienced MD adjunct to ECL, and in group 3, obese participants were treated with MD and adjunct PDT. Clinical periodontal parameters, plaque index (PI), bleeding index (BI) and probing depth (PD) along with crestal bone loss (CBL) were assessed at baseline, 3 months, and 6 months. PICF was collected to evaluate the levels of IL-6 and TNF-α. Kruskal-Wallis and Bonferroni post hoc test were employed for the comparison of peri‑implant inflammatory parameters and PICF cytokine profiles among the study groups.

RESULTS

Clinical peri‑implant parameters (PI, BI and PD) at baseline among subjects in group 1, group 2 and group 3 were comparable (p > 0.05). At 3 months follow up, mean scores of peri‑implant PI, BI, and PD (P <0.05) in group 1 (control) were significantly higher compared to group 2 (ECL) and 3 (PDT) (p < 0.05). At 6 months follow-up, PI and BI mean scores among groups 1, 2, and 3 were comparable (p>0.05). At 6 months participants in groups 2 and 3 noted significant difference (p<0.05) compared to baseline with no difference noted in the control group (p>0.05).

CONCLUSION

Photodynamic therapy and Er, Cr: YSGG adjunct to NSMD demonstrated significant improvement in peri‑implant inflammatory parameters in obese individuals. Multicentric clinical trials are suggested to extrapolate the findings of the present study.

Should Quality of Glycemic Control Guide Dental Implant Therapy in Patients with Diabetes? Focus on: Peri-Implant Diseases

BACKGROUND AND AIM

Traditionally patients with metabolic conditions such as diabetes mellitus are considered not suitable candidates for dental implant therapy due to increased risk of infection, impaired bone healing or the potential for vascular complications. Peri-implantitis as the more progressive form of peri-implant disease involves bone loss and estimated to occur in nearly half of all implant cases long-term. Despite extensive research on association of hyperglycemia with dental implants in preclinical and animal models, translational effort to clinical practice is hampered by discrepancies in reported outcome indicators for peri-implantitis in patients with a spectrum of glycemic profiles. This review aims to evaluate clinical evidence for peri-implant disease in metabolically compromised patients and in particular in patients with poorly-controlled diabetes in order to inform clinical management of peri-implant disease.

MATERIALS AND METHODS

A comprehensive literature review was performed utilizing PubMed database and using the key word 'diabetes' combined with "dental implant" or "Periimplantitis" or/and "Preimplant disease".

RESULTS

Clinical studies with follow up more than 1year, systematic review and meta-analysis that evaluated peri-implant disease in diabetic patients in relation to glycemic control were taken into consideration in this review.

CONCLUSION

Studies reported conflicting results regarding the long-term effect of diabetes on peri-implant health regardless of the level glycemic control. Therefore, interpretation of finding and relevance to clinical practise should be considered on individual bases.

Relationship between risk markers for cardiovascular disease and peri-implant diseases

Background

The aim of this paper is to explore the serum biochemical parameters also known as risk markers for cardiovascular system, in individuals who have received dental implant treatment, and to reveal risk factors for peri-implant diseases.

Methods

The study included 58 subjects with peri-implantitis, 49 subjects with peri-implant mucositis, and 49 healthy subjects. All the subjects were assessed in terms of both peri-implant clinical parameters—probing depth (PD), bleeding on probing (BOP), the type of prosthesis, gingival index (GI), keratinized mucosa width (KMW), and plaque index (PI)—and serum biochemical parameters (e.g., LDL cholesterol, HDL cholesterol, triglyceride, total cholesterol, vitamin D, uric acid, white blood cell (WBC), neutrophil, hemoglobin (Hb), and platelet counts).

Results

KMW was the lowest in the peri-implantitis group. Compared with the other groups, the peri-implantitis group showed significantly higher levels of triglyceride, uric acid, and WBC. The peri-implantitis group had the lowest level of vitamin D. Triglyceride and uric acid levels had positive correlations with peri-implant clinical parameters.

Conclusion

High levels of triglyceride and uric acid may pose a risk for both peri-implant diseases and cardiovascular diseases. Prior to dental implant surgery, patients’ serum biochemical parameters should be checked.

Clinical and radiographic assessment of narrow-diameter and regular-diameter implants in the anterior and posterior jaw: 2 to 6 years of follow-up

Purpose

The present retrospective clinical study aimed to evaluate and compare the clinical and radiographic parameters, complications, and satisfaction in patients who received fixed prostheses supported by narrow-diameter implants (NDIs) in the anterior and posterior jaw.

Methods

Patients aged ≥30 years who had NDI-supported fixed prostheses in the anterior or posterior region of either jaw for at least 2 years were included. Complications such as chipping of the crown; loosening or fracture of the screw, crown abutment, or implant; and loss of retention were recorded. Clinical peri-implant outcomes and crestal bone loss (CBL) were measured. A questionnaire was used to record responses regarding the aesthetics and function of the fixed restorations. Analysis of variance was used to assess the significance of between-group mean comparisons. The log-rank test was performed to analyze the influence of location and prosthesis type on technical complications.

Results

Seventy-one patients (mean age: 39.6 years) provided informed consent with a mean follow-up duration of 53 months. Only bleeding on probing showed a statistically significant difference between NDIs in the anterior and posterior regions. The complication rate for NDIs in the posterior region was significantly higher than that for NDIs in the anterior region (P=0.041). For NDIs, CBL was significantly higher around splinted crowns than single crowns (P=0.022). Overall mean patient satisfaction was 10.34±3.65 on a visual analogue scale.

Conclusions

NDIs in the anterior and posterior jaws functioned equally well in terms of peri-implant soft and hard tissue health and offered acceptable patient satisfaction and reasonable complication rates.

Clinical, radiographic, and restorative peri-implant measurements of narrow and standard diameter implants in obese and nonobese patients: A 3-year retrospective follow-up study

BACKGROUND

There is dearth of studies assessing clinical, restorative, and radiographic peri-implant outcomes around narrow diameter implants (NDIs) and standard diameter implants (SDIs) in obese and nonobese subjects.

OBJECTIVE

To assess clinical, restorative, and radiographic parameters of NDIs and SDIs placed in obese and nonobese individuals.

MATERIALS AND METHODS

Obese and nonobese patients requiring NDIs and SDIs in the anterior maxilla/mandible were included. Based on the implant diameter, participants were further divided into two subgroups: (a) NDIs (3.3 mm) and (b) SDIs (4.1 mm). Peri-implant clinical measurements including plaque index (PI), bleeding on probing (BOP), probing depth (PD), and radiographic crestal bone loss (CBL) were evaluated around NDIs and SDIs at 1 and 3-year follow-up.

RESULTS

A total of 70 patients (35 obese and 35 nonobese) were included. Only BOP showed statistically significant differences between both the groups at patient level at 1 and 3-year follow-up (P < .05). There was no statistically significant difference in PI and PD around NDIs and SDIs between obese and nonobase patients. Statistical significant differences were observed in the total CBL around NDIs and RDIs among obese and nonbase subjects at 3 year follow-up (P < .05).

CONCLUSION

Both NDIs and SDIs show consistent clinical stability among obese and nonobase patients. Higher amount of bone loss was observed in obese patients compared to nonobase patients despite regular hygiene maintenance.

Clinical and radiographic indices around narrow diameter implants placed in different glycemic-level patients

BACKGROUND

Studies assessing peri-implant clinical and marginal bone resorption (MBR) around narrow diameter implants (NDIs) placed in different glycemic levels are uninvestigated.

OBJECTIVE

The present 3-year retrospective follow-up investigation was designed to explore clinical and radiographic status of NDIs placed in individuals with different glycemic control levels.

MATERIALS AND METHODS

Patients with serum hemoglobin A1c (HbA1c) levels ≥6.5% (Group-1), 5.7%-6.4% (Group-2), and 4.0%-5.0% (Group-3) were included. Clinical indices evaluating bleeding on probing (BOP), plaque scores (PI), peri-implant probing depth (PD), and MBR were recorded around NDIs at 1-, 2-, and 3-year follow-up. Serum HbA1c test was carried out for all patients to assess the profile of glycosylated hemoglobin at 1 and 3 years of follow-up.

RESULTS

A significant reduction in mean HbA1c levels from year 1 to year 3 follow-up period was seen in Group-1 only. PI varied from 0.40 in Group 1 at 2 year and 0.42 at 3-year follow-up to 0.18 at 2-year (P = 0.032) and 0.17 at 3-year (P = 0.018) follow-up, respectively. Greater BOP was noted in Group 1 (0.53) as compared with Group 2 (0.42) and Group 3 (0.21) (P = 0.048) at 3-year follow-up. PD after 3 year ranged from 2.04 mm in Group 3 to 2.32 mm in Group 1 that showed statistically significant difference (P = 0.037). No statistical significant differences were observed in MBR at any time point between the groups.

CONCLUSION

The results of this short-term follow-up study indicate that NDIs show clinical and radiographic stability, provided oral cleanliness and glycemic levels are relatively maintained. Further long-term clinical studies are needed to evaluate implant stability over the period along with controlled glycemic status.

Clinical and radiographic peri-implant health status around narrow diameter implant-supported single and splinted crowns

BACKGROUND

Studies assessing and comparing clinical and radiographic peri-implant status around narrow diameter implant-supported single crowns (NDISCs) and splinted crowns (NDISPs) are scarce.

OBJECTIVE

The aim of this retrospective study was to estimate and compare complication rates, patient satisfaction, peri-implant status and peri-implant bone loss (PBL) of NDISCs and NDISPs.

MATERIALS AND METHODS

Patients receiving narrow diameter implants (NDIs) in the posterior mandible were assessed. Technical complication and patient satisfaction were recorded. Clinical peri-implant plaque index (PI), bleeding on probing (BoP), probing depth (PD) and PBL were assessed. Technical complications and patient satisfaction were recorded. Log-rank test was computed to evaluate the influence of prostheses type and NDIs location on technical complications. P-value less than 0.05 was regarded as significant.

RESULTS

Seventy-eight patients (43 male and 35 females) agreed to follow up. The mean follow-up duration of the patients was 3.6 years. A total of 102 (43 NDISCs and 59 NDISPs) NDIs with moderately rough surfaces were included. No significant differences in PI, BoP, or PD were observed between NDISCs and NDISPs. The average PBL score was 1.17 (range: 0.03-4.15) at implant level and 1.14 (range: 0.03-4.14) at patient level. Seven implants and three patients showed peri-implantitis. The rates of technical complication of single crowns were significantly higher than those of splinted crowns (P = 0.036). PBL was significantly higher in molar sites than those in premolar sites (P = 0.041). A total of 67 patients (85.9%) were satisfied with the esthetics of the crowns, while a total of 59 patients (75.6%) were satisfied with the function of the crowns.

CONCLUSION

NDISCs and NDISPs offer high patient satisfaction and tolerable complication rates. Peri-implant conditions and peri-implant bone levels were comparable around NDISCs and NDISPs. However, bone loss of implants was higher in molar sites than those implants in premolar sites.

Clinical indices and local levels of inflammatory biomarkers in per-implant health of obese and nonobese individuals

BACKGROUND

Obesity seem to regulate peri-implant health. It is proposed that peri-implant crevicular fluid (PICF) levels of interleukin (IL)-1β and IL-6 are higher in obese as compared to nonobese individuals.

OBJECTIVE

The purpose of the present clinico-laboratory study is to estimate and compare the clinical and radiographic indices and PICF levels of IL-1β and IL-6 among obese and nonobese patients.

MATERIALS AND METHODS

Fifty patients were divided into two groups (25 obese with ≥27.5 kg/m² and 25 nonobese with <27.5 kg/m² individuals). Clinical indices for both periodontal and peri-implant evaluating plaque index (PI), bleeding on probing (BOP), probing depth (PD), clinical attachment level (CAL), and crestal bone loss (CBL) were recorded around teeth and implants. PICF was collected and assessed for the levels of IL-1β and IL-6 using enzyme-linked immunosorbent assay.

RESULTS

A significant difference was observed in PI and BOP around natural teeth and implants in obese patients, respectively (P < .05). CBL was found to be significantly higher among obese as compared to nonobese patients (P = .022). Peri-implant and periodontal PD was higher in obese as compared to nonobese but did not reach statistical significance. Levels of IL-1β and IL-6 were statistically significantly higher among obese patients as compared to nonobese (P = .001). Pearson correlation analysis showed IL-1β was positively correlated with CBL (P = .0079), whereas IL-6 showed positive correlation with both BOP (P = .0019) and CBL (P = .015) among obese patients.

CONCLUSIONS

Clinical peri-implant parameters were worse and proinflammatory biomarkers were significantly higher in obese patients compared with nonobese subjects. The findings of the present study suggests that increased proinflammatory biomarkers in PICF of obese patients may modulate peri-implant inflammation around dental implants.