Periodontal disease as a risk for dental implant failure over time: A long-term historical cohort study

Effects of adjacent periodontitis on osseointegrated dental implants

PURPOSE

This study aimed to investigate whether new-onset periodontitis or apical periodontitis in the adjacent teeth affects osseointegrated dental implants in a beagle dog model.

METHODS

One control group and 2 experimental groups (periodontitis and apical periodontitis groups) were defined based on the presence of experimental periodontitis or apical periodontitis, with 1 beagle dog randomly assigned to each group. The mandibular second and fourth premolars on both sides of the 3 beagles were extracted. Eight weeks after extraction, 4 bone-level implant fixtures, 2 on both sides of each mandible, were placed in each beagle. Six weeks after implant surgery, healing abutments were connected. After sufficient osseointegration, plaque control was performed in the control group, while periodontitis and apical periodontitis were induced in the experimental groups. The beagles were euthanized for histological analyses 20 weeks after induction of experimental periodontitis. Statistical analyses were performed using the Kruskal-Wallis test with the Bonferroni correction to compare the 3 groups.

RESULTS

The implants in the control and apical periodontitis groups were well-maintained, while those in the periodontitis group showed clinical signs of inflammation with bone resorption. The bone-to-implant contact (BIC) and bone area values in the periodontitis group were lower than those in the other groups. The distance between the implant shoulder and the first BIC was significantly greater in the periodontitis group than in the control group (P<0.05).

CONCLUSIONS

The presence of periodontitis in adjacent teeth can pose a risk to dental implants, potentially resulting in peri-implantitis. However, this was not observed for apical periodontitis. Within the limitations of this study, periodontal care is necessary to reduce the impact of periodontitis in adjacent teeth on osseointegrated implants.

Implant Health in Treated Periodontitis Patients: A Systematic Review and Meta-Analysis

BACKGROUND

The aim of this meta-analysis was to evaluate the role of a history of periodontitis on implant failure. The two main judgment criteria studied are peri-implantitis and the survival rate. The two secondary judgment criteria studied are the mean pocket depth and the mean peri-implant bone loss.

METHODS

An electronic search was performed via five databases (MEDLINE, Embase, ScienceDirect, LILACS and the Cochrane Library) and was supplemented by manual searching. The search was undertaken in June 2024.

RESULTS

Of 10 775 potentially eligible articles, 8 were included in the qualitative analysis and 10 in the quantitative synthesis.

CONCLUSIONS

This meta-analysis suggests that a history of periodontitis has a significant impact on the rate of peri-implantitis, survival rate, mean bone loss and pocket depth.

Evaluation of Survival Rates of Dental Implants and the Risk Factors: A Retrospective Follow-Up Study

Introduction The current research sets out to assess implant early survival rates and identify relevant parameters. Methods The research spanned the years 2021 and 2022 and included all individuals who had dental implants. Various criteria, such as age, sex, maxilla/mandible, implant location, immediate implant, implant diameter, implant length, and others, were used to determine the implant survival rate in the research. A multiple logistic regression model was used to show the risk variables for early survival rates of implants, and components with p < 0.05 were further included after the Chi-square test was employed to filter them. Results The current research included 128 patients who had a single implant procedure, including 70 males and 58 females. The early survival rate was 91.40%, and 117 implants were retained after implantation. Risk variables that were shown to be associated with early survival rates were patients aged 30-60 years (OR: 2.542), immediate implant placement (OR: 3.742), and implant length less than 10 mm (OR: 3.972). Conclusions Age, tooth location, implant length, and immediate implantation were risk variables that contributed to our subjects' above 91% early survival rate of implants.

Risk factors impacting the survival of implants replaced following failure: A retrospective study

AIM

This study aimed to investigate factors influencing the survival of replaced dental implants.

MATERIALS AND METHODS

Charts from 2005 to 2021 were reviewed. Replaced implants after removal for the first time were identified. Depending on their survival, the replaced group was divided into the surviving and second-removal groups. Risk factors affecting survival of replaced implants were evaluated considering clustering of multiple implants within patients.

RESULTS

The present study included 464 replaced implants of 370 patients, of which 429 and 35 implants were categorized into the surviving group and the second-removal group. The 5-year survival rate was 90.2 ± 0.18% in replaced implants at sites with a periodontitis history and 97.0 ± 0.15% at sites without a periodontitis history (p = 0.008). The 5-year survival rate was 89.1 ± 0.27% in replaced implants with guided bone regeneration (GBR) at first implant placement and 93.9 ± 0.14% at non-GBR (p = 0.032). The 5-year survival rate was 97.6 ± 0.13% in replaced implants with GBR and 90.3 ± 0.17% in replaced implants without GBR (p = 0.026). In the multivariable analysis adjusted for clinical variables, periodontitis history (adjusted hazard ratio [aHR] = 3.417; 95% confidence interval [CI] = 1.161-10.055), GBR at first implant placement (aHR = 2.152; 95% CI = 1.052-4.397) and non-GBR at primary implant replacement (aHR = 0.262; 95% CI = 0.088-0.778) were identified as independent risk factors for second implant removal.

CONCLUSIONS

Periodontitis history, GBR at first implant placement and non-GBR at primary implant replacement were identified as risk factors affecting the survival of replaced implants.

Efficacy and safety of using antibiotics to prevent post-operative complications in oral implant treatment: evidence-based review

AIMS

To identify and critically appraise available evidence on the efficacy and safety of antibiotics in preventing complications following oral implant placement treatment.

METHODS

An electronic search was performed using PubMed, Ovid MEDLINE and Cochrane Library databases up to July/21 for the purpose of answering the research question: In[healthy adults treated with dental implants]the use of[different antibiotics before or immediately after treatment]in comparison to[treatment without antibiotics]is safe and effective in terms of[infection, pain, swelling, wound dehiscence, soft tissue healing, early/late implant failure]? Following the Best Evidence Topic methodology, the included studies were categorised based on the Oxford Centre for Evidence-Based Medicine (OCEBM) ratings. The critical appraisal skills programme CASP checklist was used for the methodological analysis. The risk of bias assessment was performed according to the Cochrane Methodology for Systematic Reviews of Interventions.

RESULTS

26 of the 245 initially identified articles met our inclusion criteria for analysis after applying rigorous filters. The included human studies demonstrated significant methodological heterogeneity, precluding meta-analysis. These studies spanned evidence levels II to IV, as per OCEBM 2011 classifications, with the United States contributing the most studies (19.2%, n = 5), all at level III. The United Kingdom and Spain followed with three studies each (11.5% each), two from the UK and one from Spain classified at level II. Most studies had less than 1 year of follow-up (21%). Our analysis included 26 studies, with 38 antibiotic patient groups totalling 7459 patients. Amoxicillin was the predominant antibiotic, with various dosage regimens. Complications were observed in studies across different amoxicillin regimens at a cumulative incidence of 5%.

CONCLUSION

The evidence on antibiotics to prevent implant failure presents uncertain and heterogeneous findings. High-risk bias and underpowered studies were prevalent. Future research should prioritise multicentre, double-blinded RCTs with larger samples and longer follow-ups. Structured methodologies, antibiotic stewardship, and adherence to guidelines are needed. Amoxicillin (2 g) was commonly prescribed, but guidelines recommend 3 g, which results in relatively low complications yet there is limited evidence to support it. Clindamycin was favoured for penicillin allergies, but caution is advised due to potential implant failure risk. Consistent use of antiseptic mouthwash was observed. Future research should explore alternatives to antibiotics and antibiotic stewardship. Establishing a well-funded research consortium could yield conclusive results for clinical practice.

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.

Association between cumulative smoking exposure, span since smoking cessation, and peri-implantitis: a cross-sectional study

OBJECTIVES

To investigate the association of cumulative smoking exposure and span since smoking cessation with the occurrence of peri-implantitis.

METHODS

A sample of 350 individuals aged ≥ 35 years, with the presence of at least one osseointegrated implant functioning for > 5 years, were enrolled in the study. According to smoking habits, participants were categorized into 3 groups: non-smokers (NS; n = 212), former smokers (FC; n = 66), and current smokers (CS; n = 72). Complete peri-implant and periodontal examinations were evaluated. Associations between the occurrence of peri-implantitis and smoking habits, as well as potential confounders, were evaluated through univariate and multivariate analyses.

RESULTS

The occurrence of peri-implantitis in the NS, FS, and CS groups was 18.2%, 19.7%, and 30.5%, respectively. A high prevalence of the overall number of cases with periodontitis (54.2%) was observed in the CS group when compared to the FS and NS groups. After adjusting for confounders, the odds ratio (OR) for the occurrence of peri-implantitis was 2.63 (1.39-6.77; p < 0.001) for CS compared to NS. There was a significant dose-response relationship between pack/year of smoking and the occurrence of peri-implantitis, as well as a significant decrease in the risk as the years of smoking cessation increased.

CONCLUSIONS

The occurrence of peri-implantitis among CS was high. The cumulative smoking exposure in an incremental manner and the shorter smoking cessation span was directly associated with a higher risk for peri-implantitis.

CLINICAL RELEVANCE

Educational and preventive strategies in general health services must attempt to reduce the adverse effects of cumulative smoking exposure and to explore the beneficial effects of smoking cessation on peri-implant status.

Etiology, occurrence, and consequences of implant loss

Implant therapy aims at providing the patient with a functional and esthetically pleasing rehabilitation in a long‐term perspective. The loss of an implant constitutes a major complication, which may have an impact on the treatment plan and/or jeopardize the longevity of the restoration. Implant loss may occur during the phase of osseointegration (early) or at a later time when the previously achieved osseointegration is lost (late). The present work evaluates the evidence on the occurrence of both events and discusses etiology, risk factors, and consequences.

Association between liver cirrhosis and peri-implant diseases: a case-control study on implant- and patient-related risk factors

OBJECTIVE

The objective of this study was to evaluate the potential association between liver cirrhosis and peri-implant diseases, as well as the influence of different risk indicators on this association.

METHODS

This case-control study included 64 cases with liver cirrhosis and 128 controls without liver diseases that presented the same socio-demographic and economic profile. The specific inclusion criteria were the following: aged group of 35-55 years and presenting at least one osseointegrated implant functioning for >5 years. A full-mouth peri-implant and periodontal examination was performed and risk variables were recorded. The association between risk variables and the occurrence of peri-implant diseases was tested through univariate analysis and multivariate logistic regression, stratified by alcohol status. Additionally, a mediation analysis was performed to examine the mediating effect of age with peri-implantitis.

RESULTS

A high prevalence of peri-implantitis (29.7%) was observed among cases when compared to controls (18.0%). Individuals with cirrhosis presented ~2.5 higher chance of having peri-implantitis than controls (p<0.001). Significant variables associated with the occurrence of peri-implantitis in the final logistic model were the following: cirrhosis, alcohol use, age (>55 years), male sex, smoking, periodontitis, and number of ≤14.

CONCLUSIONS

An important risk association between liver cirrhosis and peri-implantitis was reported. Future studies with a larger sample size controlling for the patient- and implant-related confounders are needed to better understand the link between peri-implantitis and liver cirrhosis.

CLINICAL RELEVANCE

Cirrhosis individuals, age, and periodontitis, as well as alcohol use and smoking interaction, should be considered as potential risk indicators for peri-implantitis.

Current Concepts in the Management of Periodontitis

Periodontitis is a common disorder affecting >40% of adults in the United States. Globally, the severe form of the disease has a prevalence of 11%. In advanced cases, periodontitis leads to tooth loss and reduced quality of life. The aetiology of periodontitis is multifactorial. Subgingival dental biofilm elicits a host inflammatory and immune response, ultimately leading to irreversible destruction of the periodontium (i.e. alveolar bone and periodontal ligament) in a susceptible host. In order to successfully manage periodontitis, dental professionals must understand the pathogenesis, primary aetiology, risk factors, contributing factors and treatment protocols. Careful diagnosis, elimination of the causes and reduction of modifiable risk factors are paramount for successful prevention and treatment of periodontitis. Initial non-surgical periodontal therapy primarily consists of home care review and scaling and root planing. For residual sites with active periodontitis at periodontal re-evaluation, a contemporary regenerative or traditional resective surgical therapy can be utilised. Thereafter, periodontal maintenance therapy at a regular interval and long-term follow-ups are also crucial to the success of the treatment and long-term retention of teeth. The aim of this review is to provide current concepts of diagnosis, prevention and treatment of periodontitis. Both clinical and biological rationales will be discussed.

Efficacy and risks of tooth-supported prostheses in the treatment of partially edentulous patients with stage IV periodontitis. A systematic review and meta-analysis

AIM

The aim was to evaluate the efficacy and effectiveness of tooth-supported fixed prostheses in partially edentulous patients with stage IV periodontitis.

MATERIAL AND METHODS

Randomized and controlled clinical trials (RCTs and CCTs) and prospective/retrospective cohort studies or case series were searched in three databases. Survival rate of abutment teeth was considered the primary outcome. Meta-analyses were performed whenever possible.

RESULTS

Twenty-four publications were included. No RCTs or CCTs compared the efficacy of tooth-supported fixed prostheses between patients with severe periodontitis or non-periodontitis patients. Most of the data retrieved were derived from case series. The incidence of abutment-tooth loss after a follow-up period from 2 to 35.4 years was low (n = 17 studies; weighted mean incidence (WMI) = 4.8%; confidence interval (CI) [3.2, 6.5]). The corresponding figure for prostheses failure was WMI = 6.9% (n = 18; 95% CI [4.1, 9.7]). Technical complications seemed to be more frequent than biological complications (caries, endodontic failure, root fracture, etc.). Periodontal outcomes tended to remain stable over time.

CONCLUSION

Tooth-supported fixed prostheses seemed to be a valid treatment approach to restore masticatory function in patients with stage IV periodontitis once periodontal therapy has been accomplished. However, the comparative efficacy of this treatment among periodontitis and non-periodontitis patients is unclear due to the absence of clinical trials.

Reduced fracture load of dental implants after implantoplasty with different instrumentation sequences. An in vitro study

OBJECTIVES

To assess the mechanical stability of implants after implantoplasty and thermocyclic loading, the residual thickness of the instrumented areas and neighbouring tooth injury due to implantoplasty.

MATERIALS AND METHODS

Using a phantom head simulator and maxillary model implants were subjected to an implantoplasty procedure. Thirty implants were randomly assigned to receive one of three instrumentation sequences. After instrumentation, injury on neighbouring teeth was assessed. Instrumented implants and non-instrumented controls were subjected to 1.2 million cycles of thermo-mechanical loading in a chewing machine. Afterwards, maximum fracture load for all implants and an additional five pristine control implants was tested.

RESULTS

Generally, damage of neighbour teeth was a frequent finding (33 ± 56% of all cases) with considerable inter-group differences. No considerable inter-group difference for the residual implant thickness was found for different areas assessed. No implant fractured during cyclic loading. Fracture load was reduced after cyclic loading of uninstrumented implants from 2,724 ± 70 N to 2,299 ± 127 N, and after implantoplasty to 1,737 ± 165 N, while no effect by the instrumentation sequence could be observed.

CONCLUSIONS

Both implantoplasty and cyclic loading were shown to reduce the implants' maximum bending strength. Cyclic loading in a laboratory masticator, simulating a five-year equivalent of chewing, did not result in fractured implants. Since neighbouring tooth injury was assessed often, care should be taken with the selection of suitable instruments.

Oral health status and behavior in elderly Koreans with periodontal disease

OBJECTIVE

The purpose of this study was to investigate oral health status and oral health behaviors in elderly Koreans with periodontal disease.

METHODS

The data of the Seventh Korea National Health and Nutrition Examination Survey (2016-2018) were used. This cross-sectional study included 2981 individuals who were at least 65 years of age. Periodontal disease was assessed in oral health exams. Subjective oral health status (e.g., toothache) and oral health behaviors (e.g., tooth brushing and oral health examination) were assessed in health interviews. Data were analyzed using descriptive statistics, chi-square tests, and logistic regression.

RESULTS

The overall prevalence of periodontal disease in the study population was 47.5%. Individuals with periodontal disease were more likely to have a toothache than those without periodontal disease (adjusted odds ratio [aOR] = 1.46, 95% confidence interval [CI] = 1.20-1.77). Individuals with periodontal disease were also more likely to have chewing discomfort (aOR = 1.21, 95% CI = 1.01-1.44) and less likely to use oral hygiene products (aOR = 0.74, 95% CI = 0.60-0.91) than those without periodontal disease.

CONCLUSIONS

About half of elderly had the periodontal disease. Elderly Koreans with periodontal disease were more likely to have poor oral health and behavior than those without periodontal disease. The results of this study provide an insight into social and behavioral factors associated with periodontal diseases in older Koreans. It is necessary to confirm these results through prospective studies.

Long term clinical performance of 10 871 dental implants with up to 22 years of follow-up: A cohort study in 4247 patients

Background

The present retrospective study was aimed to assess the long‐term clinical performance of dental implants in a cohort study of 4247 patients.

Methods

A longitudinal observational cohort study was done on all implants performed by a single periodontist from July 1995 to April 2019. The main outcome variables of this study were implant failure and marginal bone level around implants.

Results

The study participants received a total of 10 871 implants with a mean of 2.56 implants per patient. The cohort was followed‐up to 22.2 years (mean = 4.5 ± 4.2). Among the 4247 patients of the current study, 140 patients (3.3%) experienced a combined total of 178 implant failures. According to life table analysis, at the implant level the cumulative survival rate at 3, 5, 10, and 15 years was 98.9%, 98.5%, 96.8%, and 94.0%, respectively while at patient level was 97.4%, 96.7%, 92.5%, and 86% at 3, 5, 10, and 15 years. Patients with multiple units were at a greater risk for having an implant failure. Baseline bone level was 0.09 ± 0.28 mm while at 8–10 years the mean bone level was 0.49 ± 0.74 mm. The incidence of peri‐implant mucositis at the implant level was 9.4% at 2–3 years, 9.3% at 4–5 years, 12.1% at 6–7 years, and 11.9% at 8–10 years. The incidence of peri‐implantitis was 2%, 2.6%, 3.2%, and 7.1% at 2–3, 4–5, 6–7, and 8–10 years, respectively. Cigarette smoking and diabetes mellitus were positively correlated with implant failure.

Conclusions

Though the results are promising and encouraging in terms of survival and bone level over time, it is important to emphasize the potential risk factors and consider them prior to dental implant placement.

The correlation between history of periodontitis according to staging and grading and the prevalence/severity of peri-implantitis in patients enrolled in maintenance therapy

BACKGROUND

The aim of this study was to determine if a previous history of periodontitis according to the preset definitions of the 2017 World Workshop is correlated with increased implant failure, and occurrence and severity of peri-implantitis (PI).

METHODS

A retrospective analysis of patients with a history of periodontitis who received nonsurgical and, if indicated, surgical corrective therapy prior to implant placement was performed. Periodontitis stage and grade were determined for each included patient based on data from the time of initiation of active periodontal therapy. Cox Proportional Hazard Frailty models were built to analyze the correlation between stage and grade of periodontitis at baseline with implant failure, as well as occurrence and severity of PI.

RESULTS

Ninety-nine patients with a history of periodontitis receiving 221 implants were followed for a mean duration of 10.6 ± 4.5 years after implant placement. Six implants (2.7%) failed and a higher rate of implant failure due to PI was found for grade C patients (P < 0.05), whereas only an increased trend was seen for stages III and IV compared with I and II. Grading significantly influenced the risk of marginal bone loss (MBL) >25% of the implant length (P = 0.022) in PI-affected implants. However, a direct correlation between higher-level stage and grade and PI prevalence was not recorded.

CONCLUSION

No statistically significant association between periodontitis stage or grade and the prevalence of PI was found. However, when PI was diagnosed, there was a relationship between periodontitis grade and severity of PI or the occurrence of implant failure.

Genetic Polymorphisms in Serotonin Transporter (5HTT) and Catechol-O-Methyltransferase (COMT) On Dental Implant Loss-Pilot Project

The article's abstract is not available.

Evaluation of the Association of Early Implant Failure With Local, Environmental, and Systemic Factors: A Retrospective Study

PURPOSE

This study aimed to assess the association of early implant failure (EIF) with demographic, local, environmental, and systemic factors.

METHODS

Clinical charts of 594 individuals with 2,537 dental implants were assessed. EIF was characterized by implant loss before and up to the abutment connection. Logistic regression analysis was used to verify the association between EIF and local, environmental, and systemic factors at the individual and implant levels. The chosen level of significance was 5%.

RESULTS

EIF occurred in 144 implants (5.68%) and in 97 individuals (16.3%). At the individual level, smoking habits (odds ratio [OR] = 2.54; 95% confidence interval [CI] = 1.00 to 6.47; P = .05), absence of postoperative antibiotic therapy (OR = 2.73; CI = 1.22 to 6.13; P = .02), and bone augmentation (OR = 1.83; CI = 1.17 to 2.85; P = .01) were significantly associated with EIF. At the implant level, smoking habits (OR = 2.90; CI = 1.60 to 5.26, P < .001), absence of postoperative antibiotic therapy (OR = 2.77; CI = 1.36 to 5.63, P = .005), postoperative complications (OR = 28.35; CI = 6.79 to 118.45, P < .001), implant length ≤8.5 mm (OR = 1.79; CI = 1.07 to 2.99; P = .03), and diameter <3.75 mm (OR = 1.65; CI = 1.08 to 2.52, P = .02) were associated with EIF. Age, sex, alcohol abuse, diabetes, hypertension, and long-term medication use were not associated with EIF at both individual and implant levels (P ≥ .12).

CONCLUSIONS

Smoking habits, absence of antibiotic therapy, bone augmentation, postoperative complications, implant diameter <3.75 mm, and implant length ≤8.5 mm were associated with EIF. Clinicians should be aware of these associations that should be controlled for when feasible. Future cohort studies are required to confirm the risk factors.

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.

Effects of Various Polishing Techniques on the Surface Characteristics of the Ti-6Al-4V Alloy and on Bacterial Adhesion

Ti-6Al-4V, although widely used in dental materials, causes peri-implant inflammation due to the long-term accumulation of bacteria around the implant, resulting in bone loss and eventual failure of the implant. This study aims to overcome the problem of dental implant infection by analyzing the influence of Ti-6Al-4V surface characteristics on the quantity of accumulated bacteria. Ti-6Al-4V specimens, each with different surface roughness are produced by mechanical, chemical, and electrolytic polishing. The surface roughness, surface contact angle, surface oxygen content, and surface structure were measured via atomic force microscopy (AFM), laser scanning confocal microscopy (LSCM), drop shape analysis (using sessile drop), X-ray photoelectron spectroscopy (XPS), and X-ray diffraction (XRD). The micro and macro surface roughness are 10.33–120.05 nm and 0.68–2.34 μm, respectively. The surface X direction and Y direction contact angle are 21.38°–96.44° and 18.37°–92.72°, respectively. The surface oxygen content is 47.36–59.89 at.%. The number of colonies and the optical density (OD) are 7.87 × 106–17.73 × 106 CFU/mL and 0.189–0.245, respectively. The bacterial inhibition were the most effective under the electrolytic polishing of Ti-6Al-4V. The electrolytic polishing of Ti-6Al-4V exhibited the best surface characteristics: the surface roughness of 10 nm, surface contact angle of 92°, and surface oxygen content of 54 at.%, respectively. This provides the best surface treatment of Ti-6Al-4V in dental implants.

Factors Affecting Implant Failure and Marginal Bone Loss of Implants Placed by Post-Graduate Students: A 1-Year Prospective Cohort Study

Statement of the problem: Most of the clinical documentation of implant success and survival published in the literature have been issued by either experienced teams from university settings involving strict patient selection criteria or from seasoned private practitioners. By contrast, studies focusing on implants placed and rehabilitated by inexperienced post-graduate students are scarce. Purpose: To record failure rates and identify the contributing factors to implant failure and marginal bone loss (MBL) of implants placed and rehabilitated by inexperienced post-graduate students at the one-year follow-up. Material and Methods: A prospective cohort study was conducted on study participants scheduled for implant therapy at the International University of Catalonia. An experienced mentor determined the treatment plan in accordance with the need of each participant who signed an informed consent. All surgeries and prosthetic rehabilitation were performed by the post-graduate students. Implant failure rate, contributors to implant failure, and MBL were investigated among 24 variables related to patient health, local site, and implant and prosthetic characteristics. The risk of implant failure was analyzed with a simple binary logistic regression model with generalized equation equations (GEE) models, obtaining unadjusted odds ratios (OR). The relationship between MBL and the other independent variables was studied by simple linear regression estimated with GEE models and the Wald chi² test. Results: One hundred and thirty dental implants have been placed and rehabilitated by post-graduate students. Five implants failed before loading and none after restoration delivery; survival and success rates were 96.15% and 94.62%, respectively. None of the investigated variables significantly affected the implant survival rate. At the one-year follow-up, the mean (SD) MBL was 0.53 (0.39) mm. The following independent variables significantly affected the MBL: Diabetes, implant depth placement. The width of keratinized tissue (KT) and probing depth (PD) above 3 mm were found to be good indicators of MBL, with each additional mm of probing depth resulting in 0.11 mm more MBL. Conclusion: The survival and success rates of dental implants placed and rehabilitated by inexperienced post-graduate students at the one-year follow-up were high. No contributing factor was identified regarding implant failure. However, several factors significantly affected MBL: Diabetes, implant depth placement, PD, and width of KT. Clinical Implications: Survival and success rates of dental implants placed and rehabilitated by inexperienced post-graduate students were high at the one-year follow-up, similar to experienced practitioners. No contributing factors were identified regarding implant failure; however, several factors significantly affected MBL: Diabetes, implant depth placement, PD, and KM.

Risk Factors related to Late Failure of Dental Implant-A Systematic Review of Recent Studies

Resolving late failure of dental implant is difficult and costly; however, only few reviews have addressed the risk factors associated with late failure of dental implant. The aim of this literature review was to summarize the influences of different potential risk factors on the incidence of late dental implant failure. The protocol of this systematic review was prepared and implemented based on the PRISMA (Preferred reporting items for systematic reviews and meta-analyses) guideline. In December 2018, studies published within the previous 10 years on late dental implant failure were selected by fulfilling the eligibility criteria and the risk factors identified in qualified studies were extracted by using a predefined extraction template. Fourteen eligible studies were assessed. The common risk factors for late failure were divided into three groups according to whether they were related to (1) the patient history (radiation therapy, periodontitis, bruxism and early implant failure), (2) clinical parameters (posterior implant location and bone grade 4) or (3) decisions made by the clinician (low initial stability, more than one implant placed during surgery, inflammation at the surgical site during the first year or using an overdenture with conus-type connection). Clinicians should be cautions throughout the treatment process of dental implant-from the initial examination to the treatment planning, surgical operation and prosthesis selection-in order to minimize the risk of late failure of dental implant.

Are There Contraindications for Placing Dental Implants?

There are few absolute contraindications to dental implant placement. Relative contraindications include cognitive decline, American Society of Anesthesiology patient status IV or higher categories, or medical conditions that may jeopardize the life or lifespan of the patient. Precautions for placing dental implants should be viewed with respect to the evidence-based exposures that can contribute to risk of failure, including but not limited to local, behavioral, and medical factors. Risk for dental implant failure increases in association with (1) past history of periodontal disease, (2) bruxism, (3) smoking, and (4) radiation therapy.

Toss the Floss? Evidence-Based Oral Hygiene Recommendations for the Periodontal Patient in the Age of "Flossgate"

FOCUSED CLINICAL QUESTION

What are the key considerations for effective delivery of oral hygiene home care to best manage or prevent periodontal diseases?

BACKGROUND

Plaque control is critical for the management of periodontal diseases, but not all patients demonstrate the same risk for disease progression and challenges differ based upon clinical findings. This report seeks to present evidence-based oral hygiene recommendations for a variety of common periodontal diseases.

SUMMARY

Accurate diagnosis, risk assessment, and individualized delivery of oral hygiene instruction is necessary to ensure that patients can provide adequate home care to promote health and maintain the benefits of periodontal therapy.

CONCLUSIONS

Oral hygiene techniques and recommendations should vary based upon patients' clinical presentation and risk assessment. Utilization of evidence-based strategies to deliver personalized care will allow for optimal wellness for patients.

Should implants be considered for patients with periodontal disease?

Dental implants are seen as a good option for replacing missing teeth. The success and survival rates for implants are very high. Concerns are developing about the problem of peri-implantitis. The reports of its prevalence vary but it is noted that the presence of periodontal disease is a risk factor. The issue of peri-implantitis was raised in the House of Lords in 2014. Complaints relating to implants is on the rise with the General Dental Council. Placement of implants in patients with periodontal disease is not a treatment that should be done without a full periodontal assessment and stabilisation of periodontal disease first. This review considers the risk of placing implants in patients with aggressive and chronic periodontitis.

Human Studies of Vertical and Horizontal Alveolar Ridge Augmentation Comparing Different Types of Bone Graft Materials: A Systematic Review

Alveolar ridge augmentation can be completed with various types of bone augmentation materials (autogenous, allograft, xenograft, and alloplast). Currently, autogenous bone is labeled as the “gold standard” because of faster healing times and integration between native and foreign bone. No systematic review has currently determined whether there is a difference in implant success between various bone augmentation materials. The purpose of this article was to systematically review comparative human studies of vertical and horizontal alveolar ridge augmentation comparing different types of bone graft materials (autogenous, allograft, xenograft, and alloplast). A MEDLINE search was conducted under the 3 search concepts of bone augmentation, dental implants, and alveolar ridge augmentation. Studies pertaining to socket grafts or sinus lifts were excluded. Case reports, small case series, and review papers were excluded. A bias assessment tool was applied to the final articles. Overall, 219 articles resulted from the initial search, and 9 articles were included for final analysis. There were no discernible differences in implant success between bone augmentation materials. Generally, patients preferred nonautogenous bone sources as there were fewer hospital days, less pain, and better recovery time. Two articles had industrial support; however, conclusions of whether that support influenced the outcomes could not be determined. Future comparative studies should compare nonautogenous bone sources and have longer follow-up times.

A practical approach to evidence-based dentistry: IV: how to use an article about harm

BACKGROUND AND OVERVIEW

Questions regarding harm are common in dental practice. Observational, nonrandomized studies (that is, cohort studies and case-control studies) are the designs used by investigators to answer most of these questions. A critical appraisal of these studies should include an assessment of the risk of bias, the results, and the applicability of the study. The authors provide the concepts and guidelines that dentists can apply to most effectively use articles regarding harm to guide their clinical practice.

PRACTICAL IMPLICATIONS

Dentists who wish to inform their clinical decisions regarding questions of harm can use these guidelines to decide what type of studies to search, define the specific question of interest to search efficiently for these studies, and critically appraise an article about harm.

Effect of history of periodontitis on implant success: meta-analysis and systematic review

PURPOSE

To determine if there is a relationship between history of periodontitis and dental implant success (used marginal bone loss [MBL] as the assessment criteria) and survival rates.

MATERIALS AND METHODS

PubMed search was performed in the period between 2002 and 2012. Studies qualified for the inclusion should have ≥5 years followed-up and reported the incidence of peri-implantitis and/or implant survival and/or MBL in patients with and without a history of periodontitis. A meta-analysis was performed using the random-effects model on the selected qualified articles.

RESULTS

All the 14 studies showed better implant survival rates for non-periodontitis patients' group. Six of 10 studies reported statistically significantly higher MBL and prevalence of peri-implantitis among periodontitis patients. Our meta-analysis did not find implant survival rates to be significantly lower among periodontitis patients (P = 0.99) but revealed a history of periodontitis to be significantly related to the higher prevalence of peri-implantitis (P < 0.001).

CONCLUSIONS

There is no difference, in terms of implant survival rate, between periodontitis and non-periodontitis patients. However, patients with history of periodontitis had lower implant success rate (more MBL and incidence of peri-implantitis) when compared with non-periodontitis patients.

Risk Factors for Peri-Implantitis: Effect of History of Periodontal Disease and Smoking Habits. A Systematic Review and Meta-Analysis

Objectives

The purpose of this review was to evaluate whether history of periodontitis and smoking habits could represent a risk factor for peri-implantitis and implant loss.

Material and Methods

This systematic review followed PRISMA guidelines and was registered at the PROSPERO database [registration numbers CRD42016034160 (effect of history of periodontitis) and CRD42016033676 (effect of smoking)]. Broad electronic (MEDLINE) and manual searches were conducted among articles published from January 1^st 1990 up to December 31^st 2015, resulting in 49332 records for history of periodontitis and 3199 for smoking habits. Selection criteria included prospective studies comparing two cohorts of patients, with and without the investigated risk factor, with a minimum follow-up period of three years, and reporting data on peri-implantitis and implant loss occurrence. Considering that only prospective studies were included, dichotomous data were expressed as risk ratios and 95% confidence intervals.

Results

Three studies evaluating history of periodontitis (on which quantitative analysis was performed) and one study on smoking effect were included. Both implant and patient-based meta-analyses revealed a significantly higher risk of developing peri-implantitis in patients with a history of periodontitis compared with periodontally healthy subjects, but not a statistically significant increased risk for implant loss.

Conclusions

The outcomes of this systematic review indicate history of periodontitis as a possible risk factor for peri-implantitis, while insufficient data are present in literature to evaluate the role of smoking. However, available evidence is still weak and immature, and sound epidemiological studies are needed to analyse the specific contribution of these potential risk factors.

Outcomes of implants and restorations placed in general dental practices: a retrospective study by the Practitioners Engaged in Applied Research and Learning (PEARL) Network

OBJECTIVES

The authors conducted a study to determine the types, outcomes, risk factors and esthetic assessment of implants and their restorations placed in the general practices of a practice-based research network.

METHODS

All patients who visited network practices three to five years previously and underwent placement of an implant and restoration within the practice were invited to enroll. Practitioner-investigators (P-Is) recorded the status of the implant and restoration, characteristics of the implant site and restoration, presence of peri-implant pathology and an esthetic assessment by the P-I and patient. The P-Is classified implants as failures if the original implant was missing or had been replaced, the implant was mobile or elicited pain on percussion, there was overt clinical or radiographic evidence of pathology or excessive bone loss (> 0.2 millimeter per year after an initial bone loss of 2 mm). They classified restorations as failures if they had been replaced or if there was abutment or restoration fracture.

RESULTS

The authors enrolled 922 implants and patients from 87 practices, with a mean (standard deviation) follow-up of 4.2 (0.6) years. Of the 920 implants for which complete data records were available, 64 (7.0 percent) were classified as failures when excessive bone loss was excluded from the analysis. When excessive bone loss was included, 172 implants (18.7 percent) were classified as failures. According to the results of univariate analysis, a history of severe periodontitis, sites with preexisting inflammation or type IV bone, cases of immediate implant placement and placement in the incisor or canine region were associated with implant failure. According to the results of multivariate analysis, sites with preexisting inflammation (odds ratio [OR] = 2.17; 95 percent confidence interval [CI], 1.41-3.34]) or type IV bone (OR = 1.99; 95 percent CI, 1.12-3.55) were associated with a greater risk of implant failure. Of the 908 surviving implants, 20 (2.2 percent) had restorations replaced or judged as needing to be replaced. The majority of P-Is and patients were satisfied with the esthetic outcomes for both the implant and restoration.

CONCLUSIONS

These results suggest that implant survival and success rates in general dental practices may be lower than those reported in studies conducted in academic or specialty settings.

PRACTICAL IMPLICATIONS

The results of this study, generated in the private general practice setting, add to the evidence base to facilitate implant treatment planning.

Impact of a chronic smoking habit on the osteo-immunoinflammatory mediators in the peri-implant fluid of clinically healthy dental implants

OBJECTIVE

The aim of this study was to evaluate the influence of chronic cigarette smoking on the profile of osteo-immunoinflammatory markers in the peri-implant crevicular fluid (PICF) from clinically healthy implants DESIGNS: Twenty-five smokers and 23 non-smoker subjects with a unitary screwed implant-supported crown in the molar or pre-molar region were enrolled in this study. The implants should have been in functioning for at least 12 months, and the peri-implant tissue should be clinically healthy [probing depth (PD)<4mm with no bleeding on probing (BoP) and no evidence of radiographic bone loss beyond bone remodeling]. The levels of interferon (INF)-γ, interleukin (IL)-4, IL-17, IL-1β, IL-10, IL-6, IL-8, tumor necrosis factor (TNF)-α, matrix metalloproteinase (MMP)-2, MMP-9, osteoprotegerin (OPG), soluble receptor activator of nuclear factor-κβ ligand (RANKL), osteocalcin (OC), osteopontin (OPN), transforming growth factor (TGF)-β, and cross-linked telopeptide of type I collagen (ICTP) in the PICF were quantified by a multiplexed bead immunoassay.

RESULTS

The smokers presented reduced levels of IL-4, IL-8, and TNF-α compared with the non-smoker individuals (p<0.05). In addition, although lower OPG levels were detected in the PICF of the smokers, the RANKL/OPG ratio did not show a significant difference (p>0.05). Moreover, higher ICTP concentrations and a higher TH1/TH2 ratio were observed in the PICF of the smoker patients (p<0.05). No differences between the groups were observed for the other markers evaluated (p>0.05).

CONCLUSIONS

Smoking habit modulate peri-implant cytokine profile, leading to reductions in IL-4, -8 TNF-α, and OPG levels and an increased ICTP and TH1/TH2 ratio in peri-implant crevicular fluid.

Peri-Implant Sulcus Fluid (PISF) Matrix Metalloproteinase (MMP) -8 Levels in Peri-Implantitis

INTRODUCTION

Matrix Metalloproteinase (MMP) -8 plays crucial role in pathogenesis of periodontitis and is also a possible biomarker candidate in peri-implantitis.

AIM

The aim of the study was to analyse MMP-8 levels in peri-Implant Sulcus Fluid (PISF) from peri-implantitis affected implants in smoking and non-smoking patients with different periodontal health status of natural teeth before and after peri-implantitis treatment.

SETTINGS AND DESIGN

Altogether 29 patients with peri-implantitis were recruited and divided into two study groups (11 with healthy periodontium or gingivitis, i.e. no marginal bone loss, and 18 with chronic periodontitis).

MATERIALS AND METHODS

PISF sample from one implant with peri-implantitis from each patient was collected at the baseline and six months after conservative and surgical peri-implantitis treatment, and clinical parameters were registered. Samples were analysed for MMP-8 with dento ELISA method applying a monoclonal antibody. Mucosal cell samples were also analysed for IL-1 gene polymorphism. PISF MMP-8 levels' differences between periodontal diagnosis groups and between smokers' and non-smokers' were analysed. Also, IL-1 polymorphism profiles were compared between study groups.

RESULTS

PISF MMP-8 levels were higher at the baseline compared to and after the treatment when all sampled implant sites were analysed together (p = 0.001). MMP-8 levels' distribution was broader in periodontitis patients' PISF samples, and only in periodontitis patients' group levels decreased statistically significantly after the treatment (p = 0.005). Smokers'and non-smokers' PISF MMP-8 was at similar level both at the baseline and after the treatment. No difference between distributions of IL-1 genotypes was found between study groups.

CONCLUSION

MMP-8 levels increase in peri-implantitis affected implants both in non-periodontitis and periodontitis patients, but levels still after treatment of the condition reflect intensified host response around implants and indicate challenges of controlling peri-Implantitis with any treatment modality.

Immediate Implants Placed in Fresh Sockets Associated with Periapical Pathology: A Split-Mouth Design and Survival Evaluation after 1-Year Follow-Up

PURPOSE

To compare the immediate implant success rates between sites with chronic apical lesions and healthy sites in the same patients 1 year postdelayed loading.

MATERIALS AND METHODS

One hundred sixty-eight immediate implants were placed in sixty patients at upper incisor, canine, and premolar sites. A split-mouth design was used, placing a minimum of two implants, one in a fresh socket associated with chronic periapical disease, the average lesion size was larger than 4 mm and less than 8 mm (test group), and the other(s) in a healthy fresh socket (control group). Implant survival rate at 1 year postloading delayed was compared between the groups.

RESULTS

The implant survival rate was 98.2% for the total sample (n = 168); out of the three implants lost, two were from the test group, and one was from the control group (in the same patient as one of the former). Among the surviving implants, five were also considered failures due to excessive bone loss (n = 3) and also because of the recurrence of the periapical lesions (n = 2). Survival rates were significantly lower in the test than control sites at 12 months postloading.

CONCLUSIONS

Implant survival rates were significantly lower after the immediate implantation in postextraction sockets associated with chronic periapical disease (90.8%) than in healthy postextraction sockets (98.1%).

Salivary IL-1β and red complex bacteria as predictors of the inflammatory status in sub-peri-implant niches of subjects with peri-implant mucositis

BACKGROUND AND OBJECTIVES

Salivary biomarkers may enhance diagnostic sensitivity for peri-implant disease assessment. This study aimed to investigate the association of salivary periodontopathogen count and salivary interleukin-1beta (IL-1β) level with the peri-implant crevicular fluid IL-1β response at peri-implant mucositis (PM) sites among subjects with differing periodontal disease susceptibility.

MATERIALS AND METHODS

Eighty-seven partially edentulous subjects having at least one implant with peri-implant mucositis were included: 40 with history of chronic periodontitis (P) and 47 with no history of periodontitis (NP). Salivary IL-1β, peri-implant crevicular fluid (PICF) IL-1β, and salivary red complex pathogen counts were recorded. Subjects were scored according to a threshold salivary pathogen level of more than 5log (10) counts and assigned a "red complex score." Quartiles of salivary and PICF IL-1β levels were also scored. Area under receiver operating curve (AUC) was computed to predict the highest PICF IL-1β score using salivary biomarker as predictors and age-adjusted logistic regression performed for the significant predictors.

RESULTS

In the NP group, red complex score (AUC = 0.758 P = 0.010) (odds ratio = 1.377) and salivary IL-1β (AUC = 0.708 P = 0.038) (odds ratio = 2.506) were significant predictors of highest PICF IL-1β quartile score. In the P group, no significant associations were noted.

CONCLUSIONS

Salivary biomarkers could distinguish the "high" pro-inflammatory responders at PM sites only in subjects without inherent periodontal disease susceptibility. Periodontal susceptibility may impact the immuno-inflammatory response in sub-peri-implant niches of those with peri-implant mucositis.

Investigation of the risk factors associated with the survival rate of dental implants

PURPOSE

The propose of this article was to evaluate the risk factors associated with the survival rate of the dental implants.

MATERIAL AND METHODS

This retrospective study evaluated the survival rate of 940 implants placed at the Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Istanbul University, from January 2003 to January 2011. The potential risk factors associated with the survival rate of the implants were investigated.

RESULTS

Fifteen (1.5%) of the 940 implants failed during the follow-up period. Smoking did not affect the survival rate of the implants (log-rank, 1.5; P = 0.219). The survival rate of the implants placed in the maxilla was lower than that of the implants placed in the mandible (log-rank, 4.81; P = 0.028). The 5-year survival rate of the dental implants was 98.5%.

CONCLUSIONS

There are still conflicting results about the risk factors associated with the survival rate of the implants. According to the results of this study, it is concluded that only the location of the implants is associated with the survival rates of the implants. All implant systems showed high survival rates.