Long‐Term Evaluation of Periodontal Parameters and Implant Outcomes in Periodontally Compromised Patients: A Systematic Review

Background : The aim of this systematic review is to evaluate the long‐term outcomes of patients with periodontitis submitted to periodontal therapy/maintenance and implant placement. Methods: Studies reporting clinical and/or long‐term implant outcomes from partially edentulous patients with periodontitis who were treated and followed periodontal maintenance for ≥5 years were considered eligible for the review. Screening of the articles, data extraction, and quality assessment were conducted independently and in duplicate. Results: Search of MEDLINE, EMBASE, and CENTRAL databases resulted in 959 papers, and of them 931 were excluded after title/abstract assessment. The full texts of 28 potentially eligible publications were screened, but only 10 studies met inclusion criteria. Most of the included studies (77.8%) presented a medium/high methodologic quality. The results demonstrated that patients with a diagnosis of periodontitis had satisfactory implant outcomes. Implant survival was high (92.1%) within studies reporting 10 years of follow‐up. Parameters related to probing depth, clinical attachment level, and bone loss around teeth increased the occurrence of peri‐implantitis and implant loss. Non‐attendance to periodontal maintenance and smoking habits were also associated with less favorable implant outcomes. Conclusions: This systematic review confirmed that implant therapy can be successfully used in patients with a diagnosis of periodontitis who underwent proper therapy and regular periodontal maintenance. Residual pockets, non‐attendance to the periodontal maintenance program, and smoking were considered to be negative factors for the long‐term implant outcomes.     

Long‐Term Follow‐Up of CeraOne™ Single‐Implant Restorations: An 18‐Year Follow‐Up Study Based on a Prospective Patient Cohort

Background: Knowledge on long‐term clinical performance of more than 5 years on the single‐implant CeraOne? (Nobel Biocare AB, Gothenburg, Sweden) concept is limited. Purpose: The aim of this study is to report the long‐term clinical performance of the first CeraOne single‐implant restorations, installed 17 to 19 years ago. Materials and Methods: The group comprised 57 patients provided with 65 CeraOne single‐tooth restorations. Sixty‐two all‐ceramic and three metal‐ceramic crowns were cemented between 1989 and 1991. Patients were followed up clinically and with intraoral radiographs at placement, after 1, 5, and between 17 and 19 years after placement. Results: Data were available for altogether 48 patients, followed up on an average time of 18 years. Excluding deceased patients (n = 2) and failed implant patients (n = 2), only five patients were lost to follow‐up (8.8%). Two implants failed, resulting in an 18‐year implant cumulative success rate (CSR) of 96.8%, and altogether eight original single‐crown restorations were replaced (CSR 83.8%). The most common reason for crown replacement was infra‐position of the implant crown (n = 3). Many of the remaining original crowns showed various signs of implant crown infraposition at the termination of the study. In general, the soft tissue at the restorations was assessed to be healthy and comparable with the gingiva at the adjacent natural teeth. Bone levels were on an average stable with only few patients exhibiting bone loss of more than 2 mm during 18 years in function. Conclusion: This long‐term follow‐up study of single‐implant restorations shows encouraging results with few implant failures and minimal bone loss over an 18‐year period. Original single‐crown restorations were replaced more frequently, because of, for example, implant crown infraposition and veneer fractures. The CeraOne concept proved to be a highly predictable and safe prosthodontic treatment.     

Crestal Bone Changes at Teeth and Implants in Periodontally Healthy and Periodontally Compromised Patients. A 10‐Year Comparative Case‐Series Study

Background: Limited data exist on the longitudinal crestal bone changes around teeth compared with implants in partially edentulous patients. This study sought to compare the 10‐year radiographic crestal bone changes (bone level [BL]) around teeth and implants in periodontally compromised (PCPs) and periodontally healthy (PHPs) patients. Methods: A total of 120 patients were evaluated for the radiographic crestal BL around dental implants and adjacent teeth at time of implant crown insertion and at the 10‐year follow‐up. Sixty patients had a previous history of periodontitis (PCPs), and the remaining 60 were PHPs. In each category (PCP and PHP), two different implant systems were used. The mean BL change at the implant and at the adjacent tooth at the interproximal area was calculated by subtracting the radiographic crestal BL at the time of crown cementation from the radiographic crestal BL at the 10‐year follow‐up. Results: At 10 years after therapy, the survival rate ranged from 80% to 95% for subgroups for implants, whereas it was 100% for the adjacent teeth. In all eight different patient categories evaluated, teeth demonstrated a significantly more stable radiographic BL compared with adjacent dental implants (teeth BL, 0.44 ± 0.23 mm; implant BL, 2.28 ± 0.72 mm; P <0.05). Radiographic BL changes around teeth seemed not to be influenced by the presence or absence of advanced bone loss (≥3 mm) at the adjacent implants. Conclusions: Natural teeth yielded better long‐term results with respect to survival rate and marginal BL changes compared with dental implants. Moreover, these findings also extend to teeth with an initial reduced periodontal attachment level, provided adequate periodontal treatment and maintenance are performed. As a consequence, the decision of tooth extraction attributable to periodontal reasons in favor of a dental implant should be carefully considered in partially edentulous patients.     

Crestal Bone Level Changes Around Immediately Placed Implants: A Systematic Review and Meta‐Analyses With at Least 12 Months’ Follow‐Up After Functional Loading

Background: Immediate implant placement (IIP) is a successful treatment and has the advantages of reducing time and increasing patient satisfaction. However, achieving predictable esthetic results with IIP presents a challenge because of naturally occurring bone loss postextraction. Therefore, the focused question of this systematic review is: What is the effect of IIP on crestal bone level (CBL) changes after at least 12 months of functional loading? Methods: Extensive literature review of the Cochrane and MEDLINE electronic databases and a manual search up to November 2012 identified eligible studies. Two reviewers independently assessed the study data and methodologic quality using data extraction and assessment forms. Results: Electronic and manual searches identified 648 relevant publications. A total of 57 articles satisfied the inclusion criteria. Sixteen studies had test and control groups; therefore, meta‐analyses could be performed. The results demonstrated better CBL preservation around IIP compared with implant placement in healed/native bone at 12 months [CBL difference of ?0.242 (95% confidence interval [CI], ?0.403 to ?0.080; P = 0.003)]. Similarly, platform switching around IIP showed better results compared with non–platform switching (CBL difference of ?0.770 [95% CI, ?1.153 to ?0.387; P <0.001]). There was no difference in mean CBL changes with regard to one‐stage or two‐stage IIP protocol (?0.017 [95% CI, ?0.249 to 0.216; P = 0.85]) or the use of immediate or delayed immediate implant loading (0.002 [95% CI, ?0.269 to 0.272; P = 0.99]). Conclusions: Meta‐analyses showed less CBL loss around IIP compared with implant placement in healed bone. Platform‐switched implants showed greater crestal bone preservation than non–platform‐switched implants. There was no significant difference in CBL with one‐ versus two‐stage placement or use of immediate versus delayed IIP loading. Although there were statistically significant differences favoring IIP, the small differences may not be clinically relevant. Although IIP showed favorable outcomes for CBL changes, these results should be interpreted with caution because of high heterogeneity among studies.     

A Cross‐Sectional Assessment of Biomarker Levels Around Implants Versus Natural Teeth in Periodontal Maintenance Patients

Background: Recent studies point to the clinical utility of using peri‐implant sulcular fluid (PISF) as a valuable diagnostic aid for monitoring peri‐implant tissue health. The objectives of this study are to determine the levels of key biomarkers in PISF in periodontal maintenance participants and compare them with their corresponding levels in gingival crevicular fluid (GCF) obtained from the same participants. Methods: PISF and GCF were collected from an implant and a contralateral natural tooth after the clinical examination of 73 participants. The levels of interleukin (IL)‐1α, IL‐1β, IL‐6, IL‐8, IL‐10, IL‐12, IL‐17A, tumor necrosis factor (TNF)‐α, C‐reactive protein, osteoprotegerin, leptin, and adiponectin were determined using multiplex proteomic immunoassays. The correlation of biomarker concentrations between GCF versus PISF, within GCF or PISF, and with several covariates (age, brushing frequency, days since professional cleaning, probing depth [PD], and plaque index) were also determined. Results: Significantly higher levels of IL‐17A (P = 0.02) and TNF‐α (P = 0.03) were noted in PISF when compared with their levels in GCF. Significant positive correlations were noted between the concentrations of cytokines in PISF versus their levels in GCF. Among the covariates, a significant positive correlation was noted between mean PDs around implants and levels of IL‐1β (P <0.05) and IL‐8 (P <0.05) in PISF. Conclusion: The results of this study point to the differential expression of specific biomarkers in GCF versus their levels in PISF in periodontal maintenance patients, which is critical information before establishing PISF as a diagnostic fluid to monitor peri‐implant health.     

Long-term follow-up of turned single implants placed in periodontally healthy patients after 16-22 years: radiographic and peri-implant outcome

Objectives: Retrospectively evaluate the survival, radiographic and peri‐implant outcome of single turned Brånemark^? implants after at least 16 years. Materials and methods: From 134 patients (C‐group), 101 could be contacted concerning implant survival and 50 (59 remaining implants) were clinically examined (I‐group). Marginal bone level was radiographically measured from the implant–abutment junction at baseline (=within 6 months after abutment connection) and 1–4, 5–8 and 16–22 years post‐operatively. Probing depth, gingival and plaque index were measured. Marginal bone‐level changes were analyzed using Friedman's and Wilcoxon's signed ranks tests. Spearman's correlations between radiographic and clinical parameters were calculated. Results: In the C‐group, 13 out of 166 implants in 11 out of 134 patients failed (CSR=91.5%). In the I‐group (28 males–22 females; mean age 23.9 years at baseline; range 14–57), the mean follow‐up was 18.4 years (range 16–22). The mean bone level was 1.7±0.88 mm (range ?0.8 to 5) after 16–22 years. Changes in the mean marginal bone level were statistically significant between baseline and the second measuring interval (1–4 years). Thereafter, no significant differences could be demonstrated. The mean interproximal probing depth, gingival and plaque indices were 3.9±1.27 mm, 1.2±0.81 and 0.2±0.48, respectively. Probing depth was moderately correlated with gingival inflammation (r=0.6; P<0.001) but not with bone level (P>0.05). 81.4% of the implants had a bone level ≤2nd thread and 91.5% had a probing depth ≤5 mm. 76.3% had both bone level ≤2nd thread and probing depth ≤5 mm. Conclusions and clinical implications: The single turned Brånemark^? implant is a predictable solution with high clinical survival and success rates. In general, a steady‐state bone level can be expected over decades, with minimal signs of peri‐implant disease. A minority (5%), however, presents with progressive bone loss. To cite this article :
Dierens M, Vandeweghe S, Kisch J, Nilner K, De Bruyn H. Long‐term follow‐up of turned single implants placed in periodontally healthy patients after 16–22 years: radiographic and peri‐implant outcome.
Clin. Oral Impl. Res. 23 , 2012; 197–204. doi: 10.1111/j.1600‐0501.2011.02212.x     

Treatment Outcome in Patients With Peri‐Implantitis in a Periodontal Clinic: A Retrospective Study

Background: The number of placed implants has grown during the past decade, and the prevalence of peri‐implantitis has increased. The purpose of the present study is to investigate the treatment outcome of peri‐implantitis and to identify factors influencing the treatment success rate. Methods: The study was conducted as a retrospective longitudinal study on a referral population. The material included 382 implants with peri‐implantitis in 150 patients. Peri‐implantitis was defined as presence of pocket depths ≥5 mm, bleeding at probing and/or suppuration, and the presence of implant radiographic bone loss ≥3 mm or bone loss comprising at least three threads of the implant. Variance analyses, χ² analyses, and logistic regression analysis were used for data analyses. Results: The mean age of the participants at baseline was found to be 64 years (range: 22 to 87 years). The mean ± SD follow‐up time was 26 ± 20 months, and the mean time between implant installation and baseline was 6.4 years (range: 1 to 20 years). Periodontal flap surgery with osteoplasty was the most common type of therapy (47%), and regenerative surgery procedures with bone substitute materials were chosen in 20% of the cases. The mean success rate at patient level was 69%. The results of the logistic regression analyses showed that the success rate was significantly lower for individuals with the diagnosis of severe periodontitis, severe marginal bone loss around the implants, poor oral hygiene, and low compliance. Conclusion: The effectiveness of the peri‐implantitis therapy was impaired by severe periodontitis, severe marginal bone loss around the implants, poor oral hygiene, and low compliance.     

Effects of Currently Available Surgical and Restorative Interventions on Reducing Midfacial Mucosal Recession of Immediately Placed Single‐Tooth Implants: A Systematic Review

Background: Procedures to improve peri‐implant soft‐tissue outcomes of single, immediately placed implants are a topic of interest. This systematic review investigates the effect of various surgical and restorative interventions on implant mid‐buccal mucosal level. Methods: An electronic search of five databases (January 1990 to December 2012) and a manual search of peer‐reviewed journals for relevant articles were performed. Randomized controlled clinical trials (RCTs), prospective cohort studies, and case series with at least nine participants were included, with data on midfacial mucosal recession (MR) of immediately placed implants following various surgical and restorative interventions with a follow‐up period of at least 6 months. Results: Thirty‐six studies, eight RCTs, one cohort study, and 27 case series were eligible. Six interventions were identified and reviewed: 1) palatal/lingual implant position; 2) platform‐switched abutments; 3) flapless approach; 4) bone grafts to fill the gap between buccal plate and fixture; 5) connective tissue grafts; and 6) immediate provisionalization. Three studies consistently showed that palatally/lingually positioned implants had significantly less MR when using tissue‐level implants. Mixed results were reported for interventions 2, 3, 5, and 6. One study was available for intervention 4 and did not show a benefit. Conclusions: Some interventions might be adopted to reduce the amount of MR on implants with the immediate placement approach, as suggested by the included studies, with various levels of evidence. The conflicting results among studies might be a result of differences in patient and site characteristics, e.g., tissue biotype and buccal plate thickness. Therefore, the use of these interventions might be reserved for patients with moderate to high risk of esthetic complications.