Clinical and Radiological Outcomes of Two Implants with Different Prosthetic Interfaces and Neck Configurations: Randomized,Controlled, Split‐Mouth Clinical Trial

Background: Peri‐implant bone loss seems to occur following implant placement/loading regardless of all the efforts to eliminate it. Several factors, including surgical trauma, biologic width establishment, lack of passive fit of the superstructures, implant‐abutment microgap, and occlusal overloading, may increase peri‐implant bone loss. Over the years, new interface designs were introduced and clinical studies suggest that internal conical connection and platform shifting may be advantageous for marginal bone preservation. Purpose: To compare clinical and radiological outcomes of two implant designs with different prosthetic interfaces and neck configurations in a randomized, controlled, split‐mouth clinical trial. Materials and Methods: Thirty‐four partially edentate patients randomly received at least one internal conical connection with back‐tapered collar and platform shifting design or external‐hexagon implants with flat‐to‐flat implant‐abutment interface. Primary end point was peri‐implant bone level changes at different time points, failures of implants and/or prosthesis, any complications, implant stability quotient (ISQ) values, and periodontal parameters. Results: No dropout occurred. Marginal bone changes were statistically significantly different with better results for the internal conical connection. No implants and prosthesis failures have been observed, yielding a cumulative survival rate of 100%. A high ISQ value was found for both implants, and no statistically significant difference was found for ISQ mean values between interventions at each time point (p > .05). All implants showed no bleeding on probing and a very slight amount of plaque at the 1‐year‐in‐function visit. Conclusions: Both implant designs investigated performed similarly in terms of failure rates, providing successful results up to 1 year after loading. The back‐tapered neck configuration with conical connection and built‐in platform shifting showed statistically lower marginal bone loss than straight neck configuration with flat‐to‐flat implant‐abutment interface and external‐hexagonal connection.     

Is a Fixed Hybrid Prosthesis with Distal Cantilever Appropriate for Maxillofacial Defects? A Report of Two Patients

The most important objectives in restoring the maxillofacial patient are the restoration of function and psychological improvement through esthetics. Acquired maxillary and mandibular defects due to significant trauma or surgery represent a major challenge for the clinician and patient. Dental implant‐retained prostheses represent a well‐documented and reliable treatment option and can also help patients with maxillofacial defects by eliminating denture instability and improving function. Full‐arch fixed dental hybrid prostheses provide functional and psychological advantages and also reduce the load on vulnerable soft and hard tissues in the reconstruction area. Two clinical reports are presented describing the prosthetic rehabilitation using dental implant‐supported fixed hybrid prostheses with clinical and radiographic follow‐up of 3 years.     

Trauma to an implant‐supported crown that was saved by the fixation screw: a case report

Abstract – A traumatic impact to an implant‐supported crown might damage the implant, restoration and peri‐implant tissues. Ideally, only a small prosthetic retreatment is needed for restoration, as complicated prosthetic retreatments or surgical retreatments in particular, could be very inconvenient for the patient. However, there is a deficiency in literature on how the implant, restoration and surrounding tissues generally react to impact forces. This report demonstrates a case of trauma to an implant‐supported crown in the maxillary anterior zone resulting in a displacement of the implant crown. After careful examination and follow‐up, it appeared that only the fixation screw was damaged, whereas the implant, restoration and peri‐implant tissues remained unharmed. Thanks to the protective qualities of the implant system, an easy prosthetic retreatment could restore the implant‐supported crown and a surgical retreatment was prevented.     

Digital Tissue Preservation Concept: A Workflow for Guided Immediate Implant Placement and Restoration

The digital workflow presented here allows for fabrication and placement of a definitive custom abutment at the time of tooth extraction and guided immediate implant placement, thus preserving soft tissue anatomy. Since abutment design was based on the shape of the original tooth, it represented a de facto emergence‐analog that provided ideal soft tissue support. The approach of superposing and merging of custom abutment design data with data captured intraorally after abutment placement enabled a digital impression without gingival displacement and associated trauma. The generated data facilitated the fabrication of a precisely fitting restoration concurrent with the implant healing period.     

Single-tooth implant treatment in the anterior region of the maxilla for treatment of tooth loss after trauma: a retrospective clinical and interview study

Abstract – The aim of this study was to evaluate the results of single‐tooth implant treatment in patients where teeth have been lost as a result of trauma. Also, the patients' and professionals' opinions regarding the final outcome of treatment were assessed. Thirty‐four patients with 42 lost teeth were evaluated by clinical and radiographic examinations and interviews 2–5 years after treatment. A professional who had not taken part in the treatment evaluated the implant crowns. Central maxillary incisors were the most frequently lost and replaced teeth after trauma (75%) followed by lateral incisors (21%). In patients with incomplete growth, implant treatment was generally postponed until completion of growth. Lack of space was treated by presurgical orthodontics (7%) or by selecting an implant with a reduced diameter (5%). Deficiency of bone was seen in 17% and was treated by bone grafting or local augmentation prior to implant surgery. Patients who had lost two or more teeth after trauma were all subjected to bone grafting. Preservation of roots in the alveolar process seemed to maintain the bone volume enabling better conditions for later implant placement. Forty‐one implants (97.6%) were integrated successfully. Complications were few and of minor importance (9.5% before and 12% after cementation of crowns) and could all be managed. No or minimal bone loss was seen. In general, the patients felt that they received good care and that they were well informed about their treatment. Some patients reported that the local anesthesia procedure was not pain‐free, but 71% of the patients experienced the treatment as pain‐free. For each of the variables (color, shape, height, and size of the crowns), the highest degree of satisfaction was noted in 93–98% of the patients and 91–95% of the single evaluating professional. Given that the patients have finished growth and a careful treatment planning and timing are performed, the functional and esthetical outcome of single‐tooth implant treatment today is excellent and can be recommended for replacing tooth losses after trauma in the anterior region of the maxilla.     

The Peri‐Implantitis: Implant Surfaces,Microstructure, and Physicochemical Aspects

There are two ways of looking at secondary failures of osseointegration; one is to reflect on possible causes for the failure, the other focuses on the pathology per se. In the first case, background factors such as mechanical trauma (adverse loading) or inflammations/infections are being discussed as the cause of failure. Then peri‐implantitis is a term reserved for implant disturbance due to inflammation/infections only. However, irrespective of the original reason for the failure being adverse loading or inflammation/infection, the end result with bone resorption and inflammation may be very similar. Hence, in the present article, an alternative outlook has been chosen. Trigerring factors for peri‐implantitis are generally gathered under four categories: lesions of peri‐implant attachment, presence of aggressive bacteria, excessive mechanical stress, and corrosion. If only one of these factors would start a chain reaction leading to lesions, then the other factors may combine to worsen the condition. With other words, peri‐implantitis is a general term dependent on a synergy of several factors, irrespective of the precise reason for first triggering off symptoms.     

The Frequency of Peri‐Implant Diseases: A Systematic Review and Meta‐Analysis

Background: The peri‐implant diseases, namely peri‐implant mucositis and peri‐implantitis, have been extensively studied. However, little is known about the true magnitude of the problem, owing mainly to the lack of consistent and definite diagnostic criteria used to describe the condition. The objective of the present review is to systematically estimate the overall frequency of peri‐implant diseases in general and high‐risk patients. Methods: The systematic review is prepared according to the Meta‐analysis of Observational Studies in Epidemiology statement. Studies were searched in four electronic databases, complemented by manual searching. The quality of the studies was assessed according to Strengthening the Reporting of Observational Studies in Epidemiology, and the data were analyzed using statistical software. Results: Of 504 studies identified, nine studies with 1,497 participants and 6,283 implants were included. The summary estimates for the frequency of peri‐implant mucositis were 63.4% of participants and 30.7% of implants, and those of peri‐implantitis were 18.8% of participants and 9.6% of implants. A higher frequency of occurrence of peri‐implant diseases was recorded for smokers, with a summary estimate of 36.3%. Supportive periodontal therapy seemed to reduce the rate of occurrence of peri‐implant diseases. Conclusions: Peri‐implant diseases are not uncommon following implant therapy. Long‐term maintenance care for high‐risk groups is essential to reduce the risk of peri‐implantitis. Informed consent for patients receiving implant treatment must include the need for such maintenance therapy.     

Clinical outcomes and cost effectiveness of computer‐guided versus conventional implant‐retained hybrid prostheses: A long‐term retrospective analysis of treatment protocols

1 Background

Computer‐guided systems were developed to facilitate implant placement at optimal positions in relation to the future prosthesis. However, the time, cost and, technique sensitivity involved with computer‐guided surgery impedes its routine practice. The aim of this study is to evaluate survival rates and complications associated with computer‐guided versus conventional implant placement in implant‐retained hybrid prostheses. Furthermore, long‐term economic efficiency of this approach was assessed.

2 Methods

Patients were stratified according to implant placement protocol into a test group, using computer‐guided placement, and a control group, using traditional placement. Calibrated radiographs were used to measure bone loss around implants. Furthermore, the costs of the initial treatment and prosthetic complications, if any, were standardized and analyzed.

3 Results

Forty‐five patients (149 implants in the test group and 111 implants in the control group) with a minimum follow‐up of 5 years, and a mean follow‐up of 9.6 years, were included in the study. While no significant difference was found between both groups in terms of biologic and technical complications, lower incidence of implant loss was observed in the test group (P < 0.001). A statistically significant difference in favor of the non‐guided implant placement group was found for the initial cost (P < 0.05) but not for the prosthetic complications and total cost (P > 0.05).

4 Conclusions

Computer‐guided implant placement for an implant‐supported hybrid prosthesis is a valid, reliable alternative to the traditional approach for implant placement and immediate loading. Computer‐guided implant placement showed higher implant survival rates and comparable long‐term cost to non‐guided implant placement.     

Periodontal and peri‐implant diseases: identical or fraternal infections?

Peri‐implant diseases (peri‐implantitis and peri‐implant mucositis) are bacterially driven infections. Peri‐implantitis leads to aggressive bone resorption and eventual loss of the implant. Traditionally, peri‐implantitis was regarded as microbially similar to periodontitis, and translocation of periodontal pathogens into the peri‐implant crevice was considered as a critical factor in disease causation. However, evidence is emerging to suggest that the peri‐implant and periodontal ecosystems differ in many important ways. The purpose of this review is to examine the evidence supporting microbial congruence and discordance in these two communities. Current evidence suggests that osseointegrated implants truly create unique microenvironments that force microbial adaptation and selection. Further studies that revisit the “microbial reservoir” hypothesis and identify species that play an etiologic role in peri‐implant disease and examine their transmission from teeth are needed.     

Bone alterations at implant‐supported FDPs in relation to inter‐unit distances: a 5‐year radiographic study

Objectives: The aim of this 5‐year study was to longitudinally evaluate bone alterations around implants with a conical implant–abutment interface in relation to implant–tooth and inter–implant distances. Material and methods: The patient sample comprised 43 partially dentate patients with a total of 48 implant‐supported fixed dental prostheses (FDPs) supported by 130 Astra Tech^® implants. Following FDP placement (baseline), the patients were enrolled in an individually designed supportive care program. Radiographic examinations were performed at the time of FDP installation, 1 and 5 years of follow‐up. Variables regarding implant position and proximal bone topography at tooth/implant units (n=36) and implant/implant units (n=67) were assessed with the use of a software program after scanning of the radiographs. Results: At tooth/implant units, the mean 5‐year marginal bone loss at the tooth, the implant and the mid‐proximal bone crest was 0.1, 0.4 and 0.2 mm, respectively. The mean longitudinal bone loss at the implant/implant units was 0.5 mm at the implants and 0.3 mm mid‐proximally. Multilevel regression analysis revealed that at implant/implant units, the change in the bone‐to‐implant contact level was a significant predictor with regard to the 5‐year mid‐proximal bone‐level change, whereas the horizontal inter‐unit distance showed a borderline significance (P=0.052). At tooth/implant units, no statistically significant associations were identified. Conclusions: The results of this 5‐year study revealed differences between inter‐implant and tooth–implant proximal areas with regard to bone crest alterations and associated factors. To cite this article:
Chang M, Wennström JL. Bone alterations at implant‐supported FDPs in relation to inter‐unit distances: a 5‐year radiographic study.
Clin. Oral Impl. Res. 21 , 2010; 735–740.
doi: 10.1111/j.1600‐0501.2009.01893.x     

Local risk indicators – Consensus report of working group 2

In implant dentistry, plaque control and oral hygiene practices are essential to limit the risk of complication and failure in the long term. All conditions around an implant in function that influence the load and pathogenicity of the microbiota are considered local risk indicators. They concern the prosthetic suprastructure design and the possibility for the patient to easily access each implant for plaque removal. Use of cemented prostheses should be limited to avoid excess cement acting as a foreign body and leading to peri‐implant disease. The crown margins should be supramucosal, and the connection should be precise to avoid a gap between the implant and the suprastructure. Every implant system is characterised by a specific design, surface texture and connection type. These features may influence peri‐implantitis development and progression, and the clinician should consider the risk of infection when selecting an implant. The soft‐tissue conditions around the implant, the width of keratinised mucosa, and the phenotype and thickness of the mucosa are also considered major risk indicators, as the presence of any mucosal defect around an implant can increase plaque accumulation and result in tissue inflammation. The pathogenicity of the microbiota around an implant is primarily dependent on pocket depth. Deep pockets around implants should be avoided and, if present, closely monitored and/or reduced. Proximity to natural teeth presenting endodontic and/or periodontal lesions may result in implant contamination, but the influence of the type of edentulism on perio‐pathogen presence is still unclear. These local conditions around an implant have a clear influence on peri‐implant diseases development and progression, but there is still only limited evidence regarding their role as true risk indicators.     

Possible impact of inflammatory status on C‐telopeptide pyridinoline cross‐links of Type I collagen and osteocalcin levels around oral implants with peri‐implantitis: a controlled clinical trial

Summary Detection of progression level of peri‐implantitis may help in the prevention of oral implant failure. C‐telopeptide pyridinoline crosslinks of Type I collagen (ICTP) and osteocalcin (OC) are specific markers of bone turnover and bone degradation. Determination of the ICTP and OC levels in the peri‐implant sulcus fluid (PISF) may predict the metabolic and/or inflammatory changes in the peri‐implant bone. The aim of this clinical study was to evaluate ICTP and OC levels in the PISF for oral implants with and without peri‐implant bone destruction and correlate these levels with the traditional clinical peri‐implant parameters (probing depth, plaque index, gingival index and gingival bleeding time index) and radiographic bone level measurements. Fifteen patients with 30 peri‐implant sites with bone destruction (radiographic bone loss) and health were included. Clinical parameters were measured and PISF was collected from the sites. Peri‐implant sulcus fluid ICTP and OC levels were detected by radioimmunoassay technique from PISF samples. All clinical parameters demonstrated a significant increase in peri‐implantitis sites compared with healthy sites. The PISF volume of the peri‐implantitis sites was also significantly higher than of the healthy peri‐implant sites. Although not statistically significant, a trend of increase was demonstrated in ICTP PISF samples sampled from peri‐implantitis sites compared with healthy sites. A significant increase was noticed for OC PISF level in peri‐implantitis sites compared with healthy ones. As well as peri‐implant clinical measurements, volumetric changes at PISF may be counted as an important clinical parameter to distinguish the bone destruction sites from healthy sites around oral implants.     

Can degradation products released from dental implants affect peri‐implant tissues?

This study aimed to assess the literature available on the effects, on peri‐implant tissues, of degradation products released from dental implants as a consequence of therapeutic treatment for peri‐implantitis and/or of wear‐corrosion of titanium. A literature review of the PubMed medline database was performed up to December 31, 2016. The following search terms were used: “titanium wear and dental implant”; “titanium corrosion and dental implant”; “bio‐tribocorrosion”; “peri‐implantitis”; “treatment of peri‐implantitis”; “titanium particles release and dental implant”; and “titanium ion release and dental implant”. The keywords were applied to the database in different combinations without limits of time period or type of work. In addition, the reference lists of relevant articles were searched for further studies. Seventy‐nine relevant scientific articles on the topic were retrieved. The results showed that pro‐inflammatory cytokines, infiltration of inflammatory response cells and activation of the osteoclasts activity are stimulated in peri‐implant tissues in the presence of metal particles and ions. Moreover, degenerative changes were reported in macrophages and neutrophils that phagocytosed titanium microparticles, and mutations occurred in human cells cultured in medium containing titanium‐based nanoparticles. Debris released from the degradation of dental implants has cytotoxic and genotoxic potential for peri‐implant tissues. Thus, the amount and physicochemical properties of the degradation products determine the magnitude of the detrimental effect on peri‐implant tissues.     

Histological evaluation of the peri‐implant tissues of three human‐retrieved Straumann implants

The most frequently‐used histological parameters to define dental implant osseointegration include bone‐to‐implant contact and quantitative and qualitative assessments of the surrounding tissue (rate of mineralized/non‐mineralized tissue and proportion of lamellar and woven bone compared to soft tissue or bone marrow). The aim of this paper was to present the histological features of the bone tissue surrounding three well‐functioning Straumann SLA and SLActive implants placed in two patients after 12 and 60 months of loading. The percentage of osseointegration ranged from 66.4% and 71.9% for SLA surfaces, to 88.3% for the SLActive implant. Such results confirm that osseointegration occurs with high rates of bone‐to‐implant contact in humans, and that implants can be similarly clinically successful, although they show different bone‐to‐implant contact values.     

Efficacy of Cancellous Block Allograft Augmentation Prior to Implant Placement in the Posterior Atrophic Mandible

Background: The present study evaluated the outcome of ridge augmentation with cancellous freeze‐dried block bone allografts in the posterior atrophic mandible followed by placement of dental implants. Materials and Methods: A bony deficiency of at least 3 mm, horizontally, vertically, or both, according to computerized tomography (CT) para‐axial reconstruction served as inclusion criteria. Implants were inserted after a healing period of 6 months. Bone measurements were taken prior to bone augmentation, during implant placement, and at second‐stage surgery. Marginal bone loss and crown‐to‐implant ratio were also measured. Results: Twenty‐nine cancellous allogeneic bone blocks were placed in 21 patients. The mean follow‐up was 37 months. Bone block survival rate was 79.3%. Mean horizontal and vertical bone gains were 5.6 and 4.3 mm, respectively. Mean buccal bone resorption was 0.5 mm at implant placement and 0.2 mm at second‐stage surgery. A total of 85 implants were placed. Mean bone thickness buccal to the implant neck was 2.5 mm at implant placement and 2.3 mm at second‐stage surgery. There was no evidence of vertical bone loss between implant placement and second‐stage surgery. Implant survival rate was 95.3%. All patients received a fixed implant‐supported prosthesis. At the last follow‐up, the mean marginal bone loss was 0.5 mm. The mean crown‐to‐implant ratio was 0.96. Conclusion: Implant placement in the posterior atrophic mandible following augmentation with cancellous freeze‐dried bone block allografts may be regarded as a viable treatment alternative.     

Peri‐implant soft tissue and bone crest alterations at fixed dental prostheses: a 3‐year prospective study

Objectives: The aim of this 3‐year prospective study involving patients receiving implant‐supported fixed dental prostheses (FDPs) was to longitudinally evaluate soft and hard tissue alterations from the time of implant placement. Material and methods: Sixteen subjects with 18 implant‐supported FDPs on 43 implants were included in the study. Peri‐implant soft and hard tissue assessments were performed at implant placement, 2, 6, 12, 24 and 36 months. Variables describing the peri‐implant soft tissue conditions and topography were assessed by clinical, photographic and study model assessments. Variables of implant position and bone topography were measured in radiographs taken at each examination interval. Multilevel regression models were formulated to identify factors of significance for proximal bone crest alterations and proximal soft tissue height. Results: During the first 6 months after the one‐stage implant placement surgery, the soft tissue margin receded about 0.6 mm at facial implant sites, while a mean increase was observed at tooth‐facing proximal sites (1.1 mm) and no change at inter‐implant sites. Loss in proximal bone crest height was more pronounced at inter‐implant than tooth–implant units at 6 months (0.6 vs. 0.1 mm). Between 6 and 36 months, no further significant soft or hard tissue changes were observed. Multilevel regression analysis revealed that the proximal bone crest level significantly influenced the proximal soft tissue height assessed from the implant/abutment level. Significant predictors for loss in proximal bone crest level over the 3 years were horizontal inter‐unit distance, type of proximal unit (tooth/implant or inter‐implant) and peri‐implant bone‐level change. Conclusions: Soft and hard tissue changes around implant‐supported FDPs took place primarily during the first 6 months after the one‐stage implant installation surgery. The pattern of tissue alterations during the follow‐up differed between tooth–implant and inter‐implant proximal sites. To cite this article:
Chang M, Wennström JL. Peri‐implant soft tissue and bone crest alterations at fixed dental prostheses: a 3‐year prospective study.
Clin. Oral Impl. Res. 21, 2010; 527–534.
doi: 10.1111/j.1600‐0501.2009.01874.x     

General genetic and acquired risk factors,and prevalence of peri‐implant diseases – Consensus report of working group 1

For decades, oral implants have been used successfully for the replacement of missing teeth. Nevertheless, peri‐implant diseases have become an increasingly important issue in daily practice. In this working group, the prevalence of peri‐implant mucositis and peri‐implantitis, as well as different general risk factors and their impact on the onset and progression of peri‐implant diseases, were discussed based on reviews reflecting the current state of evidence. The influence of smoking on the peri‐implant bone‐healing process and its association with peri‐implantitis has been explored in the current literature, demonstrating that smoking is an important risk indicator for the development of peri‐implantitis and implant loss. Compared with non‐smokers, smokers have a higher potential for pathological peri‐implant bone loss, which is also influenced by poor oral hygiene. Despite the fact that a growing number of genetic polymorphisms have been identified and related to periodontal diseases, there are still no genetic patterns that could act as adjuncts to clinical diagnostics in order to identify patients at higher risk of peri‐implant diseases. Long‐term medications, such as bisphosphonate therapy (> 3 years), may have an impact on implant loss. A higher incidence of implant failure was reported in patients using selective serotonin reuptake inhibitors in anti‐depression therapy. Alcoholism (defined as more than 5 units a day) has been associated with implant loss in retrospective and case–control studies, as well as in animal studies.     

Long‐term implant survival and success: a 10–16‐year follow‐up of non‐submerged dental implants

Objectives: The aim of the present study was to evaluate the long‐term results of dental implants using implant survival and implant success as outcome variables. Methods: Of the 76 patients who received 162 implants of the Straumann Dental Implant System during the years 1990–1997, 55 patients with 131 implants were recalled 10–16 years after implant placement for a complete clinical and radiographic examination, followed by a questionnaire that examined the degree of satisfaction. The incidence of biological and technical complications has been carefully analysed for each implant. Success was defined as being free of all these complications over the entire observation period. Associated factors related to peri‐implant lesions were analysed for each implant. Results: The long‐term implant cumulative survival rate up to 16 years was 82.94%. The prevalence of biological complications was 16.94% and the prevalence of technical complications was 31.09%. The cumulative complication rate after an observation period of 10–16 years was 48.03%, which meant that substantial amounts of chair time were necessary following implant placement. The majority of implant losses and biological complications were concentrated in a relatively small number of patients. Conclusion: Despite a relatively high long‐term survival rate, biological and technical complications were frequent. Patients with a history of periodontitis may have lower implant survival rates than patients without a history of periodontitis and were more prone to biological complications such as peri‐implant mucositis and peri‐implantitis. To cite this article :
Simonis P, Dufour T, Tenenbaum H. Long‐term implant survival and success: a 10–16‐year follow‐up of non‐submerged dental implants.
Clin. Oral Impl. Res. 21 , 2010; 772–777
doi: 10.1111/j.1600‐0501.2010.01912.x     

Prevalence and Predictive Factors for Peri‐Implant Disease and Implant Failure: A Cross‐Sectional Analysis

Background: Long‐term studies worldwide indicate that peri‐implant inflammation is a frequent finding and that the prevalence of peri‐implantitis correlates with loading time. Implant loss, although less frequent, has serious oral health and economic consequences. An understanding of predictive factors for peri‐implant disease and implant loss would help providers and patients make informed decisions. Methods: A cross‐sectional study was performed on 96 patients with 225 implants that were placed between 1998 and 2003. Implant placement data were collected from patient records, and patients presented for a clinical and radiographic follow‐up examination. Implant status and periodontal status were determined, the data were analyzed to determine the prevalence of peri‐implant disease or implant loss, and a predictive model was tested. Results: The mean follow‐up time for the patients was 10.9 years. The implant survival rate was 91.6%. Peri‐implant mucositis was found in 33% of the implants and 48% of the patients, and peri‐implantitis occurred in 16% of the implants and 26% of the patients. Individuals with peri‐implantitis were twice as likely to report a problem with an implant as individuals with healthy implants. Peri‐implantitis is associated with younger ages and diabetes at the time of placement and with periodontal status at the time of follow‐up. Implant loss is associated with diabetes, immediate placement, and larger‐diameter implants. Conclusions: One in four patients and one in six implants have peri‐implantitis after 11 years. The data suggest that periodontal and diabetes status of the patient may be useful for predicting implant outcomes.     

Food Impaction and Periodontal/Peri‐Implant Tissue Conditions in Relation to the Embrasure Dimensions Between Implant‐Supported Fixed Dental Prostheses and Adjacent Teeth: A Cross‐Sectional Study

Background: Food impaction and periodontal/peri‐implant tissue conditions were evaluated in relation to the embrasure dimensions between implant‐supported fixed dental prostheses (FDPs) and adjacent teeth. Methods: A total of 215 embrasures of 150 FDPs in 100 patients (55 males and 45 females, aged 27 to 83 years; mean age: 56 years) were included in the study. Clinical assessments of the periodontal/peri‐implant mucosal conditions, radiographic assessments of embrasure dimensions, and overall patient satisfaction were used as explanatory variables for the food impaction and periodontal/peri‐implant tissue conditions adjacent to implant‐supported FDPs in the generalized estimating equation (GEE) analysis. Results: Food impaction was reported in 96 (44.7%) of 215 embrasures between implant‐supported FDPs and adjacent teeth. Food impaction was reported more frequently in the embrasures with proximal contact loss than in those with tight contact (P = 0.009). Overall patient satisfaction was influenced negatively by food impaction in the proximal embrasures (P = 0.01). Among embrasure dimensions, only the embrasure surface area (ESA) significantly influenced food impaction (P = 0.03). Significant influences of various embrasure dimensions on the periodontal/peri‐implant mucosal conditions and bone level at the implant were found in the univariate and multivariate GEE analyses. Conclusions: Food impaction between implant‐supported FDPs and adjacent teeth occurred more frequently when proximal contact was lost and ESA increased. Food impaction negatively affected overall patient satisfaction. Embrasure dimensions influenced the periodontal/peri‐implant mucosal conditions and bone level at the implant.