Surgical treatment of peri‐implantitis: Prognostic indicators of short‐term results

Aim

To evaluate the clinical and radiographic short‐term (6 months) effect of surgical treatment of peri‐implantitis, and to identify prognostic indicators affecting the outcome using a multilevel statistical model.

Materials & Methods

A total of 143 implants (45 patients) with a diagnosis of progressive peri‐implantitis (progressive bone loss (PBL) ≥2.0 mm and bleeding on probing (BoP)/suppuration) received surgical treatment. Clinical and radiographic parameters were assessed 6 months postoperatively. Potential prognostic indicators on subject, implant and site level prior to surgery were analysed to evaluate the effect on individual and composite outcomes using multilevel logistic regression analysis.

Results

At the 6‐month evaluation, none of the implants demonstrated PBL and 14% of the implants were registered with the absence of bleeding and no pocket probing depth ≥6 mm. Multilevel regression analysis identified, among others, suppuration, pocket probing depth >8 mm, bone loss >7 mm and the presence of plaque as criteria associated with the outcome.

Conclusion

Resective peri‐implantitis surgery seemed to reduce the amount of peri‐implant inflammation. However, most of the sites continued to have BoP/suppuration. Thus, long‐term maintenance and evaluation is warranted. The effect of treatment was reduced by some prognostic indicators such as the presence of suppuration prior to interception and peri‐implant bone loss exceeding 7 mm.     

Influence of residual pockets on progression of periodontitis and tooth loss: results after 11 years of maintenance

Background: Limited evidence exists on the significance of residual probing pocket depth (PPD) as a predictive parameter for periodontal disease progression and tooth loss.
Aim: The aim of this study was to investigate the influence of residual PPD 5 mm and bleeding on probing (BOP) after active periodontal therapy (APT) on the progression of periodontitis and tooth loss.
Material and Methods: In this retrospective cohort, 172 patients were examined after APT and supportive periodontal therapy (SPT) for 3–27 years (mean 11.3 years). Analyses were conducted using information at site, tooth and patient levels. The association of risk factors with tooth loss and progression of periodontitis was investigated using multilevel logistic regression analysis.
Results: The number of residual PPD increased during SPT. Compared with PPD3 mm, PPD=5 mm represented a risk factor for tooth loss with odds ratios of 5.8 and 7.7, respectively, at site and tooth levels. The corresponding odds ratios for PPD=6 mm were 9.3 and 11.0 and for PPD7 mm 37.9 and 64.2, respectively. At patient level, heavy smoking, initial diagnosis, duration of SPT and PPD6 mm were risk factors for disease progression, while PPD6 mm and BOP30% represented a risk for tooth loss.
Conclusion: Residual PPD6 mm represent an incomplete periodontal treatment outcome and require further therapy.     

Intra‐oral pattern of tooth and periodontal bone loss between the age of 50 and 60 years. A longitudinal prospective study

Objective: In a 10‐year prospective study we analyzed (i) the intra‐oral pattern of and (ii) potential risk factors for tooth and periodontal bone loss in 50‐year‐old individuals. Methods: A randomized subject sample of 50‐year‐old inhabitants in the County of Värmland, Sweden, was examined at baseline and after 10 years. Data from full‐mouth clinical and radiographic examinations and questionnaire surveys of 309 (72%) of the individuals who were dentate at baseline were available for analysis. Non‐parametric tests and binary logistic multiple regression models were used for statistical analysis of the data. Results: 4.1% of the 7,101 teeth present at baseline, distributed among 39% of the subjects, were lost during the 10‐year interval. The incidence of tooth loss was highest among mandibular molars (7.5%) and lowest among canines (1.8%). The relative risk (RR) for tooth loss for endodontically compromised teeth was 4.1 and for furcation‐involved molars 2.4–6.5, depending on tooth position. Logistic regression analysis identified baseline alveolar bone level (ABL), endodontic conditions, CPITN score (Community Periodontal Index of Treatment Needs), tooth position, caries, and educational level as risk factors for tooth loss. The overall mean 10‐year ABL change was ?0.54?mm (S.E. 0.01). On a tooth level the ABL change varied between ?0.35?mm (mandibular molars) and ?0.79?mm (mandibular incisors). Smokers experienced a greater (20–131% depending on tooth type) mean bone loss than non‐smokers. The logistic regression model revealed that tooth position, smoking, and probing pocket depth ≥4?mm were risk factors for bone loss of >1?mm. No pertinent differences were observed with respect to risk factors for ABL change in the subgroup of non‐smokers compared to the results of the analysis based on the entire subject sample. Conclusion: Tooth loss was more common in the molar than in the anterior tooth regions, while periodontal bone loss had a random distribution in the dentition. The predominant risk factors identified with regard to further radiographic bone loss were ‘probing pocket depth ≥6?mm’ and ‘smoking’.     

Reliability of periodontal diagnostic tools for monitoring peri‐implant health and disease

The prevalence, causes and consequences of crestal bone loss at dental implants are a matter of debate. In recent years, a high prevalence of peri‐implant soft‐tissue inflammation, associated with peri‐implant bone loss, has been reported and the need for treatments similar to those offered for natural teeth affected by periodontitis has been proposed. This suggestion is based on the assumption that periodontal indices, such as probing pocket depth and bleeding on probing, are reliable indicators of the peri‐implant tissue conditions and good predictors of future bone loss. However, based on a critical review of the literature in the present paper, it is concluded that periodontal indices are not reliable either for identifying peri‐implant disease or for predicting future risk for peri‐implant crestal bone loss and implant failure. The long‐term experiences with dental implants, presented in the literature, indicate that the presence of bleeding on probing, probing pocket depths much larger than 4 mm and some bone loss seem to reflect, in most instances, normal conditions of well‐functioning dental implants, bearing in mind that healing of dental implants is the result of a foreign body reaction with the formation of scar tissue. Therefore, the use of probing pocket depth and bleeding on probing assessments may lead to over‐diagnosis and possibly to over‐treatment of assumed biofilm‐mediated peri‐implantitis lesions. It is the opinion of the authors of this review that a treatment should only be initiated when a clinical problem is present based on patient's symptoms (discomfort, pain), the presence of swelling, redness and pus, and significant crestal bone loss over time (as verified with radiographs). The treatment should aim at resolving the infection, which could include removal of the implant.     

A three-year prospective study of adult subjects with gingivitis. I: clinical periodontal parameters

AIM: The objective of this study was to monitor prospectively clinical parameters in subjects without signs of destructive periodontal disease who were involved in a primary prevention programme, and to determine the changes that occurred between yearly examinations over a 3-year period. MATERIAL AND METHODS: One hundred and twenty-six subjects aged at least 20 years with a maximum of two tooth sites with probing pocket depth (PPD)>4 mm and no proximal sites with clinical attachment loss participated in the study. Primary prevention was provided at baseline of the study and then every 6 months. Plaque, bleeding on probing (BoP) and PPD were scored at baseline, 1, 2 and 3 years. RESULTS: There were no significant changes in the plaque score over the 3 years. After year 1, the BoP score was significantly improved with 5.6%, while no further improvement in BoP was found at years 2 and 3. The mean PPD decreased from 2.3 to 2.1 mm over the 3 years (p<0.05). CONCLUSION: Although some individuals exhibiting minor signs of periodontal pathology may have benefited from the primary prevention, the overall clinical improvement was limited for such subjects in the present 3-year study.     

Bacterial markers vs. clinical markers to predict progression of chronic periodontitis: a 2‐yr prospective observational study

The aim of this study was to identify sites at risk for future progression, during 2 yr of maintenance, in patients with chronic periodontitis (CP), based on longitudinal clinical and microbiological monitoring. At baseline (2003), clinical and microbiological features were recorded in 50 patients with CP. Two microbial samples were obtained from each patient (one from a clinically healthy site and one from a periodontitis site) and these were analyzed using DNA–DNA hybridization involving 25 bacterial species. After non‐surgical periodontal therapy, clinical and microbiological re‐examinations were performed at the same or similar sites at 2 yr (2006) and 4 yr (2008) of maintenance. Plaque, bleeding on probing (BoP), and the number of sites with periodontitis (≥4 mm) and severe periodontitis (≥6 mm) all showed a significant decrease at 2 and 4 yr of maintenance after non‐surgical intervention. Checkerboard analysis revealed that various bacteria with a high colonization score (≥3) corroborated the clinical findings of pathology at 2003, 2006, and 2008. Different clusters of bacteria, not just the ‘red complex’, were able to predict progression of chronic periodontitis during 2 yr of maintenance (2006–2008). Therefore, quantified bacterial markers (reflecting bacterial load) and the clinical markers BoP and periodontal probing depth show comparable prediction of future disease condition.     

Retrospective study of teeth with a poor prognosis following non-surgical periodontal treatment

Aim: The aim of this retrospective study was to assess teeth with a poor prognosis and the proximal periodontium of adjacent teeth, and to identify the risk factors associated with the loss of teeth with a poor prognosis following non-surgical periodontal treatment.
Material and Methods: Teeth with a poor prognosis ( n =113), teeth adjacent to those of poor prognosis ( n =105) and non-adjacent teeth ( n =51) were evaluated in 25 non-smoking patients who had received supportive periodontal treatment for 5–16 years following non-surgical periodontal treatment at a university hospital.
Results: Probing pocket depth (PPD), percentage of alveolar bone loss, presence of tooth mobility and bleeding on probing in all teeth improved significantly after treatment. Logistic regression analysis showed that loss of teeth with a poor prognosis depended on the initial deepest PPD, tooth mobility and multi-rooted tooth.
Conclusions: Teeth with a poor prognosis did not affect the proximal periodontium of the adjacent teeth, and progression of periodontal disease in these teeth and adjacent teeth can be prevented by non-surgical periodontal treatment in non-smokers. The risk factors for loss of teeth with a poor prognosis were the initial deepest PPD, tooth mobility and multi-rooted tooth.     

Progression of Periodontitis and Tooth Loss Associated with Glycemic Control in Individuals Undergoing Periodontal Maintenance Therapy: A 5‐Year Follow‐Up Study

Background: Prospective studies that investigated the influence of glycemic control in the progression of periodontitis and tooth loss during periodontal maintenance therapy (PMT) programs have not previously been reported. The aim of the present study is to evaluate associations between glycemic control status and progression of periodontitis and tooth loss among individuals during PMT. Methods: A total of 92 individuals, all recruited from a prospective cohort with 238 participants undergoing PMT, participated in this study. Diabetes control was assessed according to percentage of glycated hemoglobin (HbA1c). Individuals were matched for sex and smoking and were divided into three groups: 23 individuals with diabetes and poor glycemic control (PGC), 23 individuals with diabetes and good glycemic control (GGC), and 46 controls with no diabetes (NDC). Full‐mouth periodontal examination, including bleeding on probing (BOP), probing depth (PD), and clinical attachment level, was performed at all PMT visits during a 5‐year interval. Results: Progression of periodontitis and tooth loss were significantly higher among PGC compared to GGC and NDC. The final logistic model in the final examination included: 1) for the progression of periodontitis, HbA1c ≥6.5% (odds ratio [OR] = 2.9), smoking (OR = 3.7), and BOP in >30% of sites (OR = 4.1); and 2) for tooth loss, HbA1c ≥6.5% (OR = 3.1), smoking (OR = 4.1), and PD 4 to 6 mm in ≤10% of sites (OR = 3.3). Conclusions: PGC individuals, especially smokers, presented with a higher progression of periodontitis and tooth loss compared to NDC and GGC individuals. This result highlights the influence of glycemic control in maintaining a good periodontal status.     

Elevated levels of salivary lactoferrin,a marker for chronic periodontitis?

Glimvall P, Wickström C, Jansson H. Elevated levels of salivary lactoferrin, a marker for chronic periodontitis? J Periodont Res 2012; 47: 655–660. © 2012 John Wiley & Sons A/S Background and Objective: Whole saliva is a complex mixture of fluids essential for the well‐being of the oral hard and soft tissues. Saliva contains numerous antimicrobial proteins that help protect the oral ecosystem from infectious agents. Chronic periodontitis is an infectious chronic inflammatory condition that affects the tooth‐supporting structures and leads to their destruction. The aim of the present study was to investigate differences in concentrations of salivary lactoferrin in subjects with and without periodontal disease and correlate these values with clinical variables associated with periodontal disease. Material and Methods: Stimulated whole saliva was collected from 17 subjects with chronic periodontitis and 17 periodontally healthy control subjects. Data relating to bleeding on probing, probing pocket depth and horizontal bone loss were registered. Concentrations of lactoferrin, lysozyme and IgA in stimulated whole saliva were quantified using ELISA. Results: Subjects with chronic periodontits showed higher concentrations of lactoferrin in stimulated whole saliva compared with periodontally healthy control subjects (p < 0.05). Salivary concentrations of lactoferrin were positively correlated with bleeding on probing (p < 0.001) and the number of sites with probing pocket depth ≥ 6 mm (p < 0.001). Conclusion: Lactoferrin is raised in stimulated whole saliva in subjects with chronic periodontitis and is correlated with probing pocket depth ≥ 6 mm.     

Plasma 25‐Hydroxyvitamin D Concentrations and Periodontal Disease in Postmenopausal Women

Background: Vitamin D has anti‐inflammatory and antimicrobial properties that, together with its influence on bone health, may confer periodontal benefit. Methods: Cross‐sectional associations (years 1997‐2000) between plasma 25‐hydroxyvitamin D concentration [25(OH)D] and periodontal measure were investigated among 920 postmenopausal women. Measures of chronic disease were defined based on: 1) alveolar crestal height (ACH) measures from intraoral radiographs and tooth loss and 2) Centers for Disease Control and Prevention (CDC)/American Academy of Periodontology (AAP) criteria using measures of clinical attachment level and probing depth (PD). Acute oral inflammation was assessed by the percentage of gingival sites that bled upon assessment with a probe. Logistic regression was used to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) for periodontal disease among participants with adequate [25(OH)D ≥50 nmol/L] compared with deficient/inadequate [25(OH)D <50 nmol/L] vitamin D status adjusted for age, dental visit frequency, and body mass index. Results: No association was observed between vitamin D status and periodontal disease defined by ACH and tooth loss (adjusted OR = 0.96, 95% CI = 0.68 to 1.35). In contrast, women with adequate compared with deficient/inadequate vitamin D status had 33% lower odds (95% CI = 5% to 53%) of periodontal disease according to the CDC/AAP definition and 42% lower odds (95% CI = 21% to 58%) of having ≥50% of gingival sites that bled. Conclusions: Vitamin D status was inversely associated with gingival bleeding, an acute measure of oral health and inflammation, and inversely associated with clinical categories of chronic periodontal disease that incorporated PD, an indicator of oral inflammation. However, vitamin D was not associated with chronic periodontal disease based on measures of ACH in combination with tooth loss.     

Retrospective comparison of clinical variables between compliant and non-compliant patients

BACKGROUND: The aim of this retrospective study was to evaluate if patients with moderate to advanced periodontitis had comparable periodontal conditions at baseline and during supportive periodontal therapy (SPT) whether they were compliant or not. METHOD: Patient-related variables were compared: age, tooth mobility, furcation involvement, number of teeth, pocket probing depth, plaque index. Compliant patients (n = 142) received complete periodontal treatment and were followed over at least 10 years (group A). Non-compliant patients either discontinued supportive periodontal therapy (n = 42, group B) or dropped out before or during periodontal surgery (n = 44, group C). RESULTS: At baseline, there were no significant differences between the 3 groups except for mobility. During SPT, mean pocket probing depth and plaque index differed significantly. CONCLUSION: These results indicate that non-compliant patients compared to compliant patients had similar periodontal conditions at baseline, but responded less favourably to periodontal surgery and maintenance.     

Maintenance of periodontal attachment levels in prosthetically treated patients with gingivitis or moderate chronic periodontitis 5-17 years post therapy

OBJECTIVES: The present retrospective analysis was performed to evaluate the long-term results of initial periodontal and fixed prosthodontic treatment in patients with gingivitis or moderate chronic periodontitis during post-therapeutic irregular maintenance of 5-17 years. MATERIAL AND METHODS: Thirty-four patients participated in the study. Baseline data were taken from the patients' records when the periodontal and the prosthetic treatment was finished. A follow-up examination was performed in conjunction with the radiographic examination including assessment of plaque, bleeding on probing, probing pocket depth, recession and probing attachment loss. Information regarding the oral hygiene habits of the subjects as well as the amount of dental and initial therapy received between the observation time was obtained from the patients' records. RESULTS: The results from the clinical trial revealed that during the mean examination period of 11 years only 31 teeth were lost. The remaining restored and non-restored teeth did not show any significant differences in attachment loss (from 2.9 mm to 3.0 mm) in spite of a higher plaque value at the follow-up examination (from 42% to 48%). The BoP remained stable in the same time period and scored 31% to 28%. CONCLUSIONS: The periodontal attachment levels were maintained during a prolonged period despite irregular maintenance care. This indicates that in a population of obviously decreased susceptibility to chronic periodontitis, it is possible that fixed reconstructions will not - even under suboptimal supportive care - jeopardize the periodontal status.     

Changes in the prevalence of residual pockets and tooth loss in treated periodontal patients during a supportive maintenance care program

Abstract. Bleeding on probing and the presence of deep periodontal pockets are considered to be the best site-specific indicators for periodontal disease progression during the maintenance phase of periodontal therapy. A major emphasis of supportive periodontal care (SPC) programs, therefore, has been the control of bleeding pockets. This investigation retrospectively evaluated the changes in the prevalence of bleeding on probing, periodontal pockets, bleeding periodontal pockets and the prevalence of tooth loss in a random sample of 273 periodontal patients participating in a supportive maintenance care program at a University Clinic. During an observation period of 67±46 months (range 5 months to 23 years), the overall incidence of all causes of tooth mortality was 0.23 ±0.49 teeth per patient per year of observation. 56% of subjects, however, did not experience any tooth loss, while less than 10% of patients lost more than 3 teeth. Thus, participation m the SPC program was effective in preventing tooth loss in the majority of patients. During the SPC period, however, a significant increase in the prevalence of periodontal pockets, and of bleeding on probing positive periodontal pockets, in particular, was observed. At completion of active periodontal therapy. 56.4% of patients were free from bleeding pockets. This decreased to a mere 13.6% at the latest SPC evaluation. The observed increases in the number of bleeding pockets was significantly associated with: longer times since completion of active periodontal therapy, more advanced periodontal diagnosis, higher %s of bleeding sites in the dentition, cigarette smoking, lack of inclusion of periodontal surgery in the active treatment phase, tooth loss, and the response to the active phase of periodontal treatment. The data presented in the paper indicate that the observed increase in the prevalence of bleeding pockets and tooth loss was not homogeneously distributed in the studied SPC population. better knowledge of risk indicators may lead to improved and more efficient risk management efforts during periodontal maintenance care.     

Periodontal risk assessment model in a sample of regular and irregular compliers under maintenance therapy: a 3-year prospective study

Background: The purpose of this study is to investigate the association of the periodontal risk assessment (PRA) model with the recurrence of periodontitis and tooth loss during periodontal maintenance therapy (PMT). Methods: In a prospective PMT program, 75 regular complier (RC) and 89 erratic complier (EC) patients were selected. A periodontal examination and PRA were performed after active periodontal therapy and after 3 years of PMT. Risk profiles (low, moderate, or high) of participants were evaluated, and the recurrence of periodontitis and tooth loss were analyzed using univariate and multivariate analyses. Results: RCs showed less recurrence of periodontitis and tooth loss than ECs (P <0.05). Rates of periodontitis recurrence in RCs and ECs were 2.7% and 3.4%, respectively, for the moderate‐risk profile and 6.7% and 11.2%, respectively, for the high‐risk profile. During PMT, 49 teeth (0.65 ± 1.4 teeth per participant) were lost in the RC group, and 70 teeth (0.78 ± 2.1 teeth per participant) were lost in the EC group. High‐risk profile participants showed more recurrence of periodontitis and lost significantly more teeth than did participants with moderate‐ or low‐risk profiles in RC and EC groups (P <0.05). Conclusion: The risk profile influenced the recurrence of periodontitis and tooth loss. RCs had less recurrence of periodontitis and less tooth loss. The PRA model can be useful in particularizing the risk of patients and adjusting recall intervals.     

Effects of smoking on healing response to non‐surgical periodontal therapy: a multilevel modelling analysis

Aim: To investigate the factors predicting non‐surgical periodontal treatment responses using multilevel multiple regression. Material and Methods: Forty men (mean 45.6 years) were recruited; 20 were smokers. A 12‐month reduction in probing pocket depth (PPD) and gain in probing attachment level (PAL) of 5814 sites were analysed, with 594 being initially diseased sites (initial PPD5 mm). Results: Variance Component models showed that site‐level variations contributed about 70–90% of the total variance. About a 10% reduction of the total variations of PPD reduction in initially diseased sites was achieved with the inclusion of the 10 predictors in the multilevel multiple regression. Multilevel multiple regression showed that three predictors, subject level: non‐smokers; tooth‐level: anterior teeth; and site level: sites without plaque at baseline, were significantly associated with a greater reduction in PPD in initially diseased sites over the 12‐month study period (p<0.05). No consistent predictor was found for PAL gain. Conclusion: Multilevel analysis was applied on periodontal treatment response data. Smokers showed less favourable PPD reduction at deep sites after non‐surgical periodontal therapy.     

Evaluation of a periodontal risk assessment model in subjects with severe periodontitis. A 5-year retrospective study

The aim of this study was to evaluate a well-established periodontal risk assessment tool in patients with severe periodontitis included in a supportive periodontal treatment (SPT) program. In total 20 individuals were included in the analysis. All subjects were randomly selected after successful periodontal treatment and at least 5 years SPT. Clinical and radiographic measurements were collected from patient records and analyzed according to the periodontal risk assessment model. Using the periodontal risk assessment model all subjects were classified as low, moderate, or high-risk patients. According to the model 7 patients were classified as moderate risk patients and 13 as high-risk patients. When comparing all the patients using only bleeding on probing (BoP) mean prevalence of 20% as a cut-off point, 15 patients were categorised as having low-moderate risk for periodontitis progression and 5 subjects as having high-risk for disease progression. The periodontal risk assessment model seems to overestimate the risk for disease progression. However the model is a suitable tool to visualize for both the clinician and the patient different variables of importance for periodontal health. The model is also beneficial to show how periodontal treatment can reduce further risk for periodontal disease.     

Influence of bonded composite resin cingulum rest seats on abutment tooth periodontal tissues: a longitudinal prospective study

This study aimed to examine the longitudinal influence of bonded composite resin cingulum rest seats on abutment tooth periodontal tissues in removable partial dentures (RPDs). Twenty-eight patients with RPDs were enrolled in the study. Thirty-one cingulum rest seats were prepared for an anterior tooth using composite resin and a standardized method for each patient. Periodontal indices such as probing pocket depth (PD), bleeding on probing (BoP), and tooth mobility (TM) were measured at the time of denture insertion (baseline) and at least 3 months postinsertion (up to 8 years). Control data were obtained from the remaining nonprepared anterior teeth on the other side of the arch. None of the bonded resin rest seats failed, but slight abrasion was observed in 3 rest seats. No significant differences were found in terms of PD, BoP, and TM between baseline and postinsertion data for abutments with bonded resin rest seats and controls. It is suggested that bonded composite resin cingulum rest seats can be used longitudinally without damaging the periodontal tissues of abutment teeth.     

Correlation between clinical parameters characterising peri-implant and periodontal health: A practice-based research in Spain in a series of patients with implants installed 4-5 years ago

Objectives: To explore peri-implant health (and relation with periodontal status) 4-5 years after implant insertion. Study Design: A practice-based dental research network multicentre study was performed in 11 Spanish centres. The first patient/month with implant insertion in 2004 was considered. Per patient four teeth (one per quadrant) showing the highest bone loss in the 2004 panoramic X-ray were selected for periodontal status assessment. Bone losses in implants were calculated as the differences between 2004 and 2009 bone levels in radiographs. Results: A total of 117 patients were included. Of the 408 teeth considered, 73 (17.9%) were lost in 2009 (losing risk: >50% for bone losses ≥7mm). A total of 295 implants were reviewed. Eight of 117 (6.8%) patients had lost implants (13 of 295 implants installed; 4.4%). Implant loss rate (quadrant status) was 1.4% (edentulous), 3.6% (preserved teeth), and 11.1% (lost teeth) (p=0.037). The percentage of implant loss significantly (p<0.001) increased when the medial/distal bone loss was ≥3 mm. The highest (p≤0.001) pocket depths were found in teeth with ≥5mm and implants with ≥3mm bone losses, with similar mean values (≥4mm), associated with higher rates of plaque index and bleeding by probing. Conclusions: The significant bi-directional relation between plaque and bone loss, and between each of these two parameters/signs and pocket depths or bleeding (both in teeth and implants, and between them) together with the higher percentage of implants lost when the bone loss of the associated teeth was ≥3 mm suggest that the patient's periodontal status is a critical issue in predicting implant health/lesion.     

Periodontal conditions in patients requesting dental implant treatment

Periodontal disease is considered a risk factor in dental implant treatment. The purpose of this study was to investigate the periodontal conditions in patients requesting dental implant therapy. A total of 169 patients visiting Department of Oral and Maxillo-Facial Implantology at Tokyo Dental College Chiba Hospital were targeted. The following intraoral parameters were measured in each patient: Community Periodontal Index (CPI) score, probing pocket depth (PPD), clinical attachment level (CAL) and bleeding on probing (BOP). Prevalence of patients with periodontal pockets was high: 38% and 28% of patients had a CPI score of code 3 and 4, respectively. Prevalence of teeth with one or more sites with PPD≥4mm was 27%. Moreover, clinical signs suggestive of periodontitis (PPD, CAL≥4mm) were found in 10-15% of tooth sites. Prevalence rates at sites with severe periodontal breakdown (PPD, CAL≥7mm) were 2-5%. These results further emphasize the importance of thorough periodontal assessment in patients prior to dental implant treatment.     

Five‐Year Changes in Periodontal Disease Measures Among Postmenopausal Females: The Buffalo OsteoPerio Study

Background: Understanding of longitudinal characteristics of periodontal disease in older females is limited. This study examined 5‐year changes in periodontal disease measures among postmenopausal females. Methods: Participants were 1,025 postmenopausal, 53‐ to 83‐year‐old females who completed baseline (1997 to 2001) and 5‐year follow‐up (2002 to 2006) whole‐mouth oral examinations in a study ancillary to the Women's Health Initiative. Periodontal disease was characterized using probing depth (PD), clinical attachment level (CAL), alveolar crest height (ACH), and tooth loss. Differences in measures between examinations were used to characterize patterns of change. Results: Baseline prevalence of none/mild, moderate, and severe periodontal disease defined using criteria of the Centers for Disease Control and Prevention was 27%, 58%, and 15%, respectively. Tooth loss attributable to periodontitis occurred in 13% of females. Mean ± SD changes in whole‐mouth mean measures showed progression when based on ACH (?0.19 ± 0.49 mm) yet relatively stable disease when based on PD (0.11 ± 0.42 mm) and CAL (0.06 ± 0.58 mm). Mean change in worst‐site ACH was greater (P <0.001) in females with severe periodontitis and osteoporosis at baseline and with tooth loss during follow‐up. Periodontal changes did not differ according to baseline age, hormone therapy use, smoking status, or age at menopause. Conclusions: Five‐year changes in periodontal measures among generally healthy postmenopausal females were, on average, small and did not suggest a consistent pattern of disease progression. Females with history of severe periodontitis or osteoporosis may experience accelerated oral bone loss despite stability or small improvement in routine probing measures.