Implant surface roughness and patient factors on long‐term peri‐implant bone loss

Dental implant placement is a common treatment procedure in current dental practice. High implant survival rates as well as limited peri‐implant bone loss has been achieved over the past decades due to continuous modifications of implant design and surface topography. Since the turn of the millennium, implant surface modifications have focused on stronger and faster bone healing. This has not only yielded higher implant survival rates but also allowed modifications in surgical as well as prosthetic treatment protocols such as immediate implant placement and immediate loading. Stable crestal bone levels have been considered a key factor in implant success because it is paramount for long‐term survival, aesthetics as well as peri‐implant health. Especially during the past decade, clinicians and researchers have paid much attention to peri‐implant health and more specifically to the incidence of bone loss. This could furthermore increase the risk for peri‐implantitis, the latter often diagnosed as ongoing bone loss and pocket formation beyond the normal biological range in the presence of purulence or bleeding on probing. Information on the effect of surface topography on bone loss or peri‐implantitis, a disease process that is to be evaluated in the long‐term, is also scarce. Therefore, the current narrative review discusses whether long‐term peri‐implant bone loss beyond physiological bone adaptation is affected by the surface roughness of dental implants. Based on comparative studies, evaluating implants with comparable design but different surface roughness, it can be concluded that average peri‐implant bone loss around the moderately rough and minimally rough surfaces is less than around rough surfaces. However, due to the multifactorial cause for bone loss the clinical impact of surface roughness alone on bone loss and peri‐implantitis risk seems rather limited and of minimal clinical importance. Furthermore, there is growing evidence that certain patient factors, such as a history of periodontal disease and smoking, lead to more peri‐implant bone loss.     

Peri‐implant parameters in head and neck reconstruction: influence of extraoral skin or intraoral mucosa

Objective: This study is designed to assess dental implants supporting overdentures in edentulous patients with operated head and neck malignancies using parameters to detect peri‐implant disease. Material and methods: Thirty‐four implants supporting overdentures in 34 oral cancer patients were examined. Clinical parameters [plaque index, probing depth, bleeding on probing (BOP), origin of peri‐implant soft tissue, and amount of irradiation] were recorded, and microbiological identification of periodontal pathogens was carried out by DNA–DNA hybridization. To identify yeast species, the samples were cultivated on Sabouraud agar plates and subsequently identified by API 20C AUX plates. An implant site showing BOP, probing pocket depth (PPD)≥5 mm and radiographic vertical bone loss was considered to have peri‐implant disease. Results: Colonization by periodontal pathogens was found on 15 implants, while yeast species were found in 14 cases. Using a univariate analysis, none of the investigated parameters (microbiologic sign, detection of yeast, origin of peri‐implant soft tissue and irradiation) were significantly correlated to signs of peri‐implant disease. In the multivariate analysis, yeast [odds ratio (OR) 12.32, P=0.033] and periodontal pathogen (OR 9.88, P=0.046) were significant predictor variables for peri‐implant disease. Yeasts were less frequently detected around implants placed in re‐vascularized skin flaps if irradiation was set as a confounder (P=0.019). Conclusions: With respect to the pilot study nature of the study peri‐implant soft tissue origin and irradiation had little influence on the development of peri‐implant disease. Yeast and periodontal pathogen were explanatory variables for the development of peri‐implant disease. Considering the effect of irradiation on the prevalence of yeast, yeast was less frequently observed in peri‐implant soft tissue of the skin. Based on these data, future studies on the role of yeast and soft tissue in peri‐implant disease should be encouraged. To cite this article:
Kwon Y‐D, Karbach J, Wagner W, Al‐Nawas B. Peri‐implant parameters in head and neck reconstruction: influence of extraoral skin or intraoral mucosa.
Clin. Oral Impl. Res. 21 , 2010; 316–320.
doi: 10.1111/j.1600‐0501.2009.01763.x     

Radiographic evaluation of modern oral implants with emphasis on crestal bone level and relevance to peri‐implant health

Implant stability and maintenance of stable crestal bone level are prerequisites for the successful long‐term function of oral implants, and continuous crestal bone loss constitutes a threat to the longevity of implant–supported prosthetic constructions. The prevalence/incidence and reasons for crestal bone loss are under debate. Some authors regard infection (i.e. peri‐implantitis) as the cause for virtually all bone loss, while others see crestal bone loss as an unavoidable phenomenon following surgery and implant loading. Irrespective of the cause of continuous crestal bone loss, correct usage and scientifically sound interpretation of radiographs are of utmost importance for evaluation of oral implants. The periapical radiographic technique is currently the preferred method for evaluating implant health based on bone loss, and digital radiographs allow easy standardization of the image contrast. It is suggested that baseline radiographs should be taken at the time the transmucosal part pierces the mucosal tissues and annually thereafter. The number of unreadable radiographs should be presented in scientific publications to give insights into the quality of the radiographic examination. It is suggested that not only mean values, but also the range of bone levels, should be presented to describe the proportion of implants that show continuous crestal bone loss. In the absence of other clinical symptoms, bleeding on probing around implants seems to be a weak indicator of ongoing or future loss of crestal bone. According to recent longitudinal studies on modern implant surfaces peri‐implantitis defined as ‘infection with suppuration associated with clinically significant progressing crestal bone loss’ occurs with a prevalence of less than 5 % in implants with 10 years in function.     

Outcome of surgical treatment of peri-implantitis: results from a 2-year prospective clinical study in humans

Aim: The aim of the present study was to evaluate the outcome of a surgical procedure based on pocket elimination and bone re‐contouring for the treatment of peri‐implantitis. Material and methods: The 31 subjects involved in this study presented clinical signs of peri‐implantitis at one or more dental implants (i.e. ≥6 mm pockets, bleeding on probing and/or suppuration and radiographic evidence of ≥2 mm bone loss). The patients were treated with a surgical procedure based on pocket elimination and bone re‐contouring and plaque control before and following the surgery. At the time of surgery, the amount of bone loss at implants was recorded. Results: Two years following treatment, 15 (48%) subjects had no signs of peri‐implant disease; 24 patients (77%) had no implants with a probing pocket depth of ≥6 mm associated with bleeding and/or suppuration following probing. A total of 36 implants (42%) out of the 86 with initial diagnosis of peri‐implantitis presented peri‐implant disease despite treatment. The proportion of implants that became healthy following treatment was higher for those with minor initial bone loss (2–4 mm bone loss as assessed during surgery) compared with the implants with a bone loss of ≥5 mm (74% vs. 40%). Among the 18 implants with bone loss of ≥7 mm, seven were extracted. Between the 6‐month and the 2‐year examination, healthy implants following treatment tended to remain stable, while deepening of pockets was observed for those implants with residual pockets. Conclusion: The results of this study indicated that a surgical procedure based on pocket elimination and bone re‐contouring and plaque control before and following surgery was an effective therapy for treatment of peri‐implantitis for the majority of subjects and implants. However, complete disease resolution at the site level seems to depend on the initial bone loss at implants. Implants with no signs of peri‐implantitis following treatment tended to remain healthy during the 2‐year period, while a tendency for disease progression was observed for the implants that still showed signs of peri‐implant disease following treatment. To cite this article:
Serino G, Turri A. Outcome of surgical treatment of peri‐implantitis: results from a 2‐year prospective clinical study in humans.
Clin. Oral Impl. Res. 22 , 2011; 1214–1220.
doi: 10.1111/j.1600‐0501.2010.02098.x     

Diagnosis and non‐surgical treatment of peri‐implant diseases and maintenance care of patients with dental implants – Consensus report of working group 3

The following consensus report is based on four background reviews. The frequency of maintenance visits is based on patient risk indicators, homecare compliance and prosthetic design. Generally, a 6‐month visit interval or shorter is preferred. At these visits, peri‐implant probing, assessment of bleeding on probing and, if warranted, a radiographic examination is performed. Diagnosis of peri‐implant mucositis requires: (i) bleeding or suppuration on gentle probing with or without increased probing depth compared with previous examinations; and (ii) no bone loss beyond crestal bone level changes resulting from initial bone remodelling. Diagnosis of peri‐implantitis requires: (i) bleeding and/or suppuration on gentle probing; (ii) an increased probing depth compared with previous examinations; and (iii) bone loss beyond crestal bone level changes resulting from initial bone remodelling. If diagnosis of disease is established, the inflammation should be resolved. Non‐surgical therapy is always the first choice. Access and motivation for optimal oral hygiene are key. The patient should have a course of mechanical therapy and, if a smoker, be encouraged not to smoke. Non‐surgical mechanical therapy and oral hygiene reinforcement are useful in treating peri‐implant mucositis. Power‐driven subgingival air‐polishing devices, Er: YAG lasers, metal curettes or ultrasonic curettes with or without plastic sleeves can be used to treat peri‐implantitis. Such treatment usually provides clinical improvements such as reduced bleeding tendency, and in some cases a pocket‐depth reduction of ≤ 1 mm. In advanced cases, however, complete resolution of the disease is unlikely.     

Chronic hyperglycemia as a risk factor in implant therapy

It has been estimated that by 2030, the number of patients with diabetes aged > 64 years will be > 82 million in underdeveloped countries, and > 48 million in developed countries. Chronic hyperglycemia delays wound healing by reducing the expression of growth factors in the wound fluid and re‐epithelialization. Impaired wound healing in patients with diabetes has also been associated with inhibition of the production of stromal cell‐derived factor‐1alpha by several tissues including bone marrow, brain, heart, spleen, and gingivae. Chronic hyperglycemia interferes with the osseointegration of implants by deferring the expression of fibronectin and integrins. Results from experimental studies have shown a significantly higher bone‐to‐implant contact around implants placed in healthy animals compared with animals with streptozotocin‐induced diabetes. Moreover, persistent hyperglycemia plays a role in abnormal differentiation of osteoclasts, thereby making bone tissue more susceptible to resorption. Furthermore, persistent hyperglycemia has also been associated with increased peri‐implant soft tissue inflammation (increased peri‐implant bleeding on probing and probing depth) and crestal bone loss. Clinical studies have shown that under optimal glycemic control dental implants can show success and survival rates of up to 100% in patients diagnosed with diabetes. Although patients with diabetes can undergo dental implant therapy and can exhibit implant survival similar to those in systemically healthy individuals, the contribution of glycemic control and regular oral hygiene maintenance cannot be disregarded.     

Periodontal parameters of osseointegrated dental implaits. A 4‐year controlled follow‐up study

The aim of this study was to evaluate the periodontal parameters of osseointegrated dental implants. The condition of the peri‐implant mucosa was assessed using periodontal parameters, i.e., of plaque index, bleeding on probing, probing pocket depth, probing attachment level and Periotest® scores as well as a radiographic parameter, over a 4‐year follow‐up period. 32 non‐submerged ITI dental implants, all placed in the mandible, were studied in 12 patients who had good oral hygiene. All patients were regularly recalled at 6‐month intervals. The overall implant success rate was 100%. None of the implants showed any signs of inflammation, radiographic bone loss or any detectable mobility during the follow‐up period. Methods similar to those used to evaluate the natural dentition were effectively employed to assess the clinical status of the dental implants. The diagnostic value of these parameters could not, however, be determined from this study due to the absence of any peri‐implant tissue complications. The results indicated that some periodontal parameters of healthy peri‐imolant mucosa might be slightly different from healthy periodontal tissue.     

Implant Patient Compliance Varies by Periodontal Treatment History

Background: This retrospective study aims to assess compliance to supportive periodontal therapy (SPT) among patients treated with dental implants with different periodontitis histories and the possible influence of their compliance on peri‐implant marginal bone level. Methods: Dental records of 106 patients treated with at least one dental implant were reviewed. A single operator who did not provide care to the patients recorded the following during the first year of implant function (first year of follow‐up), during the first 5 years of follow‐up, and during the entire follow‐up duration: 1) number of recalls; 2) compliance, calculated from registered attendance; 3) periodontal disease history; 4) peri‐implant radiographic bone level from most recent examination; and 5) clinical parameters including probing depth and bleeding on probing. Clinical and radiographic parameters were assessed at site level and analyzed for possible associations among them and with demographic parameters. Results: Collected data were based on 156 implants with an average of 6.5 ± 3.4 years (range: 1 to 13 years) in function. Patients with periodontitis history demonstrated greater compliance than patients without periodontitis history during the two longer follow‐up times. Over time, the majority of patients demonstrated partial compliance (71% to 80% of patients). Peri‐implant bone level averaged 0.9 ± 1.1 mm, without significant association with compliance level; however, positive periodontitis history and more years in function were significantly associated with greater peri‐implant bone loss. Conclusions: Patients with implants partially comply with scheduled SPT, regardless of periodontitis history. Patients who had received periodontal treatment demonstrated better compliance than those without prior periodontal therapy experiences.     

Analysis of cathepsin-K activity at tooth and dental implant sites and the potential of this enzyme in reflecting alveolar bone loss

Background: Cathepsin‐K is an enzyme involved in bone metabolism which may make this feature important for both natural teeth and dental implants. The aims of the present study are to comparatively analyze the gingival crevicular fluid (GCF)/peri‐implant sulcus fluid (PISF) cathepsin‐K levels of natural teeth and dental implants, and to assess the potential relationship between this biochemical parameter and alveolar bone loss around natural teeth and dental implants. Methods: Probing depth, bleeding on probing, gingival index, and plaque index clinical parameters were assessed, and GCF/PISF samples were obtained from natural teeth/dental implants presenting with either clinical health, gingivitis/peri‐implant mucositis, or chronic periodontitis/peri‐implantitis. Cathepsin‐K activity levels of 42 GCF samples and 54 PISF samples were determined, and marginal bone loss (MBL) measures were calculated from digitalized standardized intraoral periapical radiographs obtained from natural teeth and dental implants by using cemento‐enamel junction and the actual distance between two consecutive threads of the dental implant as reference points for natural teeth and dental implants, respectively. Results: Comparing the natural teeth group with dental implant group with regard to MBL measure, cathepsin‐K activity, and GCF/PISF volume revealed no significant differences. In both natural teeth and dental implant groups, despite higher MBL measures, cathepsin‐K activity, and GCF/PISF volumes with the presence of inflammation, it was the presence of alveolar bone loss that lead to significantly higher values for these parameters. Conclusion: We suggest cathepsin‐K as a biochemical parameter for monitoring periodontal/peri‐implant alveolar bone loss.     

Periodontal considerations of implants and implant associated microbiota

The scientific and clinical acceptance of the success of osseointegrated dental implants has been firmly established, but the relationships between clinical observation and periimplant pathogenesis is not well understood. Data and concepts regarding the diagnostic value of traditional periodontal evaluation parameters, such as pocket probing depth, bleeding on probing, attachment loss, gingival and plaque indices, and the amount of attached gingiva are discussed. The microbiologic characterization of plaque associated with various implant systems reveals many similarities and some differences compared to natural teeth. An hypothesis for the "periodontal" etiology of implant failure is proposed. The maintenance of edentulous and partially edentulous patients with implants is discussed.     

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.     

Peri-implantitis: from diagnosis to therapeutics

Peri‐implantitis is an infection of the tissue around an implant, resulting in the loss of supporting bone. Risk factors for peri‐implantitis consist of a history of periodontitis, dental plaque, poor oral hygiene, smoking, alcohol consumption and diabetes. A clinical diagnosis indicates inflammatory signs including bleeding on probing with or without suppuration and a peri‐implant pocket depth ≥5 mm. A radiograph shows images of marginal bone loss ≥2 mm. A differential diagnosis of peri‐implant mucositis, occlusal overload, retrograde peri‐implantitis and inflammatory implant periapical lesions suggests the appropriate treatment in each case. The non‐surgical treatment of peri‐implantitis, including a mechanical treatment alone or combined with antiseptics or antibiotics can improve clinical parameters in the short term but residual defects may still persist. Surgical treatment such as guided bone regeneration results in a gain of clinical attachment level and bone reconstruction in the long term. The limited effect of laser‐assisted therapy needs to be further evaluated. The concept of prevention based on early detection and regular maintenance plays a principal role in reducing the occurrence of peri‐implantitis.     

Correlation between different genotypes of human cytomegalovirus and Epstein-Barr virus and peri-implant tissue status

Background: The purpose of this study was to estimate the prevalence of different genotypes of human cytomegalovirus (HCMV) and Epstein‐Barr virus (EBV) in peri‐implantitis and mucositis sites, and to evaluate the correlation between herpesvirus presence and clinical parameters. Methods: A total of 80 dental implants (mean time of loading, 4.16 ± 1.8 years) were evaluated during the course of the study (30 peri‐implantitis, 25 mucositis and 25 healthy peri‐implant sites). The following clinical parameters were assessed: visible plaque index, bleeding on probing, suppuration and probing depth. A polymerase chain reaction (PCR) assay was used to identify the presence of different HCMV and EBV genotypes in peri‐implant tissue plaque samples. Results: HCMV‐2 was detected in 53.3% and EBV‐1 in 46.6% of the 30 peri‐implantitis sites evaluated. By contrast, HCMV‐2 was not detected in healthy periodontal sites and EBV‐1 was detected in one healthy site. A statistically significant correlation was found between the presence of HCMV‐2 and EBV‐1 genotypes and clinical parameters of peri‐implantitis. Conclusions: The results from the present study confirmed the high prevalence of HCMV‐2 and EBV‐1 in the peri‐implant tissue plaque of peri‐implantitis sites and suggests a possible active pathogenic role of the viruses in peri‐implantitis.     

Ten Years Later. Results from a Prospective Single‐Centre Clinical Study on 121 Oxidized (TiUnite™) Brånemark Implants in 46 Patients

Background: Concerns have been raised that use of surface‐modified implants may result in peri‐implant infection and marked marginal bone loss over time. Purpose: The aim of this prospective study was to evaluate the survival rate, marginal bone, and soft tissue conditions at surface‐modified titanium dental implants after 10 years of function. Material and Methods: Forty‐six totally and partially edentulous patients were provided with 121 Brånemark oxidized implants (TiUnite?, Nobel Biocare AB, Gothenburg, Sweden). Twenty‐four (20%) implants were immediate loaded and 97 (80%) were placed using a two‐stage procedure. A total of 22 single, 23 partial, and 7 total restorations were delivered. Clinical and radiographic checkups were carried out after 3, 6, 12 months, and thereafter annually up to 10 years. At these occasions, oral hygiene was evaluated and peri‐implant mucosa examined by probing. If needed, patients were enrolled in an individual program for hygiene controls and professional cleaning. Marginal bone loss was evaluated in intraoral radiographs taken at baseline and after 1, 5, and 10 years of function. Results: One (0.8%) implant failed after 8 years giving a Survival Rate (SR) of 99.2% after 10 years. A total of 11 sites (9.2%) showed bleeding on probing (BP) at the 10th annual checkup. The mean marginal bone loss was 0.7 ± 1.35 mm based on 106 readable pairs of radiographs from baseline and from the 10th annual examination. Twelve (11.3%) implants showed more than 2 mm bone loss, and five (4.7%) showed more than 3 mm of bone loss after 10 years. For the latter, all patients were smokers and had poor or acceptable oral hygiene. All five implants with >3 mm bone loss showed BP and two (1.9%) showed suppuration from the pocket. For the remaining seven implants with more than 2 mm bone loss, no correlation to smoking, oral hygiene, bleeding, or pus could be seen. Time/marginal bone level plots of the 12 implants with more than 2 mm bone loss after 10 years, showed minor changes from the first annual checkup except for the two infected implants. Conclusions: It is concluded that good long‐term clinical outcomes can be obtained with oxidized titanium dental implants. Only 1.9% of examined implants showed significant marginal bone loss together with bleeding and suppuration after 10 years of function.     

Comparison of Peri‐Implant Soft Tissue Parameters and Crestal Bone Loss Around Immediately Loaded and Delayed Loaded Implants in Smokers and Non‐Smokers: 5‐Year Follow‐Up Results

Background: The aim of this study is to compare peri‐implant soft tissue parameters (plaque index [PI], bleeding on probing [BOP], and probing depth [PD] ≥4 mm) and crestal bone loss (CBL) around immediately loaded (IL) and delayed loaded (DL) implants in smokers and non‐smokers. Methods: Thirty‐one patients with IL implants (16 smokers and 15 non‐smokers) and 30 patients with DL implants (17 smokers and 13 non‐smokers) were included. Personal data regarding age, sex, and duration and daily frequency of smoking were gathered using a questionnaire. Peri‐implant PI, BOP, and PD ≥4 mm were recorded, and mesial and distal CBL was measured on standardized digital radiographs. Multiple group comparisons were performed using the Bonferroni post hoc test (P <0.05). Results: All implants replaced mandibular premolars or molars. Mean scores of PI (P <0.05) and PD ≥4 mm (P <0.05) were statistically significantly higher in smokers compared with non‐smokers in patients with IL and DL dental implants. The mean score of BOP (P <0.05) was statistically significantly higher in non‐smokers compared with smokers in both groups. CBL (P <0.05) was statistically significantly higher in smokers compared with non‐smokers in both groups. There was no statistically significant difference in PI, BOP, PD ≥4 mm, and total CBL among smokers with IL and DL implants. Conclusions: Tobacco smoking enhances peri‐implant soft tissue inflammation and CBL around IL and DL implants. Loading protocol did not show a significant effect on peri‐implant hard and soft tissue status in healthy smokers and non‐smokers.     

A 10-year prospective clinical and radiographic study of one-stage dental implants

OBJECTIVE: The purpose of this prospective study was to evaluate one-stage dental implants clinically and radiographically after 10 years in function. MATERIAL AND METHODS: Twenty-five patients with a total of 68 implants [46 hollow screws (HS) and 22 hollow cylinders (HC)] who previously participated in 5-year prospective clinical study returned for a 10-year follow-up. For each patient, informed consent was obtained, medical and dental history was reviewed and soft and hard tissue conditions were evaluated using the modified plaque index, modified sulcus bleeding index, probing depth, suppuration, attachment level, distance from the implant crown margin to the coronal border of the peri-implant mucosa keratinized mucosa and periapical radiographs to calculate crestal bone-level changes. RESULTS: As expected, the mean crestal bone-level changes were the greatest in the first year following restoration placement, while only minimal changes were noticed in the subsequent years. HC implants showed a statistically significant higher mean crestal bone loss when compared with HS implants at year 10. Gender was also statistically significantly related to the mean crestal bone loss at years 1, 3, 5 and 10, with male subjects exhibiting more bone loss than female subjects. However, age and peri-implant soft tissue parameters showed low levels of correlation with the mean crestal bone-level changes, and proved to be weak predictors for the mean crestal bone loss at years 5 and 10. CONCLUSIONS: This study confirms that the mean crestal bone loss rates of the HS and HC implants are well within the clinically acceptable parameters. In addition, some of the clinical parameters could be used to assess and predict future crestal bone loss.     

Radiological and clinical follow-up of machined- and anodized-surface implants after mean functional loading for 33 months

Abstract: The purpose of this retrospective study was to compare peri‐implant bone loss and mucosal conditions around machined‐surface (MS) and anodized‐surface (AS) interforaminal implants in the mandible at least 30 months after placement. Fifty patients, each treated with four interforaminal screw‐type implants consecutively, were included. Thirty‐one patients (62%) with a total number of 124 implants (64 MS and 60 AS implants, both Brånemark type MKIII) were available for follow‐up. Rotational panoramic radiographs were used for evaluating marginal bone loss. Clinically, marginal plaque index (mPI), bleeding on probing (BOP) and pocket probing depth (PPD) were evaluated. AS implants showed significantly less marginal bone loss than MS implants (−1.17±0.13 vs. −1.42±0.13 mm; P=0.03). Marginal bone loss around distal implants was less pronounced at AS implants (−1.05±0.14 mm) when compared with MS implants (−1.46±0.14 mm; P=0.05). Within the smoking group, there was less peri‐implant bone loss around AS implants than around MS implants (−1.08±0.27 vs. −1.83±0.2; P=0.04). No differences between MS and AS implants were found with respect to mPI (57% vs. 67%), BOP (21% vs. 17%) and mean PPD (2.59±0.29 vs. 2.56±0.28 mm). Overall, both types of implants, in combination with bar‐supported overdentures, can produce excellent long‐term results in the interforaminal edentulous mandible with less peri‐implant bone loss around rough implant surfaces, which had beneficial effects at distal implants and in smokers.     

Clinical follow-up of unilateral, fixed dental prosthesis on maxillary implants

Aims/Background: The aims of the present study were to evaluate (1) the success rate of unilateral maxillary fixed dental prosthesis (FDPs) on implants in patients at a periodontal clinic referred for periodontal treatment, (2) the prevalence of varying mechanical and biological complications and (3) effects of potential risk factors on the success rate. Material and methods: Fifty consecutive patients were invited to participate in a follow‐up. The patients had received FDPs on implants between November 2000 and December 2003 after treatment to achieve optimal peridontal health, and the FDPs had been in function for at least 3 years. A questionnaire was sent to the patients before the follow‐up examination. Forty‐six patients with 116 implants were examined. The follow‐up comprised clinical and radiographic examinations and evaluations of treatment outcome. Results: Before implant treatment, 13% of the teeth were extracted; of these, 80% were extracted due to periodontal disease. No implants had been lost before implant loading. One implant in one patient fractured after 3 years of functional loading and three implants in another patient after 6.5 years. The most frequent mechanical complications were veneer fractures and loose bridge screws. Patients with peri‐implant mucositis had significantly more bleeding on probing around teeth and implants. Patients with peri‐implantitis at the follow‐up had more deep periodontal pockets around their remaining teeth compared with individuals without peri‐implantitis, but these differences were not significant. Smokers had significantly fewer teeth, more periodontal pockets ≥4 mm and a tendency towards greater marginal bone loss at the follow‐up, compared with non‐smokers. Conclusion: In the short term, overloading and bruxism seem more hazardous for implant treatment, compared with a history of periodontitis. To cite this article:
Wahlström M, Sagulin G‐B, Jansson LE. Clinical follow‐up of unilateral, fixed dental prosthesis on maxillary implants
Clin. Oral Impl. Res. 21 , 2010; 1294–1300.
doi: 10.1111/j.1600‐0501.2010.01948.x     

Comparison of peri‐implant clinical and radiographic status around short (6 mm in length) dental implants placed in cigarette‐smokers and never‐smokers: Six‐year follow‐up results

Background

It is hypothesized that peri‐implant clinical and radiographic inflammatory parameters (probing depth [PD], bleeding on probing [BOP] and plaque index [PI]; and radiographic (crestal bone loss [CBL]) are worse among cigarette‐smokers (CS) compared with never‐smokers (NS) with short implants.

Purpose

The present 6‐year follow‐up retrospective study compared the peri‐implant clinical and radiographic parameters in CS and NS with short dental implants (6 mm in length).

Materials and methods

Fifty‐six male individuals were included. These individuals divided into 2 groups as follows: (a) Group‐1: 29 self‐reported systemically healthy CS with 48 short‐implants; and (b) Group‐2: 27 self‐reported systemically healthy NS with 43 short implants. Peri‐implant PD, PI, BOP, and CBL were measured. Group comparisons were done using the Kruskal‐Wallis test and sample size was estimated. Level of significance was set at P values < .05.

Results

In groups 1 and 2, the follow‐up durations were 6.2 ± 0.1 years and 6.1 ± 0.3 years, respectively. A cigarette smoking history of 8.9 ± 3.6 pack years was reported by individuals in Group‐1. At follow‐up, scores of peri‐implant PD, BOP, PI, and mesial and distal CBL were comparable around short implants in both groups.

Conclusion

Under strict oral hygiene maintenance protocols, short dental implants can remain functionally stable in CS in a manner similar to NS.