Sonography in the diagnosis of peri-implant bone defects: An in vitro study on native human mandibles.

AIM: The aim of this study on native human cadavers was to compare clinical, sonographic, and radiological measurements of fenestrations, dehiscences, and 3-wall bone defects on implants. MATERIALS AND METHODS: The examination was carried out on five human mandibles. After the insertion of 27 implants, dehiscences (n = 14), fenestrations (n = 7) and 3-wall bone defects (n = 6) were prepared in a standardized manner. The direct measurement of the bone defects was carried out with a periodontal probe and the radiological examination was carried out using digital volume tomography (DVT). The ultrasound examination (US) was performed using a clinical 24-MHz US imaging probe. Means and standard deviations of the direct, US, and DVT measurements were calculated. Measurements were statistically compared using the Pearson correlation coefficient and Bland-Altman analysis. RESULTS: Bone defects were on average 3.22 ± 1.58 mm per direct measurement, 2.90 ± 1.47 mm using US, and 2.99 ± 1.52 mm per DVT assessment. Pairwise correlations of these measurements were R = .94 (p < .0001) between direct and US, R = .95 (p < .0001) between DVT and US, and R = .96 (p < .0001) between direct and DVT. The mean differences of the measurements (and 95% CI) between direct and US was 0.41 (-0.47 to 1.29), US and DVT 0.33 (-0.30 to 0.97), and direct and DVT 0.28 (-0.50 to 1.07). CONCLUSION: All peri-implant bone defects could be identified and sonographically measured. US measurements showed a strong correlation with direct and DVT measurements. The sonographic measurement accuracy was highest for dehiscences, followed by fenestrations and 3-wall bone defects.

The Influence of Crown-to-Implant Ratio on Crestal Bone Loss at Implants with Single Crowns and Bridges.

PURPOSE: To evaluate how the crown-to-implant (C/I) ratio affects the loss of crestal bone at single-crown implants and bridges in patients with periodontal disease. MATERIALS AND METHODS: Thirty-nine patients treated for periodontitis were rehabilitated with 108 implant-supported single crowns and bridges. Each patient was examined over a 5- to 20-year period on a 3 to 6-month recall schedule. At each session, we recorded periodontal clinical parameters. In addition, intraoral radiographs were taken after superstructure insertion (baseline) and then at 1, 3, 5, 10, 15, and 20 years. The study population was divided by anatomical C/I ratio (C/I ≤1, group 1 or C/I 1, group 2). RESULTS: Implants had a 96.2% 5-year survival rate, and 92.6% 20-year survival rate. The overall prevalence was 10.1% for mucositis and 1.1% for peri-implantitis. The survival rate (p = 0.68), mucositis (p = 0.325), or peri-implantitis (p = 0.077) did not significantly differ in the group comparison. The mean annual peri-implant bone loss was 0.09 0.41 mm and not significantly different between the groups. Mean bone loss was not significantly different until the 10th year of observation, during which group 2 presented significantly less bone loss. The correlation of annual bone loss and clinical C/I ratio showed a small but significant negative effect throughout the entire study period (R = -0.217; p <0.01). CONCLUSION: Increased crestal bone loss was not observed with implants with higher C/I ratios, both anatomical and clinical, and they even showed signs of less crestal bone loss.

Correlation between crestal bone loss and PPD at teeth and implants: a 5- to 20-year long-term cohort study in patients with treated periodontal disease.

OBJECTIVE: The correlation between crestal bone loss at teeth and probing pocket depth (PPD) has been established. Whether these findings can also be applied to implants is not known. The objective of this study was to determine the correlation between crestal bone loss and PPD at teeth and implants. METHOD AND MATERIALS: Thirty-one periodontitis-susceptible patients were rehabilitated with fixed implant-supported single crowns and fixed partial dentures. Each patient was examined over a 5- to 20-year period in a 3- to 6-month strict recall program. At each session, periodontal clinical parameters were recorded at teeth and implants. In addition, standardized periapical radiographs were taken after superstructure insertion (baseline) and then at 1, 3, 5, 10, 15, and 20 years. RESULTS: The survival rate of implants (94.0%) and teeth (97.3%) did not significantly differ in all patients after 20 years (P = .68). Almost all patients had a PPD ≥ 5 mm at implants and teeth throughout the observation period. The crestal bone loss at implants and teeth increased continuously, especially in patients with advanced periodontitis, without a correlation with PPD. A few patients (n = 5) had a PPD ≥ 5 mm and annual bone loss ≥ 0.2 mm at one implant, with a correlation between bone loss and PPD. CONCLUSION: In healthy implants and teeth, moderate crestal bone loss is present without correlation with PPD. A few patients showed progressive crestal bone loss at only one implant, with a correlation with PPD.

Implants in GBR-Augmented Sites in Patients Treated for Generalized Aggressive Periodontitis: A 10- to 20-Year Prospective Case Series.

The aim of this case series was to evaluate implants inserted in bone after guided bone regeneration (GBR). Fourteen patients with generalized aggressive periodontitis (GAP) who had lost one or two maxillary teeth in the incisor or premolar region were enrolled in the study. Due to bone resorption, the lateral width and vertical height of the bone were insufficient for implant placement. GBR was carried out in a staged approach using titanium-reinforced e-PTFE (expanded polytetrafluoroethylene) membranes. No bone grafts or bone substitute materials were used. After 6 to 8 months, turned-surface implants (n = 47) were inserted in augmented and nonaugmented bone sites and prosthetically treated with single crowns. All patients were examined during a 3- to 6-month recall schedule over a 10- to 20-year period, and clinical and radiographic examinations were performed. GBR yielded mean vertical and lateral bone gains of 4.5 and 7.0 mm, respectively. The implant survival rate was 100%, mucositis was present in 28.8% of sites, and peri-implantitis was not found. The annual bone loss at tooth sites was significantly higher than at implant sites in augmented bone (0.5% vs 0.2%, respectively; P = .000), and the adjacent teeth had significantly higher annual bone loss (0.8%; P = .000). Thus, severely periodontally compromised patients can be managed successfully in the long-term with the described clinical protocol.

Ultrasonography for noninvasive and real-time evaluation of peri-implant soft and hard tissue: a case series.

BACKGROUND: The diagnosis of soft and hard tissue at dental implants will be challenging in the future, as high prevalence of mucositis and peri-implantitis were described in the population. Ultrasonography is a promising non-invasive, inexpensive, painless, and radiation-free method for imaging hard and soft tissue at implants, especially an ultrasound device with a 25-MHz probe demonstrating a high correlation between ultrasound, clinical, and radiological measurements. CASE PRESENTATION: The following case series demonstrates the use of ultrasonography with high spatial resolution probe in patients with dental implants affected by soft tissue recession and/or crestal bone loss. CONCLUSION: These ultrasound images can provide valuable additional information for the assessment of peri-implant soft and hard tissue.

Turned surface implants in patients treated for periodontitis: Preliminary 10- to 20-year results of a long-term cohort study.

PURPOSE: This long-term cohort study investigated the prevalence of mucositis, peri-implantitis, bone loss and survival of turned surface implants in partially edentulous patients treated for periodontitis. MATERIALS AND METHODS: 19 patients treated for generalised chronic periodontitis (GCP) and 20 patients treated for generalised aggressive periodontitis (GAP) were orally rehabilitated with a total of 126 dental implants. Examinations were performed before implant insertion, at the time of superstructure insertion, and in the subsequent years during a 3-month recall schedule over a 10- to 20-year period. At every session, clinical parameters were recorded. Intraoral radiographs were taken after insertion of superstructures and 1, 3, 5, 10, 15 and 20 years later. RESULTS: In total, nine implants were lost during the 20-year observation period. The implant survival rate was 92.1% (GCP patients) and 90.1% (GAP patients). After 10 years, mucositis was present in 21.9% and 21.2% of implants in GCP and GAP patients, respectively. The risk of mucositis was significantly lower in patients with a removable superstructure (OR = 0.061 with P = 0.001). Peri-implantitis was present in 12.2% implants (GCP patients) and 14.1% implants (GAP patients). Implants inserted in bone quality grade 3 showed a significantly higher risk of peri-implantitis (OR = 5.658 with P = 0.003). After 10 years, implants in GAP patients did not show a significant higher bone loss (1.87 ± 1.40 mm) compared with implants in GCP patients (1.50 ± 1.30 mm). After 20 years, the total mean peri-implant bone loss was 1.98 ± 1.64 mm, almost every fifth implant revealed a bone loss > 3 mm. CONCLUSIONS: The implant survival rate in both patient groups was > 90%, and implants showed a moderate mucositis (< 30%) and peri-implantitis (< 25%) rate. Bone quality and type of superstructure seem to have had an influence on peri-implant health. These results suggest that patients with a history of periodontitis treated in a tight recall schedule can be successfully rehabilitated with turned surface implants for a follow-up period of 10 to 20 years.

Prosthodontic Treatment Outcomes in Periodontally Compromised Patients: A 6- to 20-Year Long-Term Cohort Study.

PURPOSE: To report and analyze long-term treatment outcomes in a patient cohort with severe periodontal disease treated with an employed protocol combining use of implants and double-crown prosthetic support. MATERIALS AND METHODS: A convenience sample of 16 patients with generalized severe periodontal disease were prosthodontically managed with support from 83 dental implants and 21 removable prostheses using a double-crown concept (11 implant-tooth supported and 10 implant supported). Each patient was examined 2 to 4 weeks before scheduled teeth extraction and examined again following treatment completion at the time of insertion of the superstructures. Subsequent recall examinations were performed every 3 months over a 6- to 20-year period. Predetermined clinical parameters were recorded at each session, and intraoral radiographs were taken after insertion of the superstructure and at intervals of 1, 3, 5, 10, and 20 years. RESULTS: No implant or tooth loss occurred during the individual observation periods. Mucositis was recorded around 65% of the implants and was accompanied by additional maxillary marginal bone loss around 27.7% of the implants. Mean marginal bone loss at implant sites after 5 years was 0.75 ± 0.66 mm, and after 20 years was 1.50 ± 1.45 mm. Moderate bone loss around teeth was registered after 5 years (2.8%) and 20 years (7.3%). No significant differences were found between implants in patients with tooth-implant-supported and those with implant-supported double-crown restorations. CONCLUSION: These results suggest that severely periodontally compromised patients can be successfully managed in the long term with the described clinical protocol.

A Double-Crown Concept for Restorations in Patients with Generalized Aggressive Periodontitis: Two Case Reports with 22- and 25-Year Follow-ups.

Implant-supported prosthetics are a suitable option for improving partially and totally edentulous patients' oral life quality, especially those patients with a history of periodontitis who experience early tooth loss and therefore require implant therapy. However, long-term clinical studies on dental implants have indicated that patients with periodontitis show more biologic complications and lower survival and success rates compared to periodontally healthy patients. The two clinical reports presented show that patients with aggressive periodontal diseases treated with a supportive periodontal therapy can be successfully rehabilitated with implant-supported double-crown restorations for a follow-up period of over 20 years.

Mucositis, peri-implantitis, and survival and success rates of oxide-coated implants in patients treated for periodontitis 3- to 6-year results of a case-series study.

AIM: The aim of this case-series study is to evaluate the prevalence of mucositis, peri-implantitis, and survival and success rates of oxide-coated implants in subjects treated for periodontitis. MATERIALS AND METHODS: Twenty-four subjects treated for generalized chronic periodontitis (GCP) and five treated for generalized aggressive periodontitis (GAP) were orally rehabilitated with a total of 130 dental implants. Subjects were examined 2 to 4 weeks prior to extraction of non-retainable teeth and at insertion of superstructure. Additional examinations were performed during a 3-month recall schedule over a 3- to 6-year follow-up period. Radiographs were taken after insertion of the superstructure and 1, 3, and 5 years later. RESULTS: The results showed implant survival rates of 97.1% in GCP subjects versus 96.2% in GAP subjects. The implant success rate was 77.9% in GCP subjects and 38.5% in GAP subjects. In GCP subjects, mucositis was present in 7.7% and peri-implantitis in 12.5% of the implants. In GAP subjects, 28.0% of the implants showed mucositis and 32.0% peri-implantitis. Implant failure, mucositis, and peri-implantitis were more evident in GAP subjects. Peri-implantitis was more prevalent for implants in the maxilla and implants >10 mm. After 5 years, the mean peri-implant bone loss in GAP subjects was 2.89 mm and in GCP subjects 1.38 mm. CONCLUSIONS: Periodontally diseased subjects treated in a supportive periodontal therapy can be successfully rehabilitated with oxide-coated dental implants for a follow-up period of 3- to 6-years. Implants in the maxilla and GAP subjects were more susceptible to mucositis and peri-implantitis, with lower implant survival and success rates.

Effectiveness of Computer-Based Training on Toothbrush Skills of Patients Treated With Crowns: A Randomized Controlled Trial.

BACKGROUND: This study was conducted to assess plaque removal skills in patients with fixed dental prostheses (FDP), and effectiveness of computer-based training (CBT) of different brushing techniques (Fones versus Bass technique in their common modifications). METHODS: Ninety-three patients with FDP were randomly allocated to one of three training groups: 1) C (control group); 2) F (Fones technique group); and 3) B (Bass technique group). All patients received CBT of the basics of toothbrushing. Group C received no further instructions while groups F and B received additional CBT of the modified Fones or the modified Bass technique, respectively. Plaque levels were assessed immediately after patients had been asked to perform oral hygiene to the best of their abilities. RESULTS: Prior to training, persistent plaque deposits were found at 80% of marginal sites of natural teeth immediately after patients had performed oral hygiene. Considerably fewer plaque deposits were found on FDP (43%). No significant group differences were observed 6 and 12 weeks after training, either for natural teeth or for FDP (all P >0.05). CONCLUSIONS: Plaque removal skills are low in patients with FDP. Apparently, they do not profit from CBT of the techniques studied here. Studies observing their actual brushing behavior should be conducted to elucidate reasons for their deficits and to explore why CBT does not work in this group of patients.

Width of Keratinized Mucosa at Implant Sites in Patients Treated for Generalized Aggressive Periodontitis: A Cohort Study.

PURPOSE: The aim of this cohort study was to evaluate the width of keratinized mucosa at implant sites of partially edentulous patients who were treated for generalized aggressive periodontitis. MATERIALS AND METHODS: Dental implants were placed in 35 patients who were treated for generalized aggressive periodontitis and 18 periodontally healthy individuals (controls). At baseline, the keratinized mucosa of all implants was ≥ 2 mm. Follow-up examinations were conducted every 3 months over a 4-year period. RESULTS: The implant survival rate was 97.3% in patients with generalized aggressive periodontitis and 100% in the control group. Four years after implant insertion, patients with generalized aggressive periodontitis had significantly higher clinical attachment levels at the teeth and implants compared with the controls. At all time points, in both groups the mean probing depth at the implants was significantly larger than at the teeth. The mean widths of keratinized mucosa and keratinized gingiva were not significantly different between the two groups. In both groups, the widths of keratinized mucosa and keratinized gingiva were significantly higher at the maxilla than at the mandible. Four years after baseline, the implants in the mandible showed the smallest keratinized mucosa (mean: ≤ 1 mm). CONCLUSION: During the first 4 years after implant placement, no significant changes in the keratinized mucosa at implants could be shown, either in periodontally healthy patients or in patients treated for generalized aggressive periodontitis. The keratinized gingiva at the teeth was generally significantly wider than the keratinized mucosa at the implants.

Manual versus sonic-powered toothbrushing for plaque reduction in patients with dental implants: an explanatory randomised controlled trial.

PURPOSE: The aim of the present study was to investigate plaque levels following sonic-powered and manual toothbrushing in subjects with dental implants. MATERIALS AND METHODS: This study included 36 male and 47 female partially edentulous patients (age range 45-78 years, mean age 59.8 years) that were randomly assigned to one of two treatment groups: the sonic toothbrush group (n = 42; Philips Sonicare FlexCare® toothbrush) or the manual toothbrush group (n = 41; Oral-B P40®). Clinical, microbiological and immunological examinations were performed blinded at baseline and after 3, 6, 9 and 12 months. Microbiological analyses were performed by real-time polymerase chain reaction. Immunological analyses (prostaglandin E2) were performed by chromatography-electrospray spectrometry. RESULTS: The plaque index difference between baseline and 12 months at implants showed no significant difference between sonic or manual toothbrushing in a two-sided Mann-Whitney test (W = 773.5, P = 0.426, 95% CI -0.64 to 0.20). At the end of the study, there were no significant changes in plaque index, bleeding on probing, gingival index, pocket probing depth, gingival recession, clinical attachment level or the microbiological and immunological outcomes at implants or teeth in either group. CONCLUSIONS: This study uncovered no significant difference between sonic and manual toothbrushing for plaque reduction at implants and teeth. Both toothbrushes maintain healthy peri-implant soft tissue.

Template-guided flapless implant insertion and prosthetic rehabilitation with telescopic crowns in a patient with treated generalized aggressive periodontitis: a case report.

Implant therapy offers a wide range of possibilities in prosthetics. Especially for completely edentulous patients with early tooth loss due to periodontitis, implant therapy is an option to regain a comfortable, esthetic dental rehabilitation. Several studies have indicated that osseointegrated implants can be placed successfully in periodontally compromised patients but with lower survival and success rates than in uncompromised patients. This case report describes a patient that received periodontal therapy for generalized aggressive periodontitis and achieved prosthetic rehabilitation 16 years later with telescopic crowns by means of template-guided flapless implant insertion. In particular, in patients with a history of periodontitis in which bone loss makes implant planning more complicated and in whom wound healing might be compromised, the approach presented in this paper describes a method that is predictable and minimally traumatic.

Mucositis, peri-implantitis, implant success, and survival of implants in patients with treated generalized aggressive periodontitis: 3- to 16-year results of a prospective long-term cohort study.

BACKGROUND: The aim of this prospective study is to evaluate the prevalence of mucositis, peri-implantitis, implant success, and survival in partially edentulous patients treated for generalized aggressive periodontitis (GAgP) and in periodontally healthy individuals. METHODS: Thirty-five patients treated for GAgP and 18 periodontally healthy patients orally rehabilitated with osseointegrated implants participated in the study. They were first examined 2 to 4 weeks before extraction of the non-retainable teeth (baseline) and 3 weeks after insertion of the final abutments. Additional examinations were performed during a 3-month recall schedule over a 5- to 16-year period (mean, 8.25 years). At every session, clinical parameters were recorded. At 1, 3, 5, 10, and 15 years after insertion of the superstructure, a microbiological and radiographic examination was performed. RESULTS: The results show implant survival rates of 100% in periodontally healthy individuals versus 96% in GAgP patients. The implant success rate was 33% in GAgP patients and 50% in periodontally healthy individuals. In GAgP patients, mucositis was present in 56% and peri-implantitis in 26% of the implants. In periodontally healthy individuals, 40% of the implants showed mucositis and 10% peri-implantitis. GAgP patients had a five times greater risk of implant failure, a three times greater risk of mucositis, and a 14 times greater risk of peri-implantitis. CONCLUSION: These results suggest that patients with treated GAgP are more susceptible to mucositis and peri-implantitis, with lower implant survival and success rates.

Three-dimensional measurement of bone loss at implants in patients with periodontal disease.

BACKGROUND: The aim of this prospective study is to evaluate the three-dimensional marginal bone level around implants 5 to 15 years after loading in partially edentulous patients treated for generalized chronic periodontitis (GCP) and generalized aggressive periodontitis (GAgP). METHODS: Seventeen patients with GCP and 17 patients with GAgP were treated with a total of 119 implants. Patients were examined clinically on a 3-month recall schedule after insertion of the superstructure, and radiographs were taken at fixed intervals. At the end of the observation period, cone-beam computed tomography was used for the analysis of the circumferential three-dimensional bone level (mesial, distal, buccal, and lingual/palatal) and determination of keratinized mucosa thickness (KMT). RESULTS: In both groups, a significant bone loss at implants was observed buccally (GAgP group: 4.49 ± 2.93 mm; GCP group: 3.57 ± 2.94 mm) with significantly more average bone loss in patients with GAgP (3.00 ± 1.67 mm) compared to in patients with GCP (2.45 ± 1.08 mm). The lowest values for KMT in both groups were found in the anterior mandible (GAgP group: 0.99 ± 1.13 mm; GCP group: 0.82 ± 0.91 mm). There were significant correlations between clinical parameters and bone loss in mandibles of patients with GAgP. CONCLUSIONS: The lowest value for KMT in both groups was found in the mandible. Bone loss was observed buccally and was more pronounced in patients with GAgP, with a significant correlation with keratinized mucosa and increased inflammation.

Comparison of two full-mouth approaches in the treatment of peri-implant mucositis: a pilot study.

OBJECTIVES: The aim of the present study was to test the hypothesis that an additional full-mouth disinfection results in a greater clinical and microbiological improvement compared with sole mechanical debridement within one session in patients with peri-implant mucositis and treated chronic periodontitis. MATERIAL AND METHODS: The study included 13 partially edentulous patients (mean age 51.5 years) with treated chronic periodontitis and 36 dental implants with mucositis (bleeding on probing and/or a gingival index > or =1 at least at one site at baseline, absence of peri-implant bone loss during the last 2 years before baseline). After randomized assignment to a test and a control group, patients received a one-stage full-mouth scaling with or without chlorhexidine. Clinical and microbiological examination was performed at baseline, after 1, 2, 4 and 8 months. Additional microbial samples were taken 24 h after treatment. Microbiological analysis was performed by real-time polymerase chain reaction. RESULTS: Both treatment modalities resulted in significant reductions of probing depth at implant sites after 8 months, with no significant group differences. The bacteria at implants and teeth could be reduced in every group 24 h after treatment; however, this reduction was not significant after 8 months. CONCLUSIONS: Both treatment modalities led to an improvement of the clinical parameters and a temporary reduction of the microflora at implants with mucositis, but without significant inter-group differences after 8 months.

One-stage full-mouth disinfection versus quadrant and full-mouth root planing.

OBJECTIVE: The aim of this study was to test the hypothesis that the one-stage full-mouth disinfection (FMD) provides greater clinical and microbiological improvement compared with full-mouth scaling and root planing (FM-SRP) within 24 h and quadrant scaling and root planing (Q-SRP) in patients with generalized chronic periodontitis. MATERIAL & METHODS: Twenty-eight patients were randomized into three groups. 25 patients completed the study and were the basis for analysis. The Q-SRP group was scaled quadrant-wise at 1-week intervals. The other groups received a one-stage full-mouth scaling with (FMD) and without (FM-SRP) chlorhexidine. At baseline, after 1, 2, 4 and 8 months clinical parameters were recorded and microbiological analysis was performed. RESULTS: All three treatment modalities resulted in significant clinical improvement at any time. There were only group differences after 1 and 2 months: in the FM-SRP group was a significantly higher reduction of probing depth and bleeding on probing compared with the other two groups. The bacteria could be reduced in every group although this reduction was only significant for Prevotella intermedia in the FMD group 8 months after treatment. CONCLUSION: All three treatment modalities lead to an improvement of the clinical and microbiological parameters, however, without significant group differences after 8 months.

Osseointegrated implants in subjects treated for generalized aggressive periodontitis: 10-year results of a prospective, long-term cohort study.

BACKGROUND: The aim of this prospective 10-year study of partially edentulous subjects treated for generalized aggressive periodontitis and periodontally healthy subjects was a clinical, microbiologic, and radiographic comparison of teeth and implants and assessment of the implants' success rate. METHODS: Five subjects treated for generalized aggressive periodontitis (GAgP) and five periodontally healthy subjects who were orally rehabilitated with osseointegrated implants participated in the study. First, they were examined 2 to 4 weeks before extraction of the non-retainable teeth (baseline) and 3 weeks after insertion of the final abutments. All further examinations were performed during a 3-month recall schedule over a 10-year period. At every session, clinical parameters were recorded, and the composition of the subgingival microflora was determined. Radiographs were taken at baseline after insertion of the superstructure and 1, 3, 5, 8, and 10 years later. RESULTS: Throughout the follow-up period, the peri-implant gingival index of GAgP subjects was significantly higher than in periodontally healthy subjects. There was no difference in plaque index between teeth and implants or between the two groups. The peri-implant probing depths were comparable in the two groups and remained < or =4 mm throughout the follow-up. The probing depth was significantly higher around the teeth of the GAgP subjects compared to periodontally healthy subjects. Implants of GAgP subjects showed a significantly higher attachment loss (Ø 2.4 mm). The attachment level at teeth and implants of the periodontally healthy subjects and at teeth of the GAgP subjects was almost unchanged. Microbiologically, GAgP subjects had fewer cocci and more motile rods and filaments at teeth and implants than periodontally healthy subjects. GAgP subjects showed significantly more peri-implant bone loss in the first year (Ø 2.07 mm) and in the subsequent 9 years (total 1.3 mm). Bone loss at teeth also was significantly higher at baseline (Ø 26.39%) and in the following years (total 9.3%). Implant survival rates were 100% in periodontally healthy subjects versus 83.33% in GAgP subjects. CONCLUSIONS: This 10-year study showed that partially edentulous subjects treated for GAgP can be rehabilitated successfully with osseointegrated implants. However, the bone and attachment loss at the implants were higher than in periodontally healthy subjects.

A telescopic crown concept for the restoration of partially edentulous patients with aggressive generalized periodontitis: a 3-year prospective longitudinal study.

This prospective longitudinal 3-year study compared clinical parameters and implant success rates of removable superstructures supported by both teeth and implants in patients with treated generalized aggressive periodontitis (GAP) and of cemented, implant-retained fixed superstructures in periodontally healthy patients. A total of 17 partially edentulous patients with 54 implants took part in the study. Nine patients with treated GAP received removable superstructures according to the Marburg double crown system, and eight periodontally healthy patients received fixed superstructures. Teeth were examined 2 to 4 weeks before extraction of the nonretainable teeth (baseline) and 3 weeks after insertion of the definitive abutments. Every 3 months over a 3-year period, clinical parameters were recorded and the composition of the subgingival microflora was determined. Intraoral radiographs were obtained at baseline, just after insertion of the superstructure, and 1 and 3 years later. Both groups showed mean plaque and gingival indices below 0.43 at implants and teeth. Mean probing depths around implants increased by approximately 0.7 mm and remained virtually constant for the teeth. Mean attachment loss at implants was 0.9 mm in GAP patients and 0.5 mm in healthy patients. The morphologic distribution of microorganisms in both groups showed healthy conditions. Moderate bone loss at teeth and implants was registered. Implant success rates were 100% in the healthy patients and 97.6% in the GAP patients. No significant differences were seen in the results between the groups.