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.

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.

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.

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.

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.