Peri-implant health around screw-shaped c.p. titanium machined implants in partially edentulous patients with or without ongoing periodontitis

Aim of the study

The implication that bacteria responsible for causing periodontal disease are present is peri-implantitis can no longer be in doubt. But, what is the chronology of the periodontal and peri-implant destruction ? Is it simultaneous or does one follow the other ? This 4-year retrospective study leads us to an answer to this question.

Materials and methods

This study involved 289 implants in 84 partially edentulous patients (56 women and 28 men) with a mean age of 63 years. The bone levels were assessed with long cone radiographs, the usual periodontal indices were recorded (PI, PAL) and any habits noted (number of cigarettes).

Results

The success rate for the implants at 4 years was 95.8 %, which corresponds to the loss of 12 of the 289 implants. Over the same period, 12 subjects lost one tooth and 6 others lost 2 teeth due to periodontitis. The mean loss of bone around the teeth was 0.48 mm and the loss of attachment was 0.65 mm. In the cases suffering from advanced periodontitis, the bone loss was 0.99 mm and the loss of attachment 1.22 mm.

Around the implants, the observed bone loss was 0.09 mm and for those implants with more severe disease, 0.19 mm.

No evidence could be found for a correlation between the periodontal indices and peri-implant bone loss. Neither was there evidence to show whether or not cofactors such as smoking, loss of teeth, plaque, etc. aggravated the situation.

Conclusion

In partially edentulous patients with Brånemark implants, the presence of healthy or diseased periodontium did not seem to affect the amount of marginal bone loss.

Commentary

These results are truly a plea for the defence (no need for a referendum !) in favour of implant treatment in all situations, including subjects with healthy periodontia, with stabilised disease or even inflamed. If these results can be confirmed with implants with rough surfaces (TPS, SLA…), it is not worth dwelling on the vulnerability of implants due to the absence of an epithelium-connective tissue attachment « worthy of the name » (with Sharpey's fibres and the perpendicular insertion of connective tissue fibres). It should be emphasised that the brevity of this study (4 years) means that we should take a step back and treat the results with prudence and circumspection.