History of periodontitis increases risk for peri-implant disease
MedWire News: Patients with a history of periodontitis have an increased risk for peri-implant disease compared with periodontally healthy (PHP) adults, challenging the widely held belief that implants function better than natural teeth in this setting.
It has been assumed that, in patients with a history of periodontitis, replacement of natural teeth with implants is a viable strategy as the implants would perform better under these conditions.
However, recent research by Mario Roccuzzo (University of Torino, Italy) and colleagues published in Clinical Oral Implants Research, suggests that such patients are also at higher risk for peri-implant disease, requiring additional treatment.
They conclude: "[T]he approach for multiple preventive dental extractions and implant placement, based on the assumption that the implants perform better than teeth, should be followed with extreme caution."
The aim of the study was to compare the long-term outcomes of implants placed in patients with and without a history of periodontal disease.
One hundred and one patients were classified according to whether they were PHP (n=28), or were moderately (n=37) or severely (n=36) periodontally compromised (PCP).
These patients received a total of 246 implants. Eighteen implants were removed for biologic complications.
Following implant placement, patients followed an individualized supportive periodontal therapy (SPT) program and attended clinic for scheduled follow-up sessions. After 10 years, clinical measures were recorded in all patients including implant loss, plaque score, probing depth, and treatments required.
At 10 years, the number of implants that had a probing depth greater than 6 mm (a measure of periodontitis and peri-implant disease) were 2%, 16%, and 27% for PHP, moderately PCP, and severely PCP patients, respectively. The values for both PCP groups were significantly higher than that for the PHP group.
The proportion of patients not adhering to their SPT program was 14%, 41%, and 19% in the PHP, moderately PCP, and severely PCP groups, respectively. For the moderately and severely PCP groups, significant increases were found for both groups in the nonadherent groups for both the plaque score and the presence of bleeding on probing.
Antibiotic and/or surgical therapy was required in 11%, 27%, and 47% of PHP, moderately PCP, and severely PCP patients, respectively. The differences were statistically significant between PHP and severely PCP patients.
Following these results, the authors suggest that "patients with a history of periodontitis should be informed that they are at higher risk for peri-implant disease. Moreover, patients have to be strongly motivated to strictly adhere to SPT as it has proven to be a key factor in enhancing long-term outcomes of implant therapy by controlling re-infection."
By Iain Bartlett