Abstract
ObjectivesThe aim of the present study was to investigate whether peri-implant clinical parameters (modified plaque index (mPI), bleeding and/or suppuration on probing (B/SOP)) and local factors (type of prostheses, screw emergence, platform diameter, and abutment angulation) might contribute to the development of additional bone loss and peri-implantitis around dental implants.Materials and methodsTwo hundred seventy-seven external hex connection implants placed in the posterior maxilla of 124 patients were retrospectively evaluated. They were divided into two groups: physiologic bone loss < 2 mm (PBL) or additional bone loss ≥ 2 mm (ABL). GEE logistic regression was applied to evaluate the influence of type of prostheses (implant-supported single crown (ISSC), fixed partial denture (ISFPD), and full denture (ISFD)) and clinical parameters (mPI and S/BOP) on bone loss.ResultsAmong the 277 implants, 159 (57.4%) presented PBL and 118 (42.6%) presented ABL. Within the ABL group, 20.6% implants were diagnosed with peri-implantitis. mPI significantly correlated with the type of prosthesis and the highest value of mPI (index = 3) was observed in ISFD (23.8%). Moreover, peri-implantitis was more frequently associated with ISFD (32.79%) than ISSC and ISFDP (13.79% and 13.48, respectively)ConclusionsISFD in the posterior maxilla presented high rates of ABL and showed a higher prevalence of peri-implantitis. None of the local factors seemed to contribute to the development of these conditions. Further investigations are needed to prospectively support the results of the present study.Clinical relevancePatients rehabilitated with ISFD should be carefully monitored and have more frequent maintenance visits to prevent or control peri-implant bone loss.
Highlights
Peri-implant bone loss has a multifactorial pathogenesis and it is linked to a multitude of risk factors related to the dental implant, to the patient, and to the clinician [1, 2]
The clinical diagnosis of peri-implantitis remains a controversial issue since the absence of univocal diagnostic criteria and specific thresholds [9]; it has been reported that the determination of a physiological probing depth (PD) at implant sites is difficult [3] and that PD and bleeding on probing (BOP) did not seem to be correlated with the mean bone loss [9]
generalized estimating equations (GEE) logistic regression showed that a significantly greater probability to develop additional bone loss (ABL) (OR: 3.149; 95% confidence intervals (CI): 1.256–7.895) was found in implants with modified plaque index (mPI) 3 (Table 3)
Summary
Peri-implant bone loss has a multifactorial pathogenesis and it is linked to a multitude of risk factors related to the dental implant (i.e., surface modifications, position, type of prosthesis, implant-abutment connection, timing of loading), to the patient (i.e., systemic and local factors), and to the clinician (i.e., technical skills) [1, 2]. ABL was reported to be initiated and maintained over time by iatrogenic factors or local conditions, such as occlusal trauma, implant features, and prosthetic restorations [4, 7, 8]; in the presence of ABL along with inflammation of the peri-implant connective tissues (i.e., bleeding and/or suppuration), peri-implantitis can be claimed [3]. Periimplantitis is an inappropriate term to describe all the cases of crestal bone loss [11], progressive crestal bone loss around implants in the absence of clinical signs of soft tissue inflammation is a rare event [3]
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