Page 133 - Peri-implant health: the effect of implant design and surgical procedure on bone and soft tissue stability

IMPROVEMENT OF QUALITY OF LIFE WITH IMPLANT-SUPPORTED MANDIBULAR OVERDENTURES AND THE EFFECT OF IMPLANT TYPE AND SURGICAL PROCEDURE ON BONE AND SOFT TISSUE STABILITY
statistically significant, and the moderate increase of implant surface roughness has no beneficial effect on long-term preservation of the peri-implant marginal bone level. A more detailed analysis of the paper revealed, however, that none of the 32 evaluated smooth implants showed more than 3 mm bone loss, whereas 3 out of the 32 modified implants showed bone loss between 3 and 6 mm. Only two smooth surface implants were diagnosed with peri-implantitis compared with five implants with a modified surface.53
The findings of our paper are in accordance with the paper of Donati and co- workers, concluding that the surface roughness of the implant neck has no effect on bone level up to three years. The hybrid implant system used in our study combines the benefits of faster osseointegration, due to the moderately rough implant body, and the minimally rough surface around the implant neck suggests it is less prone to develop peri-implantitis.54 Additionally, several studies conclude the beneficial effect of a smoother surface with a lower incidence of peri-implantitis and less bone loss on the long term. A further long-term follow-up of the current study population will elucidate the latter.
Besides implant survival and bone level stability, also peri-implant health is considered a perquisite for treatment success. Peri-implant health is defined on two levels. Plaque accumulation yields minor inflammation of the soft tissue surrounding the implant- restorative interface, coined as mucositis. It is diagnosed with bleeding of the tissues after probing the crevice between implant and mucosa. In a recent consensus report, the diagnosis of peri-implantitis has been redefined as a combination of probing pocket depths of at least 6 mm in combination with bleeding on probing or a bone level of at least 3 mm apical of the most coronal portion of the intraosseous part of the implant.12 In our study, no patients showed ongoing bone-loss in combination with bleeding and increasing probing pocket depths. Hence, the incidence of peri-implantitis was 0.0%.
The absence of peri-implantitis was found despite a high plaque level. This could be explained by the elderly, fully edentulous patient population. De Waal and colleagues revealed that edentulous patients restored with implants showed more plaque compared to partially edentulous patients restored with implants. However, the plaque in the fully edentulous patients harbours a potentially less pathogenic peri-implant micro-flora.55,56
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