Page 199 - Peri-implant health: the effect of implant design and surgical procedure on bone and soft tissue stability

patients, given the unethical approach this would require. Namely, regular peri- implant maintenance therapy is mandatory to prevent biologic complications and ameliorates the long-term success rate. The positive effect of regular peri-implant maintenance therapy has been described in a systematic review with meta- analysis by Monje and colleagues.50
■ ORALHEALTH-RELATEDQUALITYOFLIFE
Study III and Study IV included measuring the change in OHRQoL for patients treated with an implant-supported overdenture in the mandible. The outcome of the OHRQoL is in line with earlier published papers. All papers indicated the superiority of an implant-supported overdenture over a conventional complete denture regarding the quality of life.4,51-53 Moreover, a recently published paper investigating the difference in OHRQoL between patients with an implant fixed complete denture and patients with an implant overdenture did not find a significant difference in OHIP-49 score.54 The findings mentioned above confirm the McGill consensus statement, where it is stated that an implant-retained overdenture is the first choice of treatment for the edentulous mandible.55
■ STUDYLIMITATIONS
An important limitation in the clinical studies of this thesis could be the relatively short follow-up time. As described in Study II the bone level changes due to disease may take some years before being diagnosed clinically.56 Hence, a longer follow-up of the study population of Study III and Study V is required to assess the long-term effect of implant-related factors on the prevalence of peri-implantitis. On the other hand, a recent study by Windael and colleagues assessed fixed implant bridges on five to eight implants in fully edentulous jaws. They suggested that bone loss at two years is a predictor for bone loss at ten years.57 The Studies III, IV and V showed a minimum bone loss in the first six months and hardly any bone loss after initial remodeling up to the last follow-up visit. Moreover, concerning the study of Windael and colleagues, it could be expected that performing good oral hygiene is easier for patients treated with a removable overdenture compared to those restored with a fixed bridge. Provided that professional maintenance and
GENERAL DISCUSSION
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