Page 70 - Peri-implant health: the effect of implant design and surgical procedure on bone and soft tissue stability

CHAPTER 4
Poor oral hygiene is known as an important risk factor in the development and progression of periodontal disease.21 Poor oral hygiene initiates a persistent gingivitis, which results in a 46-times higher risk for tooth loss.22 Similarly, there is evidence that good oral hygiene should be recommended to prevent bleeding and pocket formation around implants.23 Patient less compliant with maintenance are also more prone to implant failure.24
Different systematic reviews have shown that patients with existing or ongoing periodontitis are more likely to experience implant failure and biological complications.25–32 This could be related to the type of microbiota in these patients and the ability of forming biofilms. It could also reflect a stronger immunological response to foreign bodies such as biofilm, plaque, and implant components. However, it is difficult to draw strong conclusions due to the high heterogeneity among the studies and methodological variability.33
Tobacco smoke contains nearly 4,000 chemicals such as carbon monoxide, hydrogen cyanide, and reactive oxidizing radicals. Some of those chemicals are known to be toxic and as a consequence smoking harms nearly every organ in the body including the tissues within the oral cavity. The negative effect of smoking is attributed to the impaired vascularity of the periodontal tissues rather than a vasoconstrictive effect.34 By affecting the revascularization it may lead to an impaired healing after surgery. Different systematic review identified smoking as a factor affecting implant survival and peri-implant bone loss.27,35,36 Additionally, Lindquist and colleagues identified smoking the predominant factor affecting peri-implant bone loss. However, good oral hygiene reduced the pernicious effects of smoking while poor oral hygiene aggravated bone resorption.37
Besides, the above-mentioned patient-related factors, implant-related factors can possibly influence implant treatment outcome. Today, most marketed implant surfaces are moderately rough with Sa values between 1.1 and 2 μm. A brief overview of various surface roughness for some implant brands is given in Table 1. Increasing implant surface roughness, induces qualitative and quantitative changes in biofilm formation.38 Quirynen and colleagues suggested that implants with increased surface roughness may be more prone to peri-implant bone loss and consequently, late implant failure.28 Conversely, Chappuis and colleagues showed that even rough TPS-coated implants can
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