Page 93 - Peri-implant health: the effect of implant design and surgical procedure on bone and soft tissue stability

LONG-TERM EFFECT OF SURFACE ROUGHNESS AND PATIENTS' FACTORS ON CRESTAL BONE LOSS AT DENTAL IMPLANTS. A SYSTEMATIC REVIEW AND META-ANALYSIS
Figure 3, B and C, was 20% versus 4%. Nevertheless, when combining bleeding and probing depth in the analysis only 4.1% of the implants were diagnosed with peri-implantitis. The other three studies and four study groups compare TiUnite moderately rough with machined minimally rough Bra˚nemark implants.
Patient-Related Risk Factors
In the smoking group of the Sayardoust study,154 as well as in the Arnhart study,180 TiUnite showed a better outcome whereas in the Sayardoust the non-smokers group and the Jungner group177 the machined implants led to less bone loss. In the study of Arnhart180 72% of the patients reported to smoke and also had a history of periodontal disease. This could also explain 89% of the machined surface implants with bone loss above 2 mm. For the meta-analysis the Arnhart study180 was excluded because of the synergistic effect of smoking and periodontal history in a majority of cases.
Some papers assessed bone loss around similar implants and roughness in patients with various periodontal conditions. Roccuzzo and colleagues198 demonstrated that periodontally healthy patients lost significantly less bone compared to patients with a history of moderate or severe periodontal disease. This outcome was also reflected by 8% versus 20% to 22% of the implants with bone loss above 2 mm, as can be seen in Figure 3A. Rasperini and col- leagues143 compared machined Bra˚nemark surfaces and Straumann TPS surfaces after 10 years of function in four patient groups being either periodontally healthy or periodontally compromised and with or without smoking as cofactor (Figure 3, A and C). Bone loss above 2 mm was found in 89% to 95% of the implants placed in smokers, irrespective of the implant surface or the periodontal condition. And in 78% of both implant types in periodontally compromised non-smoking patients. In the periodontally healthy and non-smokers, the TPS surface yielded 45% of the implants above 2 mm bone loss compared to only 7% in the machined smooth group. It seems that patient related risk factors affect bone loss to a bigger extent than surface roughness.
Meta-Analysis of Data
Heterogeneity. The estimated amount of total heterogeneity t2 of all included study groups was equal to 0.54 (SE = 0.084). The variability explained through the variability between groups was significant and high I2 5 99.38% (Q = 13,950.7, df = 89, p < .001). When the research groups were restricted to those with known
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