Page 97 - 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
loss is not only caused by the size and location of the microgap but also by the movement of the implant components.14,205
Bacterial colonization of the exposed implant surface206–208 may increase the risk for peri-implantitis. Vervaeke and colleagues133 showed ongoing bone loss up to 9 years of function around implants with early bone loss in patients with other risk factors such as smoking and history of periodontitis.133 Vandeweghe and colleagues209 demonstrated that initial bone remodeling around immediately loaded implants occurs during the first 3 months in conjunction with biologic width establishment. Also with a one-stage surgery and delayed loading the soft tissue and bone healing starts at time of implant placement, yet this is not monitored when the baseline is taken at placement of the restoration several months later. For this review, however, we accepted the bone loss calculations based on a baseline at any given time point between implant installation and the first year. Additionally, it was impossible to control many other factors that may affect bone loss such as implant design, surgical technique, expertise level, prosthetic treatment protocols.210 And last but not least, not all studies have the same follow-up time nor comparable patients’ profiles with respect to risk factors such as smoking habits or periodontal history. It is our belief, however, that this flaw affects all studies irrespective of implant system or implant surface roughness and hence is of secondary importance in the context of the comparison of various surface roughness and its effect on bone loss.
One of the observations of the review was that very few papers actually report on peri-implantitis prevalence and those that do so often use different diagnostic thresholds or have incomplete data reporting and missing parameters. Only 6 papers of the 87 quoted all diagnostic parameters, suggested as essential to diagnose peri-implantitis.43 This reflects that some studies yield extremely high “self-quoted” prevalence of peri-implantitis despite extremely low mean bone loss values,140,163 which is indicative of low bone loss thresholds, whereas others have extremely low prevalence percentage despite contradictory high bone loss values.163,189 These findings question the reliability of those self-reported prevalences, especially when incomplete data are presented, and point to the necessity of using more straightforward and objective parameters, such as bone loss over time. It can be concluded that researchers deliberately pay less attention to the assessment of parameters to diagnose peri-implantitis and that
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