ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Patients With A History Of Periodontal Disease Have An Increased Risk Of Peri-Implantitis
Clinical Question In an adult seeking implant therapy, does a history of periodontal disease lead to an increased risk in the development of peri-implantitis?
Clinical Bottom Line Patients with a history of periodontal disease appear to have an increased risk of developing peri-implantitis after implant placement compared to periodontally healthy patients.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 27833728Stacchi/20163 studies (Prospective Cohort Studies) / 168 total patients (518 implants placed) split into groups based on periodontal statusSystematic review of non-randomized trials
Key resultsIn this study, when the implant was used as the statistical unit, the risk ratio of peri-implantitis in periodontally healthy patients compared to patients with a history of periodontitis was 0.32 (0.04-0.46), which is statistically significant (p<0.0001). When the patient was used as the statistical unit, the risk ratio of peri-implantitis in periodontally healthy patients compared to patients with a history of periodontitis was 0.25 (0.07-0.88), which is statistically significant (p=0.003). .
#2) 26381260Sousa/201524 studies (12 prospective cohort studies, 5 case series with control group, 4 retrospective cohort studies, 3 subgroup comparison studies)/5105 patients split into groups by periodontal statusSystematic review of non-randomized trials
Key resultsThe entirety of included studies within this systematic review showed that the rate of peri-implantitis has a higher incidence in patients with a history of periodontal disease when compared to healthy patients. A strong correlation was found between the severity of periodontal disease and the rate of biological complications for dental implants.
#3) 24382358Sgolastra/201514 studies (Prospective Cohort Studies)/ 1971 patients split into groups based on periodontal statusSystematic review of non-randomized trials
Key results4 of the studies reviewed (583 patients) reported a statistically significant increase in the incidence of peri-implantitis in patients with a history of periodontal disease compared to those who were periodontally healthy
#4) 27833728Roccuzzo/2011112 partially edentulous patients split into groups based on periodontal statusProspective Cohort Study
Key resultsAuthors concluded that there is a strong statistical correlation between patients with a history of periodontal disease and implant complications and in some cases, loss. Data shows that significance increases with the severity of periodontal disease previously diagnosed. Discussion included the need for further long term clinical outcome tracking using each patient as a statistically independent unit, no matter how many implants are placed for that patient because this scenario will allow for meta-analysis and less bias.
Evidence Search "Dental Implants"[All Fields] AND "Periodontitis"[All Fields] OR "Peri-implantitis"[All Fields]
Comments on
The Evidence
Three out of four of the evidence cited are systematic reviews comprised of a majority of prospective studies with varying inclusion criteria and in the end, a leaning towards homogeneous patient pools. However, the overarching conclusion for all evidence is a finding of statistical significance in the occurrence of peri-implantitis for patients with a history of periodontal disease. Most notably, there is a consensus that the level of severity of past periodontitis will adversely affect long term success rates and forecast the need for additional periodontal bone and tissue treatments. Therefore, clinicians should communicate this to patients during treatment planning and include robust follow up hygiene and periodontal screening schedules for implant patients with a history of periodontal disease. Long term studies tracking implant success continues to be needed within the confines of randomized and blinded intervention procedures in order to verify these correlations. Additionally, studies that utilize universal periodontal diagnostics and definitions should be completed in order to support meta-analysis over longer time frames such as one to two decades.
Applicability The evidence of a correlation between a history of periodontal disease and an increased risk of peri-implantitis is shown consistently across current and past literature. Due to this, it is important to inform patients with this history of this increased risk and to stress proper maintenance and follow-up after implant placement. This evidence is applicable to any and all clinicians involved with patients seeking implants as part of a treatment plan and the long term care of implants and the involved prosthesis.
Specialty/Discipline (General Dentistry) (Oral Surgery) (Periodontics) (Prosthodontics) (Restorative Dentistry)
Keywords Dental Implants, Periodontal Disease, Peri-Implantitis, Bone loss, Risk Factors, Periodontally Compromised Patients
ID# 3295
Date of submission: 11/28/2017spacer
E-mail botto@uthscsa.edu
Author Antonella A. Botto, DDS
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