International Poster Journal of Dentistry and Oral Medicine
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Int Poster J Dent Oral Med 12 (2010), No. 1     15. Mar. 2010

Int Poster J Dent Oral Med 2010, Vol 12 No 1, Poster 479

Peri-implant health in patients attending an annual implant maintenance progam

Language: English
 

Authors:
Dr. med. dent. Stefan Lachmann, Cand. med. dent. Anna Stehberger, Dr. rer. nat. Detlef Axmann, Prof. Dr. med. dent. Heiner Weber,
Abteilung für Zahnärztliche Prothetik und Medizinische Werkstoffkunde, Zentrum für Zahn-, Mund- und Kieferheilkunde, Eberhard-Karls-Universität Tübingen, Germany

Date/Event/Venue:
September 10th-12th, 2009
IADR-CED/NOF & ID 44th Annual Meeting
Munich
 

Introduction

Peri-implant health is considered to be an important factor for long-term success of implant therapy. Findings in individuals with peri-implant mucositis or peri-implantitis are well described in the literature. Preventive and therapeutic interventions have proven to be effective in most of the cases, depending on the severity of disease an on other extrinsic and intrinsic patient and treatment variables. What, however, the general peri-implant appearance of un-selected recall hygiene patients is, needs still to be definded. Not every pocket deeper than 3 - 4 mm needs treatment and sometimes the prosthetic superstructure or the manual ability of the elderly impedes perfect oral hygiene yet does not neccessarily cause peri-implant disease in every case.
 

Objectives

The aim of the investigation was to describe variations and associations between findings of peri-implant health and related factors among arbitrarily recruited, presumably healthy recall patients with long-standing implant-borne restorations.
 

Material and Methods

74 symptom-free individuals, scheduled for their annual implant maintenance appointment at the Department for Prosthodontics of the Tübingen University Hospital, gave consent to participate in the study (Approval from the local Ethical Committee #63/2008BO2). Following an update of the patients' general medical and intra-oral clinical history investigative procedures were performed to evaluate peri-implant health (see table for details). In patients with multiple implantations only one implant was randomly chosen to avoid intra-individual dependencies on target variables. Bacterial load was measured with a commercial PCR DNA test (Hain MicroIdent, Hain Life Sciences, Nehren, Germany) and scored semi-quantitatively from 0-3 for each of the five periodonto-pathogenic species Aggregatibacter actinomycetemcomitans (Aa), Prevotella intermedia (Pi), Porphyromonas gingivalis (Pg), Tannerella forsythensis (Tf) and Treponema denticola (Td). A sum score of all 5 species was generated by adding-up the respective value of each species to a maximum possible score of 15. Statistical analyses included explorative data analysis, X²-test, ANOVA, and logistic regression analysis. Level of significance was set at p < 0.05.

Age 69 years Median 63
Range 23 - 94 years
Gender Female
Male
41
33
Medical history Not Specified
Stated in the history
31
43
 
Cardiovascular
Diabetes
Thyroid dysfunction
Others
(polyarthritis, allergies, gout, sklerodermia)
 
20
3
2
18
General oral hygiene (0-3) 1 (good)
2 (moderate)
3 (totally inadequate)
50
21
3
Tobacco consumption No
Yes
69
5
Restoration in function (years) Mean 9.5 years Median 7.8
Range 0.6 - 29.2 years
Restoration type Fixed
 
Removable
50
 
24
Single tooth crown
Bridgework
Bar attachment
Ball attachment
 30 
20
17
7
Plaque (0-3) 0
1
2
3
Mean
30
35
8
1
0.7
Pus (0-3) 0
1
74
0
Bleeding probing (0-3) 0
1
2
3
Mean
18
50
6
0
0.9
Periotest value Mean -1.2 n=47*, Median -2
Range -6-6
Pocket probing depth (mm) Mean 2.9 Median 2.8
Range 1.5-5.2
Sulcular fluid flow rate (μl/120s) Mean 0.8 Median 0.6
Range 0-9.1
Sum score microbiology Mean 1.2 Median 0
Range 0-9
Presence of any of the bacteria No
Yes
41
33
 
Aa
Pg
Pi
Tf
Td
 
14
18
6
24
6
Tab. 1: * In the remaining cases the respective Implant was splinted and not accessible for Periotest measurements
 

Results

Smokers (n = 5) scored higher for peri-implant plaque accumulation (1.4 vs 0.7 in the remaining 69 non-smokers, p = 0.02) and had a greater subgingival bacterial sum score of the 5 periodonto-pathogenic species (3.1 vs. 1.1, p = 0.04). Individuals tested positive for the prevalence of Tannerella forsythensis (n = 24) showed decreased implant stability as shown by Periotest readings than Tf-negative individuals (0.3 vs -2.0, confidence interval 2-33, odds ratio 1.25, p = 0.03). This species was found more frequently in individuals with fixed implant-retained restorations (two thirds of 50 individuals) than in cases with removable prostheses (one fifth of 24 individuals, p = 0.046). Patients reporting cardiovascular disease were responsible for 75 per cent of the prevalence of Prevotella intermedia which was not found at all in patients without any reported unterlying medical complication.


 

 

Conclusions

In almost half of all cases one or more periodonto-pathogenic bacteria species could be found in the presented implant patient group with predominantly healthy oral conditions. Even though clinical conclusions are limited due to the small number of individuals in some of the analyses' subgroups statistically significant trends could be observed within the study population. Patients with a smoking habit have been reported to be more prone to peri-implant complications. This fact is reflected by the results of the present investigation with regard to plaque status and total bacteria load. Beyond that fixed restorations and a history of cardiovascular disease seem to be associated with a an increase in periodonto-pathogenic bacteria, showing statistically significant differences for some of the species in such patients.
 

This Poster was submitted by Dr. med. dent. Stefan Lachmann.
 

Correspondence address:
Dr. med. dent. Stefan Lachmann
Eberhard-Karls-Universität Tübingen
Zentrum für Zahn-, Mund- und Kieferheilkunde, Abteilung für Zahnärztliche Prothetik und Medizinische Werkstoffkunde
Osianderstraß 2-8
72076 Tübingen
Germany