Non-grafted sinus implants in periodontally compromised patients: a time-to-event analysis.

This study reports the results of implant therapy involving a sinus membrane lift and of conventional implant therapy in 68 periodontally compromised patients treated between June 1990 and June 2002. Patients had at least two implants inserted, one of which was placed in the maxillary sinus region following fenestration of the lateral sinus wall and lifting of the sinus membrane. Two implant systems were used: a two-stage system (Astra) and a one-stage system (ITI). Annual follow-up visits included recording of plaque, probing pocket depth and measurement of the radiographic distance in millimeter from the implant shoulder to the alveolar crest. Survival analysis showed that the proportion of implants that had not been explanted after 5 years ranged between 88.7% for ITI sinus implants and 97% for ASTRA conventional implants. After 10 years, the proportion of implants remaining in situ ranged between 59% for ITI conventional implants and 97% for ASTRA conventional implants. Cox regression analyses showed that the factors influential for implant explantation were implant type (HR(ITI) = 2.8), implant length (HR(< or = 10 mm) = 3.1), patient being a smoker (HR(smoking) = 2.2) and patient having at least 20 natural teeth (HR(> or = 20 teeth) = 3.8). Our results demonstrate that sinus implants may be inserted with the same success as conventional implants in periodontally compromised patients.

Treatment of peri-implantitis by the Vector system.

AIM: To compare the effectiveness of treatment of peri-implantitis with a novel ultrasonic device, the Vector system, with that of subgingival debridement with carbon fiber curettes. MATERIAL AND METHODS: The study, comprising 11 patients with at least two screw type implants with bleeding on probing (BOP), probing pocket depth (PPD) > or =5 mm, and at least 1.5 mm radiographic bone loss and exposed implant threads, was carried out as a single blind randomized clinical trial. At baseline one randomly chosen implant in each patient was treated by the Vector system (test) while the other implant (control) was treated by submucosal debridement with a carbon fiber curette. After 3 months, the same treatments were repeated. Plaque, BOP, and PPD were recorded on all implant surfaces at baseline, and after 3 and 6 months. Bone levels were recorded on radiographs taken prior to the start of the study, and after 6 months. RESULTS: Oral hygiene around both test and control implants was improved at 3 and 6 months compared with baseline. At 6 months, four of the Vector-treated sites, and only one site treated with curettes, had stopped to bleed. In neither the test nor the control group, were there any differences between baseline and 6 months regarding PPD and bone levels. CONCLUSION: Although there was a greater reduction in the number of sites with BOP following treatment with the Vector system than following instrumentation with carbon fiber curettes, there was no significant difference between the two methods.

Implant survival in periodontally compromised patients.

BACKGROUND: Relatively little is known on the long-term prognosis of implants inserted in partially edentulous, periodontally compromised patients. METHODS: A total of 258 conventional implants, 57 two-stage and 201 one-stage implants, which were inserted in 32 and 108 patients, respectively, between June 1988 and June 2002 were followed with respect to their survival, as well as the periodontal parameters bone loss, probing depth, and bleeding on probing. All patients were periodontally compromised who had undergone periodontal surgery and were considered able to maintain a high standard of oral hygiene. RESULTS: The 5-year survival rates were 97% and 94%, respectively, for the two- and the one-stage implants. The 10-year survival rate remained high at 97% for the two-stage implants, but had dropped to 78% for the one-stage implants. Smoking, short implant length, and insertion during the later period (1995-2002) were found to be associated with an increased failure rate. CONCLUSIONS: Implants placed in patients with a history of periodontitis have a 5-year survival similar to that observed for implants installed in non-diseased persons. Although the 10-year survival of the one-stage implants was somewhat lower than has been observed for non-diseased patients, implant placement remains a good treatment alternative also for periodontally compromised patients.