A total fixed reconstruction in patients with severe chronic periodontitis and requiring immediate implant placement and loading: A retrospective clinical study

ABSTRACT Objective: Immediate implant placement has become an acceptable treatment alternative in a patient undergoing total edentulism and seeking fixed total restorations. It is still a controversial topic if previous periodontal status such as generalized chronic severe periodontitis has a nega- tive effect on implant survival rate. The focus of this study is, therefore, to determine whether generalized chronic severe periodontitis compromises implant survival rates in a patient seeking an implant-supported full-arch fixed rehabilitation. Methods: Fifty-five consecutive patients with generalized chronic severe periodontitis received 272 implants. Each jaw, 23 mandibles, and 45 maxillae were treated with a fixed full-arch prosthe- sis. The majority (95%) of the restorations were supported by 4 implants, of which the posterior 2 implants were tilted. All implants were placed immediately, and a provisional functional acrylic prosthesis was delivered on the same day of surgery. Subjects were followed up to 8.8 years. The cumulative survival rate was determined using Kaplan–Meier analysis. Results: The overall follow-up time for survival rate was up to 8.8 years. Nine implants (8 implants in maxilla and 1 implant in mandible) were lost, resulting in an overall cumulative implant survival rate of 96.3%. The axial or non-axial (tilted) placed implants resulted in a similar survival rate. Good soft tissue health was observed in almost 99% of patients. The final prosthesis survival rate was 100%. Conclusion: The results of this retrospective study indicated that patients undergoing total edentulism due to poor prognosis of the remaining teeth were treated successfully by utilizing the immediate implant placement and loading. Keywords: Dental implants, total edentulism, primary implant stability, chronic periodontitis, immediate loading ÖZ Amaç: Çekim sonrası implant yerleştirme, total dişsizliğe giden ve sabit-total restorasyonlar ara- yan hastalar için kabul edilen bir tedavi yöntemi haline gelmiştir. Genel kronik şiddetli periodon- titis (GCSP) gibi önceki periodontal durumun implant başarı oranı üzerinde olumsuz bir etkisinin olup olmadığı hala tartışmalı bir konudur. Bu nedenle bu çalışmanın amacı, implant destekli tam ark sabit rehabilitasyon arayan bir hastada GCSP'nin implant başarı oranlarını (SR'ler) etkileyip etkilemediğini belirlemektir. Yöntemler: 55 ardışık GCSP hastası 272 implant yerleştirildi. Her bir çene, 23 alt çene ve 45 üst çene sabit-tam ark protezi ile tedavi edildi. Restorasyonların çoğunluğu (%95) arkadaki iki imp- lantın eğimli olduğu dört implantla desteklenmiştir. Tüm implantlar hemen çekim sonrasi yerleş- tirildi ve ameliyatın aynı günü geçici fonksiyonel akrilik protez teslim edildi. Tüm hastalar 8.8 yıla kadar takip edildi. Kümülatif hayatta kalma oranı Kaplan-Meier analizi kullanılarak belirlendi. Bulgular: Implant başarı oranı için hastalar 8,8 yıla kadar takip edildi. Dokuz implant (maksillada 8 implant, mandibulada 1 implant) kaybedildi, bu da toplam kümülatif implant başarı oranının %96,3 olduğunu gösterdi. Dik ve eğimli implantlardaki implant başarı oranlari arasindaki fark istatistiksel olarak anlamlı değildi. Hastaların %99'unda sağlıklı yumuşak doku gözlendi. Daimi protez başarı oranı %100 idi. Sonuç: Bu retrospektif çalışmanın sonuçları, umutsuz dişleri olan ve acil implant yerleştirme ve yükleme gerektiren hastaların All-on-4 konsepti kullanılarak başarılı bir şekilde tedavi edilebileceğini gösterdi. Anahtar Kelimeler: Dental implantlar, total dişsizlik, ilk implant stabilitesi, kronik periodontitis, ani fonksiyon

Keywords:

Dental implants, total edentulism, primary implant stability chronic periodontitis,

PDF

___

1. Sima C, Viniegra A, Glogauer M. Macrophage immunomodulation in chronic osteolytic diseases-the case of periodontitis. J Leukoc Biol. 2019;105(3):473-487. [CrossRef]
2. Slots J. Primer on etiology and treatment of progressive/severe periodontitis: A systemic health perspective. Periodontol 2000. 2020;83(1):272-276. [CrossRef]
3. Di P, Lin Y, Li JH, Qiu LX, Chen B, Cui HY. Clinical study of “All-on-4” implant immediate function in edentulous patients. Zhonghua Kou Qiang Yi Xue Za Zhi. 2010;45(6):357-362.
4. Eskan MA, Uzel G, Yilmaz S. A fixed reconstruction of fully edentulous patients with immediate function using an apically tapered implant design: A retrospective clinical study. Int J Implant Dent. 2020;6(1):77. [CrossRef]
5. Maló P, de Araújo Nobre M, Lopes A, Ferro A, Botto J. The All-on-4 treatment concept for the rehabilitation of the completely edentu- lous mandible: A longitudinal study with 10 to 18 years of follow-up. Clin Implant Dent Relat Res. 2019;21(4):565-577. [CrossRef]
6. Chan MH, Holmes C. Contemporary “All-on-4” concept. Dent Clin North Am. 2015;59(2):421-470. [CrossRef]
7. Soto-Penaloza D, Zaragozí-Alonso R, Penarrocha-Diago M, Penarro- cha-Diago M. The all-on-four treatment concept: Systematic review. J Clin Exp Dent. 2017;9(3):e474-e488. [CrossRef]
8. Patzelt SB, Bahat O, Reynolds MA, Strub JR. The all-on-four treat- ment concept: A systematic review. Clin Implant Dent Relat Res. 2014;16(6):836-855. [CrossRef]
9. Chrcanovic BR, Albrektsson T, Wennerberg A. Periodontally compro- mised vs. periodontally healthy patients and dental implants: A sys- tematic review and meta-analysis. J Dent. 2014;42(12):1509-1527. [CrossRef]
10. Donos N, Laurell L, Mardas N. Hierarchical decisions on teeth vs. implants in the periodontitis-susceptible patient: The modern dilemma. Periodontol 2000. 2012;59(1):89-110. [CrossRef]
11. Koldsland OC, Scheie AA, Aass AM. Prevalence of implant loss and the influence of associated factors. J Periodontol. 2009;80(7):1069- 1075. [CrossRef] 12. Roos-Jansåker AM, Lindahl C, Renvert H, Renvert S. Nine- to four-teen-year follow-up of implant treatment. Part I: Implant loss and associations to various factors. J Clin Periodontol. 2006;33(4):283- 289. [CrossRef]
13. Schou S. Implant treatment in periodontitis-susceptible patients: A systematic review. J Oral Rehabil. 2008;35(suppl 1):9-22. [CrossRef]
14. Schou S, Holmstrup P, Worthington HV, Esposito M. Outcome of implant therapy in patients with previous tooth loss due to perio- dontitis. Clin Oral Implants Res. 2006;17(suppl 2):104-123. [CrossRef]
15. Lee KH, Maiden MF, Tanner AC, Weber HP. Microbiota of successful osseointegrated dental implants. J Periodontol. 1999;70(2):131-138. [CrossRef] 16. Mengel R, Schröder T, Flores-de-Jacoby L. Osseointegrated implants in patients treated for generalized chronic periodontitis and general- ized aggressive periodontitis: 3- and 5-year results of a prospective long-term study. J Periodontol. 2001;72(8):977-989. [CrossRef]
17. Mengel R, Flores-de-Jacoby L. Implants in regenerated bone in patients treated for generalized aggressive periodontitis: A prospec- tive longitudinal study. Int J Periodontics Restorative Dent. 2005; 25(4):331-341.
18. Mengel R, Stelzel M, Hasse C, Flores-de-Jacoby L. Osseointegrated implants in patients treated for generalized severe adult periodon- titis. An interim report. J Periodontol. 1996;67(8):782-787. [CrossRef]
19. McGuire MK. Prognosis versus actual outcome: A long-term survey of 100 treated periodontal patients under maintenance care. J Peri- odontol. 1991;62(1):51-58. [CrossRef]
20. Klemetti E. Is there a certain number of implants needed to retain an overdenture? J Oral Rehabil. 2008;35(suppl 1):80-84. [CrossRef]
21. Malo P, de Araújo Nobre M, Lopes A, Moss SM, Molina GJ. A longitu- dinal study of the survival of All-on-4 implants in the mandible with up to 10 years of follow-up. J Am Dent Assoc. 2011;142(3):310-320. [CrossRef]
22. Siadat H, Alikhasi M, Beyabanaki E, Rahimian S. Comparison of different impression techniques when using the all-on-four implant treatment protocol. Int J Prosthodont. 2016;29(3):265-270. [CrossRef]
23. Begg T, Geerts GA, Gryzagoridis J. Stress patterns around distal angled implants in the all-on-four concept configuration. Int J Oral Maxillofac Implants. 2009;24(4):663-671.
24. Kim Y, Oh TJ, Misch CE, Wang HL. Occlusal considerations in implant therapy: Clinical guidelines with biomechanical rationale. Clin Oral Implants Res. 2005;16(1):26-35. [CrossRef]
25. Maló P, Nobre Mde A, Petersson U, Wigren S. A pilot study of complete edentulous rehabilitation with immediate function using a new implant design: Case series. Clin Implant Dent Relat Res. 2006;8(4):223-232. [CrossRef]
26. Klinge B. Peri-implant marginal bone loss: An academic controversy or a clinical challenge? Eur J Oral Implantol. 2012;5(suppl):S13-S19.
27. Schuldt Filho G, Dalago HR, Oliveira de Souza JG, Stanley K, Jovanovic S, Bianchini MA. Prevalence of peri-implantitis in patients with implant-supported fixed prostheses. Quintessence Int. 2014;45(10):861-868. [CrossRef]
28. Schwarz F, Derks J, Monje A, Wang HL. Peri-implantitis. J Periodon- tol. 2018;89(suppl 1):S267-S290. [CrossRef]
29. Heitz-Mayfield LJ, Huynh-Ba G. History of treated periodontitis and smoking as risks for implant therapy. Int J Oral Maxillofac Implants. 2009;24(suppl):39-68.
30. Sato A, Ohtsuka Y, Yamanaka Y. Morning mastication enhances post- prandial glucose metabolism in healthy young subjects. Tohoku J Exp Med. 2019;249(3):193-201. [CrossRef]
31. Smith MM, Knight ET, Al-Harthi L, Leichter JW. Chronic periodontitis and implant dentistry. Periodontol 2000. 2017;74(1):63-73. [CrossRef]
32. Karoussis IK, Kotsovilis S, Fourmousis I. A comprehensive and critical review of dental implant prognosis in periodontally compromised partially edentulous patients. Clin Oral Implants Res. 2007;18(6):669- 679. [CrossRef]
33. Van der Weijden GA, van Bemmel KM, Renvert S. Implant therapy in partially edentulous, periodontally compromised patients: A review. J Clin Periodontol. 2005;32(5):506-511. [CrossRef]
34. Cheng Z, Zheng W. Clinical effect and aesthetic observation of all- on-4 immediate loading implant denture in severe periodontitis. Evid Based Complement Alternat Med. 2021;2021:3120260. [CrossRef]
35. Mazzocchi A, Passi L, Moretti R. Retrospective analysis of 736 implants inserted without antibiotic therapy. J Oral Maxillofac Surg. 2007;65(11):2321-2323. [CrossRef]