Is the degree of physiological bone remodeling a predictive factor for peri‐implantitis?

Abstract

Background The amount of initial physiological bone remodeling (IPBR) after implant placement varies and the ways it may play a role in peri‐implantitis development remains unknown. The aim of this retrospective study was to investigate the association between the amount of IPBR during the first year of implant placement and incidence of peri‐implantitis as well as the pattern of progressive bone loss. Methods Clinical and radiographic documentation of implants at the time of implant placement (T0), 1 year ± 6 months after crown placement (T1), and at a ≥2‐year follow‐up from implant placement (T2) were retrospectively collected. IPBR was defined as the bone loss occurring from implant placement to the end of the bone remodeling (T1). Cases were grouped into those diagnosed with (test) or without peri‐implantitis (PIm) (control). Linear regression model under generalized estimation equation approach was estimated to assess correlation between marginal bone loss (MBL) rates in both periods (T1‐T0) and (T2‐T1). Receiver operating characteristics curve was estimated to explore an optimal cut‐off point of T1‐T0 MBL to discriminate between PIm and no‐PIm implants. Results A total of 45 patients receiving 57 implants without PIm and 40 with PIm were included. There were no associations between PIm and IPBR (p > 0.05), nor between BML of (T2‐T1) and (T1‐T0). However, arch and total follow‐up showed significant influence on the probability of PIm. Splinted implants showed an MBL rate of 0.60‐mm/year higher than non‐splinted implants (p < 0.001) from T1 to T2. Conclusion No statistically significant association was found between IPBR and incidence of peri‐implantitis.

Can Peri-Implant Marginal Bone Loss Progression and a-MMP-8 Be Considered Indicators of the Subsequent Onset of Peri-Implantitis? A 5-Year Study

“…The results of our previous analysis [ 11 ], performed on the same sample at a follow-up of 2 years, showed that implants with increased MBL rates at 6 months after loading were likely to exhibit additional MBL. This correlation was confirmed by the present analysis, performed after 5 years of loading, which showed no statistically significant relationship between MBL progression and the onset of P. Similar results have been reported by Rodriguez et al [ 10 ], who evaluated in a sample of 45 patients receiving 57 implants the possible relationship between the amount of early MBL and the presence of P after 1 year of loading. These data indicated that, although most of the implants presenting a high initial level of MBL exhibited progressively high MBL in the following years, the degree of MBL progression did not influence the onset of P. Some authors [ 8 , 9 , 10 , 11 ] have speculated that if MBL during the healing/remodeling phase exceeds a certain threshold, it may create a niche for pathogenic microorganisms, providing a more anaerobic environment and promoting P. Therefore, the MBL level could already be indicative and predictive of the development of P during the remodeling phase.…”

“…It has been also hypothesized that a high degree of early marginal bone loss (MBL) might be a predictive factor for the subsequent onset of peri-implant inflammatory diseases [ 8 , 9 , 10 , 11 ]. Defining as “pathological” any MBL that exceeds the bone loss threshold during the healing/remodeling phase, several authors have highlighted that early increased MBL may be indicative of P development, as it may create a niche for pathogenic micro-organisms, providing a more anaerobic environment and promoting progressive bone loss [ 11 , 12 ].…”

“…Although these bone-loss thresholds provide easy clinical ‘cutoffs’, they do not predict future MBL. Since marginal bone remodeling is a dynamic process, the rate of MBL has recently been proposed as a better index of implant success than bone-loss or bone-level values [ 8 , 9 , 10 , 11 ].…”

“…To date, the role played by the initial MBL degree in the development of P remains unknown [ 27 ]. Although some studies have reported that there is no association between the amount of initial physiological bone remodeling during the first year of implant placement and the incidence of P [ 10 , 11 ], a recent investigation of Lähteenmäki et al [ 22 ] indicated that high a-MMP-8 levels in PISF were significantly more prevalent for dental implants with MBL > 2 mm.…”

Non-surgical treatment of peri-implantitis with and without erythritol air-polishing a 12-month randomized controlled trial

“…The inclusion criterium was diagnosis of peri-implantitis on at least one dental implant based on the definition from the consensus report of workgroup 4 of the 2017 World Workshop [ 32 ]. Because baseline data were available peri-implantitis diagnosis was based on (I) progressive bone loss beyond initial bone remodeling (CBL loss ≥ 2 mm), (II) increased PD compared with previous examinations in at least one site around the implant (PD ≥ 4 mm), and (III) presence of bleeding and/or suppuration on gentle probing [ 33 ] Initial full mouth or experimental site-specific dental plaque scores were not an inclusion criterium. Staging of periodontitis of the included patients was performed according to the 2017 classification [ 34 ].…”