Osseointegrated Implants in Patients Treated for Generalized Severe Adult Periodontitis. An Interim Report

Abstract

This study presents oral rehabilitation with osseointegrated implants in partially edentulous patients treated for generalized severe adult periodontitis. Five female patients aged between 31 and 44 received a total of 36 implants and were observed for 1 year after insertion of the superstructure. Three months before implantation, venous blood samples were taken from the patients and five periodontally healthy controls, and the serum examined with highly sensitive ELISA test kits for interleukin 1 beta (IL-1 beta) and interleukin 6 (IL-6). Clinical examination covered the plaque index (PI) and gingival index (GI) at teeth and implants plus probing depth (PD) and clinical attachment level (CAL) at the teeth. Microbiological evaluation of teeth and implants was performed by dark-field analysis, and DNA analysis was performed in addition 1 year after insertion of the superstructure. Radiological controls of the teeth were carried out with standard single-tooth films in the 2 years preceding implantation and at baseline. Following implantation, further controls of the teeth and implants were undertaken immediately after insertion of the superstructure and 1 year thereafter. The immunological examination revealed that the IL-1 beta (0.22 +/- 0.2 pg/ml) (means +/- SD) and IL-6 (2.27 +/- 2.8 pg/ml) level was slightly, but not significantly, higher in the patients than in the control group (IL-1 beta: 0.06 +/- 0.06 pg/ml and IL-6: 0.64 +/- 0.2 pg/ml) (P > 0.05). The clinical results show that the GI at the teeth rose slightly from 0.0 to 0.2, and at the implants from 0.3 to 0.4. The PI rose slightly from 0.3 to 0.7 at the teeth and from 0.2 to 0.9 at the implants. Neither the GI nor the PI revealed any significant difference between teeth and implants. Clinical attachment loss at the teeth was minimal at 4.7 to 4.8 mm. Comparison between the teeth and the implants revealed no essential difference in bacterial flora; neither Actinobacillus actinomycetemcomitans nor Porphyromonas gingivalis was recorded at any location. Small quantities of Prevotella intermedia were detected at the teeth and implants of one patient. Radiological evaluation 1 year after insertion of the superstructure revealed a mean bone loss of 0.62 mm at the implants. The bone loss at the teeth during the same period was 0.3%, whereas it had been 1.5% in each of the 2 previous years. These results suggest that there is only a slight difference between the periodontal and peri-implant areas in patients with generalized severe adult periodontitis. The full potential for implants in these patients, however, needs to be shown in controlled longitudinal studies.

Assessment of interleukin-1beta and interleukin-6 in the crevicular fluid around healthy implants, implants with peri-implantitis, and healthy teeth: a cross-sectional study

“…In contrast to the above-mentioned studies, Mengel et al26 in 1996 compared two groups of periodontitis and normal implant patients and reported no significant difference in the levels of IL-6 and IL-1β between the two groups.…”

Interleukins IL-6, IL-8, IL-10, IL-12 and periimplant disease. An update

“…Some of the studies in our review reported increased levels of IL-6, IL-8, IL-10 and IL-12 in periimplant disease, revealing their implication in the destruction of periimplant tissue and their usefulness as markers of periimplant disease (1,2,4, 7-9). In contrast, other authors o�served no relationship �etween IL-6 and IL-10 levels and periimplant disease (2,7,8,10), discarding their implication in early dental implant loss (4). Regarding IL-6, Liskmann et al (1), on studying the levels of IL-6 in the crevicular fluid of the periimplant sulcus in 30 patients, recorded increased concentrations in patients with periimplant disease -a positive correlation �eing o�served with the clinical parameters (�leed-ing, pocket depth and gingival index).…”

The evaluation of bacterial flora in progress of peri‐implant disease

“…Meanwhile, a number of studies have demonstrated a consistent success rate of implants and stable maintenance of implants even in those patients who had lost their teeth due to periodontal disease. [7][8][9][10] Mombelli and Lang 11 proposed cumulative interceptive supportive therapy (CIST) as a guideline for treating implants affected by peri-implant disease (Fig 1). In this therapy, treatment is classified into classes A to D according to the extent of progression of peri-implant disease.…”