Peri‐implant tissue health in reconstructed atrophic maxillae—report of 88 patients and 470 implants

Abstract

The aim of this study was to evaluate the soft-tissue health around 470 implants placed in the upper jaw of 88 patients with severe maxillary atrophy. All patients underwent a reconstruction procedure which included a composite bone grafting from the iliac crest to the maxillary sinus. Evaluation was performed at a mean implant lifetime of 21.6+/-10.9 months. The following parameters were used: probing depth, plaque-, gingival-, bleeding index and width of the buccal keratinized mucosa. They were calculated as means for each implant and related to the type of superstructure and the thickness of the original sinus floor. (higher or lower than 5 mm). A high percentage of bleeding on probing was observed in obviously clinically healthy peri-implant pockets. Bleeding on probing and deeper probing depth were especially observed in the group with severe maxillary atrophy (less than 5 mm initial height of the sinus floor.) There was a significant increase in mean peri-implant probing depth and gingiva index in overdentures versus fixed bridges. No differences were observed with respect to the width of the keratinized buccal mucosa. It was concluded that implants in the reconstructed maxilla and supporting overdentures had a higher risk for bone loss, based on the worse peri-implant tissue health observed.

Associations of clinical characteristics and interval between maintenance visits with peri-implant pathology

“…This represents the classical clinical manifestation of peri-implant pathology, namely, DP accumulation, followed by B resulting from gingival inflammation and PIP formation. This finding was previously reported (2,53,54). The type of mucosa (keratinized vs. non-keratinized) might also be important in disease incidence and development; however, our study did not investigate mucosa type, and thus the effect of this variable is unknown.…”

Various Techniques to Increase Keratinized Tissue for Implant Supported Overdentures: Retrospective Case Series

“…In many cases, performing oral hygiene was reported to be painful as a result to the absence of the keratinized tissue surrounding the implant. Moreover, discomfort has been related to mechanical irritation due to the mobility of the nonkeratinized tissue under function [17, 18]. …”

“…There was a significantly higher gingival index and probing depth in overdenture versus fixed prosthesis cases [18]. It has been reported that implants supporting overdentures had more risk for bone loss, based on poorer peri-implant tissue health [18]. Adibrad et al investigated the association between the width of the keratinized tissue and the health status of the soft tissue around implants supporting overdentures.…”

“…These studies conclude that the presence of keratinized tissue around implant-supported overdentures is a factor effecting bone maintenance and soft tissue health around those implants [17, 18]. …”

Significance of the Width of Keratinized Mucosa on the Health Status of the Supporting Tissue Around Implants Supporting Overdentures

“…Also, in many cases tooth-brushing is painful for these patients because of the thin buccal mucosa, which is often formed after implant placement procedures. 7 For many years the presence of an ''adequate'' zone of gingiva was considered critical for the maintenance of gingival health and prevention of periodontal disease progression. Friedman 8 stated that ''inadequate'' zone of gingiva would facilitate subgingival plaque formation because of improper pocket closure resulting from the movability of the marginal tissue.…”