Dental Implants: high failure rates in aggressive periodontitis

It has been reported that patients with periodontal disease have a higher level of peri-implantitis and lower implant survival rates that periodontally health patients.

The aim of this review was to assess whether generalised aggressive periodontitis (GAgP) has similar survival rates (SRs) and marginal bone loss (MBL) when compared with patients with chronic periodontitis (CP) and/or healthy patients (HPs).

Methods

Searches were conducted in the Medline, Embase, Cochrane Central Register of Controlled Trials, and Cochrane Oral Health Group Trials Register databases. This was supplemented by handsearches in a number of implant related journals and the reference lists of identified articles. Prospective or retrospective trials with more than 12 months follow up after implant loading where outcomes of the implant-supported prosthesis in patients with a history of GAgP were compared with another group were considered. The primary outcomes were survival rates (SRs) and marginal bone loss (MBL). Two reviewers independently assessed study quality was by using the Newcastle-Ottawa scale (NOS).

Results

6 studies (290 patients, 834 implants) were included.
All 6 were prospective studies.
Follow up periods ranged from 12- 120 months.
5 out of 6 studies were from the same research group.

Generalised aggressive periodontitis vs Healthy Patients

Risk Ratio (95% CI)

Generalised aggressive periodontitis vs chronic periodontitis

Risk Ratio (95% CI)

Implant survival

0.96 (0.91 to 1.01)

0.94 (0.87 to 1.01

‘failure rate’

4.00 (1.79 to 8.93)*

3.97 (1.68 to 9.37)*

* Significant P <0.001

	Marginal bone loss WMD (95% CI)
Healthy Patients vs Chronic periodontitis	0.15 mm (0.04 to 0.26)
Healthy Patients vs generalised aggressive periodontitis	-0.28 mm (-0.36 to -0.19)
Chronic periodontitis vs generalised aggressive periodontitis	-0.43 mm (-0.53 to -0.33)

WMD = Weighted mean difference

Conclusions

The authors concluded

Implant placement in patients with a history of GAgP might be considered a viable option to restore oral function with survival outcomes similar to those found in both patients with CP and HPs. However, the risk ratio for failure in patients with GAgP is significantly higher when compared with HPs (4.0) and those with CP (3.97)

Commentary

This review considers a similar question to the review we reported last week (Dental Elf 7^th Nov 2014). In that review they had a much clearer definition on implant failure (complete loss) whereas here it is unclear. This review focuses one studies involving GAgP, which is much less prevalent, so far fewer studies are included. While all the included studies were rated as medium high quality on the NOS they were relatively small and all bar one are from the same research group. The review we considered last week looked more widely at failure rates in periodontal compromised compared with periodontally health patients and suggested that periodontitis increased the risk of implant failure.