Ten-year results of a three arms prospective cohort study on implants in periodontally compromised patients. Part 2: clinical results

OBJECTIVES:The aim of this study was to compare long-term outcomes of implants placed both in patients treated for periodontitis and in periodontally healthy patients (PHP). MATERIAL AND METHODS: One hundred and twelve partially edentulous patients were consecutively enrolled in private specialist practice and divided into three groups according to their initial periodontal condition: PHP, moderately periodontally compromised patients (PCP) and severely PCP. Implants were placed to support fixed prostheses, after successful completion of initial periodontal therapy [full-mouth plaque score (FMPS) <25%, full-mouth bleeding score (FMBS) <25%]. At the end of active periodontal treatment (APT), patients were asked to follow an individualized supportive periodontal therapy (SPT) program. Diagnosis and treatment of peri-implant biological complications was performed according to cumulative interceptive supportive therapy. At 10 years, clinical measures were recorded by two calibrated operators, blinded to the initial patient classification, on 101 patients, as 11 were lost to follow-up. The number of sites treated according to therapy modalities C and D (antibiotics and/or surgery) during the 10 years was registered. RESULTS:Eighteen implants were removed for biological complications. Antibiotic and/or surgical therapy was performed in 10.7% of cases in PHP, in 27% of cases in moderate PCP and in 47.2% cases in severe PCP, with a statistically significant differences between PHP and severe PCP (P = 0.002). At the final examination, the percentage of implants, with at least one site which presented a PD ≥6 mm, was respectively 1.7% for PHP, 15.9% for moderate PCP and 27.2% for severe PCP, with a statistically significant difference between PHP and moderate PCP (P = 0.005) and PHP and severe PCP (P = 0.0001). CONCLUSION:Patients with a history of periodontitis presented a statistically significant higher number of sites which required additional treatment. Therefore, patients with a history of periodontitis should be informed that they are more at risk for peri-implant disease. This underlines the value of the SPT in enhancing long-term outcomes of implant therapy, particularly in subjects affected by periodontitis. Therefore, the approach for multiple preventive dental extractions and implant placement, based on the assumption the implants perform better than teeth, should be followed with extreme caution.