HasanDisclosure 3. M elker DJ, Richardson CR. Root reshaping: an integral component of periodontalThe author reports no conflicts of interest with anything mentioned in this article. surgery. Int J Periodontics Restorative Dent. 2001 Jun;21(3):296-304.References 4. M elker DJ. Biologic shaping from a restorative prospective. J Implant Adv Clin1. S adan A, Adar P. Esthetic proportions versus biologic width considerations: a Den. 2013;5(8):27-32. clinical dilemma. J Esthet Dent. 1998;10(4):175-81. 5. A hmad I. The Health, Function and Aesthetic Triad. Protocols for Predictable Aesthetic Dental Restorations: Blackwell Munksgaard; 2008. p. 21-54.2. G argiulo A, Wentz F. Dimensions of the dentogingival junction in humans. J Periodontol. 1953;32:261-7. The Journal of Implant & Advanced Clinical Dentistry ATTENTION PROSPECTIVE AUTHORS JIACD wants to publish your article! For complete details regarding publication in JIACD, please refer to our author guidelines at the following link:http://www.jiacd.com/authorinfo/author-guidelines.pdf or email us at: [email protected] The Journal of Implant & Advanced Clinical Dentistry • 51
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Occurrence Regions and Sites of Peri-implanMtunakata et al Inflammation with Bone Resorption in Japanese Partially-Edentulous PatientsMotohiro Munakata1• Noriko Tachikawa1 • Katsuichiro Maruo2, Aoi Sakuyama1 • Yoko Yamaguchi1 • Shohei Kasugai1AbstractBackground: The aim of this study was to was identified. The mean functional loadingclarify the occurrence regions and sites of time of these implants was 8.4 years. Occur-peri-implant bone resorption and inflamma- rence regions were frequently found in thetion in Japanese partially-edentulous patients. molar regions in maxilla (15.4%) and the molar region in mandible (10.0%). In these lesionsMethods: Five hundred one partially-edentu- detected radiologically, the bleeding on prob-lous patients with 738 implants in function for ing was seen in 95.2% of the buccal sitesmore than 5 years, were included in this study in mandibular molar regions, 70.0% of thefor the evaluation of the bone resorption by palatal sites in maxillary molar regions andusing dental radiograph and probing. Con- 56.7% of the buccal sites in maxillary molarsidering physiological bone remodeling, the regions with statistically significant differences.mean mesio-distal bone resorption around theimplant was measured on dental radiograph. Conclusions: From the limitation of the infor- mation in this study, it was concluded that theResults: In 65 patients (13.0% of the total sites that tend to be vulnerable to peri-implantpatients) with 76 implants (10.3% of the inflammation were the buccal site in mandi-total implants), peri-implant bone resorption ble, and the buccal and palatal sites in maxilla. KEY WORDS: Dental implants, peri-implantitis, bone loss1. Oral Implantology and Regenerative Dental Medicine, Tokyo Medical and Dental University, Tokyo, Japan, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8549, Japan.2. Department of Prosthodontic Dentistry for Function of TMJ and Occlusion, Kanagawa Dental University The Journal of Implant & Advanced Clinical Dentistry • 53
Munakata et al Introduction Photo 1: Dental implant with significant facial bone loss.Dental implants have been successfully used in the diagnosis of both peri-implant mucositis andthe treatment of complete and partial edentulous peri-implantitis, while the concomitant detectionpatient subjects.1 Nevertheless, dental implant of marginal peri-implant bone loss in radiographsfailures have also been reported.2,3 These fail- will distinguish peri-implantitis from mucositis.7ures are classified on the basis of chronology, i.e. Radiographic techniques including panoramicearly or late failure. Early dental implant failures tomography and intra-oral radiography with longare attributed to surgical trauma, inadequate cone paralleling techniques have been widelybone volume, lack of primary stability, intra-osse- used to monitor marginal bone levels aroundous infection, and bacterial contamination of the implants and diagnose interproximal bonerecipient site.3,4 Late dental implant failures are loss.9 However, conventional radiography doesassociated with peri-implantitis and/or biome- not enable to monitor facial and lingual/palatalchanical overload.2,3,5 In the Sixth European Work- bone levels (Photo 1) around the implants beingshop on Periodontology, peri-implant disease insensitive in detecting early bone changes andwas a collective term for inflammatory reactions underestimating bone loss.10,11 In clinical situa-in the tissues surrounding an implant.6,7 “Peri- tions, cases where suppuration is found only onimplant mucositis” is defined as inflammation of the buccal side or lingual/palatal sites, casesthe mucosa around an implant without loss of with BOP, or cases with advanced bone resorp-supporting bone, while “peri-implantitis” is char- tion on the buccal and lingual/palatal sites areacterized by loss of supporting bone together often experienced (Fig. 1). The aim of this studywith mucosa inflammation. It has been reported was to clarify the occurrence regions and sitesthat peri-implant mucositis occurs in 80% of the of peri-implant bone resorption and inflamma-subjects and in 50% of the implant sites and that tion in Japanese partially-edentulous patients.peri-implantitis is identified in 28% and 56% ofsubjects and in 12% and 43% of implant sites,respectively.7 As potential risk factors for peri-implantitis, Heitz-Mayfield8 listed the history ofperiodontal disease, diabetes mellitus, smoking,oral hygiene condition, alcohol intake, genotype,presence of cornified mucosa, and the implantsurface property. Oral hygiene condition, historyof periodontal disease, smoking, and diabetesmellitus, etc., have been reported as related riskfactors. Thus, the disease will be obviously morefrequent in the future, as long as a specific ther-apy or prevention will not established. Clinically,bleeding and/or suppuration following probinghas been proposed as a valuable clinical sign for54 • Vol. 6, No. 3 • June 2014
Munakata et alFigure 1: Frequent implant regions. Figure 2: Frequent implant sites of inflammation in maxillary molar region. Material and Methods Figure 3: Frequent implant sites of inflammation inThe present clinical study was approved by the mandible molar region.Ethical Committee, Faculty of Dentistry, TokyoMedical and Dental University, and the writ- tal radiographic evaluation at least 1 year afterten informed consents were obtained from all the placement of the superstructures, since thethe patients. Subjects were 501 partial eden- reference time point should be considered oftulous Japanese patients (738 implants) who the bone remodeling within one year after load-received superstructure more than 5 years ing. In the radiographs the distance betweenago. All the patients who had implants inserted the reference point and the most coronal posi-and superstructures made at Dental Hospital,Tokyo Medical and Dental University, between1999 and 2006, were examined. Severe illness,uncontrolled diabetes, untreated periodontaldisease and a history of head and neck radia-tion were excluded from the analysis. Probingpocket depth (PPD) and bleeding on probing(BOP) in the peri-implant sulcus where boneresorption was observed on the dental radio-graph were explored with the 4-point method.In addition, the mean height of vertical bonedefects at the both sites of the mesial and distalareas of implants was measured from the den- The Journal of Implant & Advanced Clinical Dentistry • 55
Munakata et alFigure 4: Morphological change of the bone due to peri- Figure 5: Morphological change of the bone due to peri-implantitis in a case with sufficient width. Saucer-shaped implantitis in a case with insufficient width. Defect of thebone resorption occurs evenly toward the mesio-distal and bucco-lingual bone wall and thread exposure are inducedbucco-lingual directions. during the process of developing saucer-shaped bone resorption.tion of bone to implant contact was assessed atthe both of mesial and distal aspects of the 76 Resultsimplants using a magnifying lens (×10) with a0.1mm graded scale. Peri-implantitis was diag- Peri-implantitis was diagnosed in 65 patients (76nosed when the bone resorption was pictured as implants) of the 501 patients (738 implants). The2 mm or larger on dental radiograph and further patient related prevalence rate of peri-implantitis wasBOP was observed in the peri-implant sulcus. 13.0% (smokers history: 25%). The implant related prevalence rate of peri-implantitis was 10.3%.Data Analyses● Reference of peri-implantitis in different Forty-two women and 23 men of 65 peri-implan- titis were included in this study with the mean age four regions of 62.5 years. The mean time period after the place-● Examination of BOP in implant sites ment of the superstructure was 8.4 years. The mean● Man-Whitney U-test was conducted for bone resorption in peri-implantitis was 3.8 ± 1.5 mm. The mean PPD was 5.6 ± 1.5 mm (Table 1). comparisons between different regions and sites. A p-value less than 0.05 was Occurrence regions were frequently found considered statistically significant. All in the molar regions in maxilla (15.4%, p < 0.01) statistical analyses were performed and the molar region in mandible (10.0%) (Fig. 2). using the IBM SPSS Statistics.21 BOP around implant sites was observed in the buccal sites of the molar regions in man- dible with 95.2% of the rate (p < 0.01), and in the palatal and buccal sites of the molar56 • Vol. 6, No. 3 • June 2014
Munakata et alFigure 6: Decision tree for the diagnosis of peri-implant bone loss.regions in maxilla with 70.0%(p < 0.01) and were vulnerable regardless of the failure pattern.56.7%(p < 0.01) of the rate, respectively (Fig. 3). The present study resulted in very frequent Discussion onsets molar regions in the maxilla and mandibular where plaque control is difficult, similar to that in nat-Occurrence regions and sites, usefulness of ural teeth. The different results were found possiblyradiography because Fransson et al studied the peri-implantitisFransson et al 12 reported that peri-implantitis was rate in total implants including healthy implants, thefound in about 40% of implants in a 5- to 23-year rate of implant-supported fixed complete denturesobservation period. As for regions of onset, the rate (FCD) without remaining tooth was remarkably highin the maxillary molar region was as low as 30% (74%), and bone loss in 3 threads or more and PPDand 52% in the mandibular molar region. They of 6 mm or more were classified as peri-implantitis.16reported that implants placed in the anterior region The presence of BOP, suppuration, and peri- The Journal of Implant & Advanced Clinical Dentistry • 57
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