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Gun-Britt Sagulin
Leif E. Jansson
Authors affiliations:
Monica Wahlstrom, Gun-Britt Sagulin, Department
of Prosthetics at Kista-Skanstull, Public Dental
Health, Stockholm, Sweden
Leif E. Jansson, Department of Periodontology at
Kista-Skanstull, Public Dental Health, Stockholm,
Sweden
Corresponding author:
Monica Wahlstrom
Folktandvarden Skanstull
Gotgatan 100
118 62 Stockholm
Sweden
Tel.: 46 8 12316400
Fax: 46 8 6446271
e-mail: monica.wahlstrom@ftv.sll.se
clinic referred for periodontal treatment, (2) the prevalence of varying mechanical and
biological complications and (3) effects of potential risk factors on the success rate.
Material and methods: Fifty consecutive patients were invited to participate in a follow-up.
The patients had received FDPs on implants between November 2000 and December 2003
after treatment to achieve optimal peridontal health, and the FDPs had been in function for
at least 3 years. A questionnaire was sent to the patients before the follow-up examination.
Forty-six patients with 116 implants were examined. The follow-up comprised clinical and
radiographic examinations and evaluations of treatment outcome.
Results: Before implant treatment, 13% of the teeth were extracted; of these, 80% were
extracted due to periodontal disease. No implants had been lost before implant loading.
One implant in one patient fractured after 3 years of functional loading and three implants
in another patient after 6.5 years. The most frequent mechanical complications were veneer
fractures and loose bridge screws. Patients with peri-implant mucositis had significantly
more bleeding on probing around teeth and implants. Patients with peri-implantitis at the
follow-up had more deep periodontal pockets around their remaining teeth compared
with individuals without peri-implantitis, but these differences were not significant.
Smokers had significantly fewer teeth, more periodontal pockets 4 mm and a tendency
towards greater marginal bone loss at the follow-up, compared with non-smokers.
Conclusion: In the short term, overloading and bruxism seem more hazardous for implant
treatment, compared with a history of periodontitis.
Date:
Accepted 11 February 2010
To cite this article:
Wahlstrom M, Sagulin G-B, Jansson LE. Clinical followup of unilateral, fixed dental prosthesis on maxillary
implants
Clin. Oral Impl. Res. 21, 2010; 12941300.
doi: 10.1111/j.1600-0501.2010.01948.x
1294
Implant treatment
Age.
Gender.
Medical history and medications.
Questions about the function of the
FDP.
FDPs time in function.
Smoking habits: non-smoker, former
smoker, current smoker.
Number of remaining teeth before
treatment and at the follow-up.
Reasons for tooth extractions.
Temporomandibular disorders: occurrence of subjective and objective symptoms, parafunctions and interferences,
occlusal wear, and use of interocclusal
appliance.
Bone augmentation.
Number of implants.
Implant sites.
Implant system.
Design of prosthetic construction:
material in the supraconstruction
(Table 1), cemented or screw-retained
FDP, type of abutments, number of
bridge units and cantilevers (Table 2).
BOP.
PPD at four sites per tooth and implant
using a periodontal measuring probe
(CP-12, Hu-Friedy, Chicago, IL, USA).
Titanium/sinfony
Gold/porcelain
Titanium/porcelain
Wirobond/porcelain
1
34
1
10
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With light force, the probe was vertically inserted into the pocket between
the mucosa and the implant.
Peri-implant mucositis, defined by
BOP, PPDo4 mm, and without loss
of marginal bone around the implant.
Peri-implantitis, defined by the color
and shape of peri-implant mucosa,
bleeding or pus on probing, PPD
4 mm, and marginal bone loss mesial
and distal of the fixtures 42 mm clearly
visible on radiographs, compared with
baseline radiographs made at the first
follow-up visit, in most cases 1 year
after prosthetic loading
Implant loss.
Mechanical complication of the supraconstruction and/or the implant during
functional loading.
Difficulties in maintaining proper oral
hygiene caused by the design of the
bridge or patients motoric disability.
Maintenance program for oral health.
Statistics
1296 |
38
1 2
26
16 4
13
23 6
5 6
3 1
Biological complications
%
100
90
80
70
60
50
40
30
20
10
0
Baseline
Follow-up
0-9
10-19
20-29
30
100
90
80
70
60
50
40
30
20
10
0
0-9
10-19
20-29
30
Number of periodontal
pockets 6 mm
Number of periodontal
pockets 4 mm
Fig. 1. Distribution of probing pocket
4 mm at baseline and at the follow-up.
Results
Variable
depths
depths
Table 3. The relative frequency distribution (%) of answers to anamnesis variables on the
questionnaire
Variable
Yes (%)
No (%)
Smoker
Former smoker
Takes snuff
Subjective symptoms of temporomandibular disorders
Bruxism
Frequent headache
Use of interocclusal appliance
Bleeding around implants
Satisfied with implants
Chewing habits were changed
Subjective symptoms caused by the implants
Satisfied with the esthetics of the implants
Subjective feeling of difference between implants and teeth
Regretted the choice of implant treatment
11
57
7
13
31
9
28
35
89
13
20
98
13
0
89
43
93
87
69
91
72
65
11
87
80
2
87
100
c 2010 John Wiley & Sons A/S
Table 4. Median values (range) for periodontal variables associated with smoking history
Smoking history
Smokers
Former smokers
Non-smokers
5
26
15
20 (1429)
17 (824)
23 (1628)
4 (323)
0 (03)
0 (01)
40 (54.8)
53.8 (50.8)
26.7 (45.8)
4 (049)
3.5 (023)
1 (04)
2 (037)
3 (034)
2 (044)
Table 5. Frequency distributions of subjects with peri-implant mucositis and peri-implantitis associated with smoking history
Smoking history
Number of patients
with mucositis
Number of patients
with peri-implantitis
Smokers
Former smokers
Non-smokers
Total
5
26
15
46
3
5
2
10
1
1
0
2
Discussion
The present study consisted of 46 patients
and the analyses were performed at the
patient level. Thus, the material consisted
of a limited number of data and the analyses were performed using non-parametric
tests as these tests have the advantage of
not requiring the assumption of normality
or the assumption of homogeneity of variance. The multiple comparisons between
different groups may result in mass significance, which means an increased risk of
rejecting a correct hypothesis.
Consensus statements and recommendations (Lang et al. 2004) regarding implant
survival and complications for implantsupported FDPs in an ordinary population
noted that the cumulative survival rate of
FDPs that are supported by oral implants
was 95% after 5 years in function and
86.7% after 10 years in function. In our
limited material, the survival rate of FDPs
was 93.5% after 37 years in function.
Most studies are based on the FDP survival
rate from treatment in the mandible and
the maxilla, while our study only reports
results from maxillary treatment. Jemt &
Lekholm (1995) observed a lower FDP
survival rate in the maxilla.
The Pjetursson et al. (2004) review of
four studies on the effects of FDPs on
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Table 6. Median values (range) for periodontal variables associated with the presence of peri-implant mucositis, peri-implantitis, and
implant loss
Diagnosis
Peri-implant mucositis
Peri-implantitis
Implant loss (due to fracture)
Number of
bleeding sites
at probing
Percentage (SD) of
subjects with a
marginal bone loss
1/3 of root length
Number of
teeth at
follow-up
Number of
periodontal
pockets
4 mm
10
36
19.5 (1326)
20 (829)
3.5 (049)
1 (013)
2 (023)
0 (03)
8.5 (044)
1.5 (021)
30 (48.3)
47.2 (50.6)
2
44
17.5 (1619)
20 (829)
26.5 (449)
1.5 (023)
10.5 (023)
0 (03)
22 (737)
2 (044)
100 (-)
40.9 (49.7)
2
44
17.5 (1619)
20 (829)
2 (04)
1.5 (049)
0 (00)
0 (023)
15.5 (724)
2 (044)
100 (-)
40.9 (48.2)
1298 |
Number of
periodontal
pockets
6 mm
Acknowledgements:
The authors
thank Ms Birgitta Sunehed for technical
and administrative assistance.
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c 2010 John Wiley & Sons A/S
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c 2010 John Wiley & Sons A/S