Jan Håkansson

Effectiveness of Implant Therapy Analyzed in a Swedish Population: Prevalence of Peri-implantitis

Peri-implantitis is an inflammatory disease affecting soft and hard tissues surrounding dental implants. As the global number of individuals that undergo restorative therapy through dental implants increases, peri-implantitis is considered as a major and growing problem in dentistry. A randomly selected sample of 588 patients who all had received implant-supported therapy 9 y earlier was clinically and radiographically examined. Prevalence of peri-implantitis was assessed and risk indicators were identified by multilevel regression analysis. Forty-five percent of all patients presented with peri-implantitis (bleeding on probing/suppuration and bone loss >0.5 mm). Moderate/severe peri-implantitis (bleeding on probing/suppuration and bone loss >2 mm) was diagnosed in 14.5%. Patients with periodontitis and with ≥4 implants, as well as implants of certain brands and prosthetic therapy delivered by general practitioners, exhibited higher odds ratios for moderate/severe peri-implantitis. Similarly, higher odds ratios were identified for implants installed in the mandible and with crown restoration margins positioned ≤1.5 mm from the crestal bone at baseline. It is suggested that peri-implantitis is a common condition and that several patient- and implant-related factors influence the risk for moderate/severe peri-implantitis (ClinicalTrials.gov NCT01825772).

Effectiveness of Implant Therapy Analyzed in a Swedish Population Early and Late Implant Loss

Treatment outcomes in implant dentistry have been mainly assessed as implant survival rates in small, selected patient groups of specialist or university clinical settings. This study reports on loss of dental implants assessed in a large and randomly selected patient sample. The results were aimed at representing evaluation of effectiveness of implant dentistry. Using the national data register of the Swedish Social Insurance Agency, 4,716 patients were randomly selected. All had been provided with implant-supported restorative therapy in 2003. Patient files of 2,765 patients (11,311 implants) were collected from more than 800 clinicians. Information on patients, treatment procedures, and outcomes related to the implant-supported restorative therapy was extracted from the files. In total, 596 of the 2,765 subjects, provided with 2,367 implants, attended a clinical examination 9 y after therapy. Implant loss that occurred prior to connection of the supraconstruction was scored as an early implant loss, while later occurring loss was considered late implant loss. Early implant loss occurred in 4.4% of patients (1.4% of implants), while 4.2% of the patients who were examined 9 y after therapy presented with late implant loss (2.0% of implants). Overall, 7.6% of the patients had lost at least 1 implant. Multilevel analysis revealed higher odds ratios for early implant loss among smokers and patients with an initial diagnosis of periodontitis. Implants shorter than 10 mm and representing certain brands also showed higher odds ratios for early implant loss. Implant brand also influenced late implant loss. Implant loss is not an uncommon event, and patient and implant characteristics influence outcomes (ClinicalTrials.gov NCT01825772).

Peri-implantitis – onset and pattern of progression

BACKGROUND While information on the prevalence of peri-implantitis is available, data describing onset and progression of the disease are limited. MATERIAL & METHODS A 9-year follow-up examination of 596 randomly selected implant-carrying individuals identified 62 patients with moderate/severe peri-implantitis. Longitudinal assessments of peri-implant marginal bone levels were used to construct a statistical model with bone loss as the dependent variable. A multilevel growth model estimated the pattern of bone loss for each implant/patient. Onset of peri-implantitis was determined by evaluating the cumulative percentage of implants/patients presenting with estimated bone loss at each year following prosthesis delivery. RESULTS The analysis showed a non-linear, accelerating pattern of bone loss at the 105 affected implants. The onset of peri-implantitis occurred early, and 52% and 66% of implants presented with bone loss of >0.5 mm at years 2 and 3 respectively. A total of 70% and 81% of subjects presented with ≥1 implants with bone loss of >0.5 mm at years 2 and 3 respectively. CONCLUSIONS It is suggested that peri-implantitis progresses in a non-linear, accelerating pattern and that, for the majority of cases, the onset occurs within 3 years of function.

Patient‐reported outcomes of dental implant therapy in a large randomly selected sample

BACKGROUND In addition to traditional clinical parameters, the need to include patient-reported assessments into dental implant research has been emphasized. AIM The aim of this study was to evaluate patient-reported outcomes following implant-supported restorative therapy in a randomly selected patient sample. MATERIAL AND METHODS Four thousand seven hundred and sixteen patients were randomly selected from the data register of the Swedish Social Insurance Agency. A questionnaire containing 10 questions related to implant-supported restorative therapy was mailed to each of the individuals about 6 years after therapy. Associations between questionnaire data, and (i) patient-related, (ii) clinician-related and (iii) therapy-related variables were identified by multivariate analyses. RESULTS Three thousand eight hundred and twenty-seven patients (81%) responded to the questionnaire. It was demonstrated that the overall satisfaction among patients was high. Older patients presented with an overall more positive perception of the results of the therapy than younger patients and males were more frequently satisfied in terms of esthetics than females. While clinical setting did not influence results, patients treated by specialist dentists as opposed to general practitioners reported a higher frequency of esthetic satisfaction and improved chewing ability. In addition, patients who had received extensive implant-supported reconstructions, in contrast to those with small reconstructive units, reported more frequently on improved chewing ability and self-confidence but also to a larger extent on implant-related complications. CONCLUSION It is suggested that patient-perceived outcomes of implant-supported restorative therapy are related to (i) age and gender of the patient, (ii) the extent of restorative therapy and (iii) the clinician performing the treatment.

Consumption of dental treatment in patients with inflammatory bowel disease, a register study.

Objective The aim of this study was to compare the consumption of dental treatment among patients with Crohn´s disease (CD) or ulcerative colitis (UC) compared to age and gender matched control groups. Design The study group comprised 2085 patients with CD and 3161 with UC from the Uppsala-Örebro region and from the Stockholm region. The patients in the cohort were diagnosed between 1960 and 1989. Patients up to 70 years of age were included in the study. The two patients groups were compared to age- and gender-matched, randomly selected control groups from the same geographic area comprising a corresponding number of participants. Results CD patients had significantly higher total number of procedures registered (p < 0.000). The difference was most pronounced for removable dentures (+65%), fillings in front teeth (+52%) and endodontic treatment (+46%) when Crohn’s patients were compared to controls (p<0.001). The corresponding figures for UC patients were also a significantly higher total number of procedures (p < 0.005), more clinical examinations (p<0.000), fillings in canines and incisors (p < 0.001) and fillings in bicuspids and molars (p < 0.000). Conclusion This study demonstrate that CD and UC individuals use more dental treatment compared to an age-gender matched control group, and more caries-related treatments. The difference was most pronounced for restorative treatment in patients with Crohn’s.