Does a history of periodontal disease affect implant survival?

Abstract

Data sources Three electronic databases were searched (Medline, EMBASE and Cochrane Central) with date of publication between January 2003 and May 2018. Only articles written in English were included. Following electronic searches, the authors conducted manual searches of oral implant/periodontal journals from January 2012 to May 2018. In the event of disagreement on article selection, a further senior reviewer would make the final decision on its inclusion or exclusion following discussion.

Study selection In total, 172 articles from the electronic search and ten from manual search were identified for initial screening. From the title and abstract, 18 articles were identified for full-text screening. Following this, 13 articles were included for quantitative synthesis and meta-analysis. The articles assessed the impact of history of periodontitis (HP) on implant survival, radiographic bone loss, pocket depth and bleeding on probing around the dental implant. All studies were either cohort or controlled studies. Seven of the 13 identified studies were prospective. Included studies fulfilled the following criteria: any human studies with supportive periodontal treatment (SPT) application, details of SPT provided in the studies for implant maintenance, compares the outcomes of implants from both patients with and without a HP and peri-implant conditions recorded.

Data extraction and synthesis Data extraction followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance. The Newcastle-Ottawa Scale was used to carry out quality assessment. Data was extracted to calculate risk ratio (RR) of implant survival, weighted mean difference (WMD) for radiographic bone loss, pocket depth, bleeding on probing and plaque index in patients with and without a HP.

Results Implant survival rate was assessed as the primary outcome. Secondary outcomes also assessed were radiographic bone loss, pocket depth, bleeding on probing and plaque indices. In implants with rough surfaces, the HP group showed a reduced implant survival rate (RR: 0.96, 95% CI: 0.94-0.98, P <0.001) even under regular supportive post-implant treatment. They also showed more radiographic marginal bone loss (WMD: 0.34 mm, 95% CI: 0.2-0.48, P <0.001), pocket depth (WMD: 0.47 mm, 95% CI: 0.19-0.74, P <0.001) and bleeding on probing (WMD: 0.08 mm, 95% CI: 0.04-0.11, P <0.001) when compared to the non-HP group. In implants with a machined surface, again the HP group had more radiographic bone loss (WMD: 0.88 mm, 95% CI: 0.65-1.11, P <0.001) than the non-HP group. However, in implants with machined surfaces, there was no statistically significant difference in survival rate between HP and non-HP groups (RR: 0.98, 95% CI: 0.92-1.04, P = 0.895).

Conclusion In implants with rough surfaces, a history of periodontal disease has a negative impact on survival rate, even with SPT.