Outcome of implant therapy in patients with previous tooth loss due to periodontitis

BACKGROUND: It is frequently debated whether implant treatment in individuals with previous tooth loss due to periodontitis is characterized by an increased incidence of implant loss and peri-implantitis. OBJECTIVE: The objective of the present systematic review was to assess whether individuals with previous tooth loss due to periodontitis have an increased risk of loss of suprastructures, loss of implants, peri-implantitis, and peri-implant marginal bone loss as compared with individuals with previous tooth loss due to reasons other than periodontitis. SEARCH STRATEGY: Studies considered for inclusion were searched in MEDLINE (PubMed) and relevant journals were hand searched. Moreover, reference lists of articles selected for full-text screening as well as previously published reviews relevant for the present systematic review were searched. The search was performed by one reviewer and was restricted to human studies published from January 1, 1980 to January 1, 2006. No language restrictions were applied. SELECTION CRITERIA: Prospective and retrospective cohort studies with at least a 5-year follow-up comparing the outcome of implant treatment in individuals with periodontitis-associated and non-periodontitis-associated tooth loss, respectively, were included. The outcome measures were survival of suprastructures, survival of implants, occurrence of peri-implantitis, and peri-implant marginal bone loss. The 5- and 10-year time points were evaluated. DATA COLLECTION AND ANALYSIS: Screening of eligible studies, methodological quality assessment, and data extraction were conducted in duplicate and independently by two of the authors. The authors were contacted for missing information. Results were expressed as random effect models using weighted mean differences for continuous outcomes and relative risk for dichotomous outcomes with 95% confidence intervals (CIs). MAIN RESULTS: Two studies with a 5- and 10-year follow-up, respectively, were identified including a total of 33 patients with tooth loss due to periodontitis and 70 patients with non-periodontitis-associated tooth loss. There was no significant difference in the survival of the suprastructures after 5 years. Furthermore, there were no significant differences in the survival of the implants after 5 and 10 years. However, there were significantly more patients affected by peri-implantitis in the group with periodontitis-associated tooth loss during the 10-year follow-up period, risk ratio (RR) 9 (95% CI 3.94-20.57). Moreover, significantly increased peri-implant marginal bone loss was observed in patients with periodontitis-associated tooth loss after 5 years, mean difference 0.5 mm (95% CI 0.06-0.94). CONCLUSIONS: The survival of the suprastructures and the implants was not significantly different in individuals with periodontitis-associated and non-periodontitis-associated tooth loss. However, significantly increased incidence of peri-implantitis and significantly increased peri-implant marginal bone loss were revealed in individuals with periodontitis-associated tooth loss. The small sample size and the methodological quality assessment of the two studies suggest that the results should be interpreted with caution. Consequently, further long-term studies focusing particularly on the outcome of implant treatment in young adults with aggressive periodontitis are needed before final conclusions can be drawn about the outcome of implant treatment in patients with a history of periodontitis.