OBJECTIVES: The aim of the present study was to evaluate the long-term result of implant therapy, using implant loss as outcome variable.

MATERIAL AND METHOD: Two hundred and ninty-four patients had received implant therapy (Brånemark System) during the years of 1988-1992 in Kristianstad County, Sweden. The patients were recalled to the speciality clinic 1 and 5 years after placement of the suprastructure. Between 2000 and 2002, 9-14 years after implant placements, the patients were again called in for a complete clinical and radiographic examination.

RESULTS: Two hundred and eighteen patients treated with 1057 implants were examined. Twenty-two patients had lost 46 implants and 12 implants were considered "sleeping implants". The overall survival rate was 95.7%. Implant loss appeared in a cluster in a few patients and early failures were most common. Eight patients lost more than one fixture. A significant relationship was observed between implant loss and periodontal bone loss of the remaining teeth at implant placement. Maxillary, as opposed to mandibulary implants, showed more implant loss if many implants were placed in the jaw. A significant relationship between smoking habits and implant loss was not found.

CONCLUSION: A history of periodontitis seems to be related to implant loss.

OBJECTIVES: The aim of this study was to analyse the proportions of peri-implant lesions at implants after 9-14 years of function.

MATERIAL AND METHODS: Two hundred and ninety-four patients underwent implant therapy during the years 1988-1992 in Kristianstad County. These individuals were recalled to the speciality clinic 1 and 5 years after placement of the suprastructure. Between 2000 and 2002, 218 patients with 999 implants were examined clinically and radiographically.

RESULTS: Forty-eight per cent of the implants had probing depth > or =4 mm and bleeding on probing (peri-implant mucositis). In 20.4% of the implants, the bone level was located 3.1 mm apical to the implant shoulder. Progressive bone loss (> or =1.8 mm) during the observation period was found in 7.7% of the implants. Peri-implantitis defined as bone loss > or =1.8 mm compared with 1-year data (the apical border of the bony defect located at or apical to the third thread, i.e. a minimum of 3.1 mm apical to the implant shoulder), combined with bleeding on probing and or pus, were diagnosed among 16% of the patients and 6.6% of the implants.

CONCLUSION: After 10 years in use without systematic supportive treatment, peri-implant lesions is a common clinical entity adjacent to titanium implants.

OBJECTIVE: The aim of the present paper was to analyse, on patient and implant basis, factors related to peri-implant lesions.

MATERIAL AND METHODS: Two hundred and eighteen patients treated with titanium implants were examined for biological complications at existing implants 9-14 years after initial therapy. The effects of several potentially explanatory variables, both on patient and on implant levels, were analysed.

RESULTS: On the implant level, the presence of keratinized mucosa (p = 0.02) and plaque (p = 0.005) was associated with mucositis (probing depth > or =4 mm + bleeding on probing). The bone level at implants was associated with the presence of keratinized mucosa (p = 0.03) and the presence of pus (p < 0.001). On the patient level, smoking was associated with mucositis, bone level and peri-implantitis (p = 0.02, <0.001 and 0.002, respectively). Peri-implantitis was related to a previous history of periodontitis (p = 0.05).

CONCLUSIONS: Individuals with a history of periodontitis and individuals who smoke are more likely to develop peri-implant lesions.

OBJECTIVES: The purpose of the present paper is to review available information on the treatment of peri-implant mucositis and peri-implantitis.

MATERIALS AND METHODS: The results of animal research and human studies are presented. Proposed strategies for the treatment of peri-implantitis presented in the literature are also included.

RESULTS: Most of the information accessible at this time derives from case reports. The reports provide evidence that efforts to reduce the submucosal infection may result in short-term improvements of the peri-implant lesion. They also indicate that regenerative procedures in intrabony peri-implant defects can result in the formation of new bone.

CONCLUSIONS: Several uncertainties remain regarding the treatment of peri-implantitis. Properly conducted long-term follow-ups of consecutively treated cases would seem to be a realistic avenue for accumulation of more information. This may assist in establishing the predictability, magnitude and stability of improvements that can be achieved.

OBJECTIVES: The aim of this prospective cohort study was to compare two regenerative surgical treatment modalities for peri-implantitis.

MATERIAL AND METHODS: Thirty-six patients having a minimum of one osseointegrated implant, with a progressive loss of bone amounting to > or =3 threads (1.8 mm) following the first year of healing, combined with bleeding and/or pus on probing, were involved in this study. The patients were assigned to two different treatment strategies. After surgical exposure of the defect, granulomatous tissue was removed and the infected implant surface was treated using 3% hydrogen peroxide. The bone defects were filled with a bone substitute (Algipore). In 17 patients (Group 1), a resorbable membrane (Osseoquest) was placed over the grafted defect before suturing. In 19 patients (Group 2), the graft was used alone.

RESULTS: One-year follow-up demonstrated clinical and radiographic improvements. Probing depths were reduced by 2.9 mm in Group 1 and by 3.4 mm in Group 2. Defect fill amounted to 1.5 and 1.4 mm, respectively. There was no significant difference between the groups.

CONCLUSION: It is possible to treat peri-implant defects with a bone substitute, with or without a resorbable membrane.

OBJECTIVES: The aim was to study a regenerative surgical treatment modality for peri-implantitis employing submerged healing.

MATERIAL AND METHODS: Twelve patients, having a minimum of one osseointegrated implant with peri-implantitis, with a progressive loss of >or=3 threads (1.8 mm) following the first year of healing were involved in the study. After surgical exposure of the defect, granulomatous tissue was removed and the implant surface was treated using 3% hydrogen peroxide. The bone defects were filled with a bone substitute (Algipore), a resorbable membrane (Osseoquest) was placed over the grafted defect and a cover screw was connected to the fixture. The implant was then covered by flaps and submerged healing was allowed for 6 months. After 6 months the abutment was re-connected to the supra-structure.

RESULTS: A 1-year follow-up demonstrated clinical and radiographic improvements. Probing depth was reduced by 4.2 mm and a mean defect fill of 2.3 mm was obtained.

CONCLUSION: Treatment of peri-implant defects using a bone graft substitute combined with a resorbable membrane and submerged healing results in defect fill and clinical healthier situations.