2013 Volume 26 Issue 1 Pages 21-29
Purpose: Peri-implantitis (PI) is often caused by infection from periodontopathic bacteria (PB). In partially edentulous patients, PI is reportedly characterized by transmission of PB from remaining teeth to implants, resulting in similar compositions of subgingival microbial flora in both areas. Recent prospective epidemiological studies have demonstrated that the risk of PB transmission increases in patients with untreated or severe periodontitis, in whom periodontal pockets tend to remain after treatment, thereby reducing rates of implant survival and success. The present study retrospectively evaluated case series study data to determine relationships between clinical course of implant therapy and detection (or non-detection) of PB from before implant therapy until post-treatment maintenance in patients with or without periodontitis. Methods: The subjects were 62 patients (including 22 patients with periodontitis) for whom at least 2 years had elapsed since placement and fitting of an implant and superstructure. Data were obtained from a battery of clinical tests (probing pocket depth, bleeding on probing, pus discharge, radiographic assessment of alveolar bone resorption) and PB testing conducted before implant placement (baseline), upon fitting of the superstructure,at least 2 years after fitting of the superstructure (re-evaluation 1) and 3-6 months after treatment of the implant site based on the cumulative interceptive supportive therapy (CIST) protocol (re-evaluation 2). Correlations between presence or absence of PB and presence or absence of PI at each test point as well as presence or absence of clinical improvement after PI treatment were then statistically evaluated. Results: 1. Patients who tested positive for PB in remaining teeth at baseline also had a significantly higher positive PB test rate in implants at fitting of the superstructure than patients who tested negative for PB at baseline. This trend was particularly pronounced among periodontitis patients. 2. PI patients had a significantly higher positive PB test rate at re-evaluation 1 and at superstructure fitting than their non-PI counterparts. 3. The clinical improvement rate after PI treatment was significantly lower in patients who tested positive for PB in remaining teeth at baseline and at superstructure fitting compared to patients who tested negative. Conclusion: The present results indicate that transmission of PB from remaining teeth to implants and subsequent persistent infection are prone to occur in periodontitis patients, suggesting that this transmission is a risk factor for both PI and diminished treatment response in peri-implantitis therapy.
