Long-Term Biological Complications of Dental Implants Placed Either in Pristine or in Augmented Sites
Amsterdam 2018
Risks and Biologic Complications Associated with Implant Dentistry
Consensus Statement
Treatment Outcomes and Continuing Care
Preamble

Placement of dental implants in conjunction with augmentation procedures is well documented and has been shown to yield high predictability in terms of implant survival rates and volume stability. However, a comparison between the long-term prevalence of biological complications at implants placed in pristine sites (sites not requiring augmentation prior to or in conjunction with implant placement) versus augmented sites is lacking.

This systematic review investigated and compared the prevalence of biological complications and failure (loss) of implants placed in pristine versus augmented sites after a mean observation period of at least 10 years. The following focused questions were addressed:

In patients with osseointegrated dental implants, are there differences in biological complications at implants placed in pristine versus augmented sites?
In patients with osseointegrated dental implants, are there differences in failure rates of implants placed in pristine versus augmented sites?

The systematic review included 8 investigations (1 RCT, 1 case-control study, 1 cross-sectional study, 5 case series). The mean number of patients included across the studies was 56.9 (range: 15–96 patients), while the mean number of implants was 113.5 (range: 15–153 implants) with a mean follow-up of 11.1 years (range: 10–15 years).

Various augmentation techniques (e.g., lateral and/or vertical augmentation, augmentation prior to or at the time of implant placement, and alveolar ridge preservation procedures prior to implant placement), as well as a range of augmentation materials (e.g., autogenous bone and bone substitutes) and barrier membranes (e.g., resorbable and nonresorbable) were included in the four studies reporting on implant placement in augmented sites. All included studies reported that patients were enrolled in supportive care following implant therapy.

No statistically significant differences were observed between implants placed in pristine versus augmented sites for any outcome variable both at patient and implant level. High heterogeneity concerning patient sampling, case definitions of biological complications and eligibility criteria were observed.

Sufficient data were available to perform meta-analyses for the primary outcome (biological complications) and secondary outcome (implant failure).

Consensus Statements
  • There is evidence that patients receiving implants in augmented sites may display a comparable prevalence of peri-implant mucositis compared with patients receiving implants in pristine sites. Patients with implants placed in pristine sites have a prevalence of peri-implant mucositis of 22.4% (95% CI: 6%–38%) compared with a prevalence of 19.6% (95% CI: 0%–40%) for patients with implants in augmented sites.
    This statement is based on 1 RCT, 1 case–control study, and 4 case series studies.
     
  • There is evidence that the long-term prevalence of peri-implantitis in patients with implants in pristine sites and augmented sites is low. The prevalence of peri-implantitis in patients with implants in augmented sites is more variable and less predictable compared with the prevalence in patients with implants in pristine sites. The weighted mean prevalence of peri-implantitis in patients with implants in augmented sites was 17.8% (95% CI: 0%–37%) compared with that of 10.3% (95% CI: 4%–17%) in patients with implants in pristine sites.
    This statement is based on 1 RCT, 1 case–control study, and 4 case series studies.
     
  • There is some evidence that the long-term prevalence of implant failure (loss) in patients with implants in pristine sites and augmented sites is low. The weighted mean prevalence of implant failure (loss) in patients with implants in augmented sites was 3.6% (95% CI: 0%–8%) compared with that of 2.5% (95% CI: 1%–4%) in patients with implants in pristine sites.
    This statement is based on 1 RCT, 1 case–control study, and 4 case series studies.
     
  • In patients with a history of treated periodontitis (moderate and severe) receiving implant therapy in pristine sites, compliance with regular supportive care yields lower long-term implant failure (loss) compared with patients not complying with regular supportive care.
    This statement is based on 1 study.
     
  • There is limited evidence concerning the effect of regular supportive care in patients with a history of treated periodontitis receiving implants in augmented sites.
    This statement is based on 1 study.
Clinical Recommendations
  • For the long-term monitoring of biological complications, at what time points should implants placed in augmented sites be assessed?
    The time of completion of the implant-supported prosthesis should be used as a baseline for assessment. Similar to implants placed in pristine sites, implants placed in augmented sites should have time-points for subsequent assessments determined by the individual risk profile of the patient.
     
  • Do patients with implants in augmented sites require specific supportive care?
    Patients with implants in augmented and pristine sites should both be enrolled in regular supportive care. Special consideration should be given to periodontally susceptible patients with implants placed in augmented sites.
Review Paper
Classification Tags
Biological Complications
Bone Augmentation
Bone Management
Complications
Consensus Statement
Long-Term Data
Mucositis
Outcomes
Peri-Implantitis
Surgery
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Publication date: November 16, 2018 | Review date: November 09, 2018 | Next review date: November 09, 2021