Generalized Aggressive Periodontitis as a Risk Factor for Dental Implant Failure: A Systematic Review and Meta-Analysis

• Autores: Alberto Monje
• Localización: Journal of periodontology, ISSN 0022-3492, Nº. 10, 2014, págs. 1398-1407
• Idioma: inglés
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• Resumen

  • Background: Dental implant placement is a widely used treatment that provides functional and esthetic resolution for patients suffering from tooth loss. However, the incidence of peri-implant diseases has been rising recently. Periodontal diseases and peri-implant diseases share many similarities. Hence, it is important to find out whether patients with aggressive periodontal disease possess a higher risk of developing peri-implant diseases. The aim of this study is to study whether generalized aggressive periodontitis (GAgP) has similar survival rates (SRs) and marginal bone loss (MBL) when compared with patients with chronic periodontitis (CP) and/or healthy patients (HPs).

    Methods: An electronic literature search was conducted by one reviewer (AM) in several databases from 2000 to 2013, including MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Cochrane Oral Health Group Trials Register databases, for articles written in English up to November 2013. Human clinical trials, either prospective or retrospective, that compared implant SR and MBL in patients with a history of GAgP versus those with CP or HPs were included.

    Results: A total of six non-randomized prospective clinical trials met the inclusion criteria. The results showed SRs of 83.3% to 100% (GAgP), 96.4% to 100% (CP), and 96.9% to 100% (HP) over a mean period of 48.01 ± 71.99 months, with an overall risk ratio of 0.96 (95% confidence interval [CI] = 0.91 to 1.01, P = 0.14, GAgP versus HP) and 0.94 (95% CI = 0.87 to 1.01, P = 0.09, GAgP versus CP). However, when the �failure rate� as studied outcome was examined, meta-analysis presented an overall risk ratio of 4.00 for the comparison between patients with AgP and HPs and an overall risk ratio of 3.97 when compared with patients with CP. The MBL weighted mean difference for each subgroup was 0.15 mm (95% CI = 0.04 to 0.26, HP versus CP), -0.28 mm (95% CI = -0.36 to -0.19, HP versus GAgP), and -0.43 mm (95% CI = -0.53 to -0.33, CP versus GAgP) over a mean period of 30 ± 18 months.

    Conclusions: Implant placement in patients with a history of GAgP might be considered a viable option to restore oral function with survival outcomes similar to those found in both patients with CP and HPs. However, the risk ratio for failure in patients with AgP is significantly higher when compared with HPs (4.0) and those with CP (3.97).

    Success in implant dentistry relies on the initial osseointegration and long-term stability.1 Patient systemic factors and susceptibility to periodontal diseases, implant macrodesign and microdesign, and periodontal pathogenic bacteria, among others, have all been shown to play a role in achieving long-term implant stability.2 Consequently, many clinical studies have aimed at analyzing the effect of a history of previous periodontal disease on implant treatment success.3-10 Although a higher incidence of peri-implantitis and a lower implant survival rate (SR) were reported in patients susceptible to periodontitis,11,12 there is still disagreement on the level of this relationship.13,14 As occurs in natural dentition, once the disease is established and progressing, it determines implant prognosis. In this sense, it is important to mention that the preexisting ecologic conditions of the oral cavity influence biofilm formation on implants. It has been established that residual pockets act as niches of infection for dental implants15 and that putative periodontal pathogens are present even 1 year after periodontally affected teeth are extracted.16 Furthermore, it also has been established that putative periodontal pathogens increase with longer loading time and that this increase is more accentuated in patients with a history of periodontitis or peri-implant infections.17 Whereas chronic periodontitis (CP), associated with either local or systemic factors, is the most common form of the disease, aggressive periodontitis (AgP) is less frequent (<1% of the population).18 However, the presence of potential risks such as AgP may also have an influence on implant success. Despite some common histopathologic characteristics shared between chronic and aggressive forms19 and the different criteria and methods that were used to diagnose and define AgP, three major characteristics were used to define the aggressive disease: 1) clinically healthy with the exception of periodontitis; 2) rapid attachment loss (AL) and bone breakdown; and 3) familial aggregation.20,21 It often occurs in younger patients (<30 years of age), specifically the localized form, but it may also affect older patients.22 Other characteristics can also be used in the diagnosis of the disease: 1) amounts of microbial deposits inconsistent with the severity of periodontal tissue breakdown; 2) elevated proportions of Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis; 3) phagocyte abnormalities; 4) hyper-responsive macrophage phenotype, including elevated levels of prostaglandin E2 and interleukin (IL)-1?; and 5) self-arresting progression of AL and bone loss.20-22 Polymorphisms in genes regulating the expression of IL-1, IL-6, IL-10, tumor necrosis factor, E-selectins, Fc-? receptor, cluster of differentiation 14, toll-like receptors, caspase recruitment domain 15, vitamin D receptor, lactoferrin, caldesmon, heat shock protein 70, and Stac protein23 and major histocompatibility complexes A9 and B1524 were associated with AgP. As a consequence of these polymorphisms, the inflammatory profile is altered, including, but not limited to, polymorphonuclear neutrophil (PMN) transendothelial migration and signaling functions,25 reduced chemotactic response, and depression in neutrophil phagocytosis and superoxide production.26 Assuming that each periodontal entity has a distinct progressive pattern and different bacteria associated with it, it is critical to note that the numerous factors related to implant failure and the absence of long-term studies in association with a history of generalized AgP (GAgP) do not permit the drawing of noticeable correlations with implant survival/success. Nonetheless, it is necessary to treat and control periodontal disease, regardless of its progression pattern and subtype, before implant therapy is initiated to improve implant long-term treatment success.12 Several studies3-8 aimed at analyzing the influence of a history of aggressive periodontal disease on implant treatment outcome in terms of SR and marginal bone loss (MBL). Results from these longitudinal studies suggest that patients with GAgP experienced higher implant failure rates when compared with patients with CP and healthy patients (HP). However, there is still no consensus, which is achievable by a well-designed systematic review that clarifies the effect of previous history of GAgP on implant treatment outcome. Henceforth, the present study aims at assessing whether patients who suffered from GAgP have a higher implant failure rate and MBL in implant prostheses when compared with patients with CP and/or HPs.