PROGRESSIVE PERI-IMPLANTITIS - INCIDENCE AND PREDICTION OF PERI-IMPLANT ATTACHMENT LOSS

The aim of this prospective study was to characterize an implant patie nt population exhibiting clinical signs of peri-implantitis and to det ermine subsequently the incidence of progressive attachment loss. The predictive values of diagnostic parameters were evaluated. 25 patients with 54 endosseous implants that had been loaded for 41+/-15 months w ere included in the study. Clinical parameters included the assessment of plaque, bleeding on probing, probing depth, attachment levels, and Periotest(R) values. Probing measurements were performed in duplicate by means of a controlled force electronic probe (Periprobe(R)). Peri- implant crevicular fluid samples were collected and assayed for neutra l proteolytic enzyme (NPE) activity (Periocheck(R)). Analysis of dupli cate baseline probing data revealed a high degree of reproducibility ( mean difference: 0.1 +/- 0.3 mm). A minimum threshold of 1.0 mm (>3xS. D.) loss of probing attachment was chosen to classify a site as positi ve for breakdown. Alternatively, the tolerance method was employed to identify sites with progressive attachment loss. After 6 months, irres pective of the analytical method, 6 percent of all sites (in 19% of th e implants) and 28% of the patients had experienced further peri-impla nt attachment loss. There were significant differences (p < 0.05) in m ean plaque (73% vs. 45%) and NPE (36% vs. 12%) scores between patients with progressive peri-implantitis and those with stable peri-implant conditions. Both bleeding on probing and the NPE-test were characteriz ed by high negative predictive values, and thus negative scores can se rve as indicators for stable peri-implant conditions. For monitoring p eri-implant health during recall visits, attachment level recordings w ith a controlled force electronic probe in conjunction with enzymatic diagnostic tests of the host response can be recommended. (C) Munksgaa rd, 1996.