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J Am Dent Assoc, Vol 140, No 4, 468-469. © 2009 American Dental Association

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	ABSTRACT

TOP ABSTRACT Clinical question. Review methods. Main results. Conclusions. FOOTNOTES  Importance and context. Strengths and weaknesses of... Strength and weakness of... Implications for dental...

 
Systematic review conclusion. Limited evidence exists to support the premise that subjects with a history of treated periodontitis are more likely to experience implant loss or other implant-related complications than are subjects without a history of periodontitis.

Critical summary assessment. The authors’ extensive review of the current literature yielded limited evidence supporting decreased implant longevity and increased implant-related complications in subjects treated for periodontitis.

Evidence quality rating. Limited.

	Clinical question.

TOP ABSTRACT Clinical question. Review methods. Main results. Conclusions. FOOTNOTES  Importance and context. Strengths and weaknesses of... Strength and weakness of... Implications for dental...

 
In osseointegrated implants placed in partially dentate patients, how do survival and success rates, osseous levels and incidence of peri-implantitis compare for patients with a history of treated periodontitis and those without a history of treated periodontitis?

	Review methods.

TOP ABSTRACT Clinical question. Review methods. Main results. Conclusions. FOOTNOTES  Importance and context. Strengths and weaknesses of... Strength and weakness of... Implications for dental...

 
The authors systematically searched two databases (Ovid MEDLINE and EMBASE). The search covered the literature up to and including March 2006. The authors included randomized clinical trials, case control and cohort studies, and case series. They performed a three-stage quality screening twice to increase precision. Studies selected for inclusion involved description of one or more of the specified outcomes: survival and success rates, osseous levels and incidence of peri-implantitis. The authors supplemented the search by hand-checking bibliographies of review articles.

	Main results.

TOP ABSTRACT Clinical question. Review methods. Main results. Conclusions. FOOTNOTES  Importance and context. Strengths and weaknesses of... Strength and weakness of... Implications for dental...

 
The authors included nine studies (three prospective cohort studies and six retrospective case-control studies) with varied study designs and methods.

Overall, the nine studies’ investigators compared at least 2,130 implants placed in 585 patients treated for periodontitis with at least 1,750 implants in 730 patients without a history of treated periodontitis. Investigators in eight studies reported that subjects without a history of treated periodontitis had higher rates of implant survival and success than did subjects with a history of treated periodontitis. Investigators in five studies reported less bone loss in the group without treated periodontitis, and investigators in three studies reported fewer occurrences of peri-implantitis in that group as well. In general, researchers in few of the included studies found a statistically significant difference in measured outcomes between the two groups.

	Conclusions.

TOP ABSTRACT Clinical question. Review methods. Main results. Conclusions. FOOTNOTES  Importance and context. Strengths and weaknesses of... Strength and weakness of... Implications for dental...

 
The authors could not make definitive conclusions because of the lack of control for confounding and the variability among case definitions and methods. There is some evidence for less favorable implant therapy outcomes in subjects treated for chronic and aggressive periodontitis. Additional well-designed research, controlled for bias and using uniform outcome definition, will be necessary to yield conclusive evidence.

	FOOTNOTES

Dr. Pinto is the director, Oral Medicine Clinical Center, University of Pennsylvania, 240 S. 40th St., Suite 214, Philadelphia, Pa. 19104, e-mail "apinto{at}dental.upenn.edu". He also is an evidence reviewer for the American Dental Association. Address reprint requests to Dr. Pinto.

Dr. Rethman is a private practitioner in Kaneohe, Hawaii. He also is an evidence reviewer for the American Dental Association.

Dr. Hagenbruch is a private practitioner in Harvard, Ill. He also is an evidence reviewer for the American Dental Association.

No sources of funding for this systematic review were listed.

	Importance and context.

TOP ABSTRACT Clinical question. Review methods. Main results. Conclusions. FOOTNOTES  Importance and context. Strengths and weaknesses of... Strength and weakness of... Implications for dental...

 
Outcome assessment is paramount to understanding the long-term prognosis of implant therapy. From a biological perspective, it is plausible that a history of treated periodontitis may predispose patients to infections or other phenomena that may put implants at enhanced risk of failure. The findings of this review suggested that patients with a history of treatment for periodontitis may require aggressive self-care and professional maintenance care after implant placement.

	Strengths and weaknesses of the systematic review.

TOP ABSTRACT Clinical question. Review methods. Main results. Conclusions. FOOTNOTES  Importance and context. Strengths and weaknesses of... Strength and weakness of... Implications for dental...

 
The authors used valid and reliable search methods. They assessed methodological quality by using pre-established criteria, evaluator consensus and a three-tier screening of selected manuscripts. They also assessed publication bias.

	Strength and weakness of the evidence.

TOP ABSTRACT Clinical question. Review methods. Main results. Conclusions. FOOTNOTES  Importance and context. Strengths and weaknesses of... Strength and weakness of... Implications for dental...

 
Only nine studies met the inclusion criteria. All studies had differences in terms of methods and outcome definitions. Some studies reported implant-level data, whereas others reported subject-level data. Only two studies reached statistical significance. Additionally, the risk for methodological bias was high in all but one cohort study and one case series, both of which the authors judged to be at medium risk of bias. They made no adjustment for comorbidities (such as smoking) in any study. Differences in outcomes and methods hindered the comparison of results among studies and weakened the conclusions.

	Implications for dental practice.

TOP ABSTRACT Clinical question. Review methods. Main results. Conclusions. FOOTNOTES  Importance and context. Strengths and weaknesses of... Strength and weakness of... Implications for dental...

 
Only limited conclusions can be reached from this review. The literature provides weak evidence of an association between a history of treated periodontitis and unfavorable implant outcomes. The authors of articles included in this review did not standardize the outcome definitions, and the methodology the authors used to assess them in the studies reviewed was limited. Clinicians may consider informing patients of the preliminary evidence, albeit weak, that supports an increased potential for implant failure in subjects with a history of treated periodontitis.

	FOOTNOTES

TOP ABSTRACT Clinical question. Review methods. Main results. Conclusions. FOOTNOTES  Importance and context. Strengths and weaknesses of... Strength and weakness of... Implications for dental...

Critical Summaries is prepared by experts working with the American Dental Association Center for Evidence-Based Dentistry and is supported by grant 1 G08 LM008956-01A2 from the National Library of Medicine and the National Institute of Dental and Craniofacial Research.

For more information on the evidence quality rating provided above and additional critical summaries, please visit "http://ebd.ada.org".

This article has been cited by other articles:

				W. Gillette PERIODONTITIS AND IMPLANTS J Am Dent Assoc, August 1, 2009; 140(8): 966 - 966. [Full Text] [PDF]

This Article Abstract Full Text (PDF) A correction has been published Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Pinto, A. Articles by Hagenbruch, J. F. Search for Related Content PubMed Articles by Pinto, A. Articles by Hagenbruch, J. F. Related Collections Periodontics