| Abstract | Liječenje bezubosti s dentalnim implantatima je danas uobičajeno u većini zemalja zapadnog
svijeta. Procjenjuje se kako je uspješnost takova liječenja iznimno velika, iako postoji i dalje
potreba za istraživanjima na velikom broju bolesnika kojima su postavljeni implantati, a u
kojih bi se promatrali lokalni i sistemski čimbenici koji dovode do neuspjeha ovog načina
liječenja. Stoga je cilj ovog istraživanja bio ustanoviti je li prisutnost prijašnje parodontalne
bolesti, stupanj oralne higijene odnosno krvarenje pri sondiranju (KPS) i plak cijele usne
šupljine (PCUS), pušenje, sistemske bolesti kao i same karakteristike postavljenih dentalnih
implantata (veličina, tip) utječu na neuspjeh implant-protetske terapije. Analizirani su podaci
od 670 bolesnika kojima je ugrađeno 1260 dentalnih implantata i koji su praćeni tijekom pet
godina najmanje. Za statističku obradu korišten je Medcalc (v11.4). Kategorički podatci
obrađivani su hi-kvadrat testom (Chi-square). Kontinuirane varijable (dob, KPS, PCUS) nisu
bile normalnih distribucija te su stoga bile analizirane neparametrijskim Mann-Whitney U
testovima. P vrijednosti manje od 0,05 smatrane su značajnima.
Rezultati ovog istraživanja su pokazali kako je 9 implantata bilo izgubljeno pri čemu nije bilo
znakovite razlike u tipu implantata ili načinu pričvršćenja suprastrukture. Ipak, zanimljivo je
da je većina tih bolesnika imala parodontnu bolest. Nadalje nije bilo znakovite razlike između
pušača i nepušača vezano uz gubitak implantata.Nije bilo znakovitih razlika s obzirom na
sistemske bolesti ovih bolesnika. Nadalje, rezultati ovog istraživanja su pokazali kako tip
implantata (konični odnosno cilindrični) i vrsta vezivanja suprastrukture na implantat
(cementirani ili vijak) nisu imali znakovitog utjecaja na KPS ili PCUŠ. Kod pušača je u svim
slučajevima došlo do značajnog poboljšanja KPS i PCUŠ, a koji su ujedno imali i značajno
lošije inicijalno KPS stanje (0,0037) od onih koji nisu pušili, no za PCUŠ nije bilo značajnosti
(p=0,4218). U bolesnika s parodontalnom bolesti došlo je do poboljšanja KPS i PCUŠ nakon
60 mjeseci praćenja te nije bilo razlika u odnosu na osobe koje nisu imale parodontozu.
Također, nije bilo značajnih razlika niti u KPS ili PCUS između osoba s dijabetesom i onih
bez dijabetesa nakon petogodišnjeg praćenja. Ateroskleroza je imala znakovit negativan
utjecaj na KPS ali ne i na PCUŠ nakon pet godina praćenja. Možemo zaključiti kako je jedino
parodontitis imao znakovit utjecaj na neuspjeh implanto-protetskog liječenja. |
| Abstract (english) | Background and objectives: The treatment of edentulousness with dental implants is usual a
procedure in most of the western countries. From the published data it is well known that
previous data upon periodontal disease and smoking might lead to the more frequent failure of
implanto-prosthetic therapy. Systemic diseases such as diabetes mellitus, atherosclerosis,
cardiovascular disorders, thyroid disease, osteoporosis, chemotherapy and radiotherapy in the
head and neck area have been proposed as a factors that might contribute to the failure of
implanto-prosthetic therapy. Furthermore, implant characteristics such as type, diameter and
length of implant as well as its connection with prosthetic suprastructure (screw retained or
cemented one) migh influence the success of implanto-prosthetic therapy. Also, surgical
technique and placement in the upper or lower jaw might additionally influence the success of
impalnto-prosthetic therapy. It is estimated that such a treatment is highly successful,
although there is still a need for studies which would include local and systemic factors on big
populations in order to detect potential failures. The aim of this study was to analyze whether
the previous presence of periodontal disease, oral hygiene status i.e. bleeding on probing
(BOP) and full mouth plaque index (FMPI), smoking, systemic diseases as well as implant
characteristics (type, length, shape) and type of connection with prosthetic suprastructure
affect implant-prosthetic failure.
Methods: Data from 670 patients were retrieved in whom 1260 dental implants were installed
and who were followed in the course of at least five to ten years. All patients were treated in
the private clinic in Zagreb by one experienced clinican. In every participant anamnestic data
regarding age, gender, smoking habit, previous data upon periodontal disease, systemic
diseases such as diabetes mellitus, atherosclerosis etc. were registered. In every patient, type
of implant (lenght, diameter and shape) was registered as well as place in the bone where was
installed as well as type of retention of the prosthetic suprastructure (cemented/screw
retained). Plaq index of the full mouth was assesed together with bleeding on probing. The
participants were called for recall after five years in order to determine whether periimplantitis
was present or unsuccesful osseointegration nas occurred. Data were analysed
using Medcalc (v11.4). Categorical data were analysed by the Chi-square test. Continued
variables (age, BOP, FMPI) were not normally distributed, therefore the non-paramteric
Mann-Whitney test was used. P values lower than 0.05 were significant. The influence of
local and systemic factors on the success of implanto-prosthetic therapy was assesed by
multiple logistic regression analysis. Loss of implants was dependent variable while age,
smoking, previous data upon periodontal disease, type, length and diameter of implants, type
of retention with prosthetic suprastructure and systemic diseases were independent variables.
Results: Forty five patients had systemic diseases 45 pacijenata (6.7%), and diabetes mellitus
was the most common one among them (n=35), followed by atherosclerosi (n=8), diabetes
and atherosclerosis (n=5), diabetes mellitus type 1 (n=3), lymphoma (n=1) and hepatitis C
(n=1). One third of the patients were smokers (33.4%). Most of the patients were 41-60 years
old, mean age 53.9%. All patients were treated during the period of the year 2008 till the year
2012. therefore the obtained data could be retrieved for at least five years. One hundred and
70 patients had periodontal disease, while 500 patients were without periodontal disease. Of
670 patients, 628 patients had only one procedure. The number of installed implants was one
in 333 patients, i.e. more than one in 337 patients. Nine implants were lost during the period
of five years. There were no differences regarding the type of implant or type of connection to
prosthetic suprastructure. However, most of these patients had a periodontal disease. There
were no significant differences in dental implant failure between smokers and non-smokers
and between patients with systemic diseases and those without systemic diseases.
Furthermore, the results of this study showed that implant type (straight vs tapered) and type
of connection with prosthetic suprastructure (cemented or screw retained) did not affect BOP
and FMPI. In smokers, significant improvement of BOP and FMPI was noticed. Initially, the
smokers had significantly worse BOP (0,0037) when compared to the non-smokers, however,
there were no differences regarding FMPI (p=0,4218) between the two groups. In patients
with periodontal disease, an improvement of BOP and FMPI was seen after 5 years of followup
and no significant differences were found when compared to patients without periodontal
disease. There were no signficant differences in BOP and FMPI between patients with
diabetes and those without diabetes after five years of follow-up. Atherosclerosis had a
negatively significant effect of BOP, but without FMPI after five years of follow-up.
Conclusion: We might conclude that periodontal disease had significant impact on the implant-prosthetic therapy. |
