Smoking, Diabetes Mellitus, Periodontitis, and Supportive Periodontal … · 2016-06-16 · SPT Yes 246 (51.8) 21 (8.5) 0.0114 873 (53.7) 28 (3.2) 0.0028 ... supportive periodontal

Smoking, Diabetes Mellitus, Periodontitis, andSupportive Periodontal Treatment as FactorsAssociated With Dental Implant Survival: A

Long-Term Retrospective Evaluation ofPatients Followed for Up to 10 Years

Rachel Anner, DMD,* Yoav Grossmann, DMD,† Yael Anner,‡ and Liran Levin, DMD§

During the past decade, the use ofosseointegrated implants as afoundation for prosthetic re-

placement of missing teeth has becomehighly predictable and successful.1 How-ever, certain risk factors might predisposeindividuals to lower success rates.2

Survival of oral implants has beensystematically analyzed in the 4th Eu-ropean Workshop on Periodontologyin 2002.1 It is evident that the survivalof oral implants is very high. How-ever, an initial loss of 2.5% of allimplants is expected in routine implanttherapy. After functional loading, im-plant loss was 2% to 3%, over a 5-yearobservation period for implants sup-porting fixed restorations, whereas inoverdenture therapy, �5% of the im-plants were expected to be lost withinthat period.

Furthermore, Holm-Pedersen etal3 reported that 0.5% to 1.3% im-

plants are lost per year of functionresulting in survival rates of between80% and 90% after 10 years depend-ing on the clinical situation of the im-plants and prosthetic rehabilitation.

In a recent systematic review ofthe literature, it was found that smok-

ing adversely affects implant survivaland success and is more pronounced inareas of poor quality, trabecular bone.2

Type 2 diabetes may have an adverseeffect on implant survival rates, but adefinitive conclusion could not bemade because of the limited number of

*Private practice, Kfar-Saba, Israel.†Senior Prosthodontist, Maxillofacial Prosthodontics Services,Oral & Maxillofacial Center, Sheba Medical Center, TelHashomer, Israel.‡Medical Student, Ben-Gurion University of the Negev, BeerSheva, Israel.§Clinical Instructor, Department of Oral Rehabilitation, TheMaurice and Gabriela Goldschleger School of Dental Medicine,Tel Aviv University, Tel Aviv, Israel; and Department ofPeriodontology, School of Graduate Dentistry, Rambam HealthCare Campus, Haifa, Israel.

Reprint requests and correspondence to: Liran Levin,DMD, Department of Oral Rehabilitation, TheMaurice and Gabriela Goldschleger, School of DentalMedicine, Tel Aviv University, Tel Aviv, Israel,E-mail: [email protected]

ISSN 1056-6163/10/01901-057Implant DentistryVolume 19 • Number 1Copyright © 2010 by Lippincott Williams & Wilkins

DOI: 10.1097/ID.0b013e3181bb8f6c

Objectives: To evaluate the fac-tors associated with long-term im-plant survival in a large cohort ofpatients in regular follow-up untildata collection.

Methods: The study populationconsisted of 475 patients who werereferred to a private clinic limited toPeriodontics and Implantology be-tween November 1995 and July 2006.Data were collected from patient fileswith regards to smoking habits, peri-odontal condition, diabetes mellitus,implant survival, and time when im-plant failure occurred. Patients weredivided into those who participated ina supportive periodontal program inthe clinic and those who only attendedthe annual free-of-charge implantexamination.

Results: A total of 1626 implantswere placed with a follow-up rangingfrom 1 to 114 months (average30.82 � 28.26 months). Overall, 77(4.7%) implants were lost in 58(12.2%) patients after a mean periodof 24.71 � 25.84 months. More than

one-half of the patients (246; 51.7%)participated in a structured supportiveperiodontal program in the clinic, and229 (48.3%) only attended to the an-nual free-of-charge implant examina-tion. Smoking and attendance in aregular supportive periodontal pro-gram were statistically associatedwith implant survival. Patients with(treated) moderate-to-advanced chronicperiodontal disease demonstratedhigher implant failure rates but, thisdifference did not reach statisticalsignificance. Diabetes mellitus wasnot related to implant survival in thispatient cohort.

Conclusions: Smoking and atten-dance in a regular supportive peri-odontal program were found to bestrongly related to implant survival.Special attention should be given tocontinuous periodontal supportiveprograms to implant patients.(Implant Dent 2010;19:57–64)Key Words: tobacco, periodontitis, di-abetes mellitus, supportive therapy,implant failure

IMPLANT DENTISTRY / VOLUME 19, NUMBER 1 2010 57

studies included in the review. A his-tory of treated periodontitis does notseem to adversely affect implant sur-vival rates but it could have a negativeinfluence on implant success rates,particularly over longer periods.2

Hultin et al4 stated that there arefew available studies evaluating thelong-term effect of supportive peri-odontal programs for implant patients.The authors highlighted in their con-clusions4 the need for such studies tobe initiated.

The purpose of this study was toevaluate the influence of smoking,diabetes mellitus, periodontitis, andsupportive periodontal treatment asfactors associated with long-term (upto 10 years) implant survival in a largecohort of patients who were in regularfollow-up until data collection.

MATERIALS AND METHODS

The study population consisted of475 patients (176 men, 37%; 299women, 63%; average age 51.96 �11.98) who were referred to a privateclinic limited to Periodontics and Im-plantology between November 1995and July 2006. A total of 1626 implantswere placed by a single surgeon (R.A.)in these patients. Implants were placedafter completion of periodontal cause-related therapy and periodontal stabiliza-tion. Follow-up ranged from 1 to 114months (average 30.82 � 28.26 months).

All patients were offered a free-of-charge annual examination and

follow-up after implant placement.Only patients who were in routinefollow-up until data collection wereincluded in the evaluation. Demo-graphic parameters (age, gender, etc.)were similar between this follow-upgroup and the patients who were ex-cluded because of their lack of adher-ence to follow-up appointments (datanot shown).

Data were collected from patientfiles with regards to smoking habits,periodontal condition, diabetes melli-tus, implant survival, and time whenimplant failure occurred. Patients werealso divided into those who partici-pated in a supportive periodontal pro-gram in the clinic and those who onlyattended the annual free-of-charge im-plant examination.

Data were analyzed with statisti-cal software (SPSS 12.0; SPSS, Inc.,Chicago, IL) using z test for propor-tions and �2 test. A 5% significancelevel was used.

RESULTS

Smoking was reported by 63(13.2%) patients and diabetes mellitusby 49 (10.3%). Periodontal diseasewas diagnosed in 311 (65.4%) of thepatients. Overall, 77 (4.7%) implantswere lost in 58 (12.2%) patients after amean period of 24.71 � 25.84 months.

In the structured supportive peri-odontal program in the clinic, 246 pa-tients (51.7%) participated and 229(48.3%) only attended the annual

free-of-charge implant examination.Smoking and attendance in a regularsupportive periodontal program wereassociated with implant survival(Table 1). Patients with treatedmoderate-to-advanced chronic peri-odontal disease showed higher im-plant failure rates, but this differencedid not reach statistical significance.Diabetes mellitus was not related toimplant survival in this patient co-hort (Table 1). The odds ratio was1.89 for attendance in a regular sup-portive periodontal program andsmoking (P � 0.05) (Table 2).

DISCUSSION

An implant-supported restorationoffers a predictable treatment for toothreplacement.7–9 Nevertheless, failuresthat mandate immediate implant re-moval do occur.6,10�13 The conse-quences of implant removal jeopardizethe clinician’s efforts to accomplishsatisfactory function and esthetics. Forthe patient, this usually involves fur-ther cost and additional procedures.14

Reported predictors for implantsuccess and failure are generally di-vided into patient-related factors (e.g.,general patient health status, smokinghabits, quantity and quality of bone,and oral hygiene maintenance), im-plant characteristics (e.g., dimensions,coating, and loading), implant loca-tion, and clinician experience.15

The overall first-year survivalrate for dental implants is between

Table 1. Factors Associated With Dental Implant Survival

FactorNo. of

Patients (%)No. of Patients

With Failed Implants (%) P *No. of

Implants (%)

No. ofFailed

Implants (%) P *

SmokingYes 63 (13.3) 13 (20.6) 0.0286 226 (13.9) 21 (9.3) 0.0006No 412 (86.7) 45 (10.9) 1400 (86.1) 56 (4)

Diabetes mellitusYes 49 (10.3) 4 (8.2) 0.3628 177 (1.09) 5 (2.8) 0.2076No 426 (89.7) 54 (12.7) 1449 (89.1) 72 (5)

Periodontal diseaseYes 311 (65.5) 43 (13.8) 0.1388 1171 (72) 61 (5.2) 0.1498No 164 (34.5) 15 (9.1) 455 (28) 16 (3.5)

SPTYes 246 (51.8) 21 (8.5) 0.0114 873 (53.7) 28 (3.2) 0.0028No 229 (48.2) 37 (16.2) 753 (46.3) 49 (6.5)

P values in bold represents statistical significance. Smoking and attendance in a regular supportive periodontal program were associated with implant survival. Patients with treated moderate-to-advancedchronic periodontal disease showed higher implant failure rates but this difference did not reach statistical significance. Diabetes mellitus was not related to implant survival in this patient cohort.

*z test for proportions.

58 FACTORS ASSOCIATED WITH DENTAL IMPLANT SURVIVAL • ANNER ET AL

92% and 97%.16 An additional 1% ofall implants that are initially suc-cessful and rehabilitated are lost ev-ery year because of complications.17

In this study, the survival rates fallbetween the reported survival ratesin the literature.18

Hultin et al4 conducted a studythat systematically reviewed whethersupportive implant treatment during afollow-up of at least 10 years afterfunctional loading is effective in pre-venting biological complications andfixture loss. It was concluded that, todate, there are few available studiesthat evaluate the long-term effect ofsupportive programs for implant pa-tients and that there is an urgent needfor such studies to be initiated. Thisreport clearly illustrates that there is animportant role for regular continuoussupportive periodontal therapy in im-plant patients to increase implantsurvival over time. In the treatmentstrategies for periodontitis, the needfor supervised training and re-enforcement of self-performed oralhygiene is well established. Also, indental implant patients, instruction inbrushing and interproximal cleaningshould be initiated as soon as the pros-thetic reconstruction is connected. Inan elderly patient, reduced capacity ofdiligence and manual dexterity is notuncommon, thus requiring frequentprofessional training visits and clean-ing of abutment surfaces to removebacterial biofilms. Although there isno direct evidence in the literature tosuggest the importance of supportivetherapy for implants as for periodon-tally treated teeth, periodontal therapyhas been suggested to precede implanttherapy in partially dentate patients,19

whereas systematic and continuous

monitoring of the periodontal andperi-implant tissue conditions issuggested to prevent recurrence ofperiodontal disease and allow earlydiagnosis and treatment of peri-implant diseases.20

Other environmental- and patient-related factors contribute to implantfailures. Nitzan et al21 report a rela-tionship between marginal implantbone loss and smoking habits. Ahigher incidence of marginal implantbone loss was found in the smokinggroup, which was more pronounced inthe maxilla. A higher degree of com-plications, or implant failure rates,were found in smokers with and with-out bone grafts.22,23 However, in an18-month study of 1183 implants, Ku-mar et al24 report similar survival rates(97% and 94.4%) for smokers andnonsmokers. In this study, smokersexhibited a significantly lower sur-vival rate than nonsmokers. Smokersundergoing both implant-related sur-gical procedures and dental implanta-tion should be encouraged by theirdentists, oral and maxillofacial sur-geons, or treating physicians to ceasesmoking, emphasizing that smokingcan increase complications and reducethe success rate of these procedures.

Successful osseointegration hasbeen shown in patients with differenttypes of periodontitis.25,26 However,these reports do not offer compara-tive data between periodontallycompromised patients who havebeen treated and periodontallyhealthy patients. Nevertheless, a sys-tematic review by Van der Weijdenet al27 conclude that the outcome ofimplant therapy in periodontitis pa-tients may be different comparedwith individuals without such a his-

tory in terms of loss of supportingbone and implant loss.

In a systematic review of implantoutcomes in treated periodontitis sub-jects, Ong et al20 conclude that there issome evidence that patients treated forperiodontitis may experience more im-plant loss and complications aroundimplants including higher bone lossand peri-implantitis than nonperiodon-titis patients. Evidence was strongerfor implant survival than implant suc-cess. In this report, periodontal diseasepatients demonstrated higher implantfailure rates but this difference did notreach statistical significance, whichcould be attributed to the fact that thepatients were treated in a periodontalclinic and their periodontal conditionwas “controlled.” Consequently, ap-propriate consent should be obtainedbefore implant therapy is provided toperiodontal patients.

Diabetes mellitus is one of themost commonly encountered contrain-dications to dental implant therapy.Glycemic control is viewed as a criti-cal variable in identifying whether pa-tients with diabetes are eligible forimplant therapy.28–30 This view on theimportance of glycemic control in im-plant success has been reinforced.31–33

Several clinical reports suggest that inpatients with “well-controlled” type 2diabetes mellitus, dental implant suc-cess rates (92%–100%) may not besignificantly compromised.32–34 In ad-dition, a large multicenter study ofdental implant success report an im-plant failure rate of only 7.8% for 255implants placed in “selected” patientswith type 2 diabetes mellitus.31

The hypothesis that patients withdiabetes are appropriate candidatesfor implants and that compromises inglycemic control may not excludeimplant success has been explored.35

This study found no evidence ofdiminished clinical success or signif-icant early healing complications as-sociated with implant therapy inpatients with controlled type 2 dia-betes mellitus, which agrees with theformer study.

CONCLUSIONS

Smoking and attendance in a reg-ular supportive periodontal program

Table 2. Odds Ratio Calculated for Dental Implant Failure

Factor Odds Ratio

95% ConfidenceInterval

P*Lower Upper

Smoking 1.89 1.08 3.30 0.029Diabetes mellitus 0.65 0.96 1.15 0.49 (NS)Periodontal disease 1.65 0.87 1.01 0.11 (NS)SPT 1.89 1.14 3.13 0.012

The table shows that smokers and patients not attending in a regular supportive periodontal program had an odds ratio of 1.89 forimplant failure.

*Chi-square test.

IMPLANT DENTISTRY / VOLUME 19, NUMBER 1 2010 59

were found to be strongly related toimplant survival. It is highly recom-mended to maintain implant patientsunder a strict supportive periodontaltreatment protocol that might contrib-ute to implant survival.

ACKNOWLEDGMENTS

The authors thank Ms. Rita Lazar, Sci-entific Editor, The Maurice and Gab-riela Goldschleger School of DentalMedicine, Tel Aviv University, TelAviv, Israel, for scientific editorialassistance.

Disclosure

The authors claim to have no finan-cial interest in any company or any ofthe products mentioned in this article.

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60 FACTORS ASSOCIATED WITH DENTAL IMPLANT SURVIVAL • ANNER ET AL

Abstract Translations

GERMAN / DEUTSCHAUTOR(EN): Rachel Anner, DMD, Yoav Grossmann,DMD, Yael Anner und Liran Levin, DMD.Rauchen, Diabetes mellitus, Parodontitis und unterstut-zende parodontale Behandlung als Faktoren in Verbindungmit dem Erhalt von Zahnimplantaten: Eine langfristigeretrospektive Beurteilung von Patienten mit einem Nach-verfolgungszeitraum von bis zu 10 Jahren

ZUSAMMENFASSUNG: Zielsetzungen: Es war beabsich-tigt, die Faktoren zu beurteilen, die mit einem langfristigenUberleben von Implantaten bei einer großen Patientengruppemit regelmaßigen Nachuntersuchungen bis zur Datenzusam-menstellung in Verbindung stehen. Methoden: Die Studien-zielgruppe bestand aus 475 Patienten, die in einer aufParodontologie spezialisierten Privatklinik im Zeitraumvon November 1995 und Juli 2006 behandelt wurden. DieDaten wurden aus den Patientenakten gewonnen. Hierbeiwurde besonderer Fokus auf Rauchgewohnheiten, par-odontalen Status, Diabetes mellitus, Implantatuberlebenund den Zeitpunkt eines eventuellen Implantatversagensgelegt. Die Patienten wurden in Gruppen aufgeteilt. EineGruppe bestand aus den Patienten, die an einem unterstut-zenden Parodontalprogramm in der Klinik teilnahmen, unddie andere aus den Patienten, die nur ausschließlich an derjahrlichen und kostenfreien Implantatuntersuchung teil-nahmen. Ergebnisse: Insgesamt wurden 1626 Implantateeingepflanzt. Der Nachverfolgungszeitraum lag zwischen1 bis zu 114 Monaten (durchschnittlich 30.82 � 28.26Monate). Im Ganzen versagten 77 (4.7%) Implantate bei58 (12.2%) Patienten nach einem durchschnittlichen Zei-traum von 24.71 � 25.84 Monaten. Mehr als die Halfte derPatienten (246; 51.7%) nahmen an einem strukturiertenUnterstutzungsprogramm zur parodontalen Versorgung inder Klinik teil und 229 (48.3%) Patienten besuchten nurdie jahrliche und kostenfreie Implantatuntersuchung.Rauchen und die Teilnahme am regelmaßigen unterstut-zenden Parodontalprogramm wurden statistisch mit demUberleben der Implantate in Verbindung gebracht. Pati-enten mit einer (behandelten) moderaten bis fortgeschrit-tenen chronischen parodontalen Erkrankung wiesen hohereVersagensquoten bei der Implantierung auf. Dieser Unter-schied erreichte allerdings keine statistische Bedeut-samkeit. Das Vorliegen eines Diabetes mellitus wurde beidieser Patientengruppe nicht mit dem Implantatuberlebenin Verbindung gebracht. Schlussfolgerungen: Rauchenund die Teilnahme am regelmaßigen unterstutzenden Par-odontalprogramm konnten als sehr stark mit dem Uberle-ben der Implantate in Verbindung gebracht werden.Besondere Aufmerksamkeit sollte dem Besuch re-

gelmaßiger und unterstutzend wirkender Parodontalpro-gramme bei Implantatpatienten gezollt werden.

SCHLUSSELWORTER: Tabak, Parodontitis, Diabetes mel-litus, unterstutzende Therapie, Implantatversagen

SPANISH / ESPAÑOLAUTOR(ES): Rachel Anner, DMD, Yoav Grossmann, DMD,Yael Anner y Liran Levin, DMD.Fumar, diabetes mellitus, periodontitis y tratamiento peri-odontico de apoyo como factores asociados con la supervi-vencia de implantes dentales: Una evaluacion retrospectivade largo plazo en pacientes seguidos hasta 10 anos

ABSTRACTO: Proposito: Evaluar los factores asociados conla supervivencia a largo plazo de implantes en un gruponumeroso de pacientes en seguimientos normales hasta larecoleccion de datos. Metodos: La poblacion del estudioconsistio en 475 pacientes, derivados a una clínica privadalimitada a periodontica e implantología entre noviembre de1995 y julio de 2006. Los datos se recolectaron de la historiadel paciente con respecto a fumar, condicion periodontica,diabetes mellitus, supervivencia del implante y tiempo en elque fallo el implante. Se dividio a los pacientes entre los queparticiparon en un programa periodontico de apoyo en laclínica y los que solamente completaron el examen anual delimplante gratis. Resultados: Se colocaron un total de 1626implantes con un seguimiento que vario entre 1 y 114 meses(promedio 30.82 � 28.26 meses). En general, 77 (4.7%)implantes se perdieron en 58 (12.2%) pacientes luego de unperíodo medio de 24.71 � 25.84 meses. Mas de la mitad delos pacientes (246; 51.7%) participaron en un programa pe-riodontico de apoyo en la clínica y 229 (48.3%) solamenteparticiparon en el examen anual del implante gratis. Fumar yconcurrir a un programa regular periodontico de apoyo estuvoestadísticamente asociado con la supervivencia de los implan-tes. Los pacientes con enfermedad periodontica cronica mod-erada a avanzada (tratados) demostraron una tasa mas alta defalla del implante, pero esta diferencia no alcanzo un nivelestadísticamente significativo. La diabetes mellitus no estuvorelacionada con la supervivencia de los implantes en estegrupo de pacientes. Conclusiones: Se encontro que fumar yconcurrir a un programa regular periodontico de apoyo esta-ban altamente relacionados con la supervivencia del im-plante. Se debera prestar atencion especial a programascontinuos periodonticos de apoyo para los pacientes conimplantes.

PALABRAS CLAVES: tabaco, periodontitis, diabetes melli-tus, terapia de apoyo, falla del implante

IMPLANT DENTISTRY / VOLUME 19, NUMBER 1 2010 61

PORTUGUESE / PORTUGUÊSAUTOR(ES): Rachel Anner, Doutora em Medicina Dentaria,Yoav Grossmann, Doutor em Medicina Dentaria, Yael Annere Liran Levin, Doutores em Medicina Dentaria.Tratamento de tabagismo, diabete melito, periodontite eperiodontal de suporte como fatores associados a sobrevi-vencia de implante dentario: Avaliacao retrospectiva delongo prazo de pacientes acompanhados por ate 10 anos

RESUMO: Objetivo: Avaliar os fatores associados a so-brevivencia de implante de longo prazo numa grande co-orte de pacientes em acompanhamento regular ate a coletade dados. Metodos: A populacao do estudo era formadapor 475 pacientes encaminhados a uma clínica particularlimitada a Periodontia e Implantologia entre novembro de1995 e julho de 2006. Os dados foram coletados de pron-tuarios de pacientes com relacao a habitos de fumar, con-dicao periodontal, diabete melito, sobrevivencia deimplante e momento em que ocorreu a falha no implante.Os pacientes foram divididos em aqueles que participaramde um programa periodontal de suporte na clínica e aquelesque compareceram apenas ao exame de implante anualgratuito. Resultados: Um total de 1626 implantes foi co-locado com um intervalo de acompanhamento de 1 a 114meses (media 30.82 � 28.26 meses). No total, 77 (4.7%)implantes foram perdidos em 58 (12.2%) pacientes aposum período medio de 24.71 � 25.84 meses. Mais dametade dos pacientes (246; 51.7%) participou de um pro-grama periodontal de suporte estruturado na clínica e 229(48.3%) compareceram apenas ao exame de implante anualgratuito. O tabagismo e o comparecimento a um programaperiodontal de suporte regular foram estatisticamente associadosa sobrevivencia de implante. Os pacientes com doenca periodon-tal cronica (tratada) moderada a avancada demonstraram taxasmais altas de falha de implante, mas essa diferenca nao alcancousignificado estatístico. A diabete melito nao estava relacionada asobrevivencia de implante nessa coorte de pacientes. Conclu-soes: Descobriu-se que o tabagismo e o comparecimento a umprograma periodontal de suporte regular estavam fortementerelacionados a sobrevivencia de implante. Especial atencao deveser dada a programas periodontais de suporte contínuos parapacientes de implante.

PALAVRAS-CHAVE: tabaco, periodontite, diabete melito,terapia de suporte, falha de implante

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�$%&'$. ����. � ����� �������, ��������� ��������������� ��������� � ���������������������, � ������ ����� �� ������ ����������� ��������� ����� �� ����� ��������������� ������. �����.����� ��, �������� ������������, ������� �� 475 �� ������, ����-�������� � ������� ������ � ��� ������� �� ���-��������� � ���������� � ������ 1995 . ����� 2006 . � �������� �� ������ ��� �������������, �����!���� ����������� � �������, ���-������ ���������, ������ � ��� �������� �������,������������� ��������� � �������, ����� ��-����� �������� ���������� ���������.�� ����� ��� �������� �� ���, ��� �������������� � ���������� �������� �����������!��������������� �������, � ���, ��� ����� ����!������� �� �������� ��������� ����������� � ��� � ���� ��������� ���������. ���� ���."��� ��� ���������� 1626 ����������, ��������������� ������� �� 1 �� 114 ���� �� (� �������30,82 � 28,26 ���� ��). " ���� �� �������� 77 (4,7%) ���������� � 58 (12,2 %) �� ������. ������,������ ������� �������� ����������, � �������������� 24,71 � 25,84 ���� �. #��� ��������� ������ (246; 51,7 %) �������� ������� � ���-���������� �� ����������� ����� ���������� ���-����� �����������!�� ������������� �������, �229 (48,3 %) ����!�� ������ ����� �� ����������������� ����������� � ��� � ���� ������������������. #�� ������������� ��������������������� ����������� ����� �������� �����!����� ����������� �������� �������������������!�� ������������� ������� ��������������� ���������. �� ����� (�������-���� ������) � ����������� ������������ ���������� ������� �� ������� �� ������ ����������� ������� ��� ��� ���������� ���������, ��$�� ����� � �� ������ ������ ������������������������. %���� ����� ������� ��������������� � �������������� ��������� � ����������� �� ������ �� ���������. ����. #��������� ��!��������� ����� ����� �������� �����!����� ����������� �������� �������������������!�� ������������� ������� ��������������� ���������. ������ �������� ��-��� ���� ������ �������� ��������������������!�� ������������� ������� ���� ������ � �����������.

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62 FACTORS ASSOCIATED WITH DENTAL IMPLANT SURVIVAL • ANNER ET AL

TURKISH / TURKCEYAZARLAR: Rachel Anner, DMD, Yoav Grossmann, DMD,Yael Anner and Liran Levin, DMD.Dental implant sagkalımı ile iliskili faktorler olarak sigaraicme, diabetes mellitus, periodontit ve destekleyici periodon-tal tedavi: 10 yıla kadar takip edilen hastaların uzun-sureliretrospektif degerlendirmesi

OZET: Amac: Veri derlenmesine kadar duzenli sekilde takipedilen genis hasta kohortunda uzun-sureli implant sagkalımıile iliskili faktorleri degerlendirmek. Yontem: Calısma popu-lasyonu, Kasım 1995 ile Temmuz 2006 arasında sadece Pe-riodontik ve Implantoloji calısması yapan bir ozel klinigehavale edilen 475 hastadan olustu. Hasta dosyalarından sigaraicme alıskanlıkları, periodontal durum, diabetes mellitus, im-plant sagkalımı ve implant basarısızlıgının tarihine iliskinbilgiler toplandı. Hastalar, klinikteki destekleyici bir peri-odontal programa katılanlar ve sadece yıllık ucretsiz implanttetkikine gelenler olmak uzere iki gruba ayrıldı. Bulgular:Hastalarda toplam 1626 implant yerlestirildi ve takip suresi 1

ila 114 ay arasında degisti (ortalama 30.82 � 28.26 ay).Genel olarak, 58 (%12.2) hastada 77 (4.7%) implant ortalama24.71 � 25.84 ay sonra basarısızlıga ugradı. Hastaların ya-rısından fazlası (246; 51.7%) klinikte yapılan destekleyici birperiodontal programa katılırken, 229 (48.3%) hasta sadeceyıllık olarak yapılan ucretsiz implant tetkikine geldi. Sigaraicmenin ve duzenli sekilde destekleyici bir periodontal pro-grama katılmanın sagkalım ile istatistiksel acıdan anlamlıduzeyde iliskili oldugu goruldu. Orta ila ileri derecede (tedaviedilmis) kronik periodontal hastalıgı olan olgularda dahayuksek implant basarısızlık oranları gorulduyse de bu farklı-lık istatistiksel acıdan anlamlı degildi. Bu hasta kohortundadiabetes mellitus implant sagkalımı ile baglantılı bulunmadı.Sonuc: Sigara icmenin ve duzenli sekilde destekleyici birperiodontal programa katılmanın sagkalım ile buyuk olcudeiliskili oldugu goruldu. Implant hastalarına surekli periodon-tal destek programları sunmaya ozen gosterilmelidir.

ANAHTAR KELIMELER: tutun, periodontit, diabetes mel-litus, destekleyici terapi, implant basarısızlıgı

JAPANESE /

IMPLANT DENTISTRY / VOLUME 19, NUMBER 1 2010 63

CHINESE /

KOREAN /

64 FACTORS ASSOCIATED WITH DENTAL IMPLANT SURVIVAL • ANNER ET AL