Marginal bone stability around bone level versus tissue level implants in non-compliant patients with healthy or reduced periodontium: A 10-year retrospective study

Joyce Nicolas, Nada Bou Abboud Naaman, Johnny Nohra, Mark Bou Chaaya


The aim of this retrospective study was to investigate the effects of bone level implants (BL) in non-compliant patients on marginal bone alterations compared with the tissue level implants group (TL) at a mean follow-up period of at least 10 years. This study reports on 44 non-compliant patients selected from 3 private practices located in Beirut. Patients selected underwent implant surgery between 2005 and 2009 and had BL (Branemark and 3I Biomet) or TL (Straumann) implants. Periapical radiographs were taken directly after loading and at least at 10 years later. Crestal bone loss (CBL) for a total of 140 implants, including 97 BL and 43 TL implants was measured on radiographic images using the image tool software. Image calibration was done according to implant length. Hygiene level, smoking status and implant surface were also registered. After a mean period of 10 years, implants in the TL group had a mean CBL of 1.18± 0.89 (0.85 on the mesial side and 1.5 on the distal side). The BL group showed a mean CBL of 0.97 ± 0.64 (0.65 on the mesial side and 1.29 on the distal side). No significant difference (p >0.05) was found between the 2 groups. Hygiene level was significantly associated with mesial and average bone loss. TiUnite surface showed a lower distal bone loss compared to SLA and acid etched surfaces. Furthermore, the average bone loss was significantly elevated in multiple-implant compared to single-tooth fixed implant restorations. No significant difference in bone loss was found between the maxilla and the mandible or between non-smokers and smokers. Analysis of the obtained results did not reveal a lower bone loss between bone level and tissue level implants in patients who didn’t commit to a strict maintenance program. However, bone loss was strongly correlated to hygiene level, confirming the importance of SPT and compliance. 



Le but de ce travail était d’évaluer rétrospectivement, et après au moins 10 ans de fonction, les changements du niveau osseux crestal autour des implants «niveau osseux» par opposition aux implants «niveau muqueux» chez des patients qui n’ont pas suivi un programme de maintenance parodontale. Les dossiers médicaux des patients de trois cabinets privés à Beyrouth ont été analysés. Les patients qui ont subi une chirurgie implantaire depuis 10 ans (entre 2005 et 2008), recevant des implants Straumann «niveau muqueux»(TL) ou Branemark/3i Biomet «niveau osseux» (BL) et n’ayant pas suivi un programme de maintenance ont été évalué. 44 patients ont été inclus dans l’étude, et les radiographies prises directement après mise en charge et après 10 ans ont été comparées. La standardisation des radios a été réalisée selon la longueur de l’implant. D’autres paramètres ont été enregistrés comme le niveau d’hygiène, le tabagisme et la surface implantaire. Au total, 140 implants comprenant 97 implants BL and 43 implants TL ont été inclus dans cette étude. Après 10 ans de mise en charge, le groupe TL a présenté une perte osseuse moyenne de 1.18± 0.89 (0.85 en mésial et 1.5 en distal) alors que le groupe BL a montré une perte osseuse moyenne de 0.97 ± 0.64 (0.65 en mésial et 1.29 en distal). Les études statistiques n’ont pas montré de différences significatives (p >0.05) entre les groupes. Une corrélation positive a été révélée entre la perte osseuse et le niveau d’hygiène. La surface implantaire TiUnite a montré une perte osseuse moindre en distal comparée aux autres surfaces. Par contre, nos résultats n’ont pas pu montrer une différence significative dans la perte osseuse entre le maxillaire et la mandibule ou une corrélation avec le tabagisme. L’analyse des résultats n’a pas montré une résorption osseuse marginale moindre entre les implants BL et TL chez les patients n’ayant pas suivi un protocole de maintenance parodontale. Toutefois, la perte osseuse est corrélée à l’hygiène buccale d’où l’importance de la maintenance. 

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