Hard tissue dimensional changes following implant removal due to peri‐implantitis: A retrospective study

Abstract

Background The current evidence regarding the alterations experienced by the alveolar ridge (hard tissue changes) after implant removal due to peri‐implantitis is limited. Purpose To assess the hard tissue dimensional changes following implant removal due to peri‐implantitis. Material and methods Clinical records were examined to identify patients with implants that had to be removed due to a hopeless prognosis secondary to peri‐implantitis due to expendability of peri‐implantitis implants for functional reasons. Patients with preoperative and postoperative cone‐beam computed tomography (CBCT) scans were included. Patient‐related, implant‐related, and surgery‐related factors were assessed based on the clinical records. Linear measurements were made to evaluate the influence of bone plate thickness (BPT), ridge width (RW), and ridge height (RH) at various levels upon the outcome of implant removal. A descriptive statistical analysis of the quantitative and qualitative variables was performed. Correlations of the variables with the primary outcome (dimensional changes) were tested using univariate and multivariate analyses (multinomial random intercept mixed model linear regressions). Results A total of 26 patients (nimplants = 79) met the eligibility criteria. The mean decrease in RW at 1 and 3 mm below the crest was 11.3% and 4.4%, respectively (P < 0.001). Buccal and lingual RH was significantly reduced by 2.2% and 6.3%, respectively (P < 0.001). Few patient‐related, implant‐related, and surgery‐related factors appeared to have an impact upon the hard tissue dimensional changes. Bone regeneration simultaneous to implant removal minimized the dimensional changes of the ridge both vertically (5% lesser buccal RH reduction) and horizontally (12% lesser RW reduction) when compared with spontaneous healing. The use of a reverse‐torque removal kit seemed to be critical in limiting the dimensional changes of the ridge. Conclusions Minimal hard tissue changes can be expected following implant removal due to peri‐implantitis. Simultaneous bone regeneration procedures and the use of a removal kit may considerably reduce the impact upon the dimensional changes (NCT04534361).

Management and sequelae of dental implant removal

“…For these scenarios, bone grafting simultaneous to implant removal has proven beneficial in terms of ridge preservation. 50 Moreover, in such cases the clinician should consider the restorability of the infected implant. If a fixed implant-supported partial/complete denture supported by the adjacent healthy implants can efficiently rehabilitate the edentulous site, then it might be advisable to focus treatment options on preventing peri-implantitis of the surviving implants (Figure 4).…”

“…The presence of keratinized mucosa around dental implants is desirable to prevent the occurrence/recurrence of biological peri‐implant complications; 8,11‐51 therefore, soft‐tissue grafting should be contemplated in cases of deficient keratinized mucosa of the buccal peri‐implant site 52‐54 …”

It is all about peri‐implant tissue health

“…A significant reduction in ridge width, measured between pre and postoperative cone‐beam computed tomography scans, was observed at 1 mm and 3 mm below the crest, amounting to 11.3% and 4.4%, respectively. Mean ridge height at both buccal and lingual aspects was also significantly reduced, amounting to 2.2% and 6.3%, respectively 37 …”

“…At present, very limited data exist on the dimensional changes of the alveolar ridge following implant removal 37 . A significant reduction in ridge width, measured between pre and postoperative cone‐beam computed tomography scans, was observed at 1 mm and 3 mm below the crest, amounting to 11.3% and 4.4%, respectively.…”

“…Mean ridge height at both buccal and lingual aspects was also significantly reduced, amounting to 2.2% and 6.3%, respectively. 37 For the planning of further treatment, the clinician should be aware of reported survival rates of implants placed in sites of previously lost implants. [38][39][40][41][42][43][44][45][46][47] In particular, the weighted mean implant survival rate after a period of 20-120 months amounted to 86.3%, with a wide range from 71% to 96% noted in the studies evaluated.…”