The purpose of this article is to identify the types of complications that have been reported in conjunction with endosseous root form implants and associated implant prostheses. A Medline and an extensive hand search were performed on English-language publications beginning in 1981. The searches focused on publications that contained clinical data regarding success/failure/complications. The complications were divided into the following 6 categories: surgical, implant loss, bone loss, peri-implant soft tissue, mechanical, and esthetic/phonetic. The raw data were combined from multiple studies and means calculated to identify trends noted in the incidences of complications. The most common implant complications (those with a greater than a 15% incidence) were loosening of the overdenture retentive mechanism (33%), implant loss in irradiated maxillae (25%), hemorrhage-related complications (24%), resin veneer fracture with fixed partial dentures (22%), implant loss with maxillary overdentures (21%), overdentures needing to be relined (19%), implant loss in type IV bone (16%), and overdenture clip/attachment fracture (16%). It was not possible to calculate an overall complications incidence for implant prostheses because there were not multiple clinical studies that simultaneously evaluated all or most of the categories of complications. Although the implant data had to be obtained from different studies, they do indicate a trend toward a greater incidence of complications with implant prostheses than single crowns, fixed partial dentures, all-ceramic crowns, resin-bonded prostheses, and posts and cores.

Clinical complications with implants and implant prostheses.

Aim: This systematic literature review was performed to investigate if smoking interferes with the prognosis of implants with and without accompanying augmentation procedures compared with non-smokers.

Methods: A systematic electronic and handsearch (articles published between 1989 and 2005; English and German language; search terms “dental or oral implants and smoking”; “dental or oral implants and tobacco”) was performed to identify publications providing numbers of failed implants, related to the numbers of smokers and non-smokers for meta-analysis. Publications providing statistically examined data of implant failures or biologic complications among smokers compared with non-smokers were included for systematic review.

Results: Of 139 publications identified, 29 were considered for meta-analysis and 35 for systematic review. Meta-analysis revealed a significantly enhanced risk for implant failure among smokers [implant-related odds ratio (OR) 2.25, confidence interval (CI95%) 1.96–2.59; patient-related OR 2.64; CI95% 1.70–4.09] compared with non-smokers, and for smokers receiving implants with accompanying augmentation procedures (OR 3.61; CI95% 2.26–5.77, implant related). The systematic review indicated significantly enhanced risks of biologic complications among smokers. Five studies revealed no significant impact of smoking on prognosis of implants with particle-blasted, acid-etched or anodic oxidized surfaces.

Conclusion: Smoking is a significant risk factor for dental implant therapy and augmentation procedures accompanying implantations.

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Smoking Interferes With the Prognosis of Dental Implant Treatment: A Systematic Review and Meta-Analysis

Background: Implant treatment is an attractive substitute to traditional fixed/removable prosthetic appliances. In patients with diabetes, dental implant therapy has been considered a contraindication. Hyperglycemia augments the severity of periodontal disease, and glycemic control is an essential variable in determining the success of dental implants in subjects with diabetes. Subjects with well-controlled diabetes may not be significantly compromised and can have high dental implant success rates compared to individuals with poorly controlled diabetes. The focused questions addressed in this systematic review were as follows: Can patients with diabetes be good candidates for dental implant therapy? And how does hyperglycemia and glycemic control influence osseointegration? Methods: A systematic literature search of MEDLINE/PubMed articles published from 1982 up to and including July 2009 was independently performed by two investigators. In addition, reference lists of original and review articles were searched. The search strategy was to use the following terms in different combinations: dental implants, immediate implants, osseointegration, periodontal disease, diabetes, hyperglycemia, metabolic control, and glycemic control. The search included studies on humans and diabetes-induced animal models. The selection criteria included all levels of available evidence. Suitable variables included the implant survival rate among individuals with diabetes, effects of hyperglycemia and glycemic control on bone, and maintenance of dental implants in subjects with diabetes. Articles published only in the English language were considered, and unpublished data were not sought. Results: We initially identified 33 studies. Fifteen studies, which did not fulfill the selection criteria, were excluded. The included studies reported that poorly controlled diabetes negatively affects implant osseointegration; however, under optimal serum glycemic control, osseointegration can successfully occur in patients with diabetes. Animal studies have confirmed that osseointegration can be successfully achieved in insulincontrolled rats with diabetes, whereas in uncontrolled rats with diabetes, the bone-to-implant contact appears to decrease with time. The use of antiseptic mouthrinses and oral-hygiene maintenance helps in achieving a successful dental implant osseointegration in subjects with diabetes. Conclusion: A successful dental implant osseointegration can be accomplished in subjects with diabetes with good metabolic control (serum glycemic level and hemoglobin A1c in normal range) in a similar manner as in subjects without diabetes. J Periodontol 2009;80:1719-1730.

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Impact of Diabetes Mellitus and Glycemic Control on the Osseointegration of Dental Implants: A Systematic Literature Review

Objectives: To review the evidence for the association between diabetes and periodontal and peri-implant conditions and the impact of periodontal therapy in subjects with diabetes. Material and Methods: A search of MEDLINE-PubMed was performed up to and including December 2007. The search was limited to clinical studies published in English. Publications on animal studies were excluded. The selection criteria included all levels of available evidence. Results: Evidence on the association between diabetes and periodontitis supports the concept of increased severity but not extent of periodontitis in subjects with poorly controlled diabetes. Subjects with controlled diabetes do not show an increase in extent and severity of periodontitis. Periodontitis is associated with poor glycaemic control and diabetes-related complications. It is inconclusive that periodontal therapy with or without the use of antibiotics results in improvements of glycaemic control and of markers of systemic inflammation. Evidence is lacking to indicate that implant therapy in subjects with diabetes yields long-term outcomes comparable with those of nondiabetic subjects. Conclusions: Poorly controlled diabetes may be considered a risk factor for increased severity of periodontitis. The effects of periodontal therapy on glycaemic control and systemic inflammation is not proven beyond doubt and need to be confirmed in largescale randomized-controlled clinical trials.

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Effects of diabetes mellitus on periodontal and peri-implant conditions: update on associations and risks.

The aim of the present study was to assess the influence of endogenous and local factors on the occurrence of implant failure up to the abutment stage. The study comprised a group of 399 consecutive patients, which represented the total of patients who had been treated from 1995 to 1997 (with a total of 1263 Branemark Bran-system implants) at the Department of Periodontology of the University Hospital, Catholic University Leuven. For each patient, the medical history was carefully examined. Data collection and analysis were mainly focused on endogenous factors such as hypertension, osteoporosis, hypo- or hyperthyroid function, chemotherapy, diabetes type I or II, Crohn's disease, some local factors (e.g. bone quality, reason for tooth loss) and breach of sterility during surgery. The reason for tooth loss, smoking habits, radiotherapy and other local bone factors (bone quality and quantity) were also recorded. Implant failures were recorded up to the abutment connection. The present study indicated a success rate until this stage of 97.8%. General factors such as heavy smoking, chemotherapy plus poor bone quality increased implant failure rate. Radiotherapy, limited bone volume and claustrophobia, which led to breaching the strict preoperative rules of asepsis, appeared to be the most relevant local factors for early implant failures.

The relative impact of local and endogenous patient-related factors on implant failure up to the abutment stage.

It has become increasingly common for controlled diabetic patients to be considered as candidates for dental implants. This study reports on the results of placing implants in 34 patients with diabetes who were treated with 227 Branemark implants. At the time of second-stage surgery, 214 of the impl

Thomas J. Balshi

Papers

Dental implants in the diabetic patient: a retrospective study.