INTRODUCTION:

Modern dental practitioners often put implant therapy on the first treatment option to replace lost teeth instead of traditional methods that have been modified^1,2. Modified ostial changes should be expected after lost teeth and fixture placement that may result in problematic condition and affect aesthetics^3–5. Ostial resorption occurs after the placement of implant fixture upto the first contact of the alveolar bonde with the rough surface^6,7, peri implant ostial resorption can be assessed by radiographic films and it's usually not more than 1.5mm in the first 12 months^8–10. Dental implants are used for replacement of multiple loss teeth in jaws of definitive restoration^10–12. Sub-ostial resorption may depend upon the position of the coronal division of the dental implant in relation to the alveolar bone^13,14, the construction of an boundary (micro space) among the implant apparatus and the type of the collar and platform of fixture^15–17.Golden methods to estimate the triumph rates of implant and relentless contamination, and no persistent peri apical radiolucency¹⁸. Radiograph and regularly appeal to imagine anatomic structure like alveolar bone^3,19. Conventional intra oral radiograph shows interdental alveolar bone levels¹⁶. Peri implantitis bone level assessment is broadly conventional by radiological imaging techniques^20–22. Conventional intraoral imaging or OPG radiographs are commonly used. In the severely resorbed jaw bone, anterior mandible^23,24. OPG radiographs are preferred to intra oral radiographs for evaluating ostial resorption around fixtures. Standard peri apical view of radiographs and OPG is usually used in preparation of patients to dental implant as these views show the fine details in oromandibular maxillary area^25,26. Rotational OPG is a popular form of radiography in dentistry generally that no imaging modality gives as much information about the jaw with such a small radiation dose²⁷.

The important role of peri implant radiographs to detect the condition and the quality of bone around the condition and the quality of bone around the implant surface is incontestable^28,29. Radiographs after surgery are important to find out the correct insertion and direction of the implant; in addition, according to the world workshop on the classification of periodontics and peri implant, disease and condition were adopted to establish the diagnosis of peri implant disease^30–32. A radiograph should be performed at the time of prosthetic loading to be used, as a baseline evaluation to determine alveolar bone level over time^33,34. Peri implantitis health is defined as the absence of clinical signs of inflammation bleeding and/or suppuration on gentle probing, without radiographs bone loss visible on radiographs^35,36. Hence radiographic imaging is important to clarify apical bone loss of supportive bone known indicators of peri implantitis.

Our team has extensive knowledge and research experience that has translate into high quality publications^{37,38,39,40,41,42,43,44,45–50,51–55,56}. The aim of the current study is to evaluate peri implantitis from extra oral and intra oral radiographs and correlate between age, gendre, tooth number and bone loss.

MATERIAL AND METHODS:

The current study was a comparative, descriptive and retrospective study where the required data of the patients reported to the department of implantology in a private teaching dental hospital in Chennai was collected by reviewing patient's records and analysing them. The ethical approval of the current study was obtained from the institutional ethical board. The data was obtained from the Dental Information Archiving Software. The total sample size obtained from the data was 188. Data of stage 2 review after implant placement of patients were included in the study. Exclusion criteria were all incomplete and censored data. The data was cross verified using photographs and reviewed by an additional reviewer to minimize error. The data has high internal validity and low external validity. The data was entered in a methodical manner and was tabulated in Microsoft excel sheet. The tabulated data was imported to SPSS software (IBM) for statistical analysis.

RESULTS:

Figure 1: The pie chart depicts the frequency distribution of age of the patients who underwent placement of implants. Blue depicts the age between 18-30 years of age, green depicts 31-40 years, brown depicts 41-50 years, purple 51-60 years and yellow depicts 61-70 years of age. It is evident that patients of 31- 40 years of age underwent implant placement more frequently.

Figure 2: The pie chart represents the frequency distribution of gender of patients who underwent implant placement. Orange depicts males and purple depicts females. It is evident that males (60%) underwent implant placement more than females (40%).

Figure 3: The above figure depicts the frequency distribution of bone loss occurring in peri implantitis. Green represents no bone loss, pink represents 1 mm of bone loss, blue represents 2 mm, black represents 3 mm and red represents 4 mm of bone loss at the site of implant placement. It is evident that most patients (60.73% ) did not experience bone loss.

Figure 4: The above represents the correlation between age and gender with bone loss. Blue represents male and green represents females. The X axis represents the age of the patient and the Y axis represents the mean bone loss. It shows that an equal number of males and females had bone loss at 18-30 years of age. Males had more bone loss at 31-40years of age(9%). Females had more bone loss at 41-50years of age(14.27%) and 51-60years of age(24.36%). Only males had bone loss at the age of 61-70years ( 19.49%)

Figure 6: The above figure depicts the correlation between the gender of the patient with bone loss. Green represents no bone loss, pink represents 1 mm of bone loss, blue represents 2 mm, black represents 3 mm and red represents 4 mm of bone loss at the site of implant placement. The X axis represents the gender of the patients and the Y axis represents the amount of bone loss.It is evident that males have greater bone loss than females.

Figure 7: The above figure depicts the correlation between the age of the patients and the amount of bone loss. Green represents no bone loss, pink represents 1 mm of bone loss, blue represents 2 mm, black represents 3 mm and red represents 4 mm of bone loss at the site of implant placement. The X axis represents the age of the patients and the Y axis represents the amount of bone loss. It is evident that 31-40years of patients mostly exhibited no bone loss. 41-50 years old patients exhibited the most bone loss of 1mm. Both 31-40years and 41-50years old patients exhibited an equal percentage 2 mm of bone loss. 3mm bone loss was mostly exhibited by 18-30years old patients and 4mm by 51-60 years old patients.

DISCUSSION:

In treatment of peri implantitis, early diagnosis has been emphasised by its impact on the marginal bone loss was not fully investigated. For earlier detection of radiographic changes of implant, regular check up is necessary for the patients with risk of peri implantitis^26,57,58. Although some patients did not follow the regular check up program before peri implantitis diagnosis, all patients regularly visited after peri implantitis diagnosis and were taken to a professional cleaning procedure at 3-5 month intervals during more than 5 years^59,60. As result, the bone level of non surgically treated 31 implants were well maintained for more than 5 years follow up periods^61,62. Additional bone loss after non surgical therapy was approximately 0.5 mm in average during following periods although the recurrence of inflammation appeared in some cases during follow up periods and repetitive non surgical therapy was performed to resolve the inflammation^63,64. The importance of regular supportive care to maintain the periodontal and peri implant health has been emphasised in previous studies⁶⁵ . Recently Langevell and Jne reported that the success rate of peri implantitis treatment was significantly lower in the patients with poor oral hygiene and low compliance regardless of their treatment modulation⁶⁶. Similarly, Serino and Stross presented the importance of proper oral hygiene instructions in maintaining healthy peri implant tissues⁶⁷. This study is in correlation to another study conducted by Hee Yung in 2015. They concluded that males were commonly associated with bone loss and also patients with cardiovascular disease and Diabetes Mellitus. The advantage of the study was that it included a varied population and had the ability to perform preference analysis. The limitations were that it had a very limited geographic area of coverage and small sample size.

CONCLUSION:

Oral Pantomogram and Intra Oral Periapical Radiograph are good for evaluation of successful implant and monitoring the prognosis and stability and durability as the radiographs are available in most dental centres and clinics with less cost.

ACKNOWLEDGEMENT:

The authors would like to acknowledge the help and support rendered by The Department of Oral medicine, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University for the constant assistance with the research.

FUNDING:

The present project is funded by

Saveetha Institute of Medical and Technical Sciences

Saveetha Dental College and Hospitals

Saveetha University

A.I. Abu Dakir Dental Clinic, Chennai.

CONFLICT OF INTEREST:

None declared.

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Received on 29.12.2021 Modified on 31.01.2022

Research J. Science and Tech. 2022; 14(4):219-225.

DOI: 10.52711/2349-2988.2022.00036