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HERRERA ET AL .
Background
Background
Substantial evidence indicates that subjects with advanced/rapidly progressing forms of periodontitis have a higher risk of implant loss and peri-implantitis, when compared with the general population, or with individuals without a history of periodontitis (Schwarz et al., 2018; Carra et al., 2021). While some of the risk seems to be associated with placement of dental implants before achieve- ment of full control of periodontitis and, perhaps, with subjects with nicotine addiction who cannot quit cigarette smoking, the available evidence does not allow excluding that a portion of the increased risk associated with periodontitis may persist even after appropriate periodontal treatment. The assumption that the health and function of dental implants in adequately treated and well- maintained stage IV periodontitis patients parallels the longevity observed for dental implants in the general population is probably optimistic. The systematic review by Carra et al. (2021) was based on 7 pro- spective and 10 retrospective studies and accounted for 1718 implants placed in patients with a history of periodontitis and 2879 implants placed in patients with no history of periodontitis to restore. Eight out of the 17 studies (47%) included both non-smokers and smokers, the latter group representing 1.7% – 28.8% of the patient sample. One study considered non-smokers only, and the remaining seven studies did not provide any detail about smoking habits. The type of supportive periodontal/implant care was reported in only 11 of 17 studies (64.7%), but the patient's compliance to the recall intervals was rarely defined. Although the overall mean implant sur- vival rate, at a follow-up of at least 5 years, was high also in patients with a history of periodontitis (94.7%, 95% CI [92.3; 97.1]), pooled data analysis demonstrated that implant-supported fixed dental pros- theses have a greater risk of failure (risk ratio — RR: 1.9, 95% CI [1.31; 2.79]) and peri-implantitis (RR: 3.3, 95% CI [1.31; 8.3]) in patients with a history of periodontitis, compared with patients with no history of periodontitis. The magnitude of the risk was considered clinically rele- vant, particularly after 5 years of follow-up from implant loading (haz- ard ratio — HR: 2.11, 95% CI [1.18; 3.79]).
Long-term studies have shown that dental prostheses retained by a combination of teeth and dental implants show higher rates of failure and tooth loss compared with dental prostheses supported by teeth or implants alone. In treatment planning, whenever alternatives exist, such designs should be avoided.
9 | CLINICAL RECOMMENDATIONS: CASE TYPE 3
Case type 3: partially edentulous patients who can be prosthetically restored without full-arch rehabilitation.
9.1
| Clinical recommendations for case type
3 with tooth-delimited gaps
R9.1. What is the effectiveness of prosthetic rehabilitation in patients with periodontitis stage IV where tooth preservation is feasible, with one or multiple tooth-delimited gaps, and adequate residual periodontal support and maintainability of the remaining teeth? (Common question for Recommendations R9 . 1 , R9 . 2 , R9 . 3 , R9 . 4)
PICOS question addressed by a SR
R9.1: Evidence-based recommendation In partially edentulous stage IV periodontitis patients with tooth-delimited edentulous spaces , different options (namely tooth-supported fixed dental prostheses , implant-supported fixed dental prostheses , removable dental prostheses , or no prosthetic rehabilitation) may be considered . Supporting literature (Carra et al., 2021; Gotfredsen et al., 2021; Montero et al., 2021) Quality of evidence Low Grade of recommendation GradeO — $ Strength of consensus Consensus (1.4% of the group abstained due to potential CoI)
R8.6. Which are the specific considerations for the design of dental implants restorations in stage IV periodontitis patients?
Background
PICOS question addressed by a SR
Intervention
R8.6: Expert consensus-based recommendation Due to the risk of tooth loss and prosthesis failure , we suggest avoiding combined tooth/implant-supported fixed partial dental prostheses if alternatives are feasible . Supporting literature (Montero et al., 2021) and Expert opinion Quality of evidence Low Grade of recommendation GradeB — " Strength of consensus Unanimous Consensus (7.8% of the group abstained due to potential CoI)
Interventions include tooth-supported fixed dental prostheses, implant-supported fixed dental prostheses, removable dental prosthe- ses (RDPs), or no prosthetic rehabilitation, in periodontitis stage IV patients with one or multiple tooth-delimited gaps, and adequate residual periodontal support and maintainability of the remaining teeth.
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