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BMC Oral Health
BMC Oral Health
BMC Oral Health
1472-6831
BioMed Central London

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10.1186/s12903-024-04806-5
Research
Analysis of risk indicators for implant failure in patients with chronic periodontitis
Zhang Qiang 1
Guo Sheng 2
Li Yuan 1
Li Zhou 1
Wang Deli 3
Zhang Kai zhang_kai533@163.com

4
1 https://ror.org/042g3qa69 grid.440299.2 Department of Stomatology, The Second People’s Hospital of Changzhi, Shanxi, 046000 China
2 Oral Implantology Center, Changsha Stomatological Hospital, Changsha, 410005 China
3 https://ror.org/00mc5wj35 grid.416243.6 0000 0000 9738 7977 Department of Stomatology, Mudanjiang Medical College, Mudanjiang, Heilongjiang 157011 China
4 Changzhi Deminxin Dental Clinic, No. 1, Junxuan Building, Huaihai Street, Luzhou District, Changzhi City, Shanxi Province 046000 China
8 9 2024
8 9 2024
2024
24 105113 6 2024
23 8 2024
© The Author(s) 2024
2024
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Dental implant restoration shows an effective method for the rehabilitation of missing teeth. The failure rate of periodontal implants in patients with chronic periodontitis is associated with periodontal flora, inflammation, and long-term periodontal bone resorption caused by chronic periodontitis. However, the therapeutic effects of dental implant restoration on inflammation in patients with chronic periodontitis have not addressed. The purpose of this study is to evaluate the risk indicators for inflammation, bone loss and implant failure in patients with chronic periodontitis. A total of 284 patients with dental implant restoration were recruited and divided into periodontally healthy patients (n = 128) and chronic periodontitis patients (n = 156). Periodontal indices including probing depth (PD), sulcus bleeding index (SBI), plaque index (PLI), gingival bleeding (GIL) and bleeding on probing (BOP) were compared in two groups. Inflammatory cytokines including tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), interleukin-1 (IL-1), matrix metalloproteinase-2 (MMP-2) and matrix metalloproteinase-9 (MMP-9) levels at baseline, 6 and 12 months after surgery, and the implant survival rate at 12 months after surgery, as well as the risk factors associated with failure of dental implant were also assessed. Outcomes demonstrated that patients in the chronic periodontitis group had higher values of periodontal indices than those in the periodontally healthy group. All inflammatory parameters in the chronic periodontitis group were higher than those in the periodontally healthy group and negatively associated with the chronic periodontal index (CPI) in chronic periodontitis patients. Chronic periodontitis patients had higher the prevalence of mucositis and peri-implantitis than patients with healthy periodontium. Implant diameter, length and design was associated with the risk of implant failure for chronic periodontitis patients receiving dental implant. The cumulative implant failure rate and incidence of implant fractures for chronic periodontitis patients at 12 months after surgery were 12.10% and 7.23% (p < 0.05), respectively, while were lower in the heathy periodontitis patients. Location, diameter, implant design, immediate loading and bone defect were risk indicators for bone loss for dental implant patients. The risk factors associated with failure of dental implant was higher in chronic periodontitis patients than patients in the periodontally healthy group (14.25% vs. 4.92%, p < 0.05). In conclusion, data in the current study indicate that inflammation is a risk indicator bone loss, implant fracture and implant failure in patients with chronic periodontitis.

Keywords

Dental implant
Chronic periodontitis
Inflammation
Periodontal indices
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pmcIntroduction

Dental implant restoration is a common choice for the treatment of missing teeth [1]. Dental implant is effective in dental restoration and presents good long-term efficacy [2]. The survival of dental implants is associated with multiple factors including bone mineral density loss, diabetes mellitus, smoking history, sulcus bleeding index, and periodontal probe depth [3–5]. Chronic periodontitis is a progressive disease, which leads to loss of several teeth for the common inflammatory risk factors with other systemic and chronic inflammatory disorders [6]. Chronic periodontitis patients demonstrate greater bacterial diversity compared with healthy implant subjects that contributes to the risk of implant failure [7]. Many reports showed that peri-implantitis and chronic periodontitis are common risk factors for implant failure [8–10], but little is known about the correlations between inflammation and implant failure in patients with chronic periodontitis.

Epidemiologic evidence showed that chronic periodontitis is more frequent in patients with corrosive teeth than in healthy controls, suggesting that periodontitis can significantly affect the implant success rate and survival [11]. Dental implant in these patients can be a successful outcome after systematic periodontitis treatment before dental implant restoration [12]. A study has focused on inflammatory cytokines such as tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), interleukin-1 (IL-1) in patients with chronic periodontitis [13]. In addition, meta-analysis revealed that patients with periodontitis have higher risk for implant loss and present significantly high interproximal bone loss (IBL) compared to periodontally healthy patients [14]. Incorrect treatment of periodontitis will lead to loss of soft-tissue integrity and predispose to peri-implant disease for dental implant restoration patients [15]. Furthermore, a study has indicated that periodontitis is regarded as a potential risk factor for implant success and survival [16]. Improvement of periodontal indices before dental implant restoration contributes to maintaining implants for patients with a history of periodontitis. Moreover, patients with inactive periodontitis also have elevated gingival levels of inflammatory cytokines, which is positively correlated with peri-implant mucosal inflammation and implant loss [17]. Meanwhile, many studies also indicate that microRNAs can be regarded as specific biomarkers for periimplant disease, and their presence in peri-implant crevicular fluid lays the foundations for the development of a noninvasive and site-specific liquid biopsy [18–20].

Periodontitis or peri-implantitis are two most important risks of implant failure, and the higher incidence of complications in periodontitis patients is come from ill issue [21]. Many risk factors are involved in the development of chronic periodontitis and most likely interact or overlap that increase the incidence of complications in periodontitis patients [22]. In this study, we investigated the therapeutic effect of dental implant restoration on dentition defect and inflammation in patients with chronic periodontitis. The changes of periodontal indices, inflammatory cytokines, and implant survival rate were assessed in patients in the periodontally healthy patients and chronic periodontitis patients. The prevalence of mucositis and peri-implantitis, risk indicators for bone loss were also compared between chronic periodontitis patients and periodontally healthy patients during 12-month investigations.

Materials and methods

Patients

A total of 284 patients who would like to receive dental implant were recruited between May 2021 and October 2022 in The Second People’s Hospital of Changzhi. Patients were divided into periodontally healthy patients (n = 128) and chronic periodontitis patients (n = 156). The diagnosis of chronic periodontitis was determined by the Clinical Application of the New Classification of Periodontal Diseases [23]. A total of 5 cases were dropped out from chronic periodontitis group and 3 cases in periodontally healthy group were dropped out because of extraction of the experimental tooth. This study reported the 12-month follow-up of a parallel group and was approved by the Ethical Committee of The Second People’s Hospital of Changzhi (Approval number: TSPHCZ20210501).

Exclusion and inclusion criteria

Exclusion criteria included as follow: (1) patients with immunosuppressive diseases; (2) alcohol consumption; (3) cancer patients; (4) pregnancy and lactation; (5) acute illness or pulpal pain patients; (6) patients undergoing orthodontic treatment; (7) patients on long-term medications that affect the expression of gingivitis or periodontitis. Inclusion criteria included as follow: (1) patients with chronic periodontal disease in the chronic periodontal group; (2) patients with good general health and had not received previous periodontal therapy; (3) age more than 18 years; (4) patients with or without smoking.

Implants design

All patients received standard, standard plus, or tapered design, with diameters of 4.1–4.8 mm. The lengths of dental implant were 8 mm, 10 mm, or 12 mm for chronic periodontitis patients and periodontally healthy patients. All surgeries were conducted by open flap using standard protocols as described previously [24]. All implants were fixed in suitable prosthetic positions. The impact of implants design on crestal bone level (CBL) and marginal bone loss (MBL) was evaluated as risk indicator of implant failure [25].

Analysis of periodontal indices

The clinical parameters in dental implant patients including probing depth (PD), sulcus bleeding index (SBI), plaque index (PLI), gingival bleeding (GIL) and bleeding on probing (BOP) were recorded by evaluating peri-implant condition [26]. The prevalence of mucositis and peri-implantitis were evaluated by using a manual periodontal probe (PC-PUNC 15 Hu-Friday, Chicago, USA) as described previously [27].

Analysis of inflammation cytokines

Venous blood was collected form each participant at the indicated time (month 0, 3, 6, 9 and 12). Serum was obtained by using centrifugation. Inflammatory cytokines including tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), interleukin-1 (IL-1), matrix metalloproteinase-2 (MMP-2) and matrix metalloproteinase-9 (MMP-9) levels at baseline, 3, 6, 9 and 12 months after surgery were determined by specific ELISA kit (KOMA BIOTECH INC., USA) according to the manufacturer’s instructions.

Parameters measurement

The prevalence of mucositis and periimplantitis was diagnosed by experts in implant dentistry using the 2018 classification case definitions [28]. Incidence of implant fractures was recorded by telephone follow-up. Bone loss was measured using intraoral periapical and transgingival probing [29].

Statistical analyses

Nominal variables were expressed as mean ± standard deviation (SD) or frequencies and percentages. Statistical analyses were analyzed using SPSS 22.0 (SPSS Inc., USA). Intergroup comparisons were conducted using the student t test. The chi-square test was used to compare the significance of nominal variables between groups. The Shapiro-Wilk test was used to determine the normality of the data. A p value less than 0.05 was considered statistically significant.

Results

Characteristic of patients

The study cohort of 284 dental implant patients with or without chronic periodontitis was followed for up to 12 months, with a mean of 44.6 ± 12.7 years old. Participants included 128 periodontally healthy patients and 156 chronic periodontitis patients. Baseline characteristics are shown in Table 1. There are 5 cases in the chronic periodontitis group and 3 cases in periodontally healthy group dropped out because of extraction of the experimental tooth. No significant differences were observed between two groups. Two participants (one in chronic periodontitis group and one in periodontally healthy group) were unavailable to complete the investigation for study unrelated reasons. The flow chart of the study subjects’ participation in this study is shown in Fig. 1.

Table 1 Characteristic of patients receiving dental implant

Parameters	Chronic periodontitis patient	Periodontally healthy patient	P value	
Number	156 (54.9%)	128 (45.1%)	0.142	
Age (years)	45.3 ± 12.2	45.0 ± 12.7	0.742	
Dropout	5 (3.2%)	3 (2.3%)	0.534	
Died case	1 (0.6%)	1 (0.8%)	0.728	
Location				
Anterior mandible	75 (48.1%)	61 (47.7%)	0.856	
Posterior mandible	81 (51.9%)	67 (52.3%)	0.862	
Smoking	42 (26.9%)	31 (24.2%)	0.634	
Non-smoking	114 (73.1%)	97 (75.8%)	0.768	

Fig. 1 Study flow diagram with number of patients screened and included in the final analysis

Implant diameter and design

The implant diameters of the implants were standard design with regular or wide neck, diameters of 4.1–4.8 mm and lengths of 8, 10, or 12 mm. All patients received the standard, standard plus, and tapered design (Table 2). Implant diameter and design were compared in periodontally healthy patients and chronic periodontitis patients. As shown in Fig. 2A, there was a significant difference in CBL between periodontally healthy patients and chronic periodontitis patients after 6-month dental implant, which was regarded as a function of implant diameter. A significant difference of MBL was observed after dental implant between two groups during 12-month observation (Fig. 2B). Figure 2C-F demonstrates that implant diameter and length did not affect MBL in periodontally healthy patients but presented a significant decrease in chronic periodontitis patients. Long diameter and lengths of implants increased the MBL in patients with chronic periodontitis patients. Figure 2G-H demonstrates that the various design groups had different mean bone level in periodontally healthy patients and chronic periodontitis patients. Results show that tapered design had lower MBL than standard and standard plus design in chronic periodontitis patients. However, no significant difference was observed in periodontally healthy patients under different implant design.

Table 2 Implant design, diameter and lengths for patients receiving dental implant

Parameters	Chronic periodontitis patient	Periodontally healthy patient	P value	
Design				
Standard,	68 (43.6%)	58 (45.3%)	0.416	
Standard plus	58 (37.2%)	42 (32.8%)	0.541	
Tapered	30 (23.4%)	28 (21.9%)	0.489	
Implant diameter				
4.1 (mm)	86 (55.1%)	72 (56.3%)	0.742	
4.8 (mm)	70 (44.9%)	56 (43.7%)	0.685	
Lengths				
8 mm	68 (43.6%)	60 (46.9%)	0.648	
10 mm	52 (33.3%)	42 (32.8%)	0.724	
12 mm	36 (20.1%)	26 (20.3%)	0.842	

Fig. 2 Effect of implant diameter, length, and design on MBL in patients after dental implant. (A) Mean crestal bone level (CBL) between periodontally healthy patients and chronic periodontitis patients. (B) Mean marginal bone loss (MBL) between periodontally healthy patients and chronic periodontitis patients. (C-D) Effect of implant diameter on MBL for periodontally healthy patients (C) and chronic periodontitis patients (D). (E-F) Effect of implant length on MBL for periodontally healthy patients (E) and chronic periodontitis patients (F). (G) Effect of implant design on MBL in chronic periodontitis patients. (H) Effect of implant design on MBL in periodontally healthy patients. *p < 0.05, **p < 0.01

Periodontal indices

Periodontal indices were compared during the investigation between periodontally healthy patients and chronic periodontitis patients. Figure 3A-B shows that periodontally healthy patients had lower PD and SBI than chronic periodontitis patients. The mean PD values were 2.12 mm and 1.92 mm in chronic periodontitis patients and periodontally healthy patients, respectively, which was significant difference (p < 0.01). As shown in Fig. 3C-E, chronic periodontitis patients had relatively high PLI, GIL and BOP compared to periodontally healthy patients. The various design groups had similar periodontal indices between the two groups (Table 3).

Fig. 3 Changes of periodontal indices in patients after dental implant. (A-E) PD (A), SBI (B), PLI (C), GIL (D) and BOP (E) between periodontally healthy patients and chronic periodontitis patients. *p < 0.05, **p < 0.01

Table 3 Periodontal indices in patients receiving various dental implant design

Group	Periodontally healthy patient	Chronic periodontitis patient	
Parameters	Standard	Standard plus	Tapered	Standard	Standard plus	Standard	
PD	1.90 ± 0.32	1.92 ± 0.34	1.88 ± 0.28	2.06 ± 0.40	2.00 ± 0.34	2.17 ± 0.51	
SBI	0.07 ± 0.02	0.08 ± 0.03	0.09 ± 0.03	0.15 ± 0.04	0.12 ± 0.03	0.18 ± 0.05	
PLI	1.42 ± 0.34	1.45 ± 0.35	1.40 ± 0.30	1.62 ± 0.25	1.57 ± 0.22	1.68 ± 0.29	
GIL	1.12 ± 0.26	1.16 ± 0.32	1.15 ± 0.27	1.45 ± 0.20	1.40 ± 0.16	1.53 ± 0.22	
BOP	0.55 ± 0.12	0.50 ± 0.10	0.60 ± 0.14	0.73 ± 0.13	0.70 ± 0.10	0.82 ± 0.15	

Inflammatory cytokines

Inflammatory cytokines were investigated in patients in 12-month follow-up. Date show that chronic periodontitis patients had higher serum level of TNF-α, IL-6, IL-1, MMP-2 and MMP-9 than periodontally healthy patients at 3, 6, 9 and 12 months after surgery (Fig. 4A-E). Inflammatory cytokines were positively associated with the CPI in chronic periodontitis patients (Fig. 4F). No significant differences of inflammatory cytokines were observed among standard, standard plus, and tapered design in periodontally healthy patients (Table 4). However, tapered design represented higher levels of inflammatory cytokines than those patients in standard and standard plus group.

Fig. 4 Inflammatory cytokines in patients after dental implant. (A-E) Serum levels of TNF-α, IL-6, IL-1, MMP-2, and MMP-9 between periodontally healthy patients and chronic periodontitis patients. (F) Associations between the inflammatory cytokines and chronic periodontal index (CPI) in chronic periodontitis patients. **p < 0.01

Table 4 Inflammatory cytokines in patients after dental implant using standard, standard plus, and tapered design

Group	Periodontally healthy patient	Chronic periodontitis patient	
Parameters	Standard	Standard plus	Tapered	Standard	Standard plus	Tapered	
TNF-α	30.25 ± 3.63	27.18 ± 3.20	32.68 ± 4.72	42.65 ± 5.85	40.80 ± 5.22	44.66 ± 5.71	
IL-6	7.22 ± 2.42	7.01 ± 2.04	7.83 ± 2.57	10.48 ± 2.76	9.98 ± 2.05	10.68 ± 2.90	
IL-1	90.64 ± 11.26	86.25 ± 8.25	96.83 ± 12.78	110.80 ± 13.61	106.73 ± 15.78	116.35 ± 16.74	
MMP-2	28.35 ± 5.83	27.25 ± 4.80	28.35 ± 5.83	41.58 ± 8.68	40.47 ± 7.56	42.98 ± 9.07	
MMP-9	330.40 ± 26.82	323.64 ± 22.53	341.92 ± 28.47	540.20 ± 36.80	534.72 ± 34.52	550.61 ± 40.55	

The prevalence of mucositis and peri-implantitis

The prevalence of mucositis and peri-implantitis were investigated in patients with or without chronic periodontitis after dental implant. Dental implant for patients with chronic periodontitis had higher prevalence of mucositis than patients with healthy periodontal tissue (14.52% vs. 4.67%). Data also found that chronic periodontitis increased the prevalence of peri‐implantitis compared to periodontally healthy patients (Table 5). The prevalence of peri-implantitis were 20.16% and 6.00% in patient with chronic periodontitis and periodontally healthy patient group, respectively. Notably, results show that tapered design increased the prevalence of mucositis and peri‐implantitis at implant and patient level compared to standard and standard plus design (Fig. 5).

Table 5 The prevalence of mucositis and peri-implantitis in patients after dental implant

Parameters	Periodontally healthy patient	Chronic periodontitis patient	P value	
Mucositis	7 (4.67%)	18 (14.52%)	0.004	
Peri-implantitis	9 (6.00%)	25 (20.16%)	0.001	

Fig. 5 Effect of implant design on the prevalence of mucositis and peri-implantitis. (A-B). The prevalence of mucositis (A) and peri‐implantitis (B) between periodontally healthy patients and chronic periodontitis patients under standard, standard plus, and tapered design. *p < 0.05, **p < 0.01

Implant survival rate

Implant survival rate was recorded in all patients who received dental implant. Results show that the implant survival rate was 87.90% and 95.3% at 6 and 12 months, respectively. There were 15 and 7 implant failures cases in chronic periodontitis patient and periodontally healthy patient, respectively (Table 6). Of the 4 implant failure cases that occurred after loading, 8 implant failures were related to peri-implantitis and 3 implants failed in relationship to biomechanical load for patient with chronic periodontitis. However, 2 implant failure that occurred after loading, 3 implant failures were related to peri‐implantitis and 2 implants failed in relationship to biomechanical load for periodontally healthy patients. No significant differences of implant survival rate were observed among different implant diameter (p > 0.05) and length (p > 0.05) for patients after dental implant within the group. Tapered design demonstrated higher implant survival rate than those patients in standard and standard plus group (Fig. 6).

Table 6 The implant survival rate in patients after dental implant

Parameters	Periodontally healthy patient	Chronic periodontitis patient	P value	
Implant survival rate	144 (96.00%)	109 (87.90%)	0.037	
Implant failure				
Occurred after loading	2 (1.33%)	4 (3.23%)	0.005	
Related to peri-implantitis	3 (2.00%)	8 (6.45%)	0.003	
Biomechanical load	2 (1.33%)	3 (2.42%)	0.004	
Implant diameter				
4.1 (mm)	1 (0.67%)	2 (1.61%)	0.042	
4.8 (mm)	2 (1.33%)	3 (2.42%)	0.036	
Lengths				
8 mm	2 (1.33%)	4 (3.23%)	0.012	
10 mm	1 (0.67%)	3 (2.42%)	0.028	
12 mm	1 (0.67%)	3 (2.42%)	0.028	

Fig. 6 Effect of implant design on implant survival in patients after dental implant. *p < 0.05

Incidence of implant fractures

As shown in Table 7, incidence of implant fractures was not significant difference in patients with or without chronic periodontitis. The incidence rate of implant fractures was 7.26% and 3.33% in patient with chronic periodontitis and periodontally healthy patient group, respectively. No significant differences of implant fractures rate were observed among different implant length for patients after dental implant within the group (p > 0.05). Long implant increased the incidence of implant fractures in patient with chronic periodontitis compared to those in periodontally healthy patients. Figure 7A shows that long implant diameter increased the incidence of implant fractures. Tapered design decreased the incidence of implant fractures compared with standard and standard plus design (Fig. 7B).

Table 7 The incidence of implant fractures in patients after dental implant

Parameters	Periodontally healthy patient	Chronic periodontitis patient	P value	
Implant fractures	5 (3.33%)	9 (7.26%)	0.005	
Lengths				
8 mm	1 (0.67%)	1 (0.81%)	0.075	
10 mm	1 (0.67%)	3 (2.42%)	0.005	
12 mm	3 (2.00%)	5 (4.03%)	0.003	

Fig. 7 Incidence of implant fractures in patients with or without chronic periodontitis. (A) Effect of implant diameter on implant fractures in patients after dental implant. (B) Effect of implant design on implant fractures in patients after dental implant. *p < 0.05, **p < 0.01

Risk indicators for bone loss

All risk indicators for bone loss were analyzed in patients undergone dental implant restoration. As shown in Table 8, location, diameter, implant design, immediate loading and bone defect were risk indicators for bone loss for dental implant patients.

Table 8 Risk indicators for bone loss in patients after dental implant

Group	Periodontally healthy patient	Chronic periodontitis patient		
Variables	Failure risk (%)	HR (95%CI)	Failure risk (%)	HR (95%CI)	P value	
Implant location	2.16	1.40	2.34	1.40	0.263	
Implant diameter	3.04	3.24	3.20	3.24	0.356	
Implant design	8.84	4.06	4.51	5.06	0.024	
Immediate loading	3.54	3.56	3.85	3.56	0.426	
Bone defect	4.56	6.57	4.61	6.57	0.682	

Univariate analysis showed no significant association between bone loss and implant location (HR: 1.40; 95% CI; P = 0.263), implant diameter (HR: 3.24; 95% CI; P = 0.356), immediate loading (HR: 3.56; 95% CI; P = 0.426), and bone defect (HR: 6.57; 95% CI; P = 0.682) between chronic periodontitis patients and periodontally healthy patients. Figure 8 shows that tapered design showed lower bone loss than standard and standard plus design (HR: 4.06; 95% CI; P = 0.024) both in chronic periodontitis patient and periodontally healthy patient.

Fig. 8 Effect of implant diameter and design on bone loss in patients after dental implant. **p < 0.01

The risk factors associated with failure of dental implant

The risk factors associated with failure of dental implant were assessed in this study. Table 9 shows that the risk factors associated with failure of dental implant included smoking, periodontitis, implant location, bone condition, type of implant, implant length and diameter and surgery-related factors. Implant location and surgery-related factors did not affect the failure of dental implant. Smoking, type of implant, implant length and diameter, and chronic periodontitis increased the risk of failure of dental implant for chronic periodontitis patients. Univariate analysis showed a significant association between implant failure and smoking (HR: 1.30; 95% CI; P = 0.037), periodontitis (HR: 1.34; 95% CI; P = 0.002), implant length (HR: 2.46; 95% CI; P = 0.014), implant diameter (HR: 2.30; 95% CI; P = 0.023), and implant design (HR: 1.79; 95% CI; P = 0.001). Overall, the risk factors associated with failure of dental implant for chronic periodontitis patients and periodontally healthy patients were 14.25% and 4.92%, respectively.

Table 9 The risk factors associated with failure of dental implant

Group	Periodontally healthy patient	Chronic periodontitis patient		
Variables	Failure risk (%)	HR (95%CI)	Failure risk (%)	HR (95%CI)	P value	
Smoking	4.21	1.30	7.68	1.30	0.037	
Periodontitis	5.12	1.34	10.37	1.34	0.002	
Implant location	2.36	2.81	3.82	2.81	0.068	
Bone condition	3.61	1.00	3.86	1.00	0.674	
Implant diameter	2.64	2.30	6.06	2.30	0.023	
Implant length	1.88	2.46	2.05	2.46	0.016	
Implant design	3.41	1.79	5.68	1.79	0.010	
Surgery-related factors	1.84	1.00	1.92	1.00	0.426	

Discussion

Dental implant therapy is the most commonly used treatment for missing teeth [30]. However, the risk factors associated with failure of dental implant have not been fully investigated, especially for patients with chronic periodontitis. In this study, the effects of implant diameter, length and design on survival and fracture were evaluated in all participants. The risk factors associated with failure of dental implant were also assessed. Data have shown that dental implant decreased the occurrence rate of periodontitis and decreased inflammatory cytokines for patients with chronic periodontitis. The significant risk factors analysis for dental implant failure have indicated that smoking, type of implant, implant length and diameter, and chronic periodontitis increased the risk of failure of dental implant.

It has been clarified that various local and systemic factors can damage the integrity of osseointegration after dental implant [31]. Implant placement in patients with chronic periodontitis should receive treatment to minimize the risk of implant failure [32]. Evidence suggests that implant failure and bone loss is not associated with machined and rough surface dental implants in patients with periodontitis [33]. A study has reported a high prevalence for oral disease and a potential association of a systemic compromised status and smoking habits with the risk of dental implant [34]. In this study, dental implant in patients with chronic periodontitis was considered a viable option to restore oral function with survival outcomes lower to those found in periodontally healthy patient. A previous study showed that the prevalence of mucositis and peri-implantitis frequently observed in dental implant patients when using strict criteria [27]. Interestingly, outcomes in this study found that chronic periodontitis patients after dental implant surgery had relatively high prevalence of mucositis and peri-implantitis at implant and patient level.

The basic complications of dental implants include biomechanical overload, inflammation, and other causes, which will lead to implant fracture, implant failure, and failure of soft tissue preservation [35]. The common risk factors for failure of dental implants contain the patient history posterior implant location and bone grade, and inflammation at the surgical site [36]. Regarding the inflammatory cytokines, a partial or a complete inducements were reported to be significant risk factors to failure of dental implant [37]. In this study, data have shown that levels of TNF-α, IL-6, IL-1, MMP-2, and MMP-9 were upregulated in chronic periodontitis patients after dental implant surgery. Indhuja R Saraswathi et al. have reported that monitoring serum level of IL-6 and TNF-α can evaluate the therapeutic effect of periodontitis [38]. This study provides evidence that nonsurgical periodontal therapy contributes to reduction in serum level of IL-6 and TNF-α in systemically healthy subjects with chronic periodontitis and subjects with hypothyroidism and chronic periodontitis.

Several studies have shown that location, diameter, and design is significantly associated with late failure of dental implant [39–41]. As for implant factors, various design for dental implant did not affect periodontal indices but stimulated high inflammatory cytokines in chronic periodontitis patients compared with periodontally healthy patients. In addition, a significant difference of CBL was observed in patients after dental implant based on various implant diameter and design. It was noted that approximate 7.26% of chronic periodontitis patients presented implant fractures that might be directly attributed to inflammation with sites around implant in chronic periodontitis patients. Furthermore, results in this study proposed that implant design was associated with the implant survival rate, and chronic periodontitis increased bone loss with sites exhibiting inflammation [42]. Notably, data in this study indicated that smoking, type of implant, implant length and diameter, and chronic periodontitis increased the risk of failure of dental implant, and evidence suggested that chronic periodontitis is a risk factor for implant loss, implant fracture and implant failure. Angkoon Khaohoen et al. found that implant material, implant design, and bone density are pivotal factors affecting the success rates of dental implant placement in low-density bone [43]. In addition, there are no statistical differences in behavior and MBL when using abutment heights greater than 2.5 mm of transmucosal portion and when placed implants with 13 mm length [44]. Differently, data in this study found that wide diameter and long implant of implants markedly increased the MBL in patients with chronic periodontitis patients, which was in accord with a study reported by Heba Ezzeldin Khorshid [45]. Meanwhile, we speculated that PD and SBI might be associated with the survival of dental implant.

Several limitations of the study should address. First, outcomes did not analyze the comparison of patients age with factors of chronic periodontitis and failure of dental implant. Second, the correlation between chronic periodontitis treatment outcomes and the implant failure did not investigate. Third, this study did not classify the severity of chronic periodontitis and the association between the severity of chronic periodontitis and the study outcome did not analyze in this study. Therefore, further study should be conducted to investigate the association between the degree of chronic periodontitis, patients age, chronic periodontitis treatment outcomes and implant failure in patients with chronic periodontitis.

In conclusion, data in this study demonstrate that dental implant is an alternative method for treatment of dentition defect. Chronic periodontitis patients after dental implant surgery increase the risk of bone loss, the prevalence of mucositis and peri-implantitis. Cause of implant fracture, implant failure is attributed to implant design, implant length and inflammation with sites around implant tooth in chronic periodontitis patients. Interestingly, many factors, such as smoking, type of implant, implant length and diameter are associated with the risk of failure of dental implant for chronic periodontitis patients. The data of this study highlight risks to consider when trying to prevent bone loss and further failure of dental implant reported cases of chronic periodontitis patients.

Acknowledgements

None.

Author contributions

Qiang Zhang and Kai Zhang conceived and designed the study, wrote, and revised the manuscript. Sheng Guo, Yuan Li, Zhou Li, Deli Wang performed the experiment, and analyzed the data. All the authors approved the final manuscript as submitted.

Funding

None.

Data availability

The datasets used in this study are available from the corresponding author on reasonable request.

Declarations

Ethics approval and consent to participate

This study was approved by the Ethics Review Committee of The Second People’s Hospital of Changzhi. All patients gave the informed consent.

Consent for publication

The written informed consent was obtained from all patients and all patients agreed to publish the data.

Competing interests

The authors declare no competing interests.

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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