PREDICTING THE RISK OF PERIIMPLANTITIS IN SUBANTRAL MAXILLARY AUGMENTATION
DOI:
https://doi.org/10.35220/2523-420X/2024.1.9Keywords:
dental implantation, peri-implantitis, regenerative dentistry, bone grafting, lateral sinus lift fluor augmentation, upper jawAbstract
The study aimed to determine the frequency of dental implant loss (disintegration) in patients after open sinus lifting (OSL) for defects in the lateral maxillary area, and to identify risk factors for this complication based on multifactorial analysis and logistic regression. Materials and methods. The research involved 240 patients who received 517 dental implants after OSL (after 6 months). Factors considered included gender, age, smoking, time after tooth extraction, reason for tooth extraction, side and volume of operation, type of bone replacement material, residual height of the alveolar ridge, restored height of the alveolar ridge, and complications during OSL. Statistical analysis aimed to identify factors associated with an increased risk of complications in the early and late postoperative periods. For analyzing the risk of complications in patients with dental implants, univariate logistic regression model was built for each factor, as well as multifactorial analysis with ROC curves was conducted, using EZR (v.1.54). Results. The study included 240 patients with 517 dental implants, with women making up 54 % of the participants. Ages ranged from 29 to 71 years old (50.7±7,39), and 77 patients (32 %) were smokers. The distribution of implants was nearly even between the left (51 %) and right (49 %) sides. The leading cause of tooth loss was caries and its complications (69 %), periodontal tissue diseases (21 %), and dento-alveolar trauma (10 %). The residual height of the alveolar ridge before open sinus lifting was 1 mm in 80 cases (26 %), ranged from 1 to 2 mm in 117 cases (37 %), from 2 to 3 mm in 93 cases (30 %), and from 3 to 4 mm in 20 cases (7 %). After the introduction of bonereplacement material, directly before dental implantation, the restored height of the alveolar ridge made up 6-9 mm in 150 dental implant sites (29 %), and 9-12 mm in 367 sites (71 %). Among the osteointegrating dental implants with various thread pitches and widths, 233 (45 %) had a relatively “aggressive” thread, while 284 (55 %) had a “non-aggressive” thread. Bone replacement material used was xenogenic, made from deproteinized bovine bone in 278 cases (89.7 %), and autologous bone blocks in 32 cases (10.3 %). Out of 310 sinus lifting procedures, complications developed in 17 patients (7 %) in 21 operated sinuses. In 9 cases (3 %), adverse inflammatory processes led to the complete loss of the bone graft, necessitating repeated sinus lifting and delaying comprehensive rehabilitation. Dental implants (DI) were placed in the P2 (second premolar) area in 101 cases (20 %), in the M1 (first molar) area in 353 cases (68 %), and in the M2 (second molar) area in 63 cases (12 %). All implants were loaded using the traditional two-stage protocol six months after placement. Rejection/disintegration of dental implants was observed in 32 patients (13 %) in the early postoperative period or after loading (placement of prosthetic constructions), with a total of 43 instances (8 %). Conclusions. The study concludes that the logistic regression model based on the combined effect of risk factors (p<0.05), shows a very strong association (AUC=0.84, 95 % CI 0.78-0.91) with the factors, and can be used in treatment for patients with distal maxillary defects.
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