title: Outcomes of implants and restorations placed in general dental practices: a retrospective study by the Practitioners Engaged in Applied Research and Learning (PEARL) Network.
abstract: OBJECTIVE
  The authors conducted a study to determine the types, outcomes, risk factors and esthetic assessment of implants and their restorations placed in the general practices of a practice-based research network.
  
  
  METHODS
  All patients who visited network practices three to five years previously and underwent placement of an implant and restoration within the practice were invited to enroll. Practitioner-investigators (P-Is) recorded the status of the implant and restoration, characteristics of the implant site and restoration, presence of peri-implant pathology and an esthetic assessment by the P-I and patient. The P-Is classified implants as failures if the original implant was missing or had been replaced, the implant was mobile or elicited pain on percussion, there was overt clinical or radiographic evidence of pathology or excessive bone loss (> 0.2 millimeter per year after an initial bone loss of 2 mm). They classified restorations as failures if they had been replaced or if there was abutment or restoration fracture.
  
  
  RESULTS
  The authors enrolled 922 implants and patients from 87 practices, with a mean (standard deviation) follow-up of 4.2 (0.6) years. Of the 920 implants for which complete data records were available, 64 (7.0 percent) were classified as failures when excessive bone loss was excluded from the analysis. When excessive bone loss was included, 172 implants (18.7 percent) were classified as failures. According to the results of univariate analysis, a history of severe periodontitis, sites with preexisting inflammation or type IV bone, cases of immediate implant placement and placement in the incisor or canine region were associated with implant failure. According to the results of multivariate analysis, sites with preexisting inflammation (odds ratio [OR] = 2.17; 95 percent confidence interval [CI], 1.41-3.34]) or type IV bone (OR = 1.99; 95 percent CI, 1.12-3.55) were associated with a greater risk of implant failure. Of the 908 surviving implants, 20 (2.2 percent) had restorations replaced or judged as needing to be replaced. The majority of P-Is and patients were satisfied with the esthetic outcomes for both the implant and restoration.
  
  
  CONCLUSIONS
  These results suggest that implant survival and success rates in general dental practices may be lower than those reported in studies conducted in academic or specialty settings.
  
  
  CONCLUSIONS
  The results of this study, generated in the private general practice setting, add to the evidence base to facilitate implant treatment planning.
authors: Dr. Da Silva is a practitioner-investigator in the Practitioners Engaged in Applied Research and Learning (PEARL) Network and an assistant professor and the chair, Department of Restorative Dentistry and Biomaterials Sciences; medical director, Harvard Dental Center, Harvard School of Dental Medicine, Harvard University, Boston.
authors: John D
authors: JD
authors: Da Silva
authors: Dr. Kazimiroff is a practitioner-investigator in the Practitioners Engaged in Applied Research and Learning (PEARL) Network and director, Community Dentistry and Health Promotion, Department of Dentistry, Montefiore Medical Center, The University Hospital of the Albert Einstein College of Medicine, Bronx, N.Y.
authors: Julie
authors: J
authors: Kazimiroff
authors: Dr. Papas is a practitioner-investigator in the Practitioners Engaged in Applied Research and Learning (PEARL) Network and The Johansen Professor of Dental Research and head, Division of Dental Public Health Research and Oral Medicine, School of Dental Medicine, Tufts University, Boston.
authors: Athena
authors: A
authors: Papas
authors: Dr. Curro is a clinical professor of pharmacology and oral medicine, Department of Oral and Maxillofacial Pathology, Radiology and Medicine, New York University College of Dentistry, New York City; director, Clinical Pharmacology/Regulatory Affairs, Bluestone Center for Clinical Research, New York University College of Dentistry; and director, Practitioners Engaged in Applied Research and Learning (PEARL) Network, New York City.
authors: Frederick A
authors: FA
authors: Curro
authors: Dr. Thompson is a professor, Department of Biomaterials, Biomimetics and Biophotonics, King's College London Dental Institute, Guy Hospital, London; and director, Practitioners Engaged in Applied Research and Learning (PEARL) Network, Protocol Development and Training, New York City.
authors: Van P
authors: VP
authors: Thompson
authors: Mr. Vena is a statistician, The EMMES Corporation, Rockville, Md., and principal investigator, Data Coordinating Center, Practitioners Engaged in Applied Research and Learning (PEARL) Network Data Coordinating Center, New York City.
authors: Donald A
authors: DA
authors: Vena
authors: Ms. Wu is a statistician, The EMMES Corporation, Rockville, Md.
authors: Hongyu
authors: H
authors: Wu
authors: Mr. Collie is a project manager, The EMMES Corporation, Rockville, Md.
authors: Damon
authors: D
authors: Collie
authors: Dr. Craig is an associate professor, Department of Basic Sciences and Craniofacial Biology and Department of Periodontology and Implant Dentistry, New York University College of Dentistry, New York City. Address correspondence to Dr. Craig, Department of Basic Sciences and Craniofacial Biology, New York University College of Dentistry, 345 E. 24th St., New York, N.Y. 10010, e-mail rgc1@nyu.edu.
authors: Ronald G
authors: RG
authors: Craig
mesh_terms: D015921:Dental Implants; D019232:Dental Restoration Failure; D003793:Dental Restoration, Permanent; D004955:Esthetics, Dental; D005260:Female; D005792:General Practice, Dental; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D019239:Practice Patterns, Dentists' / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States
chemical_list: D015921:Dental Implants
keywords: Implant therapy; implant treatment outcomes; practice-based research