title: Bone Remodeling around Implants Placed in Augmented Sinuses in Patients with and without History of Periodontitis.
abstract: BACKGROUND
  Susceptible individuals may be more prone to bone loss after augmentation procedures.
  
  
  OBJECTIVE
  Identify plausible clinical and biological factors influencing apical and marginal bone remodeling at implants placed in augmented sinuses, in patients with and without history of periodontitis.
  
  
  METHODS
  This prospective cross-sectional clinical study analyzed implant bone levels in a group of 104 patients with and without history of periodontitis undergoing 139 sinus augmentation procedures. Marginal and apical bone loss (MBL/ABL) was measured post-loading using a standardized digital technique. Measurements were taken preoperatively, at second stage implant uncovery, one year after loading and at an average of 53-months follow-up. Odds ratios were calculated to evaluate risks factors of contributing variables, such as, smoking, history of periodontitis, membrane perforation, surgical approach, grafting material, use of PRP, and implant design/dimensions.
  
  
  RESULTS
  Patients with history of periodontitis were 8.43 times more likely to present more than 2mm of MBL than patients without it (p =.041; CI95%: 1.09-65.12). Smokers were 4.97 times more likely to present over 2 mm of MBL than non-smokers (p =.003; CI95%: 1.70-14.54). Sinus membrane perforations were 11.4 times more likely to present ABL than those without perforation (p = 0.007; CI95%: 1.94-66.93). Mean MBL/ABL after 1-year post-loading and at last control were 0.49/0.56 mm and 0.67/0.46 mm, respectively. The use of a collagen membrane to cover the antrostomy and only xenograft as grafting material decreased ABL by 0.9 mm. The combination of autologous/xenograft bone was 4.04 times more likely to present higher ABL than xenograft alone (p = 0.023; CI95%: 1.21-13.45). Overall implant survival/success rates were 94.39%/91.33%, respectively.
  
  
  CONCLUSIONS
  Smoking and previous history of periodontitis negatively affects implant MBL. Sinus membrane perforation was associated with higher ABL. Lack of association between bone remodeling at marginal and apical areas suggests that they are different and independent processes.
authors.affiliation: Professor, Department of Stomatology II, Oral Medicine, School of Medicine and Odontology, University of Basque Country, Leioa, Spain.
authors.forename: Agurne
authors.initials: A
authors.lastname: Uribarri
authors.affiliation: Professor, Department of Stomatology II, Oral Medicine, School of Medicine and Odontology, University of Basque Country, Leioa, Spain.
authors.forename: Eneritz
authors.initials: E
authors.lastname: Bilbao
authors.affiliation: Professor, Department of Stomatology II, Oral Medicine, School of Medicine and Odontology, University of Basque Country, Leioa, Spain.
authors.forename: Xabier
authors.initials: X
authors.lastname: Marichalar-Mendia
authors.affiliation: Professor, Department of Stomatology II, Oral Medicine, School of Medicine and Odontology, University of Basque Country, Leioa, Spain.
authors.forename: Rafael
authors.initials: R
authors.lastname: Martínez-Conde
authors.affiliation: Chairman, Director of Department of Stomatology II, Oral Medicine, School of Medicine and Odontology, University of Basque Country, Leioa, Spain.
authors.forename: José M
authors.initials: JM
authors.lastname: Aguirre
authors.affiliation: Consultant, Department of Periodontics, VA Hospital, Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
authors.forename: Fernando
authors.initials: F
authors.lastname: Verdugo
mesh_terms: D000328:Adult; D000368:Aged; D016301:Alveolar Bone Loss / Q000209:etiology; D016723:Bone Remodeling; D016025:Bone Transplantation; D003430:Cross-Sectional Studies; D003758:Dental Implantation, Endosseous; D015921:Dental Implants; D005260:Female; D064593:Heterografts; D006801:Humans; D008297:Male; D008437:Maxilla / Q000503:physiopathology / Q000601:surgery; D008439:Maxillary Diseases / Q000209:etiology / Q000601:surgery; D008875:Middle Aged; D010518:Periodontitis / Q000150:complications*; D011446:Prospective Studies; D059546:Sinus Floor Augmentation; D012907:Smoking / Q000009:adverse effects
chemical_list: D015921:Dental Implants
keywords: bone grafting; bone remodeling; bone resorption; bone substitute; bone transplantation; dental implant; maxillary sinus floor augmentation; xenograft