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4
Comprehensive Treatment Planning
for the Patient with Oral or
Systemic Infl ammation
THE EFFICACY OF
OSSEOINTEGRATED DENTAL
IMPLANTS FOR PERIODONTALLY
COMPROMISED PATIENTS
Myron Nevins and David M. Kim
Twenty-fi ve years have elapsed since the
North American continent was graced by the
presentation from P.I. Brånemark and his
breakthrough research on osseointegrated
implants at the 1982 Toronto Conference on
Osseointegration in Clinical Dentistry. His
team’s treatment regime to reverse edentulism
and restore the dignity and mastication of
dentally disadvantaged patients has revolutionized
dental treatment planning and signifi
cantly upgraded the prognosis both of
edentulous patients and partially dentate
patients (Adell et al. 1981, 1990; Brånemark
et al. 1977; Buser et al. 1990; Jemt et al.
1989; Lekholm et al. 1999; van Steenberghe
et al. 1990).
Since the introduction, the patient population
who would benefi t from safe and effi cacious
prostheses anchored by titanium
implants has continually expanded. However,
the debate continues on whether similar
Osseointegration and Dental Implants Edited by Asbjorn Jokstad
© 2008 John Wiley & Sons, Inc. ISBN: 978-0-813-81341-7
success and survival rates can be anticipated
in partially edentulous, periodontally compromised
patients. These patients demonstrated
damage in quality and dimension of
the remaining alveolar ridge due to a history
of periodontal disease and consequential loss
of teeth (Ellegaard et al. 1997). It may be
reasonable to anticipate that the risk of periimplant
infections is higher if the periodontal
disease is not defi nitely treated before the
implant placement. A 10-year prospective
study comparing the clinical and radiographic
changes in periodontal and peri-implant conditions
revealed a correlation between these
conditions (Karoussis et al. 2004).
Before a pessimistic argument can be
made for implant treatment in periodontally
compromised patients, it is necessary to
evaluate available evidence and collate this
with an awareness of current treatment
trends and clinical judgment (Nevins 2001).
There have been numerous studies documenting
a high degree of success in implant
therapy in properly treated and wellmaintained
periodontitis-susceptible subjects
(Ellegaard et al. 1997; Mengel et al. 2001;
Nevins and Langer 1995; Sbordone et al.
1999) (Figs. 4.1a–4.1d).
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