1. Surgery skills analysed
A surgeon’s skills and experience may affect implant success so this retrospective study based on 2,670 patients who received 10,096 implants at one specialist clinic sought to clarify the situation. Only the data of patients and implants treated by surgeons who had inserted a minimum of 200 implants at the clinic were included. The factors bone quantity, bone quality, implant location, implant surface, and implant system were analysed. The differences between the survival curves of each of 10 surgeons were statistically significant as were bruxism, intake of antidepressants, location, implant length, and implant system. The surgeon with the most failures inserted the most implants in poor bone sites and mainly used turned implants; the surgeon with the least failures used mainly modern implants. Separate survival analyses of turned and modern implants stratified for the individual surgeon showed statistically significant differences in cumulative survival. Although a direct causal relationship could not be ascertained, the study suggests that a surgeon’s technique, skills, and/or judgment may negatively influence implant survival rates.

Chrcanovic BR et al. Impact of different surgeons on dental implant failure. Int J Prosthodontics 2017 30: 445-454.

Q On the basis of these results, would a surgeon placing implants be best advised to:
A Completely stop doing so for dento-legal reasons
B Carry on regardless
C Think carefully about the appropriateness of the site of placement
D Consider using more traditional style implants

  1. Narrow focus
The evaluation of the long-term survival, complications, peri-implant conditions, marginal bone loss, and patient satisfaction of fixed dental prostheses supported by narrow diameter implants (NDIs) in the posterior jaws was the purpose of this research. The retrospective cohort study had a mean follow-up time of 10.1 years of relevant patients. Implant survival, hardware complication, a range of periodontal measurements including marginal bone loss (MBL), and patient satisfaction were evaluated in 67 patients with 98 NDIs (premolar site: 81, molar site: 17, single crowns: 33, splinted restorations: 65). The overall implant survival rates were 96.9% at implant level and 97.0% at patient level. Veneer chipping was the most common hardware complication (18.4% implant level: 19.4% patient level). The average MBL was 1.19 mm (implant level) and 1.15 mm (patient level). Eight implants (8.5%) and six patients (9.2%) were diagnosed with peri-implantitis. Fifty-eight patients (89.2%) were satisfied with the aesthetics of the restorations and 55 patients (84.6%) with their function. Narrow diameter implants could be a predictable treatment option in the long term.

Shi JY et al. Long-term outcomes of narrow diameter implants in posterior jaws: A retrospective study with at least 8-year follow-up. Clin Oral Implants Res 2017 Aug 28.

Q Referring to the ‘patient level’ statistics for implant survival rates, veneer chipping and marginal bone loss, which is the correct sequence of results?
A 96.9%, 19.4%, 1.19 mm
B 97%, 19.4%, 1.15 mm
C 18.4%, 96.9%, 1.15 mm
D 97%, 96.9%, 1.19 mm

  1. Systemic risk factors for peri-implantitis and more
This investigation, based on a 3-year epidemiological surveillance open cohort study, aimed to provide an insight of the prevalence of periodontitis, dental caries and peri-implant pathology and to compare inferentially between healthy and systemic compromised patients.
A total of 22,009 patients were observed (average age 48.5 years). The prevalence rate of periodontitis, dental caries and peri-implant pathology was 17.6%, 36.6% and 13.9%, respectively. The systemic condition specific models yielded diabetes and HIV+ as risk indicators for periodontitis; cardiovascular conditions, diabetes and neurologic conditions as risk indicators for dental caries; and smoking habits as a risk indicator for all three oral diseases. Attributable fractions estimated a potential reduction of 12.2% of periodontitis, and 4.3% of dental caries cases if the exposure to systemic conditions was prevented; while the prevention of exposure to smoking alone would result in a potential reduction of 37%, 7%, and 39% of periodontitis, dental caries, and peri-implant pathology cases, respectively.

de Araujo Nobre M, Malo P. Prevalence of periodontitis, dental caries, and peri-implant pathology and their relation with systemic status and smoking habits: Results of an open-cohort study with 22,009 patients in a private rehabilitation center. J Dent 2017 Jul 25.

Q The prevention/removal of one risk factor would reduce 37%, 7%, and 39% of periodontitis, dental caries, and peri-implant pathology cases respectively. Which is it?
B Smoking
C Diabetes
D Cardiovascular conditions

  1. Smoking gets the thumbs down again
The aim of the present retrospective study was to compare the peri-implant clinical and radiographic inflammatory parameters among cigarette-smokers (CS, n=44, group 1) waterpipe-smokers (WS, n=41, group 2) and never-smokers (NS, n=43, group 3). Demographic data were collected using a questionnaire. Peri-implant plaque index (PI), bleeding on probing (BOP) and probing depth (PD) were measured and crestal bone loss (CBL) was assessed on standardised digital radiographs. Peri-implant PI and PD were higher in groups 1 and 2 compared with group 3, however peri-implant BOP was significantly higher in group 3 compared with individuals in the other two groups. Peri-implant total marginal bone loss was significantly higher in groups 1and 2 compared with group 3. There was difference in PI, BOP, PD and CBL among participants in groups 1 and 2. Peri-implant soft tissue inflammatory parameters and crestal bone loss were worse in CS and WS smokers compared with NS. There is no difference in these parameters among CS and WS.

Al Harthi SS et al. Comparison of peri-implant clinical and radiographic inflammatory parameters among cigarette and waterpipe (Narghile) smokers and never-smokers. J Periodontol 2017 Aug 04.

Q Would you advise waterpipe-smokers that:
A They are at just as great a risk of peri-implantitis as cigarette smokers
B Smoking a waterpipe is less dangerous periodontally speaking than cigarette smoking
C Peri-implantitis will be less of a risk for them
D Never-smokers don’t know what they are missing