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ePaper created 2015-11-17, 15:11:47 | version 1.38.0
70 Volume 1 | Issue 1/2015 Journal of Oral Science & Rehabilitation Influence of smoking and oral hygiene on success of implants placed after direct sinus lift Abstract Ob jec tive Theobjectiveofthisstudywastoevaluatetheinfluenceofsmokingand oralhygieneonthesuccessandperiimplantmarginalbonelossofim- plantsplacedinone-stageandtwo-stagedirectsinusliftprocedures. Ma teria ls a n d m eth od s Aretrospective clinical studyofpatientswho underwent direct sinus liftandimplantplacementwasconducted.Forty-sixpatientswith58 directsinusliftswereincludedandatotalof102implantswereplaced. Cigaretteconsumptionwasquantifiedandtheleveloforalhygienede- terminedatthetimeofsurgeryusingasimplifiedcalculusandplaque index. Bone loss and implant success (according to Buser’s criteria) weremonitoredafter12monthsofprostheticloading. Res ults Thesuccessrateforimplantsplacedafterdirectsinusliftwas93.1%at 12 months. There was a higher success rate in nonsmokers (94.2%) than in smokers (90.9%), with a mean bone loss of 0.52 mm (range: 0.21–0.84 mm) in nonsmokers and 0.60 mm (0.24–0.92 mm) in smokersatthe12-monthfollow-up.Thesuccessrateinpatientswith poor oral hygiene was lower (81.8%) than in patients with good (95.5%) or regular hygiene (92.3%). Furthermore, there was a mean bone loss of 0.51 mm (0.21–0.82 mm) in patients with good oral hy- giene, 0.57 mm (0.24–0.82)with regularhygiene and 0.66 mmwith poor hygiene (0.32–0.92 mm). There was no statistically significant relationship (p > 0.05) between bone loss or implant success and smokingororalhygiene. C on c lus ion Within its limitations,the present investigation suggeststhat smok- ingandpoororalhygienemaynegativelyinfluencetheoutcomeofim- plantsplacedbothinone-stageandtwo-stagedirectsinusliftproce- dures. However, differences were in no case statistically significant andstudieswithlargersamplesizesshouldbeconductedtocorrobo- rateorrefutethesefindings. Keyword s Sinus lift, oral hygiene, smoking, bone loss. S uc c es s of im pla n ts place d af te r di re ct si nu s li f t Introduction Placing implants in the posterior maxilla can be a complex procedure when there is atrophy of the alveolarridgeandmaxillarysinuspneumatization. In some cases, these anatomical limitations may beovercomeusingsinusliftprocedures.1 Thesuc- cess rates of implants placed after sinus lift are similartothoseofimplantsplacedinmaturebone.2 However, the residual alveolar bone height ap- pearstoinfluenceimplantsurvival.Riosetal.con- ducted a systematic review and divided the out- comes intotwo groups accordingto residualbone height:≤ 4 mminGroup1and> 4 mminGroup2.3 The implant survival rate was 96% (range: 80–100%)forGroup1and99%(range:97–100%) forGroup2.3 In addition to bone atrophy, factors such as smoking and poor oral hygiene have been sug- gestedto increasethe risk ofimplantfailure inthe posteriormaxilla.4 Severalstudieshaveaddressed the association between smoking and the out- comeofimplantsplacedusingconventionaltech- niques;5–7 however, few studies have addressed the influence of smoking on the success of im- plants placed after direct maxillary sinus lift. In all ofthepublishedstudies,highertobaccoconsump- tion yielded higher complication and/or implant failurerates;8–15,1,16–19 however,thiseffectwasnot alwaysstatisticallysignificant(Table1).6,12–14 The influence of oral hygiene has frequently been considered in implant studies. In some stud- ies, poorhygienewas associatedwith higherperi- implant marginal bone loss.20 Contrarily, other studiesdidnotfindthisrelationship.21–23 However, evidence relating patient oral hygiene to the out- comeofimplantsplacedafterdirectsinusliftpro- ceduresisscarce.Onlyonestudywasfound,andit reportedastatisticallysignificantlyhigherimplant failurerateinpatientswithpoororalhygiene.11 The objective ofthis studywasto evaluatethe influence ofsmoking and oralhygiene onthe suc- cess and periimplant marginal bone loss of im- plants placed in one-stage and two-stage direct sinusliftprocedures.