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ePaper created 2015-11-17, 15:11:47 | version 1.38.0
74 Volume 1 | Issue 1/2015 Journal of Oral Science & Rehabilitation those obtained in the present study: a success rate of 93.1% for 102 implants placed after 58 direct sinus lifts. The mean bone loss at 12 months was 0.62 mm for simultaneously placed implants and 0.54 mm for those placed in a second stage. No statistically significant differences were observed. These results were similar to those of Felice et al.: one year after loading, one-stage-treated implants lost an average of 1.01 mm of periimplant bone and two-stage sites about 0.93 mm.29 Similarly, afteroneyear of follow-up, Jodia et al.30 reported a marginal bone loss of between 0.68 and 1.22 mm for si- multaneously placed implants, and Kahnberg and Vannas-Löfqvist31 of 0.8 mm for implants placed in a delayed mode. In the literature, smoking has often been associated with a higher failure rate for con- ventionally placed dental implants,32–35, 7 worse osseointegration, as well as more frequent periimplantitis, bone loss and bleeding.36, 37 However, in studies published on sinus lift, there is no unanimity regarding the effect of smoking on treatment outcomes. In five of the reviewed studies (Table 1), statistically signifi- cant differences were found, observing a higher success rate in nonsmokers than in smokers.9, 10, 11, 15, 1 In one study, only smoking > 15 cigarettes/day and a residual ridge height of < 4 mm were significantly associated with reduced implant survival.17 In other studies,8, 12–14 no statistically significant relationship was found between smoking and implant suc- cess, although failure rates were higher among smokers. Moreover, Levin et al. observed rele- vantcomplicationsinone-thirdofthesmokers, compared with only 7.7% ofthe nonsmokers.12 A recent systematic review evaluated the effects oftobacco smoking on the survival rate of dental implants placed in areas of maxillary sinus lift. Eight studies, three prospective and fiveretrospective,wereincluded.Smokingwas associated with increased implant failure rates in most individual studies and in the overall meta-analysis. However, when only prospec- tivestudieswereconsidered,nosignificantdif- ferences in implant failure were observed be- tween smokers and nonsmokers.38 Similar re- sults were obtained in this study: the implant failure rate and bone loss were slightly higher in smokers, but with the available sample size these differences were not statistically significant. The literature clearlydemonstratesthe negative response of the periimplant mucosa to plaque accumulation;39–41 however, there is disagree- ment regarding the influence of oral hygiene on the success of conventionally placed implants. Mombelli et al.,21 Smith and Zarb,22 and Baelum and Ellegaard argue that hygiene did not influ- ence implant outcomes (success and bone loss) in the short term.23 However, Lindquist et al. ob- served a higher bone loss in patients with poor oral hygiene.5 The influence of hygiene on the success of implants placed after direct sinus lift has been more rarely studied. Kan et al.11 evalu- ated oral hygiene according to the modified plaque index as described by Mombelli et al.21 and reported a failure rate of 1.4% in patients with good oral hygiene, 13.9% with fair hygiene and 60% with poor oral hygiene; the differences between the groups were statistically signifi- cant.11 In ourstudy, a lowerimplant success rate wasfoundinpatientswithpoorhygiene(81.8%), compared with patients with regular and good hygiene (92.3% and 95.5%, respectively). The differences did not reach statisticalsignificance, but the comparison between poor hygiene and the other two categories tended to significance (p = 0.058). Infact, a difference ofover10%with such a predictable treatment technique may be considered of clinical relevance, and the lack of statistical significance is probably related to the smallnumberofpatientswithpoororalhygiene. Conclusion Within its limitations, the present investigation suggests that smoking and poor oral hygiene may negatively influence the outcome of im- plants placed both in one-stage and two-stage direct sinus lift procedures. However, the differ- ences were in no case statistically significant, and prospective studieswith largersample sizes and longer follow-up are necessary to corrobo- rateorrefutethesefindings. Competinginterests The authors declare that theyhave no conflict of interestsrelatedtothisstudy. S uc c es s of im pla n ts place d af te r di re ct si nu s li f t Luis Martorell Calatayud,* Javier Romero Millán,* David Peñarrocha Oltra,* Maria Peñarrocha Diago,* Berta García Mira* & Miguel Peñarrocha Diago* * Oral Surgery Unit, Department of Stoma- tology, Faculty of Medicine and Odontology, University of Valencia, Valencia, Spain Corresponding author: Dr. David Peñarrocha Oltra Clínicas odontológicas Gascó Oliag, 1 46021 Valencia Spain T & F +34 963 86 4139 david.penarrocha@uv.es T & F +34963864139