The Relationship Between the Amount of Peri-implant Keratinized Mucosa and Patient Satisfaction

Abstract

Background: The aim of this study was to evaluate the relationship between periimplant soft tissue health, the amount of periimplant keratinized mucosa, and the satisfaction of patients who applied to the Ankara University Faculty of Dentistry and had a fixed implant-assisted restoration in the premolar and/or molar region at least 1 year after the functional loading of implant treatment. Methods: 40 implants from 40 patients, of which 24 were female and 16 were male, were included in our study. Periimplant soft tissue health was objectively evaluated with clinical measurements and a radiographic examination. The amount of keratinized mucosa around the implants was measured and recorded. Afterwards, the patients were asked to fill out a (subjective) questionnaire that included socio-demographic data and evaluated their satisfaction with their implants by VAS. Results: All patients in the healthy group had keratinized mucosa. In this study, a mean total VAS score of 8.40 out of 10 indicates that patients are satisfied with implant treatments. However, the relationship between chewing, speech, aesthetics, pain and discomfort, the presence of bleeding scores, and the total VAS score was statistically significant. There was a statistically significant difference between those without keratinized mucosa, those with inadequate keratinized mucosa, and those with present/adequate keratinized mucosa in terms of speech VAS score (p=0.050). Conclusions: In our study, the presence of keratinized mucosa significantly affected VAS scores at the speech level. KEYWORDS Dental implants, oral mucosa, patient satisfaction, periimplant

Keywords

• Dental implants
• oral mucosa
• patient satisfaction
• periimplant

Periimplant Keratinize Mukoza Miktarı İle Hasta Memnuniyeti Arasındaki İlişki

Abstract

Amaç: Bu araştırmanın amacı; Ankara Üniversitesi Diş Hekimliği Fakültesi’ne başvuran, implant tedavisinin fonksiyonel yüklemesi üzerinden en az 1 yıl geçmiş, premolar ve/veya molar bölgede sabit bir implant destekli restorasyonu olan hastaların implant çevresi yumuşak doku sağlığı, keratinize mukoza miktarı ve memnuniyetleri arasındaki ilişkiyi değerlendirmekti. Gereç ve Yöntemler: Çalışmamıza 24'ü kadın, 16'sı erkek olmak üzere 40 hastaya ait 40 implant dahil edildi. Periimplant yumuşak doku sağlığı, klinik ölçümler ve radyografik inceleme ile objektif olarak değerlendirildi. İmplantların etrafındaki keratinize mukoza miktarı ölçüldü ve kaydedildi. Daha sonra hastalardan sosyo-demografik verileri içeren ve implantlarından memnuniyetlerini VAS ile değerlendiren (subjektif) bir anket doldurmaları istendi. Bulgular: Sağlıklı gruptaki tüm hastalarda keratinize mukoza vardı. Bu çalışmada ortalama toplam VAS skorunun 10 üzerinden 8,40 olması hastaların implant tedavilerinden memnun olduğunu göstermektedir. Ancak çiğneme, konuşma, estetik, ağrı ve rahatsızlık, kanama varlığı skorları ve toplam VAS skoru arasındaki ilişki istatistiksel olarak anlamlıydı. Konuşma VAS skoru açısından keratinize mukozası olmayanlar, yetersiz keratinize mukozası olanlar ve keratinize mukozası var/yeterli olanlar arasında istatistiksel olarak anlamlı fark vardı (p=0,050). Sonuçlar: Çalışmamızda keratinize mukoza varlığı konuşma düzeyindeki VAS skorlarını anlamlı olarak etkiledi. ANAHTAR KELİMELER Dental implantlar, oral mukoza, hasta memnuniyeti, implant çevresi

Keywords

• Dental implantlar
• oral mukoza
• hasta memnuniyeti
• implant çevresi

References

1. 1. Carranza FA Jr, Carraro JJ. Mucogingival techniques in periodontal surgery. Journal of Periodontology 1970;41:294–299.
2. 2. Hall, W.B. The current status of mucogingival problems and their therapy. Journal of Periodontology 1981;52:569–575.
3. 3. Matter, J. Free gingival grafts for the treatment of gingival recession: a review of some techniques. Journal of Clinical Periodontology 1982;9:103 –114.
4. 4. Ueno D, Nagano T, Watanabe T, Shirakawa S, Yashima A, Gomi K. Effect of the Keratinized Mucosa Width on the Health Status of Peri-implant and Contralateral Periodontal Tissues: A Crosssectional Study. Implant Dent 2016;25:796-801.
5. 5. Nabers CL. Repositioning the Attached Gingiva. J Periodontol 1954;25(1):38-39.
6. 6. Gottsegen R. Frenum position and vestibule depth in relation to gingival health. Oral Surg Oral Med Oral Pathol; 1954;7(10):1069-1078.
7. 7. Friedman N. Mucogingival Surgery: The Apically Repositioned Flap. J Periodontol; 1962;33(4):328-340.
8. 8. Thoma DS, Benić GI, Zwahlen M, Hämmerle CH, Jung RE. A systematic review assessing soft tissue augmentation techniques. Clin Oral Implants Res 2009;20(Suppl 4):146-65.

9. 9. Lang NP, Löe H. The relationship between the width of keratinized gingiva and gingival health. J Periodontol. 1972;43(10):623-7.
10. 10. Sanz M, Lorenzo R, Aranda JJ, Martin C, Orsini M. Clinical evaluation of a new collagen matrix (Mucograft prototype) to enhance the width of keratinized tissue in patients with fixed prosthetic restorations: a randomized prospective clinical trial. J Clin Periodontol. 2009;36(10):868-76.
11. 11. Wennstrom JL, Bengazi F, Lekholm U. The influence of the masticatory mucosa on the peri-implant soft tissue condition. Clinical Oral Implants Research 1994;5(1):1–8.
12. 12. Berglundh T, J. Lindhe J. Dimension of the peri-implant mucosa, Biological width revisited. Journal of Clinical Periodontology; 1996;23(10): 971–973.
13. 13. Block MS, Gardiner D, Kent JN. Hydroxyapatite-coated cylindrical implants in the posterior mandible: 10-year observations. Int J Oral Maxillofac Implants 1996;11: 626–633.
14. 14. Warrer K, Buser D, Lang NP. Plaque-induced peri- implantitis in the presence or absence of keratinized mucosa, An experimental study in monkeys. Clin Oral Implants Res 1995;6:131–138.
15. 15. Zarb GA, Schmitt A. The longitudinal clinical effectiveness of osseointegrated dental implants: The Toronto study, Part III: problems and complications encountered. J Prosthet Dent 1990;64:185–194.
16. 16. Kim BS, Kim YK, Yun PY, Yi YJ, Lee HJ, Kim SG, et al. Evaluation of peri-implant tissue response according to the presence of keratinized mucosa. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009;107(3):e24-28.
17. 17. Brito C, Tenenbaum CH,Wong BKC, Schmitt C, Nogueira-Filho G. Is keratinized mucosa indispensable to maintain peri-implant health? A systematic review of the literature J Biomed Mater Res B Appl Biomater. 2014;102(3):643-50.
18. 18. Frisch E, Ziebolz D, Vach K, Ratka-Krüger P. The effect of keratinized mucosa width on peri-implant outcome under supportive postimplant therapy. Clin Implant Dent Relat Res. 2015;17 Suppl 1:e236-44.
19. 19. Kaurani P, Kaurani M. Awareness of dental implants as a treatment modality amongst people residing in Jaipur (Rajasthan). J Clin Diagn Res. 2010;4(6):3622-6.
20. 20. Ergun S, Çekici A, Saruhanoğlu A, Kazancıoğlu O, Uzman A, Ak G, Tanyeri H. The satisfaction degree evaluation of the patients treated with dental implants. Ataturk University Faculty of Dentistry 2009;19(3): p. 181-186.
21. 21. Vermylen K, Collaert B, Lindén U, Björn AL, De Bruyn H. Patient satisfaction and quality of single‐tooth restorations: A 7‐year follow‐up pilot study in private dental practices. Clinical oral implants research. 2003 Feb;14(1):119-24.
22. 22. Pjetursson BE, Karoussis I, Bürgin W, Brägger U, Lang NP. Patients' satisfaction following implant therapy: a 10‐year prospective cohort study. Clinical oral implants research. 2005 Apr;16(2):185-93.
23. 23. Arlin ML. The periodontal examination and consultation. The diagnostic components. Oral Health. 1986;76(1):37-42.
24. 24. Dursun E, Lin GH, Taheri S, Chu SJ, Wang HL, Tözüm TF (2018). A comparison of aesthetic features of pre-existing natural tooth vs postimplant restoration in the aesthetic zone: A retrospective 12-month follow-up. Int J Oral Maxillofac Implants 2018;33:919–928.
25. 25. Schwarz F, Becker J, Civale S, Sahin D, Iglhaut T, Iglhaut G. Influence of the width of keratinized tissue on the development and resolution of experimental peri-implant mucositis lesions in humans..Clin Oral Implants Res. 2018;29(6):576-582.
26. 26. Berglundh T, J. Lindhe J. Dimension of the peri-implant mucosa, Biological width revisited. Journal of Clinical Periodontology 1996; 23(10):971–973.
27. 27. Zitzmann NU, Berglundh T, Marinello CP, Lindhe J. Experimental peri‐implant mucositis in man. Journal of clinical periodontology. 2001 Jun;28(6):517-23.
28. 28. Boynueğri D, Nemli SK, Kasko YA. Significance of keratinized mucosa around dental implants: a prospective comparative study. Clinical Oral Implants Research 2013; 24(8):928–933.
29. 29. Zigdon H, Machtei EE. The dimensions of keratinized mucosa around implants affect clinical and immunological parameters. Clin Oral Implants Res 2008;19:387-392.
30. 30. Schrott AR, Jimenez M, Hwang JW. Five-year evaluation of the influence of keratinized mucosa on peri-implant soft- tissue health and stability around implants supporting full-arch mandibular fixed prostheses. Clin Oral Implants Res 2009;20:1170–1177.
31. 31. Chung DM, Oh TJ, Shotwell JL, Misch CE, and Wang HL. Significance of keratinized mucosa in maintenance of dental implants with different surfaces. Journal of Periodontology 2006;77(8):1410–1420.
32. 32. Adibrad M, Shahabuei M, Sahabi M. Significance of the width of keratinized mucosa on the health status of the supporting tissue around implants supporting overdentures. Journal of Oral Implantology 2009;35(5):232–237.
33. 33. Bouri A Jr, Bissada N, Al-Zahrani MS. Width of keratinized gingiva and the health status of the supporting tissues around dental implants. Int J Oral Maxillofacial Implants 2008;23:323–326.
34. 34. Mericske-Stern R, Steinlin Schaffner T, Marti P, Geering A H. Peri-implant mucosal aspects of ITI implants supporting overdentures. A five-year longitudinal study. Clin Oral Implants Res.1994;5(1):9-18.
35. 35. Zigdon H, Machtei EE. The dimensions of keratinized mucosa around implants affect clinical and immunological parameters. Clin Oral Implants Res 2008; 19:387-392.
36. 36. Kazor CE, Al-Shammari K, Sarment DP, Misch CE, Wang HL. Implant plastic surgery:a review and rationale. J Oral Implantol 2004;30:240-54.
37. 37. Palacci P, Nowzari H. Soft tissue enhance ment around dental implants. Periodontol 2000 2008; 47:113-32.
38. 38. Cairo F, Pagliaro U, Nieri M. Soft tissue man agement at implant sites. J Clin Periodontol 2008;35(8 Suppl):163-7.
39. 39. Wennstrom JL, Derks J. Is there a need for keratinized mucosa around implants to maintain health and tissue stability? Clinical Oral Implants Research 2012;23(6):136–146.
40. 40. Lin GH, Chan HL, Wang HL. The Significance of Keratinized Mucosa on Implant Health: A Systematic Review. J Periodontol 2013;84:1755-67.
41. 41. Costa FO, Takenaka-Martinez S, Cota LO, Ferreira SD, Silva GL, Costa JE. Peri-implant disease in subjects with and without preventive maintenance: a 5-year follow-up. J Clin Periodontol 2012; 39:173-181.
42. 42. Crespi R, Cappare P, Gherlone E. A 4-year evaluation of the peri-implant parameters of immediately loaded implants placed in fresh extraction sockets. J Periodontol 2010;81:1629–1634.
43. 43. Pranskunas M, Poskevicius L, Juodzbalys G, Kubilius R, Jimbo R. Influence of Peri-Implant Soft Tissue Condition and Plaque Accumulation on Peri-Implantitis: A Systematic Review. J Oral Maxillofac Res 2016;7:e2.
44. 44. Canakci CF, Canakci V. Pain experienced by patients undergoing different periodontal
45. 45. Allen PF, McMillan AS, Walshaw D, Patient expectations of oral implant-retained prostheses in a UK dental hospital. Br Dent J, 1999;186(2): p. 80-4.
46. 46. Gbadebo OS, Lawal FB, Sulaiman AO, Ajayi DM. Dental implant as an option for tooth replacement: the awareness of patients at a tertiary hospital in a developing country. Contemp Clin Dent. 2014;5(3):302-6.
47. 47. Akagawa Y, Okane H, Kondo N, Tsuga K, Tsuru H. Comparative evaluation of chewing function with removable partial dentures and fixed prostheses supported by the single-crystal sapphire implant in the Kennedy Class II partially edentulous mandible. Int J Oral Maxillofac Implants. 1989;4(3):205-10.
48. 48. Carr AB, Laney WR. Maximum occlusal force levels in patients with osseointegrated oral implant prostheses and patients with complete dentures. Int J Oral Maxillofac Implants.1987;2(2):101-8.
49. 49. Blomberg S, Lindquist LW. Psychological reactions to edentulousness and treatment with jawbone-anchored bridges. Acta Psychiatr Scand. 1983;68(4):251-62.
50. 50. Annibali S, Vestri AR, Pilotto A, La Monaca G, Di Carlo S, Cristalli MP. Patient satisfaction with oral implant rehabilitation: evaluation of responses to a questionnaire. Annali di stomatologia. 2010 Jul;1(3-4):2.
51. 51. Babbush CA. Posttreatment quantification of patient experiences with full-arch implant treatment using a modification of the OHIP 14 questionnaire. J Oral Implantol. 2012;38(3):251-60.
52. 52. Gurgel BC, Pascoal AL, Souza BL, Dantas PM, Montenegro SC, OLIVEIRA AG, Calderon PD. Patient satisfaction concerning implant-supported prostheses: an observational study. Brazilian Oral Research. 2015 Feb 11;29:1-6.
53. 53. Baracat LF, Teixeira AM, dos Santos MB, da Cunha VD, Marchini L. Patients' expectations before and evaluation after dental implant therapy. Clinical implant dentistry and related research. 2011 Jun;13(2):141-5.
54. 54. Al‐Zubeidi MI, Alsabeeha NH, Thomson WM, Payne AG. Patient satisfaction and dissatisfaction with mandibular two‐implant overdentures using different attachment systems: 5‐year outcomes. Clinical implant dentistry and related research. 2012 Oct;14(5):696-707.
55. 55. Balaguer J, García B, Peñarrocha M, Peñarrocha M. Satisfaction of patients fitted with implant-retained overdentures. Med Oral Patol Oral Cir Bucal. 2011 Mar 1;16(2):e204-9.
56. 56. Levine RA, Clem D, Beagle J, Ganeles J, Johnson P, Solnit G, Keller GW. Multicenter retrospective analysis of the solid-screw ITI implant for posterior single-tooth replacements. International Journal of Oral & Maxillofacial Implants. 2002 Jul 1;17(4).
57. 57. Moghadam M, Dias R, Kuyinu E, Ferguson MB, Mucciolo T, Jahangiri L. Predoctoral fixed implant patient satisfaction outcome and challenges of a clinical implant competency. Journal of dental education. 2012 Apr;76(4):437-42.
58. 58. Awad MA, Feine JS. Measuring patient satisfaction with mandibular prostheses. Community Dent Oral Epidemiol, 1998;26(6): p. 400-5.
59. 59. Siadat H, Alikhasi M, Mirfazaelian A, Geramipanah F, Zaery F. Patient satisfaction with implant‐retained mandibular overdentures: a retrospective study. Clinical implant dentistry and related research. 2008 May;10(2):93-8.
60. 60. Meijer HJ, Raghoebar GM, Van't Hof MA, Geertman ME, Van Oort RP. Implant‐retained mandibular overdentures compared with complete dentures; a 5‐years' follow‐up study of clinical aspects and patient satisfaction. Clinical oral implants research. 1999 Jun;10(3):238-44.
61. 61. Cibirka RM, Razzoog M, Lang BR. Critical evaluation of patient responses to dental implant therapy. J Prosthet Dent 1997;78(6): p. 574-81.
62. 62. Boerrigter EM, Stegenga B, Raghoebar GM, Boering G. Patient satisfaction and chewing ability with implant-retained mandibular overdentures: a comparison with new complete dentures with or without preprosthetic surgery. Journal of oral and maxillofacial surgery. 1995 Oct 1;53(10):1167-73.
63. 63. Bakke M, Holm B, Gotfredsen K. Masticatory function and patient satisfaction with implant-supported mandibular overdentures: a prospective 5-year study. Int J Prosthodont 2002; 15(6): p. 575-81.
64. 64. Schram JH, Boerrigter PJ, The TY. Influence of two hormone replacement therapy regiments, oral oestradiol valerate and cyproterone acetate versus transdermal oestradiol and oral dydrogesterone, on lipid metabolism. Maturitas. 1995 Sep 1;22(2):121-30.
65. 65. Wismeijer D, Vermeeren JI, van Waas MA. Patient satisfaction with overdentures supported by one-stage TPS implants. International Journal of Oral & Maxillofacial Implants. 1992 Mar 1;7(1).
66. 66. Chang M, Wennström JL, Andersson B. Esthetic outcome of implant-supported single-tooth replacements assessed by the patient and by prosthodontists. International Journal of Prosthodontics. 1999 Jul 1;12(4).
67. 67. Adler L, Liedholm E, Silvegren M, Modin C, Buhlin K, Jansson L. Patient satisfaction 8–14 years after dental implant therapy–a questionnaire study. Acta Odontologica Scandinavica. 2016 Jul 3;74(5):423-9.