TRANSLATED VERSION+ORIGINAL; AN INTERESTING ARTICLE BY LIN: Has the Predictability of “Osseointegration” Eclipsed That of Advanced Periodontal Treatment?
Has the Predictability of “Osseointegration” Eclipsed That of Advanced Periodontal Treatment?
“オッセオインテグレーション”の予知性は進行した歯周治療の予知性をしのぐのか？
Author: Li-Deh
Lin, DDS, PhD
The International Journal of Prosthodontics 2009;22:524-525.
Translation:
Satoshi Kato, DDS
最近の系統的レビュー（文献総覧）によれば、口腔インプラントはその10年後の評価として、歯周疾患が成功裏に治療された歯の寿命（生存率 longevity）をしのいでいない。1,2 一方、インプラントは予後に疑問や長期使用に耐えられないであろう歯の代わりとして使用されるが、ほとんどの研究において、インプラント治療の予後は、もともと伝統的治療法でよい予後が期待できる歯牙と比較されてきた。1 同じ考慮が天然歯の寿命とインプラントの予後の比較を邪魔する混乱を招いてきた。疫学的、日常の患者からのデータに由来する天然歯の寿命よりインプラントの寿命が長いのかどうかということは考慮されなかったnot of interest 。治療決定遂行過程decision-making processにおいて、臨床家は,インプラントによる交換を意図する疑問な歯牙、またはインプラント治療が問題の多い歯の支台を使う傾向のある伝統的治療法より、予知性が高いのかに焦点を当てるべきである。
Predictability
of Advanced Periodontal Therapies
進行歯周治療の予知性
最新のレビューによって、歯周支持が減少しているが健康である支台歯と歯周的に健全な支台歯との好意的favorable（都合のよい？）結果が示唆されている。3 このレビューにおいて、わずか6編の論文によるものであり、加えて歯周補綴治療はスウェーデンの2つの大学の専門のクリニックで供給されたものであることに言及することは重要である。このような包括的治療が高度に動機付けされた高いレベルのプラークコントロールを積極的好意的に維持可能である患者たちへ供給されたということもまた重要である。長期固定式歯科補綴について、平均14年間の合計失敗率は26.4%,そして20年時の成功率52.8%が報告されたが、この結論は一般化できないかもしれない。3
高度に協力的患者でさえも、ある歯牙が将来に疑問を残すものとして診断されたとき、歯牙の歯周治療への反応を予測するのに臨床的媒介因子clinical parametersは無力ineffectiveであった。4 歯牙喪失因子を予測するときの臨床的媒介因子clinical parameters使用時（ポケットの深さや根分岐部病変）の*感度sensitivityは0.60、そして特異度specificityは0.90であった（Table 1）。ポケットの深さや根分岐部病変に基づいて予後に疑問が残るとみなされた歯の30%が15年の最小メインテナンス期間（治療期間のmedian：20年）で喪失した。さらに、歯周治療に貧弱に反応した患者600人のうちの17％に、疑問の残る歯の65%から88%の喪失が観られた。これらの結果は、伝統的歯周治療に対する歯周的に妥協的な歯の反応に、予知性があるとはいえない、さらに患者の17%に戦略的抜歯を伴う早期の積極的介入が必要であろうことを示唆している。 しかしこのような患者におけるインプラント治療にどれほどの予知性があるのだろうか？
*感度sensitivity：感度、感応性、敏感性（ある病気Ｄをある検査Ｔを使って診断する場合、[ＴによってＤであるとされた患者数]/[真にＤである患者数]を感度、[Ｔが陰性であり、Ｄでないされた患者数]/[真にＤでない患者数]を特異度specificityと呼ぶ）
病気の検査を例にとると，
sensitivity（敏感度）・・・病気を発見する能力で，a/(a+c)
specificity（特異度）・・・非病人を病気だと誤診しない能力で，d/(b+d)
検査a
疾病
|
|||
あり
|
なし
|
||
陽性
|
ｂ
|
||
陰性
|
ｃ
|
ｄ
|
Prognosis
of Implants in Replacing Periodontally Involved Teeth with Questionable
Prognosis
予後に疑問の残る歯周疾患罹患歯と交換したインプラントの予後
破壊的歯周病を持つ患者持たない患者のインプラント喪失の中長期的データを比較した研究において、インプラント生存率survival ratesは90%を以上であり、両者とも大変似通っていた。5 もし生存率ではなく成功率success ratesが比較され、プロービングデプスや年間骨喪失annual
bone lossが成功基準success criteriaに追加された場合、慢性歯周疾患の既往を持つ患者における、10年後のインプラント成功率はより低かった（71.4%）。
予後に疑問の残る歯周疾患に罹患した歯とインプラントの予後を比較したらどうなるのであろうか？ インプラントと天然歯との間のランダム化比較臨床試験（RCTs：Randomized Controlled Clinical Trials）と比較可能な長期研究はない。しかしながら、上述のごとく、歯周疾患罹患歯と交換したインプラントの10年生存率は90%から92%であり、歯周的問題を抱え予後に疑問の残る歯の平均22年のメインテナンス期間での生存率は70%であった。4,5 長期追跡調査follow-upにおいて予後に疑問を残す歯の65%から88%が失われる伝統的歯周治療に抵抗する患者群におけるインプラント治療の予後に関するさらなる研究が必要である。
ほとんどの研究が生存/寿命の成果survival/longevity
outcomeの比較をレビューされている。これからの研究は、二つの治療法の比較において生理的/全身的physiological/physicalそして行動学的/心理社会学的behavioral/psychosocial成果の評価が必要であろう。
Conclusion 結論
オッセオインテグレーションの予知性はよい予後を伴う進行した歯周治療を受けた歯の予知性をしのいでいないであろう、しかし、特にある特異的グループの患者群において予後に疑問の残る歯とインプラントを比較した場合、好ましい初期の結果が観察される。
歯が以下に一つかそれ以上該当した場合、予後の疑問があると考えられる。
References
1.
Holm-Pederson
P, Lang NP, Muller F. What are the longevities of teeth and oral implants? Clin
Oral Implants Res 2007;18(suppl 3):15-19.
2.
Tomasi
C, Wennström JL, Berglundh T. Longevity of teeth and implants - a systematic
review. J Oral Rehabil. 2008;35 (Suppl 1):23-32.
3.
Lulic
M, Brägger U, Lang NP, Zwahlen M, Salvi GE. Ante's (1926) law revisited: a
systematic review on survival rates and complications of fixed dental
prostheses (FDPs) on severely reduced periodontal tissue support. Clin Oral
Implants Res 2007;18 Suppl3:63-72.
4.
Hirsfeld
L, Wasserman B. A long –term survey of tooth loss in 600 treated periodontal
patients. J Periodontol 1978;49:225-237.
5.
Karoussis
IK, Kotsovilis S, Fourmousis I. A comprehensive and critical review of dental
implant prognosis in periodontally compromised partially edentulouspatients.
Clin Oral Implants Res 2007;18:669-679.
Prognosis of Implants in Replacing Periodontally Involved Teeth with Questionable Prognoses
In studies comparing the mid- or long-term data of the implants lost in patients with and without destructive periodontal disease, the data suggested that the sur- vival rates of the implants were well above 90% and very similar in both groups.5 If the success rates instead of survival rates were compared and probing depth and annual bone loss were added to the success criteria, then the implant success rate after 10 years was lower in patients with a history of chronic periodontitis (71.4%).
What if we compare the prognosis of the implants to the periodontally involved teeth with questionable prognoses? Randomized controlled clinical trials and comparable long-term studies between implants and natural teeth are not available. However, as mentioned above, the survival rates of implants replacing the pe- riodontally involved teeth were 90% to 92% after 10 years, and that of the periodontally treated teeth re- garded as having a questionable prognosis was 70% after an average maintaining period of 22 years.4,5
References
1. Holm-Pedersen P, Lang NP, Müller F. What are the longevities of teeth and oral implants? Clin Oral Implants Res 2007;18(suppl 3):15–19.
2. Tomasi C, Wennström JL, Berglundh T. Longevity of teeth and im- plants—A systematic review. J Oral Rehabil 2008;35(suppl 1):23–32.
3. Lulic M, Brägger U, Lang NP, Zwahlen M, Salvi GE. Ante’s (1926) law revisited: A systematic review on survival rates and compli- cations of fixed dental prostheses (FDPs) on severely reduced periodontal tissue support. Clin Oral Implants Res 2007;18(suppl
3):63–72.
4. Hirshfeld L, Wasserman B. A long-term survey of tooth loss in 600
treated periodontal patients. J Periodontol 1978:49:225–237.
5. Karoussis IK, Kotsovilis S, Fourmousis I. A comprehensive and crtitical review of dental implant prognosis in periodontally compromised partially edentulous patients. Clin Oral Implants Res 2007;18:669–679.
Has the Predictability of
“Osseointegration” Eclipsed
That of Advanced Periodontal
Treatment?
Li-Deh Lin, DDS, PhD
Associate Professor, School of Dentistry National Taiwan University, Taipei, Taiwan Fax: 886-2-23831346
Email: lidehlin@ntu.edu.tw
Recent systematic reviews suggest that oral implants, when evaluated after 10 years of service, do not sur- pass the longevity of periodontally compromised yet successfully treated natural teeth.1,2 While implants are used to replace teeth with questionable or poor long-term prognoses, in most studies reviewed, the prognosis of implant therapy has been compared to teeth that may have originally had a favorable or fair prognosis with traditional therapies.1 Similar concerns can be applied to the confusion stemming from com- parisons of the longevity of natural teeth and implants. Whether implants have a longer life span than that of natural teeth derived from data of epidemiologic stud- ies or routine dental patients is not of interest.2 During the decision-making process, clinicians should focus on whether implants will survive better than the ques- tionable teeth they are meant to replace, or whether implant therapies will have a more predictable prog- nosis than the traditional treatment modalities that tend to use these compromised natural-teeth abut- ments.
Predictability of Advanced Periodontal Therapies
A recent review suggested that tooth abutments with severely reduced but healthy periodontal support com- pare favorably with periodontally intact abutments.3 It is worthwhile to mention that in this review, only six pa- pers were included and all periodontal and prosthetic treatments were provided in the specialist clinics of two Swedish universities. It is also important that such a comprehensive treatment was provided only to highly motivated patients, willing and capable of maintaining a high standard of plaque control. This conclusion may not be generalized since after an average of 14 years the total failure rate was 26.4%, and a survival rate of 52.8% at year 20 was reported for long-span fixed dental prostheses.3
Even with highly compliant patients, clinical para- meters were ineffective in predicting the response of a tooth to periodontal therapies when a tooth was diag- nosed as having a questionable prognosis.4 The sensi- tivity of using clinical parameters (such as pocket depth or furcation involvement) as predicting factors of tooth loss was 0.60 and specificity was 0.90 (Table 1). Thirty percent of teeth regarded as having a question-able prognosis based on pocket depth or furcation involvement were lost after a minimum maintaining period of 15 years (median treatment time: 20 years). Furthermore, 65% to 88% of questionable teeth were lost in 17% of the 600 patients who responded poorly to the peri-odontal therapies. These data suggest that the response of periodontally compromised teeth to traditional peri-odontal therapies may not be predictable initially and early active intervention with strategic extraction may be indicated for 17% of patients. But how predictable is the implant therapy in these patients?
Li-Deh Lin, DDS, PhD
Associate Professor, School of Dentistry National Taiwan University, Taipei, Taiwan Fax: 886-2-23831346
Email: lidehlin@ntu.edu.tw
Recent systematic reviews suggest that oral implants, when evaluated after 10 years of service, do not sur- pass the longevity of periodontally compromised yet successfully treated natural teeth.1,2 While implants are used to replace teeth with questionable or poor long-term prognoses, in most studies reviewed, the prognosis of implant therapy has been compared to teeth that may have originally had a favorable or fair prognosis with traditional therapies.1 Similar concerns can be applied to the confusion stemming from com- parisons of the longevity of natural teeth and implants. Whether implants have a longer life span than that of natural teeth derived from data of epidemiologic stud- ies or routine dental patients is not of interest.2 During the decision-making process, clinicians should focus on whether implants will survive better than the ques- tionable teeth they are meant to replace, or whether implant therapies will have a more predictable prog- nosis than the traditional treatment modalities that tend to use these compromised natural-teeth abut- ments.
Predictability of Advanced Periodontal Therapies
A recent review suggested that tooth abutments with severely reduced but healthy periodontal support com- pare favorably with periodontally intact abutments.3 It is worthwhile to mention that in this review, only six pa- pers were included and all periodontal and prosthetic treatments were provided in the specialist clinics of two Swedish universities. It is also important that such a comprehensive treatment was provided only to highly motivated patients, willing and capable of maintaining a high standard of plaque control. This conclusion may not be generalized since after an average of 14 years the total failure rate was 26.4%, and a survival rate of 52.8% at year 20 was reported for long-span fixed dental prostheses.3
Even with highly compliant patients, clinical para- meters were ineffective in predicting the response of a tooth to periodontal therapies when a tooth was diag- nosed as having a questionable prognosis.4 The sensi- tivity of using clinical parameters (such as pocket depth or furcation involvement) as predicting factors of tooth loss was 0.60 and specificity was 0.90 (Table 1). Thirty percent of teeth regarded as having a question-able prognosis based on pocket depth or furcation involvement were lost after a minimum maintaining period of 15 years (median treatment time: 20 years). Furthermore, 65% to 88% of questionable teeth were lost in 17% of the 600 patients who responded poorly to the peri-odontal therapies. These data suggest that the response of periodontally compromised teeth to traditional peri-odontal therapies may not be predictable initially and early active intervention with strategic extraction may be indicated for 17% of patients. But how predictable is the implant therapy in these patients?
Prognosis of Implants in Replacing Periodontally Involved Teeth with Questionable Prognoses
In studies comparing the mid- or long-term data of the implants lost in patients with and without destructive periodontal disease, the data suggested that the sur- vival rates of the implants were well above 90% and very similar in both groups.5 If the success rates instead of survival rates were compared and probing depth and annual bone loss were added to the success criteria, then the implant success rate after 10 years was lower in patients with a history of chronic periodontitis (71.4%).
What if we compare the prognosis of the implants to the periodontally involved teeth with questionable prognoses? Randomized controlled clinical trials and comparable long-term studies between implants and natural teeth are not available. However, as mentioned above, the survival rates of implants replacing the pe- riodontally involved teeth were 90% to 92% after 10 years, and that of the periodontally treated teeth re- garded as having a questionable prognosis was 70% after an average maintaining period of 22 years.4,5
Further studies are needed to investigate the prognosis for implants in patients refractory to the traditional
periodontal therapies who lost 65% to 88% of questionable teeth in long-term follow up.
Most studies reviewed compared the
survival/longevity outcome. Further studies are needed
to evaluate the physiologic/physical and behav-
ioral/psychosocial outcomes in comparing the two
treatment modalities.
Conclusion
The predictability of osseointegration may not eclipse that of the advanced periodontal treatment in teeth with favorable prognoses, but favorable initial results were observed if implants were compared to teeth with questionable prognoses, especially in a specific group of patients.
Conclusion
The predictability of osseointegration may not eclipse that of the advanced periodontal treatment in teeth with favorable prognoses, but favorable initial results were observed if implants were compared to teeth with questionable prognoses, especially in a specific group of patients.
References
1. Holm-Pedersen P, Lang NP, Müller F. What are the longevities of teeth and oral implants? Clin Oral Implants Res 2007;18(suppl 3):15–19.
2. Tomasi C, Wennström JL, Berglundh T. Longevity of teeth and im- plants—A systematic review. J Oral Rehabil 2008;35(suppl 1):23–32.
3. Lulic M, Brägger U, Lang NP, Zwahlen M, Salvi GE. Ante’s (1926) law revisited: A systematic review on survival rates and compli- cations of fixed dental prostheses (FDPs) on severely reduced periodontal tissue support. Clin Oral Implants Res 2007;18(suppl
3):63–72.
4. Hirshfeld L, Wasserman B. A long-term survey of tooth loss in 600
treated periodontal patients. J Periodontol 1978:49:225–237.
5. Karoussis IK, Kotsovilis S, Fourmousis I. A comprehensive and crtitical review of dental implant prognosis in periodontally compromised partially edentulous patients. Clin Oral Implants Res 2007;18:669–679.
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