DISCUSSION

An analysis of risk indicators for changes in crestal bone level, as a measure of bone loss (MBL), surrounding dental implants has been reported in this study. Furthermore, the impact of the choice of thresholds in determining prevalence of mucositis and peri‐implantitis has been considered. Importantly, this private practice report includes conventional patients and sites as well as at risk patients and at risk sites, therefore, unlike controlled studies with stringent selection criteria, it may better reflect the expected outcomes in daily clinical practice.

The following patient related risk indicators were found to be significant with regard to MBL: autoimmune disease, smoking and bisphosphonate use. Patients taking steroids for other chronic conditions were pooled, at the patient level, with patients having active autoimmune disease. The presence of steroid use or autoimmune disease had no impact on early bone scores but then showed increasing MBL over time (Figure 1A). The effect on MBL may result from the impaired bone healing owing to the osteopenic effect of steroids or the immune suppression in a manner similar to that seen on the rate of periodontal disease in patients with rheumatoid arthritis. Furthermore, this may lead to the occurrence of sporadic infection events, which may have an outlier effect on average MBL; however, conclusions drawn were limited by the small sample of patients in this category.

Regarding smoking, the results confirmed that heavy smoking can have a significant effect on MBL (Figure 1B). However, this result may be limited by the low prevalence of heavy smokers, at less than 2%, which is low by international standards, but is the expected rate for a high socioeconomic status (SES) cohort in Canada.

As previously published in this cohort and in other studies, bisphosphonate therapy for osteoporosis, did not impact survival. However it did pose as a significant risk for MBL over time (Figure 1C).