136 Appendices mucositis was 37.7% after five years and 64.6% after ten years whereas the patient level incidence of peri-implantitis was 10.4% after five years and 19.5% after ten years. After ten years, the extent of peri-implant mucositis and peri-implantitis is 52.8% and 43.8% respectively. In terms of severity, 26.5% of all affected implants suffered from > 3mm bone loss and 17.6% of all affected implants was lost. It was concluded that three out of five fully edentulous patients with implant-supported maxillary overdentures experience peri-implant mucositis after ten years. Peri-implantitis occurs in one out of five patients after ten years. Despite these incidence rates, implant survival remains high. Peri-implantitis can eventually lead to implant loss and is an example of late implant failure. The aim of chapter 7 was to assess implant retreatment in a group of patients whose maxillary implants were all failing after full arch rehabilitation. Treatment involved implant removal, augmentation and placement of an overdenture supported by four to six implants. Seventy implants in fifteen patients were evaluated at 3.3±2.5 years (range 1.1-8.6 years) after loading. Overall implant survival was 95.7%. Three implants were lost within the first year of function. Marginal bone level change was -0.32±0.46 mm, mean probing depth was 4.55±1.59 mm. Plaque, calculus, inflammation, and bleeding were hardly seen (median 0). Patients scored their satisfaction with their overdentures as high (mean overall score 8.7±1.2, max. 10). It can be concluded that replacement of multiple failing implants in an edentulous maxilla after bone augmentation is a safe and predictable treatment procedure when applied as an implant supported overdenture. The main research outcomes are discussed in chapter 8. In general, it can be concluded that a maxillary overdenture retained by four implants with a bar-clip attachment remains the gold standard. Alternative treatment modalities, such as a maxillary overdenture retained by four implants with solitary attachments or retained by two implants and a bar-clip attachment or solitary attachments, resulted in a higher implant loss compared to the gold standard. Based on the present thesis and current research, the following model might be a clinical guideline to approach implant overdenture therapy for edentulous patients experiencing problems with their maxillary conventional denture.
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