93 Maxillary implant overdentures: peri-implant infections 6.1 INTRODUCTION Patients experiencing problems with their maxillary conventional denture can benefit from implant-supported maxillary overdenture therapy1. Studies show satisfying results on implant survival, with high patient related satisfaction scores and low incidences of prosthetic complications2-7. However, the epidemiology of peri-implant mucositis and peri-implantitis has hardly been reported. Peri-implant mucositis is the mucosal inflammatory lesion surrounding implants, without the loss of supporting peri‐implant bone8. The general prevalence of peri-implant mucositis is estimated to be 43% – 47% at patient level9,10 and 29% at implant level10. Peri-implantitis is the pathological condition occurring in the tissues surrounding dental implants, characterized by inflammation combined with progressive loss of supporting bone11.The general prevalence of peri-implantitis is estimated to be 20 – 22% at patient level 9,10 and 9% at implant level10. Careful interpretation of the prevalence of both unfavorable peri-implant diseases is required since a variety of case definitions is used in literature, causing high heterogeneity across studies9,12. Apart from prevalence (i.e. the chance of having a particular disease), the incidence (i.e., the chance of developing a disease during a specific period), the extent (i.e., the proportion of affected implants in affected patients) and the severity (i.e., the degree of bone loss at affected implants) are needed to fully appreciate the epidemiology of peri-implant diseases9,13. Research on the incidence of peri-implant diseases is limited to a few prospective studies14-18. Peri-implant mucositis incidence is poorly reported in these studies. When derived from bleeding-scores, implant-level incidences vary between 17%-89%. Peri-implantitis incidence ranges between 1-65% at patient level and 1-39% at implant level after a follow-up ranging from 5-13 years. Extent and severity are not reported in literature. Stoker et al.19 studied the incidence of peri-implant diseases in fully edentulous patients. They treated a group of 94 patients with mandibular overdentures and reported a peri-implantitis patient level incidence of 5% after 8.3 years. Using a stricter threshold for peri-implantitis, Meijer et al.20 performed a sub-analysis of two prospective studies on patients with mandibular overdentures. They reported a patient level incidence of 16.7% and 29.7% after 5 and 10 years, respectively. The peri-implant mucositis incidence was 51.9% and 57.0% after 5 and 10 years, respectively. Lopes et al.21 described peri-implantitis in a small group of fully edentulous patients with fixed prostheses in both jaws and reported a patient level incidence of 8.7% after 5 years. Regarding the maxilla, Slot et al.6,7 described four groups with implant overdentures and reported a peri-implantitis incidence of between 4.5 and 17.2% and a peri-implant mucositis incidence of between 27.3 and 45.5%, at patient level after 5 years. Long-term results are, however, currently lacking. Therefore, the purpose of this study was to assess the incidence, extent and severity of peri-implantitis and peri-implant mucositis in fully edentulous patients with implant-retained maxillary overdentures, by performing a sub-analysis on the data of two prospective studies trials with a 10-year follow-up. 6
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