Jennifer Ringeling* Puria Parvini* Christoph Weinbach* Georg-Hubertus Nentwig Katrin Nickles Peter Eickholz
Authors’ affiliations: Jennifer Ringeling, Private Practice, Kassel, Germany Puria Parvini, Christoph Weinbach, GeorgHubertus Nentwig, Department of Oral Surgery and Implantology, Center for Dentistry and Oral Medicine (Carolinum), Johann Wolfgang GoetheUniversity Frankfurt, Frankfurt am Main, Germany Katrin Nickles, Peter Eickholz, Department of Periodontology, Center for Dentistry and Oral Medicine (Carolinum), Johann Wolfgang GoetheUniversity Frankfurt, Frankfurt am Main, Germany Corresponding author: Prof. Dr. med. dent. Peter Eickholz Poliklinik f€ ur Parodontologie Zentrum der Zahn- Mund- und Kieferheilkunde (Carolinum) Johann Wolfgang Goethe-Universit€at Frankfurt Theodor-Stern-Kai 7 (Haus 29), 60596 Frankfurt am Main Germany Tel.: +49 69 6301 5642 Fax: +49 69 6301 3753 e-mail: [email protected]
Discomfort/pain due to pocket probing at teeth and endosseous implants: a cross-sectional study
Key words: dental implants, discomfort/pain, peri-implant probing, periodontal probing,
visual analogue scale Abstract Aim: Patients seem to feel more discomfort/pain after peri-implant probing than after periodontal probing. However, there is not one single study to address this clinical observation. Thus, this study was designed to compare discomfort/pain after peri-implant and periodontal probing. Methods: Each of three dentists recruited and examined 20 patients each contributing one pair of one dental implant and a contralateral natural tooth. Periodontal and peri-implant probing depths (PPD) and probing attachment level (PAL) were assessed. Whether the implant or the tooth was measured first was randomly assigned. Immediately after probing, the patients scored discomfort/ pain using a visual analogue scale (VAS). Results: A total of 60 patients (median; lower/upper quartile: age 62.5; 47.5/69.0 years; 35 females, five smokers) were examined. With the exception of PPD at the deepest site (implants: 4.0; 3.0/ 5.5 mm; teeth: 3.0; 3.0/4.0 mm; P = 0.032), clinical parameters (PPD, PAL, bleeding on probing, suppuration) were well balanced between implants and teeth. Peri-implant probing (VAS: 16.4; 8.7/ 28.2) caused significantly (P = 0.011) more discomfort/pain than periodontal probing (9.1; 4.6/18.2). Repeated-measures analysis identified peri-implant probing causing more discomfort than periodontal probing related to the examiner (P = 0.046). Conclusions: On average, peri-implant probing caused significantly more discomfort/pain than periodontal probing.
*These authors equally contributed to this work. Date: Accepted 13 June 2015 To cite this article: Ringeling J, Parvini P, Weinbach C, Nentwig G-H, Nickles K, Eickholz P. Discomfort/pain due to pocket probing at teeth and endosseous implants: a cross-sectional study. Clin. Oral Impl. Res. 00, 2015, 1–5. doi: 10.1111/clr.12669
Periodontal and peri-implant infections have aetiologic and anatomical similarities. Thus, the assessment of peri-implant probing parameters belongs to the routine examinations to assess peri-implant health or disease (Lang et al. 2000; Rinke et al. 2011). A decisive clinical variable is bleeding on probing (BOP) that is common to peri-implant mucositis and peri-implantitis (Heitz-Mayfield 2008; Lindhe & Meyle 2008). Increased probing pocket depths (PPD) are a main sign of implant failure (Salcetti et al. 1997). Thus, peri-implant probing with metal or plastic probes is an indispensable part of periimplant diagnosis. The assessment of periimplant PPD is less reproducible than measurements at teeth (Mombelli et al. 1997; Eickholz et al. 2001). Comparable to measurements at teeth, a force of 0.25 N is most appropriate for peri-implant probing (Mombelli et al. 1997). Further, peri-implant probing is harmless for peri-implant tissues as
© 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
periodontal probing is harmless for periodontal tissues (Etter et al. 2002;). By peri-implant probing, different parameters may be measured: PPD, probing attachment level (PAL) between pocket base and implant shoulder (Salcetti et al. 1997) and additional to BOP exudation or suppuration. PPD > 5 mm is a sign for peri-implantitis (Lang et al. 2000). BOP is also a sign of inflammation, and suppuration is a sign of disease activity (Thierbach & Eger 2013). However, patients seem to feel more discomfort/pain after peri-implant probing than after periodontal probing. This may be due to the discrepancies between periodontal and peri-implant tissues or may be due to on average higher levels of inflammation around implants than around teeth. The higher the degree of periodontal inflammation the more discomfort/pain is elicited by periodontal probing (Heft et al. 1991). However, there is not one single study to assess the clinical
1
Ringeling et al Discomfort/pain due to pocket probing
observation of more discomfort/pain after peri-implant than after periodontal probing. Thus, this study was designed to compare discomfort after peri-implant and periodontal probing.
Material and methods Patients
All patients attending the Dept. of Oral Surgery and Implantology, Center for Dentistry and Oral Medicine (Carolinum), Johann Wolfgang Goethe-University Frankfurt or the private practice Dres. Claar & Kollegen, Kassel for periodontal or peri-implant examinations were asked to participate in this cross-sectional split-mouth study if they fulfilled the following inclusion criteria. Patients were included from 16 October 2013 until 26 February 2014. The study complied with the rules of the Declaration of Helsinki and was approved by the Institutional Review Board for Human Studies of the Medical Faculty of the GoetheUniversity Frankfurt/Main (Application# 307/13). All participating individuals were informed on risks and benefits as well as on the procedures of the study and gave written informed consent. Inclusion criteria: At least 18 years of age One dental implant and 1 contralateral tooth. Contralateral means located in the same jaw (maxilla/mandible) and the same region (anteriors/premolars/molars). In cases where more than one pair of implant and contralateral tooth were found, the more anterior pair was included. Written informed consent.
• •
• •
Exclusion criteria: Requirement of systemic antibiotics for measures that may cause transitory bacteraemia (e.g. pocket probing).
All patients were asked after current and former smoking status, diabetes mellitus, and degree of education (secondary modern school [9–10 years of school], college [Abitur: 12–13 years of school], university). Patients who reported smoking or had quit smoking for
Authors’ affiliations: Jennifer Ringeling, Private Practice, Kassel, Germany Puria Parvini, Christoph Weinbach, GeorgHubertus Nentwig, Department of Oral Surgery and Implantology, Center for Dentistry and Oral Medicine (Carolinum), Johann Wolfgang GoetheUniversity Frankfurt, Frankfurt am Main, Germany Katrin Nickles, Peter Eickholz, Department of Periodontology, Center for Dentistry and Oral Medicine (Carolinum), Johann Wolfgang GoetheUniversity Frankfurt, Frankfurt am Main, Germany Corresponding author: Prof. Dr. med. dent. Peter Eickholz Poliklinik f€ ur Parodontologie Zentrum der Zahn- Mund- und Kieferheilkunde (Carolinum) Johann Wolfgang Goethe-Universit€at Frankfurt Theodor-Stern-Kai 7 (Haus 29), 60596 Frankfurt am Main Germany Tel.: +49 69 6301 5642 Fax: +49 69 6301 3753 e-mail: [email protected]
Discomfort/pain due to pocket probing at teeth and endosseous implants: a cross-sectional study
Key words: dental implants, discomfort/pain, peri-implant probing, periodontal probing,
visual analogue scale Abstract Aim: Patients seem to feel more discomfort/pain after peri-implant probing than after periodontal probing. However, there is not one single study to address this clinical observation. Thus, this study was designed to compare discomfort/pain after peri-implant and periodontal probing. Methods: Each of three dentists recruited and examined 20 patients each contributing one pair of one dental implant and a contralateral natural tooth. Periodontal and peri-implant probing depths (PPD) and probing attachment level (PAL) were assessed. Whether the implant or the tooth was measured first was randomly assigned. Immediately after probing, the patients scored discomfort/ pain using a visual analogue scale (VAS). Results: A total of 60 patients (median; lower/upper quartile: age 62.5; 47.5/69.0 years; 35 females, five smokers) were examined. With the exception of PPD at the deepest site (implants: 4.0; 3.0/ 5.5 mm; teeth: 3.0; 3.0/4.0 mm; P = 0.032), clinical parameters (PPD, PAL, bleeding on probing, suppuration) were well balanced between implants and teeth. Peri-implant probing (VAS: 16.4; 8.7/ 28.2) caused significantly (P = 0.011) more discomfort/pain than periodontal probing (9.1; 4.6/18.2). Repeated-measures analysis identified peri-implant probing causing more discomfort than periodontal probing related to the examiner (P = 0.046). Conclusions: On average, peri-implant probing caused significantly more discomfort/pain than periodontal probing.
*These authors equally contributed to this work. Date: Accepted 13 June 2015 To cite this article: Ringeling J, Parvini P, Weinbach C, Nentwig G-H, Nickles K, Eickholz P. Discomfort/pain due to pocket probing at teeth and endosseous implants: a cross-sectional study. Clin. Oral Impl. Res. 00, 2015, 1–5. doi: 10.1111/clr.12669
Periodontal and peri-implant infections have aetiologic and anatomical similarities. Thus, the assessment of peri-implant probing parameters belongs to the routine examinations to assess peri-implant health or disease (Lang et al. 2000; Rinke et al. 2011). A decisive clinical variable is bleeding on probing (BOP) that is common to peri-implant mucositis and peri-implantitis (Heitz-Mayfield 2008; Lindhe & Meyle 2008). Increased probing pocket depths (PPD) are a main sign of implant failure (Salcetti et al. 1997). Thus, peri-implant probing with metal or plastic probes is an indispensable part of periimplant diagnosis. The assessment of periimplant PPD is less reproducible than measurements at teeth (Mombelli et al. 1997; Eickholz et al. 2001). Comparable to measurements at teeth, a force of 0.25 N is most appropriate for peri-implant probing (Mombelli et al. 1997). Further, peri-implant probing is harmless for peri-implant tissues as
© 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
periodontal probing is harmless for periodontal tissues (Etter et al. 2002;). By peri-implant probing, different parameters may be measured: PPD, probing attachment level (PAL) between pocket base and implant shoulder (Salcetti et al. 1997) and additional to BOP exudation or suppuration. PPD > 5 mm is a sign for peri-implantitis (Lang et al. 2000). BOP is also a sign of inflammation, and suppuration is a sign of disease activity (Thierbach & Eger 2013). However, patients seem to feel more discomfort/pain after peri-implant probing than after periodontal probing. This may be due to the discrepancies between periodontal and peri-implant tissues or may be due to on average higher levels of inflammation around implants than around teeth. The higher the degree of periodontal inflammation the more discomfort/pain is elicited by periodontal probing (Heft et al. 1991). However, there is not one single study to assess the clinical
1
Ringeling et al Discomfort/pain due to pocket probing
observation of more discomfort/pain after peri-implant than after periodontal probing. Thus, this study was designed to compare discomfort after peri-implant and periodontal probing.
Material and methods Patients
All patients attending the Dept. of Oral Surgery and Implantology, Center for Dentistry and Oral Medicine (Carolinum), Johann Wolfgang Goethe-University Frankfurt or the private practice Dres. Claar & Kollegen, Kassel for periodontal or peri-implant examinations were asked to participate in this cross-sectional split-mouth study if they fulfilled the following inclusion criteria. Patients were included from 16 October 2013 until 26 February 2014. The study complied with the rules of the Declaration of Helsinki and was approved by the Institutional Review Board for Human Studies of the Medical Faculty of the GoetheUniversity Frankfurt/Main (Application# 307/13). All participating individuals were informed on risks and benefits as well as on the procedures of the study and gave written informed consent. Inclusion criteria: At least 18 years of age One dental implant and 1 contralateral tooth. Contralateral means located in the same jaw (maxilla/mandible) and the same region (anteriors/premolars/molars). In cases where more than one pair of implant and contralateral tooth were found, the more anterior pair was included. Written informed consent.
• •
• •
Exclusion criteria: Requirement of systemic antibiotics for measures that may cause transitory bacteraemia (e.g. pocket probing).
All patients were asked after current and former smoking status, diabetes mellitus, and degree of education (secondary modern school [9–10 years of school], college [Abitur: 12–13 years of school], university). Patients who reported smoking or had quit smoking for
