This study is carried out to assess the soft and hard tissue conditions around dental implant cases at the Faculty of Dentistry Universiti Teknologi MARA (UiTM). Methods: Patients with dental implants of more than 6 months in function were recalled for clinical and radiographic evaluation. Probing pocket depth, suppuration, bleeding, recession and plaque index were clinically evaluated. Periapical radiograph (IOPA) were also taken. The data from the findings were statistically evaluated using SPSS program. Result: 14.3% of implants placed in consider healthy, 4.8% implants have clinical stability and 81% have peri-implant mucositis and none of the participants have peri-implantitis and severe peri-implantitis. Conclusion: Within the limitation of this study, it’s concluded that the status of peri-implant tissues is mainly affected by gender, systemic disease, smoking status,oral hygiene and years of implants functioning in oral condition. In addition, age plays a significant role that contribute to periimplant health

Hasirin, Rosharina Azian

Hidayat, Mohd Faizal Hafez

Kamar Affendi, Nur Hafizah

Wan Mohd Noor, Wan Anis Sufiah

English

Universiti Teknologi MARA Institutional Repository

Volume 1 | 2019   PROCEEDING BOOK OF
 9TH DENTAL STUDENTS’ SCIENTIFIC SYMPOSIUM 
 
6 
Evaluation of Peri-Implant Soft and Hard Tissues Around 
Dental Implants Placed at the Faculty of Dentistry, UiTM. 
 
Mohd Faizal Hafez Hidayat1, Nur Hafizah Kamar Affendi1, Rosharina Azian Hasirin1 and Wan Anis Sufiah Wan Mohd 
Noor1 
1Faculty of Dentistry, Universiti Teknologi MARA, Sungai Buloh Campus, 47000 Sungai Buloh, Selangor, Malaysia  
Background: This study is carried out to assess the soft and hard tissue conditions around dental implant 
cases at the Faculty of Dentistry Universiti Teknologi MARA (UiTM). Methods: Patients with dental 
implants of more than 6 months in function were recalled for clinical and radiographic evaluation. 
Probing pocket depth, suppuration, bleeding, recession and plaque index were clinically evaluated. 
Periapical radiograph (IOPA) were also taken. The data from the findings were statistically evaluated 
using SPSS program. Result: 14.3% of implants placed in consider healthy, 4.8% implants have clinical 
stability and 81% have peri-implant mucositis and none of the participants have peri-implantitis and 
severe peri-implantitis. Conclusion: Within the limitation of this study, it’s concluded that the status of 
peri-implant tissues is mainly affected by gender, systemic disease, smoking status,oral hygiene and years 
of implants functioning in oral condition. In addition, age plays a significant role that contribute to 
periimplant health.  
 
1. Introduction 
The application of dental implant as part of 
prosthetic mouth rehabilitations has proven to be 
satisfactory restoration to fulfill patient’s function and 
aesthetics, as well as its long-term survival(1). 
Nevertheless, even in successful osseointegration, 
dental implants can loss supportive bone that mainly 
due to local inflammation during the course of 
periimplant disease that can include two different 
entities: peri-implant mucositis and periimplantitis. (2) 
The prevalence of peri-implant diseases has not yet 
been presented with absolute values due to insufficient 
number of studies (3). The absence of this information 
may be attributed to the lack of standardization of the 
scientific methodology; as well as, to the different 
definitions for peri-implant diseases (3-5). Peri-implant 
mucositis is clinically described as the inflammation of 
the peri-implant mucosa without bone loss; being the 
most important clinical diagnosis the presence of 
bleeding on probing (BOP) (7). Peri-implantitis is 
associated with clinical characteristics of mucositis in 
combination with radiographic presence of bone loss 
(8,9). The numbers of implants placed in Malaysia is 
increasing, however studies done to evaluate the post 
treatment of periodontal tissue condition is lacking (6). 
Dental implants once placed, needs to be maintained in 
order avoid failures and complications.  Maintenance is 
a decisive factor for obtaining success when implant is 
first inserted into the alveolar bone (10). It is therefore 
important to ensure that the periodontal tissues are 
healthy with no sign of inflammation, which can lead 
to peri-mucositis and peri-implantitis that contribute to 
the main goal of conducting this study (11). 
 
 
2. Materials and method 
Sample size was calculated using to be 29 participants 
in reference to the paper by Matarazzo 2018 (20). 
Ethical approval was obtained from the Ethical 
Committee of Universiti Teknologi MARA (UiTM) 
Shah Alam. Twenty-eight patients record that have 
implants placed in function for more than 6 months 
was obtained from Department of Implantology, 
Faculty of Dentistry, However, 11 out of 28 patients 
responded and have agreed to participate in the 
research. The procedures of the research were clearly 
explained to the patient and consent was taken to 
record the demographic details and clinical findings. 
Inter and intra examiner calibration was done by one 
supervisor and two researchers for the reliability of soft 
tissue evaluation. The clinical parameters assess 
include the probing pocket depth (PD), presence or 
absence of suppuration (SUP), presence or absence of 
bleeding upon probing (BOP), recession (R) and 
plaque index (PI) (5). Meanwhile, hard tissue was 
evaluated by observing the marginal bone level (MBL) 
with intraoral periapical radiograph (IOPA). Based on 
the clinical findings of the soft and hard tissues, each of 
the implants were categorized according to the 
description mentioned by Matarazzo et al 2018: 
 
1.Peri-implant health: Absence of BoP/SUP, and MBL 
less than 2mm 
 
2.Clinical Stability: Absence of BoP/SUP, and MBL 
more than 2mm 
 
3.Peri-implant mucositis: Presence of BoP/SUP, and 
MBL less than 2mm 
 
Volume 1 | 2019   PROCEEDING BOOK OF
 9TH DENTAL STUDENTS’ SCIENTIFIC SYMPOSIUM 
 
7 
4. Peri-implantitis: Presence of BoP/SUP, and MBL 
more than 2mm 
 
5. Severe Peri-implantitis: Presence of BoP/SUP, and 
MBL more than 3mm 
Implants was further categorized into further 
classification include location in the maxilla or 
mandible, single, multiple, screw and cemented type of 
restoration. The result were analysed using the 
Statistical Program for Social Science (SPSS) version 
25 using the Pearson chi-square was used to test the 
association between peri-implant diseases with 
independent variables such as age, smoking status and 
oral hygiene.  
3. Results 
Eleven out of 28 participants contacted have agreed to 
participate in the research. The genders are nearly 
equal with 5 males and 6 females participants varied 
from 32 to 60 years old. There are 3 participants who 
are smokers, 5 are non-smokers and 3 were ex-smokers. 
The medical status of the participants were recorded 
with 47.6% are fit and healthy, 42.9% have 
hypercholesterolemia, 9.5% have hypertension and 
none of the patients were diagnosed with diabetes. 
From 11 participants, a total of 21 implants have been 
evaluated because each individual participants may 
have several numbers of implants placed in the mouth 
from 1 to 4 implants with 45.5 % of the participant 
having only 1 implant, 36.4% have 2 implants, 9.1 % 
have 3 implants and lastly 9.1% have 4 implants placed. 
All of the implants evaluated are located at the 
posterior region, in which 65% from mandible and 
35% from maxilla. From what we have observed, most 
of the patients have 70% screwed abutment and 30% 
are cemented. In this study, 60% of the dental implants 
are single retained abutments and 40% are multiple 
retained abutment implants. The periodontal status of 
dental implants evaluated were 14.3% were considered 
healthy, 4.8% of having clinical stability and the 
majority of the implants were with peri-implant 
mucositis (81.0%). 
4. Discussion 
Peri-implant mucositis is a common peri-implant 
disease occurred in implant patients in this study 
sample. There are many risk factors that are associated 
with peri-implant mucositis such as oral hygiene, 
smoking status, medical condition and gender 
(17).  Oral hygiene is a very important factor that can 
affect various condition inside the oral cavity including 
the tissue condition surrounding the dental implant (17). 
Just like teeth, biofilm can accumulate at the surface of 
the implant. However, due to the rough surface of the 
implants, it is more favorable for the biofilm to 
accumulate compared to the surface of teeth. Hence, it 
is imperative for patients with dental implants to have 
exceptional oral hygiene by brushing specifically 
around dental implants to prevent the formation of oral 
biofilm. In our study, there is an association between 
plaque score and peri-implant health. Therefore, patient 
is advice for maintenance of oral hygiene by home care 
cleaning and regular follow up. Smoking is a common 
worldwide negative social behavior (19). It is known 
that smoking is a risk factor for various medical 
diseases and dental implants are no exception (18). 
According to Haas R et. al,1996 and Schwartz-Arad D 
et. al,2002, smoking has a strong influence on the 
complication rates of dental implants. Smokers with 
dental implants are more likely to have significant 
marginal bone loss after implant placement compare to 
non-smokers, it increases the incidence of peri-
implantitis, deep mucosal pockets around dental 
implants, inflammation of the peri-implant mucosa, 
and increased resorption of peri-implant bone (13,14). 
In a study by Levin et al.,2008 current smokers 
demonstrated higher marginal bone loss during all time 
intervals than ex-smokers, but both demonstrated 
higher marginal bone loss than nonsmokers (15). 
Finally, Rinke et al. (2011) has conducted a 
retrospective cross‐sectional study in which smoking is 
regarded as a risk indicator for peri‐implant mucositis 
(16). However, in our study, there is no association 
between smoking and peri-implantitis mainly due to 
limited number of data collection. As for gender, 
Ferreira et al. (2006) demonstrated that the male gender 
could be considered as a risk indicator for peri‐
mucositis both in the single and the multiple regression 
analysis. (17). Thus, in our research there is an 
association between gender and peri-implant health. 
Age also have strong association that contribute to 
implant health due to longer healing time, more 
systemic health problem and poorer bone condition 
(20). 
The objective of this study was not fulfilled, as there 
were important shortcomings that we have not 
anticipated and lessons learned. Clinical studies require 
participation of subjects to be interested in the 
participation of the study. Eligible participants were 
mostly not interested to be recalled for the examination 
of their dental implants, as they perceived that their 
implants have no problems. This is a common problem 
with early peri-implant disease as the signs and 
symptoms do not involve pain and urgent care. Usually 
patient would seek help once there is pain and their 
dental implant is starting to get loose. Therefore, it is 
important to reinforce and educate patients regarding 
the importance of maintenance program even after 
implants was deemed to be successful by patients. 
5. Reference 
1. Berglundh T, Persson L, Klinge B. A systematic 
review of the incidence of biological and technical 
complications in implant dentistry reported in 
prospective longitudinal studies of at least 5 years. 
Journal of clinical periodontology. 2002;29:197-212. 
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8 
2. Claffey N, Clarke E, Polyzois I, Renvert S. Surgical 
treatment of peri‐implantitis. Journal of clinical 
periodontology. 2008;35:316-32. 
3. Zitzmann NU, Berglundh T. Definition and 
prevalence of peri‐implant diseases. Journal of clinical 
periodontology. 2008;35:286-91. 
4.Koldsland OC, Scheie AA, Aass AM (2010) 
Prevalence of peri-implantitis related to severity of the 
disease with different degrees of bone loss. J 
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5..Mir-Mari J, Mir-Orfila P, Figueiredo R, Valmaseda-
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implant diseases. A cross-sectional study based on a 
private practice environment. J ClinPeriodontol 39: 
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6.Goh V, Goo CL, Leung WK. Prevention of peri-
implantitis should start at treatment planning. 
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recording gingivitis and plaque. Int Dent J 25: 229-235. 
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session IV. Quintessence, England. 
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Evaluation of peri-implant soft and hard tissues around dental implants placed at the Faculty of Dentistry, UiTM / Mohd Faizal Hafez Hidayat … [et al.]

http://ir.uitm.edu.my/id/eprint/30149/1/K_MOHD%20FAIZAL%20HAFEZ%20HIDAYAT%20DSSS%20B%2019.pdf

Evaluation of peri-implant soft and hard tissues around dental implants placed at the Faculty of Dentistry, UiTM / Mohd Faizal Hafez Hidayat … [et al.]

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