Implant prosthetic rehabilitation in controlled HIV-positive patients: A proscpective longitudinal study with one-year follow-up

Aim. This prospective longitudinal clinical trial aim ed to evaluate survival of implantprosthetic rehabilitation in controlled HIV-positive patients. Methods. This mono-centric study (IRCCS San Raffaele Hospital in Milan, Italy) included Hiv-patients with a stable disease, requiring implant rehabilitation (total or partial), with good oral hygiene. Each patient received at least one dental implant. After 90 days in the upper jaw and 60 days in the lower jaw, the appropriate prosthesis was delivered. One year follow-up after implant insertion was considered. Survival criteria for implant are presence of implant stability, absence of radiolucent zone around the implants, no mucosal suppuration, and no pain. (Buser e Albrektsson). Primary outcome measures were prosthetic failures, implant failures, peri-implant marginal bone level changes (MBLC) and biological and prosthetic complications (perimplantitis, pus, pain, paresthesia in the lower jaw, implant fracture). Data were recorded immediately after the insertion of the fixture (T0), and 6 (T1) and 12 months (T2) after. Results. Implants were positioned in 68 patients (22 females and 46 males) (194 implants). Two drop outs occurred for exacerbation of the disease before the six month of follow-up, and 66 patients (with 190 implants) completed the study. Forty-eight patients (70.6%) received total removable dentures (among them 30 subjects received the upper dental arch, and 18 patients received the lower dental arch); 11 patients (16.2%) received partial prosthesis and 9 patients (13.2%) received single elements rehabilitations. Implant failure occurred in 9 patients (15 fixtures out of 190). They were early implant failures due to primary infection (5 fixtures out of 190: 2.6%) and to perimplantitis (10 fixtures out of 190: 5.2%). Prosthetic failure was registered in 2 patients (3% of patients) due to the loss of all the fixtures. Pus and pain were observed in 4/7 and 3/7 patients with perimplantitis, respectively. In three patients with serious perimplantitis, pus and pain were observed together. No fractures of fixtures or paresthesia were registered. At T2, in 66 patient with 190 fixtures, the mean perimplant MBLC was -1.19±0.87 mm. Conclusion. Within its limitations, the study showed that in a well-controlled population of HIV patients who maintained proper oral hygiene and accepted to follow a proper professional maintenance protocol, implant rehabilitation can be a suitable options with results. slightly worse to those obtained in normal population. An higher incidence of peri-implant infections in the first six months, probably linked to immunological conditions, was present pointing to the need of a proper protocol for infection control.