O one year follow-up of implant prosthetic rehabilitation in controlled hiv-positive patients: The role of CD4 level, smoking habits and oral hygiene

Aim. The purpose of this study was therefore to investigate the associations between variables related to the survival of implant-prosthesis treatment (implant failures, prosthetic failures, biological complication, marginal bone level change - MBLC -) and systemic CD4+ level, smoking habits, and oral hygiene. In recent data about implantprosthetic rehabilitation in well controlled HIV patients, it appears that – although a proper oral hygiene and a professional maintenance protocol – these patients show slight worse result than an healthy population; implant failure occurred in 7.9% of fixtures (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%). A possible explanation is their systemic disease (whose state is indicated by the CD4+ level), although other factors as cigarette smoking and oral hygiene can affect implant infections. Methods. This one-year follow-up mono-centric study (IRCCS San Raffaele Hospital in Milan, Italy) included 66 well controlled Hiv-patients (22 females and 44 males), treated with implant rehabilitation, with good oral hygiene. Each patient received at least one dental implant (totally 190 fixtures) and an appropriate prosthesis after 90 days in the upper jaw and 60 days in the lower jaw. Results. There was no significant difference between patients with CD4+ ≤749.5 and patients with CD4+ >749.5, in any of the outcome variables. Patients who smoked > 10 cigarettes/day suffered a statistically significant greater number of implant failures respect to no/light smokers (p<0.005); had a statistically significant greater number of perimplantitis (p<0.001), greater frequency distribution of pus (p<0.007), greater frequency distribution of reported pain (p<0.009) respect to no/ light smokers. Conclusion. The number of implant failures, prosthetic failures, the MBLC, and number and type of complications (perimplantitis, pus, pain, paraesthesia) were evaluated on the base of the level of CD4+ in the blood, and the smoking habits and correlated with the level of periodontal health (PI, BI, and PPD). Implant failures, prosthetic failures, complications, or MBLC were not significantly associated to the level of CD4+ in the blood. But HIV-positive heavy smokers (>10 cigarettes/day) demonstrate an increased risk of early implant failure, of peri implantitis and self reported pain. The number of implant failures, prosthetic failures, perimplantitis, episodes of pus and pain did not correlate with bleeding or oral higiene or probing (BE, PI or PPD).