***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE Our purpose was to measure the agreement , reliability , construct validity , and feasibility of a measurement tool to assess  systematic review s ( AMSTAR ) . STUDY DESIGN AND SETTING We r and omly selected 30 systematic review s from a data base . Each was assessed by two review ers using : ( 1 ) the enhanced quality assessment question naire ( Overview of Quality Assessment Question naire [ OQAQ ] ) ; ( 2 ) Sacks ' instrument ; and ( 3 ) our newly developed measurement tool ( AMSTAR ) . We report on reliability ( interobserver kappas of the 11 AMSTAR items ) , intraclass correlation coefficients ( ICCs ) of the sum scores , construct validity ( ICCs of the sum scores of AMSTAR compared with those of other instruments ) , and completion times . RESULTS The interrater agreement of the individual items of AMSTAR was substantial with a mean kappa of 0.70 ( 95 % confidence interval [ CI ] : 0.57 , 0.83 ) ( range : 0.38 - 1.0 ) . Kappas recorded for the other instruments were 0.63 ( 95 % CI : 0.38 , 0.78 ) for enhanced OQAQ and 0.40 ( 95 % CI : 0.29 , 0.50 ) for the Sacks ' instrument . The ICC of the total score for AMSTAR was 0.84 ( 95 % CI : 0.65 , 0.92 ) compared with 0.91 ( 95 % CI : 0.82 , 0.96 ) for OQAQ and 0.86 ( 95 % CI : 0.71 , 0.94 ) for the Sacks ' instrument . AMSTAR proved easy to apply , each review taking about 15 minutes to complete . CONCLUSIONS AMSTAR has good agreement , reliability , construct validity , and feasibility . These findings need confirmation by a broader range of assessors and a more diverse range of review BACKGROUND The aim of this prospect i ve study is to evaluate the prevalence of mucositis , peri-implantitis , implant success , and survival in partially edentulous patients treated for generalized aggressive periodontitis ( GAgP ) and in periodontally healthy individuals . METHODS Thirty-five patients treated for GAgP and 18 periodontally healthy patients orally rehabilitated with osseointegrated implants participated in the study . They were first examined 2 to 4 weeks before extraction of the non-retainable teeth ( baseline ) and 3 weeks after insertion of the final abutments . Additional examinations were performed during a 3-month recall schedule over a 5- to 16-year period ( mean , 8.25 years ) . At every session , clinical parameters were recorded . At 1 , 3 , 5 , 10 , and 15 years after insertion of the superstructure , a microbiological and radiographic examination was performed . RESULTS The results show implant survival rates of 100 % in periodontally healthy individuals versus 96 % in GAgP patients . The implant success rate was 33 % in GAgP patients and 50 % in periodontally healthy individuals . In GAgP patients , mucositis was present in 56 % and peri-implantitis in 26 % of the implants . In periodontally healthy individuals , 40 % of the implants showed mucositis and 10 % peri-implantitis . GAgP patients had a five times greater risk of implant failure , a three times greater risk of mucositis , and a 14 times greater risk of peri-implantitis . CONCLUSION These results suggest that patients with treated GAgP are more susceptible to mucositis and peri-implantitis , with lower implant survival and success rates OBJECTIVE To monitor clinical , microbiological and host-derived alterations occurring around teeth and titanium implants during the development of experimental gingivitis/mucositis and their respective healing sequence in humans . MATERIAL AND METHODS Fifteen subjects with healthy or treated periodontal conditions and restored with dental implants underwent an experimental 3-week period of undisturbed plaque accumulation in the m and ible . Subsequently , a 3-week period with optimal plaque control was instituted . At Days 0 , 7 , 14 , 21 , 28 , 35 and 42 , the presence/absence of plaque deposits around teeth and implants was assessed , ( plaque index [ PlI ] ) and the gingival/mucosal conditions were evaluated ( gingival index[GI ] ) . Subgingival/submucosal plaque sample s and gingival/mucosal crevicular fluid ( CF ) sample s were collected from two pre-determined sites around each experimental unit . CF sample s were analyzed for matrix-metalloproteinase-8 ( MMP-8 ) and interleukin-1beta ( IL-1β ) . Microbial sample s were analyzed using DNA-DNA hybridization for 40 species . RESULTS During 3 weeks of plaque accumulation , the median PlI and GI increased significantly at implants and teeth . Implant sites yielded a greater increase in the median GI compared with tooth sites . Over the 6-week experimental period , the CF levels of MMP-8 were statistically significantly higher at implants compared with teeth ( P<0.05 ) . The CF IL-1β levels did not differ statistically significantly between teeth and implants ( P>0.05 ) . No differences in the total DNA counts between implant and tooth sites were found at any time points . No differences in the detection frequency were found for putative periodontal pathogens between implant and tooth sites . CONCLUSION Peri-implant soft tissues developed a stronger inflammatory response to experimental plaque accumulation when compared with that of their gingival counterparts . Experimental gingivitis and peri-implant mucositis were reversible at the biomarker level . Clinical ly , however , 3 weeks of resumed plaque control did not yield pre-experimental levels of gingival and peri-implant mucosal health indicating that longer healing periods are needed Dental implants have become an often used alternative to replace missing teeth , result ing in an increasing percentage of the adult population with implant supported prosthesis . Although favourable long-term results of implant therapy have been reported , infections occur . Until recently few reports included data on peri-implant infections , possibly underestimating this complication of implant treatment . It is possible that some infections around implants develop slowly and that with time peri-implantitis will be a common complication to implant therapy as an increasing number of patients have had their implants for a long time ( > 10 years ) . Data on treatment of peri-implant lesions are scarce leaving the clinician with limited guidance regarding choice of treatment . The aim of this thesis was to study the frequency of implant loss and presence of peri-implant lesions in a group of patients supplied with Brånemark implants 9 - 14 years ago , and to relate these events to patient and site specific characteristics . Moreover three surgical treatment modalities for peri-implantitis were evaluated . The thesis is based on six studies ; Studies I-III included 218 patients and 1057 implants followed for 9 - 14 years evaluating prevalence of , and factors related to implant loss  ( Paper I ) and prevalence of peri-implant infections  and related factors ( Paper I-III ) . Study IV is a review describing different treatment modalities of peri-implant infections . Study V is a prospect i ve cohort study involving 36 patients and 65 implants  , evaluating the use of a bone substitute with or without the use of a resorbable membrane . Study VI is a case series with 12 patients and 16 implants  , evaluating a bone substitute in combination with a resorbable membrane and submerged healing . This thesis demonstrated that : After 9 - 14 years the survival rates of dental implants are high ( 95.7 % ) . Implant loss seems to cluster within patients and are related to periodontitis evidence d as bone loss on radiographs at remaining teeth before implant placement . ( Paper I ) Peri-implantitis is a common clinical entity after 9 - 14 years . ( Paper II ) Using the implant as the statistical unit the level of keratinized mucosa and pus were explanatory for a bone level at > or =3 threads ( 1.8 mm ) . When the patient was used as a statistical unit a history of periodontitis and smoking were explanatory for peri-implantitis . ( Paper III ) Animal research has demonstrated that re-osseointegration can occur . The majority of human studies were found to be case reports . Using submerged healing and bone transplants , bone fill can occur in peri-implant defects . ( Paper IV ) Surgical treatment of peri-implantitis using a bone substitute with or without a resorbable membrane result ed in similar pocket depth reduction , attachment gain and defect fill . ( Paper V ) Bone substitute in combination with a resorbable membrane and a submerged healing result ed in defect fill > or = 2 threads ( 1.2 mm ) in 81 % of the implants . ( Paper VI ) In conclusion : 9 - 14 years after implant installation peri-implant lesions are a common clinical entity . Smokers and patients with a history of periodontal disease are at higher risk to develop peri-implantitis . Clinical improvements and defect fill can be obtained with various surgical techniques using a bone substitute AIM To determine the incidence of peri-implantitis in individuals with mucositis in a 5-year follow-up study . MATERIAL AND METHODS A sample of 212 partially edentulous individuals , rehabilitated with dental implants , underwent periodontal and peri-implant clinical examinations in 2005 ( baseline ) . Five years later , 80 individuals who had been diagnosed with mucositis in the baseline examination were re-examined . These individuals were divided into two groups : one group with preventive maintenance during the study period ( GTP ; n = 39 ) , and another group without preventive maintenance ( GNTP ; n = 41 ) . The following parameters were clinical ly evaluated : plaque index , bleeding on periodontal and peri-implant probing , periodontal and peri-implant probing depth , suppuration and peri-implant bone loss . The influence of biological and behavioural risk variables associated with the occurrence of peri-implantitis was analysed using univariate and multivariate logistic regression analyses . RESULTS The incidence of peri-implantitis in the global sample was 31.2 % ( GNTP = 43.9 % and GTP = 18.0 % ) . CONCLUSION The absence of preventive maintenance in individuals with pre-existing peri-implant mucositis was associated with a high incidence of peri-implantitis . Clinical parameters , such as bleeding on peri-implant probing , periodontal probing depth and the presence of periodontitis were associated with a higher risk of developing peri-implantitis AIM The aim of the present study was to analyze tissue reactions to plaque formation following ligature removal at commercially available implants exposed to experimental peri-implantitis . MATERIAL AND METHODS Six Labrador dogs about 1 year old were used . All m and ibular premolars and the three anterior premolars in both sides of the maxilla were extracted . After 3 months four implants representing four different implant systems with different surface characteristics -- implant group A ( turned ) , B ( TiOblast ) , C ( s and blasted acid-etched ; SLA ) and D (TiUnite)--were placed in a r and omized order in the right side of the m and ible . Three months after implant installation experimental peri-implantitis was initiated by placement of ligatures in a submarginal position and plaque accumulation . At week 12 , when about 40 - 50 % of the supporting bone was lost , the ligatures were removed . During the subsequent 24-week period plaque accumulation continued . Radiographic and clinical examinations were performed during the ' active breakdown ' period ( plaque accumulation and ligatures ) and the plaque accumulation period after ligature removal . The experiment was terminated at week 36 . RESULTS The bone loss that took place during the ' active breakdown ' period varied between 3.5 and 4.6 mm . The additional bone loss that occurred during the plaque accumulation period after ligature removal was 1.84 ( A ) , 1.72 ( B ) , 1.55 ( C ) and 2.78 mm ( D ) . CONCLUSION Spontaneous progression of experimentally induced peri-implantitis occurred at implants with different geometry and surface characteristics . Progression was most pronounced at implants of type D ( TiUnite surface ) A clinical trial was performed to study the result of periodontal treatment following different modes of periodontal surgery in patients not recalled for maintenance care . The material consisted of 25 patients distributed into 5 groups . Following an initial examination , all patients underwent presurgical treatment including case presentation and instruction in oral hygiene measures . This instruction was given once . The various patient groups were then subjected to one of the following surgical procedures : 1 ) the apically repositioned flap operation including elimination of bony defects 2 ) the apically repositioned flap operation including curettage of bony defects but without removal of bone 3 ) the " Widman flap " technique including elimination of bony defects 4 ) the " Widman flap " technique including curettage of bony defects but without removal of bone 5 ) gingivectomy including curettage of bony defects but without removal of bone . Six , 12 and 24 months after completion of the treatment , the patients were recalled for assessment of their oral hygiene st and ard and periodontal conditions . The results showed that case presentation and oral hygiene instruction given once , only temporarily improved the patient 's oral hygiene habits . Renewed accumulation of plaque in the operated areas result ed in recurrence of periodontal disease including a significant further loss of attachment . All five different techniques for surgical pocket elimination were equally ineffective in preventing recurrence of destructive periodontitis A 
    Output:
    
Similarly , significant effects of history of periodontal disease were obtained for peri-implantitis for both implant and patient levels .
Furthermore , mean PIMT interval was demonstrated to influence the incidence of peri-implantitis at implant but not patient level .
PIMT interval showed significance at both levels .
Within the limitations of the present systematic review , it can be concluded that implant therapy must not be limited to the placement and restoration of dental implants but to the implementation of PIMT to potentially prevent biologic complications and hence to heighten the long-term success rate .