Comparative biology of chronic and aggressive periodontitis vs. peri-implantitis

Microbiologic results after non-surgical erbium-doped:yttrium, aluminum, and garnet laser or air-abrasive treatment of peri-implantitis: a randomized clinical trial

BACKGROUND

The purpose of this study is to assess clinical and microbiologic effects of the non-surgical treatment of peri-implantitis lesions using either an erbium-doped:yttrium, aluminum, and garnet (Er:YAG) laser or an air-abrasive subgingival polishing method.

METHODS

In a 6-month clinical trial, 42 patients with peri-implantitis were treated at one time with an Er:YAG laser or an air-abrasive device. Routine clinical methods were used to monitor clinical conditions. Baseline and 6-month intraoral radiographs were assessed with a software program. The checkerboard DNA-DNA hybridization method was used to assess 74 bacterial species from the site with the deepest probing depth (PD) at the implant. Non-parametric tests were applied to microbiology data.

RESULTS

PD reductions (mean ± SD) were 0.9 ± 0.8 mm and 0.8 ± 0.5 mm in the laser and air-abrasive groups, respectively (not significant). No baseline differences in bacterial counts between groups were found. In the air-abrasive group, Pseudomonas aeruginosa, Staphylococcus aureus, and Staphylococcus anaerobius were found at lower counts at 1 month after therapy (P <0.001) and with lower counts in the laser group for Fusobacterium nucleatum naviforme (P = 0.002), and Fusobacterium nucleatum nucleatum (P = 0.002). Both treatments failed to reduce bacterial counts at 6 months. Porphyromonas gingivalis counts were higher in cases with progressive peri-implantitis (P <0.001).

CONCLUSIONS

At 1 month, P. aeruginosa, S. aureus, and S. anaerobius were reduced in the air-abrasive group, and Fusobacterium spp. were reduced in the laser group. Six-month data demonstrated that both methods failed to reduce bacterial counts. Clinical improvements were limited.

Prevalence and microbiological diversity of Archaea in peri-implantitis subjects by 16S ribosomal RNA clonal analysis

BACKGROUND AND OBJECTIVE

This study evaluated the prevalence and the molecular diversity of Archaea in the subgingival biofilm samples of subjects with peri-implantitis.

MATERIAL AND METHODS

Fifty subjects were assigned into two groups: Control (n = 25), consisting of subjects with healthy implants; and Test (n = 25), consisting of subjects with peri-implantitis sites, as well as a healthy implant. In the Test group, subgingival biofilm samples were taken from the deepest sites of the diseased implant. In both groups, subgingival biofilm was collected from one site with a healthy implant and from one site with a periodontally healthy tooth. DNA was extracted and the 16S ribosomal RNA gene was amplified with universal primer pairs for Archaea. Amplified genes were cloned and sequenced, and the phylotypes were identified by comparison with known 16S ribosomal RNA sequences.

RESULTS

In the Control group, Archaea were detected in two and three sites of the implant and the tooth, respectively. In the Test group, Archaea were detected in 12, 4 and 2 sites of diseased implants, healthy implants and teeth, respectively. Diseased implants presented a significantly higher prevalence of Archaea in comparison with healthy implants and natural teeth, irrespective of group. Over 90% of the clone libraries were formed by Methanobrevibacter oralis, which was detected in both groups. Methanobacterium congelense/curvum was detected in four subjects from the Test group and in two subjects from the Control group.

CONCLUSION

Although M. oralis was the main species of Archaea associated with both healthy and diseased implant sites, the data indicated an increased prevalence of Archaea in peri-implantitis sites, and their role in pathogenesis should be further investigated.

Microbial diversity of peri-implant biofilms on implant fixed bar and telescopic double crown attachments

One of the principal problems in oral implantation is inflammation of peri-implant hard and soft tissues caused by bacterial biofilms. The purpose of the present study was to evaluate the microbial diversity of peri-implant biofilms on 2 different implant-anchored attachment types in vivo. Samples of peri-implant sulcus fluid were collected from 8 patients with implant-supported bar attachments and 8 patients with implant-anchored telescopic double crown attachments. Samples of sulcus fluid of the adjacent teeth were also collected from the partially edentulous patients with implant fixed telescopic double crowns. The mixed amplicons of 16S rRNA fragments of different bacterial origins were separated by use of single-strand conformation polymorphism analysis to identify the predominant bacterial genera. With 3.5 ± 2.1 different predominant bacterial genera in the sulcus fluid surrounding implant-supported bar attachments and 6.3 ± 3.1 different predominant genera in the sulcular fluid of implant-anchored double crown attachments, the differences were not statistically significant (P = .11). The microbial diversity in the sulcus fluid surrounding the remaining dentition was similar to that of the implant fixed telescopic attachments (6.3 ± 2.1). Aside from host response and other individual factors, the microbial diversity of peri-implant biofilms seems to be impaired by cofactors such as the possibility of cleaning the implant-supported supraconstructions and the different plaque-retaining sites. Nevertheless, these differences do not lead to statistically significant differences in the microbial diversity of peri-implant plaques.

A 2-year prospective study on immediate loading with fluoride-modified implants in the edentulous mandible

OBJECTIVES

Chemically modified surfaces were introduced during the last decade to improve indications for implant treatment. The fluoride-modified implant (Osseospeed(®)) was launched in 2004 and clinical studies suggest a more rapid bone formation and stronger bone to implant contact. However, limited clinical data are available on marginal bone loss and the outcome after >1 year under immediate loading conditions is not fully understood. Hence, the purpose of this prospective study was to present implant survival and marginal bone level data when fluoride-modified implants are supporting a fully functional rehabilitation from the day after surgery in the completely edentulous mandible.

MATERIALS AND METHODS

Twenty-five patients, completely edentulous in the mandible, were consecutively treated with five fluoride-modified implants that were functionally loaded with a provisional screw retained restoration. Marginal bone loss was measured from day of surgery to 3, 6, 12 and 24 months. Implants were considered successful after 24 months if radiographic bone loss did not exceed 1 mm and no pain or mobility was caused under a torque of 20 N cm. Statistical analysis was carried out on both patient and implant levels.

RESULTS

All implants survived and mean bone loss on implant level after 3, 6, 12 and 24 months was 0.14, 0.13, 0.11 and 0.11 mm, respectively. Bone loss was only statistically significant between baseline and 3 months (P<0.001) and remained unchanged afterward. None of the implants lost >1 mm of bone after 2 years. On the patient level, the mean bone loss after 2 years was 0.12 mm (SD 0.14; range -0.06 to 0.55) with probing pocket depth 2.45 mm (SD 0.43; range 1.3-3.1) and bleeding index 0.55% (SD 0.34; range 0-1).

CONCLUSION

Immediate loading of fluoride-modified implants is a predictable treatment yielding a high survival and success rate after 2 years.