The use of autologous bone for augmentation procedures leads to low prevalence of peri-implantitis-a retrospective study over a 20-year period

Peri-Implant Health and Perfusion Parameters in Patients After Microvascular Jaw Reconstruction: A Clinical Cohort Study

INTRODUCTION

The aim of this study was to evaluate perfusion parameters and clinical features of healthy implants and implants affected by peri-implant disease in patients who had undergone microvascular jaw reconstruction.

METHODS

A total of 25 patients with 92 implants placed in microvascular transplants were included. Of these, 68 implants showed healthy peri-implant tissue, 12 were affected by peri-implant mucositis, and 12 were diagnosed with peri-implantitis. Peri-implant perfusion was measured mesially and distally at the implant shoulder using laser Doppler flowmetry and tissue spectrophotometry (LDF-TS), followed by a clinical evaluation, including measurement of probing depths, bleeding on probing (BOP), plaque index, biotype, type of implant, the restoration and the presence of keratinized tissue. Perfusion parameters were compared between the healthy implants and the implants with peri-implant disease based on the conventional BOP-based diagnosis of peri-implantitis, and the associations between the perfusion values and clinical measurements were analyzed. Optimal cut-off values for predicting peri-implantitis were calculated with receiver operating characteristics.

RESULTS

The mean relative amount of hemoglobin and mean blood flow were significantly different between healthy implants and implants with peri-implant mucositis and peri-implantitis (p = 0.003 and p = 0.002, respectively). However, there are interindividual differences that appear to influence blood flow values as well. When a linear mixed regression model was applied, including the patient as a random variable, the difference in blood flow was no longer statistically significant (p = 0.400). Still, the optimal cut-off value of mean blood flow for predicting peri-implantitis was determined to be > 46.5 AU (AUC = 0.788; p < 0.001; CI = 0.695-0.881; sensitivity = 1.00, specificity = 0.60).

CONCLUSION

Implants in microvascular flaps are particularly vulnerable to peri-implant disease. Risk factors are the lack of keratinized peri-implant tissue, fixed restorations, bone-level implants, and high plaque levels. As a noninvasive and objective method, LDF-TS can contribute to risk assessment by evaluating perfusion parameters and help detect the early onset of peri-implant disease.

3D-printed bredigite scaffolds with ordered arrangement structures promote bone regeneration by inducing macrophage polarization in onlay grafts

Bone tissue engineering scaffolds may provide a potential strategy for onlay bone grafts for oral implants. For determining the fate of scaffold biomaterials and osteogenesis effects, the host immune response is crucial. In the present study, bredigite (BRT) bioceramic scaffolds with an ordered arrangement structure (BRT-O) and a random morphology (BRT-R) were fabricated. The physicochemical properties of scaffolds were first characterized by scanning electron microscopy, mechanical test and micro-Fourier transform infrared spectroscopy. In addition, their osteogenic and immunomodulatory properties in an onlay grafting model were investigated. In vitro, the BRT-O scaffolds facilitated the macrophage polarization towards a pro-regenerative M2 phenotype, which subsequently facilitated the migration and osteogenic differentiation of bone marrow-derived mesenchymal stem cells. In vivo, an onlay grafting model was successfully established in the cranium of rabbits. In addition, the BRT-O scaffolds grafted on rabbit cranium promoted bone regeneration and CD68 + CD206 + M2 macrophage polarization. In conclusion, the 3D-printed BRT-O scaffold presents as a promising scaffold biomaterial for onlay grafts by regulating the local immune microenvironment.

Oral health-related quality of life (OHRQoL) and implant therapy: A prospective multicenter study of preoperative, intermediate, and posttreatment assessment

The purpose of this multicenter continuation study was to use high patient numbers in order to generate reliable statements regarding the association between different implant indications and OHRQoL. Patients with various types of indication for dental implants, ranging from single tooth loss to edentulous jaws, were included. Quality of life relating to dental implants was assessed through the oral health impact profile (OHIP-G-21), which has a summary score from 0 to 20 in healthy patients. In total, 16 253 patients from 29 centers (European Centers for Dental Implantology (ECDI)) were involved in the study between 2009 and 2021.8251 patients (50.7%) completed the questionnaire after implant insertion, and 4996 patients (30.7%) after prosthodontic treatment. The average age was 54 years (range 18-88 years). Posterior single-tooth gap (28.5%) and free-end gap (27.8%) were the most frequent indications. The preoperative OHIP-G-21 score for all patients was 32.81 (SD 11.92), while the score during the healing period was 30.00 (SD 10.72), and after completion of treatment 27.24 (SD 9.26) (p < 0.001). The most significant improvements in OHIP-G-21 scores were in the indication of edentulous jaw (phase 1, 41.81 (SD 15.53); phase 2, 35.39 (SD 14.22); phase 3, 29.60 (SD 10.12) (p < 0.001). The study revealed significant improvements in the most frequently reported problems (chewing, serious concerns, appearance) (p < 0.001). Insertion of dental implants and prosthodontic rehabilitation led to an improved OHRQoL for patients with all indications for dental implants. Special attention should be paid to patients with edentulous jaw, since in comparison with other indications it had the greatest impact on improving OHRQoL. The psychological dissatisfaction scale of the OHIP-G-21 represented the most important factors for patients, and these scores were substantially influenced by implant therapy. Thus, treating physicians should increase their focus on these factors, in order to avoid dissatisfaction and increase the likelihood of complete implant therapy success.