Extent of peri-implantitis-associated bone loss

Unraveling the Applicability of LbL Coatings for Drug Delivery in Dental Implant-Related Infection Treatment

Peri-implantitis is an inflammatory condition caused by bacterial biofilms adhered on dental implant surfaces that cause progressive tissue destruction from the host's inflammatory response. The adverse effects of peri-implantitis progression can go beyond just losing the implant. This highlights the importance of implementing strategies to stabilize disease in the short term. Layer-by-layer (LbL) assembly is a promising avenue in the field of peri-implantitis management due to its applicability with a variety of substances, in addition to being an easy, versatile, and flexible process for multilayer formation to act directly in the affected site. In this Review, our objective is to offer comprehensive chemical and biological insights into the LbL system, clarifying its specific application as antimicrobial coatings, with concern for the physical site and purpose. Additionally, we delve deeper into the concepts of onset and progression of peri-implantitis, aiming to elucidate the precise indications for employing the LbL system as a coating for implant abutments in peri-implantitis treatment. Finally, we correlate the chemical composition of the LbL system with its functionality while also addressing the challenges posed by the uncontrolled environment of the oral cavity, which ultimately restricts its clinical applicability.

Treatment of absent maxillary lateral incisors: orthodontic space closure and associated procedures

Missing maxillary lateral incisors can be treated either with orthodontic space closure or preservation of the edentulous space for tooth replacement. Orthodontic space closure coupled with non-invasive post-orthodontic cosmetic dentistry is a compelling option compatible with optimal function, favourable aesthetics, and periodontal health in the long-term. We present the rationale for space closure and detail contemporary clinical strategies underpinning interdisciplinary treatment planning and excellence in finishing.

Surface Topography Has Less Influence on Peri-Implantitis than Patient Factors: A Comparative Clinical Study of Two Dental Implant Systems

OBJECTIVES

This study aims to assess the risk of peri-implantitis (PI) onset among different implant systems and evaluate the severity of the disease from a population of patients treated in a university clinic. Furthermore, this study intends to thoroughly examine the surface properties of the implant systems that have been identified and investigated.

MATERIAL AND METHODS

Data from a total of six hundred and 14 patients were extracted from the Institute of Clinical Dentistry, Dental Faculty, University of Oslo. Subject- and implant-based variables were collected, including the type of implant, date of implant installation, medical records, recall appointments up to 2022, periodontal measurements, information on diabetes, smoking status, sex, and age. The outcome of interest was the diagnosis of PI, defined as the occurrence of bleeding on probing (BoP), peri-implant probing depth (PD) ≥ 5 mm, and bone loss (BL). Data were analyzed using multivariate linear and logistic regression. Scanning electron microscopy, light laser profilometer, and X-ray photoelectron spectroscopy were utilized for surface and chemical analyses.

RESULTS

Among the patients evaluated, 6.8% were diagnosed with PI. A comparison was made between two different implant systems: Dentsply Sirona, OsseospeedTM and Straumann SLActive, with mean follow-up times of 3.84 years (SE: 0.15) and 3.34 years (SE: 0.15), respectively. The surfaces have different topographies and surface chemistry. However, no significant association was found between PI and implant surface/system, including no difference in the onset or severity of the disease. Nonetheless, plaque control was associated with an increased risk of developing PI, along with the gender of the patient. Furthermore, patients suffering from PI exhibited increased BL in the anterior region.

CONCLUSION

No differences were observed among the evaluated implant systems, although the surfaces have different topography and chemistry. Factors that affected the risk of developing PI were plaque index and male gender. The severity of BL in patients with PI was more pronounced in the anterior region. Consequently, our findings show that success in implantology is less contingent on selecting implant systems and more on a better understanding of patient-specific risk factors, as well as on implementing biomaterials that can more effectively debride dental implants.

Peri-implantitis as the consequence of errors in implant therapy

Peri-implantitis is a plaque-associated pathologic condition occurring in tissues around dental implants, characterized by inflammation in the peri-implant mucosa and subsequent progressive loss of supporting bone. It is a highly prevalent disease, as extensively estimated by large-population, cross-sectional studies. As peri-implant diseases represent opportunistic infections, it is reasonable to assume that nonideal conditions, local and/or general, may favor the progression of peri-implant inflammation. Some of these conditions could be a result of poor planning and/or inadequate execution of any step of the entire process treatment. This article describes the major possible factors in implant therapy that may lead to peri-implantitis. For some of these (ie, inappropriate patient selection, insufficient periodontal therapy, lack of diagnosis and management of peri-implant mucositis, erratic supportive peri-implant/periodontal therapy) there is a good level of evidence, whereas for others (ie, wrong implant placement, poor postoperative care, inadequate prosthetic reconstruction, lack of assessment and management of peri-implant soft-tissue deficiencies) there is little scientific evidence. More research is therefore needed to clearly identify the errors and/or complications possibly leading to peri-implantitis, particularly over the long term.

Influence of eight debridement techniques on three different titanium surfaces: A laboratory study

OBJECTIVES

Debridement methods may damage implant surfaces. This in vitro study investigated eight debridement protocols across three implant surfaces to assess both biofilm removal and surface alterations.

MATERIAL AND METHODS

One hundred sixty commercially pure titanium discs were treated to simulate commercially available titanium implant surfaces-smooth, abraded and abraded and etched. Following inoculation with whole human saliva to create a mixed species biofilm, the surfaces were treated with eight debridement methods currently used for clinical peri-implantitis (n = 10). This included air abrasion using powders of glycine, sodium bicarbonate and calcium carbonate; conventional mechanical methods-piezoelectric scaler, carbon and stainless steel scalers; and a chemical protocol using 40% citric acid. Following treatment, remaining biofilm was analysed using scanning electron microscopy and crystal violet assays. For statistical analysis, ANOVA was applied (p < 0.05).

RESULTS

All debridement techniques resulted in greater than 80% reduction in biofilm compared with baseline, irrespective of the surface type. Glycine powder delivered through an air polishing system eliminated the most biofilm. Mechanical instruments were the least effective at eliminating biofilm across all surfaces and caused the greatest surface alterations. Citric acid was comparable with mechanical debridement instruments in terms of biofilm removal efficacy. Titanium surfaces were least affected by air abrasion protocols and most affected by mechanical methods.

CONCLUSIONS

Mechanical protocols for non-surgical debridement should be approached with caution. Glycine powder in an air polisher and 40% citric acid application both gave minimal alterations across all implant surfaces, with glycine the superior method in terms of biofilm removal.

What is the prevalence of peri-implantitis? A systematic review and meta-analysis

Background

Peri-implantitis is a usual finding but estimates of its prevalence fluctuate very much. This may be due to the wide variety of disease definitions. This systematic review aims to estimate the overall prevalence of peri-implantitis and the effect of different study designs, function times and use of probing depth on prevalence rate.

Methods

Following electronic and manual searches of the literature published from January 2005 to December 2021, data were extracted from the studies fitting the study criteria. Fifty-seven articles were included in this study.

Results

Prevalence of peri-implantitis was 19.53% (95% CI 12.87–26.19) at the patient-level, and 12.53% (95% CI 11.67–13.39) at the implant-level and it remains highly variable even following restriction to the clinical case definition. The use of probing depth like diagnostic criteria affected the prevalence data.

Conclusion

The results indicate that it remains essential the identification of the diagnostic markers for more accurate disease classification.

Radiographic peri-implant bone loss after a function time up to 15 years

OBJECTIVE

The aim was to assess the degree of radiographic peri-implant bone loss over a follow-up period up to 15 years. In addition, another aim was to identify risk indicators for peri-implant bone loss and for moderate-severe peri-implantitis at patient- and implant level.

MATERIALS AND METHODS

This is a cross-sectional clinical and radiological study of 147 patients with a total of 425 implants in combination with data collected retrospectively for baseline variables. To calculate the peri-implant bone loss (primary outcome variable), the radiographic bone level measurements from baseline were compared to the radiographic bone level measurements at the final radiographic measurement. Multilevel analyses were adopted with peri-implant bone loss and peri-implantitis as outcome variables.

RESULTS

The mean follow-up time was 12.5 years (range 10-15) and the mean age of the patients was 63 years (range 29-83). The mean peri-implant bone loss was 0.94 mm (S.D. 1.3). The prevalence of moderate-severe peri-implantitis at patient level was 17% and 8.9% at implant level. The peri-implant bone loss was significantly more pronounced in healthy implants if moderate-severe peri-implantitis was present in at least one implant within the same patient. The presence of moderate-severe peri-implantitis was significantly associated with general periodontitis Stages III or IV at follow-up and smoking.

CONCLUSION

The presence of moderate-severe peri-implantitis at patient level was found to be a risk indicator of peri-implant bone loss in healthy implants, while smoking and general periodontitis Stages III and IV were risk indicators of moderate-severe peri-implantitis.

Clinical evaluation of periodontal pathogen levels by real-time polymerase chain reaction in peri-implantitis patients

OBJECTIVE

The mechanisms underlying the onset and progression of peri-implantitis are similar to those of periodontitis, and the causative bacteria are believed to similar. Previous studies support an association between peri-implantitis and periodontal pathogen. Thus, we investigated the bacterial flora of peri-implantitis patients in comparison to those of healthy implant and periodontitis patients.

MATERIALS AND METHODS

In total, 70 patients visiting Tokyo Dental College Chiba Hospital were divided into four groups: healthy, periodontitis, healthy implant, and peri-implantitis. For each group, the following five periodontal pathogens were detected using real-time polymerase chain reaction: Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, Tannerella forsythia, Treponema denticola, and Prevotella intermedia.

RESULTS

The average copy number of total bacteria was significantly higher in the periodontitis group than in the other groups. P. gingivalis was detected in the periodontitis and peri-implantitis groups at levels as high as 18.92% and 12.29%, respectively, and P. intermedia was found in the peri-implantitis group at a rate of 2.06%. Nevertheless, periodontal pathogens were generally detected at lower levels in the peri-implantitis group than in the periodontitis group.

CONCLUSION

We found lower bacterial counts in the peri-implantitis group relative to the periodontitis group. Our results suggest that the peri-implant tissue is less resistant to bacteria, so even a small number of bacteria can be a risk factor for peri-implantitis and the causative agent of peri-implantitis can be bacteria other than periodontal pathogen.

Assessment of Levels of C-Reactive Proteins and Interleukin 6 in Patients with Peri-Implantitis: A Case-Control Study

Aim:

The present study was undertaken for assessing the C-reactive proteins (CRP) levels and IL-6 levels in patients with peri-implantitis.

Materials and Methods:

A total of 20 patients with confirmed clinical and radiographic diagnosis of peri-implantitis were included in the present study. Another set of 20 subjects who reported for routine health check-up were included as healthy controls. All the subjects were recalled in the morning and fasting (minimum of 12 h) venous blood samples were obtained. Plain vials were used for collecting the venous blood which was sent to the laboratory for biochemical analysis. In the laboratory, levels of CRP were assessed by means of latex enhanced nephelometric method, and interleukin 6 (IL-6) was assessed by means of Elisa kit.

Results:

Mean levels of CRPs in patients of the peri-implantitis group and the control group was found to be 0.795 mg/dL and 0.294 mg/dL respectively. Mean IL-6 levels among the patients of the peri-implantitis group and the control group was found to be 12.178 pg/ml and 6.458 pg/ml respectively. While analyzing statistically, significant results were obtained.

Conclusion:

Enhanced periodontal inflammation in peri-implantitis patients is accompanied by a considerable increase in the concentration of CRPs and IL-6.

A 5-year retrospective analysis of biologic and prosthetic complications associated with single-tooth endosseous dental implants: Practical applications

FOCUSED CLINICAL QUESTION

What are the key considerations of the incidence and timing for single-tooth implant complications, including early failure, biological complications, and prosthetic complications?

SUMMARY

Single-tooth dental implants have been shown to have a high overall survival rate, but implant complications affect patient satisfaction and may lead to costly and/or time-consuming repair and revision. Assessing the incidence and types of biologic and prosthetic complications and the timing of such complications is helpful so that the underlying causes can be addressed during the treatment planning process. Furthermore, identification of patient demographics, patient-, implant-, and site-specific factors associated with such complications may allow for more comprehensive risk assessment during treatment planning.

CONCLUSIONS

Overall, dental implants have a high survival rate. Identification of the incidence of both biologic and prosthetic complications and minimizing their impact in patients with dental implants is critical to overall implant success. Utilization of careful treatment planning and dental implant fixtures, surgical protocols, and prosthetic designs that reduce complication rates can improve patient acceptance and outcomes. Further research is necessary to fully assess complication rates and risk factors.

Prevalence and risk/protective indicators of peri-implant diseases: A university-representative cross-sectional study

AIM

To evaluate the prevalence of peri-implant diseases and to identify risk/protective indicators of peri-implantitis.

MATERIALS AND METHODS

Two hundred and forty randomly selected patients from a university clinic database were invited to participate. Those who accepted, once data from their medical and dental history were collected, were examined clinically and radiographically to assess the prevalence of peri-implant health and diseases. Peri-implantitis was defined as the presence of BoP/SoP together with radiographic bone levels (BL) ≧2 mm. An intermediate peri-implant health category between peri-implant mucositis and peri-implantitis was also identified, defined by the presence of BoP/SoP together with 1 mm ≦BL < 2 mm. A multilevel multivariate logistic regression analysis was carried out to identify those factors associated either positively (risk) or negatively (protective) with peri-implantitis.

RESULTS

Ninety-nine patients with a total of 458 dental implants were analyzed. The prevalences of pre-periimplantitis and of peri-implantitis were, respectively, 31.3% and 56.6% at patient-level, while 31.7% and 27.9% at implant level. The following factors were identified as risk indicators for peri-implantitis: smoking (OR = 3.59; 95% CI: 1.52-8.45), moderate/severe periodontitis (OR = 2.77; 95% CI: 1.20-6.36), <16 remaining teeth (OR = 2.23; 95% CI: 1.05-4.73), plaque (OR = 3.49; 95% CI: 1.13-10.75), implant malposition (too vestibular: OR = 2.85; 95% CI: 1.17-6.93), implant brand (Nobel vs. Straumann: OR = 4.41;95% CI: 1.76-11.09), restoration type (bridge vs. single crown: OR = 2.47; 95% CI: 1.19-5.12), and trauma as reason of tooth loss (vs. caries: OR = 6.51; 95% CI: 1.45-29.26). Conversely, the following factors were identified as protective indicators: interproximal flossing/brushing (OR = 0.27; 95% CI: 0.11-0.68), proton pump inhibitors (OR = 0.08; 95% CI: 0.01-0.90), and anticoagulants (OR = 0.08; 95% CI: 0.01-0.56).

CONCLUSIONS

Peri-implant diseases are highly prevalent among patients with dental implants in this university-based population. Several factors were identified as risk- and protective- indicators of peri-implantitis.

Clinical Decision Making for Primary Peri-Implantitis Prevention: Practical Applications

FOCUSED CLINICAL QUESTION

When planning dental implant therapy, what risk-reduction strategies allow practitioners to select patients, sites, and restorative plans that decrease the incidence of peri-implant disease?

SUMMARY

With a marked increase in the number of patients receiving dental implants to treat partial or complete edentulism, it follows that the prevalence of peri-implant mucositis and peri-implantitis have increased. Risks associated with implant therapies may vary based upon underlying local, environmental, surgical, patient, prosthetic, and fixture-related factors. Furthermore, an emphasis on preventative measures and maintenance should be undertaken to avoid development and progression of peri-implant diseases. Thorough risk assessment, proper treatment planning, and early diagnosis and intervention are critical in the absence of definitive data of long-term success of treatments for peri-implant condition. Given the difficulty in intervention once peri-implantitis is established, identification of risk factors and development of treatment plans to address those factors before dental implant therapy is critical to the long-term health and success of dental implants.

CONCLUSIONS

A patient-centered, evidence based approach to dental implant treatment planning to reduce the risk for peri-implantitis should be undertaken. Systematic diagnosis of disease state(s) and evaluation of the etiologic and modifying risk factors for peri-implant diseases can yield more optimal outcomes to reduce peri-implantitis rates.

Prevalence of Peri-Implantitis in Implants with Turned and Rough Surfaces: a Systematic Review

Objectives

Moderately-rough implant surface may improve implant therapy in terms of bone integration, but the increased surface roughness might affect the initiation and development of peri-implantitis. The aim of the present review was to compare the prevalence of peri-implantitis in implants with rough and turned (machined) implant surfaces.

Material and Methods

An electronic literature search was conducted of the MEDLINE and EMBASE databases for articles published between 1 January 1990 and 1 March 2018. Clinical human studies in the English language that had reported on prevalence of peri-implantitis in tuned and rough surface implants were searched. The initial search resulted in 690 articles.

Results

Eight articles with 2992 implants were included in the systematic review. The incidence of peri-implantitis for two implant surfaces varied between studies. A meta-analysis was not feasible due to the heterogeneity among studies. Implant with rough surfaces were more favourable for plaque accumulation during short-term follow-up. On a long-term, turned implants surfaces were associated with more plaque and higher peri-implant bone loss. Peri-implant clinical parameters and survival rate for two implant surfaces was similar.

Conclusions

Within the limitations of the present study, rough implant surface does not seem to increase the incidence of peri-implantitis in comparison to turned implants surface.

Understanding Peri-Implantitis as a Plaque-Associated and Site-Specific Entity: On the Local Predisposing Factors

The prevalence of implant biological complications has grown enormously over the last decade, in concordance with the impact of biofilm and its byproducts upon disease development. Deleterious habits and systemic conditions have been regarded as risk factors for peri-implantitis. However, little is known about the influence of local confounders upon the onset and progression of the disease. The present narrative review therefore describes the emerging local predisposing factors that place dental implants/patients at risk of developing peri-implantitis. A review is also made of the triggering factors capable of inducing peri-implantitis and of the accelerating factors capable of interfering with the progression of the disease.

Peri-implantitis and the prosthodontist

Peri-implantitis has been described as progressive crestal bone loss around a dental implant. The condition is poorly understood, and is challenging to manage; it is commonly and widely attributed to issues with the implant, the implant surface, surgical technique and oral hygiene. The effect of prosthodontic stages of treatment on the postoperatively established state has not been adequately investigated. It is the authors' contention that the manner in which the implant is restored contributes significantly to prognosis and peri-implant disease experience, and that the role of prosthodontic aspects of treatment in the causation of peri-implantitis may be seriously underestimated. The prosthodontist has a clear role and responsibility in the avoidance of future peri-implant problems by ensuring that implants are restored in an entirely biologically and biomechanically sound manner. The number of implant treatments carried out year-on-year is rising apace, with more and more implants being restored in general dental practice. With the rapid emergence of lower cost dental implant systems and a broadening range of generic restorative options and components for well-established systems, there is an increasing need to consider and understand how the implant restorative process may have a negative impact upon the peri-implant tissues, and how this effect may be minimised and peri-implant health promoted and maintained by paying attention to detail throughout the entire process.

Antibacterial Effects of Garlic Extracts and Ziziphora Essential Oil on Bacteria Associated with Peri-Implantitis

INTRODUCTION

Peri-implantitis is an inflammatory process, characterized by loss of bone around implants and bleeding on probing. Colonization of bacteria in the pocket created around the implant is one of the most important aetiologic factors involved. Although antibiotics are routinely used and are effective agents against this bacterial infection, due to the side effects and drug resistance of these medications, researchers are more interested in using herbal derivatives. There are relatively limited number of studies in this respect.

AIM

To evaluate and compare the antibacterial effects of the extracts of Allium sativum and Ziziphora clinopodioides essential oil on S. aureus and P. aeruginosa.

MATERIALS AND METHODS

In this in vitro study conducted at Tabriz University of Medical Sciences between March 2016 and July 2016, aqueous and methanolic extracts of garlic and ziziphora essential oil were prepared and then their effects on one standard strain of P. aeruginosa and two standard strains of S. aureus and 18 clinical strains, (nine strains of P. aeruginosa and nine strains of S. aureus) which had been isolated from wound and blood cultures, were evaluated using the reference broth macro dilution method and disk diffusion technique. Data were evaluated with descriptive statistical techniques and t-test for independent groups, using SPSS 17.

RESULTS

Aqueous and methanolic extracts of garlic did not exhibit inhibitory effects on S. aureus and P. aeruginosa. Minimum Inhibitory Concentration (MIC) and Minimum Bactericidal Concentration (MBC) for ziziphora essential oil against S. aureus were 0.25 and 0.5 μg/mL, respectively. The mean diameter of growth inhibition zone for S. aureus in the ziziphora essential oil group (0.25μg/mL) and Vancomycin group (10 μg/mL) were 26.09±5.8 and 14.63±1.20 mm respectively (p<0.001). Growth inhibition zone for P. aeruginosa were observed in only one (35 mm) and three cases (12.5±3.4 mm) in the ziziphora essential oil group (0.5 μg/mL) and Nalidixic acid group (10 μg/mL) respectively.

CONCLUSION

The essential oil of ziziphora exhibited a favourable antibacterial effect on S. aureus; therefore, its extract can be used as an effective antimicrobial agent alone or in association with other antibiotics in the treatment of infections due to S. aureus.

Patient satisfaction 8-14 years after dental implant therapy - a questionnaire study

OBJECTIVE

The aim of this questionnaire study was to investigate patient satisfaction 8-14 years after dental implant therapy and complications influencing the degree of satisfaction.

MATERIALS AND METHODS

A questionnaire was sent by post to 587 patients at a specialist clinic of periodontology. The questionnaire consisted of 19 statements or questions such as the degree of satisfaction with the implants and knowledge of complications. In nine of the questions, respondents were asked to grade the extent of their agreement with a statement by selecting from fixed answers. Three of the questions were designed to be answered using a visual analog scale.

RESULTS

In total, 400 individuals (81%) responded to the questionnaire. The mean time elapsed since implant installation was 10 years. A great majority (81%) experienced a high chewing comfort and was satisfied or sufficiently satisfied (94%) with the aesthetic aspects of their implant restorations, while 32% of the individuals had experienced problems with their implant reconstructions. The disadvantage that patients remarked on was the cost of the treatment. Those who had experienced problems with their implant reconstructions were also less satisfied with the treatment.

CONCLUSION

A great majority of the patients expressed a high degree of satisfaction with their dental implants 8-14 years after the treatment. Patients were less satisfied if they had experience of problems with their implant reconstructions and in cases when the clinicians were unable to resolve their complications.

Clinical, Radiographic and Microbiological Evaluation of High Level Laser Therapy, a New Photodynamic Therapy Protocol, in Peri-Implantitis Treatment; a Pilot Experience

Aim. Endosseous implants are widely used to replace missing teeth but mucositis and peri-implantitis are the most frequent long-term complications related with dental implants. Removing all bacterial deposits on contaminated implant surface is very difficult due to implant surface morphology. The aim of this study was to evaluate the bactericidal potential of photodynamic therapy by using a new high level laser irradiation protocol associated with hydrogen peroxide in peri-implantitis. Materials and Methods. 10 patients affected by peri-implantitis were selected for this study. Medical history, photographic documentation, periodontal examination, and periapical radiographs were collected at baseline and 6 months after surgery. Microbiological analysis was performed with PCR Real Time. Each patient underwent nonsurgical periodontal therapy and surgery combined with photodynamic therapy according to High Level Laser Therapy protocol. Results. All peri-implant pockets were treated successfully, without having any complication and not showing significant differences in results. All clinical parameters showed an improvement, with a decrease of Plaque Index (average decrease of 65%, range 23–86%), bleeding on probing (average decrease of 66%, range 26–80%), and probing depth (average decrease of 1,6 mm, range 0,46–2,6 mm). Periapical radiographs at 6 months after surgery showed a complete radiographic filling of peri-implant defect around implants treated. Results showed a decrease of total bacterial count and of all bacterial species, except for Eikenella corrodens, 6 months after surgery. Conclusion. Photodynamic therapy using HLLT appears to be a good adjunct to surgical treatment of peri-implantitis.

Effectiveness of Implant Therapy Analyzed in a Swedish Population

Peri-implantitis is an inflammatory disease affecting soft and hard tissues surrounding dental implants. As the global number of individuals that undergo restorative therapy through dental implants increases, peri-implantitis is considered as a major and growing problem in dentistry. A randomly selected sample of 588 patients who all had received implant-supported therapy 9 y earlier was clinically and radiographically examined. Prevalence of peri-implantitis was assessed and risk indicators were identified by multilevel regression analysis. Forty-five percent of all patients presented with peri-implantitis (bleeding on probing/suppuration and bone loss >0.5 mm). Moderate/severe peri-implantitis (bleeding on probing/suppuration and bone loss >2 mm) was diagnosed in 14.5%. Patients with periodontitis and with ≥4 implants, as well as implants of certain brands and prosthetic therapy delivered by general practitioners, exhibited higher odds ratios for moderate/severe peri-implantitis. Similarly, higher odds ratios were identified for implants installed in the mandible and with crown restoration margins positioned ≤1.5 mm from the crestal bone at baseline. It is suggested that peri-implantitis is a common condition and that several patient- and implant-related factors influence the risk for moderate/severe peri-implantitis (ClinicalTrials.gov NCT01825772).

About gravity and occlusal forces in the jaws: Review

Mechanical forces resulting from gravitation seem to be essential for structural adaptation and remodeling of skeletal bones. These forces have the capability of delivering powerfully distorting stimuli to skeletal bones in a very short time, several times a day, in a uniform direction. Facial and jaw bones are not subjected to gravity impact forces. These bones need a mechanism of “compensation” for this deficiency. The goal is achieved by a unique mechanism that substitutes for gravity impact forces - the mechanism of occlusal load transmission to the bone via the periodontal apparatus space. In cases of early loss of teeth and loss of periodontal ligament this mechanism will be missing resulting in premature bone aging.

10-year survival and success rates of 511 titanium implants with a sandblasted and acid-etched surface: a retrospective study in 303 partially edentulous patients

PURPOSE

This retrospective study assessed the 10-year outcomes of titanium implants with a sandblasted and acid-etched (SLA) surface in a large cohort of partially edentulous patients.

MATERIALS AND METHODS

Records of patients treated with SLA implants between May 1997 and January 2001 were screened. Eligible patients were contacted and invited to undergo a clinical and radiologic examination. Each implant was classified according to strict success criteria.

RESULTS

Three hundred three patients with 511 SLA implants were available for the examination. The mean age of the patients at implant surgery was 48 years. Over the 10-year period, no implant fracture was noted, whereas six implants (1.2%) were lost. Two implants (0.4%) showed signs of suppuration at the 10-year examination, whereas seven implants had a history of peri-implantitis (1.4%) during the 10-year period, but presented with healthy peri-implant soft tissues at examination. The remaining 496 implants fulfilled the success criteria. The mean Plaque Index was 0.65 (±0.64), the mean Sulcus Bleeding Index 1.32 (±0.57), the mean Probing Depth 3.27 mm (±1.06), and the mean distance from the implant shoulder to the mucosal margin value -0.42 mm (±1.27). The radiologic mean distance from the implant shoulder to the first bone-to-implant contact was 3.32 mm (±0.73).

CONCLUSION

The present retrospective analysis resulted in a 10-year implant survival rate of 98.8% and a success rate of 97.0%. In addition, the prevalence of peri-implantitis in this large cohort of orally healthy patients was low with 1.8% during the 10-year period.

Photofunctionalization enhances bone-implant contact, dynamics of interfacial osteogenesis, marginal bone seal, and removal torque value of implants: a dog jawbone study

OBJECTIVE

Ultraviolet (UV) light treatment of titanium, ie, photofunctionalization, has been extensively reported to enhance the osteoconductivity of titanium in animal and in vitro studies. This is the first study to examine whether photofunctionalization is effective on commercial dental implants in vivo.

MATERIALS AND METHODS

Dental implants with a microroughened surface were placed into dog jawbones. Photofunctionalization was performed by treating implants with UV light for 15 minutes using a photo device immediately before placement. Four weeks after placement, bone-implant integration was evaluated using a removable torque test and static and dynamic histology.

RESULTS

Implant surfaces were converted from hydrophobic to super-hydrophilic after photofunctionalization. Removable torque for photofunctionalized implants was significantly higher by 50% than that for untreated implants. Bone-implant contact (BIC) was significantly higher for photofunctionalized implants in all zones examined: marginal, cortical, and bone marrow zones. An intensive mineralized layer was exclusively present in marginal bone at photofunctionalized interface. Dynamic histology identified early-onset, long-lasting robust bone deposition at photofunctionalized interface.

CONCLUSIONS

Photofunctionalization enhanced the morphology, quality, and behavior of periimplant osteogenesis, including the increased BIC, expedited robust interfacial bone deposition, and improved marginal bone seal and support.

Preventing and Treating Peri-Implantitis: A Cost-Effectiveness Analysis

BACKGROUND

A large number of treatments for peri-implantitis are available, but their cost-effectiveness remains uncertain. This study evaluates the cost-effectiveness of preventing and treating peri-implantitis.

METHODS

A Markov model was constructed that followed each implant over 20 years. Supportive implant therapy (SIT) for managing peri-implant mucositis and preventing development of peri-implantitis was either provided or not. Risk of peri-implantitis was assumed to be affected by SIT and the patient's risk profile. If peri-implantitis occurred, 11 treatment strategies (non-surgical or surgical debridement alone or combined with adjunct therapies) were compared. Treatments and risk profiles determined disease progression. Modeling was performed based on systematically collected data. Primary outcomes were costs and proportion of lost implants, as assessed via Monte Carlo microsimulations.

RESULTS

Not providing SIT and performing only non-surgical debridement was both least costly and least effective. The next best (more costly and effective) option was to provide SIT and perform surgical debridement (additional 0.89 euros per 1% fewer implants lost). The most effective option included bone grafts, membranes, and laser treatment (56 euros per 1%). For patients at high risk, the cost-effectiveness of SIT increased, whereas in low-risk groups, a cost-optimized strategy was cost-effective.

CONCLUSIONS

Although clinical decision-making will be guided mainly by clinical condition, cost-effectiveness analyses might add another perspective. Based on these findings, an unambiguous comparative effectiveness ranking was not established. However, cost-effectiveness was predominantly determined by provision of SIT and initial treatment costs. Transferability of these findings to other healthcare systems needs further confirmation.

Treatment of peri-implantitis and the failing implant

Appropriate treatment of implants is becoming increasingly important for the general dentist as the number of implants placed per year continues to increase. Early diagnosis of peri-implantitis is imperative; initiating the correct treatment protocol depends on a proper diagnosis. Several risk factors exist for the development of peri-implantitis, which can guide patient selection and treatment planning. Treatment of peri-implantitis should be tailored to the severity of the lesion (as outlined by the cumulative interceptive supportive treatment protocol), ranging from mechanical debridement to explantation. Several surgical and nonsurgical treatment alternatives exist. There is little consensus on superior treatment methods.

Missing upper incisors: a retrospective study of orthodontic space closure versus implant

Background

The aim of this retrospective study was to compare the esthetic, periodontal, and functional outcomes of orthodontic space closure versus implant substitution in patients with missing maxillary incisors 5 years after completion of treatment.

Methods

The study group consisted of ten patients treated with orthodontic space closure (six males, four females, mean age 19 ± 2.1 years at the completion of treatment) and ten patients treated with implant insertion (five males, five females, mean age 20 ± 1.4 years at the time of implant insertion). Tooth mobility, plaque index, probing depth, infraocclusion, open gingival embrasure (black triangle), and temporomandibular joint function were recorded at the 5.6 years follow-up. Self-perceived dental esthetic appearance was also evaluated through a visual analog scale (VAS) questionnaire. T-test was used to evaluate the data.

Results

All patients were equally satisfied with the appearance of their teeth 5.6 ± 0.4 years after the completion of treatment. No statistically significant differences were found in relation to the VAS scores of the subjects (P < 0.857). No significant differences were found in tooth mobility, plaque index (P < 0.632), and the prevalence of signs and symptoms of temporomandibular disorders. However, significant infraocclusion was noticed in all implant patients (P < 0.001). Probing depth was also significantly higher in implant patients (P < 0.001).

Conclusions

Orthodontic space closure and implant of missing maxillary incisors produced similar, well-accepted esthetic results. None of the treatments impaired temporomandibular joint function. Nevertheless, infraocclusion was evident in implant patients. Space closure patients also showed better periodontal health in comparison with implant patients.

10-year survival rate and the incidence of peri-implant disease of 374 titanium dental implants with a SLA surface: a prospective cohort study in 177 fully and partially edentulous patients

PURPOSE

This prospective cohort study evaluates the 10-year survival and incidence of peri-implant disease at implant and patient level of sandblasted, large grid, and acid-etched titanium dental implants (Straumann, soft tissue level, SLA surface) in fully and partially edentulous patients.

MATERIAL AND METHODS

Patients who had dental implant surgery in the period between November 1997 and June 2001, with a follow-up of at least 10 years, were investigated for clinical and radiological examination. Among the 506 inserted dental implants in 250 patients, 10-year data regarding the outcome of implants were available for 374 dental implants in 177 patients. In the current study, peri-implantitis was defined as advanced bone loss (≧1.5 mm. postloading) in combination with bleeding on probing.

RESULTS

At 10-year follow-up, only one implant was lost (0.3%) 2 months after implant surgery due to insufficient osseointegration. The average bone loss at 10 year postloading was 0.52 mm. Advanced bone loss at 10-year follow-up was present in 35 dental implants (9.8%). Seven percent of the observed dental implants showed bleeding on probing in combination with advanced bone loss and 4.2% when setting the threshold for advanced bone loss at 2.0 mm. Advanced bone loss without bleeding on probing was present in 2.8% of all implants.

CONCLUSION

In this prospective study, the 10-year survival rate at implant and patient level was 99.7% and 99.4%, respectively. Peri-implantitis was present in 7% of the observed dental implants according to the above-mentioned definition of peri-implantitis. This study shows that SLA implants offer predictable long-term results as support in the treatment of fully and partially edentulous patients.

The epidemiology of peri-implantitis

AIM

To review the literature on the prevalence and incidence of peri-implantitis.

METHODS

Out of 322 potentially relevant publications we identified 29 articles concerning 23 studies, with information on the presence of signs of peri-implantitis in populations of at least 20 cases.

RESULTS AND CONCLUSIONS

All studies provided data from convenience samples, typically from patients who were treated in a clinical center during a certain period, and most data were cross-sectional or collected retrospectively. Based on the reviewed papers one may state that the prevalence of peri-implantitis seems to be in the order of 10% implants and 20% patients during 5-10 years after implant placement but the individual reported figures are rather variable, not easily comparable and not suitable for meta-analysis. Factors that should be considered to affect prevalence figures are the disease definition, the differential diagnosis, the chosen thresholds for probing depths and bone loss, differences in treatment methods and aftercare of patients, and dissimilarities in the composition of study populations. Smoking and a history of periodontitis have been associated with a higher prevalence of peri-implantitis.

Reconstructive procedures for treating peri-implantitis: a systematic review

This review aimed at evaluating the effectiveness of reconstructive procedures for treating peri-implantitis. Searches of electronic databases and cross-referencing were performed for human comparative clinical trials with ≥ 10 implants for ≥ 12 months of follow-up, reporting radiographic defect fill and at least one of the following parameters: probing depth reduction, clinical attachment level gain, bleeding on probing reduction, and mucosal recession. The searches retrieved 430 citations. Only 1 randomized controlled trial was identified, which compared reconstructive therapy and open flap debridement. Case series studies were also included to evaluate the overall performance of the reconstructive procedures. Twelve studies were finally included. Meta-analysis revealed that the weighted mean radiographic defect fill was 2.17 mm (95% confidence interval [CI]: 1.46-2.87 mm), probing depth reduction was 2.97 mm (95% CI: 2.38-3.56 mm), clinical attachment level gain was 1.65 mm (95% CI: 1.17-2.13 mm), and bleeding on probing reduction was 45.8% (95% CI: 38.5%-53.3%). Great variability in reparative outcomes was found, attributed to patient factors, defect morphology, and reconstructive agents used. Currently, there is a lack of evidence for supporting additional benefit of reconstructive procedures to the other treatment modalities for managing peri-implantitis.

Does residual cement around implant-supported restorations cause peri-implant disease? A retrospective case analysis

OBJECTIVES

The purpose of this study was to determine the relationship between patients with a history of periodontitis and development of cement-related peri-implant disease.

MATERIALS AND METHODS

Seventy-seven patients with 129 implants for this retrospective analysis were selected from completed implant cases that were scheduled for regular maintenance or had experienced mechanical or biological complications between years 2006 and 2011 in private practice. Implants with extracoronal residual cement and implants without cement remnants were analyzed. The selected cases were further divided into two groups--implants in patients with history of periodontitis (1) and implants in periodontitis-free individuals (2). The selection of these groups was made on the basis of treatment history and orthopantomograph. As a control group, a set of 238 screw-retained implant restorations, delivered to 66 patients during the same period of time was examined. The incidence of peri-implant disease among implants in all groups was calculated.

RESULTS

Peri-implant disease was evident in 62 of 73 implants with cement remnants (85%). All implants in group 1 developed peri-implantitis--4 early and 35 delayed disease cases. In the periodontally healthy group, 20 of 31 implants were diagnosed with peri-implant mucositis, 3 implants had early peri-implantitis, and 11 implants with cement remnants did not develop biological complications. In the group of implants without cement remnants, peri-implant disease was diagnosed in 17 of 56 cases (30%). In contrast, only two occurrences of peri-implant disease were registered in the control group of screw-retained restorations (1.08%).

CONCLUSIONS

Implants with cement remnants in patients with history of periodontitis may be more likely to develop peri-implantitis, compared with patients without history of periodontal infection.

Clinical and microbiological characteristics of peri-implantitis cases: a retrospective multicentre study

OBJECTIVES

The aim of this study was to follow patient cases retrospectively in a longitudinal manner from the time of implant placement to the time they were diagnosed with peri-implant disease, and to identify associated clinical and microbiological features of peri-implant disease.

MATERIAL AND METHODS

A total of 281 patient cases were chosen from the archives of the Oral Microbiological Diagnostic Laboratory, Gothenburg, Sweden, based on bacterial samples taken from diseased implants. A form was designed and filled in separately for each case including data on patient, implant and disease profile.

RESULTS

Most cases were severe peri-implantitis cases (91.4%). In 41.3% of the patients, peri-implantitis was developed early, already after having implants in function less than 4 years. The type of implant surface was significantly associated with the time in years implants were in function, before disease was developed (P < 0.05). The microbiological results by both culture and checkerboard analysis, although failed to fully correspond to the severity of the disease in terms of magnitude, proved to show that peri-implantitis is a polymicrobial anaerobic infection with increased number of AGNB (aerobic Gram-negative bacilli) in 18.6% of the patients.

CONCLUSIONS

Peri-implantitis is a biological complication of implants in function that poses a threat to their long-term survival. It may develop earlier around implants with rough surfaces and it may represent a true infection. Microbiological sampling methods should be improved and uniformed so as to fully unveil the microbiological profile of the disease.