Supportive post-implant therapy: patient compliance rates and impacting factors: 3-year follow-up

Prevention of retrograde peri-implantitis caused by pulpal/periapical lesions in adjacent teeth: A literature review

OBJECTIVES

To present a comprehensive review on retrograde peri-implantitis (RPI), focusing on its epidemiology, etiology, clinical manifestations, classification, treatment, and prevention strategies.

DATA

The widespread development of implantology has led to heightened concerns regarding implant failure attributed to peri-implantitis (PI). In contrast to conventional PI, retrograde peri-implantitis (RPI), defined as inflammation originating from the apical of the implant towards the crown, has gained increasing attention. Various factors can contribute to RPI, among which untreated pulpal/periapical lesions from adjacent teeth are considered as main causes.

SOURCES AND STUDY SELECTION

Using PubMed as the source for eligible literature, a total of 73 cases (from 36 articles) were identified for review. The search items are: ("retrograde peri-implantitis" OR "periapical peri-implantitis" OR "peri-apical implant lesion*") AND ("risk factor*" OR "treatment*" OR "prevent*").

CONCLUSIONS

Currently, clinicians often inadequately address the evaluation and management of pulpal/periapical lesions in the adjacent teeth in RPI, neglecting its causes and further the preventive measures. Overall, RPI influences the success of dental implants and therefore valid diagnosis and prevention are obligatory. Until now, there has been no relative instructions for clinicians. Moreover, new research directions (e.g. molecular biology and immunology) as well as innovative treatment (e.g. lasers and novel materials) may facilitate the precise prevention and early diagnosis of RPI.

Retrospective assessment of patients' risk for peri-implant diseases using the implant disease risk assessment (IDRA) tool: A cohort study

INTRODUCTION

The implant disease risk assessment (IDRA) tool was designed to assess an individual's risk of developing peri-implant diseases by evaluating and integrating multiple risk factors. This study aimed to evaluate the IDRA tool to determine the risk of developing peri-implant disease in patients rehabilitated with dental implants.

METHODS

A retrospective observational cross-sectional study was conducted, collecting data from 92 patients with 92 selected dental implants. Data included the history of periodontitis, sites with bleeding on probing (BoP), teeth and/or implants with probing depths (PDs) ≥ 5 mm, alveolar bone loss relative to the patient's age, susceptibility to periodontitis, the frequency of supportive periodontal therapy (SPT), the distance from the restorative margin (RM) of the implant-supported prosthesis to the marginal bone crest (MBC), and factors related to the prosthesis itself. Additionally, the validated instrument periodontal risk assessment (PRA) was employed for comparison. Statistical analyses utilized Chi-square, Mann-Whitney, and ROC curve.

RESULTS

Outcomes indicated that 62 implants (67.4%) were classified as high-risk. Among the IDRA parameters, history of periodontitis was the primary factor contributing to an increased risk (p < 0.001). IDRA revealed high sensitivity (100%) and low specificity (63%) (AUC = 0.685; 95% CI: 0.554-0.816; p = 0.047), and there was a low agreement between the IDRA and PRA tools (Kappa = 0.123; p = 0.014). The peri-implant disease developed in 16 implants with 5.44 (±2.50) years of follow-up, however, no significant association was observed between the high- and low-medium risk groups and the occurrence of peri-implant diseases.

CONCLUSION

Most of the evaluated implants presented high IDRA risk. The IDRA tool exhibited high sensitivity and low specificity; no significant association was observed between the risk profile and the development of peri-implant diseases.

The Oral Microbiome of Peri-Implant Health and Disease: A Narrative Review

Peri-implantitis disease has increased significantly over the last years, resulting in increased failure of implants. Many factors may play a role in implant complications and failure, including ones related to the oral microbiota. This literature review aims to summarize the current knowledge of microbiome of implants in health and disease, focusing not only on the presence/absence of specific microbiota or on their relative abundance, but also on their phenotypic expression and their complex relationships with the host. The authors examined the MEDLINE database and identified key topics about peri-implant oral microbiome in health and disease. The peri-implant microbiome differs from that of the tooth, both in health and disease, as they are structurally and chemically different. The adhesion and formation of the peri-implant biofilm can be affected by the surface energy, topography, wettability, and electrochemical charges of the implant surface. In addition, the morphogenesis of the tissues surrounding the dental implant also differs from the tooth, making the dental implant more susceptible to bacterial infection. This interplay between the microbiome and the host immune system in peri-implant infections still needs to be elucidated.

Supportive therapy following peri-implantitis treatment: A retrospective study on compliance

BACKGROUND

The compliance rate with supportive therapy following peri-implantitis treatment (SPIT) remains unknown. The present retrospective study was carried out to assess the compliance rate and the factors influencing compliance in a private practice setting.

MATERIALS AND METHODS

Patients were divided into three groups according to compliance rate: regular compliance (RC ≥2 SPIT/year), erratic compliance (EC <2 SPIT/year), and non-compliance (NC <1 SPIT/year). Overall, 17 patient- (n = 8) and site-related variables (n = 9) were explored as potential confounders of compliance. The Chi2 test was applied to assess the association between categorical variables and determine the odds ratio (OR).

RESULTS

The study comprised 159 patients restored with 1075 implants, of which 469 were treated for peri-implantitis and met the inclusion criteria. A total of 57.2% were RC, 25.8% EC, and 17% NC. The multivariate analysis showed that smoking and grade C periodontitis reduced the likelihood of RC (OR = 0.28, p < .001) when compared to complete edentulism or non-smoking. Moreover, age demonstrated being associated with follow-up when SPIT was interrupted in EC and NC (OR = 0.94, p = .007).

CONCLUSION

Comprehensive information, provided prior to peri-implantitis treatment, regarding the importance of adhering to SPIT after peri-implantitis treatment to achieve/maintain peri-implant health, resulted in ~60% regular compliance rate (NCT05772078).

Cross-kingdom microbial interactions in dental implant-related infections: is Candida albicans a new villain?

Candida albicans, an oral fungal opportunistic pathogen, has shown the ability to colonize implant surfaces and has been frequently isolated from biofilms associated with dental implant-related infections, possibly due to its synergistic interactions with certain oral bacteria. Moreover, evidence suggests that this cross-kingdom interaction on implant can encourage bacterial growth, leading to increased fungal virulence and mucosal damage. However, the role of Candida in implant-related infections has been overlooked and not widely explored or even considered by most microbiological analyses and therapeutic approaches. Thus, we summarized the scientific evidence regarding the ability of C. albicans to colonize implant surfaces, interact in implant-related polymicrobial biofilms, and its possible role in peri-implant infections as far as biologic plausibility. Next, a systematic review of preclinical and clinical studies was conducted to identify the relevance and the gap in the existing literature regarding the role of C. albicans in the pathogenesis of peri-implant infections.

Fitting pieces into the puzzle: The impact of titanium-based dental implant surface modifications on bacterial accumulation and polymicrobial infections

Polymicrobial infection is the main cause of dental implant failure. Although numerous studies have reported the ability of titanium (Ti) surface modifications to inhibit microbial adhesion and biofilm accumulation, the majority of solutions for the utilization of Ti antibacterial surfaces have been testedin in vitro and animal models, with only a few developed surfaces progressing into clinical research. Motivated by this huge gap, we critically reviewed the scientific literature on the existing antibacterial Ti surfaces to help understand these surfaces' impact on the "puzzle" of undesirable dental implant-related infections. This manuscript comprises three main sections: (i) a narrative review on topics related to oral biofilm formation, bacterial-implant surface interactions, and on how implant-surface modifications can influence microbial accumulation; (ii) a critical evidence-based review to summarize pre-clinical and clinical studies in an attempt to "fit pieces into the puzzle" to unveil the best way to reduce microbial loads and control polymicrobial infection around dental implants showed by the current in vivo evidence; and (iii) discussion and recommendations for future research testing emerging antibacterial implant surfaces, connecting basic science and the requirements for future clinical translation. The findings of the present review suggest no consensus regarding the best available Ti surface to reduce bacterial colonization on dental implants. Smart release or on-demand activation surface coatings are a "new piece of the puzzle", which may be the most effective alternative for reducing microbial colonization on Ti surfaces, and future studies should focus on these technologies.

Peri-implant bone-level changes in the second decade of loading with regard to the implant-abutment connection: a retrospective study on implants under systematic aftercare

BACKGROUND

This retrospective study investigates the change in the peri-implant bone level (PBL) during the 2nd decade of intraoral function in patients complying with a 'supportive implant therapy' (SIT) program. The results were statistically analyzed with respect to the implant abutment connection used.

METHODS

In a private practice, only patients with 20-year SIT compliance were identified. Of these, all patients with 10- and 20-year radiographs available were selected. Therefore, no control group was possible and implant losses had to be excluded. Two experienced researchers assessed the peri-implant bone levels. As three different abutment connection concepts (bone-level butt-joint, bone-level conical and tissue-level conical) and two different implant surfaces (machined vs. roughened) were involved, statistical analyses were performed to detect potential differences.

RESULTS

Ninety-three implants from 36 patients with 20-year SIT compliance and available radiographs were included in the study. At study baseline (10 years intraoral), a mean bone loss of - 1.7 mm (median - 1.2; standard deviation [sd] 1.4, range: 0 to - 7.2) was recorded. After 20 years, we found a mean bone loss of - 2.5 mm (median - 2.3, sd 1.79, range: - 0.5 to + 7.4). Furthermore, we found a mean bone loss of 0.8 mm in intraoral function from year 10 to year 20 (mean: 0.08 mm per year); this change was independent of the abutment connection type.

CONCLUSIONS

During the 2nd decade of function, peri-implant bone loss in patients with SIT compliance might be small in value and should not be expected in all implants.

Breaking the wave of peri-implantitis

Peri-implant diseases are prevalent with a weighted mean prevalence rate of 43% across Europe and 22% across South and North America. Although the main etiologic agent is bacterial biofilm, a myriad of factors influence the initiation and progression of the disease. Unfortunately, the treatment of peri-implant diseases is at best favorable in the short term with a high rate of persistent inflammation and recurrence. Therefore, it is sensible to consider and control all potential factors that may predispose an implant to peri-implant tissue inflammation in an attempt to avoid the disease. This paper reviews recent evidence on factors that may predispose implants to peri-implantitis and measures that can be taken to prevent it.

Supportive Implant Therapy (SIT): A Prospective 10-Year Study of Patient Compliance Rates and Impacting Factors

The main objective of this study is to present patient compliance rates and influential factors for regular attendance in a systematic implant aftercare program (Supportive Implant Therapy; SIT) within a 10-year observation period. From 2005 to 2008, we identified 233 patients with 524 implants and implant-supported restorations at the study center. They had been instructed to attend an SIT program with 3-month recall intervals. A 2019 clinical prospective cohort study on 10-year compliance rates was performed. Data were assessed yearly in regression analyses to identify influential factors. Noncompliance rates increased during the period (4.8%, year 1; 39.7%, year 10). Total noncompliance was observed in four patients (1.7%) with 10 implants. “Age,” “Gender,” “Diabetes”, and “Surgical case complexity” showed no correlation with patient compliance. “Smoking” and “Cardiovascular diseases” significantly influenced patients in one of ten years, while “Number of implants per patient”, “Type of implant-supported prostheses”, and “Pre-existing experience in a prophylaxis program” reached significance after several years. When patients with implant-supported restorations are strongly recommended and frequently remotivated to comply with an SIT program with 3-month recall, an approximately 60% compliance rate after 10 years is achievable. Previous prophylaxis program experience, increased number of implants per patient, and removable implant-supported prostheses may be strong influential factors for increased patient compliance.

Patient compliance as a risk factor for the outcome of implant treatment

Peri-implantitis can be explained using a multicausality model. Many factors are involved in the etiology of peri-implantitis, but patient compliance also plays a key role. Oral hygiene, attending recall visits, smoking behavior, and therapy comprehension are relevant factors that contribute to peri-implant health. The clinician should create the most optimal conditions for patients to facilitate adequate oral self-care and to help patients improve their oral hygiene skills. Implementation of a supportive periodontal therapy program is mandatory to control inflammation and plaque accumulation, as well as to keep the incidence of peri-implant diseases low. Patient compliance, including plaque control and dental follow-up, must be optimal. Consequently, precautions must be taken with patients treated with dental implants.

The effect of supportive care in preventing peri-implant diseases and implant loss: A systematic review and meta-analysis

OBJECTIVE

To evaluate the influence of supportive treatment (SPT) during a maintenance period after implant placement on implant survival rate (SR) and incidence of peri-implant diseases.

MATERIAL AND METHODS

A systemic literature search for studies published up to June 2018 was conducted by two independent reviewers using Pubmed/MEDLINE, EMBASE, and Cochrane Central databases. Clinical controlled trials (CCT) involved in SPT protocol with more than 1-year follow-up were included. Quantitative meta-analyses were carried out to analyze the risk ratio (RR) of SR, the incidence of peri-implantitis, and peri-implant mucositis between SPT and non-SPT groups. Any potential confounding factors were investigated using meta-regression.

RESULTS

Nine CCTs fulfilled the criteria. To evaluate the influence of SPT on SR, peri-implantitis, and peri-implant mucositis, six of nine, three of nine, and three of nine articles were included in further meta-analysis, respectively. SPT group significantly showed higher SR (RR: 1.10; p < 0.001), lower prevalence of peri-implantitis (RR: 0.25; p < 0.001) and peri-implant mucositis (RR: 0.57; p < 0.001) than the non-SPT group. Meta-regression of the selected studies failed to find an association between SR, peri-implantitis, and peri-implant mucositis and confounding factors: application of chemical agents and the frequency of SPT.

CONCLUSION

SPT can potentially improve peri-implant health in terms of SR, peri-implantitis, and peri-implant mucositis. Additionally, the correlation in recall interval and adjunctive use of chemical agents during SPT to peri-implant diseases and implant loss could not be found.

Evaluation of prognosis related to compliance with supportive periodontal treatment in patients with chronic periodontitis: a clinical retrospective study

Purpose

The purpose of this study was to evaluate the prognostic effect of patient compliance with supportive periodontal treatment (PC-SPT). Chronic periodontitis patients were classified based on their compliance level, and factors affecting PC-SPT and the prognosis of PC-SPT were investigated.

Methods

This study selected 206 patients who started SPT after receiving periodontal treatment between 2010 and 2012. Patients who continued SPT through February 2016 were included. The patients were classified according to whether they exhibited complete compliance (100% of visits), excellent compliance (≥70% of visits), incomplete compliance (<70% of visits), or non-compliance (only 2 visits). Patient characteristics that could affect PC-SPT, such as age, sex, distance of the clinic from their residence, implantation, and periodontal treatment, were investigated. The number of newly decayed and extracted teeth, alveolar bone level changes around the teeth and implants, and implant removal were examined to evaluate the prognosis of PC-SPT.

Results

Sex and the presence of an implant significantly affected PC-SPT. Additionally, the number of newly decayed and extracted teeth and changes in alveolar bone levels around the teeth and implants were significant prognostic factors related to PC-SPT.

Conclusions

PC-SPT in chronic periodontitis patients will help maintain periodontal health and prevent further periodontal disease.

MasterOnline Periodontology and Implant Therapy-revisited after seven years: A case study of the structures and outcomes in a blended learning CPD

INTRODUCTION

There is a great need for postgraduate training and continuing professional development (CPD), specifically in the field of periodontology. Despite the plenty of periodontal CPDs, there is a lack of information about the performance of CPDs in a blended learning setting. This study is a case study of the structures and outcomes in a blended learning CPD programme in periodontology, the MasterOnline Periodontology and Implant Therapy hosted by the University of Freiburg's Dental School.

MATERIAL AND METHODS

The structures of the blended learning CPD were analysed with the aims to (i) make explicit how various innovative educational methods and ICT tools can be successfully applied to a Web-supported postgraduate periodontology training programme, (ii) identify the programme's impact on learning transfer in students' dental practices and (iii) identify other outcomes, synergies and any changes required during the existence. Using qualitative interviewing, the various types of learning transfer and elements of the study programme that foster transfer could be exemplified.

RESULTS

A period of 7 years was analysed. In this duration, 50 students successfully graduated to a master of science. Qualitative interviews were performed with six students and four teachers affirming the learning transfer in a blended learning setting.

CONCLUSIONS

This case study shows that blended learning can be a successful approach for CPD in dentistry.

Effect of doxycycline-treated hydroxyapatite surface on bone apposition: A histomophometric study in murine maxillae

Improved osseointegration of dental implants is imperative in clinic. Effect of doxycycline on promoting bone formation after implant placement was expected due to its inhibitory properties on inflammation and osteoclastogenesis. To evaluate new bone formation on the hydroxyapatite (HA)-coated implant surface, which was treated with doxycycline, in comparison with the untreated HA surface, half of the HA-coated implants were soaked in doxycycline solution (DOX group) whereas the other HA-coated implants were untreated (HA group). Eight weeks after extracting the maxillary first molars of 4-week-old male mice, the implants of both groups were placed at the extracted site. 4 and 8 weeks after surgery, the samples were evaluated radiologically and histomorphometrically. Bone-implant contact of DOX group was statistically higher than the one of HA group at 4 and 8 weeks. New bone area between the threads of the implants also statistically increased at 8 weeks in DOX group compared to HA group.

Implant maintenance for the prevention of biological complications: Are you ready for the next challenge?

With increasing knowledge of wound biology and material sciences, the provision of dental implants as a treatment modality has become increasingly predictable and more commonly used to replace missing teeth. However, without appropriate follow up, peri-implant diseases could develop and affect the long-term success of implants. Currently, there is not enough focus on the prevention of peri-implant diseases, as compared to the definition of the disease, its prevalence, and treatment. In the present study, we aim to summarize various factors influencing the successful maintenance of dental implants and highlight current gaps in knowledge. Factors influencing the successful maintenance of dental implants can be divided into three categories: implant-, dentist-, and patient-related factors. Patients with dental implants are often more dentally aware, and this offers an advantage. Compared to gingiva, peri-implant mucosa responds at a different pace to the bacterial challenge. Dental practitioners should be aware of how treatment protocols affect long-term success, and be vigilant in detecting peri-implant diseases at an early stage. Compared to periodontal maintenance, less longitudinal studies on implant maintenance are available, and therefore, there is a tendency to rely heavily on information extrapolated from the periodontal literature. More studies on the significance of implant maintenance care are required.

The Efficacy of Supportive Peri-Implant Therapies in Preventing Peri-Implantitis and Implant Loss: a Systematic Review of the Literature

Objectives

To study the efficacy of supportive peri-implant therapies in preventing clinical and radiological signs of peri-implantitis and implant loss.

Material and Methods

Longitudinal human studies, published between January 1, 2006, and February 1, 2016, were included based on an electronic search using MEDLINE and EMBASE databases and complemented by a manual search. Articles were included only if 1) they comprised a group of patients involved in/adhering to regular supportive peri-implant therapies (SPTs) and a control group without such therapies or with poor adherence to them, 2) the protocol of the SPTs was clearly described and 3) the outcome was indicated by means of clinical/radiological changes or implant loss.

Results

After initially identifying a total of 710 titles and abstracts, 12 full text articles were selected for eligibility assessment. Seven studies, three prospective and four retrospective, fulfilled the inclusion criteria for this review.

The frequency of recall visits varied between the studies from a minimum of one visit every three months to an individually tailored regimen. In all the studies a lack of SPTs or poor adherence to them resulted in significantly higher frequencies of sites with mucosal bleeding, deepened peri-implant pockets or alveolar bone loss. In line with the above, a lack of/poor adherence to SPTs was associated with higher implant loss.

Conclusions

To prevent peri-implantitis, an individually tailored supportive programme based on patient motivation and re-instruction in oral hygiene measures combined with professional implant cleaning seem to be crucial.

Analysis of factors associated with maintenance discontinuation in implant patients

Maintenance following implant treatment is essential to ensure long-term stability. Accordingly, the objective of this study was to investigate the factors leading patients to discontinue maintenance following implant treatment. Among the 729 patients that underwent implantation at the Department of Oral Implantology, Osaka Dental University Hospital from January 2008 to December 2012, 41 patients were excluded from the study. Exclusion criteria comprised patients without a superstructure attachment, those who only underwent maxillary sinus floor augmentation procedures and those who discontinued visiting the hospital prior to superstructure attachment. Treatment was discontinued in 181 patients. The rate of discontinuation was 26.6 %. The odds ratio (OR) in the adjustment model was 1.552 (95 % CI 1.078–2.236) in males when compared with females. When compared with those who were 30–64 years old, the OR was 5.818 (95 % CI 3.017–11.220) in those 29 years old or younger and 1.561 (95 % CI 1.021–2.386) in those 65 years old or older. Moreover, when compared with those with a O’Leary’s Plaque Control Record of all teeth and superstructures (PCR) level of 20 % or less following superstructure attachment, the OR was 2.113 (95 % CI 1.471–3.035) in those with a PCR level of 20 % or more following superstructure attachment. It is highly important to decrease maintenance discontinuation, especially in patients aged 29 years old or younger with a PCR level of 20 % or more following superstructure attachment. Moreover, a support system must be developed to enable patients with difficulties visiting the hospital to continue their maintenance program.