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Sadeghian Dehkord E, De Carvalho B, Ernst M, Albert A, Lambert F, Geris L. Influence of physicochemical characteristics of calcium phosphate-based biomaterials in cranio-maxillofacial bone regeneration. A systematic literature review and meta-analysis of preclinical models. Mater Today Bio 2024; 26:101100. [PMID: 38854953 PMCID: PMC11157282 DOI: 10.1016/j.mtbio.2024.101100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 05/20/2024] [Accepted: 05/21/2024] [Indexed: 06/11/2024] Open
Abstract
Objectives Calcium phosphate-based biomaterials (CaP) are the most widely used biomaterials to enhance bone regeneration in the treatment of alveolar bone deficiencies, cranio-maxillofacial and periodontal infrabony defects, with positive preclinical and clinical results reported. This systematic review aimed to assess the influence of the physicochemical properties of CaP biomaterials on the performance of bone regeneration in preclinical animal models. Methods The PubMed, EMBASE and Web of Science databases were searched to retrieve the preclinical studies investigating physicochemical characteristics of CaP biomaterials. The studies were screened for inclusion based on intervention (physicochemical characterization and in vivo evaluation) and reported measurable outcomes. Results A total of 1532 articles were retrieved and 58 studies were ultimately included in the systematic review. A wide range of physicochemical characteristics of CaP biomaterials was found to be assessed in the included studies. Despite a high degree of heterogeneity, the meta-analysis was performed on 39 studies and evidenced significant effects of biomaterial characteristics on their bone regeneration outcomes. The study specifically showed that macropore size, Ca/P ratio, and compressive strength exerted significant influence on the formation of newly regenerated bone. Moreover, factors such as particle size, Ca/P ratio, and surface area were found to impact bone-to-material contact during the regeneration process. In terms of biodegradability, the amount of residual graft was determined by macropore size, particle size, and compressive strength. Conclusion The systematic review showed that the physicochemical characteristics of CaP biomaterials are highly determining for scaffold's performance, emphasizing its usefulness in designing the next generation of bone scaffolds to target higher rates of regeneration.
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Affiliation(s)
- Ehsan Sadeghian Dehkord
- GIGA In Silico Medicine, Biomechanics Research Unit (Biomech), University of Liège, Belgium
- Prometheus, The R&D Division for Skeletal Tissue Engineering, KU Leuven, Belgium
| | - Bruno De Carvalho
- Department of Periodontology, Oral-Dental and Implant Surgery, CHU of Liège, Belgium
- Dental Biomaterials Research Unit (d-BRU), University of Liège, Belgium
| | - Marie Ernst
- Biostatistics and Research Method Center (B-STAT), CHU of Liège and University of Liège, Belgium
| | - Adelin Albert
- Biostatistics and Research Method Center (B-STAT), CHU of Liège and University of Liège, Belgium
- Department of Public Health Sciences, University of Liège, Belgium
| | - France Lambert
- Department of Periodontology, Oral-Dental and Implant Surgery, CHU of Liège, Belgium
- Dental Biomaterials Research Unit (d-BRU), University of Liège, Belgium
| | - Liesbet Geris
- GIGA In Silico Medicine, Biomechanics Research Unit (Biomech), University of Liège, Belgium
- Prometheus, The R&D Division for Skeletal Tissue Engineering, KU Leuven, Belgium
- Department of Mechanical Engineering, Biomechanics Section (BMe), KU Leuven, Belgium
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Roccuzzo M, Mirra D, Roccuzzo A. Surgical treatment of peri-implantitis. Br Dent J 2024; 236:803-808. [PMID: 38789758 PMCID: PMC11126382 DOI: 10.1038/s41415-024-7405-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 04/22/2024] [Accepted: 04/22/2024] [Indexed: 05/26/2024]
Abstract
As utilisation of dental implants continues to rise, so does the incidence of biological complications. When peri-implantitis has already caused extensive bone resorption, the dentist faces the dilemma of which therapy is the most appropriate to maintain the implant. Since non-surgical approaches of peri-implantitis have shown limited effectiveness, the present paper describes different surgical treatment modalities, underlining their indications and limitations. The primary goal in the management of peri-implantitis is to decontaminate the surface of the infected implant and to eliminate deep peri-implant pockets. For this purpose, access flap debridement, with or without resective procedures, has shown to be effective in a large number of cases. These surgical treatments, however, may be linked to post-operative recession of the mucosal margin. In addition to disease resolution, reconstructive approaches also seek to regenerate the bone defect and to achieve re-osseointegration.
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Affiliation(s)
- Mario Roccuzzo
- Private Practice, Torino, Italy; Division of Maxillofacial Surgery, University of Torino, Italy; Department of Periodontics and Oral Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Andrea Roccuzzo
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland; Department of Oral and Maxillofacial Surgery, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark.
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3
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Bragaglia M, Sciarretta F, Filetici P, Lettieri-Barbato D, Dassatti L, Nicoletti F, Sibilia D, Aquilano K, Nanni F. Soybean Oil-Based 3D Printed Mesh Designed for Guided Bone Regeneration (GBR) in Oral Surgery. Macromol Biosci 2024; 24:e2300458. [PMID: 38198834 DOI: 10.1002/mabi.202300458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 12/22/2023] [Indexed: 01/12/2024]
Abstract
This study aims to obtain a cyto-compatible 3D printable bio-resin for the manufacturing of meshes designed from acquired real patients' bone defect to be used in future for guided bone regeneration (GBR), achieving the goal of personalized medicine, decreasing surgical, recovery time, and patient discomfort. To this purpose, a biobased, biocompatible, and photo-curable resin made of acrylated epoxidized soybean oil (AESO) diluted with soybean oil (SO) is developed and 3D printed using a commercial digital light processing (DLP) 3D printer. 3D printed samples show good thermal properties, allowing for thermally-based sterilization process and mechanical properties typical of crosslinked natural oils (i.e., E = 12 MPa, UTS = 1.5 MPa), suitable for the GBR application in the oral surgery. The AESO-SO bio-resin proves to be cytocompatible, allowing for fibroblast cells proliferation (viability at 72 h > 97%), without inducing severe inflammatory response when co-cultured with macrophages, as demonstrated by cytokine antibody arrays, that is anyway resolved in the first 24 h. Moreover, accelerated degradation tests prove that the bio-resin is biodegradable in hydrolytic environments.
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Affiliation(s)
- Mario Bragaglia
- Department of Enterprise Engineering, University of Rome "Tor Vergata", Via del Politecnico 1, Rome, 00133, Italy
| | | | - Pierfrancesco Filetici
- Multispecialty Department of Oral Surgery - Periodontology and Implant-Prosthodontic Rehabilitation, Università Cattolica del Sacro Cuore, Largo F. Vito 1, Rome, 00168, Italy
| | | | - Leonardo Dassatti
- Multispecialty Department of Oral Surgery - Periodontology and Implant-Prosthodontic Rehabilitation, Università Cattolica del Sacro Cuore, Largo F. Vito 1, Rome, 00168, Italy
| | - Fabrizio Nicoletti
- Multispecialty Department of Oral Surgery - Periodontology and Implant-Prosthodontic Rehabilitation, Università Cattolica del Sacro Cuore, Largo F. Vito 1, Rome, 00168, Italy
| | - Diego Sibilia
- Department of Life Science and Public Health, Università Cattolica del Sacro Cuore, Largo F. Vito, 1, Rome, 00168, Italy
| | - Katia Aquilano
- Department of Biology, University of Rome "Tor Vergata", Via della Ricerca scientifica 1, Rome, 00133, Italy
| | - Francesca Nanni
- Department of Enterprise Engineering, University of Rome "Tor Vergata", Via del Politecnico 1, Rome, 00133, Italy
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4
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West N, Chapple I, Culshaw S, Donos N, Needleman I, Suvan J, Nibali L, Patel A, Preshaw PM, Kebschull M. BSP Implementation of Prevention and Treatment of Peri-implant Diseases - The EFP S3 Level Clinical Practice Guideline. J Dent 2024:104980. [PMID: 38697506 DOI: 10.1016/j.jdent.2024.104980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 03/28/2024] [Indexed: 05/05/2024] Open
Abstract
OBJECTIVES to adapt the supranational European Federation of Periodontology (EFP) Prevention and Treatment of Peri-implant Diseases - The EFP S3 Level Clinical Practice Guideline for UK healthcare environment, taking into account a broad range of views from stakeholders and patients. SOURCES This UK version, based on the supranational EFP guideline [1] published in the Journal of Clinical Periodontology, was developed using S3-level methodology, combining assessment of formal evidence from 13 systematic reviews with a moderated consensus process of a representative group of stakeholders, and accounts for health equality, environmental factors and clinical effectiveness. It encompasses 55 clinical recommendations for the Prevention and Treatment of Peri-implant Diseases, based on the classification for periodontal and peri-implant diseases and conditions [2]. METHODOLOGY The UK version was developed from the source guideline using a formal process called the GRADE ADOLOPMENT framework. This framework allows for adoption (unmodified acceptance), adaptation (acceptance with modifications) and the de novo development of clinical recommendations. Using this framework, following the S3-process, the underlying evidence was updated and a representative guideline group of 111 delegates from 26 stakeholder organisations was assembled into four working groups. Following the formal S3-process, all clinical recommendations were formally assessed for their applicability to the UK and adoloped accordingly. RESULTS AND CONCLUSION Using the ADOLOPMENT protocol, a UK version of the EFP S3-level clinical practice guideline for the Prevention and Treatment of Peri-implant Diseases was developed. This guideline delivers evidence- and consensus-based clinical recommendations of direct relevance to the UK healthcare community including the public. CLINICAL SIGNIFICANCE The S3-level-guidelines combine evaluation of formal evidence, grading of recommendations and synthesis with clinical expertise of a broad range of stakeholders. The international S3-level-guideline was implemented for direct clinical applicability in the UK healthcare system, facilitating a consistent, interdisciplinary, evidence-based approach with public involvement for the prevention and treatment of peri-implant diseases.
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Affiliation(s)
- Nicola West
- Restorative Dentistry, Bristol Dental School, University of Bristol, Bristol BS1 2LY, UK; Restorative Dentistry, Bristol Dental Hospital, University Hospitals Bristol and Weston NHS Foundation Trust, Marlborough Street, Bristol, BS1 3NU, Secretary General of the European Federation of Periodontology.
| | - Iain Chapple
- Birmingham NIHR Biomedical Research Centre in Inflammation. The University of Birmingham, Birmingham, United Kingdom; Birmingham Community Healthcare NHS Foundation Trust, Birmingham, United Kingdom
| | - Shauna Culshaw
- University of Glasgow Dental School, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Nikos Donos
- Centre for Oral Clinical Research, Institute of Dentistry, Faculty of Medicine and Dentistry, Queen Mary University of London (AMUL), Turner Street, London, E1 2AD
| | - Ian Needleman
- Unit of Periodontology, UCL Eastman Dental Institute, Bloomsbury Campus, Rockefeller Building, 21 University Street, London, WC1E 6DE
| | - Jeanie Suvan
- Unit of Periodontology, UCL Eastman Dental Institute, Bloomsbury Campus, Rockefeller Building, 21 University Street, London, WC1E 6DE
| | - Luigi Nibali
- Periodontology Unit, Centre for Host-Microbiome Interactions, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, Guys Hospital, Great Maze Pond, London, SE1 9RT
| | - Amit Patel
- Birmingham Dental Specialists, Associate Professor, University of Birmingham, Birmingham, UK, President of the Association of Dental Implantology
| | - Philip M Preshaw
- School of Dentistry, University of Dundee, Dundee UK; School of Dental Sciences, University of Newcastle, Newcastle upon Tyne, UK
| | - Moritz Kebschull
- Birmingham NIHR Biomedical Research Centre in Inflammation. The University of Birmingham, Birmingham, United Kingdom; Birmingham Community Healthcare NHS Foundation Trust, Birmingham, United Kingdom; Division of Periodontics, Section of Oral, Diagnostic and Rehabilitation Sciences, College of Dental Medicine, Columbia University, New York, NY, USA; School of Dentistry, University of Birmingham, Birmingham B5 7EG, UK, President-Elect of the European Federation of Periodontology.
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Lin CH, Wang HL, Yu LW, Chou PY, Chang HC, Chang CH, Chang PC. Deep learning for the identification of ridge deficiency around dental implants. Clin Implant Dent Relat Res 2024; 26:376-384. [PMID: 38151900 DOI: 10.1111/cid.13301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 11/12/2023] [Accepted: 12/11/2023] [Indexed: 12/29/2023]
Abstract
OBJECTIVES This study aimed to use a deep learning (DL) approach for the automatic identification of the ridge deficiency around dental implants based on an image slice from cone-beam computerized tomography (CBCT). MATERIALS AND METHODS Single slices crossing the central long-axis of 630 mandibular and 845 maxillary virtually placed implants (4-5 mm diameter, 10 mm length) in 412 patients were used. The ridges were classified based on the intraoral bone-implant support and sinus floor location. The slices were either preprocessed by alveolar ridge homogenizing prior to DL (preprocessed) or left unpreprocessed. A convolutional neural network with ResNet-50 architecture was employed for DL. RESULTS The model achieved an accuracy of >98.5% on the unpreprocessed image slices and was found to be superior to the accuracy observed on the preprocessed slices. On the mandible, model accuracy was 98.91 ± 1.45%, and F1 score, a measure of a model's accuracy in binary classification tasks, was lowest (97.30%) on the ridge with a combined horizontal-vertical defect. On the maxilla, model accuracy was 98.82 ± 1.11%, and the ridge presenting an implant collar-sinus floor distance of 5-10 mm with a dehiscence defect had the lowest F1 score (95.86%). To achieve >90% model accuracy, ≥441 mandibular slices or ≥592 maxillary slices were required. CONCLUSIONS The ridge deficiency around dental implants can be identified using DL from CBCT image slices without the need for preprocessed homogenization. The model will be further strengthened by implementing more clinical expertise in dental implant treatment planning and incorporating multiple slices to classify 3-dimensional implant-ridge relationships.
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Affiliation(s)
- Cheng-Hung Lin
- Department of Electrical Engineering, College of Technology and Engineering, National Taiwan Normal University, Taipei, Taiwan
| | - Hom-Lay Wang
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA
| | - Li-Wen Yu
- Graduate Institute of Clinical Dentistry, School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan
- Division of Periodontics, Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - Po-Yung Chou
- Department of Electrical Engineering, College of Technology and Engineering, National Taiwan Normal University, Taipei, Taiwan
| | - Hao-Chieh Chang
- Graduate Institute of Clinical Dentistry, School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chin-Hao Chang
- Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan
| | - Po-Chun Chang
- Graduate Institute of Clinical Dentistry, School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan
- Division of Periodontics, Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
- School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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6
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Jia P, Tang Y, Niu L, Qiu L. Clinical and radiographic outcomes of a combined surgery approach to treat peri-implantitis. Int J Oral Maxillofac Surg 2024; 53:333-342. [PMID: 38154998 DOI: 10.1016/j.ijom.2023.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 11/17/2023] [Accepted: 11/22/2023] [Indexed: 12/30/2023]
Abstract
Peri-implant infra-bony defects are difficult to treat, and data on the management of peri-implantitis are lacking. The aim of this study was to evaluate the effect of a combined surgical approach to manage peri-implantitis: implantoplasty with xenogeneic bone grafting and a concentrated growth factor membrane. Two independent examiners analysed the medical records and radiographs taken before surgery and at the last follow-up. Data were analysed at the implant level; some patient-level data (age, sex, smoking habit) were also considered. Linear regression analysis with generalized estimating equations (GEE) was used to explore the effect of variables of interest (including marginal bone level (MBL)) on implantitis treatment success and resolution rates. The effect of the prosthesis type on postoperative clinical and radiographic parameters was also explored by GEE, with adjustment for age, sex, tooth site, location, follow-up duration, and implant length (model IV including all). Thirty patients with 72 implants were investigated. The implant survival rate was 100% over a mean observation period of 3.3 years (range 2-11 years). The treatment success rate (bone loss <0.5 mm, no bleeding on probing (BOP), no suppuration, probing depth (PD) < 5 mm) was higher in females than males (50% vs 19.0%; P = 0.008). At the last postoperative follow-up, the MBL (1.51 ± 1.07 vs 4.01 ± 1.13 mm), PD (3.61 ± 0.84 vs 6.54 ± 1.01 mm), and BOP (23.38 ± 23.18% vs 79.17 ± 15.51%) were significantly reduced when compared to pre-surgery values (all P < 0.001). Furthermore, a significantly higher PD reduction (β = -1.10 mm, 95% confidence interval -1.97 to -0.23 mm, P = 0.014) was observed for implants with a single crown than a full-arch prosthesis (GEE model IV). Preliminary clinical and radiographic data indicate that implantoplasty in combination with surgery could be an effective treatment option for peri-implantitis.
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Affiliation(s)
- P Jia
- Fourth Division, Peking University School and Hospital of Stomatology, China; National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, China; Research Center of Engineering and Technology for Digital Dentistry of the Ministry of Health, China; Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - Y Tang
- Fourth Division, Peking University School and Hospital of Stomatology, China; National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, China; Research Center of Engineering and Technology for Digital Dentistry of the Ministry of Health, China; Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - L Niu
- Fourth Division, Peking University School and Hospital of Stomatology, China; National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, China; Research Center of Engineering and Technology for Digital Dentistry of the Ministry of Health, China; Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - L Qiu
- Fourth Division, Peking University School and Hospital of Stomatology, China; National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, China; Research Center of Engineering and Technology for Digital Dentistry of the Ministry of Health, China; Beijing Key Laboratory of Digital Stomatology, Beijing, China.
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Schwarz F, Ramanauskaite A, Wetzel W, Mayer S, Obreja K, Parvini P. Clinical outcomes following a combined vertical and horizontal alveolar ridge augmentation and two-stage implant placement using either autogenous tooth roots or autogenous bone blocks. Clin Implant Dent Relat Res 2024; 26:369-375. [PMID: 38177089 DOI: 10.1111/cid.13299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/24/2023] [Accepted: 12/05/2023] [Indexed: 01/06/2024]
Abstract
AIM To assess and compare the short-term clinical outcomes following a combined vertical and horizontal alveolar ridge augmentation and two-stage implant placement using either autogenous tooth roots (TR) or autogenous bone blocks (AB). MATERIALS AND METHODS A total of n = 27 patients (TR/AB: 13/14) exhibiting n = 31 implants (TR/AB: 14/17) were available for the analysis. Each subject had been allocated to a combined vertical and horizontal alveolar ridge augmentation using either (1) healthy TR (e.g., retained wisdom teeth), or (2) monocortical AB harvested from the retromolar area (i.e. external oblique line). Clinical parameters (e.g., bleeding on probing, BOP; probing pocket depth, PD; mucosal recession, MR) were recorded after a follow-up period of 16.03 ± 4.3 months following implant placement. RESULTS The survival rates amounted to 100% in both groups. TR and AB grafted sites were associated with similar changes in mean BOP (8.97 ± 27.73%; 11.90 ± 18.97%), PD (0.53 ± 0.49; 0.47 ± 0.67 mm), and MR (0.03 ± 0.13; 0.0 ± 0.02 mm) values. The incidence of peri-implant mucositis and peri-implantitis at the patient level amounted to 15.38% and 0.0% in the TR-, and 28.57% and 7.14% in the AB group. CONCLUSIONS Both surgical procedures were associated with peri-implant tissue health and stability on the short-term.
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Affiliation(s)
- F Schwarz
- Goethe University, Department of Oral Surgery and Implantology, Frankfurt, Germany
| | - A Ramanauskaite
- Goethe University, Department of Oral Surgery and Implantology, Frankfurt, Germany
| | - W Wetzel
- Goethe University, Department of Oral Surgery and Implantology, Frankfurt, Germany
| | - S Mayer
- Goethe University, Department of Oral Surgery and Implantology, Frankfurt, Germany
| | - K Obreja
- Goethe University, Department of Oral Surgery and Implantology, Frankfurt, Germany
| | - P Parvini
- Goethe University, Department of Oral Surgery and Implantology, Frankfurt, Germany
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8
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Merli M, Fratini A, Sforza NM, Landi L, Pagliaro U, Franchi L, Nieri M. Clinical decision-making and management of stage IV periodontitis: A survey. Oral Dis 2024; 30:729-742. [PMID: 36055972 DOI: 10.1111/odi.14366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 07/16/2022] [Accepted: 08/12/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate the clinical management of stage IV periodontitis patients among clinicians within the Italian Society of Periodontology and Implantology. METHODS A cross-sectional study was designed on a web-based anonymous survey. Comparison between ordinary members (OMs) versus active and certified members (ACMs) and comparison between members with at least 10 years of experience in periodontology (Ov10) and members with less than 10 years of experience in periodontology (Un10) were performed. RESULTS A total of 324 out of 1362 members (response rate of 24%) responded to the questionnaire. ACMs and Ov10 more often reported their teams hold adequate skills to manage cases. Step I and II periodontal therapy took more time in the ACMs and Ov10 groups. ACMs used different strategies to perform step I-II therapy, and antibiotics were used less frequently than OMs. Unresponsive sites were treated more often with surgery by ACMs compared to OMs. ACMs adopted different treatment sequences compared to OMs. Ov10 group used more often CBCT, lateral cephalogram, and wax-up while Un10 group tend to avoid orthodontic therapy. CONCLUSIONS More experienced members spent more time in step I and II of periodontal therapy, used more diagnostic tools, and performed more often surgery and orthodontics in the treatment of stage IV periodontitis patients.
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Affiliation(s)
- Mauro Merli
- Adjunct Professor Politecnico delle Marche, Ancona, Italy
- Private Practice, Rimini, Italy
| | - Adriano Fratini
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | | | - Luca Landi
- CAGS Private Practice Roma and Verona, Verona, Italy
| | - Umberto Pagliaro
- Department of Experimental and Clinical Medicine, Università degli Studi di Firenze, Florence, Italy
| | - Lorenzo Franchi
- Department of Experimental and Clinical Medicine, Università degli Studi di Firenze, Florence, Italy
| | - Michele Nieri
- Department of Experimental and Clinical Medicine, Università degli Studi di Firenze, Florence, Italy
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9
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Yang L, Wang Q, Wang X, Yang Z, Ning Y, Guo Z. Horizontal ridge augmentation in the maxillary aesthetic region using the autogenous circular cortical-lamina anchoring technique: A case series study. Clin Implant Dent Relat Res 2024. [PMID: 38320956 DOI: 10.1111/cid.13311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 01/18/2024] [Accepted: 01/19/2024] [Indexed: 02/08/2024]
Abstract
AIM This case series aimed to evaluate the effectiveness of the autologous circular cortical lamina-anchoring (CCA) technique for horizontal bone augmentation in the maxillary aesthetic region. MATERIALS AND METHODS A total of 25 patients with 28 implants underwent horizontal bone augmentation using CCA followed by implant placement and crown delivery. The primary outcome measures were alveolar ridge width (ARW) and buccal bone thickness (BBT), whereas the secondary outcome measures included marginal bone loss (MBL), mid-facial mucosal margin loss (MML), clinical assessment of peri-implant and aesthetic parameters, patient-reported outcome measures (PROMs), and implant survival rates. RESULTS All 25 patients with 28 implants completed the treatment, no dropouts occurred. After CCA, the mean ARW at 1, 2, and 4 mm below the alveolar crest significantly increased from 2.38 ± 0.48, 2.85 ± 0.51, and 3.21 ± 0.53 mm to 6.80 ± 0.48, 6.99 ± 0.50, and 8.08 ± 0.52 mm, respectively. At the 3-year follow-up, the mean BBT0 , BBT2 , and BBT4 slightly decreased from 2.51 ± 0.26, 2.63 ± 0.31, and 2.75 ± 0.29 mm to 2.43 ± 0.27, 2.51 ± 0.30, and 2.64 ± 0.28 mm, respectively. Although the overall MBL was <0.15 mm, the results were statistically significant. The mean MML at the 3-year follow-up was 0.02 mm. All implant sites showed acceptable peri-implant and aesthetic outcomes. Incisions healed without complications, and no significant differences in PROMs observed at any time point. The 3-year follow-up showed a 100% implant survival rate. CONCLUSION The autologous CCA technique is a useful method for increasing ARW and maintaining BBT in the maxillary aesthetic region.
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Affiliation(s)
- Liqing Yang
- Center of Oral Implantology, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, P. R. China
| | - Qing Wang
- Department of Orthodontics, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, P. R. China
| | - Xinyi Wang
- Center of Oral Implantology, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, P. R. China
| | - Zijing Yang
- Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, P. R. China
| | - Yingyuan Ning
- Center of Oral Implantology, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, P. R. China
| | - Zehong Guo
- Center of Oral Implantology, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, P. R. China
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10
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Berglundh T, Mombelli A, Schwarz F, Derks J. Etiology, pathogenesis and treatment of peri-implantitis: A European perspective. Periodontol 2000 2024. [PMID: 38305506 DOI: 10.1111/prd.12549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 12/19/2023] [Accepted: 12/22/2023] [Indexed: 02/03/2024]
Abstract
Peri-implantitis is a plaque-associated pathological condition occurring in tissues around dental implants. It is characterized by inflammation in the peri-implant mucosa and progressive loss of supporting bone. Over the last 30 years, peri-implantitis has become a major disease burden in dentistry. An understanding of the diagnosis, etiology and pathogenesis, epidemiology, and treatment of peri-implantitis must be a central component in undergraduate and postgraduate training programs in dentistry. In view of the strong role of European research in periodontology and implant dentistry, the focus of this review was to address peri-implantitis from a European perspective. One component of the work was to summarize new and reliable data on patients with dental implants to underpin the relevance of peri-implantitis from a population perspective. The nature of the peri-implantitis lesion was evaluated through results presented in preclinical models and evaluations of human biopsy material together with an appraisal of the microbiological characteristics. An overview of strategies and outcomes presented in clinical studies on nonsurgical and surgical treatment of peri-implantitis is discussed with a particular focus on end points of therapy and recommendations presented in the S3 level Clinical Practice Guideline for the prevention and treatment of peri-implant diseases.
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Affiliation(s)
- Tord Berglundh
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Andrea Mombelli
- Division of Regenerative Dental Medicine and Periodontology, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Frank Schwarz
- Department of Oral Surgery and Implantology, Goethe University, Carolinum, Frankfurt, Germany
| | - Jan Derks
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Cucchi A, Maiani F, Franceschi D, Sassano M, Fiorino A, Urban IA, Corinaldesi G. The influence of vertical ridge augmentation techniques on peri-implant bone loss: A systematic review and meta-analysis. Clin Implant Dent Relat Res 2024; 26:15-65. [PMID: 38114425 DOI: 10.1111/cid.13282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 08/09/2023] [Accepted: 09/12/2023] [Indexed: 12/21/2023]
Abstract
INTRODUCTION The primary aim of this systematic review was to investigate and compare the outcomes of different vertical ridge augmentation (VRA) techniques in relation to peri-implant bone loss (PBL), after at least 12 months of functional loading. MATERIAL AND METHODS The search was conducted to find all the studies about VRA and measurements of PBL with at least 12 months follow-up. Three pairwise meta-analysis (MA) was performed to completely evaluate the outcomes. RESULTS A total of 42 studies were included, of which 11 were randomized clinical trials (RCTs). RCTs were available only for guided bone regeneration (GBR), onlay, and inlay techniques. The weighted mean estimate (WME) of PBL value was found to be 1.38 mm (95% confidence interval [95% CI]: 1.10-1.66) after a mean follow-up of 41.0 ± 27.8 months. GBR, Inlay, Onlay, osteodistraction, and SBB represented in weight 32.9%, 30.6%, 25.0%, 7.6%, and 3.9%, respectively; and their WME (95% CI) were 1.06 (0.87-1.26) mm, 1.72 (1.00-2.43) mm, 1.31 (0.87-1.75) mm, 1.81 (0.87-1.75) mm, and 0.66 (0.55-0.77) mm, respectively. Among the secondary outcomes, the analysis was conducted for vertical bone gain, healing complication rate, surgical complication rate, implant survival, and success rate. CONCLUSIONS The primary findings of the meta-analysis, based on the changes between final and baseline values, showed that the peri-implant bone loss could be influenced by the type of intervention but there is a need to evaluate in RCTs the behavior of the peri-implant bone levels after long-term follow-up for all techniques.
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Affiliation(s)
| | | | - Debora Franceschi
- Department of Experimental and Clinic Medicine, University of Florence, Firenze, Italy
| | - Michele Sassano
- Department of Life Sciences and Public Health, Catholic University of The Sacred Heart, Rome, Italy
| | - Antonino Fiorino
- Department of Neuroscience and Reproductive and Odontostomatological Sciences, "Federico II" University of Naples, Napoli, Italy
| | - Istvan A Urban
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
- Department of Periodontics, University of Szeged, Szeged, Hungary
- Urban Regeneration Institute, Budapest, Hungary
| | - Giuseppe Corinaldesi
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
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12
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De Carvalho B, Dory E, Trus C, Pirson J, Germain L, Lecloux G, Lambert F, Rompen E. Biological performance of a novel bovine hydroxyapatite in a guided bone regeneration model: A preclinical study in a mandibular defect in dogs. Clin Implant Dent Relat Res 2024; 26:183-196. [PMID: 37789642 DOI: 10.1111/cid.13260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 06/21/2023] [Accepted: 07/29/2023] [Indexed: 10/05/2023]
Abstract
OBJECTIVES This preclinical model study aims to evaluate the performance and safety of a novel hydroxyapatite biomaterial (Wishbone Hydroxyapatite, WHA) on guided bone regeneration compared to a commercially available deproteinized bovine bone mineral (Bio-Oss, BO). MATERIAL AND METHODS Twenty-four beagle dogs were allocated to three timepoint cohorts (4, 12, and 26 weeks) of eight animals each. In all animals, four critical-sized, independent wall mandibular defects were created (32 defects/cohort). Each animal received all four treatments, allocated randomly to separated defects: WHA + collagen membrane (M), BO + M, no treatment (Sham, Sh), and Sh + M. At each timepoint, the specimens were harvested for histologic and histomorphometric analyses to determine the newly formed bone and osteoconductivity. RESULTS At 4 weeks, bone regeneration was significantly higher for WHA + M (46.8%) when compared to BO + M (21.4%), Sh (15.1%), and Sh + M (23.1%) (p < 0.05); at 12 and 26 weeks, regeneration was similar for WHA and BO. Bone-to-material contact increased over time similarly for WHA + M and BO + M. From a safety point of view, inflammation attributed to WHA + M or BO + M was minimal; necrosis or fatty infiltrate was absent. CONCLUSIONS WHA + M resulted in higher bone regeneration rate than BO + M at 4 weeks. Both BO + M and WHA + M were more efficient than both Sh groups at all timepoints. Safety and biocompatibility of WHA was favorable and comparable to that of BO.
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Affiliation(s)
- Bruno De Carvalho
- Department of Periodontology, Oro-Dental and Implant Surgery, Dental Biomaterial Research Unit, Liège, Belgium
| | | | | | | | | | - Geoffrey Lecloux
- Department of Periodontology, Oro-Dental and Implant Surgery, Dental Biomaterial Research Unit, Liège, Belgium
| | - France Lambert
- Department of Periodontology, Oro-Dental and Implant Surgery, Dental Biomaterial Research Unit, Liège, Belgium
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Baima G, Romano F, Roato I, Mosca Balma A, Pedraza R, Faga MG, Amoroso F, Orrico C, Genova T, Aimetti M, Mussano F. Efficacy of a Solution Containing 33% Trichloroacetic Acid and Hydrogen Peroxide in Decontaminating Machined vs. Sand-Blasted Acid-Etched Titanium Surfaces. J Funct Biomater 2024; 15:21. [PMID: 38248688 PMCID: PMC10816840 DOI: 10.3390/jfb15010021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/27/2023] [Accepted: 01/09/2024] [Indexed: 01/23/2024] Open
Abstract
This in vitro study assessed the efficacy of a solution containing 33% trichloroacetic acid (CCl3COOH; TCA) and hydrogen peroxide (H2O2) in decontaminating machined (MAC) and sand-blasted acid-etched (SBAE) titanium surfaces. A total of 80 titanium disks were prepared (40 MAC and 40 SBAE). Streptococcus sanguinis and Enterococcus faecalis strains were incubated on 36 samples, while the remaining 44 were kept as controls. Roughness analysis and scanning electron microscopy were used to evaluate the surface features before and after TCAH2O2 treatment. The viability of human adipose-derived mesenchymal stem cells (ASCs) after TCAH2O2 decontamination was assessed with a chemiluminescent assay along with cell morphology through fluorescent staining. TCAH2O2 preserved the surface topography of MAC and SBAE specimens. It also effectively eradicated bacteria on both types of specimens without altering the surface roughness (p > 0.05). Also, no significant differences in protein adsorption between the pristine and TCAH2O2-treated surfaces were found (p = 0.71 and p = 0.94). While ASC proliferation remained unchanged on MAC surfaces, a decrease was observed on the decontaminated SBAE specimens at 24 and 48 h (p < 0.05), with no difference at 72 h (p > 0.05). Cell morphology showed no significant changes after 72 h on both surface types even after decontamination. This study suggests TCAH2O2 as a promising decontamination agent for titanium surfaces, with potential implications for peri-implant health and treatment outcomes.
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Affiliation(s)
- Giacomo Baima
- Department of Surgical Sciences, University of Turin, 10126 Turin, Italy; (F.R.); (I.R.); (A.M.B.); (R.P.); (F.A.); (M.A.); (F.M.)
- DIMEAS, Politecnico di Torino, 10129 Turin, Italy
| | - Federica Romano
- Department of Surgical Sciences, University of Turin, 10126 Turin, Italy; (F.R.); (I.R.); (A.M.B.); (R.P.); (F.A.); (M.A.); (F.M.)
| | - Ilaria Roato
- Department of Surgical Sciences, University of Turin, 10126 Turin, Italy; (F.R.); (I.R.); (A.M.B.); (R.P.); (F.A.); (M.A.); (F.M.)
| | - Alessandro Mosca Balma
- Department of Surgical Sciences, University of Turin, 10126 Turin, Italy; (F.R.); (I.R.); (A.M.B.); (R.P.); (F.A.); (M.A.); (F.M.)
| | - Riccardo Pedraza
- Department of Surgical Sciences, University of Turin, 10126 Turin, Italy; (F.R.); (I.R.); (A.M.B.); (R.P.); (F.A.); (M.A.); (F.M.)
- DIMEAS, Politecnico di Torino, 10129 Turin, Italy
- Institute of Sciences and Technologies for Sustainable Energy and Mobility, National Council of Research, 10135 Turin, Italy;
| | - Maria Giulia Faga
- Institute of Sciences and Technologies for Sustainable Energy and Mobility, National Council of Research, 10135 Turin, Italy;
| | - Federico Amoroso
- Department of Surgical Sciences, University of Turin, 10126 Turin, Italy; (F.R.); (I.R.); (A.M.B.); (R.P.); (F.A.); (M.A.); (F.M.)
- DIMEAS, Politecnico di Torino, 10129 Turin, Italy
| | - Clarissa Orrico
- Fondazione Ricerca Molinette—Onlus, A.O.U. Città della Salute e della Scienza, 10126 Turin, Italy;
| | | | - Mario Aimetti
- Department of Surgical Sciences, University of Turin, 10126 Turin, Italy; (F.R.); (I.R.); (A.M.B.); (R.P.); (F.A.); (M.A.); (F.M.)
| | - Federico Mussano
- Department of Surgical Sciences, University of Turin, 10126 Turin, Italy; (F.R.); (I.R.); (A.M.B.); (R.P.); (F.A.); (M.A.); (F.M.)
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Kaigler D, Misch J, Alrmali A, Inglehart MR. Periodontists and stem cell-based therapy for alveolar bone regeneration: A national survey. J Periodontol 2024. [PMID: 38196330 DOI: 10.1002/jper.23-0506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 11/06/2023] [Accepted: 11/06/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND Stem cell-based therapy for bone regeneration has received attention in medical settings but has not yet been used in clinical practice for treating alveolar bone defects. The objectives of this study were to explore whether periodontists had heard about this approach, and if so how, how interested they were to learn about it, which attitudes and behavioral intentions they had related to using stem cell-based grafting, and what they would like to know before using this approach. METHODS Anonymous survey data were collected from 481 members of the American Academy of Periodontology (response rate: 19.41%). RESULTS Responses showed 35.3% had heard about stem cell-based therapy, mostly from publications (9.6%) and meetings (8.3%); 76.1% wanted to learn about it through in-person continuing education (CE) courses, 68.6% in online CE courses, and 57.1% from manuals; 73% considered this approach promising; and 54.9% preferred it to traditional approaches. It was important to them that it would result in more bone volume (93%), better bone quality (90.4%), and accelerated healing (83.2%). Also, 60.1% considered it likely/very likely that they would adopt this approach, 54% that patients would prefer it, and 62.1% that it would benefit their practice. When asked what they would like to know about this approach, information about short- and long-term outcomes, cost, and logistical considerations were most frequently named. CONCLUSIONS These findings provide the basis to develop educational interventions for periodontists about this novel approach and inform future research activities aimed to translate this approach to clinical practice.
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Affiliation(s)
- Darnell Kaigler
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA
- Department of Biomedical Engineering, College of Engineering, University of Michigan, Ann Arbor, Michigan, USA
| | - Jonathan Misch
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA
| | - Abdusalam Alrmali
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA
- Department of Oral Medicine, Oral Pathology, Oral and Maxillofacial Surgery, University of Tripoli School of Dentistry, Tripoli, Libya
| | - Marita R Inglehart
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA
- Department of Psychology, College of Literature, Science and Arts (LS & A), University of Michigan, Ann Arbor, Michigan, USA
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Chan MH, Kang J. Diagnosis and Treatment of Periimplant Mucositis and Periimplantitis: An Overview and Related Controversial Issues. Dent Clin North Am 2024; 68:167-202. [PMID: 37951632 DOI: 10.1016/j.cden.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
Periimplant mucositis and periimplantitis are common complications of dental implant. This article provides a comprehensive overview of the 2017 World Workshop's new definition, clinical and radiographic presentation, pathogenesis, risk factors, and classification of periimplant diseases. Also, the authors discuss various types of instruments, materials, and techniques commonly used for treatment of nonsurgical and surgical periimplantitis. Lastly, the authors include some controversial topics surrounding this subject.
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Affiliation(s)
- Michael H Chan
- Oral & Maxillofacial Surgery, Department of Veterans Affairs, New York Harbor Healthcare System (Brooklyn Campus), 800 Poly Place (Bk-160), Brooklyn, NY 11209, USA; Oral & Maxillofacial Surgery, Department of Oral and Maxillofacial Surgery, The Brooklyn Hospital Center, 121 DeKalb Avenue (Box-187), Brooklyn, NY 11201, USA.
| | - Joseph Kang
- Oral & Maxillofacial Surgery, Department of Oral and Maxillofacial Surgery, The Brooklyn Hospital Center, 121 DeKalb Avenue (Box-187), Brooklyn, NY 11201, USA
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16
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Romito GA, Fonseca MA, Soares HH, de Oliveira Lazarin R, Sapata VM, Nishyama R, Conde MC, Hammerle CHF, Schwarz F, Villar CC. Clinical outcomes following atrophic alveolar ridge reconstruction using collagenated xenogeneic bone block or autogenous bone block: One-year follow-up of a randomized controlled clinical. J Clin Periodontol 2024; 51:14-23. [PMID: 37846853 DOI: 10.1111/jcpe.13891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 09/21/2023] [Accepted: 10/03/2023] [Indexed: 10/18/2023]
Abstract
AIM This investigation aimed to evaluate the 1-year survival of implants placed after staged lateral alveolar ridge augmentation using equine-derived collagenated xenogeneic bone blocks (CXBBs) or autogenous bone block (ABB). MATERIALS AND METHODS Fifty patients who underwent lateral augmentation in a previous trial were included. The primary outcome measure was implant survival at the 1-year follow-up, and secondary outcomes included implant success, peri-implant clinical and volumetric parameters, pink aesthetic scores (PES) and patient-reported outcome measures. Data analysis involved Fisher's exact test, the Mann-Whitney U-test and the Wilcoxon signed-rank test. RESULTS In this study, no late implant failures were observed. The cumulative survival rates were 78.6% for the CXBB group and 90.9% for the ABB group, with no difference between the groups. Similarly, the success rates were 53.6% and 63.6%, respectively, showing no significant difference. Peri-implant clinical and volumetric parameters indicated the presence of healthy peri-implant tissues surrounding implants placed in both CXBB- and ABB-augmented sites. PES were 8.5 and 11.0 for implants placed in CXBB- and ABB-augmented sites, respectively. Furthermore, patient satisfaction rates were high and similar between the groups. CONCLUSIONS Dental implants placed in both CXBB- and ABB-augmented ridges demonstrated no statistically significant differences in clinical, volumetric and aesthetic outcomes, along with high patient satisfaction rates.
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Affiliation(s)
| | | | - Herbert Horiuti Soares
- Discipline of Periodontics, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | | | - Vitor Marques Sapata
- Discipline of Periodontics, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Roger Nishyama
- Discipline of Prosthodontics, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Marina Clemente Conde
- Discipline of Periodontics, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | | | - Frank Schwarz
- Department of Oral Surgery and Implantology, Carolinum, Johann Wolfgang Goethe-University Frankfurt, Frankfurt, Germany
| | - Cristina Cunha Villar
- Discipline of Periodontics, School of Dentistry, University of São Paulo, São Paulo, Brazil
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17
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Gao Y, Gao S, Yao Y, Cai X. Hard tissue stability outside the buccal bone arch contour after guided bone regeneration in the anterior maxilla: A retrospective cohort radiographic study. Clin Oral Implants Res 2023; 34:1373-1384. [PMID: 37771049 DOI: 10.1111/clr.14181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 08/28/2023] [Accepted: 09/10/2023] [Indexed: 09/30/2023]
Abstract
OBJECTIVES To radiographically evaluate the stability of the bone substitute augmented outside the buccal bony arch contour in the maxillary esthetic zone. MATERIALS AND METHODS Patients who missed a single anterior tooth and received simultaneous GBR in implant surgery were included. The contralateral homonymous area of the implant site was horizontally mirrored as the individual bone arch contour. According to the relative position of the postoperative buccal grafts and bone arch contour at the implant shoulder, 62 patients were allocated into the outside-contour (OC) and inside-contour (IC) groups. Cone-beam computed tomography was performed before surgery, after implant insertion, before re-entry surgery, and at follow-up. The profilometric changes of the buccal bone plate were analyzed via the bone distance to the mirrored bony contour. RESULTS At the implant shoulder, the bone distance in the OC group was higher than that in the IC group, with statistically significant differences at re-entry surgery and follow-up. However, the bone grafts outside the bone arch contour were reduced into the contour after remodeling and showed more bone resorption than the IC group. At other vertical levels below the implant shoulder, bony grafting of overcontour 1-2 mm range was favorable to regenerate stable bone plates reaching the individual contour at follow-up. CONCLUSIONS The overaugmented bone outside the buccal bone arch contour tended to remodel into the original contour, which indicates that the anterior bone arch contour is worthy of careful observation for deciding buccolingual implant position and bone augmentation width.
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Affiliation(s)
- Yang Gao
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Implant Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Shaojingya Gao
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Implant Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yangxue Yao
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Implant Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Xiaoxiao Cai
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Implant Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, China
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18
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Meijer HJA, Stellingsma K, Vissink A, Raghoebar GM. Two adjacent implant-supported restorations in the aesthetic region: A 10-year prospective case series. Clin Implant Dent Relat Res 2023; 25:1216-1224. [PMID: 37670074 DOI: 10.1111/cid.13274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 07/01/2023] [Accepted: 08/21/2023] [Indexed: 09/07/2023]
Abstract
INTRODUCTION The treatment outcome of two adjacent implant-supported restorations in the maxillary aesthetic region was assessed regarding peri-implant soft and hard tissues, and satisfaction during a 10-year follow-up period. METHODS Twenty patients missing two adjacent teeth in the maxillary aesthetic region and treated with two implant-supported restorations were followed prospectively. The patients' clinical and radiographic parameters, as well as their satisfaction, were scored for a 10-year follow-up period. RESULTS Seventeen patients' data were available for the 10-year follow-up. The survival rate of the implants and restorations was 100%. The 10-year mean peri-implant bone change at the side facing the adjacent tooth was +0.11 ± 0.57 mm and at the side facing the adjacent implant was -0.08 ± 0.50 mm. The peri-implant soft tissues were healthy and the patients' satisfaction was high, but the papilla-index showed compromised inter-implant papillae and low Pink Esthetic Scores. These figures were of the same magnitude at all time points. CONCLUSION While it is difficult to obtain sufficient inter-implant papillae and satisfactory Pink Esthetic Scores, the initial treatment results remained stable and the patients were satisfied with the final result throughout the 10-year follow-up period.
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Affiliation(s)
- Henny J A Meijer
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Restorative Dentistry, Dental School, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Kees Stellingsma
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Arjan Vissink
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Gerry M Raghoebar
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Alani A, Tewari N, Calvert G. Contemporary issues in the management of dental trauma. Br Dent J 2023; 235:946-956. [PMID: 38102262 DOI: 10.1038/s41415-023-6564-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 08/25/2023] [Accepted: 09/03/2023] [Indexed: 12/17/2023]
Abstract
Contemporary diagnosis and management of traumatic dental injuries requires a multifaceted understanding of the pathological and psychological impact over a patient's lifetime. The legacy of dental trauma injuries can have repercussions for the dentition and supporting tissues, requiring complicated multidisciplinary clinical input. Foresight is required to ensure optimal aesthetic and functional outcomes. Mitigating risks and maximising benefits in patients presenting with polytrauma can be challenging, but if optimally managed at the acute presentation, the long-term burden to the patient and the clinician is reduced. This paper aims to discuss the contemporary clinical dilemmas, challenges and controversies related to the management of dental trauma.
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Affiliation(s)
- Aws Alani
- King´s College Hospital, London, United Kingdom.
| | - Nitesh Tewari
- All India Institute of Medical Sciences, New Delhi, India
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20
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Shi S, Han L, Su J, Guo J, Yu F, Zhang W. Clinical efficacy of transcrestal sinus floor augmentation, in comparison with lateral approach, in sites with residual bone height ≤6 mm: A systematic review and meta-analysis. Clin Oral Implants Res 2023; 34:1151-1175. [PMID: 37548090 DOI: 10.1111/clr.14155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 07/05/2023] [Accepted: 07/19/2023] [Indexed: 08/08/2023]
Abstract
OBJECTIVE This paper addressed two focused questions: Focused question 1 (Q1) "what is the clinical efficacy of transcrestal sinus floor augmentation (TSFA), as compared to lateral sinus floor augmentation (LSFA) in sites with residual bone height (RBH) ≤6 mm, in randomized clinical trials (RCTs) and controlled clinical trials (CCTs)?"; Focused question 2 (Q2) "what is the estimated effectiveness of TSFA for outcomes in Q1, in RCTs, CCTs or cohort studies?" MATERIALS AND METHODS An electronic search (PubMed, EMBASE, The Cochrane Central Register of Controlled Trials) and hand search were conducted from January 1986 until December 2022. All eligible clinical studies expressly reporting TSFA in sites with RBH ≤6 mm were included. The data were extracted, and the risk of bias in individual studies was evaluated. Meta-analysis was performed whenever possible. RESULTS Seven RCTs were included for Q1 and 25 studies (9 RCTs, 2 CCTs, 14 single arm cohort studies) for Q2. Q1: Meta-analysis did not show significant difference in the implant survival, sinus membrane perforation and marginal bone loss between TSFA and LSFA groups. Q2: Meta-analysis showed TSFA had a high implant survival rate (96.5%, 95% CI: 93.2%-98.9%) at least 1 year after surgery, and limited sinus membrane perforation (5.4%, 95% CI: 2.7%-8.8%). The results also presented higher patient satisfaction for TSFA. CONCLUSION With the limitations of the present study (high risk of bias in individual studies), it can be concluded that there was no significant difference in implant survival, Schneiderian membrane perforation and MBL between two approaches in sites with RBH ≤6 mm.
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Affiliation(s)
- Shaojie Shi
- Department of Stomatology, 920th Hospital of Joint Logistics Support Force, Kunming, China
| | - Luyao Han
- Department of Pulmonary and Critical Care Medicine, Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Jun Su
- Department of Stomatology, 920th Hospital of Joint Logistics Support Force, Kunming, China
| | - Jianmei Guo
- Department of Stomatology, 920th Hospital of Joint Logistics Support Force, Kunming, China
| | - Fan Yu
- Department of Stomatology, 927th Hospital of Joint Logistics Support Force, Pu'er, China
| | - Wenyun Zhang
- Department of Stomatology, 920th Hospital of Joint Logistics Support Force, Kunming, China
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Alotaibi FF, Rocchietta I, Buti J, D'Aiuto F. Comparative evidence of different surgical techniques for the management of vertical alveolar ridge defects in terms of complications and efficacy: A systematic review and network meta-analysis. J Clin Periodontol 2023; 50:1487-1519. [PMID: 37495541 DOI: 10.1111/jcpe.13850] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 06/04/2023] [Accepted: 06/29/2023] [Indexed: 07/28/2023]
Abstract
AIM To systematically appraise the available evidence on vertical ridge augmentation (VRA) techniques and estimate a treatment-based ranking on the incidence of complications as well as their clinical effectiveness. MATERIALS AND METHODS Searches were conducted in six databases to identify randomized clinical trials comparing VRA techniques up to November 2022. The incidence of complications (primary) and of early, major, surgical and intra-operative complications, vertical bone gain (VBG), marginal bone loss, need for additional grafting, implant success/survival, and patient-reported outcome measures (secondary) were chosen as outcomes. Direct and indirect effects and treatment ranking were estimated using Bayesian pair-wise and network meta-analysis (NMA) models. RESULTS Thirty-two trials (761 participants and 943 defects) were included. Five NMA models involving nine treatment groups were created: onlay, inlay, dense-polytetrafluoroethylene, expanded-polytetrafluoroethylene, titanium, resorbable membranes, distraction osteogenesis, tissue expansion and short implants. Compared with short implants, statistically significant higher odds ratios of healing complications were confirmed for all groups except those with resorbable membranes (odds ratio 5.4, 95% credible interval 0.92-29.14). The latter group, however, ranked last in clinical VBG. CONCLUSIONS VRA techniques achieving greater VBG are also associated with higher incidence of healing complications. Guided bone regeneration techniques using non-resorbable membranes yield the most favourable results in relation to VBG and complications.
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Affiliation(s)
- Faisal F Alotaibi
- Unit of Periodontology, UCL Eastman Dental Institute, London, UK
- Department of Oral and Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, Prince Sattam bin Abdulaziz University, Alkharj, Saudi Arabia
| | | | - Jacopo Buti
- Unit of Periodontology, UCL Eastman Dental Institute, London, UK
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22
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Xu J, Zhao B, Lin W, Liu Y, Zhang X, Wang Y, Zhang Y, Liu W, Seriwatanachai D, Yuan Q. Periplaneta americana extract promotes osteoblast differentiation of human alveolar bone marrow mesenchymal stem cells. Oral Dis 2023; 29:3540-3550. [PMID: 36516336 DOI: 10.1111/odi.14470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 12/06/2022] [Accepted: 12/12/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVES This study aims to investigate the effects of Traditional Chinese medicine, Periplaneta americana extract (PAE), on osteoblast differentiation of human alveolar bone marrow-derived mesenchymal stem cells (hABMMSCs). MATERIALS AND METHODS Human alveolar bone marrow-derived mesenchymal stem cells were treated with different concentrations of PAE. Cell Counting Kit-8 (CCK-8) assay and transwell migration assay were conducted to evaluate cell proliferation and migration, respectively. Alkaline phosphatase (ALP) staining, ALP activity assay, and Alizarin red S staining were performed to detect osteogenesis in hABMMSCs. In addition, real-time quantitative polymerase chain reaction (RT-qPCR) and western blot (WB) assay were performed to evaluate expression levels of osteogenic markers. Finally, RNA sequencing analysis and WB were carried out to elucidate the underlying mechanism. RESULTS A total of 0.1 mg/ml PAE promoted cell proliferation and migration. PAE also increased ALP activity and mineralized nodule formation of hABMMSCs. In addition, PAE upregulated the expression of osteogenesis-related genes (RUNX2, COL1A1, and BGLAP). RNA-sequencing analysis revealed that PAE activated the focal adhesion signaling pathway. Treatment with Defactinib, an inhibitor of FAK, attenuated the effects induced by PAE. CONCLUSIONS PAE could enhance osteoblast differentiation of hABMMSCs through focal adhesion signaling pathway, suggesting a therapeutic potential for the alveolar bone defect.
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Affiliation(s)
- Jie Xu
- State Key Laboratory of Oral Diseases, National Clinical Research Centre for Oral Disease, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Bin Zhao
- State Key Laboratory of Oral Diseases, National Clinical Research Centre for Oral Disease, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Weimin Lin
- State Key Laboratory of Oral Diseases, National Clinical Research Centre for Oral Disease, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yuting Liu
- State Key Laboratory of Oral Diseases, National Clinical Research Centre for Oral Disease, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Xiao Zhang
- State Key Laboratory of Oral Diseases, National Clinical Research Centre for Oral Disease, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yuan Wang
- State Key Laboratory of Oral Diseases, National Clinical Research Centre for Oral Disease, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yanjun Zhang
- State Key Laboratory of Oral Diseases, National Clinical Research Centre for Oral Disease, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Weiqing Liu
- State Key Laboratory of Oral Diseases, National Clinical Research Centre for Oral Disease, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | | | - Quan Yuan
- State Key Laboratory of Oral Diseases, National Clinical Research Centre for Oral Disease, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Oral Implantology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
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23
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Leblebicioglu B, Tatakis DN. Complications following alveolar ridge augmentation procedures. Periodontol 2000 2023; 93:221-235. [PMID: 37489632 DOI: 10.1111/prd.12509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 05/15/2023] [Accepted: 06/18/2023] [Indexed: 07/26/2023]
Abstract
Oral rehabilitation through implant supported dental restorations often requires a ridge augmentation procedure (RAP) prior to implant fixture placement since tooth extraction/loss results in alveolar ridge deficiencies. Although RAP-related surgical techniques and biomaterials have been in practice for several decades, outcomes are not always predictable. Post-surgical complications experienced during the early or late wound healing phases may jeopardize the targeted ideal ridge dimensions, required for implant fixture placement, and may have other consequences, such as negatively impacting the patient's quality of life. This review describes reported post-surgical complications following RAP under the following subtitles: complications by tissue type, complications in function and aesthetics, complications by healing time, complications by biomaterial type, and complications by surgical protocol modalities. Specifically, RAP performed by using particulate bone graft substitutes and related complications are explored. Modalities developed to prevent/manage these complications are also discussed.
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Affiliation(s)
- Binnaz Leblebicioglu
- Division of Periodontology, College of Dentistry, The Ohio State University, Columbus, Ohio, USA
| | - Dimitris N Tatakis
- Division of Periodontology, College of Dentistry, The Ohio State University, Columbus, Ohio, USA
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24
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Ramanauskaite A, Becker K, Cafferata EA, Schwarz F. Clinical efficacy of guided bone regeneration in peri-implantitis defects. A network meta-analysis. Periodontol 2000 2023; 93:236-253. [PMID: 37490412 DOI: 10.1111/prd.12510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 05/17/2023] [Accepted: 06/19/2023] [Indexed: 07/27/2023]
Abstract
Guided bone regeneration (GBR) at peri-implantitis-related bone defects involves the placement of bone-filler particles in the intrabony defects and the application of a barrier membrane. The efficacy of different GBR-supported reconstructive measures as well as their potential superiority compared to non-GBR-supported treatment strategies for bone defects at peri-implantitis sites, however, remains unclear. Therefore, this analysis was designed to evaluate the long-term (≥12 months) clinical efficacy of GBR-supported reconstructive surgical therapy for peri-implantitis-related bone defects. In terms of resolving inflammation, the implementation of GBR protocols applying xenogenic bone substitutes yielded a higher reduction of bleeding on probing and probing depth value compared to the GBR protocol applying autogenous bone. Furthermore, for the changes in bleeding on probing and probing depths, GBR approaches using xenogenic bone showed superiority over the non-GBR treatments. Xenogenic bone with or without a barrier membrane was associated with improved radiographic bone levels and less soft tissue recession compared to the use of a GBR protocol implementing autogenous bone. Nonetheless, when interpreting this findings, the limited number of available studies with low to serious risk of bias and the short follow-up periods limited to 12 months should be considered.
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Affiliation(s)
- Ausra Ramanauskaite
- Department of Oral Surgery and Implantology, Goethe University, Carolinum, Frankfurt, Germany
| | - Kathrin Becker
- Department of Orthodontics, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Emilio A Cafferata
- Department of Oral Surgery and Implantology, Goethe University, Carolinum, Frankfurt, Germany
- Department of Periodontology, School of Dentistry, Universidad Científica del Sur, Lima, Peru
| | - Frank Schwarz
- Department of Oral Surgery and Implantology, Goethe University, Carolinum, Frankfurt, Germany
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25
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Zhao Y, Yan Q, Wu X, Hua F, Shi B. Characteristics, level of evidence, and impact of clinical studies on peri-implantitis: 2017 to 2021. J Periodontol 2023; 94:1266-1276. [PMID: 37061751 DOI: 10.1002/jper.23-0093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 04/08/2023] [Accepted: 04/12/2023] [Indexed: 04/17/2023]
Abstract
BACKGROUND The level of evidence (LOE) is an important tool in current evidence-based practice and clinical research. However, in clinical studies on peri-implantitis, the present status of the LOE and its association with research impact remains to be determined. The present study aimed to gather the characteristics and LOE of clinical studies on peri-implantitis conducted from 2017 to 2021 and assess the association of the LOE with social and scientific impact. METHODS The PubMed database was searched to retrieve clinical studies that evaluated peri-implantitis-related healthcare interventions and were published between 2017 and 2021. A 4-level modified Oxford 2011 LOE tool was used to determine the LOE of these studies. Citation count and Altmetric Attention Scores (AAS) were derived from the Web of Science and Altmetric Explorer, respectively. Multivariate generalized estimation equation (GEE) analysis was conducted to explore relationships between the LOE and citation count, and between the LOE and AAS; the publication year was considered the grouping factor for adjusting for potential clustering effects. RESULTS Two hundred and thirty-five studies were considered eligible. The percentages by level from Level-1 to Level-4 were 9.8%, 35.7%, 28.9%, and 25.5%. Multivariable GEE analyses revealed that studies with higher LOE ratings had significantly greater citation counts (p = 0.008). However, no significant association (p = 0.872) was observed between the LOE and AAS. CONCLUSIONS From 2017 to 2021, more than 40% of studies published on peri-implantitis each year had high-LOE ratings. High-LOE studies showed a tendency to have greater scientific impact.
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Affiliation(s)
- Yaoyu Zhao
- Hubei-MOST KLOS & KLOBM, School & Hospital of Stomatology, Wuhan University, Wuhan, China
- Department of Oral Implantology, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Qi Yan
- Hubei-MOST KLOS & KLOBM, School & Hospital of Stomatology, Wuhan University, Wuhan, China
- Department of Oral Implantology, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Xinyu Wu
- Hubei-MOST KLOS & KLOBM, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Fang Hua
- Centre for Evidence-Based Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Bin Shi
- Department of Oral Implantology, School & Hospital of Stomatology, Wuhan University, Wuhan, China
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26
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Roccuzzo M, Roccuzzo A, Marruganti C, Fickl S. The importance of soft tissue condition in bone regenerative procedures to ensure long-term peri-implant health. Periodontol 2000 2023; 93:129-138. [PMID: 37277923 DOI: 10.1111/prd.12496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 04/13/2023] [Accepted: 04/26/2023] [Indexed: 06/07/2023]
Abstract
Bone regenerative procedures have been widely proved to be a reliable treatment option to re-create the ideal pre-implant clinical conditions. Nevertheless, these techniques are not free from post-operative complications which might result in implant failure. Consequently, as demonstrated by the increasing recently published evidence, a careful pre- and intra-operative flap evaluation to ensure an ideal and hermetic tension-free wound closure is of paramount importance to successfully treat bony defects. In this respect, several surgical interventions mainly aimed to increase the amount of keratinized mucosa either to allow an optimal healing after a reconstructive procedure or to establish an optimal peri-implant soft tissue seal have been proposed. The present review summarizes the level of evidence on the surgical clinical aspects which have an impact on the soft tissue handling associated with bone reconstructive procedures and on the importance of soft tissue conditions to enhance and maintain peri-implant health in the long-term.
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Affiliation(s)
- Mario Roccuzzo
- Private Practice, Torino, Italy
- Division of Maxillo-Facial Surgery, University of Torino, Torino, Italy
- Department of Periodontics and Oral Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Andrea Roccuzzo
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
- Department of Oral and Maxillo-Facial Surgery, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
- Department of Restorative, Pediatric and Preventive Dentistry, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Crystal Marruganti
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
- Sub-Unit of Periodontology, Halitosis and Periodontal Medicine, University Hospital of Pisa, Pisa, Italy
- Unit of Periodontology, Endodontology and Restorative Dentistry, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Stefan Fickl
- Private Practice, Fürth, Germany
- Department of Periodontology, Julius-Maximilians-University Würzburg, Würzburg, Germany
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27
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Chan H, Rodriguez Betancourt A, Liu CC, Chiang Y, Schmidlin PR. A conceptual review on reconstructive peri-implantitis therapy: Challenges and opportunities. Clin Exp Dent Res 2023; 9:735-745. [PMID: 37735844 PMCID: PMC10582225 DOI: 10.1002/cre2.788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/24/2023] [Accepted: 09/04/2023] [Indexed: 09/23/2023] Open
Abstract
OBJECTIVES The current strategies to reconstruct lost peri-implant tissues due to the disease have been largely unpredictable. The aim of this conceptual review is to discuss relevant biological and biomechanical challenges of applying reconstructive means to treat peri-implantitis. Additionally, opportunities to improve treatment predictability are presented. MATERIAL AND METHODS A narrative review was conducted to fulfill the aim. RESULTS The four interrelated negative conditions hampering effective reconstruction are: inferior tissue perfusion, unfavorable bone topography, ineffective surface treatment, and unstable wound. First, peri-implant tissues resemble scars with reduced cellularity and vascularity, coupled with the absence of the periodontal ligament plexuses and the avascular implant and biomaterials, maintaining primary closure is a challenge, which is critical for regeneration. Second, defect morphology and bone topography surrounding implants determine the reconstructive potential. Unfortunately, noncontained defects are frequently encountered, with a combination of suprabony (horizontal bone loss) and infrabony (vertical usually involving circumferential bone loss) defects. Third, current attempts for implant surface decontamination are insufficient due to inaccessible macrostructure and rough surfaces in the micro-scale. Histologic evaluation has shown bacteria aggregation and calcified deposits around implants. Lastly, wound stability is difficult to achieve due to inherent soft tissue biomechanical quality and quantity deficiencies and mobile bone particulates. Opportunities to tackle the abovementioned challenges include the use of novel imaging technologies, such as high-frequency dental ultrasound and laser speckle imaging to evaluate tissue perfusion, soft tissue quality/quantity, and bone topography pre-surgically. The use of the operating microscope could allow better visualization and removal of etiologic factors. Strategies to improve soft tissue quality may include preoperative control of soft tissue inflammation and the potential use of biologics. Methods such as fixation to stabilize the biomaterials could be beneficial. CONCLUSIONS A more nuanced understanding of the current challenges and opportunities can lead to more effective preoperative and postoperative care protocols, ultimately improving the success rate of reconstructive procedures.
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Affiliation(s)
- Hsun‐Liang Chan
- Department of Periodontics and Oral MedicineThe University of Michigan School of DentistryAnn ArborMichiganUSA
| | - Amanda Rodriguez Betancourt
- Department of Periodontics and Oral MedicineThe University of Michigan School of DentistryAnn ArborMichiganUSA
| | - Chun Ching Liu
- Center of Dental Medicine, Division of Periodontology and Peri‐implant diseases, Clinic of Conservative and Preventive DentistryUniversity of ZurichZurichSwitzerland
| | - Yi‐Chen Chiang
- Department of Periodontics and Oral MedicineThe University of Michigan School of DentistryAnn ArborMichiganUSA
| | - Patrick R. Schmidlin
- Center of Dental Medicine, Division of Periodontology and Peri‐implant diseases, Clinic of Conservative and Preventive DentistryUniversity of ZurichZurichSwitzerland
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28
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Heitz-Mayfield LJA, Heitz F, Koong B, Huang T, Chivers P. Surgical peri-implantitis treatment with and without guided bone regeneration. A randomized controlled trial. Clin Oral Implants Res 2023; 34:892-910. [PMID: 37382408 DOI: 10.1111/clr.14116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/20/2023] [Accepted: 06/07/2023] [Indexed: 06/30/2023]
Abstract
OBJECTIVE To evaluate the efficacy of reconstructive peri-implantitis treatment. MATERIALS AND METHODS Forty participants, with peri-implantitis and a contained intraosseous defect, were randomized to access flap (control) or access flap with xenograft and collagen membrane (test). All received systemic antimicrobials. Blinded examiners recorded probing depths (PD), bleeding and suppuration on probing (BOP & SOP), soft tissue levels, and marginal bone levels (MBL) at baseline and 12 months. Patient reported outcomes were recorded. The primary outcome was PD change. RESULTS All 40 participants (40 implants) completed the 12-month study. The mean (standard deviation) PD reduction (deepest site) was 4.2 (1.8) mm in the control and 3.7 (1.9) mm in the test group. MBL gain (deepest site) was 1.7 (1.6) mm in the control and 2.4 (1.4) mm in the test group. Absence of BOP & SOP was observed at 60% of both control and test implants. Buccal recession was 0.9 (1.6) mm in the control and 0.4 (1.1) mm in the test group. A successful outcome (absence of PD ≥ 5 mm with BOP, absence of SOP and absence of progressive bone loss) was achieved for 90% of the control and 85% of test group implants. No statistically significant differences in clinical or radiographic parameters were found between treatment groups. 30% of participants experienced mild gastro-intestinal disturbances. Reporting followed CONSORT guidelines. CONCLUSION Similar clinical and radiographic improvements at 12 months were observed with high levels of patient satisfaction for both the access flap and xenograft covered by collagen membrane groups. Registered clinical trials.gov. ID:NCT03163602 (23/05/2017).
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Affiliation(s)
- Lisa J A Heitz-Mayfield
- International Research Collaborative, Oral Health and Equity, School of Human Anatomy and Biology, The University of Western Australia, Crawley, Western Australia, Australia
- Faculty of Medicine and Health, School of Dentistry, The University of Sydney, Sydney, New South Wales, Australia
- Perth Periodontal Specialists, West Leederville, Western Australia, Australia
| | - Fritz Heitz
- Perth Periodontal Specialists, West Leederville, Western Australia, Australia
| | - Bernard Koong
- Envision Medical Imaging, Wembley, Western Australia, Australia
| | - Tom Huang
- Envision Medical Imaging, Wembley, Western Australia, Australia
| | - Paola Chivers
- Institute for Health Research, The University of Notre Dame, Fremantle, Western Australia, Australia
- School of Medical and Health Sciences, ECU, Joondalup, Western Australia, Australia
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29
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Vargas SM, Johnson TM, Pfaff AS, Bumpers AP, Wagner JC, Retrum JK, Colamarino AN, Bunting ME, Wilson JP, McDaniel CR, Herold RW, Stancoven BW, Lincicum AR. Clinical protocol selection for alveolar ridge augmentation at sites exhibiting slight, moderate, and severe horizontal ridge deficiencies. Clin Adv Periodontics 2023; 13:174-196. [PMID: 36760073 DOI: 10.1002/cap.10239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 02/02/2023] [Indexed: 02/11/2023]
Abstract
FOCUSED CLINICAL QUESTION What factors identify the optimal bone augmentation techniques for managing slight, moderate, and severe horizontal alveolar ridge deficiency (ARD) at dental implant sites? SUMMARY Horizontal ARD is a concern at a high proportion of sites receiving dental implants, and clinicians have developed a variety of surgical procedures to address such defects. In a particular case, selection of the optimal treatment may depend predominantly on defect severity, location (anterior versus posterior), and configuration (contained versus noncontained). This report provides a framework for selecting an augmentation method when presented with a slight, moderate, or severe horizontal ARD at a site requiring dental implant placement. CONCLUSION Multiple treatment options are available for planned implant sites exhibiting horizontal ARD; severe posterior and slight anterior defects intuitively call for different approaches. Although rigid guidelines for selecting the optimal augmentation method do not exist, some techniques are poorly suited for esthetically demanding sites. A framework considering defect severity, location, and configuration may help guide clinical decisions on this topic.
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Affiliation(s)
- Sarah M Vargas
- Department of Periodontics, United States Army Dental Health Activity, Fort Bragg, North Carolina, USA
| | - Thomas M Johnson
- Department of Periodontics, Army Postgraduate Dental School, Fort Gordon, Georgia, USA
| | - Aaron S Pfaff
- Department of Periodontics, United States Army Dental Health Activity, Fort Wainwright, Alaska, USA
| | - April P Bumpers
- Department of Periodontics, United States Army Dental Health Activity, Fort Jackson, South Carolina, USA
| | - Jennah C Wagner
- Department of Periodontics, United States Army Dental Health Activity, Fort Meade, Maryland, USA
| | - Joseph K Retrum
- Department of Periodontics, Army Postgraduate Dental School, Fort Gordon, Georgia, USA
| | - Aaron N Colamarino
- Department of Periodontics, Army Postgraduate Dental School, Fort Gordon, Georgia, USA
| | - Megan E Bunting
- Department of Periodontics, United States Army Dental Health Activity, Fort Drum, New York, USA
| | - James P Wilson
- Department of Periodontics, United States Army Dental Health Activity, Fort Campbell, Kentucky, USA
| | - Carsen R McDaniel
- Department of Periodontics, Army Postgraduate Dental School, Fort Gordon, Georgia, USA
| | - Robert W Herold
- Department of Periodontics, Veterans Administration Medical Center, Augusta, Georgia, USA
| | - Brian W Stancoven
- Department of Periodontics, Army Postgraduate Dental School, Fort Gordon, Georgia, USA
| | - Adam R Lincicum
- Department of Periodontics, Army Postgraduate Dental School, Fort Gordon, Georgia, USA
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30
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Daubert D, Lee E, Botto A, Eftekhar M, Palaiologou A, Kotsakis GA. Assessment of titanium release following non-surgical peri-implantitis treatment: A randomized clinical trial. J Periodontol 2023; 94:1122-1132. [PMID: 37070363 PMCID: PMC10524263 DOI: 10.1002/jper.22-0716] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 04/10/2023] [Accepted: 04/12/2023] [Indexed: 04/19/2023]
Abstract
BACKGROUND Peri-implantitis is a frequent finding. Initial treatment involves non-surgical debridement of the implant surface. Recent studies have found a correlation between titanium (Ti) particle release and peri-implantitis, yet there is a dearth of information regarding the effect of various non-surgical instrumentation on particle release or peri-implantitis resolution. METHODS Patients with peri-implantitis were recruited for a randomized, blinded, parallel-group clinical trial. The implants were randomized to treatment composed of Ti curettes ("Mech" group) or implant-specific treatment composed of rotary polymer microbrushes ("Imp" group). Ti release in submucosal peri-implant plaque pre- and 8 weeks posttreatment was assessed as the primary outcome. Peri-implant probing depth, bleeding on probing, and suppuration on probing were evaluated and compared between groups. RESULTS Thirty-four participants completed treatment; 18 were randomized to the Mech group and 16 to the Imp group. The groups were comparable for Ti levels and probing depths at baseline. A trend was noted for 10-fold greater Ti dissolution in the Mech group posttreatment compared to the Imp group (p = 0.069). The Imp group had a significant reduction in probing depth posttreatment (p = 0.006), while the Mech group reduction was not significant. CONCLUSION Peri-implantitis treated non-surgically with implant-specific instruments (Imp group) had a significantly greater decrease in probing depth versus the Mech treatment group. This improvement was linked with a trend for less Ti release to the peri-implant plaque by the non-abrasive treatment.
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Affiliation(s)
- Diane Daubert
- Department of Periodontics, University of Washington, Seattle, Washington, USA
| | - Eddie Lee
- Department of Periodontics, University of Washington, Seattle, Washington, USA
| | - Antonella Botto
- Department of Periodontics, UT Health San Antonio, San Antonio, Texas, USA
| | - Mojdeh Eftekhar
- Department of Periodontics, University of Washington, Seattle, Washington, USA
| | | | - Georgios A Kotsakis
- Department of Periodontics, UT Health San Antonio, San Antonio, Texas, USA
- Department of Global Health, University of Washington, Seattle, Washington, USA
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31
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Romito GA, Soares HH, do Amaral GCLS, Fonseca MA, Sapata VM, Conde MC, Hammerle CHF, Schwarz F, Villar CC. Radiographic outcomes of ridge reconstruction with autogenous bone block versus collagenated xenogeneic bone block: A randomized clinical trial. Clin Oral Implants Res 2023; 34:863-871. [PMID: 37309738 DOI: 10.1111/clr.14114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 05/31/2023] [Accepted: 06/02/2023] [Indexed: 06/14/2023]
Abstract
AIM To compare, at different levels from the alveolar crest, the radiographic outcomes of equine-derived collagenated xenogeneic bone blocks (CXBB) and autogenous bone blocks (ABB) used for lateral alveolar ridge augmentation. MATERIALS AND METHODS Sixty-four patients with tooth gaps in atrophic alveolar ridges with ≤4 mm were randomly assigned to lateral augmentation using CXBB or ABB. The lateral bone thickness (LBT) was measured 2, 4, 6, 8, and 10 mm below the alveolar crest using CBCT scans obtained before augmentation surgery and at 30 weeks, prior to implant placement. Statistical analysis was performed using Shapiro-Wilk, Fisher's exact, Mann-Whitney, and Wilcoxon signed-rank tests. RESULTS Both CXBB and ABB resulted in significant total and buccal LBT gains at 2, 4, 6, 8, and 10 mm. LBT gains were similar between CXBB- and ABB-augmented sites, except for greater buccal LBT gains at 8 mm at CXBB-augmented sites. While ABB-augmented sites gained vertical bone height, CXBB-treated sites suffered vertical bone loss (CXBB: -0.16 mm; ABB: 0.38 mm, p < .0009). CONCLUSIONS CXBB and ABB were both associated with significant and similar LBT gains at 30 weeks.
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Affiliation(s)
| | - Herbert Horiuti Soares
- Discipline of Periodontics, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | | | | | - Vitor Marques Sapata
- Discipline of Periodontics, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Marina Clemente Conde
- Discipline of Periodontics, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | | | - Frank Schwarz
- Department of Oral Surgery and Implantology, Goethe University, Carolinum, Frankfurt, Germany
| | - Cristina Cunha Villar
- Discipline of Periodontics, School of Dentistry, University of São Paulo, São Paulo, Brazil
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32
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Cosgarea R, Roccuzzo A, Jepsen K, Sculean A, Jepsen S, Salvi GE. Efficacy of mechanical/physical approaches for implant surface decontamination in non-surgical submarginal instrumentation of peri-implantitis. A systematic review. J Clin Periodontol 2023; 50 Suppl 26:188-211. [PMID: 36550060 DOI: 10.1111/jcpe.13762] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 11/02/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022]
Abstract
AIM To evaluate the efficacy of non-surgical submarginal peri-implant instrumentation with mechanical/physical decontamination compared to non-surgical submarginal instrumentation alone or with placebo decontamination in patients with peri-implantitis. MATERIALS AND METHODS Three focused questions were addressed, and a systematic search for randomized controlled clinical trials (RCTs), controlled clinical trials, and prospective cohort studies with definitions of peri-implantitis and a minimal follow-up of 6 months was conducted. The main outcome variables were reduction in pocket probing depth (PD) and bleeding on probing (BOP). Suppuration on probing, marginal peri-implant bone level changes, patient-related outcomes and adverse events, implant survival, treatment success, and disease resolution were assessed as secondary outcomes. RESULTS Out of 239 findings, full-text articles were assessed for eligibility, and 9 (n = 9 RCTs) were included in the present review. Five studies evaluated the effects of various laser types, and in four studies efficacy of air-abrasive mechanisms and of a novel ultrasonic device was determined. At 6 months, PD reductions were observed in nine studies but only Er, Cr:YSGG laser-treated group showed statistically significant higher reductions compared to the control group. BOP was statistically significantly reduced at 6 months in two studies following the application of Er:YAG laser compared to controls. One study reported statistically significant reduction in BOP following application of air-polishing device compared to control treatment. No statistically significant differences between treatment groups were reported for the secondary outcome variables. Owing to the large heterogeneity of study designs, no meta-analysis was performed. CONCLUSIONS Available evidence on the efficacy of non-surgical submarginal peri-implant instrumentation with mechanical/physical decontamination is limited by the small number of controlled studies and the high heterogeneity of study protocols. Clinical and patient-reported benefits remain to be demonstrated.
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Affiliation(s)
- Raluca Cosgarea
- Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, Bonn, Germany
- Department of Periodontology and Peri-implant Diseases, University of Marburg, Marburg, Germany
- School of Dental Medicine, University Iuliu-Hatieganu, Cluj-Napoca, Romania
| | - Andrea Roccuzzo
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Karin Jepsen
- Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, Bonn, Germany
| | - Anton Sculean
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Søren Jepsen
- Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, Bonn, Germany
| | - Giovanni E Salvi
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
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Karlsson K, Trullenque-Eriksson A, Tomasi C, Derks J. Efficacy of access flap and pocket elimination procedures in the management of peri-implantitis: A systematic review and meta-analysis. J Clin Periodontol 2023; 50 Suppl 26:244-284. [PMID: 36217689 DOI: 10.1111/jcpe.13732] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/16/2022] [Accepted: 10/04/2022] [Indexed: 11/28/2022]
Abstract
AIM To evaluate the efficacy of access flap and pocket elimination procedures in the surgical treatment of peri-implantitis. MATERIALS AND METHODS Systematic electronic searches (Central/MEDLINE/EMBASE) up to March 2022 were conducted to identify prospective clinical studies evaluating surgical therapy (access flap or pocket elimination procedures) of peri-implantitis. Primary outcome measures were reduction of probing depth (PD) and bleeding on probing (BOP). Risk of bias was evaluated according to study design. Meta-analysis and meta-regression were performed. Results were expressed as standardized mean effect with 95% confidence interval (CI). RESULTS Evidence from studies directly comparing surgical with non-surgical therapy is lacking. Based on pre-post data originating from 13 prospective patient cohorts, pronounced reductions of PD (standardized mean effect: 2.2 mm; 95% CI 1.8-2.7) and BOP% (27.0; 95% CI 19.8-34.2) as well as marginal bone level gain (0.2 mm; 95% CI -0.0 to 0.5) were observed at evaluation time points ranging from 1 to 5 years. Wide prediction intervals suggested a high degree of heterogeneity. Reduction of mean PD increased by 0.7 mm (95% CI 0.5-0.9) for every millimetre in increase of mean PD at baseline. During the follow-up period ranging from 1 to 5 years, disease recurrence occurred frequently and implant loss was not uncommon. CONCLUSIONS Access flap and pocket elimination surgery are effective procedures in the management of peri-implantitis, although rates of disease recurrence during 5 years were high. Treatment outcomes were affected by baseline conditions.
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Affiliation(s)
- Karolina Karlsson
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Anna Trullenque-Eriksson
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Cristiano Tomasi
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Jan Derks
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
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Yang S, Wang S, Shen X, Xu Y, Chen C, He F. Radiographic evaluation of the tenting screw technique in horizontal alveolar bone augmentation: A retrospective study. Clin Implant Dent Relat Res 2023. [PMID: 37130799 DOI: 10.1111/cid.13213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 04/17/2023] [Accepted: 04/20/2023] [Indexed: 05/04/2023]
Abstract
OBJECTIVES To radiographically analyze the effects of tenting screw technique (TS) and onlay bone grafts (OG) in horizontal bone augmentation. MATERIALS AND METHODS Patients receiving horizontal bone augmentation by TS or OG were selected. The clinical outcomes and cone beam computed tomography (CBCT) data were documented pre-grafting, immediately post-grafting, before and after implantation. The survival rates, clinical complications, alveolar bone width, and volumetric bone augmentation were evaluated and statistically analyzed. RESULTS A total of 25 patients and 41 implants were involved in this study, with no grafting failures observed in either the TS group (n = 20) or the onlay group (n = 21). Volumetric bone resorption rate in the TS group (21.34%) was significantly lower than that of the OG group (29.38%). In addition, significant horizontal bone gain was achieved in both groups (TS: 6.15 ± 2.12 mm; OG: 4.86 ± 1.40 mm) during the recovery period, with higher gain in the TS group. No apparent statistical difference in terms of volumetric bone gain was observed between the TS (748.53 mm3 , 607.47 mm3 ) and OG group (811.77 mm3 , 508.49 mm3 ) immediately post-grafting or after the recovery period. CONCLUSION Both TS and OG achieved satisfactory bone augmentation effects, yet TS resulted in more bone augmentation and better stability than OG, with a reduced use of autogenous bone. Overall, the tenting screw technique can serve as an effective alternative to autogenous bone grafts.
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Affiliation(s)
- Sijia Yang
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Clinical Research Center for Oral Disease of Zhejiang Province, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, China
- Department of Prosthodontics, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Siyuan Wang
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Clinical Research Center for Oral Disease of Zhejiang Province, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, China
| | - Xiaoting Shen
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Clinical Research Center for Oral Disease of Zhejiang Province, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, China
| | - Yuzi Xu
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Clinical Research Center for Oral Disease of Zhejiang Province, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, China
| | - Cong Chen
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Clinical Research Center for Oral Disease of Zhejiang Province, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, China
| | - Fuming He
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Clinical Research Center for Oral Disease of Zhejiang Province, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, China
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Cheng J, Chen L, Tao X, Qiang X, Li R, Ma J, Shi D, Qiu Z. Efficacy of surgical methods for peri-implantitis: a systematic review and network meta-analysis. BMC Oral Health 2023; 23:227. [PMID: 37076816 PMCID: PMC10116816 DOI: 10.1186/s12903-023-02956-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 04/10/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND Peri-implantitis is the most difficult biological complication associated with dental implants, often requiring surgical treatments in advanced stages. This study compares the effectiveness of different surgical methods for peri-implantitis. METHODS Randomized controlled trials (RCTs) of different surgical treatments for peri-implantitis were extracted from EMBASE, Web of Science, Cochrane Library databases, and PubMed systematically. Pairwise comparisons and network meta-analyses (NMA) were conducted to analyze the effect of surgical treatments on probing depth (PD), radiographic bone fill (RBF), mucosal recession (MR), bleeding on probing (BOP), and clinical attachment level (CAL). In addition, risk of bias, quality of evidence, and statistical heterogeneity of the selected studies were evaluated. A total of 13 articles were included in this study, involving open flap debridement (OFD), resective therapy (RT), and augmentative therapy (AT) with and without adjunctive treatments (laser therapy, photodynamic therapy, local antibiotics, phosphoric acid, and ozone therapy). RESULTS AT improved RBF and CAL more than OFD, but does not outperform OFD in reducing peri-implant soft-tissue inflammation. AT, OFD and RT did not significantly alter the levels of MR. Addition of ozone therapy improved the effect of AT, but addition of photodynamic therapy did not affect PD reduction and CAL gain significantly. Similarly, adjuvant treatment with phosphoric acid during RT did not significantly change the outcome of BOP. CONCLUSIONS Within the limitation of this systematic review and NMA, AT was superior to OFD in improving peri-implantitis outcomes. While adjunct use of ozone therapy may further improve the efficacy of AT, the limited evidence supporting this combination therapy argues for cautionary interpretation of these results.
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Affiliation(s)
- Jing Cheng
- Stomatological Hospital of Xiamen Medical College, Xiamen Medical College, Xiamen, People's Republic of China
- Xiamen Key Laboratory of Stomatological Disease Diagnosis and Treatment, Xiamen, People's Republic of China
| | - Liang Chen
- Department of Periodontology, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, People's Republic of China
| | - Xian Tao
- Stomatological Hospital of Xiamen Medical College, Xiamen Medical College, Xiamen, People's Republic of China
- Xiamen Key Laboratory of Stomatological Disease Diagnosis and Treatment, Xiamen, People's Republic of China
| | - Xiang Qiang
- Stomatological Hospital of Xiamen Medical College, Xiamen Medical College, Xiamen, People's Republic of China
- Xiamen Key Laboratory of Stomatological Disease Diagnosis and Treatment, Xiamen, People's Republic of China
| | - Ruiying Li
- Stomatological Hospital of Xiamen Medical College, Xiamen Medical College, Xiamen, People's Republic of China
- Xiamen Key Laboratory of Stomatological Disease Diagnosis and Treatment, Xiamen, People's Republic of China
| | - Jia Ma
- Stomatological Hospital of Xiamen Medical College, Xiamen Medical College, Xiamen, People's Republic of China
- Xiamen Key Laboratory of Stomatological Disease Diagnosis and Treatment, Xiamen, People's Republic of China
| | - Dong Shi
- Department of Periodontology, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, People's Republic of China.
| | - Zijin Qiu
- Stomatological Hospital of Xiamen Medical College, Xiamen Medical College, Xiamen, People's Republic of China.
- Xiamen Key Laboratory of Stomatological Disease Diagnosis and Treatment, Xiamen, People's Republic of China.
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Bernatskiy BS, Puišys A. A Novel Approach for Implant Rehabilitation Combined with Immediate Bone and Soft-Tissue Augmentation in a Compromised Socket—A B2S Approach: Case Report with a 2-Year Follow-Up. Case Rep Dent 2023; 2023:1376588. [PMID: 37025607 PMCID: PMC10072960 DOI: 10.1155/2023/1376588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 02/20/2023] [Accepted: 02/28/2023] [Indexed: 03/30/2023] Open
Abstract
In this case report, we aimed to describe a novel approach for aesthetic rehabilitation of the anterior maxilla that combined immediate implant installation with the “Bone2Soft Tissue Reconstruction” (B2S technique), which involves the use of a triple graft harvested from the maxillary tuberosity. The regeneration potential of a tuberosity graft appeared to surpass that of corticocancellous bone grafts harvested from other intraoral donor sites and allowed for quicker regeneration of both bone and soft tissue. The B2S technique extended the indications for immediate implant placement and ridge augmentation to cases involving severe bone resorption and other complex clinical scenarios. Owing to the good visualization facilitated by open-flap access, the surgical procedures can be completed in a single intervention, which will be beneficial for both doctors and patients.
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Cucchi A, Bettini S, Ghensi P, Fiorino A, Corinaldesi G. Vertical ridge augmentation with Ti-reinforced dense polytetrafluoroethylene (d-PTFE) membranes or Ti-meshes and collagen membranes: 3-year results of a randomized clinical trial. Clin Implant Dent Relat Res 2023; 25:352-369. [PMID: 36646986 DOI: 10.1111/cid.13173] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 12/01/2022] [Accepted: 12/21/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND The present study aimed to evaluate hard and soft tissue parameters around implants placed in augmented posterior mandible, comparing Ti-reinforced d-PTFE membranes with Ti-meshes covered with collagen membranes, after 3 years of follow-up. MATERIALS AND METHODS Forty eligible patients were randomly assigned to group A (Ti-reinforced d-PTFE membrane) or group B (mesh covered with collagen membrane) for vertical ridge augmentation (VRA) and simultaneous implants. Implants were evaluated using specific peri-implant parameters for bone and soft tissues: probing pocket depth (PPD), modified plaque index (mPI), bleeding on probing (BoP), modified gingival index (mGI), thickness of keratinized tissue (tKT), width of keratinized tissue (wKT), fornix depth (FD), peri-implant bone level (PBL), interproximal bone peaks (IBP), marginal bone loss (MBL), interproximal bone loss (IBL). RESULTS A total of 28 patients with 79 implants were evaluated after 3 years of follow-up. The mean value of MBL was 0.70 mm (group A = 0.73 mm; group B = 0.71 mm), while mean IBL was 0.54 mm (group A = 0.64 mm; group B = 0.40 mm). The treatment with meshes resulted not inferior to PTFE and their clinical results appeared similar. A strong correlation between PBL and IBP was confirmed. Both study groups showed an increase of tKT and wKT values. CONCLUSION In the posterior mandible, VRA using both techniques provides stable PBLs up to 3 years. A correct soft tissue management and a strict professional oral hygiene protocol play a crucial role on peri-implant health over time.
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Affiliation(s)
| | - Sofia Bettini
- Implant Center for Edentulism and Jawbone Atrophies, Maxillofacial Surgery and Odontostomatology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Paolo Ghensi
- Department CIBIO, University of Trento, Trento, Italy
| | - Antonino Fiorino
- Department of Neuroscience and Reproductive and Odontostomatological Sciences, Federico II University of Naples, Naples, Italy
| | - Giuseppe Corinaldesi
- Section of Oral Science, Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
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Donos N, Calciolari E, Ghuman M, Baccini M, Sousa V, Nibali L. The efficacy of bone reconstructive therapies in the management of peri-implantitis. A systematic review and meta-analysis. J Clin Periodontol 2023. [PMID: 36635029 DOI: 10.1111/jcpe.13775] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 01/06/2023] [Accepted: 01/09/2023] [Indexed: 01/14/2023]
Abstract
AIM To evaluate the efficacy of bone reconstructive procedures for the reduction of probing pocket depth (PPD), bleeding on probing (BOP), and suppuration in peri-implantitis-related bone defects at ≥12-month follow-up. MATERIALS AND METHODS Three databases were searched for randomized controlled trials (RCTs) and controlled clinical trials (CCTs) that compared bone reconstructive therapies to access flap surgery (AFS) (Focused Question-FQ 1), and RCTs, CCTs, and prospective case series that assessed the efficacy of reconstructive therapies (FQ 2). Meta-analysis was performed for FQ1 when more than three studies were identified, while for FQ2 a network was drawn based on RCTs with common treatment arms. RESULTS Seven RCTs were identified for FQ1 while five RCTs and six prospective case series for FQ2. There was no significant difference in PPD change between AFS and reconstructive surgery (-0.387; p = .325) at 12 months. Furthermore, no clear differences in terms of PPD and BOP changes resulted from the different reconstructive therapies included in the network. Only a small percentage of treated cases with any modality achieved peri-implantitis resolution, as defined by different composite outcomes. CONCLUSIONS Reconstructive surgery does not offer significant improvements in peri-implant clinical parameters as compared to AFS at 12 months. It was not possible to establish a hierarchy of efficacy among the different biomaterials employed for reconstructive surgery.
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Affiliation(s)
- Nikos Donos
- Centre for Oral Clinical Research, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Elena Calciolari
- Centre for Oral Clinical Research, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.,Centro di Odontoiatria, Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italy
| | - Mandeep Ghuman
- Centre for Host-Microbiome Interactions, Faculty of Dentistry, Oral and Craniofacial Sciences, Kings College London, Guy's Hospital, London, UK
| | - Michela Baccini
- Dipartimento di Statistica, Informatica, Applicazioni 'G. Parenti' (DiSIA), University of Florence, Florence, Italy
| | - Vanessa Sousa
- Centre for Host-Microbiome Interactions, Faculty of Dentistry, Oral and Craniofacial Sciences, Kings College London, Guy's Hospital, London, UK
| | - Luigi Nibali
- Centre for Host-Microbiome Interactions, Faculty of Dentistry, Oral and Craniofacial Sciences, Kings College London, Guy's Hospital, London, UK
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Wu XY, Acharya A, Shi JY, Qian SJ, Lai HC, Tonetti MS. Surgical interventions for implant placement in the anterior maxilla: A systematic scoping review with evidence mapping. Clin Oral Implants Res 2023; 34:1-12. [PMID: 36245267 DOI: 10.1111/clr.14013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 08/26/2022] [Accepted: 09/18/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVES Simplification and standardization of interventions are critical challenges to improving performance in implant dentistry. This study aimed to systematically identify and schematically present the evidence base of the implant dentistry surgical interventions for the anterior maxilla as a basis for further development and standardization. METHODS Electronic searches were conducted in PubMed, Embase and Cochrane CENTRAL. Primary clinical studies reporting surgical interventions in the anterior maxilla, with a sample size of at least ten patients, were included. Bibliometric information and study details were extracted. Descriptive analysis and a mind map approach were used to describe the documentation of different surgical interventions. RESULTS Two hundred and seventy-two studies reporting on 9001 patients were included. Within the past two decades, the number of literatures on implant placement in the anterior maxilla has increased dramatically (7 studies before 2005, 151 studies after 2016). Overall, the evidence map identified six primary operations and 33 variations. For hopeless tooth extraction, immediate implant placement was the most frequently reported (141 studies, 4670 patients); flapless implant placement with hard tissue augmentation and immediate provisionalization was the most commonly reported variation (33 studies, 987 patients). Type 3/4 implant placement (62 studies, 1902 patients) and implant site augmentation (33 studies, 788 patients) were frequently reported for missing teeth. Geographical differences were observed, with type 2 placement studies almost exclusively from Europe. CONCLUSIONS Research on immediate implant placement was the most reported surgical intervention in the anterior maxilla. Hard tissue augmentation was frequently reported simultaneously with or before implant placement. Immediate provisionalization was mainly used for type 1 implant placement. The finding that six primary operations with 33 variations have been reported indicates the need for additional research to simplify and consolidate the surgical approach.
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Affiliation(s)
- Xin-Yu Wu
- Shanghai PerioImplant Innovation Center, Department of Oral and Maxillofacial Implantology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,College of Stomatology, Shanghai Jiao Tong University, Shanghai, China.,National Center for Stomatology, Shanghai, China.,National Clinical Research Center for Oral Diseases, Shanghai, China.,Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Aneesha Acharya
- Department of Periodontology, Dr D Y Patil Dental College & Hospital, Pimpri, India.,Faculty of Dentistry, The University of Hong Kong, Hong Kong, China
| | - Jun-Yu Shi
- Shanghai PerioImplant Innovation Center, Department of Oral and Maxillofacial Implantology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,College of Stomatology, Shanghai Jiao Tong University, Shanghai, China.,National Center for Stomatology, Shanghai, China.,National Clinical Research Center for Oral Diseases, Shanghai, China.,Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Shu-Jiao Qian
- Shanghai PerioImplant Innovation Center, Department of Oral and Maxillofacial Implantology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,College of Stomatology, Shanghai Jiao Tong University, Shanghai, China.,National Center for Stomatology, Shanghai, China.,National Clinical Research Center for Oral Diseases, Shanghai, China.,Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Hong-Chang Lai
- Shanghai PerioImplant Innovation Center, Department of Oral and Maxillofacial Implantology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,College of Stomatology, Shanghai Jiao Tong University, Shanghai, China.,National Center for Stomatology, Shanghai, China.,National Clinical Research Center for Oral Diseases, Shanghai, China.,Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Maurizio S Tonetti
- Shanghai PerioImplant Innovation Center, Department of Oral and Maxillofacial Implantology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,College of Stomatology, Shanghai Jiao Tong University, Shanghai, China.,National Center for Stomatology, Shanghai, China.,National Clinical Research Center for Oral Diseases, Shanghai, China.,Shanghai Key Laboratory of Stomatology, Shanghai, China.,European Research Group on Periodontology, Genoa, Italy
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Ramanauskaite A, Cafferata EA, Begic A, Schwarz F. Surgical interventions for the treatment of peri-implantitis. Clin Implant Dent Relat Res 2022. [PMID: 36419243 DOI: 10.1111/cid.13162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 11/01/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Peri-implantitis constitutes one of the most frequent late dental implant complications. The disease is initiated by bacterial infection; therefore, anti-infective peri-implantitis treatment strategies are required to arrest the progressive marginal bone loss and maintain the affected implant in function. Although nonsurgical treatment strategies appear to be of limited predictability, treatment outcomes have been frequently improved following surgical interventions. PURPOSE The present narrative review describes various surgical peri-implantitis treatment modalities, with respect to their indications, performance, and effectiveness. MATERIALS AND METHODS The present narrative review considered the most relevant studies in the field published in the English language. RESULTS Surgical peri-implantitis treatment approaches can be categorized as nonreconstrucive therapy, reconstructive therapy, and combined therapy (ie, reconstructive and resective therapy). In addition to disease resolution, reconstructive approaches also seek to regenerate the bone defect and achieve reosseointegration. CONCLUSIONS The severity of the disease, the regenerative potential of the defetc and esthetic demands of the patient are the factors determining the surgical peri-implantitis treatment modality.
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Affiliation(s)
- Ausra Ramanauskaite
- Department of Oral Surgery and Implantology, Johann Wolfgang Goethe-University, Carolinum, Frankfurt, Germany
| | - Emilio A Cafferata
- Department of Oral Surgery and Implantology, Johann Wolfgang Goethe-University, Carolinum, Frankfurt, Germany
| | - Amira Begic
- Department of Oral Surgery and Implantology, Johann Wolfgang Goethe-University, Carolinum, Frankfurt, Germany
| | - Frank Schwarz
- Department of Oral Surgery and Implantology, Johann Wolfgang Goethe-University, Carolinum, Frankfurt, Germany
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Targonska S, Dominiak S, Wiglusz RJ, Dominiak M. Investigation of Different Types of Micro- and Nanostructured Materials for Bone Grafting Application. NANOMATERIALS (BASEL, SWITZERLAND) 2022; 12:3752. [PMID: 36364528 PMCID: PMC9655406 DOI: 10.3390/nano12213752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 10/02/2022] [Accepted: 10/11/2022] [Indexed: 06/16/2023]
Abstract
The insufficient volume of dental ridges is one of the most severe problems regarding an oral cavity. An inadequate amount can cause problems during various types of dental treatment. Its complexity originates from the etiopathogenesis of this problem. In this study, the representatives of auto-, allo-, and xenografts are compared. The physic-chemical differences between each of them were evaluated using XRD (X-ray Powder Diffraction), a SEM (Scanning Electron Microscopy), FT-IR (Fourier transformed infrared spectroscopy), and TGA (thermogravimetric analysis). Based on the SEM images, it was observed that the origin of the material has an influence on collagen fiber compact level and porosity. Following a comparison of FT-IR spectra and XRD, the crystal and chemical structures were described. Based on TGA, different water concentrations of the investigated materials, their high thermal stability, and concentration of inorganic phase, hydroxyapatite was determined. The presented study is important because it delivers information about chemical structure and its impact on bone regeneration. This knowledge should be taken into consideration by dental clinicians, because different types of bone grafts can accommodate the achievement of various goals.
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Affiliation(s)
- Sara Targonska
- Institute of Low Temperature and Structure Research, Polish Academy of Sciences, 50-950 Wroclaw, Poland
| | - Sebastian Dominiak
- Department of Oral Surgery Medical, University of Wroclaw, 50-425 Wroclaw, Poland
| | - Rafał J. Wiglusz
- Institute of Low Temperature and Structure Research, Polish Academy of Sciences, 50-950 Wroclaw, Poland
| | - Marzena Dominiak
- Department of Oral Surgery Medical, University of Wroclaw, 50-425 Wroclaw, Poland
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Galindo‐Moreno P, Catena A, Pérez‐Sayáns M, Fernández‐Barbero JE, O'Valle F, Padial‐Molina M. Early marginal bone loss around dental implants to define success in implant dentistry: A retrospective study. Clin Implant Dent Relat Res 2022; 24:630-642. [PMID: 35831919 PMCID: PMC9796358 DOI: 10.1111/cid.13122] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 06/26/2022] [Accepted: 06/29/2022] [Indexed: 01/01/2023]
Abstract
PURPOSE The aim of this study was to establish an objective criterion in terms of marginal bone level (MBL) to know the prognosis of an implant. MATERIALS AND METHODS A group of 176 patients in whom 590 implants were placed were included in this retrospective study. Patients older than 18 years, presenting either Kennedy class I or II edentulous section, or totally edentulous at least in one of the dental arches were included in this study. Those with any type of disturbance able to alter bone metabolism or with nontreated periodontal disease were excluded. Data on radiographic MBL at loading, 6 and 18 months later, age, gender, smoking habits, history of periodontitis, bone substratum, implant, and prosthetic features were recorded. Nonparametric receiver operating curves (ROC) were constructed for the MBL at 18 months in order to establish a distinction among high bone loser (HBL) and low bone loser (LBL) implants. Differences as a function of main variables were also determined, particularly abutment height and periodontal disease. RESULTS HBL implants lost at least 0.48 mm of MBL 6 months after loading; they reached at least 2 mm of MBL 18 months after loading. MBL rate followed a nonlinear trend, except in implants restored over long prosthetic abutments and in patients with history of severe periodontitis; in whom the rate of MBL over the time was nearly zero. CONCLUSION Implants that lose more than 0.5 mm of marginal bone 6 months after loading are at great risk of not being radiographically successful anymore. Therefore, 0.5 mm of MBL is proposed as a distinctive and objective criterion of success in Implant Dentistry within a 6-month follow-up period. A prosthetic abutment height ≥2 mm resulted the most protective factor in the peri-implant bone maintenance.
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Affiliation(s)
- Pablo Galindo‐Moreno
- Department of Oral Surgery and Implant Dentistry, School of DentistryUniversity of GranadaGranadaSpain
| | - Andrés Catena
- Department of Experimental Psychology, School of PsychologyUniversity of GranadaGranadaSpain
| | - Mario Pérez‐Sayáns
- Oral Medicine, Oral Surgery and Implantology Unit, Faculty of Medicine and DentistryUniversity of Santiago de CompostelaSantiago de CompostelaSpain
| | | | - Francisco O'Valle
- Department of Pathology, School of Medicine & IBIMERUniversity of GranadaGranadaSpain,Instituto de Investigación Biosanitariaibs.GRANADAGranadaSpain
| | - Miguel Padial‐Molina
- Department of Oral Surgery and Implant Dentistry, School of DentistryUniversity of GranadaGranadaSpain
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Derks J, Ortiz‐Vigón A, Guerrero A, Donati M, Bressan E, Ghensi P, Schaller D, Tomasi C, Karlsson K, Abrahamsson I, Ichioka Y, Dionigi C, Regidor E, Berglundh T. Reconstructive surgical therapy of peri-implantitis: A multicenter randomized controlled clinical trial. Clin Oral Implants Res 2022; 33:921-944. [PMID: 35804491 PMCID: PMC9544523 DOI: 10.1111/clr.13972] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/29/2022] [Accepted: 07/04/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To evaluate the potential benefit of the use of a bone substitute material in the reconstructive surgical therapy of peri-implantitis. METHODS In this multicenter randomized clinical trial, 138 patients (147 implants) with peri-implantitis were treated surgically, randomized by coin toss to either a control (access flap surgery) or a test group (reconstructive surgery using bone substitute material). Clinical assessments, including probing pocket depth (PPD), bleeding and suppuration on probing (BOP & SOP) as well as soft tissue recession (REC), were recorded at baseline, 6 and 12 months. Marginal bone levels (MBL), measured on intra-oral radiographs, and patient-reported outcomes (PROs) were recorded at baseline and 12 months. No blinding to group allocation was performed. The primary outcome at 12 months was a composite measure including (i) implant not lost, (ii) absence of BOP/SOP at all aspects, (iii) PPD ≤5 mm at all aspects and (iv) ≤1 mm recession of mucosal margin on the buccal aspect of the implant. Secondary outcomes included (i) changes of MBL, (ii) changes of PPD, BOP%, and buccal KM, (iii) buccal REC and (iv) patient-reported outcomes. RESULTS During follow-up, four implants (one in the test group, three in the control group) in four patients were removed due to disease progression. At 12 months, a total of 69 implants in the test and 68 implants in the control group were examined. Thus, 16.4% and 13.5% of implants in the test and control group, respectively, met all predefined criteria of the composite outcome. PPD reduction and MBL gain were 3.7 mm and about 1.0 mm in both groups. Reduction in mean BOP% varied between 45% (test) and 50% (control), without significant differences between groups. Buccal REC was less pronounced in the test group (M = 0.7, SD = 0.9 mm) when compared to controls (M = 1.1, SD = 1.5 mm). PROs were favorable in both groups without significant differences. One case of allergic reaction to the antibiotic therapy was recorded. No other adverse events were noted. CONCLUSIONS Surgical therapy of peri-implantitis effectively improved the clinical and radiographic status at 12 months. While the use of a bone substitute material did not improve reductions of PPD and BOP, buccal REC was less pronounced in the test group. Patient satisfaction was high in both groups.
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Affiliation(s)
- Jan Derks
- Department of Periodontology, Institute of OdontologyThe Sahlgrenska Academy at University of GothenburgGothenburgSweden,Clinic of Periodontics, Public Dental ServiceRegion Västra GötalandGothenburgSweden
| | - Alberto Ortiz‐Vigón
- Clínica Ortiz‐VigónPerioCentrumBilbaoSpain,ETEP Research Group, Faculty of OdontologyUniversity Complutense of MadridMadridSpain
| | | | - Mauro Donati
- Department of Periodontology, Institute of OdontologyThe Sahlgrenska Academy at University of GothenburgGothenburgSweden
| | - Eriberto Bressan
- Department of Neuroscience, Faculty of OdontologyUniversity of PaduaPaduaItaly
| | | | | | - Cristiano Tomasi
- Department of Periodontology, Institute of OdontologyThe Sahlgrenska Academy at University of GothenburgGothenburgSweden
| | - Karolina Karlsson
- Department of Periodontology, Institute of OdontologyThe Sahlgrenska Academy at University of GothenburgGothenburgSweden,Clinic of Periodontics, Public Dental ServiceRegion Västra GötalandGothenburgSweden
| | - Ingemar Abrahamsson
- Department of Periodontology, Institute of OdontologyThe Sahlgrenska Academy at University of GothenburgGothenburgSweden,Clinic of Periodontics, Public Dental ServiceRegion Västra GötalandGothenburgSweden
| | - Yuki Ichioka
- Department of Periodontology, Institute of OdontologyThe Sahlgrenska Academy at University of GothenburgGothenburgSweden
| | - Carlotta Dionigi
- Department of Periodontology, Institute of OdontologyThe Sahlgrenska Academy at University of GothenburgGothenburgSweden
| | | | - Tord Berglundh
- Department of Periodontology, Institute of OdontologyThe Sahlgrenska Academy at University of GothenburgGothenburgSweden,Clinic of Periodontics, Public Dental ServiceRegion Västra GötalandGothenburgSweden
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Efficacy of concentrated growth factor versus collagen membrane in reconstructive surgical therapy of peri-implantitis: 3-year results of a randomized clinical trial. Clin Oral Investig 2022; 26:5247-5260. [PMID: 35618961 PMCID: PMC9381616 DOI: 10.1007/s00784-022-04493-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 04/13/2022] [Indexed: 11/29/2022]
Abstract
Objectives To compare the 3-year clinical and radiographic outcomes of two different reconstructive surgical management of peri-implantitis using a bone substitute in combination with either concentrated growth factor (CGF) or collagen membrane (CM). Material and methods Fifty-one patients who had at least one implant presenting peri-implantitis with an intrabony defect were filled with a xenogenic bone grafting material and covered either CGF or CM. Clinical and radiographic assessments were carried out at baseline and postoperative years 1 and 3. Three different composite outcomes were defined to evaluate treatment success at a 3-year follow-up. The effects of possible prognostic indicators on treatment success were identified by using multilevel regression analysis. Results The changes in probing depth (PD) and radiographic vertical defect depth (VDD) between baseline and year 1 and baseline and year 3 presented significantly greater decreases for the CM group in comparison with the CGF group (p < 0.05). No significant differences between the two treatment modalities were demonstrated regarding treatment success outcomes. History of periodontitis, VDD at baseline, and the number of intrabony defect walls revealed significant impacts on treatment success (p = 0.033; OR = 3.50, p = 0.039; OR = 0.975, and p = 0.024; OR = 7.0 and p = 0.019;OR = 6.0, respectively). Conclusions CM in combination with a bone substitute seems to have slightly better outcomes compared to the CGF membranes in reconstructive surgical therapy of peri-implantitis. The history of periodontitis, baseline VDD, and peri-implant bone defect configuration could be possible predictors influencing treatment success. Trial registration ClinicalTrials.gov NCT04769609. Clinical relevance For the reconstruction of peri-implant bone defects, using a bone substitute in combination with a collagen membrane may show more favorable outcomes.
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Derks J, Ichioka Y, Dionigi C, Trullenque Eriksson A, Berglundh J, Tomasi C, Graziani F. Prevention and management of peri-implant mucositis and peri-implantitis: a systematic review of outcome measures used in clinical studies in the last 10 years. Clin Oral Implants Res 2022; 34 Suppl 25:55-67. [PMID: 35343614 DOI: 10.1111/clr.13925] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 02/17/2022] [Accepted: 02/21/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate outcome measures, methods of assessment and analysis in clinical studies on the prevention and management of peri-implant mucositis and peri-implantitis. METHODS Systematic electronic searches (CENTRAL/MEDLINE/SCOPUS) up to April 2021 were conducted to identify longitudinal clinical studies with ≥10 patients on either the prevention or management of peri-implant diseases. Outcome measures of this analysis were the choice of outcome measures, methods of assessment and analytical methods. Risk of Bias was evaluated according to study design. Data were extracted into evidence tables and outcomes were analyzed in a descriptive manner. RESULTS The analysis of the 159 selected studies revealed that probing pocket depth (PPD) and bleeding/suppuration on probing (BOP) were reported in 89% and 87% of all studies, respectively. Additional outcome measures included plaque scores (reported in 64% of studies), radiographic outcomes (49%), soft tissue dimensions (34%) and composite outcomes (26%). Adverse events (8%) and patient-reported outcomes (6%) were only rarely mentioned. A total of 36% of studies clearly defined a primary outcome measure. Data on PPD, radiographic outcomes and soft tissue dimensions were primarily reported as mean values and rarely as frequency distributions. For radiographic outcomes and soft tissue dimensions, it was frequently unclear how clustered data were handled. CONCLUSIONS PPD and BOP were routinely reported in studies on prevention and management of peri-implant mucositis and peri-implantitis, while composite outcomes, adverse events and patient-reported outcomes were infrequently described.
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Affiliation(s)
- Jan Derks
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Yuki Ichioka
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Carlotta Dionigi
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Anna Trullenque Eriksson
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Jessica Berglundh
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Cristiano Tomasi
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
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Couso-Queiruga E, Mansouri CJ, Alade AA, Allareddy TV, Galindo-Moreno P, Avila-Ortiz G. Alveolar ridge preservation reduces the need for ancillary bone augmentation in the context of implant therapy. J Periodontol 2022; 93:847-856. [PMID: 35289400 PMCID: PMC9322559 DOI: 10.1002/jper.22-0030] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/21/2022] [Accepted: 03/08/2022] [Indexed: 12/01/2022]
Abstract
Background There is limited information on the need for bone augmentation in the context of delayed implant placement whether alveolar ridge preservation (ARP) is previously performed or not. The primary aim of this retrospective cohort study was to evaluate the efficacy of ARP therapy after tooth extraction compared with unassisted socket healing (USH) in reducing the need for ancillary bone augmentation before or at the time of implant placement. Methods Adult subjects that underwent non‐molar single tooth extraction with or without simultaneous ARP therapy were included in this study. Cone beam computed tomography scans obtained before tooth extraction and after a variable healing period were used to record the baseline facial bone thickness and to virtually plan implant placement according to a standard method. A logistic regression model was used to evaluate the effect of facial alveolar bone thickness upon tooth extraction and baseline therapy (USH or ARP) on the need for additional bone augmentation, adjusting for several covariates (i.e., age, sex, baseline KMW, and tooth type). Results One hundred and forty subjects that were equally distributed between both baseline therapy groups constituted the study population. Implant placement was deemed virtually feasible in all study sites. Simultaneous bone augmentation was considered necessary in 60% and 11.4% of the sites in the USH and ARP group, respectively. Most of these sites (64.2% in the USH group and 87.5% in the ARP group) exhibited a thin facial bone phenotype (<1 mm) at baseline. Logistic regression revealed that the odds of not needing ancillary bone augmentation were 17.8 times higher in sites that received ARP therapy. Furthermore, the need for additional bone augmentation was reduced 7.7 times for every 1 mm increase in facial bone thickness, regardless of baseline therapy. Conclusions Based on a digital analysis, ARP therapy, compared with USH, and thick facial alveolar bone largely reduce the need for ancillary bone augmentation at the time of implant placement in non‐molar sites.
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Affiliation(s)
- Emilio Couso-Queiruga
- Department of Periodontics, University of Iowa College of Dentistry, Iowa City, IA, USA
| | - Cyrus J Mansouri
- Department of Periodontics, University of Iowa College of Dentistry, Iowa City, IA, USA
| | - Azeez A Alade
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA, USA.,Iowa Institute for Oral Health Research, University of Iowa College of Dentistry, Iowa City, IA, USA
| | - Trishul V Allareddy
- Department of Oral Pathology, Radiology and Medicine, University of Iowa College of Dentistry, Iowa City, IA, USA
| | - Pablo Galindo-Moreno
- Department of Periodontics, University of Iowa College of Dentistry, Iowa City, IA, USA.,Department of Oral Surgery and Implant Dentistry, School of Dentistry, University of Granada, Granada, Spain
| | - Gustavo Avila-Ortiz
- Department of Periodontics, University of Iowa College of Dentistry, Iowa City, IA, USA
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Derks J, Ichioka Y, Dionigi C, Trullenque Eriksson A, Berglundh J, Tomasi C, Graziani F. Prevention and management of peri-implant mucositis and peri-implantitis: a systematic review of outcome measures used in clinical studies in the last 10 years. J Clin Periodontol 2022; 50 Suppl 25:55-66. [PMID: 35246865 DOI: 10.1111/jcpe.13608] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 02/17/2022] [Accepted: 02/21/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To evaluate outcome measures, methods of assessment and analysis in clinical studies on the prevention and management of peri-implant mucositis and peri-implantitis. METHODS Systematic electronic searches (CENTRAL/MEDLINE/SCOPUS) up to April 2021 were conducted to identify longitudinal clinical studies with ≥10 patients on either the prevention or management of peri-implant diseases. Outcome measures of this analysis were the choice of outcome measures, methods of assessment and analytical methods. Risk of Bias was evaluated according to study design. Data were extracted into evidence tables and outcomes were analyzed in a descriptive manner. RESULTS The analysis of the 159 selected studies revealed that probing pocket depth (PPD) and bleeding/suppuration on probing (BOP) were reported in 89% and 87% of all studies, respectively. Additional outcome measures included plaque scores (reported in 64% of studies), radiographic outcomes (49%), soft tissue dimensions (34%) and composite outcomes (26%). Adverse events (8%) and patient-reported outcomes (6%) were only rarely mentioned. A total of 36% of studies clearly defined a primary outcome measure. Data on PPD, radiographic outcomes and soft tissue dimensions were primarily reported as mean values and rarely as frequency distributions. For radiographic outcomes and soft tissue dimensions, it was frequently unclear how clustered data were handled. CONCLUSIONS PPD and BOP were routinely reported in studies on prevention and management of peri-implant mucositis and peri-implantitis, while composite outcomes, adverse events and patient-reported outcomes were infrequently described. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Jan Derks
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Yuki Ichioka
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Carlotta Dionigi
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Anna Trullenque Eriksson
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Jessica Berglundh
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Cristiano Tomasi
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
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Feher B, Frommlet F, Ulm C, Gruber R, Kuchler U. Preoperative buccal bone volume predicts long-term graft retention following augmentation in the esthetic zone: a retrospective case series. Clin Oral Implants Res 2022; 33:492-500. [PMID: 35194845 PMCID: PMC9314910 DOI: 10.1111/clr.13909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 01/25/2022] [Accepted: 02/17/2022] [Indexed: 11/27/2022]
Abstract
Objectives Buccal bone augmentation in the esthetic zone is routinely used to achieve optimal clinical outcomes. Nonetheless, long‐term data are sparse, and it is unknown how baseline buccal bone volume affects the retention of the augmented volume over time. Material and methods This is a long‐term follow‐up retrospective case series. After a preoperative computed tomography scan, implants were placed in the anterior maxilla following guided bone regeneration, autogenous block grafting, or both. At the follow‐up, patients received a computed tomography scan and a clinical examination. Buccal bone volume was the primary outcome. Buccal bone thickness, peri‐implant, and esthetic parameters were secondary outcomes. Results After a median follow‐up of 6.7 years (interquartile range: 4.9–9.4), 28 implants in 19 patients (median age at augmentation: 43.3 years, interquartile range: 34.4–56.7, 53% female) were followed up. Preoperative buccal bone volume at baseline (V0) showed a moderate correlation to final buccal bone volume (Vt, rs = .43) but a strong correlation to the absolute volumetric change (ΔV = Vt–V0, rs = −.80). A linear mixed model for Vt had a large intercept of 91.39 (p < .001) and a rather small slope of .11 for V0 (p = .11). Observed differences between treatments were not statistically significant in the mixed model. V0 above 105 mm3 predicted a negative volume change (ΔV < 0) with a specificity of 100% and a sensitivity of 96%. Conclusions The results suggest higher gains in sites with lower V0 and point to a cutoff V0 above which the augmented volume is not retained long‐term.
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Affiliation(s)
- Balazs Feher
- Department of Oral Surgery, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria.,Department of Oral Biology, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Florian Frommlet
- Institute of Medical Statistics, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Christian Ulm
- Department of Oral Surgery, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Reinhard Gruber
- Department of Oral Biology, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria.,Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Ulrike Kuchler
- Department of Oral Surgery, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
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Schwarz F, Jepsen S, Obreja K, Galarraga-Vinueza ME, Ramanauskaite A. Surgical therapy of peri-implantitis. Periodontol 2000 2022; 88:145-181. [PMID: 35103328 DOI: 10.1111/prd.12417] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Peri-implantitis is caused by a bacterial challenge; therefore, anti-infective treatment strategies should be employed to manage the disease. As nonsurgical approaches demonstrate limited efficacy in most cases of peri-implantitis, surgical interventions are often required. Treatment outcomes improve following access flap surgery, with or without adjunctive resective and/or augmentation measures. Whereas nonaugmentative therapies (ie, access flap surgery and resective techniques) primarily aim to resolve inflammation and arrest further disease progression, augmentation approaches also seek to regenerate the bony defect and achieve reosseointegration. Currently, limited evidence supports the superiority of augmentative surgical techniques for peri-implantitis treatment over nonaugmentation methods, and human histologic evidence for reosseointegration is sparse. For patients involved in regular postoperative maintenance programs, success of peri-implantitis surgical treatment based on various definitions of success was obtained in over half of the cases after 5-7 years. Despite surgical treatment, cases of further disease progression that required retreatment or led to implant loss were reported.
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Affiliation(s)
- Frank Schwarz
- Department of Oral Surgery and Implantology, Johann Wolfgang Goethe-University, Carolinum, Frankfurt an Main, Germany
| | - Søren Jepsen
- Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, Bonn, Germany
| | - Karina Obreja
- Department of Oral Surgery and Implantology, Johann Wolfgang Goethe-University, Carolinum, Frankfurt an Main, Germany
| | - Maria Elisa Galarraga-Vinueza
- Post-Graduate Program in Implant Dentistry (PPGO), Federal University of Santa Catarina (UFSC), Florianópolis, Brazil
| | - Ausra Ramanauskaite
- Department of Oral Surgery and Implantology, Johann Wolfgang Goethe-University, Carolinum, Frankfurt an Main, Germany
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Tomographic evaluation of the effect of simvastatin topical use on alveolar bone microarchitecture, pain and swelling after mandibular third molar extraction: a randomized controlled trial. Clin Oral Investig 2022; 26:3533-3545. [DOI: 10.1007/s00784-021-04322-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 11/24/2021] [Indexed: 11/03/2022]
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