Clinical efficacy of triclosan-containing toothpaste in peri-implant health: A systematic review and meta-analysis of randomized clinical trials

STATEMENT OF PROBLEM

Recent evidence suggests that toothpaste containing 0.3% triclosan (TCS) is more effective than regular toothpaste in improving clinical periodontal conditions. However, a consensus on whether TCS favors a healthy peri-implant environment is limited.

PURPOSE

The purpose of this systematic review and meta-analysis of randomized clinical trials was to determine the effects of TCS-containing toothpaste on dental implant health based on clinical, immunological, and microbiological parameters, as well as on reported adverse events.

MATERIAL AND METHODS

Clinical studies comparing peri-implant conditions in participants by using TCS toothpaste versus conventional fluoride toothpaste (control) were extracted from 9 databases. The studies were assessed with the Cochrane risk-of-bias tool for randomized clinical trials (RoB 2). Datasets for bleeding on probing (BOP), probing depth (PD), clinical attachment level (CAL), gingival index (GI), plaque index (PI), osteo-immunoinflammatory mediators, and bacterial load were plotted, and the standard mean difference (SMD) quantitative analysis was applied by using the Rev Man 5.3 software program. Adverse effects reported by the studies were also tabulated. The certainty of evidence was assessed by using the grading of recommendations assessment, development, and evaluation approach.

RESULTS

Six studies were included in the meta-analyses. BOP was higher in the control group than in the TCS toothpaste group at 3 months (SMD -0.59 [-1.11, -.07] P=.002, I2=77%) and 6 months (SMD -0.59 [-0.83, -0.34] P=.009, I2=79%). PD (SMD -0.04 [-0.08, -0.00] P=.04, I2=0%) was also deeper in the control group versus TCS toothpaste at 6 months (SMD -0.41 [-0.73, -0.10] P=.04, I2=77%). CAL, GI, and PI did not differ between groups (P>.05). Among the osteo-immunoinflammatory mediators, IL-10 levels increased, and IL-1β and osteoprotegerin levels decreased in the TCS toothpaste group (P<.05). Microbiological findings found that TCS toothpaste prevented the growth of periodontal pathogens, specifically in up to approximately 20% of the Prevotella intermedia. Adverse effects were not reported after toothbrushing in either group. However, most studies had "some" or "high" risk of bias, and the certainty of the evidence was considered to be "very low."

CONCLUSIONS

Most studies were short-term (3 and 6 months) analyses, and the results found that, although TCS-containing toothpaste had positive osteo-immunoinflammatory and microbiologic results, clinical parameters, including CAL, GI, and PI, were not influenced.

Treatment Strategies for Peri-Implant Mucositis: The Final Stop for Preventing Peri-Implantitis

Objectives: This article aims to provide a comprehensive overview of peri-implant mucositis, covering its etiology, risk factors, clinical features, diagnosis, and available treatment modalities. Methods: A comprehensive electronic and manual search was performed on electronic databases. Studies with focus on peri-implant mucositis were included and reviewed comprehensively. Based on the latest evidence, decisional workflows and clinical recommendations were proposed. Results: The review highlights the multifactorial etiology of peri-implant mucositis, primarily driven by bacterial biofilm accumulation. Key risk factors identified include poor oral hygiene, smoking, uncontrolled diabetes, and local factors such as implant surface characteristics and prosthesis design. Diagnostic criteria are based on the presence of clinical signs (inflammation, redness, swelling, and bleeding on probing (BoP)) and the absence of radiographic bone changes. Nonsurgical treatments, including mechanical debridement and photodynamic therapy (PDT), have shown effectiveness in managing the condition. However, the efficacy of adjunctive therapies remains inconclusive. Regular maintenance and optimal oral hygiene are critical in preventing and managing peri-implant mucositis. Conclusion: Peri-implant mucositis remains a prevalent condition in implant dentistry, with nonsurgical treatment strategies showing promising outcomes in disease management. Further research is needed to establish the long-term effectiveness of adjunctive therapies and optimize preventive strategies for maintaining peri-implant health.

The Effect of Peri-Implant Therapy on the Expression of Th17-Related Cytokines in Patients with Peri-Implant Mucositis and Peri-Implantitis: A Prospective Longitudinal Study

Background/Objectives: Cytokines related to the Th17 response have been associated with peri-implant diseases; however, the effect of peri-implant therapy on their modulation remains underexplored. To evaluate the effect of peri-implant therapy on the expression of cytokines related to the Th17 response in the peri-implant crevicular fluid (PICF) (GM-CSF, IFN-γ, IL-1β, IL-4, IL-6, IL-10, IL-12 (p70), IL-17A, IL-21, IL-23, and TNF-α) of partially edentulous patients with peri-implant disease (PID). Methods: Thirty-seven systemically healthy individuals presenting with peri-implant mucositis (PIM) (n = 20) or peri-implantitis (PI) (n = 17) were treated and evaluated at baseline (T0) and three months after therapy (T1). Clinical parameters (probing depth (PD), clinical attachment level (CAL), plaque index, and bleeding on probing index (BoP), were evaluated. The PIM group underwent non-surgical therapy, while the PI group received a surgical approach. PICF was collected with absorbent paper strips and analyzed with a multiplex assay. Results: Eighty-eight implants were treated in 37 patients (56 in the PIM group and 32 in the PI group). After therapy, significant reductions in PD, CAL, plaque index, and BoP were observed in the PIM group (p < 0.05). In the PI group, significant reductions in PD, CAL, and BoP were noted (p < 0.05). The PIM group showed a significant reduction of IL-17A and TNF-α after therapy, while the PI group showed a significant reduction of IL-1β, IL-6, and TNF-α (p < 0.05). Conclusions: The peri-implant therapy for patients with PID reduced the expression of cytokines related to the Th17 response in PICF.

LONG-TERM PREDICTIVE VALUE OF BLEEDING ON PROBING IN PERI‑IMPLANTITIS DIAGNOSIS: A SYSTEMATIC REVIEW AND META-ANALYSIS

OBJECTIVE

This systematic review and meta-analysis aimed to evaluate the diagnostic value of bleeding on probing (BOP) for peri‑implantitis detection on implant- and patient-levels, as reported in prospective and retrospective studies with at least 5 years of follow-up.

MATERIALS AND METHODS

A systematic search of 3 electronic databases was conducted and supplemented with a hand-search to identify clinical studies that reported the prevalence of peri‑implantitis and BOP after at least 5 years of functional loading. Random-effects meta-analyses were conducted to combine the proportions of peri‑implantitis among BOP positive implants and patients across studies. Heterogeneity was explored with subgroup analyses.

RESULTS

5826 patients and 17,198 implants were included in this review. Definitions of peri‑implantitis varied between studies. Thirty studies were included for assessment. Implant-level meta-analysis was conducted in 24 studies and patient-level meta-analysis in 19 studies. Overall proportion of peri‑implantitis in BOP-positive implants was 26.5% (95% CI, 21.2 to 32.1) and 35.1% (95% CI, 27.4 to 43.1) in BOP-positive patients. Substantial heterogeneity was present, and prediction intervals were 5.2%-56% and 6.4%-71.5% at the implant- and patient-level, respectively.

CONCLUSION

Within the limitations, prevalence of peri‑implantitis was found to be around 1 third in both BOP-positive implants and patients. Prevalence varied between studies. Although a guiding clinical factor in the diagnosis of peri‑implantitis, clinicians should be aware of the significant false-positive rates of BOP.

Comprehensive treatment protocol for peri-implantitis: an up-to date narrative review of the literature

This narrative review describes up-to-date treatment options for peri-implantitis and proposes a treatment protocol and flowchart based on the current scientific evidence. Peri-implantitis treatment should be based on the phased treatment protocol for periodontitis, which is a continuous flow of decisions for extraction, nonsurgical and surgical treatments with step-by-step re-evaluation. The protocol's goals are to fulfill the success criteria for peri-implantitis treatment (probing depth of ≤5 mm, and absence of bleeding on probing, suppuration, and progressive bone loss) and to halt disease progression. Fixtures with peri-implantitis can initially be classified as failed or failing. A failed implant needs to be removed. In contrast, nonsurgical and surgical treatments can be applied to a failing implant. Nonsurgical treatment should be the initial treatment for failing implants; however, sole nonsurgical treatment was regarded as inefficient for peri-implantitis. Recent studies have found that the adjunctive use of antibiotics to nonsurgical debridement increased the success of nonsurgical treatment for peri-implantitis. Surgical treatments can be classified into resective, access, and reconstructive surgeries. The technique should be selected according to the patient's bone defect configuration, which relate to regenerative potential. Various combinations of decontamination methods (e.g., mechanical, chemical, and pharmacological approaches) are required to achieve absolute surface decontamination. Clinicians should select an appropriate surface decontamination strategy according to the purpose of surgery. After signs of disease disappear and its progression is halted through active peri-implantitis treatment, it is necessary to enroll patients into maintenance programs. Compliance of patients with the maintenance program reduces the recurrence of peri-implantitis and sustains clinical success after treatment. Maintenance visits should include professional plaque control and hygiene care reinforcement for patients, and their interval should be set according to individual peri-implantitis risk. Clinicians should remind that peri-implantitis treatment is not a single procedure, but rather a continuing cycle of treatment and re-evaluation.

Impact of diabetes mellitus on the poor prognosis in patients with osseointegrated dental implants: a meta-analysis of observational studies

This meta-analysis aimed to explore the correlation between diabetes mellitus (DM) and peri-implant diseases in patients with osseointegrated dental implants. Relevant studies were searched in multiple databases from the available date of inception through 26 August 2021. The odds ratios (ORs) were used as the effect indicator for measurement data, and each effect size was given estimates and 95% confidence intervals (CIs). Begg's test was used for publication bias. Twenty-one observational studies with 24,953 participants were selected. No significant association was shown between DM and peri-implant mucositis (OR: 0.739, 95% CI: 0.394-1.383, P = 0.344). The results demonstrated that the risk of peri-implantitis was higher in DM than in non-DM (OR: 1.553, 95% CI: 1.084-2.226, P = 0.016). Smokers had higher risk of peri-implantitis than non-smoking patients (OR: 1.754, 95% CI: 1.620-1.899, P < 0.001). In addition, no significant association was shown between DM and peri-implantitis among non-smokers. The association between periodontal history (OR: 2.538, 95% CI: 0.814-7.921, P = 0.109), poor plaque control (OR: 1.700, 95% CI: 0.334-8.648, P = 0.523) and peri-implantitis was not statistically significant. No publication bias was observed for each outcome. DM increases the risk of poor outcomes in osseointegrated dental implant patients. The findings of the present study further elucidate the need for longitudinal investigations regarding risk variables that affects peri-implant tissues.

Influence of the level of compliance with preventive maintenance therapy upon the prevalence of peri-implant diseases

BACKGROUND

A study was made to evaluate peri-implant conditions in compliers and erratic compliers with peri-implant maintenance therapy (PIMT), and to assess the role of site-specific confounders.

METHODS

Erratic PIMT compliers (EC) were defined as presenting attendance < 2×/year, while regular compliers (RC) attended ≥ 2×/year. Generalized estimating equations (GEE) were employed to perform a multivariable multilevel analysis in which the peri-implant condition was established as dependent variable.

RESULTS

Overall, 86 non-smoker patients (42 RC and 44 EC) attending the Department of Periodontology of the Universitat Internacional de Catalunya were recruited consecutively on a cross-sectional basis. The mean period of loading was 9.5 year. An implant placed in an erratic patient has 88% higher probability of presenting peri-implant diseases versus RC. Furthermore, the probability of diagnosis of peri-implantitis was significantly higher in EC versus RC (odds ratio [OR] 5.26; p = 0.009). Among other factors, history of periodontitis, non-hygienic prosthesis, period of implant loading, and modified plaque index (mPI) at implant level were shown to significantly increase the risk of peri-implantitis diagnosis. Although not associated with peri-implantitis diagnosis risk, keratinized mucosa (KM) width, and vestibular depth (VD) were significantly associated to plaque accumulation (mPI).

CONCLUSIONS

Compliance with PIMT was found to be significantly associated with peri-implant condition. In this sense, attending PIMT < 2×/year may be ineffective to prevent peri-implantitis.

A Systematic Review and Meta-Analysis of the Clinical Outcomes for Adjunctive Physical, Chemical, and Biological Treatment of Dental Implants With Peri-Implantitis

The present systematic review evaluated the efficacy of adjunctive therapies in the treatment of peri-implantitis. Studies comparing the outcome of conventional surgical- or nonsurgical mechanical debridement with the addition of an adjunctive therapeutic modality were identified through an electronic and hand search of available literature. Following data extraction, meta-analyses were performed on the primary outcome measures. The effects of the adjunctive therapies on bleeding on probing (13 studies), probing pocket depth (9 studies), and radiographic bone level changes (7 studies) were analyzed to evaluate potential clinical benefit. Heterogeneity was expressed as the I2 index. Fixed and random effect models were demonstrated. The potential benefit of adjunctive therapies over control procedures was evaluated in 18 studies, representing a total of 773 implants. Quality assessment of the studies found only 3 studies to be at a low risk of bias. Meta-analysis among the different additional modalities revealed chemical therapy demonstrating significant effects in probing pocket depth reduction (0.58 mm; 0.44-0.72) and radiographic bone level gain (0.54 mm; 0.16-0.92). No significant improvements in bleeding on probing reduction were found using any adjunctive therapy. Available evidence on the benefits of adjunctive therapy to nonsurgical or surgical mechanical debridement in the treatment of peri-implantitis is limited by low numbers of standardized, controlled studies for individual therapies, heterogeneity between studies, and a variety of outcome measures. The lack of effect of any adjunctive therapy in reducing bleeding on probing questions the overall effectiveness over conventional treatment. The long-term clinical benefit potential of these therapies is not demonstrated.

In vitro efficacy of non-surgical and surgical implant surface decontamination methods in three different defect configurations in the presence or absence of a suprastructure

OBJECTIVES

Analysis of the in vitro efficacy of non-surgical and surgical dental implant surface decontamination with or without suprastructure.

MATERIALS AND METHODS

Three hundred and sixty implants were dipped in indelible red and distributed to 30°, 60°, or 90° angulated bone defect models. One hundred and twenty implants were used for each bone defect, 40 of which were assigned to a decontamination method (CUR: curette; SOSC: soundscaler; APA: air powder abrasion). Of these, 20 were subjected to a simulated non-surgical (NST) or surgical treatment (ST), with/without mucosa mask, of which 10 were carried out with (S+) or without (S-) suprastructure. Uncleaned implant surface was assessed by both-sided implant surface photography. Surface morphology changes were analyzed using scanning electron microscopy (SEM).

RESULTS

Cleaning efficacy was significantly better within NST if the suprastructure was removed (p < 0.001). No significant difference was found within ST (p = 0.304). Overall, cleaning efficacy in the order APA > SOSC>CUR decreased significantly (p < 0.0001) for both S+ and S- in NST as well as ST. Separated by NST/ST, S+/S-, defect angulation and decontamination method, only isolated significant differences in cleaning efficacy were present. Linear regression analysis revealed significant associations of remnants with the treatment approach, decontamination method, and defect angle (p < 0.0001). SEM micrographs showed serious surface damage after use of CUR and SOSC.

CONCLUSIONS

Suprastructure removal is an additional option to improve cleaning efficacy of non-surgical implant surface decontamination in this in vitro model.

Primordial and primary prevention of peri-implant diseases: A systematic review and meta-analysis

AIM

This systematic review and meta-analysis aims to assess the efficacy of risk factor control to prevent the occurrence of peri-implant diseases (PIDs) in adult patients awaiting dental implant rehabilitation (primordial prevention) or in patients with dental implants surrounded by healthy peri-implant tissues (primary prevention).

MATERIALS AND METHODS

A literature search was performed without any time limit on different databases up to August 2022. Interventional and observational studies with at least 6 months of follow-up were considered. The occurrence of peri-implant mucositis and/or peri-implantitis was the primary outcome. Pooled data analyses were performed using random effect models according to the type of risk factor and outcome.

RESULTS

Overall, 48 studies were selected. None assessed the efficacy of primordial preventive interventions for PIDs. Indirect evidence on the primary prevention of PID indicated that diabetic patients with dental implants and good glycaemic control have a significantly lower risk of peri-implantitis (odds ratio [OR] = 0.16; 95% confidence interval [CI]: 0.03-0.96; I² : 0%), and lower marginal bone level (MBL) changes (OR = -0.36 mm; 95% CI: -0.65 to -0.07; I² : 95%) compared to diabetic patients with poor glycaemic control. Patients attending supportive periodontal/peri-implant care (SPC) regularly have a lower risk of overall PIDs (OR = 0.42; 95% CI: 0.24-0.75; I² : 57%) and peri-implantitis compared to irregular attendees. The risk of dental implant failure (OR = 3.76; 95% CI: 1.50-9.45; I² : 0%) appears to be greater under irregular or no SPC than regular SPC. Implants sites with augmented peri-implant keratinized mucosa (PIKM) show lower peri-implant inflammation (SMD = -1.18; 95% CI: -1.85 to -0.51; I² : 69%) and lower MBL changes (MD = -0.25; 95% CI: -0.45 to -0.05; I² : 62%) compared to dental implants with PIKM deficiency. Studies on smoking cessation and oral hygiene behaviors were inconclusive.

CONCLUSIONS

Within the limitations of available evidence, the present findings indicate that in patients with diabetes, glycaemic control should be promoted to avoid peri-implantitis development. The primary prevention of peri-implantitis should involve regular SPC. PIKM augmentation procedures, where a PIKM deficiency exists, may favour the control of peri-implant inflammation and the stability of MBL. Further studies are needed to assess the impact of smoking cessation and oral hygiene behaviours, as well as the implementation of standardized primordial and primary prevention protocols for PIDs.

Interproximal implant thread exposure after initial bone remodeling as a risk indicator for peri-implantitis

BACKGROUND

Due to the clinical challenges involved in successfully treating peri-implantitis, it is imperative to identify patient- and implant-level risk factors for its prevention. The main goal of this retrospective longitudinal radiographic and clinical study was to investigate whether interproximal radiographic implant thread exposure after physiological bone remodeling may be a risk factor for peri-implantitis. The secondary goal was to evaluate several other potential risk indicators.

METHODS

Of 4325 active dental school patients having implants placed, 165 partially edentulous adults (77 men, 88 women) aged 30-91 with ≥2 years of follow-up upon implant restoration were included. Implants with ≥1 interproximal thread exposed (no bone-to-implant contact) (n = 98, 35%) constituted the test group and those without exposed threads (n = 182, 65%) the control group. Descriptive, binary, and multivariate regression analyses were evaluated for goodness of fit. Wald tests were used to evaluate for significance set at 0.05.

RESULTS

Of the 280 implants (98 test, 182 control), 8 (2.9%) failed over a mean follow-up period of 7.67 (±2.63) years, and 27 implants (19 test, 8 control) developed peri-implantitis, with the exposed group having eight-fold (7.82 times) adjusted greater odds than the non-exposed. The risk increased four-fold (3.77 times) with each thread exposed. No other patient- or implant-related potentially confounding risk factors were identified.

CONCLUSIONS

Exposed interproximal implant threads after physiologic bone remodeling may be an independent risk indicator for incident peri-implantitis. Hence, clinicians should closely monitor patients with implant threads that have no bone-to-implant contact for incident peri-implantitis.

Prognostic factors associated with implant loss, disease progression or favorable outcomes after peri-implantitis surgical therapy

BACKGROUND

The treatment of the peri-implantitis remains complex and challenging with no consensus on which is the best treatment approach.

PURPOSE

To examine the key local and systemic factors associated with implant loss, disease progression, or favorable outcomes after surgical peri-implantitis therapy.

MATERIALS AND METHODS

Records of patients treated for peri-implantitis were screened. Patient-, implant- and surgery-related variables on and prior to the day of the surgery were collected (T0: time of peri-implantitis treatment). If the treated implant was still in function when the data was collected, the patient invited to participate for a recall study visit (T1, longest follow-up after treatment). Impacts of the variables on the implant survival, success, and peri-implant bone change after treatment were investigated.

RESULTS

Eighty patients with 121 implants with a mean follow-up of 42.6 ± 26.3 months were included. A total of 22 implants (18.2%) were removed during the follow-up period. When relative bone loss (%) was in range 25%-50%, risk for implant removal increased 15 times compared to lower bone loss <25% (OR = 15.2; CI: 2.06-112.7; p = 0.008). Similarly, relative bone loss of >50% increased 20 times the risk of implant failure compared to the <25% (OR = 20.2; CI: 2.42-169.6; p = 0.006). For post-treatment success rate, history of periodontitis significantly increased the risk of unsuccess treatment (OR = 3.07; p = 0.04) after resective surgery).

CONCLUSION

Severe bone loss (>50%) poses significantly higher risk of treatment failure.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Implant-supported overdentures: part 2

The ability to provide high-quality complete dentures is a key skill for the general dental practitioner. The introduction of new implant attachments and dental technologies has opened the possibility of a wide variety of treatment options when considering implant-supported overdentures (ISODs).A thorough understanding of the advantages and disadvantages of ISODs is essential to ensuring appropriate treatment planning, consent and maintenance. Part one of this paper discussed the role of ISODs and the different attachment systems available. This second part will explore the relevant treatment planning considerations and maintenance requirements.

Exploring the relationship among dental caries, nutritional habits, and peri-implantitis

BACKGROUND

A study was made of the prevalence, co-occurrence and association among caries, nutritional habits, and peri-implant disease, with an analysis of the influence of other patient and implant factors upon peri-implant disease.

METHODS

The included subjects underwent a clinical examination and were asked to complete a questionnaire. Demographic data and potential lifestyle/behavioral variables were collected. Clinical and radiographic assessment allowed calculation of the decayed, missing and filled teeth (DMFT) index and peri-implant diagnosis. Uni- and multivariate multinomial logistic regression analyses were applied to identify predictors of peri-implant disease.

RESULTS

A total of 169 patients with 311 implants were studied. At patient level, 92.2% of the subjects presented at least one carious lesion, whereas 22.5% and 56.2% were diagnosed with peri-implantitis and mucositis, respectively. Those patients with more than two caries had a higher risk of mucositis (OR = 3.33). Statistically significant associations for peri-implantitis included full mouth periodontal indexes, sugar-rich diets, keratinized mucosa width, number of missing teeth and interproximal untreated caries or fillings adjacent to implants.

CONCLUSION

High caries risk profiles and mucositis/peri-implantitis tended to accumulate within subjects. A sugar-enriched diet and untreated caries or fillings adjacent to implant sites may be further considered as risk indicators of peri-implantitis.

Lack of Clinical Benefit of Implantoplasty to Improve Implant Survival Rate

The objective of this study was to compare postsurgical outcomes of resective treatment for peri-implantitis with and without implant surface modification (implantoplasty [IP]). This was accomplished by a retrospective analysis with data from patients with ≥1 implant who were surgically treated for peri-implantitis by resective therapy. Patients were divided into 2 groups regarding treatment approach: IP (test) and no IP (control). Retrospective data were obtained after implant placement (T0) and the day of peri-implantitis surgical treatment (T1). Patients were then recalled (≥1 y after T1) for clinical and radiographic examination (T2). The findings were conclusive. A total of 41 patients (68 implants; mean ± SD follow-up, 41.6 ± 24.4 mo) were included in this study. The survival rate at the implant level was 90% in the test group and 81.6% in the control group ( P > 0.05). Multilevel regression analysis showed that the probability of implant failure was influenced by marginal bone loss (MBL) at T1 and not surgical modality. For example, peri-implantitis defects ≥50% and 25% to 50% MBL were 18.6 and 8.86 times more likely to lose the implant, respectively, when compared with <25% MBL. Nonetheless, MBL changes were similar in the test and control groups ( P = 0.592). Similarly, changes in bleeding on probing, probing pocket depth, and suppuration at T2 did not differ between groups ( P > 0.05). Multilevel regression analysis indicated that clinical improvement of these parameters was influenced by the number of supportive peri-implant therapy visits ( P < 0.01). The results demonstrate little difference between the procedures. Regardless of the implant surface modification (IP) being performed or not, the survival rate of implants treated for peri-implantitis was primarily influenced by the amount of bone loss at the time of treatment. Other clinical parameters (MBL, probing pocket depth, bleeding on probing, suppuration) were influenced by the frequency of supportive peri-implant therapy visits and not by the IP procedure (ClinicalTrials.gov NCT04259840).

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

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