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Sadowsky SJ. Peri-implantitis after 40 years: Evidence, mechanisms, and implications: A mapping review. J Prosthet Dent 2023:S0022-3913(23)00114-2. [PMID: 36935269 DOI: 10.1016/j.prosdent.2023.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 02/16/2023] [Accepted: 02/16/2023] [Indexed: 03/19/2023]
Abstract
STATEMENT OF PROBLEM The high prevalence of peri-implantitis (PI) continues to plague patients and the disease is resistant to present treatment regimens. An analysis of the available research is lacking. PURPOSE Given the abundance and diversity of research on the topic of PI, the purpose of this mapping review was to synthesize the literature on the prevention of PI, the histopathology of the disease, the state of present therapeutics, and any emerging treatments. MATERIAL AND METHODS An extensive literature search was undertaken by using the electronic databases of PubMed, Web of Science, and Science Direct. The keyword strings were peri-implantitis, dental implant, risk assessment, histopathology, prosthesis design, and treatment. The filters applied were time interval from 2000 to 2002; language, English. RESULTS A total of 3635 articles were taken from PubMed, 3686 articles from Web of Science, and 2450 articles from Science Direct. After applying the inclusion and exclusion criteria to the titles and abstracts of selected investigations, 214 studies were retrieved. CONCLUSIONS The evidence reflects a concerning incidence of PI, without a predictable treatment protocol. An in-depth patient risk assessment considering risk modification, emphasis on surgical and restorative expertise, and strict recall and maintenance is essential to minimize PI.
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Affiliation(s)
- Steven J Sadowsky
- Professor, Preventive and Restorative Department, University of the Pacific Arthur A. Dugoni School of Dentistry, San Francisco, Calif.
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Muacevic A, Adler JR, Eguia A. On Peri-Implant Bone Loss Theories: Trying To Piece Together the Jigsaw. Cureus 2023; 15:e33237. [PMID: 36733558 PMCID: PMC9890078 DOI: 10.7759/cureus.33237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/26/2022] [Indexed: 01/03/2023] Open
Abstract
This review aims to explore the plausibility of new theories on the etiopathogenesis of marginal bone loss (MBL) and peri-implantitis (PI) and to discuss possible underlying pathogenic mechanisms. The former concept of osteointegration of dental implants can now be conceptualized as a foreign body response histologically characterized by a bony demarcation in combination with chronic inflammation. Different risk factors can provoke additional inflammation and, therefore, pro-inflammatory cytokine release in soft tissues and bone, leading to an overpass of the threshold of peri-implant bone defensive and regenerative capacity. Progressive bone loss observed in MBL and PI is ultimately due to a localized imbalance in the receptor activator of nuclear factor kappaB ligand (RANKL)/Receptor activator of nuclear factor κ B (RANK)/osteoprotegerin (OPG) pathway in favor of increased catabolic activity. The genetic background and the severity and duration of the risk factors could explain differences between individuals in the threshold needed to reach an imbalanced scenario. MBL and PI pathogenesis could be better explained by the "inflammation-immunological balance" theory rather than a solely "infectious disease" conception. The link between the effect of biofilm and other risk factors leading to an imbalanced foreign body response lies in osteoclast differentiation and activation pathways (over)stimulation.
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Abstract
In lamellar bone, a network of highly oriented interconnected osteocytes is organized in concentric layers. Through their cellular processes contained within canaliculi, osteocytes are highly mechanosensitive and locally modulate bone remodeling. We review the recent developments demonstrating the significance of the osteocyte lacuno-canalicular network in bone maintenance around implant biomaterials. Drilling during implant site preparation triggers osteocyte apoptosis, the magnitude of which correlates with drilling speed and heat generation, resulting in extensive remodeling and delayed healing. In peri-implant bone, osteocytes physically communicate with implant surfaces via canaliculi and are responsive to mechanical loading, leading to changes in osteocyte numbers and morphology. Certain implant design features allow peri-implant osteocytes to retain a less aged phenotype, despite highly advanced extracellular matrix maturation. Physicochemical properties of anodically oxidized surfaces stimulate bone formation and remodeling by regulating the expression of RANKL (receptor activator of nuclear factor-κB ligand), RANK, and OPG (osteoprotegerin) from implant-adherent cells. Modulation of certain osteocyte-related molecular signaling mechanisms (e.g., sclerostin blockade) may enhance the biomechanical anchorage of implants. Evaluation of the peri-implant osteocyte lacuno-canalicular network should therefore be a necessary component in future investigations of osseointegration to more completely characterize the biological response to materials for load-bearing applications in dentistry and orthopedics.
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Affiliation(s)
- F A Shah
- 1 Department of Biomaterials, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
| | - P Thomsen
- 1 Department of Biomaterials, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
| | - A Palmquist
- 1 Department of Biomaterials, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
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de Barros E Lima Bueno R, Dias AP, Ponce KJ, Wazen R, Brunski JB, Nanci A. Bone healing response in cyclically loaded implants: Comparing zero, one, and two loading sessions per day. J Mech Behav Biomed Mater 2018; 85:152-161. [PMID: 29894930 PMCID: PMC6035061 DOI: 10.1016/j.jmbbm.2018.05.044] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 04/16/2018] [Accepted: 05/30/2018] [Indexed: 01/15/2023]
Abstract
When bone implants are loaded, they are inevitably subjected to displacement relative to bone. Such micro-motion generates stress/strain states at the interface that can cause beneficial or detrimental sequels. The objective of this study is to better understand the mechanobiology of bone healing at the tissue-implant interface during repeated loading. Machined screw shaped Ti implants were placed in rat tibiae in a hole slightly bigger than the implant diameter. Implants were held stable by a specially-designed bone plate that permits controlled loading. Three loading regimens were applied, (a) zero loading, (b) one daily loading session of 60 cycles with an axial force of 1.5 N/cycle for 7 days, and (c) two such daily sessions with the same axial force also for 7 days. Finite element analysis was used to characterize the mechanobiological conditions produced by the loading sessions. After 7 days, the implants with surrounding interfacial tissue were harvested and processed for histological, histomorphometric and DNA microarray analyses. Histomorphometric analyses revealed that the group subjected to repeated loading sessions exhibited a significant decrease in bone-implant contact and increase in bone-implant distance, as compared to unloaded implants and those subjected to only one loading session. Gene expression profiles differed during osseointegration between all groups mainly with respect to inflammatory and unidentified gene categories. The results indicate that increasing the daily cyclic loading of implants induces deleterious changes in the bone healing response, most likely due to the accumulation of tissue damage and associated inflammatory reaction at the bone-implant interface.
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Affiliation(s)
- Renan de Barros E Lima Bueno
- Laboratory for the Study of Calcified Tissues and Biomaterials, Faculty of Dentistry, Université de Montréal, Montreal, QC, Canada
| | - Ana Paula Dias
- Laboratory for the Study of Calcified Tissues and Biomaterials, Faculty of Dentistry, Université de Montréal, Montreal, QC, Canada
| | - Katia J Ponce
- Laboratory for the Study of Calcified Tissues and Biomaterials, Faculty of Dentistry, Université de Montréal, Montreal, QC, Canada
| | - Rima Wazen
- Laboratory for the Study of Calcified Tissues and Biomaterials, Faculty of Dentistry, Université de Montréal, Montreal, QC, Canada
| | - John B Brunski
- Department of Surgery, School of Medicine, Stanford University, Stanford, CA, United States
| | - Antonio Nanci
- Laboratory for the Study of Calcified Tissues and Biomaterials, Faculty of Dentistry, Université de Montréal, Montreal, QC, Canada.
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Jariwala SH, Wee H, Roush EP, Whitcomb TL, Murter C, Kozlansky G, Lakhtakia A, Kunselman AR, Donahue HJ, Armstrong AD, Lewis GS. Time course of peri-implant bone regeneration around loaded and unloaded implants in a rat model. J Orthop Res 2017; 35:997-1006. [PMID: 27381807 PMCID: PMC5800527 DOI: 10.1002/jor.23360] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 07/02/2016] [Indexed: 02/04/2023]
Abstract
The time-course of cancellous bone regeneration surrounding mechanically loaded implants affects implant fixation, and is relevant to determining optimal rehabilitation protocols following orthopaedic surgeries. We investigated the influence of controlled mechanical loading of titanium-coated polyether-ether ketone (PEEK) implants on osseointegration using time-lapsed, non-invasive, in vivo micro-computed tomography (micro-CT) scans. Implants were inserted into proximal tibial metaphyses of both limbs of eight female Sprague-Dawley rats. External cyclic loading (60 or 100 μm displacement, 1 Hz, 60 s) was applied every other day for 14 days to one implant in each rat, while implants in contralateral limbs served as the unloaded controls. Hind limbs were imaged with high-resolution micro-CT (12.5 μm voxel size) at 2, 5, 9, and 12 days post-surgery. Trabecular changes over time were detected by 3D image registration allowing for measurements of bone-formation rate (BFR) and bone-resorption rate (BRR). At day 9, mean %BV/TV for loaded and unloaded limbs were 35.5 ± 10.0% and 37.2 ± 10.0%, respectively, and demonstrated significant increases in bone volume compared to day 2. BRR increased significantly after day 9. No significant differences between bone volumes, BFR, and BRR were detected due to implant loading. Although not reaching significance (p = 0.16), an average 119% increase in pull-out strength was measured in the loaded implants. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:997-1006, 2017.
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Affiliation(s)
- Shailly H. Jariwala
- Division of Musculoskeletal Sciences, Department of Orthopedics and Rehabilitation, College of Medicine, Pennsylvania State University, Hershey, PA 17033
| | - Hwabok Wee
- Division of Musculoskeletal Sciences, Department of Orthopedics and Rehabilitation, College of Medicine, Pennsylvania State University, Hershey, PA 17033
| | - Evan P. Roush
- Division of Musculoskeletal Sciences, Department of Orthopedics and Rehabilitation, College of Medicine, Pennsylvania State University, Hershey, PA 17033
| | - Tiffany L. Whitcomb
- Department of Comparative Medicine, Pennsylvania State University College of Medicine, Hershey, PA 17033
| | - Christopher Murter
- Division of Musculoskeletal Sciences, Department of Orthopedics and Rehabilitation, College of Medicine, Pennsylvania State University, Hershey, PA 17033
| | - Gery Kozlansky
- Division of Musculoskeletal Sciences, Department of Orthopedics and Rehabilitation, College of Medicine, Pennsylvania State University, Hershey, PA 17033
| | - Akhlesh Lakhtakia
- Department of Engineering Science and Mechanics, Pennsylvania State University, University Park, PA 16802-6812
| | - Allen R. Kunselman
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA 17033
| | - Henry J. Donahue
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, VA 23284
| | - April D. Armstrong
- Division of Musculoskeletal Sciences, Department of Orthopedics and Rehabilitation, College of Medicine, Pennsylvania State University, Hershey, PA 17033
| | - Gregory S. Lewis
- Division of Musculoskeletal Sciences, Department of Orthopedics and Rehabilitation, College of Medicine, Pennsylvania State University, Hershey, PA 17033
- Author to whom all correspondence should be addressed: Gregory S. Lewis, Ph.D*, Pennsylvania State University College of Medicine, 500 University Drive, Mailbox – H089, Hershey, PA-17033, Phone: (717) 531-5244, Fax no.: (717) 531-7583,
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Koutouzis T, Eastman C, Chukkapalli S, Larjava H, Kesavalu L. A Novel Rat Model of Polymicrobial Peri-Implantitis: A Preliminary Study. J Periodontol 2016; 88:e32-e41. [PMID: 27786620 DOI: 10.1902/jop.2016.160273] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Peri-implantitis is a complex polymicrobial biofilm-induced inflammatory osteolytic gingival infection that results in orofacial implant failures. To the best knowledge of the authors, there are no preclinical in vivo studies in implant dentistry that have investigated the inflammatory response to known microbial biofilms observed in humans. The aim of this study is to develop a novel peri-implant rat model using an established model of polymicrobial periodontitis. METHODS Wistar rats were used for the study of experimental peri-implantitis. One month after extraction of maxillary first molars, a titanium mini-implant was inserted. Two months after implant healing, implants were uncovered, and abutment fixing was done using cyanoacrylate to prevent abutment loosening. Rats were separated into two groups (group A: polymicrobial-infected and group B: sham-infected). One week after healing of abutments, rats were infected with Porphyromonas gingivalis, Treponema denticola, and Tannerella forsythia for 12 weeks. Bacterial colonization, bone resorption, and implant inflammation were evaluated by polymerase chain reaction (PCR), microcomputed tomography, and histology, respectively. RESULTS Three rats with four implants in the infection group and two rats with three implants in the sham-infection group were analyzed. PCR analysis revealed presence of bacterial genomic DNA, and infection elicited significant immunoglobulin (Ig)G and IgM antibody responses, indicating bacterial colonization/infection around implants. Infection induced an enhanced mean distance from implant platform to the first bone-to-implant contact, extensive peri-implantitis with advanced bone resorption, and extensive inflammation with granulation tissue and polymorphonuclear leukocytes. CONCLUSIONS To the best knowledge of the authors, this is the first study to develop a novel rat model of polymicrobial peri-implantitis. With modifications to improve implant retention it could offer significant advantages for studies of initiation and progression of peri-implantitis.
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Affiliation(s)
- Theofilos Koutouzis
- Department of Periodontology, College of Dental Medicine, Nova Southeastern University, Fort Lauderdale, FL
| | - Christie Eastman
- Department of Periodontology, College of Dentistry, University of Florida, Gainesville, FL
| | - Sasanka Chukkapalli
- Department of Periodontology, College of Dentistry, University of Florida, Gainesville, FL
| | - Hannu Larjava
- Division of Periodontics and Dental Hygiene, Faculty of Dentistry, University of British Columbia, Vancouver, BC, Canada
| | - Lakshmyya Kesavalu
- Department of Periodontology, College of Dentistry, University of Florida, Gainesville, FL.,Department of Periodontology, Oral Biology, College of Dentistry, University of Florida
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Vandeweghe S, Hawker P, De Bruyn H. An Up to 12-Year Retrospective Follow-Up on Immediately Loaded, Surface-Modified Implants in the Edentulous Mandible. Clin Implant Dent Relat Res 2015; 18:323-31. [DOI: 10.1111/cid.12322] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Stefan Vandeweghe
- Department of Periodontology and Oral Implantology; Dental School; Faculty of Medicine and Health Sciences; University of Ghent; Belgium
| | - Peter Hawker
- Victoria Specialist Centre; Adelaide South Australia Australia
| | - Hugo De Bruyn
- Department of Periodontology and Oral Implantology; Dental School; Faculty of Medicine and Health Sciences; University of Ghent; Belgium
- Periodontology, Oral Implantology, Removable and Implant Prosthetics; Ghent University; Belgium
- Department of Prosthodontics; Faculty of Odontology; Malmö University; Malmö Sweden
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