1
|
Saleh MHA, Dias DR, Kumar P. The economic and societal impact of periodontal and peri-implant diseases. Periodontol 2000 2024. [PMID: 38693603 DOI: 10.1111/prd.12568] [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: 02/01/2024] [Accepted: 03/26/2024] [Indexed: 05/03/2024]
Abstract
Periodontal and peri-implant diseases result from a chronic inflammatory response to dysbiotic microbial communities and are characterized by inflammation in the soft tissue and the ensuing progressive destruction of supporting bone, resulting in tooth or implant loss. These diseases' high prevalence, multifactorial etiology, extensive treatment costs, and significant detriment to patients' quality-of-life underscore their status as a critical public health burden. This review delineates the economic and sociocultural ramifications of periodontal and peri-implant diseases on patient welfare and healthcare economics. We delve into the implications of diagnosis, treatment, supportive care, and managing destructive tissue consequences, contrasting these aspects with healthy patients.
Collapse
Affiliation(s)
- Muhammad H A Saleh
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Debora R Dias
- Department of Dentistry, State University of Maringá, Maringá, Paraná, Brazil
| | - Purnima Kumar
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| |
Collapse
|
2
|
Giok KC, Veettil SK, Menon RK. Comparative effectiveness of interventions for the treatment of peri-implantitis: A systematic review with network meta-analysis. J Prosthet Dent 2024:S0022-3913(24)00219-1. [PMID: 38632026 DOI: 10.1016/j.prosdent.2024.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 03/15/2024] [Accepted: 03/18/2024] [Indexed: 04/19/2024]
Abstract
STATEMENT OF PROBLEM Extensive research has been carried out on the various aspects of diagnosing and treating peri-implantitis. However, clinical guidelines for the management of peri-implantitis based on high quality evidence are lacking. PURPOSE The purpose of this systematic review with network meta-analysis was to analyze the current evidence on nonsurgical and surgical interventions for the treatment of peri-implantitis and synthesize clinical guidelines based on high quality evidence. MATERIAL AND METHODS A search was conducted for trials published in Medline, Scopus, PubMed, and Cochrane Central Register of Controlled Trials from inception until July 2023. The study was registered with the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42023451056). A network meta-analysis was performed on data from randomized controlled trials that assessed nonsurgical and surgical interventions for the treatment of peri-implantitis. The interventions were ranked according to their efficacy using surface under the cumulative ranking (SUCRA) system. The grading of recommendations, assessment, development, and evaluations (GRADE) approach was used to assess the level of certainty of evidence. RESULTS A total of 45 articles were included in the quantitative analysis. The GRADE approach determined a moderate to high level of certainty of evidence. Among the nonsurgical interventions, mechanical debridement with adjunctive systemic antibiotics was significant in improving probing depth at 3 months and beyond 6 months, clinical attachment loss at 3 months, and clinical attachment loss beyond 6 months. Mechanical debridement with adjunctive topical antibiotics was significant in improving probing depth beyond 6 months, clinical attachment loss at 3 months, clinical attachment loss beyond 6 months, and radiographic bone loss beyond 6 months. Mechanical debridement with adjunctive photodynamic therapy was significant in improving probing depth beyond 6 months, clinical attachment loss at 3 months, clinical attachment loss beyond 6 months, and radiographic bone loss beyond 6 months. Mechanical debridement with adjunctive systemic antibiotics and photodynamic therapy was significant in improving probing depth beyond 6 months. Among surgical interventions, open flap debridement with implant surface decontamination and open flap debridement with decontamination and adjunctive photodynamic therapy were significant in improving probing depth at 3 months. CONCLUSIONS Mechanical debridement with adjunctive systemic antibiotics or photodynamic therapy results in improved clinical outcomes.
Collapse
Affiliation(s)
- Koay Chun Giok
- Predoctoral student, School of Dentistry, International Medical University, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Sajesh K Veettil
- Associate Professor, Department of Pharmacy Practice, School of Pharmacy, College of Pharmacy, International Medical University, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Rohit Kunnath Menon
- Assistant Professor, Prosthodontics, College of Dentistry, Ajman University, Ajman, United Arab Emirates.
| |
Collapse
|
3
|
Pereira R, Maia P, Rios-Santos JV, Herrero-Climent M, Rios-Carrasco B, Aparicio C, Gil J. Influence of Titanium Surface Residual Stresses on Osteoblastic Response and Bacteria Colonization. MATERIALS (BASEL, SWITZERLAND) 2024; 17:1626. [PMID: 38612139 PMCID: PMC11012676 DOI: 10.3390/ma17071626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 03/27/2024] [Accepted: 03/28/2024] [Indexed: 04/14/2024]
Abstract
Grit basting is the most common process applied to titanium dental implants to give them a roughness that favors bone colonization. There are numerous studies on the influence of roughness on osseointegration, but the influence of the compressive residual stress associated with this treatment on biological behavior has not been determined. For this purpose, four types of surfaces have been studied using 60 titanium discs: smooth, smooth with residual stress, rough without stress, and rough with residual stress. Roughness was studied by optic interferometry; wettability and surface energy (polar and dispersive components) by contact angle equipment using three solvents; and residual stresses by Bragg-Bentano X-ray diffraction. The adhesion and alkaline phosphatase (ALP) levels on the different surfaces were studied using Saos-2 osteoblastic cultures. The bacterial strains Streptococcus sanguinis and Lactobacillus salivarius were cultured on different surfaces, determining the adhesion. The results showed that residual stresses lead to increased hydrophilicity on the surfaces, as well as an increase in surface energy, especially on the polar component. From the culture results, higher adhesion and higher ALP levels were observed in the discs with residual stresses when compared between smooth and roughened discs. It was also found that roughness was the property that mostly influenced osteoblasts' response. Bacteria colonize rough surfaces better than smooth surfaces, but no changes are observed due to residual surface tension.
Collapse
Affiliation(s)
- Rita Pereira
- Facultad de Odontología, Universidad de Sevilla, Calle Avicena s/n, 41009 Sevilla, Spain; (R.P.); (J.V.R.-S.); (B.R.-C.)
| | - Paulo Maia
- Facultade Ciências da Saúde, Universidad Europeia de Lisboa,1500-210 Lisboa, Portugal;
| | - Jose Vicente Rios-Santos
- Facultad de Odontología, Universidad de Sevilla, Calle Avicena s/n, 41009 Sevilla, Spain; (R.P.); (J.V.R.-S.); (B.R.-C.)
| | | | - Blanca Rios-Carrasco
- Facultad de Odontología, Universidad de Sevilla, Calle Avicena s/n, 41009 Sevilla, Spain; (R.P.); (J.V.R.-S.); (B.R.-C.)
| | - Conrado Aparicio
- Facultad de Odontología, Universitat Internacional de Catalunya, c/ Josep Trueta s/n, 08195 Sant Cugat del Vallés, Spain;
| | - Javier Gil
- Bioengineering Institute of Technology, Universidad Internacional de Catalunya, c/ Josep Trueta s/n, 08195 Sant Cugat del Vallés, Spain
| |
Collapse
|
4
|
Bianconi S, Romanos G, Testori T, Del Fabbro M. Management of Advanced Peri-Implantitis by Guided Bone Regeneration in Combination with Trabecular Metal Fixtures, Two Months after Removal of the Failed Implants: Two-Year Results of a Single-Cohort Clinical Study. J Clin Med 2024; 13:713. [PMID: 38337407 PMCID: PMC10856143 DOI: 10.3390/jcm13030713] [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: 12/27/2023] [Revised: 01/19/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024] Open
Abstract
Background: Implant replacement is among the treatment options for severe peri-implantitis. The aim of this single-cohort study was to evaluate the feasibility of replacing compromised implants affected by advanced peri-implantitis with new implants with a porous trabecular metal (TM) structure. Materials and Methods: Patients with one or more implants in the posterior region showing a defect depth >50% of implant length, measured from the residual crest, were consecutively included. Two months after implant removal, patients received a TM implant combined with a xenograft and a resorbable membrane. The implant stability quotient (ISQ) was measured at placement and re-assessed five months later (at uncovering), then after 6, 12, and 24 months of function. Marginal bone loss was radiographically evaluated. Results: Twenty consecutive cases were included. One patient dropped out due to COVID-19 infection, and nineteen cases were evaluated up to 24 months. At placement, the mean ISQ was 53.08 ± 13.65 (standard deviation), which increased significantly to 69.74 ± 9.01 after five months of healing (p < 0.001) and to 78.00 ± 7.29 after six months of loading (p < 0.001). Thereafter, the ISQ remained stable for up to 24 months (80.55 ± 4.73). All implants successfully osseointegrated and were restored as planned. After two years, the average marginal bone level change was -0.41 ± 0.38 mm (95% confidence interval -0.60, -0.21), which was limited yet significantly different from the baseline (p < 0.05). Conclusions: The treatment of advanced peri-implant defects using TM implants inserted two months after explantation in combination with guided bone regeneration may achieve successful outcomes up to two years follow-up, even in the presence of low primary stability.
Collapse
Affiliation(s)
- Stefano Bianconi
- Department of Oral Surgery and Dentistry, General Hospital, 39100 Bolzano, Italy;
| | - Georgios Romanos
- Department of Periodontics and Endodontics, Stony Brook University, Stony Brook, NY 11794, USA;
| | - Tiziano Testori
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, 20122 Milan, Italy;
- Department of Implantology and Oral Rehabilitation, Dental Clinic, IRCCS Ospedale Galeazzi-Sant’Ambrogio, 20157 Milan, Italy
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI 48109, USA
- Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, MA 01451, USA
| | - Massimo Del Fabbro
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, 20122 Milan, Italy;
- Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy
| |
Collapse
|
5
|
Wang CW, Di Gianfilippo R, Kaciroti N, Ou A, Feng SW, Wang HL. Stability of peri-implantitis surgical reconstructive therapy-a (> 2 years) follow-up of a randomized clinical trial. Clin Oral Investig 2023; 28:30. [PMID: 38147180 DOI: 10.1007/s00784-023-05457-6] [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: 08/07/2023] [Accepted: 12/18/2023] [Indexed: 12/27/2023]
Abstract
OBJECTIVES This follow-up study aimed to report the 24- and 30-month outcomes of a cohort previously enrolled in a randomized clinical trial on surgical reconstructive treatment of peri-implantitis. METHODS Twenty-four patients were diagnosed with peri-implantitis and treated with surgical reconstructive therapy with or without the adjunctive use of Er:YAG laser. Within-group and between-group comparisons were tested with mixed model with repeated measures. RESULTS Regarding peri-implant pocket depth (PPD) reduction (control vs. laser test group) between 6 months (- 1.85 vs. - 2.65 mm) and 30 months (- 1.84 vs. - 3.04 mm), the laser group showed statistically significant changes but not the control group. In terms of radiographic marginal bone loss (RMBL) at 6 months (- 1.1 vs. - 1.46 mm) to 24 months (- 1.96 vs. - 2.82 mm), both groups showed statistical difference compared to baseline. The six explanted implants all were featured by severe peri-implantitis and mostly with no or limited keratinized tissue (< 2 mm) at baseline and membrane exposure after surgery. Among the 15 retained cases, eight cases achieved more than 50% peri-implant bone level gain. CONCLUSIONS Within the limitation and follow-up time frame of this trial, the outcome of the surgical reconstructive therapy sustained or improved in most of the cases. However, 25% of the implants with severe peri-implantitis failed 2 years after the surgical reconstructive therapy. The use of Er:YAG laser favors PPD reduction in the longer term up to 30 months. CLINICAL RELEVANCE Longer-term follow-up on reconstructive therapy of peri-implantitis revealed sustained or improved stability in certain cases, but the survival of implants with severe peri-implantitis has its limitation, especially when there is limited keratinized tissue (< 2 mm or no KT). TRIAL REGISTRATION Clinical Trials Registration Number: NCT03127228 and HUM00160290.
Collapse
Affiliation(s)
- Chin-Wei Wang
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA.
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan.
- Department of Dentistry, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan.
| | - Riccardo Di Gianfilippo
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Niko Kaciroti
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
| | - Alice Ou
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Sheng-Wei Feng
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Dentistry, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan
| | - Hom-Lay Wang
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| |
Collapse
|
6
|
Chiang YC, Sirinirund B, Rodriguez A, Velasquez D, Chan HL. Operating microscope-assisted reconstructive strategy for peri-implantitis: A case series report. Clin Adv Periodontics 2023. [PMID: 37724638 DOI: 10.1002/cap.10265] [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: 06/05/2023] [Revised: 08/25/2023] [Accepted: 08/26/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND Treating peri-implantitis with reconstructive means has been largely unpredictable due to access limitations for surface decontamination, unfavorable bony topography, difficulty in achieving wound stability, and inferior soft tissue qualities. A microsurgical approach with the use of the operating microscope (OM) that provides adjustable higher magnification (∼5-30 times) and coaxial illumination, coupled with the use of microsurgical instruments, may overcome, or alleviate some of the abovementioned obstacles, resulting in more predictable outcomes. METHODS Three patients received reconstructive therapy for correcting peri-implant defects under OM in private practice settings. After precise incisions to preserve soft tissue volume, the flaps were dissected prudently from underlying granulomatous tissues, which were subsequently removed, followed by controlled flap releasing under ∼10-15x magnification. Surface decontamination was performed using a piezoelectric ultrasonic device, air polishing, and hand instruments at ∼30x magnification. The biomaterial selections were dehydrated human de-epithelialized amnion-chorion membrane with mineralized allograft particulates in two cases and xenografts in one case, based on the surgeons' preference. Wound closure followed the non-submerged approach. RESULTS These cases demonstrated uneventful soft tissue healing, favorable radiographic bone fill, and disease resolution with follow-ups ranging from 2 to 4 years. CONCLUSIONS Preliminary data suggest encouraging outcomes after the microsurgical approach following biological as well as biomechanical principles for peri-implant defect reconstruction.
Collapse
Affiliation(s)
- Yi-Chen Chiang
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Benyapha Sirinirund
- Department of Restorative Dentistry and Periodontology, Faculty of Dentistry, Chiang Mai University, Chiang Mai, Thailand
| | - Amanda Rodriguez
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Diego Velasquez
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
- Private Practice, Fenton, Michigan, USA
| | - Hsun-Liang Chan
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
- Division of Periodontology, The Ohio State University College of Dentistry, Columbus, Ohio, USA
| |
Collapse
|
7
|
Calce L, Hafeez M, Hou W, Romanos GE. Thermal Effects of 445-nm Diode Laser Irradiation on Titanium and Ceramic Implants. J ORAL IMPLANTOL 2023; 49:401-406. [PMID: 37527174 DOI: 10.1563/aaid-joi-d-22-00234] [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: 11/11/2022] [Revised: 02/13/2023] [Accepted: 06/01/2023] [Indexed: 08/03/2023]
Abstract
This study aimed to evaluate temperature changes in titanium and ceramic implants after using a 445-nm diode laser under different in vitro conditions. Titanium (Ti) and ceramic (Zr) dental implants were placed into a bone analog, and an intrabony defect was created at each implant. A 445-nm diode laser was used to irradiate the defects for 30 seconds, noncontact, at 2 W in continuous wave (c.w.) and pulsed mode. The experiment was done at room temperature (21.0 ± 1°C) and in a water bath (37.0 ± 1°C). Two thermocouple probes were used to record real-time temperature changes (°C) at the coronal part of the implant (Tc) and the apex (Ta). The temperature was recorded at time 0 (To) and after 30 seconds of irradiation (Tf). The average temperature change was calculated, and a descriptive analysis was conducted (P < .05). The Ti implant resulted in the highest ΔT values coronally (29.6°C) and apically (6.7°C) using continuous wave at 21°C. The Zr implant increased to 26.4°C coronally and 5.2°C apically. In the water bath, the coronal portion of the Ti and Zr implants rose to 14.2°C and 14.01°C, respectively, using continuous waves. The ΔT values for Ti were 11.9°C coronally and 1.7°C apically when placed in a water bath using pulsed mode. The lowest ΔT occurred on the Zr implant with ΔTc and ΔTa of 4.8°C and 0.78°C, respectively. Under in vitro conditions, the 445-nm diode laser in pulsed mode seems to be safe for use on ceramic implants and should be used with caution on titanium implants.
Collapse
Affiliation(s)
- Loredana Calce
- Department of Periodontology, Laboratory for Periodontal-, Implant-, and Phototherapy, School of Dental Medicine, Stony Brook University, Stony Brook, New York
| | - Maryam Hafeez
- Department of Periodontology, Laboratory for Periodontal-, Implant-, and Phototherapy, School of Dental Medicine, Stony Brook University, Stony Brook, New York
| | - Wei Hou
- Department of Family, Population and Preventive Medicine, School of Medicine, Stony Brook, New York
| | - Georgios E Romanos
- Department of Periodontology, Laboratory for Periodontal-, Implant-, and Phototherapy, School of Dental Medicine, Stony Brook University, Stony Brook, New York
| |
Collapse
|
8
|
Cheng CD, Tsai YWC, Cheng WC, Lin FG, Weng PW, Chen YW, Huang RY, Chen WL, Shieh YS, Sung CE. The referral pattern and treatment modality for peri-implant disease between periodontists and non-periodontist dentists. BMC Oral Health 2023; 23:427. [PMID: 37370067 DOI: 10.1186/s12903-023-03135-3] [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: 03/09/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023] Open
Abstract
OBJECTIVES This study is to investigate the referral pattern and treatment modality of dentists in the management of peri-implant diseases between periodontists and non-periodontist dentists (NPDs). MATERIALS AND METHODS A total of 167 validated questionnaires were obtained from periodontists and NPDs, who had experience of placing implants for at least one year. Question I to IV asked how the dentist would respond if a patient came for treatment of their peri-implant diseases with four different scenarios according to resource of patient and disease severity. For each Scenario, dentists also replied which treatment procedures they would use if they decide to treat the patient. RESULTS Periodontal training, resource of patient, and disease severity were shown to significantly influence the referral pattern and treatment modality in the management of peri-implant disease (p < 0.05). Periodontists were more likely to use variable treatment procedures, including occlusal adjustment (OR = 2.283, p < 0.01), oral hygiene instruction (OR = 3.751, p < 0.001), topical antiseptic agent (OR = 2.491, p < 0.005), non-surgical mechanical therapy (OR = 2.689, p < 0.001), surgical therapy (OR = 2.009, p < 0.01), and remove implant (OR = 3.486, p < 0.001) to treat peri-implant diseases, compared to NPDs. CONCLUSION The periodontal specialty training, resource of patient, and disease severity significantly influenced the referral pattern and treatment modality of dentist treating an implant diagnosed with peri-implant disease. This study also highlighted the importance of educating basic periodontal and peri-implant disease-related knowledge to all dentists regularly performing dental implant treatments. CLINICAL RELEVANCE Peri-implant diseases are highly prevalent among patients with dental implants. Periodontal specialty training could enhance using variable treatment procedures to treat peri-implant diseases for dentists.
Collapse
Affiliation(s)
- Chia-Dan Cheng
- Department of Periodontology, School of Dentistry, Tri-Service General Hospital and National Defense Medical Center, Section 2, Chang-Gong Rd, Nei-Hu District, 114, No. 325, Taipei, Taiwan
| | - Yi-Wen Cathy Tsai
- Department of Periodontology, School of Dentistry, Tri-Service General Hospital and National Defense Medical Center, Section 2, Chang-Gong Rd, Nei-Hu District, 114, No. 325, Taipei, Taiwan
| | - Wan-Chien Cheng
- Department of Periodontology, School of Dentistry, Tri-Service General Hospital and National Defense Medical Center, Section 2, Chang-Gong Rd, Nei-Hu District, 114, No. 325, Taipei, Taiwan
| | - Fu-Gong Lin
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
- Department of Optometry, Asia University, Taichung City, Taiwan
| | - Pei-Wei Weng
- Department of Orthopaedics, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Department of Orthopaedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Ying-Wu Chen
- Department of Periodontology, School of Dentistry, Tri-Service General Hospital and National Defense Medical Center, Section 2, Chang-Gong Rd, Nei-Hu District, 114, No. 325, Taipei, Taiwan
| | - Ren-Yeong Huang
- Department of Periodontology, School of Dentistry, Tri-Service General Hospital and National Defense Medical Center, Section 2, Chang-Gong Rd, Nei-Hu District, 114, No. 325, Taipei, Taiwan
| | - Wei-Liang Chen
- Division of Geriatric Medicine, Department of Family Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yi-Shing Shieh
- Department of Operative Dentistry and Endodontics, School of Dentistry, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan
| | - Cheng-En Sung
- Department of Periodontology, School of Dentistry, Tri-Service General Hospital and National Defense Medical Center, Section 2, Chang-Gong Rd, Nei-Hu District, 114, No. 325, Taipei, Taiwan.
| |
Collapse
|
9
|
Chambrone L, Zucchelli G. Why is there a lack of evidence regarding errors and complications in periodontal and implant therapy? Periodontol 2000 2023; 92:13-20. [PMID: 35916780 DOI: 10.1111/prd.12445] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/23/2022] [Accepted: 05/26/2022] [Indexed: 01/09/2023]
Abstract
The occurrence of errors, complications, and adverse effects may occur as a consequence of single or multiple events related to the clinician and/or patient. Apparently, the amount of dental literature on these undesirable outcomes has not been as prolific as that obtained for conventional primary periodontal outcome measures. This review explores the potential reasons for the lack of studies reporting on errors and complications in periodontal and implant therapy, as well as other noteworthy methodological aspects, to enlighten their impact on the selection of the best (or most appropriate) "gold standard" periodontal/implant-related treatment options, and on the overall decision-making process. The following points were addressed: (a) the importance of reporting errors and complications in clinical research; (b) the adequate reporting of errors and complications in periodontology and dental implantology; and (c) efficacy trials vs effectiveness studies and their impact on the assessment and report of periodontal and implant treatment-related risks and complications.
Collapse
Affiliation(s)
- Leandro Chambrone
- Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz, CRL, Monte de Caparica, Portugal
- Unit of Basic Oral Investigation (UIBO), School of Dentistry, Universidad El Bosque, Bogota, Colombia
- Department of Periodontics, School of Dentistry, The University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Giovanni Zucchelli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA
| |
Collapse
|
10
|
Robles D, Brizuela A, Fernández-Domínguez M, Gil J. Corrosion Resistance and Titanium Ion Release of Hybrid Dental Implants. MATERIALS (BASEL, SWITZERLAND) 2023; 16:ma16103650. [PMID: 37241275 DOI: 10.3390/ma16103650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/02/2023] [Accepted: 05/09/2023] [Indexed: 05/28/2023]
Abstract
One of the strategies for the fight against peri-implantitis is the fabrication of titanium dental implants with the part close to the neck without roughness. It is well known that roughness favors osseointegration but hinders the formation of biofilm. Implants with this type of structure are called hybrid dental implants, which sacrifice better coronal osseointegration for a smooth surface that hinders bacterial colonization. In this contribution, we have studied the corrosion resistance and the release of titanium ions to the medium of smooth (L), hybrid (H), and rough (R) dental implants. All implants were identical in design. Roughness was determined with an optical interferometer and residual stresses were determined for each surface by X-ray diffraction using the Bragg-Bentano technique. Corrosion studies were carried out with a Voltalab PGZ301 potentiostat, using Hank's solution as an electrolyte at a temperature of 37 °C. Open-circuit potentials (Eocp), corrosion potential (Ecorr), and current density (icorr) were determined. Implant surfaces were observed by JEOL 5410 scanning electron microscopy. Finally, for each of the different dental implants, the release of ions into Hank's solution at 37 °C at 1, 7, 14, and 30 days of immersion was determined by ICP-MS. The results, as expected, show a higher roughness of R with respect to L and compressive residual stresses of -201.2 MPa and -20.2 MPa, respectively. These differences in residual stresses create a potential difference in the H implant corresponding to Eocp of -186.4 mV higher than for the L and R of -200.9 and -192.2 mV, respectively. The corrosion potentials and current intensity are also higher for the H implants (-223 mV and 0.069 μA/mm2) with respect to the L (-280 mV and 0.014 μA/mm2 and R (-273 mV and 0.019 μA/mm2). Scanning electron microscopy revealed pitting in the interface zone of the H implants and no pitting in the L and R dental implants. The titanium ion release values to the medium are higher in the R implants due to their higher specific surface area compared to the H and L implants. The maximum values obtained are low, not exceeding 6 ppb in 30 days.
Collapse
Affiliation(s)
- Daniel Robles
- Department of Translational Medicine CEU, San Pablo University, Urbanización Montepríncipe, Alcorcón, 28925 Madrid, Spain
- Facultad de Odontología, Universidad Europea Miguel de Cervantes, C/del Padre Julio Chevalier 2, 47012 Valladolid, Spain
| | - Aritza Brizuela
- Facultad de Odontología, Universidad Europea Miguel de Cervantes, C/del Padre Julio Chevalier 2, 47012 Valladolid, Spain
| | - Manuel Fernández-Domínguez
- Department of Oral and Maxillofacial Surgery, Hospital Monteprincipe, University CEU San Pablo, Av. de Montepríncipe s/n, Alcorcón, 28668 Madrid, Spain
| | - Javier Gil
- Bioengineering Institute of Technology, Facultad de Medicina y Ciencias de la Salud, Universidad Internacional de Catalunya, Josep Trueta s/n, Sant Cugat del Vallés, 08195 Barcelona, Spain
| |
Collapse
|
11
|
Rodriguez-González R, Monsalve-Guil L, Jimenez-Guerra A, Velasco-Ortega E, Moreno-Muñoz J, Nuñez-Marquez E, Pérez RA, Gil J, Ortiz-Garcia I. Relevant Aspects of Titanium Topography for Osteoblastic Adhesion and Inhibition of Bacterial Colonization. MATERIALS (BASEL, SWITZERLAND) 2023; 16:ma16093553. [PMID: 37176435 PMCID: PMC10180273 DOI: 10.3390/ma16093553] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 04/27/2023] [Accepted: 05/04/2023] [Indexed: 05/15/2023]
Abstract
The influence of the surface topography of dental implants has been studied to optimize titanium surfaces in order to improve osseointegration. Different techniques can be used to obtain rough titanium, however, their effect on wettability, surface energy, as well as bacterial and cell adhesion and differentiation has not been studied deeply. Two-hundred disks made of grade 4 titanium were subjected to different treatments: machined titanium (MACH), acid-attacked titanium (AE), titanium sprayed with abrasive alumina particles under pressure (GBLAST), and titanium that has been treated with GBLAST and then subjected to AE (GBLAST + AE). The roughness of the different treatments was determined by confocal microscopy, and the wettability was determined by the sessile drop technique; then, the surface energy of each treatment was calculated. Osteoblast-like cells (SaOs-2) were cultured, and alkaline phosphatase was determined using a colorimetric test. Likewise, bacterial strains S. gordonii, S. oralis, A. viscosus, and E. faecalis were cultured, and proliferation on the different surfaces was determined. It could be observed that the roughness of the GBLAST and GBLAS + AE was higher, at 1.99 and 2.13 μm of Ra, with respect to the AE and MACH samples, which were 0.35 and 0.20 μm, respectively. The abrasive treated surfaces showed lower hydrophilicity but lower surface energy. Significant differences could be seen at 21 days between SaOS-2 osteoblastic cell adhesion for the blasted ones and higher osteocalcin levels. However, no significant differences in terms of bacterial proliferation were observed between the four surfaces studied, demonstrating the insensitivity of bacteria to topography. These results may help in the search for the best topographies for osteoblast behavior and for the inhibition of bacterial colonization.
Collapse
Affiliation(s)
- Raquel Rodriguez-González
- Bioengineering Institute of Technology, Faculty of Dentistry, Universitat Internacional de Catalunya, Sant Cugat del Vallé, 08198 Barcelona, Spain
| | | | | | | | | | | | - Roman A Pérez
- Bioengineering Institute of Technology, Faculty of Dentistry, Universitat Internacional de Catalunya, Sant Cugat del Vallé, 08198 Barcelona, Spain
| | - Javier Gil
- Bioengineering Institute of Technology, Faculty of Dentistry, Universitat Internacional de Catalunya, Sant Cugat del Vallé, 08198 Barcelona, Spain
| | | |
Collapse
|
12
|
Lee W, Park JB. The clinical effect of sodium hypochlorite oral rinse on peri-implantitis lesion: A pilot study. Heliyon 2023; 9:e15859. [PMID: 37305462 PMCID: PMC10256906 DOI: 10.1016/j.heliyon.2023.e15859] [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: 10/19/2022] [Revised: 04/11/2023] [Accepted: 04/25/2023] [Indexed: 06/13/2023] Open
Abstract
Peri-implantitis poses an imminent challenge to the field of implant dentistry. Considering the promising findings of sodium hypochlorite and periodontal lesions, the aim of the present study was to evaluate the clinical effects of sodium hypochlorite oral rinse on peri-implantitis lesions. Twelve peri-implantitis patients were instructed to rinse with 15 mL of a fresh solution of 0.25% sodium hypochlorite for 30 s twice a week for 3 months. At baseline and 3-month visits, probing depth and modified sulcular bleeding index were recorded at 6 points per lesion (mesiobuccal, buccal, distobuccal, mesiolingual, lingual, and distolingual). Individual and total bacterial loads of 18 pre-designated species of microorganisms were analyzed by real-time PCR methods. Probing depth decreased after the experiment, with an average difference of 1.1 mm and a standard deviation of 1.7 mm. The modified sulcular bleeding index decreased by a mean value of 0.8 with a standard deviation of 1.1. This study demonstrated the clinical effects of sodium hypochlorite oral rinse on peri-implantitis lesions and the reduction of periodontal probing depth and gingival bleeding index. This study suggested that the concentration of 0.25% be used for treatment of peri-implantitis.
Collapse
Affiliation(s)
- Wonsup Lee
- Department of Prosthodontics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, 06591, Republic of Korea
| | - Jun-Beom Park
- Department of Periodontics, College of Medicine, The Catholic University of Korea, Seoul, 06591, Republic of Korea
- Dental Implantology, Graduate School of Clinical Dental Science, The Catholic University of Korea, Seoul, Republic of Korea
| |
Collapse
|
13
|
Huang Z, Chen G, Wu H, Huang X, Xu R, Deng F, Li Y. Ebselen restores peri-implantitis-induced osteogenic inhibition via suppressing BMSCs ferroptosis. Exp Cell Res 2023; 427:113612. [PMID: 37116735 DOI: 10.1016/j.yexcr.2023.113612] [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: 11/16/2022] [Revised: 03/12/2023] [Accepted: 04/21/2023] [Indexed: 04/30/2023]
Abstract
It is hard to reconstruct bone defects in peri-implantitis due to osteogenesis inhibited by excessive ROS. Ferroptosis, a recently identified regulated cell death characterized by iron- and reactive oxygen species- (ROS-) dependent lipid peroxidation, provides us with a new explanation. Our study aims to explore whether ferroptosis is involved in peri-implantitis-inhibited osteogenesis and confirm ebselen, an antioxidant with glutathione peroxidase (GPx)-like activity, could inhibit ferroptosis and promote osteogenesis in peri-implantitis. In this study, we used LPS to mimic the microenvironment of peri-implantitis. The osteogenic differentiation of bone-marrow-derived mesenchymal stem cells (BMSCs) was assessed by alkaline phosphatase (ALP), Alizarin Red S, and mRNA and protein expression of osteogenic-related markers. Ferroptosis index analysis included iron metabolism, ROS production, lipid peroxidation and mitochondrial morphological changes. Iron overload, reduced antioxidant capability, excessive ROS, lipid peroxidation and the characteristic mitochondrial morphological changes of ferroptosis were observed in LPS-treated BMSCs, and adding Ferrostatin-1 (Fer-1) restored the inhibitory effect of ferroptosis on osteogenic differentiation of BMSCs. Furthermore, ebselen ameliorated LPS-induced ferroptosis and osteogenic inhibition, which was reversed by erastin. Our results demonstrated that ferroptosis is involved in osteogenic inhibition in peri-implantitis and ebselen could attenuate osteogenic dysfunction of BMSCs via inhibiting ferroptosis.
Collapse
Affiliation(s)
- Ziqing Huang
- Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-Sen University, Guangzhou, PR China; Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, PR China
| | - Guanhui Chen
- Department of Stomatology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Hiokuan Wu
- Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-Sen University, Guangzhou, PR China; Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, PR China
| | - Xiaoqiong Huang
- Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-Sen University, Guangzhou, PR China; Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, PR China
| | - Ruogu Xu
- Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-Sen University, Guangzhou, PR China; Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, PR China
| | - Feilong Deng
- Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-Sen University, Guangzhou, PR China; Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, PR China.
| | - Yiming Li
- Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-Sen University, Guangzhou, PR China; Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, PR China.
| |
Collapse
|
14
|
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.
Collapse
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.
| |
Collapse
|
15
|
Scarano A, Khater AGA, Gehrke SA, Serra P, Francesco I, Di Carmine M, Tari SR, Leo L, Lorusso F. Current Status of Peri-Implant Diseases: A Clinical Review for Evidence-Based Decision Making. J Funct Biomater 2023; 14:jfb14040210. [PMID: 37103300 PMCID: PMC10142594 DOI: 10.3390/jfb14040210] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 03/25/2023] [Accepted: 04/06/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND the prevalence of peri-implant diseases is constantly growing, particularly with the increasing use of dental implants. As such, achieving healthy peri-implant tissues has become a key challenge in implant dentistry since it considers the optimal success paradigm. This narrative review aims to highlight the current concepts regarding the disease and summarize the available evidence on treatment approaches clarifying their indications for usage following the World Workshop on the Classification of Periodontal and Peri-implant Diseases (2017). METHODS we reviewed the recent literature and conducted a narrative synthesis of the available evidence on peri-implant diseases. RESULTS scientific evidence on case definitions, epidemiology, risk factors, microbiological profile, prevention, and treatment approaches for peri-implant diseases were summarized and reported. CONCLUSIONS although there are numerous protocols for managing peri-implant diseases, they are diverse and nonstandardized, with no consensus on the most effective, leading to treatment confusion.
Collapse
Affiliation(s)
- Antonio Scarano
- Department of Innovative Technologies in Medicine and Dentistry, University of Chieti-Pescara, 66100 Chieti, Italy
| | - Ahmad G A Khater
- Health Affairs Directorate, Egyptian Ministry of Health and Population, Banisuif 62511, Egypt
| | - Sergio Alexandre Gehrke
- Department of Research, Bioface/PgO/UCAM, Calle Cuareim 1483, Montevideo 11100, Uruguay
- Department of Biotecnology, Universidad Católica de Murcia (UCAM), 30107 Murcia, Spain
| | - Paola Serra
- Department of Innovative Technologies in Medicine and Dentistry, University of Chieti-Pescara, 66100 Chieti, Italy
| | - Inchingolo Francesco
- Department of Interdisciplinary Medicine, Section of Dental Medicine, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Mariastella Di Carmine
- Department of Innovative Technologies in Medicine and Dentistry, University of Chieti-Pescara, 66100 Chieti, Italy
| | - Sergio Rexhep Tari
- Department of Innovative Technologies in Medicine and Dentistry, University of Chieti-Pescara, 66100 Chieti, Italy
| | - Lucia Leo
- Department of Innovative Technologies in Medicine and Dentistry, University of Chieti-Pescara, 66100 Chieti, Italy
| | - Felice Lorusso
- Department of Innovative Technologies in Medicine and Dentistry, University of Chieti-Pescara, 66100 Chieti, Italy
| |
Collapse
|
16
|
Zakir M, Thomas D, Adams R, Farnell D, Claydon N. A Systematic Review and Meta-Analysis of the Clinical Outcomes for Adjunctive Physical, Chemical, and Biological Treatment of Dental Implants With Peri-Implantitis. J ORAL IMPLANTOL 2023; 49:168-178. [PMID: 37071563 DOI: 10.1563/aaid-joi-d-21-00204] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
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.
Collapse
Affiliation(s)
- Mehreen Zakir
- School of Dentistry, Cardiff University, Heath Park, Cardiff, CF14 4XY, United Kingdom
| | - David Thomas
- School of Dentistry, Cardiff University, Heath Park, Cardiff, CF14 4XY, United Kingdom
| | - Robert Adams
- School of Dentistry, Cardiff University, Heath Park, Cardiff, CF14 4XY, United Kingdom
| | - Damian Farnell
- School of Dentistry, Cardiff University, Heath Park, Cardiff, CF14 4XY, United Kingdom
| | - Nicholas Claydon
- School of Dentistry, Cardiff University, Heath Park, Cardiff, CF14 4XY, United Kingdom
| |
Collapse
|
17
|
Stein JM, Conrads G, Abdelbary MMH, Yekta-Michael SS, Buttler P, Glock J, Sadvandi G, Kaufmann R, Apel C. Antimicrobial efficiency and cytocompatibility of different decontamination methods on titanium and zirconium surfaces. Clin Oral Implants Res 2023; 34:20-32. [PMID: 36259118 DOI: 10.1111/clr.14014] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 07/18/2022] [Accepted: 10/13/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVES The purpose of this study was to investigate the efficiency of different implant-decontamination methods regarding biofilm modification and potential cytotoxic effects. Therefore, the amount of biofilm reduction, cytocompatibility, and elementary surface alterations were evaluated after decontamination of titanium and zirconium surfaces. MATERIAL AND METHODS Titanium and zirconium disks were contaminated with a newly developed high-adherence biofilm consisting of six microbial species. Decontaminations were performed using titanium curette, stainless steel ultrasonic scaler (US), glycine (GPAP) and erythritol (EPAP) powder air-polishing, Er:YAG laser, 1% chlorhexidine (CHX), 10% povidone-iodine (PVI), 14% doxycycline (doxy), and 0.95% NaOCl solution. Microbiologic analysis was done using real-time qPCR. For assessment of cytocompatibility, a multiplex assay for the detection of cytotoxicity, viability, and apoptosis on human gingival fibroblasts was performed. X-ray photoelectron spectroscopy (XPS) was used to evaluate chemical alterations on implant surfaces. RESULTS Compared with untreated control disks, only GPAP, EPAP, US, and Er:YAG laser significantly reduced rRNA counts (activity) on titanium and zirconium (p < .01), whereas NaOCl decreased rRNA count on titanium (p < .01). Genome count (bacterial presence) was significantly reduced by GPAP, EPAP, and US on zirconium only (p < .05). X-ray photoelectron spectroscopy analyses revealed relevant re-exposure of implant surface elements after GPAP, EPAP, and US treatment on both materials, however, not after Er:YAG laser application. Cytocompatibility was impaired by CHX, PVI, doxy, and NaOCl. CHX and PVI resulted in the lowest viability and doxy in the highest apoptosis. CONCLUSIONS Within the limits of this in vitro study, air-polishing methods and ultrasonic device resulted in effective biofilm inactivation with surface re-exposure and favorable cytocompatibility on titanium and zirconium. Chemical agents, when applied on implant surfaces, may cause potential cytotoxic effects.
Collapse
Affiliation(s)
- Jamal M Stein
- Operative Dentistry, Periodontology and Preventive Dentistry, University Hospital (RWTH), Aachen, Germany.,Private Practice, Aachen, Germany
| | - Georg Conrads
- Division of Oral Microbiology and Immunology, Department of Operative Dentistry, Periodontology and Preventive Dentistry, Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen University Hospital, Aachen, Germany
| | - Mohamed M H Abdelbary
- Division of Oral Microbiology and Immunology, Department of Operative Dentistry, Periodontology and Preventive Dentistry, Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen University Hospital, Aachen, Germany
| | | | - Patricia Buttler
- Operative Dentistry, Periodontology and Preventive Dentistry, University Hospital (RWTH), Aachen, Germany
| | - Joanna Glock
- Operative Dentistry, Periodontology and Preventive Dentistry, University Hospital (RWTH), Aachen, Germany
| | - Gelareh Sadvandi
- Operative Dentistry, Periodontology and Preventive Dentistry, University Hospital (RWTH), Aachen, Germany
| | - Robert Kaufmann
- DWI - Leibnitz-Institut für Interaktive Materialien, Aachen, Germany
| | - Christian Apel
- Department of Biohybrid & Medical Textiles (BioTex), Institute of Applied Medical Engineering, RWTH Aachen University & Hospital, Germany
| |
Collapse
|
18
|
Galarraga‐Vinueza ME, Tavelli L. Soft tissue features of peri‐implant diseases and related treatment. Clin Implant Dent Relat Res 2022. [PMID: 36444772 DOI: 10.1111/cid.13156] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 11/01/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND The need for soft tissue grafting at implant sites for preventing and treating peri-implant diseases is a currently investigated and debated topic. PURPOSE The aim of this manuscript is to explore the inflammatory mechanisms at the peri-implant soft tissue compartment, to distinguish the structural components of the peri-implant soft tissue phenotype and their role on peri-implant health, and to appraise the clinical indications and expected outcomes of soft tissue augmentation procedures at peri-implant diseased sites. MATERIALS AND METHODS This narrative review depicts the inflammatory biomarkers and mediators in the peri-implant crevicular fluid utilized to diagnose peri-implant disease and that have been shown to be associated with peri-implant soft tissue phenotype modification and disease resolution. The impact of the peri-implant soft tissue phenotype, involving keratinized mucosa (KM) width, attached mucosa (AM), mucosal thickness (MT), and supracrestal tissue height (STH), on peri-implant health, esthetic, patient's comfort and disease prevention are discussed. The manuscript also illustrates the use of ultrasonography for the detection of peri-implant health/disease and the evaluation of the treatment outcomes following surgical therapies. RESULTS Current evidence indicates that soft tissue phenotype modification at implant sites with inadequate KM width, AM and MT can be beneficial for promoting peri-implant health and improving patient's comfort and hygiene procedures. Treatment approaches and outcomes from the available literature on soft tissue phenotype modification in combination with conventional techniques at sites with peri-implant mucositis or peri-implantitis are presented and discussed in detail. CONCLUSIONS Soft tissue grafting can be beneficial in preventing and treating peri-implant diseases. Clinical recommendations based on the disease, soft tissue phenotype characteristics and bone defect morphology are provided for a comprehensive hard- and soft-tissue-oriented treatment of peri-implant disease.
Collapse
Affiliation(s)
- Maria Elisa Galarraga‐Vinueza
- Department of Prosthodontics Tufts University School of Dental Medicine Boston Massachusetts USA
- School of Dentistry Universidad de las Américas (UDLA) Quito Ecuador
| | - Lorenzo Tavelli
- Department of Oral Medicine, Infection, and Immunity, Division of Periodontology Harvard School of Dental Medicine Boston Massachusetts USA
- Center for Clinical Research and Evidence Synthesis in Oral TissuE RegeneratION (CRITERION) Boston Massachusetts USA
- Department of Periodontics and Oral Medicine University of Michigan School of Dentistry Ann Arbor Michigan USA
| |
Collapse
|
19
|
Luengo F, Sanz‐Esporrín J, Noguerol F, Sanz‐Martín I, Sanz‐Sánchez I, Sanz M. In vitro effect of different implant decontamination methods in three intraosseous defect configurations. Clin Oral Implants Res 2022; 33:1087-1097. [PMID: 35997508 PMCID: PMC9825956 DOI: 10.1111/clr.13991] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 06/24/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVES This in vitro investigation was aimed to evaluate the cleaning ability of four mechanical devices designed for decontaminating implant surfaces. MATERIAL AND METHODS Ninety-six implants were coated with permanent ink and inserted into 3D-printed resin blocks simulating three different intraosseous defect configurations (types Ib, Ic, and Ie). The four tested mechanical decontamination devices (air-polishing with glycine powder, rotating titanium brush, polyetheretherketone [PEEK]-coated ultrasonic tip, and stainless steel ultrasonic tip) were randomly applied onto the 5 mm exposed implant surface. Standardized photographs were taken from a frontal perspective and with a 30° angle coronally and apically to the implant axis. The area with remnant ink on the implant surface was calculated. RESULTS Although none of the groups achieved complete ink removal, air-polishing with glycine and titanium brushes demonstrated a higher cleaning ability when compared with ultrasonic devices either with standard or PEEK tips for all three defect configurations. For the three tested models, the best cleaning ability in all groups was shown on implant surfaces without facing an intraosseous wall. Titanium brush was the most effective when the intraosseous walls existed. Cleaning effectiveness diminished in the threads located in the apical third, especially when using air-polishing and ultrasonic devices. CONCLUSIONS Titanium brushes and air-polishing devices were more effective in removing artificial biofilm using this in vitro model, although their effectiveness was influenced by the presence of the intrabony component.
Collapse
Affiliation(s)
- Fernando Luengo
- Section of Periodontology, Faculty of OdontologyUniversity ComplutenseMadridSpain,ETEP (Etiology and Therapy of Periodontal and Peri‐implant Diseases) Research GroupUniversity ComplutenseMadridSpain
| | - Javier Sanz‐Esporrín
- Section of Periodontology, Faculty of OdontologyUniversity ComplutenseMadridSpain,ETEP (Etiology and Therapy of Periodontal and Peri‐implant Diseases) Research GroupUniversity ComplutenseMadridSpain
| | - Fernando Noguerol
- Section of Periodontology, Faculty of OdontologyUniversity ComplutenseMadridSpain
| | | | - Ignacio Sanz‐Sánchez
- Section of Periodontology, Faculty of OdontologyUniversity ComplutenseMadridSpain,ETEP (Etiology and Therapy of Periodontal and Peri‐implant Diseases) Research GroupUniversity ComplutenseMadridSpain
| | - Mariano Sanz
- Section of Periodontology, Faculty of OdontologyUniversity ComplutenseMadridSpain,ETEP (Etiology and Therapy of Periodontal and Peri‐implant Diseases) Research GroupUniversity ComplutenseMadridSpain
| |
Collapse
|
20
|
Kochar SP, Reche A, Paul P. The Etiology and Management of Dental Implant Failure: A Review. Cureus 2022; 14:e30455. [DOI: 10.7759/cureus.30455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 10/18/2022] [Indexed: 11/07/2022] Open
|
21
|
Li ZB, Li K, Du M, Ren SB, Yu Y. Surgical treatment of peri-implantitis with or without adjunctive graft material: a systematic review and meta-analysis of randomized controlled trials. Int J Oral Maxillofac Surg 2022; 52:107-117. [PMID: 35717280 DOI: 10.1016/j.ijom.2022.05.007] [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: 08/23/2021] [Revised: 05/18/2022] [Accepted: 05/19/2022] [Indexed: 10/18/2022]
Abstract
This systematic review and meta-analysis was performed to compare the clinical effect of surgical treatment of peri-implantitis alone or in combination with graft material. Literature searches were conducted up to June 20, 2020. Randomized controlled trials (RCTs) comparing the clinical effects of open flap debridement (OFD) alone and OFD with adjunctive graft materials for the treatment of peri-implantitis were included. Probing depth (PD) changes and marginal bone level (MBL) changes were assessed and expressed as the standardized mean difference (SMD) with 95% confidence interval (CI). Subgroup analyses and sensitivity analyses were conducted. The search yielded 7419 articles, five of which were analysed quantitatively. The adjunctive use of graft materials in OFD did not provide additional PD improvements (SMD 0.46, 95% CI -0.13 to 1.05; P = 0.13), but did yield additional MBL improvements (SMD 1.04, 95% CI 0.71-1.37; P < 0.01). The degradability of the material, number of implants included per patient, and risk of bias did not have significant effects on the results, but the origin of the material may affect the PD improvements. Based on the available evidence, the adjunctive use of graft materials in the surgical treatment of peri-implantitis can significantly improve MBL changes but not PD changes.
Collapse
Affiliation(s)
- Z-B Li
- Department of Periodontology, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University and Shandong Key Laboratory of Oral Tissue Regeneration and Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Jinan, Shandong, China; State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Diseases, School of Stomatology, Fourth Military Medical University, Xi'an, Shaanxi, China; Department of Periodontology, Jinan Stomatological Hospital, Jinan, China
| | - K Li
- Department of Periodontology, Jinan Stomatological Hospital, Jinan, China
| | - M Du
- School of Public Health, The University of Adelaide and Robinson Research Institute, The University of Adelaide, Adelaide, Australia
| | - S-B Ren
- Department of Stomatology, Medical Team of 66081 Troop of PLA, Zhangjiakou, China
| | - Y Yu
- Department of Periodontology, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University and Shandong Key Laboratory of Oral Tissue Regeneration and Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Jinan, Shandong, China.
| |
Collapse
|
22
|
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: 0] [Impact Index Per Article: 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.
Collapse
|
23
|
Abstract
Inappropriate and unnecessary implant therapy driven by an erroneous belief that dental implants provide enhanced function and esthetics over diseased or failing teeth has led to a growing burden of implant complications across the globe. Specifically, esthetic and biological complications frequently lead to the unfavorable prognosis of dental implants. Often, these cannot be managed predictably to improve the condition or satisfy patients' demands. In such circumstances, implant removal needs to be considered. Currently, minimally invasive methods based on reverse torque engineering are key to preserve peri-implant soft and hard tissues. Implant replacement is now feasible, as evidenced by the high survival rates of implants placed at previously failed sites. Notwithstanding these data, clinicians should still consider carefully the expendability of an implant and whether its replacement will satisfy the prosthetic, biomechanical, and esthetic demands of the patient. In the scenario where future implant placement is desired, protocols undertaken for soft/hard tissue grafting and implant placement should be based upon defect morphology and soft and hard-tissue characteristics. Currently, however, a lack of knowledge of the biological events and dimensional changes that arise following implant removal renders decision-making complex and challenging, and recommendations remain largely based upon empirical speculation. This chapter will review the indications for implant replacement for prosthetic, biomechanical, and esthetic complications, alongside considerations in decision-making, planning, implementation, and outcomes of implant replacement.
Collapse
Affiliation(s)
- Alberto Monje
- Department of Periodontics and Oral Medicine, School of Dental Medicine, University of Michigan, Ann Arbor, MI, USA.,Department of Periodontology, Universidad Internacional de Catalunya, Barcelona, Spain
| | - José Nart
- Department of Periodontology, Universidad Internacional de Catalunya, Barcelona, Spain
| |
Collapse
|
24
|
Øen M, Leknes KN, Lund B, Bunæs DF. The efficacy of systemic antibiotics as an adjunct to surgical treatment of peri-implantitis: a systematic review. BMC Oral Health 2021; 21:666. [PMID: 34961495 PMCID: PMC8711198 DOI: 10.1186/s12903-021-02020-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 12/08/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Microbial biofilm accumulation is the main cause of peri-implantitis. The majority of surgical peri-implantitis treatment protocols suggests adjunctive use of systemic antibiotics to target specific putative bacteria. The aim of this systematic review was to critically evaluate the adjunctive use of systemically administered antibiotics in surgical treatment of peri-implantitis by reviewing previously published systematic reviews and primary studies. METHODS A systematic literature search was conducted in four electronic databases (MEDLINE, The Cochrane Library, EMBASE, and Web of Science) for randomised controlled trials, cohort studies, case-control studies, and systematic reviews reporting surgical treatment of peri-implantitis with and without adjunctive systemically administered antibiotic therapy. The included systematic reviews and primary studies were qualitatively assessed using AMSTAR and GRADE, respectively. No restrictions were set for date of publication, journal, or language. RESULTS The literature search identified 681 papers. Only seven systematic reviews and two primary studies met the inclusion criteria. Four out of seven included systematic reviews concluded that no evidence exists for use of systemic antibiotics to improve the clinical outcomes in surgical treatment of peri-implantitis. One review did not estimate the level of evidence, one did not clearly state any beneficial effect, whereas one reported a limited adjunctive effect. Further, the two included primary studies did not show a long-term significant benefit of adjunctive use of systemically administrated antibiotics. However, one study reported a short-term adjunctive effect in patients with modified surface implants. Due to heterogeneity in study design, low number of included primary studies, and grade of bias, no meta-analysis was performed. CONCLUSION The use of systemically administered antibiotics as an adjunct to surgical interventions of peri-implantitis cannot be justified as a part of a standard treatment protocol. A pervasive problem is the lack of uniform diagnosis criteria for peri-implantitis, deficient information about patient characteristics, absence of high quality long-term randomised controlled trials, and authors' declaration on conflict of interest.
Collapse
Affiliation(s)
- Malene Øen
- Department of Clinical Dentistry - Periodontics, Faculty of Medicine, University of Bergen, Aarstadveien 19, 5009, Bergen, Norway
| | - Knut N Leknes
- Department of Clinical Dentistry - Periodontics, Faculty of Medicine, University of Bergen, Aarstadveien 19, 5009, Bergen, Norway.
| | - Bodil Lund
- Division of Oral Diagnostics and Oral Rehabilitation, Department of Dental Medicine, Karolinska Institutet and Medical Unit for Reconstructive Plastic- and Craniofacial Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Dagmar F Bunæs
- Department of Clinical Dentistry - Periodontics, Faculty of Medicine, University of Bergen, Aarstadveien 19, 5009, Bergen, Norway
| |
Collapse
|
25
|
Physicochemical and Biological Characterization of Ti6Al4V Particles Obtained by Implantoplasty: An In Vitro Study. Part I. MATERIALS 2021; 14:ma14216507. [PMID: 34772034 PMCID: PMC8585232 DOI: 10.3390/ma14216507] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 10/15/2021] [Accepted: 10/25/2021] [Indexed: 02/07/2023]
Abstract
Implantoplasty is a mechanical decontamination technique that consists of polishing the supra-osseous component of the dental implant with peri-implantitis. This technique releases metal particles in the form of metal swarf and dust into the peri-implant environment. In the present in vitro study, the following physicochemical characterization tests were carried out: specific surface area, granulometry, contact angle, crystalline structure, morphology, and ion release. Besides, cytotoxicity was in turn evaluated by determining the fibroblastic and osteoblastic cell viability. As a result, the metal debris obtained by implantoplasty presented an equivalent diameter value of 159 µm (range 6–1850 µm) and a specific surface area of 0.3 m2/g on average. The particle had a plate-like shape of different sizes. The release of vanadium ions in Hank’s solution at 37 °C showed no signs of stabilization and was greater than that of titanium and aluminum ions, which means that the alloy suffers from a degradation. The particles exhibited cytotoxic effects upon human osteoblastic and fibroblastic cells in the whole extract. In conclusion, metal debris released by implantoplasty showed different sizes, surface structures and shapes. Vanadium ion levels were higher than that those of the other metal ions, and cell viability assays showed that these particles produce a significant loss of cytocompatibility on osteoblasts and fibroblasts, which means that the main cells of the peri-implant tissues might be injured.
Collapse
|
26
|
Solonko M, Regidor E, Ortiz-Vigón A, Montero E, Vilchez B, Sanz M. Efficacy of keratinized mucosal augmentation with a collagen matrix concomitant to the surgical treatment of peri-implantitis: A dual-center randomized clinical trial. Clin Oral Implants Res 2021; 33:105-119. [PMID: 34651349 DOI: 10.1111/clr.13870] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 10/04/2021] [Accepted: 10/06/2021] [Indexed: 12/19/2022]
Abstract
AIM The aim of this study was to evaluate the efficacy of a xenogeneic collagen matrix to augment the width of keratinized mucosa (KM), concomitantly to the surgical treatment of peri-implantitis, when compared to the use of an autologous soft tissue graft. MATERIAL AND METHODS In this 12-month parallel-arm randomized controlled clinical trial, patients with peri-implantitis were randomly assigned, one month after non-surgical therapy, to surgical resective treatment of peri-implantitis consisting on an apically positioned flap (APF) in combination with a KM augmentation procedure, either with an autologous free gingival graft (FGG) or a collagen matrix (CM). Primary outcomes were the increase in the width of KM and probing pocket depth (PPD) reduction at 12 months. As secondary outcomes, peri-implant radiographic and patient-reported outcomes were assessed. RESULTS The intention-to-treat population consisted of 49 subjects, assigned to either the APF + FGG (n = 23) or APF + CM (n = 26) group. PPDs were reduced by 1.6 mm (SD 1.0) and 1.7 mm (SD 1.2), respectively, being these differences non statistically significant (p = .782). However, the increase in KM was significantly higher in the APF + FGG compared with APF + CM (2.5 mm [SD 1.6] vs. 1.6 mm [SD 1.2], respectively (p = .033). CONCLUSION The tested surgical modalities resulted in similar improvements of the clinical parameters. Both free gingival graft and collagen matrix significantly increased the peri-implant keratinized mucosa, but this KM gain was significantly higher with the free gingival graft. Use of CM, however, was better appreciated by the patients, in terms of pain perception and analgesic consumption, although the surgical time was similar.
Collapse
Affiliation(s)
- Myroslav Solonko
- Postgraduate Clinic of Periodontology, Faculty of Odontology, University Complutense, Madrid, Spain
| | - Erik Regidor
- Thinking Perio Research, Clínica Ortiz-Vigón Periocentrum, Bilbao, Spain
| | - Alberto Ortiz-Vigón
- Postgraduate Clinic of Periodontology, Faculty of Odontology, University Complutense, Madrid, Spain.,Thinking Perio Research, Clínica Ortiz-Vigón Periocentrum, Bilbao, Spain.,ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, University Complutense, Madrid, Spain
| | - Eduardo Montero
- Postgraduate Clinic of Periodontology, Faculty of Odontology, University Complutense, Madrid, Spain.,ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, University Complutense, Madrid, Spain
| | - Blanca Vilchez
- Postgraduate Clinic of Periodontology, Faculty of Odontology, University Complutense, Madrid, Spain
| | - Mariano Sanz
- Postgraduate Clinic of Periodontology, Faculty of Odontology, University Complutense, Madrid, Spain.,ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, University Complutense, Madrid, Spain
| |
Collapse
|
27
|
Woo HN, Cho YJ, Tarafder S, Lee CH. The recent advances in scaffolds for integrated periodontal regeneration. Bioact Mater 2021; 6:3328-3342. [PMID: 33817414 PMCID: PMC7985477 DOI: 10.1016/j.bioactmat.2021.03.012] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 03/01/2021] [Accepted: 03/02/2021] [Indexed: 02/06/2023] Open
Abstract
The periodontium is an integrated, functional unit of multiple tissues surrounding and supporting the tooth, including but not limited to cementum (CM), periodontal ligament (PDL) and alveolar bone (AB). Periodontal tissues can be destructed by chronic periodontal disease, which can lead to tooth loss. In support of the treatment for periodontally diseased tooth, various biomaterials have been applied starting as a contact inhibition membrane in the guided tissue regeneration (GTR) that is the current gold standard in dental clinic. Recently, various biomaterials have been prepared in a form of tissue engineering scaffold to facilitate the regeneration of damaged periodontal tissues. From a physical substrate to support healing of a single type of periodontal tissue to multi-phase/bioactive scaffold system to guide an integrated regeneration of periodontium, technologies for scaffold fabrication have emerged in last years. This review covers the recent advancements in development of scaffolds designed for periodontal tissue regeneration and their efficacy tested in vitro and in vivo. Pros and Cons of different biomaterials and design parameters implemented for periodontal tissue regeneration are also discussed, including future perspectives.
Collapse
Affiliation(s)
| | | | - Solaiman Tarafder
- Center for Dental and Craniofacial Research, Columbia University Medical Center, 630 W. 168 St., VC12-212, New York, NY, 10032, USA
| | - Chang H. Lee
- Center for Dental and Craniofacial Research, Columbia University Medical Center, 630 W. 168 St., VC12-212, New York, NY, 10032, USA
| |
Collapse
|
28
|
Leitão-Almeida B, Camps-Font O, Correia A, Mir-Mari J, Figueiredo R, Valmaseda-Castellón E. Effect of bone loss on the fracture resistance of narrow dental implants after implantoplasty. An in vitro study. Med Oral Patol Oral Cir Bucal 2021; 26:e611-e618. [PMID: 34162823 PMCID: PMC8412446 DOI: 10.4317/medoral.24624] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 05/31/2021] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Implantoplasty (IP) involves polishing of the exposed surface of implants affected by peri-implantitis (PI). A study was made to determine whether the degree of bone loss influences the fracture resistance of implants with or without IP. MATERIAL AND METHODS An in vitro study was carried out on 32 narrow (3.5 mm) dental implants with a rough surface and external hexagonal connection. Implantoplasty was performed in half of the implants of the sample. Both the IP and control implants were divided into two subgroups according to the amount of bone loss (3 mm or 7.5 mm). Standardized radiographic assessment of implant width was performed using specific software. The main outcome variable was the maximum compression force (Fmax) of implants when subjected to static resistance to fracture tests. Implant fractures were subsequently analyzed by scanning electron microscopy. A descriptive and bivariate analysis of the data was performed. RESULTS Significant changes in implant width were observed after IP (p<0.05). No significant differences between IP and control implants were recorded in terms of the Fmax values in the two bone loss subgroups (3 mm: control 854.37N 195.08 vs. IP 752.12N 186.13; p=0.302, and 7.5 mm: control 548.82N 80.02 vs. IP 593.69N 111.07; p=0.370). Greater bone loss was associated to a decrease in Fmax, which proved significant for the control implants (p=0.001). Fractures were more frequently located in the platform (n=13). CONCLUSIONS Implants with more apical bone levels appear to be more susceptible to fracture. On the other hand, IP does not seem to significantly decrease the fracture resistance of narrow (3.5 mm) platform dental implants with external hexagonal connections. The fact that most fractures occur in the platform area indicates that the latter is exposed to more mechanical stress.
Collapse
Affiliation(s)
- B Leitão-Almeida
- Facultat de Medicina i Ciències de la Salut (Odontologia) Universitat de Barcelona, Campus de Bellvitge C/ Feixa Llarga, s/n; Pavelló Govern, 2ª planta, Despatx 2.9 08907 - L'Hospitalet de Llobregat, Barcelona, Spain
| | | | | | | | | | | |
Collapse
|
29
|
Kao RT, Lin GH, Kapila Y, Sadowsky S, Curtis DA. A commentary on strategic extraction. J Periodontol 2021; 93:11-19. [PMID: 34435680 DOI: 10.1002/jper.20-0855] [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: 02/16/2021] [Revised: 07/23/2021] [Accepted: 08/10/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND Advancements in strategies to maintain compromised teeth combined with a greater understanding of risks associated with dental implants invite a reassessment of the benefits of strategic extraction of a tooth with a questionable prognosis or of limited strategic value. METHODS Evidence of the management of compromised teeth and decision making for strategic extraction was reviewed. Additionally, the risks for peri-implantitis were evaluated from the perspective of patient centric, biologic, and biomechanical complications. RESULTS Recent clinical innovations support a more predictable maintenance of compromised dentition, and the clinical literature provides evidence of the risks associated with dental implants. CONCLUSIONS Because of the improvements in dental management of compromised dentition, strategic extraction should be deferred, whenever possible, to avoid complications associated with peri-implantitis.
Collapse
Affiliation(s)
- Richard T Kao
- Department of Orofacial Sciences, School of Dentistry, University of California, San Francisco, California.,Private Practice, San Jose, California
| | - Guo-Hao Lin
- Department of Orofacial Sciences, School of Dentistry, University of California, San Francisco, California
| | - Yvonne Kapila
- Department of Orofacial Sciences, School of Dentistry, University of California, San Francisco, California
| | - Steven Sadowsky
- Department of Preventive and Restorative Dentistry, School of Dentistry, University of the Pacific, San Francisco, California
| | - Donald A Curtis
- Department of Restorative Dentistry, School of Dentistry, University of California, San Francisco, California
| |
Collapse
|
30
|
Mordini L, Sun N, Chang N, De Guzman JP, Generali L, Consolo U. Peri-Implantitis Regenerative Therapy: A Review. BIOLOGY 2021; 10:biology10080773. [PMID: 34440005 PMCID: PMC8389675 DOI: 10.3390/biology10080773] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 07/29/2021] [Accepted: 08/05/2021] [Indexed: 11/17/2022]
Abstract
Simple Summary Regenerative therapies are one of the options to treat peri-implantitis diseases that cause peri-implant bone loss. This review reports classic and current literature to describe the available knowledge on regenerative peri-implant techniques. Abstract The surgical techniques available to clinicians to treat peri-implant diseases can be divided into resective and regenerative. Peri-implant diseases are inflammatory conditions affecting the soft and hard tissues around dental implants. Despite the large number of investigations aimed at identifying the best approach to treat these conditions, there is still no universally recognized protocol to solve these complications successfully and predictably. This review will focus on the regenerative treatment of peri-implant osseous defects in order to provide some evidence that can aid clinicians in the approach to peri-implant disease treatment.
Collapse
Affiliation(s)
- Lorenzo Mordini
- Department of Periodontology, Tufts University School of Dental Medicine, Boston, MA 02111, USA; (N.S.); (N.C.); (J.-P.D.G.)
- Correspondence:
| | - Ningyuan Sun
- Department of Periodontology, Tufts University School of Dental Medicine, Boston, MA 02111, USA; (N.S.); (N.C.); (J.-P.D.G.)
| | - Naiwen Chang
- Department of Periodontology, Tufts University School of Dental Medicine, Boston, MA 02111, USA; (N.S.); (N.C.); (J.-P.D.G.)
| | - John-Paul De Guzman
- Department of Periodontology, Tufts University School of Dental Medicine, Boston, MA 02111, USA; (N.S.); (N.C.); (J.-P.D.G.)
| | - Luigi Generali
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with Transplant Surgery, Oncology and Regenerative Medicine Relevance (CHIMOMO), University of Modena and Reggio Emilia, 41124 Modena, Italy; (L.G.); (U.C.)
| | - Ugo Consolo
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with Transplant Surgery, Oncology and Regenerative Medicine Relevance (CHIMOMO), University of Modena and Reggio Emilia, 41124 Modena, Italy; (L.G.); (U.C.)
| |
Collapse
|
31
|
Renvert S, Giovannoli JL, Roos-Jansåker AM, Rinke S. Surgical treatment of peri-implantitis with or without a deproteinized bovine bone mineral and a native bilayer collagen membrane: A randomized clinical trial. J Clin Periodontol 2021; 48:1312-1321. [PMID: 34169551 DOI: 10.1111/jcpe.13513] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 05/31/2021] [Accepted: 06/04/2021] [Indexed: 12/11/2022]
Abstract
AIM To assess whether the use of deproteinized bovine bone mineral (DBBM) and native bilayer collagen membrane (NBCM) improved healing of peri-implantitis-related bone defects at 12 months. MATERIALS AND METHODS In a multi-centre, randomized clinical trial, 32 individuals received surgical debridement (control group [CG]), and 34 received adjunct use of DBBM and NBCM (test group [TG]). Radiographic defect fill (RDF), probing pocket depth (PPD), bleeding on probing (BOP), suppuration (SUP), recession (REC), cytokines (IL-1β, IL-1RA, IL-6, IL-8, IL-12, IP10, PDGF-BB, TNF-α, VEGF), and patient-reported outcomes (PROs) were evaluated at 3, 6, 9, and 12 months. RESULTS RDF at the deepest site amounted 2.7 ± 1.3 mm in TG and 1.4 ± 1.2 mm in CG (p <.0001). PPD was reduced by 1.9 mm in TG and 2.3 mm in CG (p = .5783). There were no significant differences between groups regarding reductions of BOP, SUP, REC, cytokines levels, or oral health impact profile (OHIP)-14 scores at 12 months. Successful treatment (RDF ≥ 1.0 mm, PPD ≤5 mm, ≤1/4 site with BOP grade 1, no SUP) was identified in 32% in TG and 21% in CG. CONCLUSIONS DBBM and NBCM resulted in significantly more RDF than debridement alone. No difference was found in any clinical parameters or PROs between the groups. ClinicalTrials.gov Identifier: NCT02375750.
Collapse
Affiliation(s)
- Stefan Renvert
- Oral Health Sciences, Kristianstad University, Kristianstad, Sweden.,School of Dental Science, Trinity College, Dublin, Ireland.,Blekinge Institute of Technology, Karlskrona, Sweden.,Faculty of Dentistry, The University of Hong Kong, Hong Kong
| | - Jean-Louis Giovannoli
- Private Practice, Paris, France.,Institute of Health, University of Corsica, Corte, France
| | | | - Sven Rinke
- Private Practice, Hanau, Germany.,Department of Prosthodontics, University Medical Center, Goettingen, Germany
| |
Collapse
|
32
|
Wada M, Mameno T, Otsuki M, Kani M, Tsujioka Y, Ikebe K. Prevalence and risk indicators for peri-implant diseases: A literature review. JAPANESE DENTAL SCIENCE REVIEW 2021; 57:78-84. [PMID: 34158874 PMCID: PMC8203834 DOI: 10.1016/j.jdsr.2021.05.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 03/18/2021] [Accepted: 05/23/2021] [Indexed: 02/08/2023] Open
Abstract
Peri-implant diseases are known as undesirable conditions that can occur after implant therapy. Although several risk indicators are becoming clear, the causes of peri-implant diseases have not been completely investigated. The purpose of this review was to summarize the prevalence and risk indicators for peri-implant diseases by referring to current papers from various angles. Many studies have reported the varied prevalence of peri-implant mucositis (23.9%-88.0% at the patient level and 9.7%-81.0% at the implant level) and peri-implantitis (8.9%-45% at the patient level and 4.8%-23.0% at the implant level). Additionally, several studies concluded that poor oral hygiene and lack of regular maintenance were strongly correlated with the development of both peri-implant mucositis and peri-implantitis. Diabetes and a history of periodontitis were revealed as risk indicators for peri-implantitis. However, there was no definitive conclusion about the correlations between peri-implant diseases and other factors such as smoking, the shape of the implant superstructure, and the condition of the keratinized mucosa. Further studies useful for evidence-based decision-making are needed for predictable implant therapy in the long term.
Collapse
Affiliation(s)
- Masahiro Wada
- Osaka University, Graduate School of Dentistry Department of Prosthodontics, Gerodontology and Oral Rehabilitation, Japan
| | - Tomoaki Mameno
- Osaka University, Graduate School of Dentistry Department of Prosthodontics, Gerodontology and Oral Rehabilitation, Japan
| | - Motohiro Otsuki
- Osaka University, Graduate School of Dentistry Department of Prosthodontics, Gerodontology and Oral Rehabilitation, Japan.,Private Dental Office, Japan
| | - Misako Kani
- Osaka University, Graduate School of Dentistry Department of Prosthodontics, Gerodontology and Oral Rehabilitation, Japan
| | - Yoshitaka Tsujioka
- Osaka University, Graduate School of Dentistry Department of Prosthodontics, Gerodontology and Oral Rehabilitation, Japan
| | - Kazunori Ikebe
- Osaka University, Graduate School of Dentistry Department of Prosthodontics, Gerodontology and Oral Rehabilitation, Japan
| |
Collapse
|
33
|
Lopez MA, Passarelli PC, Godino E, Lombardo N, Altamura FR, Speranza A, Lopez A, Papi P, Pompa G, D’Addona A. The Treatment of Peri-Implant Diseases: A New Approach Using HYBENX ® as a Decontaminant for Implant Surface and Oral Tissues. Antibiotics (Basel) 2021; 10:antibiotics10050512. [PMID: 33946370 PMCID: PMC8147150 DOI: 10.3390/antibiotics10050512] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 04/19/2021] [Accepted: 04/26/2021] [Indexed: 01/03/2023] Open
Abstract
Background: Peri-implantitis is a pathological condition characterized by an inflammatory process involving soft and hard tissues surrounding dental implants. The management of peri-implant disease has several protocols, among which is the chemical method HYBENX®. The aim of this study is to demonstrate the efficacy of HYBENX® in the treatment of peri-implantitis and to compare HYBENX® with other chemical agents used in the surgical treatment of peri-implantitis. Methods: The present study included a population of ten subjects with severe peri-implantitis. The procedure used in the study involves the application of HYBENX® after open-flap debridement. Each patient has been followed for 12 months after a single application of the decontaminant agent. Clinical and radiographical parameters were recorded at baseline, 3 months, and 12 months after treatment completion. Results: At baseline, a mean pocket probing depth (PPD) of 7.3 ± 0.5 mm and a mean clinical attachment level (CAL) of 8.8 ± 0.8 mm was recorded. An average residual PPD of 4.2 ± 0.5 mm and a mean CAL of 5.2 ± 0.8 mm were observed after 1 year. Additionally, the average of bone gain was about 3.4 mm, with a mean marginal bone level (MBL) change from 5.8 mm (baseline) to 2.4 mm (12 months). In total, 90% of the treated implants reached the success rate after the 1-year follow-up. Only in one case out of ten treated implants was resolution of the disease not achieved. Conclusion: Clinical improvements highlight that the procedure of open-flap debridement (OFD) + HYBENX® may be considered an effective technique in the treatment of peri-implantitis. From the results obtained, it can be concluded that the use of HYBENX® in the surgical treatment of peri-implantitis is promising. Overall, this protocol demands further studies to better understand the role and potential benefits of HYBENX® in the treatment of peri-implantitis.
Collapse
Affiliation(s)
| | - Pier Carmine Passarelli
- Division of Oral Surgery and Implantology, Institute of Clinical Dentistry, Department of Head and Neck, Catholic University of the Sacred Heart, Gemelli University Polyclinic Foundation, 00168 Rome, Italy; (P.C.P.); (E.G.); (N.L.); (A.S.); (A.D.)
| | - Emmanuele Godino
- Division of Oral Surgery and Implantology, Institute of Clinical Dentistry, Department of Head and Neck, Catholic University of the Sacred Heart, Gemelli University Polyclinic Foundation, 00168 Rome, Italy; (P.C.P.); (E.G.); (N.L.); (A.S.); (A.D.)
| | - Nicolò Lombardo
- Division of Oral Surgery and Implantology, Institute of Clinical Dentistry, Department of Head and Neck, Catholic University of the Sacred Heart, Gemelli University Polyclinic Foundation, 00168 Rome, Italy; (P.C.P.); (E.G.); (N.L.); (A.S.); (A.D.)
| | - Francesca Romana Altamura
- Department of Oral and Maxillo Facial Sciences, Policlinico Umberto I, “Sapienza” University of Rome, 00161 Rome, Italy; (F.R.A.); (G.P.)
| | - Alessandro Speranza
- Division of Oral Surgery and Implantology, Institute of Clinical Dentistry, Department of Head and Neck, Catholic University of the Sacred Heart, Gemelli University Polyclinic Foundation, 00168 Rome, Italy; (P.C.P.); (E.G.); (N.L.); (A.S.); (A.D.)
| | - Andrea Lopez
- Universidad Europea de Madrid, 28670 Madrid, Spain;
| | - Piero Papi
- Department of Oral and Maxillo Facial Sciences, Policlinico Umberto I, “Sapienza” University of Rome, 00161 Rome, Italy; (F.R.A.); (G.P.)
- Correspondence:
| | - Giorgio Pompa
- Department of Oral and Maxillo Facial Sciences, Policlinico Umberto I, “Sapienza” University of Rome, 00161 Rome, Italy; (F.R.A.); (G.P.)
| | - Antonio D’Addona
- Division of Oral Surgery and Implantology, Institute of Clinical Dentistry, Department of Head and Neck, Catholic University of the Sacred Heart, Gemelli University Polyclinic Foundation, 00168 Rome, Italy; (P.C.P.); (E.G.); (N.L.); (A.S.); (A.D.)
| |
Collapse
|
34
|
Wagner TP, Pires PR, Rios FS, de Oliveira JAP, Costa RDSA, Cunha KF, Silveira HLD, Pimentel S, Casati MZ, Rosing CK, Haas AN. Surgical and non-surgical debridement for the treatment of peri-implantitis: a two-center 12-month randomized trial. Clin Oral Investig 2021; 25:5723-5733. [PMID: 33725166 DOI: 10.1007/s00784-021-03874-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 03/03/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To compare surgical (ST) and non-surgical (NST) debridement for the treatment of peri-implantitis in a two-center randomized trial. MATERIALS AND METHODS Forty-five individuals with 63 implants with probing depth (PPD) ≥5mm, bleeding on probing (BOP), and radiographic bone loss ≥2mm were included. In the NST (30 implants), submucosal debridement was performed. In the ST (33 implants), a mucoperiosteal flap was raised and surfaces were decontaminated only by debridement as performed in NST. Clinical parameters and radiographs were compared at baseline and after 12 months. Means and standard errors were reported. RESULTS PPD considering all implant sites reduced significantly in NST from 4.14±0.25 to 3.25±0.18mm. In ST, PPD also significantly changed (3.74±0.22 to 3.00±0.29mm). No significant differences were observed between the two groups. For deep sites (≥7mm), PPD was 7.82±0.20mm at baseline and reduced to 5.10±0.30mm in NST, while in ST group, it was 7.11±0.11mm and changed to 5.22±0.91mm (between-groups p value=0.51). BOP significantly reduced from ~60 to 35% of all sites in both groups, without significant differences between them. When sites with radiographic bone level ≥3mm at baseline were analyzed, there was a significant difference between groups in bone gain after 12 months in favor of ST (ST=0.78±0.30mm compared to NST=0.25mm±0.13; p=0.03). CONCLUSIONS Surgical and non-surgical debridement for the treatment of peri-implantitis present similar clinical outcomes. Bone levels were better improved in ST than NST for sites with higher initial bone loss. CLINICAL RELEVANCE The treatment of peri-implantitis is still a challenge in clinical practice, since less than half of affected implants achieve health after surgical or non-surgical debridement. Considering the lack of clinically relevant differences between these two treatments, non-surgical debridement should be considered the first therapeutic choice for peri-implantitis, mainly mild to moderate cases.
Collapse
Affiliation(s)
- Tassiane Panta Wagner
- Periodontology, Faculty of Dentistry, Federal University of Rio Grande do Sul, Rua Ramiro Barcelos, 2492, Porto Alegre, RS, 90030-035, Brazil
| | | | - Fernando Silva Rios
- Periodontology, Faculty of Dentistry, Federal University of Rio Grande do Sul, Rua Ramiro Barcelos, 2492, Porto Alegre, RS, 90030-035, Brazil
| | - Joao Augusto Peixoto de Oliveira
- Periodontology, Faculty of Dentistry, Federal University of Rio Grande do Sul, Rua Ramiro Barcelos, 2492, Porto Alegre, RS, 90030-035, Brazil
| | - Ricardo Dos Santos Araujo Costa
- Periodontology, Faculty of Dentistry, Federal University of Rio Grande do Sul, Rua Ramiro Barcelos, 2492, Porto Alegre, RS, 90030-035, Brazil
| | - Kelly F Cunha
- Periodontology, Faculty of Dentistry, Federal University of Rio Grande do Sul, Rua Ramiro Barcelos, 2492, Porto Alegre, RS, 90030-035, Brazil
| | | | - Suzana Pimentel
- Periodontology, Faculty of Dentistry, Paulista University, São Paulo, Brazil
| | - Marcio Zaffalon Casati
- Periodontology, Faculty of Dentistry, Paulista University, São Paulo, Brazil.,Periodontology, Faculty of Dentistry, University of Campinas, Piracicaba, Brazil
| | - Cassiano Kuchenbecker Rosing
- Periodontology, Faculty of Dentistry, Federal University of Rio Grande do Sul, Rua Ramiro Barcelos, 2492, Porto Alegre, RS, 90030-035, Brazil
| | - Alex Nogueira Haas
- Periodontology, Faculty of Dentistry, Federal University of Rio Grande do Sul, Rua Ramiro Barcelos, 2492, Porto Alegre, RS, 90030-035, Brazil.
| |
Collapse
|
35
|
Cheung MC, Hopcraft MS, Darby IB. Dentists' preferences in implant maintenance and hygiene instruction. Aust Dent J 2021; 66:278-288. [PMID: 33538341 DOI: 10.1111/adj.12831] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND This study investigated the preferences of dentists in Australia in providing professional implant maintenance and implant-specific oral hygiene instructions (OHI). METHODS General dentists were surveyed online about their preferences in peri-implant diagnostics, maintenance provision, armamentarium used, and implant OHI techniques and frequency. RESULTS Most of the 303 respondents (96%) provided maintenance services; 87.6% reviewed implants regularly while 10.7% only performed diagnostics after detecting clinical signs/symptoms. Supragingival prosthesis cleaning was performed by 77.9% of respondents, 35.0% performed subgingival debridement, 41.9% treated peri-implant mucositis and 18.2% treated peri-implantitis. About 15% did not treat nor refer peri-implant disease, including significantly more non-implant providers and dentists without implant training. Maintenance armamentarium commonly included floss (76.3%), prophylaxis (73.9%), plastic curettes (43.3%) and stainless-steel ultrasonics (38.0%). Brushing (86.5%), flossing (73.9%) and interdental brush use (68.3%) were most commonly recommended. Implant OHI was repeated routinely by 57.4% of dentists who provided it. Dentists with greater implant training and experience were more likely to perform reviews and complex maintenance procedures. CONCLUSIONS Peri-implant diagnostics performed, treatments provided and armamentarium varied among dentists. Implant providers and those with higher levels of training had more preventative approaches to implant OHI. Possible shortcomings in disease management and OHI reinforcement were identified.
Collapse
Affiliation(s)
- M C Cheung
- Melbourne Dental School, The University of Melbourne, Melbourne, VIC, Australia
| | - M S Hopcraft
- Melbourne Dental School, The University of Melbourne, Melbourne, VIC, Australia
| | - I B Darby
- Melbourne Dental School, The University of Melbourne, Melbourne, VIC, Australia
| |
Collapse
|
36
|
Cordeiro JM, Pires JM, Souza JGS, Lima CV, Bertolini MM, Rangel EC, Barão VAR. Optimizing citric acid protocol to control implant-related infections: An in vitro and in situ study. J Periodontal Res 2021; 56:558-568. [PMID: 33538336 DOI: 10.1111/jre.12855] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 11/16/2020] [Accepted: 01/11/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The present study aimed to establish an optimized protocol for biofilm removal from titanium (Ti) surfaces using citric acid (CA) solutions. BACKGROUND Biofilm accumulation is the main factor to trigger peri-implant infections and to increase the risk of treatment failures. Although CA has been suggested as the anti-infective agent with highest potential for biofilm removal on Ti, there is no consensus that CA could improve the anti-infective treatment and its effect. METHODS Physical and chemical alterations, electrochemical behavior, cytotoxicity, and antimicrobial effect of CA on Ti discs were evaluated using four concentrations (1, 10, 20, and 40%) and two application methods (immersion and rubbing). Negative control using 0.9% NaCl was used in all experiments. To evaluate whether different application times can have similar response, polymicrobial biofilm (microcosm model) was formed on Ti and treated with CA for 1, 2, 4, and 8 min. An in situ study was conducted to verify whether the established protocol is equally effective in biofilms formed on machined and sandblasted, large-grit, and acid-etched (SLA) Ti surfaces. RESULTS CA 40% induced significantly higher surface alterations observed by confocal images and profilometry. In general, rubbing protocol decreased the surface roughness and increased the wettability (p < 0.05), exhibiting better surface cleaning by biofilm removal. CA 10% presented no indirect cytotoxicity and, when applied by rubbing for 8 min, presented proper in vitro antibacterial action and potential corrosion inhibition. When CA 10% was rubbed on Ti surfaces for 4 min, it displayed optimum cleaning ability as 8 min, working equally to remove in situ biofilm on machined and SLA surfaces. CONCLUSIONS The application of CA 10% by rubbing for at least 4 min demonstrated to be a promising protocol to eliminate biofilms formed in smooth and rougher surfaces, which could improve implant-related infection therapies.
Collapse
Affiliation(s)
- Jairo M Cordeiro
- Department of Prosthodontics and Periodontology, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Brazil
| | - Júlia M Pires
- Department of Prosthodontics and Periodontology, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Brazil
| | - João G S Souza
- Department of Prosthodontics and Periodontology, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Brazil.,Faculdade de Ciências Odontológicas (FCO), Montes Claros, Brazil.,Dental Research Division, Guarulhos University, Guarulhos, Brazil
| | | | - Martinna M Bertolini
- Division of Periodontology, Oral Health and Diagnostic Sciences Department, School of Dental Medicine, University of Connecticut, Farmington, USA
| | - Elidiane C Rangel
- Laboratory of Technological Plasmas, Institute of Science and Technology, São Paulo State University (UNESP), Sorocaba, Brazil
| | - Valentim A R Barão
- Department of Prosthodontics and Periodontology, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Brazil
| |
Collapse
|
37
|
Abd-Ul-Salam H. Peri-implantitis. INNOVATIVE PERSPECTIVES IN ORAL AND MAXILLOFACIAL SURGERY 2021:47-59. [DOI: 10.1007/978-3-030-75750-2_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
|
38
|
Solderer A, Schmidlin PR. Regenerative Surgical Therapy of Peri-implantitis: An Umbrella Review of Answered/Unanswered Questions and Future Perspectives. FRONTIERS IN DENTAL MEDICINE 2020. [DOI: 10.3389/fdmed.2020.614240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Purpose: To systemically summarize current knowledge about regeneration of peri-implant defects based on available systematic reviews.Materials and Methods: A systematic search for review articles published between 2010 and 2020 in four databases was conducted. Only systematic reviews and meta-analyses were included. Based on the available literature, five questions of clinical importance on indication for regenerative approaches, surgical technique, methods of decontamination, outcome of therapy and adjunctive use of biological factors were formulated and answered.Results: The electronic search resulted in 312 studies, from which 264 studies were published between 2010 and 2020. Finally, 18 systematic reviews and one consensus report were chosen. Data of the included studies were based on 58 to 840 implants. Data on over 4.904 implants were assessed. From the 19 studies that were included, 15 assessed the outcome of regenerative therapy; three, the surgical protocol of regenerative therapy; two, the use of laser in regenerative therapy; and one, the additional use of growth factors in regenerative peri-implant therapy. Three studies assessed more than one topic.Conclusions: In general, a partial bone fill can be expected in 85% of regenerative procedures. Regeneration leads to a mean of 57% of greater bone fill, compared to open flap surgery only. Defect configuration plays a crucial role in the outcome, whereas the role and extent of benefit of different surgical protocols are still not clear.
Collapse
|
39
|
Shimchuk AA, Weinstein BF, Daubert DM. The impact of a change in classification criteria on the prevalence of peri-implantitis: A cross-sectional analysis. J Periodontol 2020; 92:1339-1346. [PMID: 33277941 DOI: 10.1002/jper.20-0566] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 10/09/2020] [Accepted: 11/30/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Peri-implantitis is a frequent finding but estimates of its prevalence vary widely. This may be due to the wide variety of disease definitions. In 2017 the World Workshop on Periodontal and Peri-implant Diseases and Conditions established new criteria for disease definitions. The aim of this study is to assess the potential impact of a new definition on the future reporting of peri-implant disease. METHODS Data from a 2015 report of peri-implant prevalence were examined using the new diagnostic criteria. This cross-sectional study was performed on 95 patients with 220 implants who had their implants placed between 1998 and 2003. An examiner masked to the previous diagnosis examined the radiographs and patient data to make a diagnosis based on 3 mm of bone loss from the expected level of bone. This reanalysis was used to calculate the prevalence of peri-implant disease and generate new relative risk indicators. RESULTS The mean follow-up time for the patients was 10.9 years. Using the 2017 criteria, peri-implant mucositis was found in 35.3% of the implants and 52.2% of the subjects, and peri-implantitis occurred in 8.7% of the implants and 15.2% of the subjects. This constituted a drop in peri-implantitis at both patient and implant level of nearly 50% from the prior analysis. Smoking at time of implant placement emerged as a new risk factor in this analysis that was not identified in the prior analysis. CONCLUSIONS The new diagnostic criteria significantly reduce the reported prevalence of peri-implantitis and bring new risk factors into focus.
Collapse
Affiliation(s)
| | | | - Diane M Daubert
- Department of Periodontics, University of Washington, Seattle, WA
| |
Collapse
|
40
|
Trombelli L, Severi M, Farina R, Simonelli A. Sub-Periosteal Peri-Implant Augmented Layer Technique to Treat Peri-Implantitis Lesions. Clin Adv Periodontics 2020; 10:169-174. [PMID: 32369680 DOI: 10.1002/cap.10107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 04/20/2020] [Indexed: 11/07/2022]
Abstract
INTRODUCTION The efficacy of surgical regenerative procedures to treat peri-implantitis lesions has been extensively reviewed. Regenerative treatment showed a variable rate of success, in terms of pocket reduction, gain in bone support, and elimination of signs of infection/inflammation. The aim of the present case report is to illustrate the use of the sub-periosteal peri-implant augmented layer (SPAL) technique to correct peri-implantitis defects CASE PRESENTATION: Surgical treatment of three class Ib and one class Ic peri-implantitis lesions in three patients was performed by means of the SPAL technique. A partial-thickness flap was elevated, leaving the periosteal layer on the buccal cortical bone plate. The periosteal layer was in turn elevated to create a pouch, which was used to stabilize a bovine-derived xenograft (deproteinized bovine bone mineral) at the peri-implant buccal bone defect. No barrier membrane was used. In case of insufficient dimensions of peri-implant mucosa, a connective tissue graft (CTG) was buccally positioned at the most coronal portion of the implant. Treatment resulted in substantial reconstruction of peri-implant support associated with reduced probing depth and absence of inflammation. CONCLUSIONS SPAL technique with or without additional CTG may be a suitable option to obtain clinical remission of peri-implantitis defects associated with buccal bone dehiscence.
Collapse
Affiliation(s)
- Leonardo Trombelli
- Research Center for the Study of Periodontal and Peri-Implant Diseases, University of Ferrara, Ferrara, Italy
- Operative Unit of Dentistry, Azienda Unità Sanitaria Locale, Ferrara, Italy
| | - Mattia Severi
- Research Center for the Study of Periodontal and Peri-Implant Diseases, University of Ferrara, Ferrara, Italy
| | - Roberto Farina
- Research Center for the Study of Periodontal and Peri-Implant Diseases, University of Ferrara, Ferrara, Italy
- Operative Unit of Dentistry, Azienda Unità Sanitaria Locale, Ferrara, Italy
| | - Anna Simonelli
- Research Center for the Study of Periodontal and Peri-Implant Diseases, University of Ferrara, Ferrara, Italy
| |
Collapse
|
41
|
Leitão-Almeida B, Camps-Font O, Correia A, Mir-Mari J, Figueiredo R, Valmaseda-Castellón E. Effect of crown to implant ratio and implantoplasty on the fracture resistance of narrow dental implants with marginal bone loss: an in vitro study. BMC Oral Health 2020; 20:329. [PMID: 33213442 PMCID: PMC7678153 DOI: 10.1186/s12903-020-01323-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 11/10/2020] [Indexed: 12/27/2022] Open
Abstract
Background Peri-implantitis is a biological complication that affects soft and hard tissues around dental implants. Implantoplasty (IP) polishes the exposed implant surface, to decontaminate it and make it less prone to bacterial colonization. This study investigates whether a higher clinical crown-to-implant-ratio (CIR) reduces implant fracture resistance and whether implants are more fracture-prone after IP in the presence of 50% of bone loss.
Methods Forty-eight narrow platform (3.5 mm) 15 mm long titanium dental implants with a rough surface and hexagonal external connection were placed in standardized bone-like resin casts leaving 7.5 mm exposed. Half were selected for IP. The IP and control groups were each divided into 3 subgroups with different clinical CIRs (2:1, 2.5:1 and 3:1). The implant wall width measurements were calculated using the software ImageJ v.1.51 through the analysis of plain x-ray examination of all the samples using standardized mounts. A fracture test was performed and scanning electron microscopy was used to evaluate maximum compression force (Fmax) and implant fractures. Results IP significantly reduced the implant wall width (P < 0.001) in all reference points of each subgroup. Fmax was significantly higher in the 2:1 subgroup (control = 1276.16 N ± 169.75; IP = 1211.70 N ± 281.64) compared with the 2.5:1 (control = 815.22 N ± 185.58, P < 0.001; IP = 621.68 N ± 186.28, P < 0.001) and the 3:1 subgroup (control = 606.55 N ± 111.48, P < 0.001; IP = 465.95 N ± 68.57, P < 0.001). Only the 2.5:1 subgroup showed a significant reduction (P = 0.037) of the Fmax between the controls and the IP implants. Most fractures were located in the platform area. Only 5 implants with IP of the 2:1 CIR subgroup had a different fracture location (4 fractures in the implant body and 1 in the prosthetic screw). Conclusions IP significantly reduces the fracture resistance of implants with a 2.5:1 CIR. The results also suggest that the CIR seems to be a more relevant variable when considering the resistance to fracture of implants, since significant reductions were observed when unfavorable CIR subgroups (2.5:1 and 3:1 CIR) were compared with the 2:1 CIR samples.
Collapse
Affiliation(s)
- Bruno Leitão-Almeida
- Faculty of Dental Medicine, Center for Inter-Disciplinary Research in Health (CIIS), Universidade Católica Portuguesa, Estrada da Circunvalação, 3504-505, Viseu, Portugal.
| | - Octavi Camps-Font
- Oral Surgery and Implantology, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - André Correia
- Faculty of Dental Medicine, Center for Inter-Disciplinary Research in Health (CIIS), Universidade Católica Portuguesa, Estrada da Circunvalação, 3504-505, Viseu, Portugal
| | - Javier Mir-Mari
- Oral Surgery and Implantology, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Rui Figueiredo
- Oral Surgery and Implantology, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Eduard Valmaseda-Castellón
- Oral Surgery and Implantology, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| |
Collapse
|
42
|
Li Y, Zheng J, Gong C, Lan K, Shen Y, Ding X. Development of an immunogenomic landscape for the competing endogenous RNAs network of peri-implantitis. BMC MEDICAL GENETICS 2020; 21:208. [PMID: 33081707 PMCID: PMC7576812 DOI: 10.1186/s12881-020-01145-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 10/12/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Peri-implantitis is an inflammation that occurs around the implant, resulting in varying degrees of inflammatory damage to the soft and hard tissues. The characteristic criterion is the loss of the supporting bone in an inflammatory environment. However, the specific mechanisms and biomarkers involved in peri-implantitis remain to be further studied. Recently, competing endogenous RNAs (ceRNA) and immune microenvironment have been found to play a more important role in the inflammatory process. In our study, we analyzed the expression of immune related microRNAs (miRNAs), long noncoding RNAs (lncRNAs) and message RNAs (mRNAs) in peri-implantitis by analyzing GSE33774 and GSE57631. METHODS In this study, we explored the expression profile data of immune-related lncRNAs, miRNAs and mRNAs, and constructed immune-related ceRNA network involved in the pathogenesis of peri-implantitis. In addition, the CIBERSORT was used to evaluate the content of immune cells in normal tissues and peri-implantitis to detect the immune microenvironment of peri-implantitis. RESULTS In the analysis, 14 DElncRNAs, 16 DEmiRNAs, and 18 DEmRNAs were used to establish an immune related ceRNA network and the immune infiltration patterns associated with peri-implantitis was discovered. Through the mutual verification of the two datasets, we found that GSK3B and miR-1297 may have important significance in the immune microenvironment and pathogenesis of peri-implantitis and GSK3B was closely related to four types of immune cells, especially with the highest correlation with resting mast cells (P = 0.0003). CONCLUSIONS Through immune-related ceRNA network, immune-related genes (IRGs) and immune cell infiltration can further comprehensively understand the pathogenesis of peri-implantitis, which built up an immunogenomic landscape with clinical significance for peri-implantitis.
Collapse
Affiliation(s)
- Yang Li
- Department of Stomatology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China.,State key laboratory of molecular engineering of polymers, Fudan University, Shanghai, P.R. China
| | - Jina Zheng
- Department of Dermatology, Zhongshan Hospital, Fudan University, Shanghai, P.R. China
| | - Chanjuan Gong
- Department of Stomatology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China
| | - Kengfu Lan
- Department of Stomatology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China
| | - Yuqing Shen
- Department of Stomatology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China.
| | - Xiaojun Ding
- Department of Stomatology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China. .,State key laboratory of molecular engineering of polymers, Fudan University, Shanghai, P.R. China.
| |
Collapse
|
43
|
Khan A, Goyal A, Currell SD, Sharma D. Management of Peri-Implantitis Lesions without the Use of Systemic Antibiotics: A Systematic Review. Dent J (Basel) 2020; 8:E106. [PMID: 32937892 PMCID: PMC7576475 DOI: 10.3390/dj8030106] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 08/31/2020] [Accepted: 09/08/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND This systematic review aims to assess the current evidence on the efficacy of surgical and non-surgical debridement techniques in the treatment of peri-implantitis lesions without the use of any antimicrobials. METHOD Five electronic databases (MEDLINE, Pubmed, Scopus, CINAHL and Cochrane) were used, alongside hand searches, to find relevant articles. Full-text articles that were randomised controlled trials, published in the English language from 2011 onwards without pre-operative, peri-operative and post-operative antibiotic usage were included. The study was conducted according to the latest Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-P protocols, the latest Cochrane Risk of Bias tool and each investigated intervention was evaluated using the grading of recommendation, assessment, development and evaluation (GRADE) system. RESULTS The search yielded 2718 results. After initial screening, 38 full-text articles were assessed for eligibility. From these, 11 studies satisfied all inclusion criteria. These 11 articles described six non-surgical and five surgical debridement therapies. Most articles were classified as having either a high risk of bias or presenting with some concerns. Small sample sizes, in combination with this risk of bias, meant that all interventions were adjudged to be of either low or very low quality of evidence. CONCLUSION While all investigated modalities displayed some sort of efficacy, this review suggests that a surgical approach may be best suited to treating peri-implantitis lesions in the absence of antibiotic therapy. Despite this weak indication, further research is required in this field.
Collapse
Affiliation(s)
- Ahsen Khan
- College of Medicine and Dentistry, James Cook University, 14-88 McGregor Road, Smithfield, QLD 4878, Australia; (A.K.); (A.G.); (S.D.C.)
| | - Ankit Goyal
- College of Medicine and Dentistry, James Cook University, 14-88 McGregor Road, Smithfield, QLD 4878, Australia; (A.K.); (A.G.); (S.D.C.)
| | - Scott D. Currell
- College of Medicine and Dentistry, James Cook University, 14-88 McGregor Road, Smithfield, QLD 4878, Australia; (A.K.); (A.G.); (S.D.C.)
| | - Dileep Sharma
- College of Medicine and Dentistry, James Cook University, 14-88 McGregor Road, Smithfield, QLD 4878, Australia; (A.K.); (A.G.); (S.D.C.)
- Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, QLD 4878, Australia
| |
Collapse
|
44
|
Wang CW, Ashnagar S, Gianfilippo RD, Arnett M, Kinney J, Wang HL. Laser-assisted regenerative surgical therapy for peri-implantitis: A randomized controlled clinical trial. J Periodontol 2020; 92:378-388. [PMID: 32761810 DOI: 10.1002/jper.20-0040] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 04/07/2020] [Accepted: 04/18/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Different surgical approaches have been proposed to treat peri-implantitis defects with limited effectiveness and predictability. Laser has been proposed as an effective tool to assist in bacterial decontamination and modulating peri-implant tissue inflammation. The aim of this pilot clinical trial was to evaluate the adjunctive benefits of Er:YAG laser irradiation for regenerative surgical therapy of peri-implantitis-associated osseous defects. METHODS Twenty-four patients diagnosed with peri-implantitis with a radiographic infrabony defect were randomized into two groups. Both test and control groups received the following treatment: open flap mechanical debridement, supracrestal implantoplasty, bone grafting using a mixture of human allograft with demineralized bone matrix human allograft putty, and then covered with acellular dermal matrix membrane. The only difference in the test group was the adjunctive use of Er:YAG laser to modulate and remove inflammatory tissue as well as to decontaminate the implant surface. Clinical assessments, including pocket depth (PD), clinical attachment level (CAL), and gingival index (GI) were performed by calibrated masked examiners for up to 6 months following surgery. Standardized radiographs were also taken to evaluate linear bone gain and defect bone fill. Student t-tests were used to analyze those clinical parameters. RESULTS Both groups showed significant reductions in PD, GI, and CAL gain overtime. The test group demonstrated significantly higher PD reductions at the site level compared to the control group (2.65 ± 2.14 versus 1.85 ± 1.71 mm; test versus control, P = 0.014). There were no statistical differences found in CAL gain (1.90 ± 2.28 versus 1.47 ± 1.76 mm; test versus control), GI reduction (-1.14 ± 1.15 versus -1.04 ± 0.89; test versus control), radiographic linear bone gain (1.27 ± 1.14 versus 1.08 ± 1.04 mm; test versus control) or proportional defect size reduction (- 24.46 ± 19.00% versus -15.19 ± 23.56%; test versus control). There was a positive trend for test patients on PD reduction and CAL gain found in narrow infrabony defects. Major membrane exposure negatively impaired the overall treatment outcome of CAL gain (2.47 ± 1.84 versus 1.03 ± 1.48 mm; no/minor versus major exposure, P = 0.051) and PD reduction in the test group (-3.63 ± 2.11 versus -1.66 ± 1.26 mm, P = 0.049). CONCLUSION This pilot study indicated using laser irradiation during peri-implantitis regenerative therapy may aid in better probing PD reduction. Nonetheless, a larger sample size and longer follow-up is needed to confirm if Er:YAG laser irradiation provides additional clinical benefits for peri-implantitis regenerative therapy (Clinicaltrials.gov: NCT03127228).
Collapse
Affiliation(s)
- Chin-Wei Wang
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | | | - Riccardo Di Gianfilippo
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Michelle Arnett
- Division of Dental Hygiene, University of Minnesota School of Dentistry, Minneapolis, Minnesota, USA
| | - Janet Kinney
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Hom-Lay Wang
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| |
Collapse
|
45
|
Roccuzzo M, Fierravanti L, Pittoni D, Dalmasso P, Roccuzzo A. Implant survival after surgical treatment of peri‐implantitis lesions by means of deproteinized bovine bone mineral with 10% collagen: 10‐year results from a prospective study. Clin Oral Implants Res 2020; 31:768-776. [DOI: 10.1111/clr.13628] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 03/15/2020] [Accepted: 04/10/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Mario Roccuzzo
- Private practice Torino Italy
- Division of Maxillo‐facial SurgeryUniversity of Torino Torino Italy
- Department of Periodontics and Oral MedicineUniversity of Michigan MI USA
| | | | | | - Paola Dalmasso
- Department of Public Health and PediatricsUniversity of Torino Torino Italy
| | - Andrea Roccuzzo
- Department of Periodontology, School of Dental MedicineUniversity of Bern Bern Switzerland
- Department of Oral and Maxillofacial SurgeryCopenhagen University Hospital (Rigshospitalet) Copenhagen Denmark
| |
Collapse
|
46
|
Favero G, Apaza Alccayhuaman KA, Silva ER, Bengazi F, Urbizo J, Kotsu M, Botticelli D. Effect of lack of plaque control after the surgical treatment of peri-implantitis at surfaces with different characteristics: an experimental study in dogs. Oral Maxillofac Surg 2020; 24:431-439. [PMID: 32594345 DOI: 10.1007/s10006-020-00870-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 06/18/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVE The aim of the present study was to evaluate the effect of the induction of peri-implantitis and of plaque accumulation on implants with different surface characteristics after the surgical treatment. MATERIAL AND METHODS All mandibular premolars and first molars were extracted bilaterally in six dogs. After 3 months, two non-submerged implants were installed, each with either a hydrophilic sandblasted and acid-etched surface stored in saline solution (SLActive) or an acid-etched and modified with calcium ions surface (UnicCa). After 3 months, ligatures were placed in the sulcus around the implants to induce an experimental peri-implantitis and plaque accumulation was allowed. After 3 months, ligatures were removed and, after one more month of plaque accumulation, a surgical treatment was performed using gauzes soaked in saline and irrigations. X-rays were taken at this stage. Plaque control maintenance was established at the control sites, while plaque accumulation was allowed at the test sites (plaque sites). After 5 months, biopsies were obtained. Marginal bone levels were compared between x-rays and histological assessments. RESULTS At the time of peri-implantitis treatment, two SLActive implants were lost. At the euthanasia, seven more implants were lost only in the plaque group, one control and six test implants. The calculated mean values of the marginal bone level of the two surfaces at the treatment were 3.65 ± 1.71 mm in the control group, and 3.65 ± 1.76 mm in the plaque group (p = 0.463). The additional marginal bone loss after 5 months from surgical treatment was 0.67 ± 0.67 mm (UnicCa, 0.48 ± 1.06 mm and SLActive, 0.79 ± 2.10 mm) and 3.11 ± 1.38 mm (UnicCa, 2.67 ± 1.87 mm and SLActive, 3.94 ± 2.11 mm) for the control and plaque groups, respectively (p = 0.028). CONCLUSIONS The lack of plaque control after the surgical treatment of the peri-implantitis strongly influenced the marginal bone loss.
Collapse
Affiliation(s)
- Giovanni Favero
- ARDEC Academy, Viale Giovanni Pascoli 67, 47923, Rimini, Italy
| | | | - Erick Ricardo Silva
- Depto CTBMF e Periodontia, FORP-USP-Faculty of Ribeirão Preto (SP), Ribeirão Preto, Brazil
| | - Franco Bengazi
- Faculty of Dentistry, University of Medical Science, La Habana, Cuba
| | - Joaquin Urbizo
- Faculty of Dentistry, University of Medical Science, La Habana, Cuba
| | - Mitsuo Kotsu
- ARDEC Academy, Viale Giovanni Pascoli 67, 47923, Rimini, Italy
| | | |
Collapse
|
47
|
Aghazadeh A, Persson RG, Renvert S. Impact of bone defect morphology on the outcome of reconstructive treatment of peri-implantitis. Int J Implant Dent 2020; 6:33. [PMID: 32548733 PMCID: PMC7297900 DOI: 10.1186/s40729-020-00219-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 04/24/2020] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES To assess if (I) the alveolar bone defect configuration at dental implants diagnosed with peri-implantitis is related to clinical parameters at the time of surgical intervention and if (II) the outcome of surgical intervention of peri-implantitis is dependent on defect configuration at the time of treatment. MATERIALS AND METHODS In a prospective study, 45 individuals and 74 dental implants with ≥ 2 bone wall defects were treated with either an autogenous bone transplant or an exogenous bone augmentation material. Defect fill was assessed at 1 year. RESULTS At baseline, no significant study group differences were identified. Most study implants (70.7%, n = 53) had been placed in the maxilla. Few implants were placed in molar regions. The mesial and distal crestal width at surgery was greater at 4-wall defects than at 2-wall defects (p = 0.001). Probing depths were also greater at 4-wall defects than at 2-wall defects (p = 0.01). Defect fill was correlated to initial defect depth (p < 0.001). Defect fill at 4-wall defects was significant (p < 0.05). CONCLUSIONS (I) The buccal-lingual width of the alveolar bone crest was explanatory to defect configuration, (II) 4-wall defects demonstrated more defect fill, and (III) deeper defects resulted in more defect fill.
Collapse
Affiliation(s)
| | - Rutger G Persson
- Faculty of Health Sciences, Kristianstad University, SE-291 88, Kristianstad, Sweden.,Department of Periodontics, University of Washington, Seattle, WA, USA.,Department of Oral Medicine, University of Washington, Seattle, WA, USA
| | - Stefan Renvert
- Faculty of Health Sciences, Kristianstad University, SE-291 88, Kristianstad, Sweden. .,Blekinge Institute of Technology, SE-371 79, Karlskrona, Sweden. .,School of Dental Science, Trinity College, Dublin, Ireland. .,Faculty of Dentistry, The University of Hong Kong, Hong Kong, SAR, China.
| |
Collapse
|
48
|
Mayer Y, Ginesin O, Horwitz J. A nonsurgical treatment of peri-implantitis using mechanic, antiseptic and anti-inflammatory treatment: 1 year follow-up. Clin Exp Dent Res 2020; 6:478-485. [PMID: 32185910 PMCID: PMC7453777 DOI: 10.1002/cre2.286] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 03/01/2020] [Accepted: 03/03/2020] [Indexed: 12/12/2022] Open
Abstract
Aims The study's aim was to assess the clinical outcome 6 and 12 months after a nonsurgical treatment of peri‐implantitis per se or in conjunction with a combination of local antiseptic and anti‐inflammatory treatment. Materials and methods Included were 69 patients with periodontitis, with 106 implants, diagnosed with peri‐implantitis. Peri‐implantitis was defined as radiographic bone loss ≥3 mm, probing depth (PD) ≥ 6 mm, with bleeding on probing. Group M peri‐implantitis was treated with ultrasonic debridement and soft tissue curettage. Group P had additional implant surface treatment with rotatory hand piece composed of chitosan bristle, soft tissue curettage combined with application of 0.95% hypochlorite and 1 mg minocycline HCl. Results After 6 months, both groups demonstrated significant reduction of mean plaque index, PD, and clinical attachment level (0.71 ± 0.57, 0.81 ± 0.55; 4.77 ± 0.73 mm, 4.42 ± 0.5 mm; 5.03 ± 0.86 mm, 5.13 ± 0.73 mm; respectively) and bleeding on probing. After 6 and 12 months, group P showed significantly better PD results compared to group M. The bleeding was significantly less in group P after 12 months (15.3% ± 6.2, 25.1% ± 8.2, respectively). Conclusions Adjunctive treatment with local antiseptic and anti‐inflammatories during mechanical phase was positively associated with inflammation reduction and connective tissue reattachment.
Collapse
Affiliation(s)
- Yaniv Mayer
- Department of Periodontology, School of Graduate Dentistry, Rambam Health Care Campus, Haifa, Israel.,Periocenter Ltd., Haifa, Israel
| | - Ofir Ginesin
- Department of Periodontology, School of Graduate Dentistry, Rambam Health Care Campus, Haifa, Israel.,Periocenter Ltd., Haifa, Israel
| | - Jacob Horwitz
- Department of Periodontology, School of Graduate Dentistry, Rambam Health Care Campus, Haifa, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| |
Collapse
|
49
|
Aljohani M, Yong SL, Bin Rahmah A. The effect of surgical regenerative treatment for peri-implantitis: A systematic review. Saudi Dent J 2020; 32:109-119. [PMID: 32180667 PMCID: PMC7063412 DOI: 10.1016/j.sdentj.2019.10.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 10/14/2019] [Accepted: 10/21/2019] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVES The purpose of the present study was to systematically review literature on the effectiveness of surgical regenerative treatment for peri-implantitis. METHODS Different databases were searched including the Cochrane Central Register of Controlled Trials, EMBASE and MEDLINE. Primary outcomes were changes in probing pocket depth (PPD), bleeding on probing (BOP), radiographic marginal bone level (RBL) and signs of infection. Secondary outcomes were facial marginal recession, aesthetic outcomes and cost of treatment. Only randomised controlled trials (RCTs) with a minimum of 12 months follow-up period after regenerative surgical treatment were selected according to PRISMA guidelines. MAIN RESULTS Five studies were selected. The highest mean reduction of PPD was 3.1 mm in a bovine-derived xenograft (BDX) group. The highest percentage reduction of BOP occurred in patients treated with implantoplasty and saline (a reduction of 85.2%). The highest mean defect fill of RBL was reported in the porous titanium granules group (3.6 mm). Mean reductions of PPD, RBL and facial marginal soft tissue recession were statistically insignificant (p-value > 0.05) in the studies included. However, the mean reduction in BOP was statistically significant (p-value < 0.05) in four studies as compared to the baseline (before treatment). A high heterogeneity among the studies included, regarding surgical protocols, defects morphology and selection of biomaterials, was found. CONCLUSION All studies included showed an improvement in clinical conditions after surgical regenerative treatment for peri-implantitis. However, no study has shown any statistical significance in its approach. There is a lack of scientific evidence in literature regarding which type of bone substitute has superiority in the treatment of peri-implantitis, as well as the role of barrier membranes, methods for detoxification of implant surfaces and antimicrobial prescriptions. For these reasons further well-designed RCTs are recommended.
Collapse
Affiliation(s)
- Marwan Aljohani
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Taibah University, Madina, Saudi Arabia
- Faculty of Biology, Medicine and Health, Division of Dentistry, the University of Manchester, United Kingdom
| | - Sin L Yong
- Faculty of Biology, Medicine and Health, Division of Dentistry, the University of Manchester, United Kingdom
| | - Abdullah Bin Rahmah
- Faculty of Biology, Medicine and Health, Division of Dentistry, the University of Manchester, United Kingdom
- Department of Periodontics and Community Dentistry, King Saud University, College of Dentistry, Riyadh, Saudi Arabia
| |
Collapse
|
50
|
Pranno N, La Monaca G, Polimeni A, Sarto MS, Uccelletti D, Bruni E, Cristalli MP, Cavallini D, Vozza I. Antibacterial Activity against Staphylococcus Aureus of Titanium Surfaces Coated with Graphene Nanoplatelets to Prevent Peri-Implant Diseases. An In-Vitro Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E1568. [PMID: 32121336 PMCID: PMC7084449 DOI: 10.3390/ijerph17051568] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 02/25/2020] [Accepted: 02/27/2020] [Indexed: 12/17/2022]
Abstract
Dental implants are one of the most commonly used ways to replace missing teeth. Nevertheless, the close contact with hard and soft oral tissues expose these devices to infectious peri-implant diseases. To prevent such infection, several surface treatments have been developed in the last few years to improve the antimicrobial properties of titanium dental implants. In this in-vitro pilot study, the antimicrobial activity of titanium surfaces coated with different types of graphene nanoplatelets are investigated. Six different colloidal suspensions of graphene nanoplatelets (GNPs) were produced from graphite intercalated compounds, setting the temperature and duration of the thermal shock and varying the number of the exfoliation cycles. Titanium disks with sand-blasted and acid-etched surfaces were sprayed with 2 mL of colloidal GNPs suspensions. The size of the GNPs and the percentage of titanium disk surfaces coated by GNPs were evaluated through a field emission-scanning electron microscope. The antibacterial activity of the specimens against Staphylococcus aureus was estimated using a crystal violet assay. The dimension of GNPs decreased progressively after each sonication cycle. The two best mean percentages of titanium disk surfaces coated by GNPs were GNPs1050°/2 and GNPs1150°/2. The reduction of biofilm development was 14.4% in GNPs1150°/2, 20.1% in GNPs1150°/3, 30.3% in GNPs1050°/3, and 39.2% in GNPs1050°/2. The results of the study suggested that the surface treatment of titanium disks with GNPs represents a promising solution to improve the antibacterial activity of titanium implants.
Collapse
Affiliation(s)
- Nicola Pranno
- Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, 00100 Rome, Italy; (N.P.); (A.P.); (I.V.)
| | - Gerardo La Monaca
- Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, 00100 Rome, Italy; (N.P.); (A.P.); (I.V.)
| | - Antonella Polimeni
- Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, 00100 Rome, Italy; (N.P.); (A.P.); (I.V.)
| | - Maria Sabrina Sarto
- SNN Lab, Sapienza Nanotechnology & Nano-Science Laboratory, Sapienza, University of Rome, 00100 Rome, Italy; (M.S.S.); (D.C.)
- DIAEE, Department of Astronautical, Electrical, Energy Engineering, Sapienza University of Rome, 00100 Rome, Italy
| | - Daniela Uccelletti
- BBCD, Department of Biology and Biotechnology, Sapienza University of Rome, 00100 Rome, Italy; (D.U.); (E.B.)
| | - Erika Bruni
- BBCD, Department of Biology and Biotechnology, Sapienza University of Rome, 00100 Rome, Italy; (D.U.); (E.B.)
| | - Maria Paola Cristalli
- Department of Biotechnologies and Medico Surgical Sciences, Sapienza University of Rome, 00100 Rome, Italy;
| | - Domenico Cavallini
- SNN Lab, Sapienza Nanotechnology & Nano-Science Laboratory, Sapienza, University of Rome, 00100 Rome, Italy; (M.S.S.); (D.C.)
- DIAEE, Department of Astronautical, Electrical, Energy Engineering, Sapienza University of Rome, 00100 Rome, Italy
| | - Iole Vozza
- Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, 00100 Rome, Italy; (N.P.); (A.P.); (I.V.)
| |
Collapse
|