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Budmiger R, Peku E, Imber JC, Salvi GE, Staehli A, Roccuzzo A. Early and late implant loss in a university-based periodontal setting: A retrospective analysis on 1821 patients and 2639 implants over a period of 18 years. Swiss Dent J 2024; 134:105-121. [PMID: 38739773 DOI: 10.61872/sdj-2024-02-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Indexed: 05/16/2024]
Abstract
The aim of this study was to retrospectively analyze the implant failure rate, not due to peri-implantitis, in periodontally compromised patients rehabilitated with at least one dental implant placed in a specialist university setting over the last 18 years. Records of patients receiving dental implants at the Department of Periodontology, University of Bern, Switzerland, between 2005 and 2022 were analyzed. Data on 1821 patients with 2639 implants were retrieved. Fifty-nine patients experienced implant loss (rate at patient level: 3.2%) out of which 2.1% were early and 1.1% late implant losses, respectively. The majority of the 59 patients were males (68%) and 27.1% were smokers. Eight mm implants were lost with the highest rate (42.4%) followed by 10 mm implants (31.8%). The rate of lost maxillary implants was more than twice as high compared with that of mandibular implants (69.7 vs. 30.3%). Within the study limitations, the implant failure rate in this cohort of patients enrolled in regular supportive periodontal and peri-implant care, was low.
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Affiliation(s)
- Raffael Budmiger
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland.
| | - Emir Peku
- Department of Oral and Maxillofacial Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland.
| | - Jean-Claude Imber
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland.
| | - Giovanni E Salvi
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland.
| | - Alexandra Staehli
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland.
| | - Andrea Roccuzzo
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland.
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Roccuzzo A, Mancini L, Marruganti C, Ramieri G, Salvi GE, Sculean A, Roccuzzo M. Long-term treatment outcomes of single maxillary buccal peri-implant soft tissue dehiscences: A 10-year prospective study. Clin Implant Dent Relat Res 2024; 26:150-157. [PMID: 37691144 DOI: 10.1111/cid.13273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/17/2023] [Accepted: 08/21/2023] [Indexed: 09/12/2023]
Abstract
INTRODUCTION To evaluate the 10-year clinical outcomes following surgical treatment of shallow isolated peri-implant soft-tissue dehiscences (PSTD) at single tissue level dental implants. METHODS The baseline population included 16 patients (16 implants) displaying an isolated peri-implant maxillary buccal soft-tissue dehiscence. The recipient bed was prepared with a minimally-invasive split-thickness flap limited to the buccal aspect to stabilize the tuberosity connective tissue graft (CTG) onto the periosteum. At the end of treatment, patients were enrolled in an individualized supportive peri-implant care (SPC) program. The aesthetic outcome was evaluated on photographs by three clinicians using a visual analog scale (VAS). RESULTS SPC during the 10-years proceeded uneventfully in all patients. A total of 12 patients completed the 10-year examination, as 3 patients dropped-out and 1 implant was lost. Complete PSTD coverage was obtained at 7 implant sites (i.e., 58%) while the mean PSTD coverage amounted to 89.6% ± 17.1% without statistically significant differences between 1 and 10 years (p > 0.05). Stable peri-implant parameters (i.e., PD and BoP) and full-mouth scores (i.e., FMPS, FMBS) were recorded throughout the observation period (p > 0.05). The aesthetic improvements obtained in the short-term were maintained up to 10 years. CONCLUSION Within their limits, the present results indicate that the proposed surgical technique is a simple and reliable treatment option for the treatment of single maxillary buccal PSTDs in selected cases with positive results up to 10 years in patients under regular SPC (NCT04983758-this clinical trial was not registered prior to participant recruitment).
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Affiliation(s)
- Andrea Roccuzzo
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
- Department of Oral and Maxillofacial Surgery, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - Leonardo Mancini
- Center for Clinical Research and Evidence Synthesis in Oral Tissue Regeneration (CRITERION), Boston, Massachusetts, USA
| | - Crystal Marruganti
- Department of Medical Biotechnologies, Unit of Periodontology, Endodontology and Restorative Dentistry, University of Siena, Siena, Italy
| | - Guglielmo Ramieri
- Division of Maxillofacial Surgery, University of Torino, Torino, Italy
| | - Giovanni E Salvi
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Anton Sculean
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Mario Roccuzzo
- Division of Maxillofacial Surgery, University of Torino, Torino, Italy
- Department of Periodontics and Oral Medicine, University of Michigan, Michigan, USA
- Private Practice, Torino, Italy
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Stähli A, Ferrari J, Schatzmann AS, Weigel LD, Roccuzzo A, Imber JC, Duong HY, Eick S, Lang NP, Salvi GE, Sculean A. Clinical evaluation of a novel protocol for supportive periodontal care: A randomized controlled clinical trial. J Periodontol 2024. [PMID: 38291892 DOI: 10.1002/jper.23-0527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 01/04/2024] [Indexed: 02/01/2024]
Abstract
BACKGROUND The aim of this study was to compare the clinical efficacy and the patient perception of subgingival debridement with either guided biofilm management (GBM) or conventional scaling and root planing (SRP) during supportive periodontal care (SPC). METHODS Forty-one patients in SPC were randomly assigned to either treatment with GBM or SRP every 6 months. The primary outcome was the percentage of bleeding on probing (BoP) at 1 year. Moreover, pocket probing depths (PPD), recession, and furcation involvements were also measured. Full-mouth and specific site analyzes were performed at baseline, 6 and 12 months of SPC. Patient comfort was evaluated using a visual analogue scale (VAS) at 12 months. RESULTS At 1 year, mean BoP percentage decreased from 12.2% to 9.0% (p = 0.191) and from 14.7% to 7.9% (p = 0.004) for the GBM and SRP groups, respectively. Furcation involved multirooted teeth but no through-and-through lesions were significantly fewer in the GBM than in the SRP group after 12 months (p = 0.015). The remaining parameters showed slight improvement in both groups without any statistically significant differences between the two groups after 1 year. Pain evaluation as patient reported outcome measures (pain evaluation) was in favor (p = 0.347) of the SRP group, while overall satisfaction was similar for both groups. Treatment time was not statistically significantly different between the two groups (p = 0.188). CONCLUSION In well-maintained SPC patients, SRP protocols resulted in significant clinical improvements in terms of BoP; however, for the other clinical improvements, similar efficacy for both GBM and SRP was observed.
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Affiliation(s)
- Alexandra Stähli
- Department of Periodontology, University of Bern, Bern, Switzerland
| | - Jvana Ferrari
- Department of Periodontology, University of Bern, Bern, Switzerland
| | | | | | - Andrea Roccuzzo
- Department of Periodontology, University of Bern, Bern, Switzerland
| | | | - Ho-Yan Duong
- Department of Periodontology, University of Bern, Bern, Switzerland
| | - Sigrun Eick
- Department of Periodontology, University of Bern, Bern, Switzerland
| | - Niklaus P Lang
- Department of Periodontology, University of Bern, Bern, Switzerland
| | - Giovanni E Salvi
- Department of Periodontology, University of Bern, Bern, Switzerland
| | - Anton Sculean
- Department of Periodontology, University of Bern, Bern, Switzerland
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Roccuzzo A, Morandini M, Stähli A, Imber JC, Sculean A, Salvi GE. Clinical and radiographic outcomes of implant-supported zirconia fixed dental prostheses with cantilever extension: A proof-of-principle study with a follow-up of at least 1 year. Clin Oral Implants Res 2023; 34:1073-1082. [PMID: 37485971 DOI: 10.1111/clr.14138] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 06/27/2023] [Accepted: 07/13/2023] [Indexed: 07/25/2023]
Abstract
OBJECTIVES To test the reliability of full zirconia implant-supported fixed dental prostheses with cantilever extension (FDPCs) after at least 1 year of function. MATERIALS AND METHODS Thirty-five patients in need of implant-supported single unit crowns (SUC) and FDPCs in posterior areas were enrolled. After implant placement, patients were rehabilitated with screw-retained full-zirconia FDPCs. Implant survival rate, pocket probing depth (PPD), presence/absence of bleeding on probing (BoP), and presence/absence of mechanical/technical complications were recorded. Mesial and distal radiographic marginal bone levels (mBLs) from baseline (i.e., recall appointment 3-6 months after implant loading [T0]) to the follow-up examination (i.e., latest recall appointment after at least 12 months after T0 [T1]), were calculated. RESULTS Thirty patients with 34 FDPCs (31 SUCs and 3 FDPs) supported by 37 implants were available for analysis after a mean loading time of 2.6 ± 1.5 years (range: 13-87 months). No implants were lost. MBLs and mean PPD values did not change statistically significantly from T0 to T1 from 0.92 mm ± 0.42 to 0.96 mm ± 0.38 (95% CI: -0.07/0.17; p = .418) and from 2.99 mm ± 0.70 to 3.27 mm ± 0.71 (95% CI: -0.11/0.68; p = .25) respectively. Peri-implant mucositis was diagnosed in 22 cases. Screw-loosening and zirconia chipping occurred 1× in 4 patients. CONCLUSION Within the limitations of the present proof-of-principle study, the use of full-zirconia FDPCs in posterior areas seems a valid and safe short-term treatment option.
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Affiliation(s)
- Andrea Roccuzzo
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Michele Morandini
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Alexandra Stähli
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Jean-Claude Imber
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Anton Sculean
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Giovanni E Salvi
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
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Roccuzzo A, Weigel L, Marruganti C, Imber JC, Ramieri G, Sculean A, Salvi GE, Roccuzzo M. Longitudinal assessment of peri-implant diseases in patients with and without history of periodontitis: A 20-year follow-up study. Int J Oral Implantol (Berl) 2023; 16:211-222. [PMID: 37767616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
PURPOSE To longitudinally assess the prevalence of peri-implant health, peri-implant mucositis and peri-implantitis in a cohort of patients with and without history of periodontitis over a 20-year period. MATERIALS AND METHODS Eighty-four patients who attended a specialist private periodontal practice were evaluated prospectively 10 and 20 years after prosthesis delivery. Following successful completion of periodontal/implant therapy, patients (172 implants) were enrolled on an individualised supportive periodontal care programme. Clinical and radiographic parameters were collected to assess the prevalence of peri-implant health and diseases. Prevalence of peri-implantitis and peri-implant mucositis was calculated based on the case definition set out in 2018. A multilevel logistic regression analysis was conducted to assess potential risk or protective factors. RESULTS The analysis was performed on 22 periodontally healthy and 62 periodontally compromised patients rehabilitated with 39 and 130 implants, respectively. The 10-year prevalence of peri-implant health, peri-implant mucositis and peri-implantitis was 21.4%, 67.9% and 10.6%, respectively, whereas the 20-year prevalence was 29.8%, 47.6% and 33.3%, respectively. Non-compliant periodontally compromised patients showed a statistically significantly increased risk at 20 years of both peri-implant mucositis (odds ratio 11.1; 95% confidence interval 1.8-68.6) and peri-implantitis (bone loss and probing depth) (odds ratio 14.3; 95% confidence interval 1.8-32.9). High full-mouth plaque and bleeding scores were associated with higher odds of both peri-implant mucositis and peri-implantitis. CONCLUSIONS Peri-implant diseases were prevalent in patients rehabilitated with dental implants and followed up for a period of 20 years. History of periodontal disease and a lack of compliance with a tailored supportive periodontal care programme were identified as risk factors for peri-implant diseases.
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Weigel LD, Scherrer A, Schmid L, Stähli A, Imber JC, Roccuzzo A, Salvi GE. Marginal bone level changes around dental implants with one or two adjacent teeth - A clinical and radiographic retrospective study with a follow-up of at least 10 years. Clin Oral Implants Res 2023; 34:872-880. [PMID: 37340736 DOI: 10.1111/clr.14115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 05/15/2023] [Accepted: 06/05/2023] [Indexed: 06/22/2023]
Abstract
AIM To compare mean bone level (mBL) changes around dental implants with one or two adjacent teeth after a function time of ≥10 years. MATERIALS AND METHODS One hundred thirty three periodontally compromised patients (PCPs) with 551 implants enrolled in supportive periodontal care (SPC) were screened. Implants were categorized either into group TIT (tooth-implant-tooth) or into group TIG (tooth-implant-gap). MBL changes from delivery of restoration (i.e., baseline) to follow-up were calculated in millimeters and compared between implants and adjacent teeth. Survival rates and the need for surgical interventions during SPC were recorded. RESULTS Eighty seven patients with 142 implants were re-evaluated after a mean observation time of 14.5 ± 3.5 years. The mBL at mesial implant sites in the TIT group increased -0.07 ± 0.92 mm and decreased in the TIG group 0.52 ± 1.34 mm, respectively (95% CI: 0.04/1.14, p = .037). At distal implant sites, the mBL in the TIT group increased -0.08 ± 0.84 mm and decreased 0.03 ± 0.87 in the TIG group, respectively (95% CI: -0.20/0.42, p = .48). The overall implant loss rate was 3.5% (n = 5; 2 TIT, 3 TIG), without a statistically significant difference between the two groups (95% CI: 0.18/7.07, p = .892). Tooth loss rates (TIT: 12.3%, TIG: 12.3%) were not statistically significantly different (OR = 1.00, p = .989). CONCLUSION High tooth and implant survival rates were observed in PCPs. The presence of one or two adjacent teeth seemed to have no impact on marginal bone level changes.
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Affiliation(s)
- Lucienne D Weigel
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Angelina Scherrer
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Lucas Schmid
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Alexandra Stähli
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Jean-Claude Imber
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Andrea Roccuzzo
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
- Department of Oral and Maxillofacial Surgery, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - Giovanni E Salvi
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
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Salvi GE, Roccuzzo A, Imber JC, Stähli A, Klinge B, Lang NP. Clinical periodontal diagnosis. Periodontol 2000 2023. [PMID: 37452444 DOI: 10.1111/prd.12487] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 02/16/2023] [Accepted: 03/14/2023] [Indexed: 07/18/2023]
Abstract
Periodontal diseases include pathological conditions elicited by the presence of bacterial biofilms leading to a host response. In the diagnostic process, clinical signs such as bleeding on probing, development of periodontal pockets and gingival recessions, furcation involvement and presence of radiographic bone loss should be assessed prior to periodontal therapy, following active therapy, and during long-term supportive care. In addition, patient-reported outcomes such as increased tooth mobility, migration, and tilting should also be considered. More important to the patient, however, is the fact that assessment of signs of periodontal diseases must be followed by an appropriate treatment plan. Furthermore, it should be realized that clinical and radiographic periodontal diagnosis is based on signs which may not reflect the presence of active disease but rather represent the sequelae of a previous bacterial challenge. Hence, the aim of the present review is to provide a summary of clinical and radiographic diagnostic criteria required to classify patients with periodontal health or disease.
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Affiliation(s)
- Giovanni E Salvi
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Andrea Roccuzzo
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Jean-Claude Imber
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Alexandra Stähli
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Björn Klinge
- Department of Periodontology, Faculty of Odontology, Malmö University, Malmö, Sweden
- Division of Oral Diseases, Department of Dental Medicine, Karolinska Institute, Stockholm, Sweden
| | - Niklaus P Lang
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
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Cosgarea R, Roccuzzo A, Jepsen K, Sculean A, Jepsen S, Salvi GE. Efficacy of mechanical/physical approaches for implant surface decontamination in non-surgical submarginal instrumentation of peri-implantitis. A systematic review. J Clin Periodontol 2023; 50 Suppl 26:188-211. [PMID: 36550060 DOI: 10.1111/jcpe.13762] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 11/02/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022]
Abstract
AIM To evaluate the efficacy of non-surgical submarginal peri-implant instrumentation with mechanical/physical decontamination compared to non-surgical submarginal instrumentation alone or with placebo decontamination in patients with peri-implantitis. MATERIALS AND METHODS Three focused questions were addressed, and a systematic search for randomized controlled clinical trials (RCTs), controlled clinical trials, and prospective cohort studies with definitions of peri-implantitis and a minimal follow-up of 6 months was conducted. The main outcome variables were reduction in pocket probing depth (PD) and bleeding on probing (BOP). Suppuration on probing, marginal peri-implant bone level changes, patient-related outcomes and adverse events, implant survival, treatment success, and disease resolution were assessed as secondary outcomes. RESULTS Out of 239 findings, full-text articles were assessed for eligibility, and 9 (n = 9 RCTs) were included in the present review. Five studies evaluated the effects of various laser types, and in four studies efficacy of air-abrasive mechanisms and of a novel ultrasonic device was determined. At 6 months, PD reductions were observed in nine studies but only Er, Cr:YSGG laser-treated group showed statistically significant higher reductions compared to the control group. BOP was statistically significantly reduced at 6 months in two studies following the application of Er:YAG laser compared to controls. One study reported statistically significant reduction in BOP following application of air-polishing device compared to control treatment. No statistically significant differences between treatment groups were reported for the secondary outcome variables. Owing to the large heterogeneity of study designs, no meta-analysis was performed. CONCLUSIONS Available evidence on the efficacy of non-surgical submarginal peri-implant instrumentation with mechanical/physical decontamination is limited by the small number of controlled studies and the high heterogeneity of study protocols. Clinical and patient-reported benefits remain to be demonstrated.
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Affiliation(s)
- Raluca Cosgarea
- Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, Bonn, Germany
- Department of Periodontology and Peri-implant Diseases, University of Marburg, Marburg, Germany
- School of Dental Medicine, University Iuliu-Hatieganu, Cluj-Napoca, Romania
| | - Andrea Roccuzzo
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Karin Jepsen
- Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, Bonn, Germany
| | - Anton Sculean
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Søren Jepsen
- Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, Bonn, Germany
| | - Giovanni E Salvi
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
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Roccuzzo A, Fanti R, Mancini L, Imber JC, Stähli A, Molinero-Mourelle P, Schimmel M, Sculean A, Salvi GE. Implant-supported fixed dental prostheses with cantilever extensions: State of the art and future perspectives. Int J Oral Implantol (Berl) 2023; 16:13-28. [PMID: 36861678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
Partial fixed dental prostheses supported by dental implants have become a reliable long-term treatment option. Nevertheless, the replacement of two adjacent missing teeth, irrespective of location, still represents a clinical challenge. To overcome this, the use of fixed dental prostheses with cantilever extensions has gained popularity with a view to limiting morbidity, reducing costs and avoiding major surgical interventions prior to implant placement. The present review summarises the level of evidence for the use of fixed dental prostheses with cantilever extensions both in the posterior and anterior regions and indicates the advantages and disadvantages of each treatment, focusing on available medium- to long-term outcomes.
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10
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Iorio-Siciliano V, Blasi A, Isola G, Sculean A, Salvi GE, Ramaglia L. Resolution of peri-implant mucositis at tissue- and bone-level implants: A 6-month prospective controlled clinical trial. Clin Oral Implants Res 2023; 34:450-462. [PMID: 36807939 DOI: 10.1111/clr.14051] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 02/06/2023] [Accepted: 02/12/2023] [Indexed: 02/23/2023]
Abstract
OBJECTIVE The objective of the study was to compare resolution of inflammation of naturally occurring peri-implant mucositis (PM) at tissue-level (TL) and bone-level (BL) implants after non-surgical mechanical debridement. MATERIALS AND METHODS Fifty-four patients with 74 Implants with PM were allocated in two groups (39 TL and 35 BL implants) and treated by means of subgingival debridement using a sonic scaler with a plastic tip without adjunctive measures. At baseline and at 1, 3, 6 months, the full-mouth plaque score (FMPS), full-mouth bleeding score (FMBS), probing depth (PD), bleeding on probing (BOP), and modified plaque index (mPlI) were recorded. The primary outcome was BOP change. RESULTS After 6 months, the FMPS, FMBS, PD, and number of implants with plaque decreased statistically significantly in each group (p < .05); however, no statistically significant differences were found between TL and BL implants (p > .05). After 6 months, 17 (43.6%) TL and 14 (40%) BL implants showed a BOP change in (17.9%) and (11.4%), respectively. No statistical difference was recorded between groups. CONCLUSIONS Within the limitations of present study, the findings showed no statistically significant differences in terms of changes in clinical parameters following non-surgical mechanical treatment of PM at TL and BL implants. A complete resolution of PM (i.e., no BOP at all implant sites) was not achieved in both groups.
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Affiliation(s)
| | - Andrea Blasi
- Department of Periodontology, University of Naples Federico II, Naples, Italy
| | - Gaetano Isola
- Department of General Surgery and Medical-Surgical Specialties, Unit of Periodontology, University of Catania, Catania, Italy
| | - Anton Sculean
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Giovanni E Salvi
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Luca Ramaglia
- Department of Periodontology, University of Naples Federico II, Naples, Italy
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Salvi GE, Stähli A, Imber JC, Sculean A, Roccuzzo A. Physiopathology of peri-implant diseases. Clin Implant Dent Relat Res 2022. [PMID: 36515007 DOI: 10.1111/cid.13167] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 11/29/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Peri-implant health is characterized by the absence of clinical signs of soft tissue inflammation. Peri-implant diseases are initiated by the presence of bacterial biofilms and share a similar etiology as that involved in the onset of periodontal diseases. PURPOSE To summarize available evidence on the physiopathology of peri-implant diseases with emphasis on similarities and differences with periodontal diseases. MATERIALS AND METHODS Evidence on the biologic mechanisms involved in the pathogenesis of peri-implant mucositis and peri-implantitis were explored in the recent scientific literature. RESULTS Findings of studies in animals and in humans indicate that experimental peri-implant mucositis leads to a larger inflammatory connective tissue infiltrate and to a higher frequency of bleeding sites around implants compared with teeth. Tissue destruction at experimental peri-implantitis sites is more pronounced compared with that at experimental periodontitis sites. Although human periodontitis and peri-implantitis lesions share similarities with respect to etiology and clinical features, they represent distinct entities from a physiopathologic point of view. CONCLUSIONS Diagnosis of peri-implant health requires a clinical examination to confirm absence of peri-implant soft tissue inflammation. In order to make a correct diagnosis and select the appropriate therapeutic steps to manage peri-implant diseases, knowledge of their pathogenetic mechanisms is required.
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Affiliation(s)
- Giovanni E Salvi
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Alexandra Stähli
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Jean-Claude Imber
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Anton Sculean
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Andrea Roccuzzo
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
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Roccuzzo A, Imber J, Marruganti C, Salvi GE, Ramieri G, Roccuzzo M. Clinical outcomes of dental implants in patients with and without history of periodontitis: A 20-year prospective study. J Clin Periodontol 2022; 49:1346-1356. [PMID: 36054302 PMCID: PMC9804375 DOI: 10.1111/jcpe.13716] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 07/26/2022] [Accepted: 08/07/2022] [Indexed: 01/05/2023]
Abstract
AIM To present the 20-year clinical outcomes of tissue-level implants in partially edentulous patients previously treated for periodontitis and in periodontally healthy patients (PHP). MATERIAL AND METHODS The original population consisted of 149 partially edentulous patients consecutively enrolled in a private specialist practice and divided into three groups: PHP, moderately periodontally compromised patients (mPCP) and severely PCP (sPCP). After successful completion of periodontal/implant therapy, patients were enrolled in an individualized supportive periodontal care (SPC) programme. RESULTS Eighty-four patients rehabilitated with 172 implants reached the 20-year examination. During the observation time, 12 implants were removed (i.e., 11 due to biological complications and 1 due to implant fracture), leading to an overall implant survival rate of 93% (i.e., 94.9% for PHP, 91.8% for mPCP and 93.1% for sPCP [p = .29]). At 20 years, PCP compliant with SPC did not present with significantly higher odds of implant loss compared with PHP compliant with SPC (p > .05). Conversely, PCP not compliant with SPC experienced implant loss with odds ratio of 14.59 (1.30-164.29, p = .03). CONCLUSIONS Tissue-level implants, placed after comprehensive periodontal therapy and SPC, yield favourable long-term results. However, patients with a history of periodontitis and non-compliant with SPC are at higher risk of biological complications and implant loss.
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Affiliation(s)
- Andrea Roccuzzo
- Department of PeriodontologySchool of Dental Medicine, University of BernBernSwitzerland,Department of Oral and Maxillofacial SurgeryCopenhagen University Hospital (Rigshospitalet)CopenhagenDenmark,Department of Restorative, Pediatric and Preventive DentistrySchool of Dental Medicine, University of BernBernSwitzerland
| | - Jean‐Claude Imber
- Department of PeriodontologySchool of Dental Medicine, University of BernBernSwitzerland
| | - Crystal Marruganti
- Department of Surgical, Medical and Molecular Pathology and Critical Care MedicineUniversity of PisaPisaItaly,Sub‐Unit of Periodontology, Halitosis and Periodontal MedicineUniversity Hospital of PisaPisaItaly,Unit of Periodontology, Endodontology and Restorative Dentistry, Department of Medical BiotechnologiesUniversity of SienaSienaItaly
| | - Giovanni E. Salvi
- Department of PeriodontologySchool of Dental Medicine, University of BernBernSwitzerland
| | | | - Mario Roccuzzo
- Division of Maxillofacial SurgeryUniversity of TorinoTorinoItaly,Department of Periodontics and Oral MedicineUniversity of MichiganAnn ArborMichiganUSA,Private PracticeTorinoItaly
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13
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Roccuzzo A, Klossner S, Stähli A, Imber JC, Eick S, Sculean A, Salvi GE. Non-surgical mechanical therapy of peri-implantitis with or without repeated adjunctive diode laser application. A 6-month double-blinded randomized clinical trial. Clin Oral Implants Res 2022; 33:900-912. [PMID: 35775311 PMCID: PMC9546299 DOI: 10.1111/clr.13969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 06/14/2022] [Accepted: 06/24/2022] [Indexed: 11/27/2022]
Abstract
Objectives The objective of this study is to investigate the outcomes following non‐surgical therapy of peri‐implantitis (PI) with or without adjunctive diode laser application. Materials and methods A double‐blinded randomized controlled clinical trial was carried out in 25 subjects with 25 implants diagnosed with PI. Following curettage of granulation tissue, test implants (T) were treated with adjunctive application of a diode laser for 90 s (settings: 810 nm, 2.5 W, 50 Hz, 10 ms), while at control implants (C) non‐activated adjunctive diode laser was applied. The entire treatment procedure was performed at days 0 (i.e., baseline), 7 and 14. The primary outcome measure was change in mean pocket probing depth (PPD). Clinical and microbiological outcomes, as well as host‐derived inflammatory markers were evaluated at baseline, 3 and 6 months, while radiographic outcomes were assessed at baseline and at the 6‐month follow‐up. Results No statistically significant differences with respect to baseline patient characteristic were observed. After 6 months, both test and control implants yielded statistically significant PPD changes compared with baseline (T: 1.28 and C: 1.47 mm) but without statistically significant difference between groups (p = .381). No statistically significant changes in peri‐implant marginal bone levels were detected (p = .936). No statistically significant differences between test and control implants were observed with respect to microbiological and host‐derived parameters (p > .05). At the 6‐month follow‐up, treatment success was observed in 41.7% (n = 5) of test and 46.2% (n = 6) of control patients, respectively (p = .821). Conclusion Repeated adjunctive application of diode laser in the non‐surgical management of PI failed to provide significant benefits compared with mechanical instrumentation alone.
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Affiliation(s)
- Andrea Roccuzzo
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Sabrina Klossner
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Alexandra Stähli
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Jean-Claude Imber
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Sigrun Eick
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Anton Sculean
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Giovanni E Salvi
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
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14
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Duong HY, Roccuzzo A, Stähli A, Salvi GE, Lang NP, Sculean A. Oral health-related quality of life of patients rehabilitated with fixed and removable implant-supported dental prostheses. Periodontol 2000 2022; 88:201-237. [PMID: 35103325 PMCID: PMC9304161 DOI: 10.1111/prd.12419] [Citation(s) in RCA: 61] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Dental implants have become a mainstream treatment approach in daily practice, and because of their high survival rates over time, they have become the preferred treatment option for prosthetic rehabilitation in many situations. Despite the relatively high predictability of implant therapy and high costs to patients, patient perceptions of success and patient-reported outcome measures have become increasingly significant in implant dentistry. Increasing numbers of publications deal with oral health-related quality of life and/or patient-reported outcome measures. The aim of this paper was to provide an overview of the available evidence on oral health-related quality of life of fully and partially dentate patients rehabilitated with fixed and removable implant-supported dental prostheses. A comprehensive electronic search was performed on publications in English up to 2021. A selection of standardized questionnaires and scales used for the evaluation of oral health-related quality of life were analyzed and explained. The analysis encompassed three aspects: a functional evaluation of oral health-related quality of life, an esthetic assessment of oral health-related quality of life, and a cost-related evaluation of oral health-related quality of life for rehabilitation with dental implants. The data demonstrated that the preoperative expectations of patients markedly affected the outcomes perceived by the patients. As expected, reconstructions supported by implants substantially improved the stability of conventional dentures and allowed improved function and patient satisfaction. However, from a patient's perspective, oral health-related quality of life was not significantly greater for dental implants compared with conventional tooth-supported prostheses. The connection of the implants to the prostheses with locators or balls indicated high oral health-related quality of life. The data also suggest that patient expectation is not a good predictor of treatment outcome. In terms of esthetic outcomes, the data clearly indicate that patients' perceptions and clinicians' assessments differed, with those of clinicians yielding higher standards. There were no significant differences found between the esthetic oral health-related quality of life ratings for soft tissue-level implants compared with those for bone-level implants. Comparison of all-ceramic and metal-ceramic restorations showed no significant differences in patients' perceptions in terms of esthetic outcomes. Depending on the choice of outcome measure and financial marginal value, supporting a conventional removable partial denture with implants is cost-effective when the patient is willing to invest more to achieve a higher oral health-related quality of life. In conclusion, the oral health-related quality of life of patients rehabilitated with implant-supported dental prostheses did not show overall superiority over conventional prosthetics. Clinicians' and patients' evaluations, especially of esthetic outcomes, are, in the majority of cases, incongruent. Nevertheless, patient-reported outcomes are important in the evaluation of function, esthetics, and the cost-effectiveness of treatment with implant-supported dental prostheses, and should be taken into consideration in daily practice.
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Affiliation(s)
- Ho-Yan Duong
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Andrea Roccuzzo
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Alexandra Stähli
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Giovanni E Salvi
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Niklaus P Lang
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Anton Sculean
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
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15
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Kloukos D, Roccuzzo A, Stähli A, Sculean A, Katsaros C, Salvi GE. Effect of combined periodontal and orthodontic treatment of tilted molars and of teeth with intra-bony and furcation defects in stage-IV periodontitis patients: A systematic review. J Clin Periodontol 2021; 49 Suppl 24:121-148. [PMID: 34761413 DOI: 10.1111/jcpe.13509] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 04/26/2021] [Accepted: 05/25/2021] [Indexed: 01/01/2023]
Abstract
AIM To assess the effect of combined periodontal and orthodontic treatment (OT) in stage-IV periodontitis patients. MATERIALS AND METHODS Three focused questions were addressed using the Population, Intervention, Comparison, Outcome, and Study Design criteria. Randomized controlled trials (RCTs), controlled clinical trials, follow-up studies, case series, and controlled/uncontrolled before/after studies were assessed for inclusion. Primary outcomes included mean changes in pocket probing depth (PPD) and clinical attachment level (CAL). Qualitative synthesis of results was performed and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS Out of 916 records, 1 retrospective case series study reported the effect of OT of tilted molars, 2 RCTs and 10 prospective and 2 retrospective case series studies reported the effect of OT of treated intra-bony defects and 0 articles reported the effect of OT of treated furcation defects. Mean PPD changes were reported in 14 articles, and mean CAL changes were reported in 8 articles. Risk of bias was high in both included RCTs, critical in nine articles, and serious in four articles. No articles included patient-reported outcomes, and three articles reported harms/adverse effects. CONCLUSIONS Evidence is limited by (i) the lack or low number of included studies, (ii) the apparent methodological and clinical heterogeneity, and (iii) the high risk of bias of the retrieved studies. No solid conclusions could be drawn concerning OT in stage-IV periodontitis patients with respect to tilted molars, teeth with treated intra-bony defects, and teeth with treated furcation defects.
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Affiliation(s)
- Dimitrios Kloukos
- Department of Orthodontics and Dentofacial Orthopedics, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Andrea Roccuzzo
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Alexandra Stähli
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Anton Sculean
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Christos Katsaros
- Department of Orthodontics and Dentofacial Orthopedics, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Giovanni E Salvi
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
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16
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Monje A, Amerio E, Farina R, Nart J, Ramanauskaite A, Renvert S, Roccuzzo A, Salvi GE, Schwarz F, Trombelli L, Wang HL. Significance of probing for monitoring peri-implant diseases. Int J Oral Implantol (Berl) 2021; 14:385-399. [PMID: 34726848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Peri-implant diseases at implant sites represent the most considerable concern for many dental clinicians nowadays due to their detrimental effect on implant longevity. Preventive measures include patient education and motivation, supportive peri-implant therapy and routine assessment of the hard and soft tissues. Nevertheless, the reliability of clinical parameters to monitor peri-implant conditions is subject to debate. As such, the primary purpose of the present review was to gain further insight into the diagnostic accuracy of probing as a clinical tool to monitor dental implants and assist clinicians in preventing peri-implant diseases. Studies have recommended periodic probing to monitor the condition of the peri-implant tissues. Increased probing pocket depth, profuse bleeding on probing and suppuration at implants are clinical signs that have been associated with peri-implantitis; thus, if these clinical parameters are present, radiographic assessment is encouraged to make a definitive diagnosis considering potential inaccuracies related to local and/or systemic factors identified in the present review.
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17
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Iorio-Siciliano V, Ramaglia L, Isola G, Blasi A, Salvi GE, Sculean A. Changes in clinical parameters following adjunctive local sodium hypochlorite gel in minimally invasive nonsurgical therapy (MINST) of periodontal pockets: a 6-month randomized controlled clinical trial. Clin Oral Investig 2021; 25:5331-5340. [PMID: 33687555 PMCID: PMC8370947 DOI: 10.1007/s00784-021-03841-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 02/16/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND The mechanical disruption and removal of the subgingival biofilm represent the most important step in the treatment of periodontitis. However, in deep periodontal pockets, mechanical removal of the subgingival biofilm is difficult and frequently incomplete. Preliminary findings indicate that the use of amino acid buffered sodium hypochlorite (NaOCl) gel may chemically destroy the bacterial biofilm and facilitate its mechanical removal. OBJECTIVES To clinically evaluate the efficacy of minimally invasive nonsurgical therapy (MINST) of periodontal pockets with or without local application of an amino acid buffered sodium hypochlorite (NaOCl) gel. MATERIALS AND METHODS Forty untreated patients diagnosed with severe/advanced periodontitis (i.e. stage III/IV) with a slow/moderate rate of progression (i.e. grade A/B) were randomly allocated in two treatment groups. In the test group, the periodontal pockets were treated by means of MINST and NaOCl gel application, while in the control group, treatment consisted of MINST alone. Full-mouth plaque scores (FMPS), full-mouth bleeding scores (FMBS), probing depths (PD), clinical attachment levels (CAL) and gingival recessions (GR) were assessed at baseline and at 6 months following therapy. The primary outcome variable was PD reduction at sites with PD ≥ 5 mm at baseline. RESULTS At 6 months, statistically significant differences between the two groups were found (p = 0.001) in terms of PD and CAL change. No statistically significant differences were found in terms of GR (p = 0.81). The number of sites with PD ≥ 5 mm and BOP (+) decreased statistically significantly (p = 0.001), i.e. from 85.3 to 2.2% in the test group and from 81.6 to 7.3% in the control group, respectively. Statistically significant differences between test and control groups were recorded at 6 months (p = 0.001). MINST + NaOCl compared to MINST alone decreased statistically significantly (p = 0.001) the probability of residual PDs ≥ 5 mm with BOP- (14.5% vs 18.3%) and BOP+ (2.2% vs. 7.2%). CONCLUSIONS Within their limits, the present results indicate that (a) the use of MINST may represent a clinically valuable approach for nonsurgical therapy and (b) the application of NaOCl gel in conjunction with MINST may additionally improve the clinical outcomes compared to the use of MINST alone. CLINICAL RELEVANCE In patients with untreated periodontitis, treatment of deep pockets by means of MINST in conjunction with a NaOCl gel may represent a valuable approach to additionally improve the clinical outcomes obtained with MINST alone.
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Affiliation(s)
- Vincenzo Iorio-Siciliano
- Department of Periodontology, School of Dental Medicine, University of Naples Federico II, Via S. Pansini 5, 80131, Naples, Italy.
| | - Luca Ramaglia
- Department of Periodontology, School of Dental Medicine, University of Naples Federico II, Via S. Pansini 5, 80131, Naples, Italy
| | - Gaetano Isola
- Department of Biomedical, Odontostomatological Sciences and of Morphological and Functional Immages, School of Dentistry, University of Messina, AOU Policlinico "G.Martino", Via C.Valeria 1, 98125, Messina, Italy
- Department of General Surgery and Surgical-Medical Specialities, School of Dentistry University of Catania, Via Sofia 78, 95125, Catania, Italy
| | - Andrea Blasi
- Department of Periodontology, School of Dental Medicine, University of Naples Federico II, Via S. Pansini 5, 80131, Naples, Italy
| | - Giovanni E Salvi
- Department of Periodontology, School of Dental Medicine, University of Bern, Freiburgstrasse 7, CH-3010, Bern, Switzerland
| | - Anton Sculean
- Department of Periodontology, School of Dental Medicine, University of Bern, Freiburgstrasse 7, CH-3010, Bern, Switzerland
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18
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De Ry SP, Roccuzzo A, Lang NP, Heitz-Mayfield LJ, Ramseier CA, Sculean A, Salvi GE. Evaluation of the implant disease risk assessment (IDRA) tool: A retrospective study in patients with treated periodontitis and implant-supported fixed dental prostheses (FDPs). Clin Oral Implants Res 2021; 32:1299-1307. [PMID: 34388276 PMCID: PMC9290928 DOI: 10.1111/clr.13828] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 05/26/2021] [Accepted: 07/08/2021] [Indexed: 01/06/2023]
Abstract
Aim To evaluate the Implant Disease Risk Assessment (IDRA) tool for the prediction of peri‐implantitis in treated periodontitis patients with implant‐supported fixed dental prostheses (FDPs) after at least 5 years of function. Material and methods From the patient pool of implant patients enrolled in a regular supportive periodontal therapy programme (SPT) for at least 5 years, 239 patients were screened. Eighty patients met the inclusion criteria and underwent evaluation through the criteria of the IDRA tool. Areas under the curve (AUCs) for receiver operating characteristic (ROC) curves including 95% confidence intervals were estimated. Results Seventy‐nine patients (43 males and 36 females, 8 smokers), aged on average 59.0 years (range: 40–79 years) at baseline (i.e. FDP delivery) were analysed. The calculated IDRA‐risk was in 34 patients (42.5%) a moderate risk, while 45 patients (56.3%) were considered at high IDRA‐risk. One patient categorized at low IDRA‐risk was excluded from the analysis. The AUC was 0.613 (95% CI: 0.464–0.762) if the IDRA‐risk was associated with prevalence of peri‐implantitis at the most recent follow‐up. Peri‐implantitis was diagnosed in 4 patients (12%) at moderate and in 12 patients (27%) at high IDRA‐risk, respectively. The calculated odds ratio for developing peri‐implantitis in patients with high IDRA‐risk compared with patients with moderate IDRA‐risk was 2.727 with no statistically significant difference between the two groups (95% CI: 0.793–9.376). Conclusion Within the limitations of the present retrospective study, the IDRA algorithm might represent a promising tool to assess patients at moderate or high risk of developing peri‐implantitis.
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Affiliation(s)
- Siro P De Ry
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Andrea Roccuzzo
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland.,Department of Oral and Maxillofacial Surgery, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - Niklaus P Lang
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Lisa J Heitz-Mayfield
- International Research Collaborative, Faculty of Science, The University of Western Australia, Perth, West Perth, Australia
| | - Christoph A Ramseier
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Anton Sculean
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Giovanni E Salvi
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
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De Ry SP, Roccuzzo A, Lang NP, Sculean A, Salvi GE. Long-term clinical outcomes of periodontal regeneration with Enamel Matrix Derivative (EMD): a retrospective cohort study with a mean follow-up of 10 years. J Periodontol 2021; 93:548-559. [PMID: 34258767 PMCID: PMC9373923 DOI: 10.1002/jper.21-0347] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/10/2021] [Accepted: 07/10/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND Despite the large body of evidence on the efficacy of Enamel Matrix Derivative (EMD) in the treatment of periodontal intrabony defects, few studies reported long-term data (≥ 10-year). METHODS Periodontal patients treated with regenerative surgery with EMD between 1999 and 2012 were invited to participate in a clinical examination. The following clinical parameters were recorded and compared at baseline (T0), 6 months after surgery (T1) and after at least 8 years of follow-up (T2): probing depth (PD), gingival recession (GR), clinical attachment level (CAL), plaque and bleeding scores. The primary outcome variable was CAL change. RESULTS Forty-one patients with 75 treated teeth were available for analysis. Out of these, 68 (tooth survival rate: 90.7%) reached the latest follow-up with a mean observation period of 10.3 years (range: 8.0-21.3). The most frequent reason for tooth loss was recurrence of periodontal disease. Tooth survival curves showed a statistically significant difference between smokers and non-smokers (p = 0.028). Mean CAL changed from 8.43 ± 1.86 (T0) to 6.47 ± 1.70 (T1) (p<0.001) and to 5.91 ± 1.83 (T2) (p<0.001). At T1, a CAL gain of ≥3 mm was measured in 35% of the defects while at T2 it was detected in 51% of cases. CONCLUSIONS Within their limitations, the present results have shown that in intrabony defects, the clinical improvements obtained following regenerative surgery with EMD can be maintained on a mean period of 10 years. Smoking status and maxillary molars were correlated with an increased risk for tooth and CAL loss, respectively. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Siro P De Ry
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Andrea Roccuzzo
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Niklaus P Lang
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Anton Sculean
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Giovanni E Salvi
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
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20
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Salvi GE, Stähli A, Schmidt JC, Ramseier CA, Sculean A, Walter C. Adjunctive laser or antimicrobial photodynamic therapy to non-surgical mechanical instrumentation in patients with untreated periodontitis: A systematic review and meta-analysis. J Clin Periodontol 2021; 47 Suppl 22:176-198. [PMID: 31859395 DOI: 10.1111/jcpe.13236] [Citation(s) in RCA: 71] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 12/07/2019] [Accepted: 12/14/2019] [Indexed: 12/13/2022]
Abstract
AIM To compare the adjunctive effects of lasers or antimicrobial photodynamic therapy (aPDT) to non-surgical mechanical instrumentation alone in untreated periodontitis patients. MATERIALS AND METHODS Two focused questions were addressed using the Population, Intervention, Comparison and Outcome criteria as follows: in patients with untreated periodontitis, (a) does laser application provide adjunctive effects on probing pocket depth (PPD) changes compared with non-surgical instrumentation alone? and (b) does application of aPDT provide adjunctive effects on PPD changes compared with non-surgical instrumentation alone? Both randomized controlled clinical trials (RCTs) and controlled clinical trials (CCTs) were included. Results of the meta-analysis are expressed as weighted mean differences (WMD) and reported according to the PRISMA guidelines. RESULTS Out of 1,202 records, 10 articles for adjunctive laser and 8 for adjunctive aPDT were included. With respect to PPD changes, 1 meta-analysis including 2 articles (total n = 42; split-mouth design) failed to identify a statistically significant difference (WMD = 0.35 mm; 95%CI: -0.04/0.73; p = .08) in favour of adjunctive aPDT (wavelength range 650-700 nm). In terms of adjunctive laser application, a high variability of clinical outcomes at 6 months was noted. Two articles included patient-reported outcomes and 10 reported on the presence/absence of harms/adverse effects. CONCLUSIONS Available evidence on adjunctive therapy with lasers and aPDT is limited by (a) the low number of controlled studies and (b) the heterogeneity of study designs. Patient-reported benefits remain to be demonstrated.
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Affiliation(s)
- Giovanni E Salvi
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Alexandra Stähli
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Julia C Schmidt
- Department of Periodontology, Endodontology and Cariology, University Center for Dental Medicine (UZB), University of Basel, Basel, Switzerland
| | - Christoph A Ramseier
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Anton Sculean
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Clemens Walter
- Department of Periodontology, Endodontology and Cariology, University Center for Dental Medicine (UZB), University of Basel, Basel, Switzerland
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21
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Salvi GE, Stähli A, Schmidt JC, Ramseier CA, Sculean A, Walter C. Reply letter to the editor. J Clin Periodontol 2021; 48:553-554. [PMID: 33527412 DOI: 10.1111/jcpe.13431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 01/05/2021] [Accepted: 01/15/2021] [Indexed: 02/03/2023]
Affiliation(s)
- Giovanni E Salvi
- School of Dental Medicine, Department of Periodontology, University of Bern, Bern, Switzerland
| | - Alexandra Stähli
- School of Dental Medicine, Department of Periodontology, University of Bern, Bern, Switzerland
| | - Julia C Schmidt
- Department of Periodontology, Endodontology and Cariology, University of Basel, University Center for Dental Medicine (UZB), Basel, Switzerland
| | - Christoph A Ramseier
- School of Dental Medicine, Department of Periodontology, University of Bern, Bern, Switzerland
| | - Anton Sculean
- School of Dental Medicine, Department of Periodontology, University of Bern, Bern, Switzerland
| | - Clemens Walter
- Department of Periodontology, Endodontology and Cariology, University of Basel, University Center for Dental Medicine (UZB), Basel, Switzerland
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22
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Schmid E, Roccuzzo A, Morandini M, Ramseier CA, Sculean A, Salvi GE. Clinical and radiographic evaluation of implant-supported single-unit crowns with cantilever extension in posterior areas: A retrospective study with a follow-up of at least 10 years. Clin Implant Dent Relat Res 2021; 23:189-196. [PMID: 33448601 DOI: 10.1111/cid.12973] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 11/16/2020] [Accepted: 12/17/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Implant-supported restorations with cantilever extension may display high rates of biological and technical complications. PURPOSE To report the outcomes of single-unit crowns with cantilever extension (SCCs). MATERIALS AND METHODS Patients with SCCs were reevaluated after ≥10 years of loading. Radiographic marginal bone levels (mBLs) at baseline (ie, delivery of SCCs) and follow-up were calculated and compared between implant surfaces adjacent to and distant from the cantilever extension. Implant survival and success rates were calculated. RESULTS Twenty-one patients with 25 SCs supported by 25 implants were reevaluated after a mean of 13.6 ± 3.8 years (range: 10-19 years). No implants were lost. The mean overall mBLs changed from 0.99 mm ± 0.95 at baseline to 0.95 mm ± 0.99 at follow-up (p = 0.853). The mean pocket probing depths changed from 3.39 mm ± 0.62 at baseline to 3.34 mm ± 0.54 at follow-up (p = 0.635). Loss of retention occurred 3× in 2 patients (14.3%). At follow-up, peri-implant health was diagnosed in 10 (48%) and peri-implant mucositis in 11 (52%) patients, respectively. CONCLUSIONS Within the limitations of the present study, the use of implant-supported SCs with cantilever extension in posterior areas represents a reliable long-term treatment option with a 100% implant survival rate and minimal marginal bone level changes.
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Affiliation(s)
- Eric Schmid
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Andrea Roccuzzo
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland.,Department of Oral and Maxillofacial Surgery, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - Michele Morandini
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Christoph A Ramseier
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Anton Sculean
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Giovanni E Salvi
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
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Schmid E, Eick S, Sculean A, Salvi GE. Peri-Implant Diseases: Characteristics of the Microbiota and of the Host Response in Humans - A Narrative Review. Monogr Oral Sci 2021; 29:98-104. [PMID: 33427228 DOI: 10.1159/000510186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 07/10/2020] [Indexed: 11/19/2022]
Abstract
The present narrative review provides a summary of the temporal and spatial reactions of the oral microbiome to the placement of a dental implant into the oral cavity, depicting the most important interactions between the oral microbiota and the host response involved in the development of peri-implant infections in humans (i.e., peri-implant mucositis and peri-implantitis). Starting with the formation of a pellicle to acute and rampant peri-implant inflammation, a number of steps, including biofilm formation, aggressive bacterial invasion, and host defense mechanisms, are involved. Better understanding of the factors related to the host response and changes in the composition of microbiota has led to the development of novel treatment modalities. Finally, a short outlook into the future is provided.
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Affiliation(s)
- Eric Schmid
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland,
| | - Sigrun Eick
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Anton Sculean
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Giovanni E Salvi
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
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24
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A Ramseier C, Petitat C, Trepp S, Lang NP, Eick S, Adam R, Ccahuana-Vasquez RA, Barker ML, Timm H, Klukowska M, Salvi GE. Clinical Parameters and Oral Fluid Biomarkers in Gingivitis Subjects using an Electric Toothbrush with Irrigator vs a Manual Toothbrush Alone over 8 Weeks: A Randomised Controlled Clinical Trial. Oral Health Prev Dent 2021; 19:137-147. [PMID: 33615769 DOI: 10.3290/j.ohpd.b966767] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PURPOSE To compare clinical outcomes and oral fluid biomarkers in gingivitis subjects using an electric toothbrush/irrigator combination (test) or a manual toothbrush alone (control) over 8 weeks. MATERIALS AND METHODS Subjects were randomly assigned to two groups of n = 30. In both groups, toothbrushing was performed twice daily at home and no additional interdental cleaning aids were allowed. Plaque Index (PLI), Gingival Index (GI), whole saliva (WS), and gingival crevicular fluid (GCF) samples were collected at weeks 2, 4, and 8. RESULTS Subjects' mean age was 23 years and 52% were female. Overall baseline means were 1.31 for PLI, 1.07 for GI, and 34.9 for number of bleeding sites. At every follow-up visit, both groups differed statistically significantly (p < 0.001) from baseline for all clinical parameters. The test group demonstrated statistically significantly (p < 0.001) greater reductions in GI vs the control group by 18% at week 2, 17% at week 4 and 24% at week 8. The test group also demonstrated statistically significantly (p < 0.002) greater reductions in the number of bleeding sites vs the control group by 33% at week 2, 34% at week 4 and 43% at week 8. Between-group comparisons for both WS and GCF revealed numerical trends for decreased levels of interleukin (IL)-1β in GCF after 4 and 8 weeks, but these were not statistically significant. CONCLUSION In subjects using the electric toothbrush/irrigator combination, increased clinical improvements may be found accompanied by similarly improved trends for oral fluid biomarkers such as IL-1β.
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Lin Z, Strauss FJ, Lang NP, Sculean A, Salvi GE, Stähli A. Efficacy of laser monotherapy or non-surgical mechanical instrumentation in the management of untreated periodontitis patients. A systematic review and meta-analysis. Clin Oral Investig 2020; 25:375-391. [PMID: 33170372 PMCID: PMC7819921 DOI: 10.1007/s00784-020-03584-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 09/11/2020] [Indexed: 01/16/2023]
Abstract
Objective To evaluate and compare the effects of laser monotherapy with non-surgical mechanical instrumentation alone in untreated periodontitis patients. Materials and methods A focused question was formulated based on the Population, Intervention, Comparison, Outcome, and Study design criteria (PICOS): in patients with untreated periodontitis, does laser mono-therapy provide adjunctive effects on pocket probing depth (PPD) changes compared with non-surgical instrumentation alone? Both randomized controlled clinical trials (RCTs) and controlled clinical trials (CCTs) were included. The results of the meta-analyses are expressed as weighted mean differences (WMD) and reported according to the PRISMA guidelines. Results The search yielded 1268 records, out of which 8 articles could be included. With respect to PPD changes, a meta-analysis including 5 articles (n = 148) failed to identify statistically significant differences in favor of laser monotherapy for PPD change (WMD = 0.14 mm; 95% CI: − 0.04/0.32; z = 1.51; p = 0.132) nor for clinical attachment level (CAL) (WMD = 0.04 mm; 95% CI: − 0.35/0.42; z = 0.19; p = 0.850). Data on cost-effectiveness are lacking. One study reported patient-related outcome measures (PROMS). Conclusions In untreated periodontitis patients, laser monotherapy does not yield superior clinical benefits compared with non-surgical mechanical instrumentation alone. Clinical relevance In untreated periodontitis patients, mechanical instrumentation with hand and/or ultrasonic instruments remains the standard of care.
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Affiliation(s)
- Zhikai Lin
- Department of Periodontology, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland.,Department of Periodontology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Franz J Strauss
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland.,Department of Conservative Dentistry Faculty of Dentistry , University of Chile , Santiago, Chile
| | - Niklaus P Lang
- Department of Periodontology, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland
| | - Anton Sculean
- Department of Periodontology, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland
| | - Giovanni E Salvi
- Department of Periodontology, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland
| | - Alexandra Stähli
- Department of Periodontology, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland.
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26
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Schmid E, Morandini M, Roccuzzo A, Ramseier CA, Sculean A, Salvi GE. Clinical and radiographic outcomes of implant‐supported fixed dental prostheses with cantilever extension. A retrospective cohort study with a follow‐up of at least 10 years. Clin Oral Implants Res 2020; 31:1243-1252. [DOI: 10.1111/clr.13672] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 09/02/2020] [Accepted: 09/13/2020] [Indexed: 12/13/2022]
Affiliation(s)
- Eric Schmid
- Department of Periodontology School of Dental Medicine University of Bern Bern Switzerland
| | - Michele Morandini
- Department of Periodontology School of Dental Medicine University of Bern Bern Switzerland
| | - Andrea Roccuzzo
- Department of Periodontology School of Dental Medicine University of Bern Bern Switzerland
- Department of Oral and Maxillofacial Surgery Copenhagen University Hospital (Rigshospitalet) Copenhagen Denmark
| | - Christoph A. Ramseier
- Department of Periodontology School of Dental Medicine University of Bern Bern Switzerland
| | - Anton Sculean
- Department of Periodontology School of Dental Medicine University of Bern Bern Switzerland
| | - Giovanni E. Salvi
- Department of Periodontology School of Dental Medicine University of Bern Bern Switzerland
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Windisch P, Orban K, Salvi GE, Sculean A, Molnar B. Vertical-guided bone regeneration with a titanium-reinforced d-PTFE membrane utilizing a novel split-thickness flap design: a prospective case series. Clin Oral Investig 2020; 25:2969-2980. [PMID: 33040203 PMCID: PMC8060182 DOI: 10.1007/s00784-020-03617-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 10/01/2020] [Indexed: 12/01/2022]
Abstract
Objectives To evaluate the feasibility of a newly proposed minimally invasive split-thickness flap design without vertical-releasing incisions for vertical bone regeneration performed in either a simultaneous or staged approach and to analyze the prevalence of adverse events during postoperative healing. Materials and methods Following preparation of a split-thickness flap and bilaminar elevation of the mucosa and underlying periosteum, the alveolar bone was exposed over the defects, vertical GBR was performed by means of a titanium-reinforced high-density polytetrafluoroethylene membrane combined with particulated autogenous bone (AP) and bovine-derived xenograft (BDX) in 1:1 ratio. At 9 months after reconstructive surgery, vertical and horizontal hard tissue gain was evaluated based on clinical and radiographic examination. Results Twenty-four vertical alveolar ridge defects in 19 patients were treated with vertical GBR. In case of 6 surgical sites, implant placement was performed at the time of the GBR (simultaneous group); in the remaining 18 surgical, sites implant placement was performed 9 months after the ridge augmentation (staged group). After uneventful healing in 23 cases, hard tissue fill was detected in each site. Direct clinical measurements confirmed vertical and horizontal hard tissue gain averaging 3.2 ± 1.9 mm and 6.5 ± 0.5 mm respectively, in the simultaneous group and 4.5 ± 2.2 mm and 8.7 ± 2.3 mm respectively, in the staged group. Additional radiographic evaluation based on CBCT data sets in the staged group revealed mean vertical and horizontal hard tissue fill of 4.2 ± 2.0 mm and 8.5 ± 2.4 mm. Radiographic volume gain was 1.1 ± 0.4 cm3. Conclusion Vertical GBR consisting of a split-thickness flap and using titanium-reinforced non-resorbable membrane in conjunction with a 1:1 mixture of AP+BDX may lead to a predictable vertical and horizontal hard tissue reconstruction. Clinical relevance The used split-thickness flap design may represent a valuable approach to increase the success rate of vertical GBR, resulting in predicable hard tissue regeneration, and favorable wound healing with low rate of membrane exposure. Electronic supplementary material The online version of this article (10.1007/s00784-020-03617-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Peter Windisch
- Faculty of Dentistry, Department of Periodontology, Semmelweis University, Budapest, Hungary
| | - Kristof Orban
- Faculty of Dentistry, Department of Periodontology, Semmelweis University, Budapest, Hungary
| | - Giovanni E Salvi
- Department of Periodontology, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland
| | - Anton Sculean
- Department of Periodontology, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland.
| | - Balint Molnar
- Faculty of Dentistry, Department of Periodontology, Semmelweis University, Budapest, Hungary
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Cosgarea R, Eick S, Jepsen S, Arweiler NB, Juncar R, Tristiu R, Salvi GE, Heumann C, Sculean A. Microbiological and host-derived biomarker evaluation following non-surgical periodontal therapy with short-term administration of systemic antimicrobials: secondary outcomes of an RCT. Sci Rep 2020; 10:16322. [PMID: 33004857 PMCID: PMC7530673 DOI: 10.1038/s41598-020-73054-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 09/04/2020] [Indexed: 12/23/2022] Open
Abstract
Nonsurgical periodontal therapy with adjunctive use of systemic antimicrobials (for 7–14 days) showed improved clinical, microbiological and immunological results over the mechanical protocol alone. Considering the increasing risk for antimicrobial resistance with longer antibiotic regimes, it is important to establish the optimal antibiotic protocol with a maximum antimicrobial benefit and minimum risk for adverse effects. The aim of the study was to evaluate the microbiological and inflammatory outcomes 12-months after a 3-/7-day systemic antibiotic protocol [amoxicillin (AMX) + metronidazole (MET)] adjunctive to subgingival debridement in severe periodontitis compared to mechanical treatment alone. From the initially treated 102 patients, 75 subjects (Placebo group: n = 26; 3-day AMX + MET group: n = 24; 7-day AMX + MET group: n = 25) completed the 12-month examination. Clinical parameters, eight periodontal pathogens and inflammatory markers were determined at baseline and 3-, 6-, 12-months after therapy using real-time PCR and ELISA respectively. After 6 months, several periodontopathogens were significantly more reduced in the two antibiotic groups compared to placebo (p < 0.05). After 1 year, both antibiotic protocols showed significant reductions and detection of the keystone pathogen P. gingivalis compared to placebo. Antibiotic protocols, smoking, disease severity, baseline-BOP, -CAL and -IL-1β, as well as detection of T. denticola at 12-months significantly influenced the residual number of deep sites. The present data indicate that the systemic use of both short and longer antibiotic protocols (AMX + MET) adjunctive to nonsurgical periodontal therapy lead to higher microbiological improvements compared to subgingival debridement alone. The two investigated antibiotic protocols led to comparable microbiological and inflammatory results.
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Affiliation(s)
- Raluca Cosgarea
- Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, Welschnonnen str 17, 53111, Bonn, Germany. .,Clinic for Prosthetic Dentistry, University Iuliu-Hatieganu, Cluj-Napoca, Romania. .,Department of Periodontology and Peri-implant Diseases, Philipps University Marburg, Marburg, Germany.
| | - S Eick
- Department of Periodontology, University of Bern, Bern, Switzerland
| | - S Jepsen
- Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, Welschnonnen str 17, 53111, Bonn, Germany
| | - N B Arweiler
- Department of Periodontology and Peri-implant Diseases, Philipps University Marburg, Marburg, Germany
| | - R Juncar
- Department of Dental Medicine, University of Oradea, Oradea, Romania
| | - R Tristiu
- Clinic for Prosthetic Dentistry, University Iuliu-Hatieganu, Cluj-Napoca, Romania
| | - G E Salvi
- Department of Periodontology, University of Bern, Bern, Switzerland
| | - C Heumann
- Department for Statistics, Ludwig-Maximilians University, Munich, Germany
| | - A Sculean
- Department of Periodontology, University of Bern, Bern, Switzerland
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Monje A, Eick S, Buser D, Salvi GE. Microbial and host-derived biomarker changes during ligature-induced and spontaneous peri-implantitis in the Beagle dog. J Periodontal Res 2020; 56:93-100. [PMID: 32885473 DOI: 10.1111/jre.12797] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 07/01/2020] [Accepted: 08/07/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To evaluate microbial and host-derived biomarker changes during experimental peri-implantitis in the Beagle dog. BACKGROUND Limited data exist on the microbial and biomarker changes during progressive bone loss as result of experimental peri-implantitis. METHODS In total, 36 implants (ndogs = 6) were assessed over 3 episodes of ligature-induced peri-implantitis followed by a period of spontaneous progression. Implants with hybrid (H) and completely rough (R) surface designs were used. Clinical and radiographic parameters were recorded at 4 timepoints. Peri-implant sulcus fluid was collected from the buccal and lingual aspects of the implants. The presence of 7 bacterial species and 2 host-derived biomarkers was assessed during the study period. RESULTS Total bacterial counts were significantly correlated with marginal bone loss (MBL) (r = .21; P = .009). Further, Phorphyromonas gulae (Pg) and Tannerella forsythia (Tf) were commonly correlated with MBL, suppuration (SUP) and the sulcular bleeding index scores (mSBI) (P < .05). Other bacteria were further correlated with SUP, mSBI, and MBL. While the analyzed bacteria dropped, Prevotella intermedia (Pi) further increased during the spontaneous progressive phase (P < .05). Total bacterial load did not differ significantly between H and R implants. Host-derived IL-10 was undetected along the study period. IL-1β positively correlated with probing pocket depth (r = .18; P = .03). During spontaneous progression, H implants displayed statistically significant lower levels of IL-1β (P = .003). CONCLUSION Experimental peri-implantitis is associated with an increase in bacterial counts. While Pg and Tf are associated with ligature-induced disease progression, Pi augmented its load during the spontaneous progressive phase. IL-1β is associated with pocket probing depth and influenced by implant surface characteristics during the spontaneous progression phase.
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Affiliation(s)
- Alberto Monje
- Department of Periodontology, Universidad Internacional de Catalunya, Barcelona, Spain.,Department of Periodontology, School of Dental Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Sigrun Eick
- Department of Periodontology, University of Bern, Bern, Switzerland
| | - Daniel Buser
- Department of Stomatology and Oral Surgery, University of Bern, Bern, Switzerland
| | - Giovanni E Salvi
- Department of Periodontology, University of Bern, Bern, Switzerland
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Pons R, Nart J, Valles C, Salvi GE, Monje A. Self-administered proximal implant-supported hygiene measures and the association to peri-implant conditions. J Periodontol 2020; 92:389-399. [PMID: 32761897 DOI: 10.1002/jper.20-0193] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 06/16/2020] [Accepted: 07/10/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Dental plaque biofilm is considered to be the underlying cause of peri-implant diseases. Moreover, it has been corroborated recently the association between the presence of these diseases and deficiently designed implant-supported prostheses. In this regard, professional-administered oral hygiene measures have been suggested to play a dominant role in prevention. METHODS A cross-sectional study was conducted in dental implant patients according to accessibility for self-performed oral hygiene using a 0.5 mm interproximal brush. Periodontal and peri-implant status were assessed based on clinical and radiographic variables to determine the prevalence of peri-implant diseases. In addition, the participants completed a questionnaire on the efficiency and accessibility for self-performed proximal hygiene. Associations of descriptive data were analyzed using the chi-squared test and Mann-Whitney U-test. Correlations of the variables with the primary outcome (accessibility) were assessed by means of generalized estimation equations and multilevel logistic regression models. RESULTS Based on an a priori power calculation, a total of 50 patients (171 implants) were consecutively recruited. From these, 46% of the prostheses allowed proper access for performing proximal hygiene whereas 54% of the prostheses precluded proper access. Poor access for proximal hygiene displayed tendency towards statistical significance with peri-implant disease (OR = 2.31; P = 0.090), in particular with peri-implant mucositis (OR = 2.43; P = 0.082) when compared to good access. In addition, an association was observed to increased levels of mucosal redness (P = 0.026) and the full-mouth bleeding score (P = 0.018). On the other hand, the presence of peri-implant disease was related to self-reported assessment of oral hygiene measures (P = 0.015) and to patient perception of gingival/mucosal bleeding when performing oral hygiene (P = 0.026). In turn, the diagnosis of peri-implant disease was significantly associated to the quantity and quality of information provided at the time of implant therapy (P = 0.004), including the influence of confounders upon disease occurrence (P = 0.038) CONCLUSIONS: To a certain extent, accessibility for self-performed proximal hygiene is associated to the peri-implant condition. On the other hand, the information received by the patient from the dental professional is essential for self-monitoring of the peri-implant conditions and for alerting to the possible presence of disorders.
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Affiliation(s)
- Ramón Pons
- Department of Periodontology, Universitat Internacional de Catalunya, Barcelona, Spain
| | - José Nart
- Department of Periodontology, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Cristina Valles
- Department of Periodontology, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Giovanni E Salvi
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Alberto Monje
- Department of Periodontology, Universitat Internacional de Catalunya, Barcelona, Spain
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Iorio-Siciliano V, Blasi A, Stratul SI, Ramaglia L, Octavia V, Salvi GE, Sculean A. Healing of periodontal suprabony defects following treatment with open flap debridement with or without an enamel matrix derivative: A randomized controlled clinical study. Clin Oral Investig 2020; 25:1019-1027. [PMID: 32562077 DOI: 10.1007/s00784-020-03392-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 06/03/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To compare the healing of suprabony defects following treatment with either open flap debridement (OFD) and application of an enamel matrix derivative (EMD) with OFD alone. METHODS Eighty patients with suprabony periodontal defects were randomly assigned to treatment with OFD + EMD (test) or OFD alone (control). The primary outcome variable was the difference in clinical attachment level (CAL) gain. At baseline and after 12 months, full-mouth plaque scores (FMPS), full-mouth bleeding scores (FMBS), probing depths (PD), gingival recessions (GR), and CAL were recorded. RESULTS Sixty-five patients were available for the 12-month follow-up examination. At 12 months, the mean FMPS was 21.9 ± 3.0% in the OFD + EMD and 21.1 ± 2.4% in the OFD group, respectively (p = 0.30), while mean FMBS measured 20.4 ± 3.4% in the OFD + EMD group and 19.9 ± 2.9% in the OFD group (p = 0.48). Mean CAL gain at sites treated with OFD + EMD was statistically significantly different (p = 0.0001) compared with sites treated with OFD alone (3.4 ± 0.6 mm vs 1.8 ± 0.6 mm). A statistically significant difference (p = 0.0001) was found between mean PD change in the OFD + EMD (3.9 ± 0.6 mm) and OFD alone (3.2 ± 0.6 mm) treated groups and also in terms of mean GR change between treatment with OFD + EMD (0.5 ± 0.7 mm) and OFD alone (1.4 ± 1.0 mm) (p = 0.001). CONCLUSION Within their limits, the present results indicate that in suprabony periodontal defects, the application of EMD in conjunction with OFD may additionally improve the clinical outcomes compared with OFD alone. CLINICAL RELEVANCE In periodontal suprabony defects, the application of EMD in conjunction with OFD may additionally enhance the clinical outcomes in terms of CAL gain and PD reduction.
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Affiliation(s)
- Vincenzo Iorio-Siciliano
- Department of Periodontology, University of Naples Federico II, Via S Pansini 5, 80131, Naples, Italy.
| | - Andrea Blasi
- Department of Periodontology, University of Naples Federico II, Via S Pansini 5, 80131, Naples, Italy
| | - Stefan-Ioan Stratul
- Department of Periodontology, Victor Babes University, Piata Eftimie 2, 300041, Timisoara, Romania
| | - Luca Ramaglia
- Department of Periodontology, University of Naples Federico II, Via S Pansini 5, 80131, Naples, Italy
| | - Vela Octavia
- Department of Periodontology, Victor Babes University, Piata Eftimie 2, 300041, Timisoara, Romania
| | - Giovanni E Salvi
- Department of Periodontology, School of Dental Medicine, University of Bern, Freiburgstrasse 7, CH-3010, Bern, Switzerland
| | - Anton Sculean
- Department of Periodontology, School of Dental Medicine, University of Bern, Freiburgstrasse 7, CH-3010, Bern, Switzerland
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Cvjetinovic A, Ramseier CA, Salvi GE, Laugisch O. [Chemical additives in toothpastes to inhibit calculus formation]. Swiss Dent J 2020; 130:503-513. [PMID: 32512986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Dental calculus has a secondary effect on the pathogenesis of periodontal diseases by harboring bacterial biofilm on its rough surfaces. Consequently, professional removal of both calculus and biofilm is a crucial part of the therapy and prevention of gingivitis and periodontitis. Today, crystal growth inhibitors such as zinc ions in the form of zinc chloride or zinc citrate, and pyrophosphates alone or in combination with copolymer are added to toothpastes to prevent the mineralization of the dental biofilm. In addition, triclosan is used as an antimicrobial agent in combination with copolymer as an additive in toothpastes to reduce the amount of plaque and thus the substrate for calculus formation. In clinical trials, chemical additives have demonstrated an inhibiting impact on calculus formation. However, it must be clarified that in addition to home-based oral hygiene, the formation of dental calculus depends on other factors such as access to professional dental care, diet, age, ethnicity, time since last professional tooth cleaning, systemic diseases or medications. However, since chemical additives in toothpastes do not reach the deeper sites of periodontal pockets, they are recommended for the inhibition of supragingival calculus formation, thus assisting the primary prevention of gingivitis as well as the secondary prevention of periodontal disease.
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Affiliation(s)
| | | | - Giovanni E Salvi
- Klinik für Parodontologie, Zahnmedizinische Kliniken der Universität Bern
| | - Oliver Laugisch
- Klinik für Parodontologie und periimplantäre Erkrankungen, Medizinisches Zentrum für Zahn-, Mund- und Kieferheilkunde der Philipps-Universität, Marburg, Deutschland
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Monje A, Pons R, Roccuzzo A, Salvi GE, Nart J. Reconstructive therapy for the management of peri‐implantitis via submerged guided bone regeneration: A prospective case series. Clin Implant Dent Relat Res 2020; 22:342-350. [DOI: 10.1111/cid.12913] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 03/27/2020] [Accepted: 04/08/2020] [Indexed: 12/19/2022]
Affiliation(s)
- Alberto Monje
- Department of Periodontology Universitat Internacional de Catalunya Barcelona Spain
| | - Ramón Pons
- Department of Periodontology Universitat Internacional de Catalunya Barcelona Spain
| | - Andrea Roccuzzo
- Department of Periodontology, School of Dental Medicine University of Bern Bern Switzerland
- Department of Oral and Maxillofacial Surgery Copenhagen University Hospital (Rigshospitalet) Copenhagen Denmark
| | - Giovanni E. Salvi
- Department of Periodontology, School of Dental Medicine University of Bern Bern Switzerland
| | - José Nart
- Department of Periodontology Universitat Internacional de Catalunya Barcelona Spain
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Salvi GE, Moëne R, Wallkamm B, Hicklin SP, Bischof M, Nedir R, Mombelli A, Sculean A. Clinical and radiographic changes at tissue level implants with either a machined or a modified transmucosal neck surface: A 3-year multicentre randomized controlled proof-of-concept study. J Clin Periodontol 2020; 47:500-508. [PMID: 31912523 DOI: 10.1111/jcpe.13249] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 12/03/2019] [Accepted: 01/04/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Surface modification may yield enhanced soft tissue adhesion to transmucosal titanium implant necks. AIM To evaluate and compare changes in soft tissues around implants with a modified hydrophilic sandblasted and acid-etched neck (mSLA; test) to those with a machined neck (M; control). MATERIALS AND METHODS Implants with a diameter of 4.1 mm and a neck height of 1.8 mm were randomly inserted in healed sites with pristine bone of the posterior maxilla or mandible. The modified Sulcus Bleeding Index (mSBI) (primary outcome) was assessed at baseline (BL) and 6, 12 and 36 months. Secondary outcomes included the assessment of pocket probing depth (PPD), mucosal recession (REC) and clinical attachment level (CAL). Standardized radiographs were taken at time of implant placement, at BL and after 12 and 36 months. RESULTS Of the 43 randomized subjects, 38 (19 test and 19 controls) completed the 36-month follow-up. Implant survival rates amounted to 95.5% (test) and 100% (control) (p > .05). At 36 months, 77.6% of test implants and 78.9% of control implants were without any bleeding sites (mSBI = 0; p > .05). The 36-month success rate was 86.4% in the test and 85.7% in the control group, respectively (p > .05). At 36 months, the mean radiographic bone level change from BL was 0.33 ± 0.69 mm at test implants and 0.12 ± 0.3 mm at control implants (p > .05). CONCLUSION Tissue level implants with a hydrophilic mSLA transmucosal neck failed to yield clinical and radiographic benefits compared with implants with a machined neck up to 3 years.
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Affiliation(s)
- Giovanni E Salvi
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Raphaël Moëne
- Division of Periodontology, School of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Beat Wallkamm
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland.,Private Practice, Langenthal, Switzerland
| | - Stefan P Hicklin
- Division of Fixed Prosthodontics and Biomaterials, School of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Mark Bischof
- Swiss Dental Clinics Group, Ardentis Clinique Dentaire, Lausanne, Switzerland
| | - Rabah Nedir
- Swiss Dental Clinics Group, Ardentis Clinique Dentaire, Lausanne, Switzerland
| | - Andrea Mombelli
- Division of Periodontology, School of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Anton Sculean
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
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Graziani F, Chappuis V, Molina A, Lazarin R, Schmid E, Chen S, Salvi GE. Effectiveness and clinical performance of early implant placement for the replacement of single teeth in anterior areas: A systematic review. J Clin Periodontol 2019; 46 Suppl 21:242-256. [PMID: 30821840 DOI: 10.1111/jcpe.13092] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 02/09/2019] [Accepted: 02/21/2019] [Indexed: 11/28/2022]
Abstract
AIM To assess the effectiveness and clinical performance of early implant placement, 4-8 (Type 2) or 12-16 weeks (Type 3) after extraction, in single anterior sites. METHODS Studies reporting on Type 2 and Type 3 implant placement were identified. Findings were summarized in evidence tables. Main outcome was implant survival. Peri-implant soft and hard tissues changes, periodontal parameters, aesthetics and patient-reported outcomes were also evaluated. Quality of reporting of the included studies was evaluated through Consort, Newcastle-Ottawa scale and IHE quality appraisal checklist. RESULTS Nineteen eligible articles (seven from one RCT, three from two CCTs and nine from three case series) reporting on 140 patients and 140 implants were included. Type 3 implants showed comparable results to Type 4: 95% vs. 100% survival rates. Studies reported high values of implant survival, minimal technical and biological complications and high aesthetic scores in both short and long-term follow-ups for both Type 2 and Type 3 implant placement. Quality evaluation highlighted important weaknesses in the included trials. CONCLUSIONS Limited data on Type 2 and Type 3 implant placement appear to indicate that they can perform well both short and long term. However, the limited number of cases, the significant heterogeneity of the included studies and the high risk of biases importantly reduce the generalizability of the findings. CRD42018117363.
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Affiliation(s)
- Filippo Graziani
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Vivianne Chappuis
- Department of Oral Surgery and Stomatology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Ana Molina
- ETEP (Etiology and Therapy of Periodontal Diseases) Research Group, Complutense University, Madrid, Spain
| | - Rafael Lazarin
- Department of Oral Surgery and Stomatology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Eric Schmid
- Department of Oral Surgery and Stomatology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Stephen Chen
- Department of Periodontics, Melbourne Dental School, University of Melbourne, Melbourne, Vic., Australia
| | - Giovanni E Salvi
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
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Tonetti MS, Jung RE, Avila-Ortiz G, Blanco J, Cosyn J, Fickl S, Figuero E, Goldstein M, Graziani F, Madianos P, Molina A, Nart J, Salvi GE, Sanz-Martin I, Thoma D, Van Assche N, Vignoletti F. Management of the extraction socket and timing of implant placement: Consensus report and clinical recommendations of group 3 of the XV European Workshop in Periodontology. J Clin Periodontol 2019; 46 Suppl 21:183-194. [PMID: 31215112 DOI: 10.1111/jcpe.13131] [Citation(s) in RCA: 98] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 05/03/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND The transition from a tooth requiring extraction to its replacement (with a dental implant) requires a series of clinical decisions related to timing, approach, materials, cost-effectiveness and the assessment of potential harm and patient preference. This workshop focused on the formulation of evidence-based consensus statements and clinical recommendations. METHODS Four systematic reviews covering the areas of alveolar ridge preservation/bone grafting, immediate early and delayed implant placement and alveolar bone augmentation at the time of implant placement in a healed ridge formed the basis of the deliberations. The level of evidence supporting each consensus statement and its strength was described using a modification of the GRADE tool. RESULTS The evidence base for each of the relevant topics was assessed and summarized in 23 consensus statements and 12 specific clinical recommendations. The group emphasized that the evidence base mostly relates to single tooth extraction/replacement; hence, external validity/applicability to multiple extractions requires careful consideration. The group identified six considerations that should assist clinicians in clinical decision-making: presence of infection, inability to achieve primary stability in the restoratively driven position, presence of a damaged alveolus, periodontal phenotype, aesthetic demands and systemic conditions. CONCLUSIONS A substantial and expanding evidence base is available to assist clinicians with clinical decision-making related to the transition from a tooth requiring extraction to its replacement with a dental implant. More high-quality research is needed for the development of evidence-based clinical guidelines.
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Affiliation(s)
- Maurizio S Tonetti
- Division of Periodontology and Implant Dentistry, Faculty of Dentistry, University of Hong Kong, Hong Kong, China.,European Research Group on Periodontology, Genova, Italy
| | - Ronald E Jung
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, University of Zurich, Zurich, Switzerland
| | | | - Juan Blanco
- Department of Surgery and Medical-Surgical Specialties (Dentistry area), Unit of Periodontology, University of Santiago de Compostela, Santiago, Spain
| | - Jan Cosyn
- Department of Dentistry, University of Ghent, Ghent, Belgium
| | - Stefan Fickl
- Division of Periodontology, University of Würzburg, Würzburg, Germany
| | - Elena Figuero
- ETEP (Etiology and Therapy of Periodontal Diseases) Research Group, Department of Dental Clinic Specialties, Faculty of Dentistry, University Complutense, Madrid, Spain
| | - Moshe Goldstein
- Department of Periodontology, Hebrew University, Jerusalem, Israel
| | - Filippo Graziani
- Sub-Unit of Periodontology, Halitosis and Periodontal Medicine, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Phoebus Madianos
- Department of Periodontology, Kapodistrian University, Athens, Greece
| | - Ana Molina
- ETEP (Etiology and Therapy of Periodontal Diseases) Research Group, Department of Dental Clinic Specialties, Faculty of Dentistry, University Complutense, Madrid, Spain
| | - Jose Nart
- Department of Periodontology, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Giovanni E Salvi
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Ignacio Sanz-Martin
- ETEP (Etiology and Therapy of Periodontal Diseases) Research Group, Department of Dental Clinic Specialties, Faculty of Dentistry, University Complutense, Madrid, Spain
| | - Daniel Thoma
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, University of Zurich, Zurich, Switzerland
| | - Nele Van Assche
- Private Practice of Periodontology and Implantology, Geel, Belgium
| | - Fabio Vignoletti
- ETEP (Etiology and Therapy of Periodontal Diseases) Research Group, Department of Dental Clinic Specialties, Faculty of Dentistry, University Complutense, Madrid, Spain
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Iorio-Siciliano V, Blasi A, Sammartino G, Salvi GE, Sculean A. Soft tissue stability related to mucosal recession at dental implants: a systematic review. Quintessence Int 2019; 51:28-36. [PMID: 31463483 DOI: 10.3290/j.qi.a43048] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To assess the stability of soft tissues around implants by comparing mucosal recessions in patients with keratinized mucosa (test) with patients without keratinized mucosa (control) around osseointegrated dental implants. METHOD AND MATERIALS The PICO criteria used were as follows: Population, patients with osseointegrated dental implants; Intervention/exposure, presence of a keratinized mucosa; Comparison/control, absence of keratinized mucosa; Outcome, presence or absence of peri-implant mucosal recessions (mm). DATA SOURCES An electronic search of Medline, Embase, and Cochrane Oral Health Group specialist trials supplemented by manual searching was conducted to identify studies reporting outcomes of at least 5 years on the presence of mucosal recessions at implants with or without attached mucosa. Mucosal recession (MR) was set as primary outcome. Prospective cohort studies published in English language up to October 2018, with a mean follow-up period of at least 5 years, reporting keratinized tissue height ≥ 2 mm and < 2 mm or presence/absence of keratinized tissue, with fixed implant-supported prostheses. The homogeneity of studies was assessed by DerSimonian and Laird test (Q test). The differences in terms of gingival recession around implants reported between test groups (keratinized mucosa ≥ 2 mm) and control (keratinized mucosa < 2 mm or no keratinized mucosa) were compared. Two studies reporting 201 patients with 514 tissue level implants were selected for the final analysis. RESULTS Due to the high heterogeneity between the selected studies, no statistical test could be performed. However, in both studies a deeper mucosal recession occurred when keratinized mucosa was < 2 mm: 0.61 ± 0.10 (-0.90; -0.32) and -1.92 ± 0.12 (-2.16; -1.68), respectively. CONCLUSION Within their limitations, the findings indicate that after a mean observation period of at least 5 years, the presence of keratinized mucosa may lead to less mucosal recession at dental implants.
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Abstract
OBJECTIVES This narrative review was prepared for the 2017 World Workshop of the American Academy of Periodontology and European Federation of Periodontology to address key questions related to the clinical condition of peri-implant mucositis, including: 1) the definition of peri-implant mucositis, 2) conversion of peri-implant health to the biofilm-induced peri-implant mucositis lesion, 3) reversibility of peri-implant mucositis, 4) the long-standing peri-implant mucositis lesion, 5) similarities and differences between peri-implant mucositis at implants and gingivitis at teeth, and 6) risk indicators/factors for peri-implant mucositis. METHODS A literature search of MEDLINE (PubMed) and The Cochrane Library up to and including July 31, 2016, was carried out using the search strategy (peri-implant[All Fields] AND ("mucositis"[MeSH Terms] OR "mucositis"[All Fields])) OR (periimplant[All Fields] AND mucosits[All Fields]). Prospective, retrospective, and cross-sectional studies and review papers that focused on risk factors/indicators for peri-implant mucositis as well as experimental peri-implant mucositis studies in animals and humans were included. FINDINGS Peri-implant mucositis is an inflammatory lesion of the soft tissues surrounding an endosseous implant in the absence of loss of supporting bone or continuing marginal bone loss. A cause-and-effect relationship between experimental accumulation of bacterial biofilms around titanium dental implants and the development of an inflammatory response has been demonstrated. The experimental peri-implant mucositis lesion is characterized by an inflammatory cell infiltrate present within the connective tissue lateral to the barrier epithelium. In long-standing peri-implant mucositis, the inflammatory cell infiltrate is larger in size than in the early (3-week) experimental peri-implant mucositis lesion. Biofilm-induced peri-implant mucositis is reversible at the host biomarker level once biofilm control is reinstituted. Reversal of the clinical signs of inflammation may take longer than 3 weeks. Factors identified as risk indicators for peri-implant mucositis include biofilm accumulation, smoking, and radiation. Further evidence is required for potential risk factors, including diabetes, lack of keratinized mucosa, and presence of excess luting cement. CONCLUSIONS Peri-implant mucositis is caused by biofilm accumulation which disrupts the host-microbe homeostasis at the implant-mucosa interface, resulting in an inflammatory lesion. Peri-implant mucositis is a reversible condition at the host biomarker level. Therefore, the clinical implication is that optimal biofilm removal is a prerequisite for the prevention and management of peri-implant mucositis. An understanding of peri-implant mucositis is important because it is considered a precursor for peri-implantitis.
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Affiliation(s)
- Lisa J A Heitz-Mayfield
- Department of Anatomy, Biology and Human Physiology, International Research Collaborative-Oral Health and Equity, University of Western Australia, IRCOHE, Crawley, WA, Australia.,Faculty of Dentistry, University of Sydney, Surry Hills, NSW, Australia
| | - Giovanni E Salvi
- Department of Periodontology, University of Bern, Bern, Switzerland
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Berglundh T, Armitage G, Araujo MG, Avila-Ortiz G, Blanco J, Camargo PM, Chen S, Cochran D, Derks J, Figuero E, Hämmerle CHF, Heitz-Mayfield LJA, Huynh-Ba G, Iacono V, Koo KT, Lambert F, McCauley L, Quirynen M, Renvert S, Salvi GE, Schwarz F, Tarnow D, Tomasi C, Wang HL, Zitzmann N. Peri-implant diseases and conditions: Consensus report of workgroup 4 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. J Periodontol 2019; 89 Suppl 1:S313-S318. [PMID: 29926955 DOI: 10.1002/jper.17-0739] [Citation(s) in RCA: 410] [Impact Index Per Article: 82.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 02/06/2018] [Accepted: 03/01/2018] [Indexed: 11/09/2022]
Abstract
A classification for peri-implant diseases and conditions was presented. Focused questions on the characteristics of peri-implant health, peri-implant mucositis, peri-implantitis, and soft- and hard-tissue deficiencies were addressed. Peri-implant health is characterized by the absence of erythema, bleeding on probing, swelling, and suppuration. It is not possible to define a range of probing depths compatible with health; Peri-implant health can exist around implants with reduced bone support. The main clinical characteristic of peri-implant mucositis is bleeding on gentle probing. Erythema, swelling, and/or suppuration may also be present. An increase in probing depth is often observed in the presence of peri-implant mucositis due to swelling or decrease in probing resistance. There is strong evidence from animal and human experimental studies that plaque is the etiological factor for peri-implant mucositis. Peri-implantitis is a plaque-associated pathological condition occurring in tissues around dental implants, characterized by inflammation in the peri-implant mucosa and subsequent progressive loss of supporting bone. Peri-implantitis sites exhibit clinical signs of inflammation, bleeding on probing, and/or suppuration, increased probing depths and/or recession of the mucosal margin in addition to radiographic bone loss. The evidence is equivocal regarding the effect of keratinized mucosa on the long-term health of the peri-implant tissue. It appears, however, that keratinized mucosa may have advantages regarding patient comfort and ease of plaque removal. Case definitions in day-to-day clinical practice and in epidemiological or disease-surveillance studies for peri-implant health, peri-implant mucositis, and peri-implantitis were introduced. The proposed case definitions should be viewed within the context that there is no generic implant and that there are numerous implant designs with different surface characteristics, surgical and loading protocols. It is recommended that the clinician obtain baseline radiographic and probing measurements following the completion of the implant-supported prosthesis.
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Affiliation(s)
- Tord Berglundh
- Department of Periodontology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Gary Armitage
- University of California San Francisco, San Francisco, CA, USA
| | | | | | - Juan Blanco
- Universidad Santiago de Compostela, Santiago, Spain
| | | | | | - David Cochran
- University of Texas Health Science Center, San Antonio, TX, USA
| | - Jan Derks
- Department of Periodontology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Christoph H F Hämmerle
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, University of Zurich, Zurich, Switzerland
| | | | - Guy Huynh-Ba
- University of Texas Health Science Center, San Antonio, TX, USA
| | | | - Ki-Tae Koo
- Seoul National University, Seoul, South Korea
| | - France Lambert
- Department of Periodontology and Oral Surgery, University of Liège, Liège, Belgium
| | - Laurie McCauley
- School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | | | | | - Giovanni E Salvi
- Department of Periodontology, University of Bern, Bern, Switzerland
| | - Frank Schwarz
- Department of Oral Surgery and Implantology, Carolinum, Goethe University, Frankfurt, Germany
| | | | - Cristiano Tomasi
- Department of Periodontology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Hom-Lay Wang
- School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - Nicola Zitzmann
- Department of Reconstructive Dentistry, University of Basel, Basel, Switzerland
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Abstract
OBJECTIVES This narrative review was prepared for the 2017 World Workshop of the American Academy of Periodontology and European Federation of Periodontology to address key questions related to the clinical condition of peri-implant mucositis, including: 1) the definition of peri-implant mucositis, 2) conversion of peri-implant health to the biofilm-induced peri-implant mucositis lesion, 3) reversibility of peri-implant mucositis, 4) the long-standing peri-implant mucositis lesion, 5) similarities and differences between peri-implant mucositis at implants and gingivitis at teeth, and 6) risk indicators/factors for peri-implant mucositis. METHODS A literature search of MEDLINE (PubMed) and The Cochrane Library up to and including July 31, 2016, was carried out using the search strategy (peri-implant[All Fields] AND ("mucositis"[MeSH Terms] OR "mucositis"[All Fields])) OR (periimplant[All Fields] AND mucosits[All Fields]). Prospective, retrospective, and cross-sectional studies and review papers that focused on risk factors/indicators for peri-implant mucositis as well as experimental peri-implant mucositis studies in animals and humans were included. FINDINGS Peri-implant mucositis is an inflammatory lesion of the soft tissues surrounding an endosseous implant in the absence of loss of supporting bone or continuing marginal bone loss. A cause-and-effect relationship between experimental accumulation of bacterial biofilms around titanium dental implants and the development of an inflammatory response has been demonstrated. The experimental peri-implant mucositis lesion is characterized by an inflammatory cell infiltrate present within the connective tissue lateral to the barrier epithelium. In long-standing peri-implant mucositis, the inflammatory cell infiltrate is larger in size than in the early (3-week) experimental peri-implant mucositis lesion. Biofilm-induced peri-implant mucositis is reversible at the host biomarker level once biofilm control is reinstituted. Reversal of the clinical signs of inflammation may take longer than 3 weeks. Factors identified as risk indicators for peri-implant mucositis include biofilm accumulation, smoking, and radiation. Further evidence is required for potential risk factors, including diabetes, lack of keratinized mucosa, and presence of excess luting cement. CONCLUSIONS Peri-implant mucositis is caused by biofilm accumulation which disrupts the host-microbe homeostasis at the implant-mucosa interface, resulting in an inflammatory lesion. Peri-implant mucositis is a reversible condition at the host biomarker level. Therefore, the clinical implication is that optimal biofilm removal is a prerequisite for the prevention and management of peri-implant mucositis. An understanding of peri-implant mucositis is important because it is considered a precursor for peri-implantitis.
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Affiliation(s)
- Lisa J A Heitz-Mayfield
- Department of Anatomy, Biology and Human Physiology, International Research Collaborative-Oral Health and Equity, University of Western Australia, IRCOHE, Crawley, WA, Australia.,Faculty of Dentistry, University of Sydney, Surry Hills, NSW, Australia
| | - Giovanni E Salvi
- Department of Periodontology, University of Bern, Bern, Switzerland
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Meyle J, Casado P, Fourmousis I, Kumar P, Quirynen M, Salvi GE. General genetic and acquired risk factors, and prevalence of peri-implant diseases - Consensus report of working group 1. Int Dent J 2019; 69 Suppl 2:3-6. [PMID: 31478573 DOI: 10.1111/idj.12489] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
For decades, oral implants have been used successfully for the replacement of missing teeth. Nevertheless, peri-implant diseases have become an increasingly important issue in daily practice. In this working group, the prevalence of peri-implant mucositis and peri-implantitis, as well as different general risk factors and their impact on the onset and progression of peri-implant diseases, were discussed based on reviews reflecting the current state of evidence. The influence of smoking on the peri-implant bone-healing process and its association with peri-implantitis has been explored in the current literature, demonstrating that smoking is an important risk indicator for the development of peri-implantitis and implant loss. Compared with non-smokers, smokers have a higher potential for pathological peri-implant bone loss, which is also influenced by poor oral hygiene. Despite the fact that a growing number of genetic polymorphisms have been identified and related to periodontal diseases, there are still no genetic patterns that could act as adjuncts to clinical diagnostics in order to identify patients at higher risk of peri-implant diseases. Long-term medications, such as bisphosphonate therapy (> 3 years), may have an impact on implant loss. A higher incidence of implant failure was reported in patients using selective serotonin reuptake inhibitors in anti-depression therapy. Alcoholism (defined as more than 5 units a day) has been associated with implant loss in retrospective and case-control studies, as well as in animal studies.
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Affiliation(s)
- Joerg Meyle
- Department of Periodontology, University of Giessen, Giessen, Germany
| | - Priscila Casado
- Dentistry Department, Fluminense Federal University, Niterói, RJ, Brazil
| | | | - Purnima Kumar
- Division of Periodontology, College of Dentistry, The Ohio State University, Columbus, OH, USA
| | - Marc Quirynen
- Department of Oral Health Sciences, University of Leuven, Leuven, Belgium
| | - Giovanni E Salvi
- Department of Periodontology, School of Dental Medicine, University of Berne, Berne, Switzerland
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Abstract
As periodontal and peri-implant diseases represent opportunistic infections, antiinfective therapy is the method of choice. Correctly performed, the treatment outcomes will include resolution of the inflammation concomitant with shrinkage of the tissues, reflected in reduced probing depths. Depending on the patient data obtained after initial antiinfective therapy, further - mostly surgical - treatment may be rendered to reach the goals of a healthy periodontium and peri-implant tissues. Patient compliance is as important as operator skills for optimal treatment outcomes. Regenerative therapy may be applied in compliant patients and for appropriate defects. This article depicts the historical development of periodontal therapy during the 20th century and addresses the various outcome parameters to be used in daily decision making. Obviously, nonsurgical therapy has gained clinical relevance, resulting in highly satisfactory treatment outcomes in many cases. The critical probing depth above which positive attachment gain is registered varies from one treatment modality to another. It is a concept that helps facilitate decision making for additional therapeutic measures after initial therapy. Treatment of peri-implant mucositis prevents development of peri-implantitis. Hence, nonsurgical treatment of mucositis is frequently performed during the continuous monitoring of oral implants. This chapter of Periodontology 2000 presents evidence for the prevention and therapy of peri-implant diseases.
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Affiliation(s)
- Niklaus P Lang
- Department of Periodontology, University of Berne, Berne, Switzerland
| | - Giovanni E Salvi
- Department of Periodontology, University of Berne, Berne, Switzerland
| | - Anton Sculean
- Department of Periodontology, University of Berne, Berne, Switzerland
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Heitz-Mayfield LJ, Aaboe M, Araujo M, Carrión JB, Cavalcanti R, Cionca N, Cochran D, Darby I, Funakoshi E, Gierthmuehlen PC, Hashim D, Jahangiri L, Kwon Y, Lambert F, Layton DM, Lorenzana ER, McKenna G, Mombelli A, Müller F, Roccuzzo M, Salvi GE, Schimmel M, Srinivasan M, Tomasi C, Yeo A. Group 4 ITI Consensus Report: Risks and biologic complications associated with implant dentistry. Clin Oral Implants Res 2019; 29 Suppl 16:351-358. [PMID: 30328181 DOI: 10.1111/clr.13307] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 05/17/2018] [Indexed: 12/28/2022]
Abstract
OBJECTIVES The aim of Working Group 4 was to address topics related to biologic risks and complications associated with implant dentistry. Focused questions on (a) diagnosis of peri-implantitis, (b) complications associated with implants in augmented sites, (c) outcomes following treatment of peri-implantitis, and (d) implant therapy in geriatric patients and/or patients with systemic diseases were addressed. MATERIALS AND METHODS Four systematic reviews formed the basis for discussion in Group 4. Participants developed statements and recommendations determined by group consensus based on the findings of the systematic reviews. These were then presented and accepted following further discussion and modifications as required by the plenary. RESULTS Bleeding on probing (BOP) alone is insufficient for the diagnosis of peri-implantitis. The positive predictive value of BOP alone for the diagnosis of peri-implantitis varies and is dependent on the prevalence of peri-implantitis within the population. For patients with implants in augmented sites, the prevalence of peri-implantitis and implant loss is low over the medium to long term. Peri-implantitis treatment protocols which include individualized supportive care result in high survival of implants after 5 years with about three-quarters of implants still present. Advanced age alone is not a contraindication for implant therapy. Implant placement in patients with cancer receiving high-dose antiresorptive therapy is contraindicated due to the associated high risk for complications. CONCLUSIONS Diagnosis of peri-implantitis requires the presence of BOP as well as progressive bone loss. Prevalence of peri-implantitis for implants in augmented sites is low. Peri-implantitis treatment should be followed by individualized supportive care. Implant therapy for geriatric patients is not contraindicated; however, comorbidities and autonomy should be considered.
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Affiliation(s)
| | | | | | | | | | | | - David Cochran
- University of Texas Health Science Center, San Antonio, Texas
| | - Ivan Darby
- University of Melbourne, Melbourne, Victoria, Australia
| | | | | | | | | | - Yongdae Kwon
- Kyung Hee University School of Dentistry, Seoul, Korea
| | | | | | | | | | | | | | | | | | | | | | | | - Alvin Yeo
- National Dental Centre, Singapore, Singapore
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44
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Ramseier CA, Nydegger M, Walter C, Fischer G, Sculean A, Lang NP, Salvi GE. Cover Image. J Clin Periodontol 2019. [DOI: 10.1111/jcpe.13089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ramseier CA, Nydegger M, Walter C, Fischer G, Sculean A, Lang NP, Salvi GE. Time between recall visits and residual probing depths predict long-term stability in patients enrolled in supportive periodontal therapy. J Clin Periodontol 2019; 46:218-230. [PMID: 30499586 DOI: 10.1111/jcpe.13041] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 10/30/2018] [Accepted: 11/26/2018] [Indexed: 11/28/2022]
Abstract
AIM To relate the time between recall visits and residual periodontal probing depths (PPDs) to periodontal stability in patients enrolled in supportive periodontal therapy (SPT). MATERIALS AND METHODS Retrospective data on residual PPDs from 11,842 SPT visits were evaluated in SPT patients at the Medi School of Dental Hygiene (MSDH), Bern, Switzerland, 1985-2011. A residual PPD-based algorithm was developed to compute SPT intervals with no expected change of residual PPD. RESULTS A total of 883 patients aged 43.9 (±13.0) years and 55.4% (n = 489) being females were identified. Linear mixed model analysis yielded highest statistically significant impact on PPD change with time between SPT visits, presence of residual PPD ≥4 mm, and bleeding on probing (p < 0.0001). Patients returning for SPT five times consecutively earlier than computed presented mean % PPDs ≥4 mm of 5.8% (±3.9) compared with patients returning later (19.2%, ±7.6) (p < 0.0001). Additionally, patients attending >50% of their SPT visits earlier versus later demonstrated increased periodontal stability after 5 years (p = 0.0002) and a reduced frequency of tooth loss (0.60, ±0.93 versus 1.45, ±2.07) after 20 years (p < 0.0001). CONCLUSIONS To reach and maintain periodontal stability during SPT, individual quantitative data from comprehensive residual PPD profiles may contribute to the improved planning of SPT intervals.
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Affiliation(s)
- Christoph A Ramseier
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Martina Nydegger
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Clemens Walter
- Department of Periodontology, Endodontology and Cariology, School of Dental Medicine, University of Basel, Basel, Switzerland
| | | | - Anton Sculean
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Niklaus P Lang
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Giovanni E Salvi
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
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46
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Williams R, Salvi GE, Madianos PN. In Memoriam, Steven Offenbacher (1950‐2018). J Clin Periodontol 2018. [DOI: 10.1111/jcpe.13043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Ray Williams
- UNC‐Chapel Hill School of Dentistry Periodontology Brauer Hall Chapel Hill North Carolina United States
| | - Giovanni E Salvi
- University of Bern Department of Periodontology Freiburgstrasse 7 BernSwitzerland
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Salvi GE, Monje A, Tomasi C. Long‐term biological complications of dental implants placed either in pristine or in augmented sites: A systematic review and meta‐analysis. Clin Oral Implants Res 2018; 29 Suppl 16:294-310. [DOI: 10.1111/clr.13123] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2017] [Indexed: 12/20/2022]
Affiliation(s)
- Giovanni E. Salvi
- Department of PeriodontologySchool of Dental MedicineUniversity of Bern Bern Switzerland
| | - Alberto Monje
- Department of Oral Surgery and StomatologySchool of Dental MedicineUniversity of Bern Bern Switzerland
| | - Cristiano Tomasi
- Department of PeriodontologyInstitute of OdontologyThe Sahlgrenska Academy at University of Gothenburg Gothenburg Sweden
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Salvi GE. Zahn versus. Implantat: welche unterschiede wirken sich auf die entstehung und progression von parodontitis bzw. Peri-implantitis aus. Clin Oral Implants Res 2018. [DOI: 10.1111/clr.26_13355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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49
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Monje A, Insua A, Monje F, Muñoz F, Salvi GE, Buser D, Chappuis V. Diagnostic accuracy of the implant stability quotient in monitoring progressive peri-implant bone loss: An experimental study in dogs. Clin Oral Implants Res 2018; 29:1016-1024. [DOI: 10.1111/clr.13368] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 07/10/2018] [Accepted: 08/18/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Alberto Monje
- Department of Oral Surgery and Stomatology, ZMK School of Dental Medicine; University of Bern; Bern Switzerland
- Department of Periodontology; International University of Catalonia; Barcelona Spain
| | - Angel Insua
- Department of Oral Surgery and Implant Dentistry, School of Dentistry; University of Santiago de Compostela; Santiago de Compostela Spain
| | - Florencio Monje
- Private Practice, Division of Oral and Maxillofacial Surgery; CICOM; Badajoz Spain
| | - Fernando Muñoz
- School of Veterinary Medicine; University of Santiago de Compostela; Santiago Spain
| | - Giovanni E. Salvi
- Department of Periodontology, School of Dental Medicine; University of Bern; Bern Switzerland
| | - Daniel Buser
- Department of Oral Surgery and Stomatology, ZMK School of Dental Medicine; University of Bern; Bern Switzerland
| | - Vivianne Chappuis
- Department of Oral Surgery and Stomatology, ZMK School of Dental Medicine; University of Bern; Bern Switzerland
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Berglundh T, Armitage G, Araujo MG, Avila-Ortiz G, Blanco J, Camargo PM, Chen S, Cochran D, Derks J, Figuero E, Hämmerle CHF, Heitz-Mayfield LJA, Huynh-Ba G, Iacono V, Koo KT, Lambert F, McCauley L, Quirynen M, Renvert S, Salvi GE, Schwarz F, Tarnow D, Tomasi C, Wang HL, Zitzmann N. Peri-implant diseases and conditions: Consensus report of workgroup 4 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. J Periodontol 2018. [PMID: 29926955 DOI: 10.1002/jper.17‐0739] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A classification for peri-implant diseases and conditions was presented. Focused questions on the characteristics of peri-implant health, peri-implant mucositis, peri-implantitis, and soft- and hard-tissue deficiencies were addressed. Peri-implant health is characterized by the absence of erythema, bleeding on probing, swelling, and suppuration. It is not possible to define a range of probing depths compatible with health; Peri-implant health can exist around implants with reduced bone support. The main clinical characteristic of peri-implant mucositis is bleeding on gentle probing. Erythema, swelling, and/or suppuration may also be present. An increase in probing depth is often observed in the presence of peri-implant mucositis due to swelling or decrease in probing resistance. There is strong evidence from animal and human experimental studies that plaque is the etiological factor for peri-implant mucositis. Peri-implantitis is a plaque-associated pathological condition occurring in tissues around dental implants, characterized by inflammation in the peri-implant mucosa and subsequent progressive loss of supporting bone. Peri-implantitis sites exhibit clinical signs of inflammation, bleeding on probing, and/or suppuration, increased probing depths and/or recession of the mucosal margin in addition to radiographic bone loss. The evidence is equivocal regarding the effect of keratinized mucosa on the long-term health of the peri-implant tissue. It appears, however, that keratinized mucosa may have advantages regarding patient comfort and ease of plaque removal. Case definitions in day-to-day clinical practice and in epidemiological or disease-surveillance studies for peri-implant health, peri-implant mucositis, and peri-implantitis were introduced. The proposed case definitions should be viewed within the context that there is no generic implant and that there are numerous implant designs with different surface characteristics, surgical and loading protocols. It is recommended that the clinician obtain baseline radiographic and probing measurements following the completion of the implant-supported prosthesis.
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Affiliation(s)
- Tord Berglundh
- Department of Periodontology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Gary Armitage
- University of California San Francisco, San Francisco, CA, USA
| | | | | | - Juan Blanco
- Universidad Santiago de Compostela, Santiago, Spain
| | | | | | - David Cochran
- University of Texas Health Science Center, San Antonio, TX, USA
| | - Jan Derks
- Department of Periodontology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Christoph H F Hämmerle
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, University of Zurich, Zurich, Switzerland
| | | | - Guy Huynh-Ba
- University of Texas Health Science Center, San Antonio, TX, USA
| | | | - Ki-Tae Koo
- Seoul National University, Seoul, South Korea
| | - France Lambert
- Department of Periodontology and Oral Surgery, University of Liège, Liège, Belgium
| | - Laurie McCauley
- School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | | | | | - Giovanni E Salvi
- Department of Periodontology, University of Bern, Bern, Switzerland
| | - Frank Schwarz
- Department of Oral Surgery and Implantology, Carolinum, Goethe University, Frankfurt, Germany
| | | | - Cristiano Tomasi
- Department of Periodontology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Hom-Lay Wang
- School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - Nicola Zitzmann
- Department of Reconstructive Dentistry, University of Basel, Basel, Switzerland
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