Diagnosis of peri-implantitis in the absence of baseline data: A diagnostic accuracy study

OBJECTIVES

The aim of the present study was to evaluate the diagnostic accuracy of clinical and radiographic evaluations made at a single time point during follow-up in identifying (a) a history of peri-implant bone loss and (b) the presence of peri-implantitis.

MATERIAL & METHODS

427 patients provided with implant-supported reconstructions 9 years earlier were evaluated clinically by Probing Pocket Depth, Bleeding or Suppuration on Probing (PPD, BoP & SoP) and radiographically. Bone levels were assessed relative to the most coronal point of the intra-osseous part of the implant. A history of bone loss and diagnosis of peri-implantitis was confirmed through baseline documentation (direct evidence). Diagnostic accuracy of radiographic bone levels at 9 years and clinical findings (indirect evidence/secondary case definition) in identifying a history of bone loss and peri-implantitis were evaluated through correlation and multilevel regression analyses as well as receiver operating characteristic curves. Results were expressed as sensitivity/specificity and area under the curve (AUC).

RESULTS

Bone levels observed at 9 years were highly accurate in identifying pronounced bone loss (>2 mm; AUC = 0.96; 95% CI 0.95-0.98). In the absence of baseline documentation, a secondary case definition based on the presence of BoP/SoP & bone level ≥ 1 mm (indirect evidence) provided the overall best diagnostic accuracy (AUC = 0.80; 95% CI 0.77-0.82) in identifying peri-implantitis cases (direct evidence: BoP/SoP & bone loss > 0.5 mm). Moderate/severe peri-implantitis (BoP/SoP & bone loss > 2 mm) was most accurately identified by the combination of BoP/SoP & bone level ≥ 2 mm (AUC = 0.93; 95% CI 0.91-0.96). Sensitivity of the secondary case definition suggested by the 2017 World Workshop of Periodontology (WWP) (BoP/SoP ≥ 1 site & bone level ≥ 3 mm & PPD ≥ 6 mm) was low.

CONCLUSIONS

The present results underline the importance of baseline documentation for the correct diagnosis of peri-implantitis, especially in its early/incipient forms. The secondary case definition of peri-implantitis suggested at the 2017 WWP demonstrated a high level of specificity but low sensitivity. Moderate/severe peri-implantitis was most accurately identified by the combination of BoP/SoP & bone level ≥ 2 mm.

Clinical findings and history of bone loss at implant sites

OBJECTIVES

The aim of the present study was to evaluate whether clinical findings at implant sites are relevant as screening tests for a history of marginal bone loss.

MATERIAL AND METHODS

427 patients provided with implant-supported reconstructions 9 years earlier were evaluated clinically (probing pocket depth (PPD), bleeding on probing (BoP)) and radiographically. A history of bone loss was confirmed through baseline documentation. Diagnostic accuracy was evaluated through receiver operating characteristic curves and multi-level regression analyses. Results were expressed as sensitivity/specificity, area under the curve, and odds ratios.

RESULTS

While the sensitivity of PPD in regard to bone loss was low, specificity was generally high. Multi-level modeling revealed that each additional millimeter of PPD corresponded to an additional bone loss of 0.30 mm (95% CI 0.27; 0.33). The sensitivity of BOP in regard to bone loss >2 mm was 80.9% (95% CI 73.9; 86.7), while the specificity was 42.2% (95% CI 39.6; 44.8).

CONCLUSIONS

Clinical parameters at implant sites obtained at a single time point were associated with a history of marginal bone loss. While BoP demonstrated a high level of sensitivity, the sensitivity of PPD was generally low. The present data suggest that BoP is a relevant screening test for history of bone loss.

Performance evaluation of survival regression models in analysing Swedish dental implant complication data with frailty

The use of inappropriate methods for estimating the effects of covariates in survival data with frailty leads to erroneous conclusions in medical research. This study evaluated the performance of 13 survival regression models in assessing the factors associated with the timing of complications in implant-supported dental restorations in a Swedish cohort. Data were obtained from randomly selected cohort (n = 596) of Swedish patients provided with dental restorations supported in 2003. Patients were evaluated over 9 years of implant loss, peri-implantitis or technical complications. Best Model was identified using goodness, AIC and BIC. The loglikelihood, the AIC and BIC were consistently lower in flexible parametric model with frailty (df = 2) than other models. Adjusted hazard of implant complications was 45% (adjusted Hazard Ratio (aHR) = 1.449; 95% Confidence Interval (CI): 1.153-1.821, p = 0.001) higher among patients with periodontitis. While controlling for other variables, the hazard of implant complications was about 5 times (aHR = 4.641; 95% CI: 2.911-7.401, p<0.001) and 2 times (aHR = 2.338; 95% CI: 1.553-3.519, p<0.001) higher among patients with full- and partial-jaw restorations than those with single crowns. Flexible parametric survival model with frailty are the most suitable for modelling implant complications among the studied patients.

Occurrence and clustering of complications in implant dentistry

OBJECTIVES

The aim was to evaluate the overall occurrence and potential clustering of biological and technical complications in implant dentistry.

MATERIAL AND METHODS

596 patients provided with implant-supported reconstructions were evaluated for the occurrence of (a) technical complications, (b) peri-implantitis and (c) implant loss during a period of 9 years. Time and type of event were scored, and potential risk factors were explored through parametric modelling of survival and hazards. Clustering of complications was assessed at the patient level, and patient satisfaction was evaluated by questionnaire completed at the 9-year examination.

RESULTS

42% of patients were affected by technical and/or biological complications during the 9-year observation period. Extent of therapy (Hazard Ratio 2.5: patients with partial jaw restorations; HR 3.9: patients with full jaw restorations) and a history of periodontitis (HR 1.6) were identified as risk factors. While technical complications occurred mostly as isolated events, 41% of subjects identified with peri-implantitis and 52% of subjects with implant loss also presented with other complications. The hazard for technical complications and implant loss peaked at 0.7 years and 0.2 years, respectively, while the hazard for peri-implantitis was consistent throughout the observation period. The overall proportion of satisfied patients at 9 years was high (95%), and only minor differences between individuals with and without complications were noted.

CONCLUSIONS

Complications following implant-supported restorative therapy were common findings. Extent of therapy and periodontitis were identified as risk factors. While technical complications occurred in an isolated pattern, peri-implantitis and implant loss demonstrated clustering with other types of complications.

Can nature conservation and wood production be reconciled in managed forests? A review of driving factors for integrated forest management in Europe

Integrated forest management (IFM) can help reconcile critical trade-offs between goals in forest management, such as nature conservation and biomass production. The challenge of IFM is dealing with these trade-offs at the level of practical forest management, such as striving for compromises between biomass extraction and habitat retention. This paper reviews some of the driving factors that influence the integration of nature conservation into forest management. The review was conducted in three steps - a literature review, an expert workshop and an expert-based cooperative analysis. Of 38 driving factors identified, three were prioritised by more of the participants than any of the others: two are socio-cultural factors, identity (how people identify with forest) as well as outreach and education, and one is economic - competitiveness in forest value chains. These driving factors correspond to what are considered in the literature as enablers for IFM. The results reveal that targeted, group-oriented, adaptive and innovative policy designs are needed to integrate nature conservation into forest management. Further, the results reveal that a "one-size-fits-all" governance approach would be ineffective, implying that policy instruments need to consider contextually specific driving factors. Understanding the main driving factors and their overall directions can help to better manage trade-offs between biodiversity conservation and biomass production in European forests.

Fetal cerebral Doppler changes and outcome in late preterm fetal growth restriction: prospective cohort study

OBJECTIVES

To explore the association between fetal umbilical and middle cerebral artery (MCA) Doppler abnormalities and outcome in late preterm pregnancies at risk of fetal growth restriction.

METHODS

This was a prospective cohort study of singleton pregnancies at risk of fetal growth restriction at 32 + 0 to 36 + 6 weeks of gestation, enrolled in 33 European centers between 2017 and 2018, in which umbilical and fetal MCA Doppler velocimetry was performed. Pregnancies were considered at risk of fetal growth restriction if they had estimated fetal weight and/or abdominal circumference (AC) < 10^th percentile, abnormal arterial Doppler and/or a fall in AC growth velocity of more than 40 percentile points from the 20-week scan. Composite adverse outcome comprised both immediate adverse birth outcome and major neonatal morbidity. Using a range of cut-off values, the association of MCA pulsatility index and umbilicocerebral ratio (UCR) with composite adverse outcome was explored.

RESULTS

The study population comprised 856 women. There were two (0.2%) intrauterine deaths. Median gestational age at delivery was 38 (interquartile range (IQR), 37-39) weeks and birth weight was 2478 (IQR, 2140-2790) g. Compared with infants with normal outcome, those with composite adverse outcome (n = 93; 11%) were delivered at an earlier gestational age (36 vs 38 weeks) and had a lower birth weight (1900 vs 2540 g). The first Doppler observation of MCA pulsatility index < 5^th percentile and UCR Z-score above gestational-age-specific thresholds (1.5 at 32-33 weeks and 1.0 at 34-36 weeks) had the highest relative risks (RR) for composite adverse outcome (RR 2.2 (95% CI, 1.5-3.2) and RR 2.0 (95% CI, 1.4-3.0), respectively). After adjustment for confounders, the association between UCR Z-score and composite adverse outcome remained significant, although gestational age at delivery and birth-weight Z-score had a stronger association.

CONCLUSION

In this prospective multicenter study, signs of cerebral blood flow redistribution were found to be associated with adverse outcome in late preterm singleton pregnancies at risk of fetal growth restriction. Whether cerebral redistribution is a marker describing the severity of fetal growth restriction or an independent risk factor for adverse outcome remains unclear, and whether it is useful for clinical management can be answered only in a randomized trial. © 2020 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.

Maternal Sildenafil vs Placebo in Pregnant Women With Severe Early-Onset Fetal Growth Restriction: A Randomized Clinical Trial

IMPORTANCE

Severe early onset fetal growth restriction caused by placental dysfunction leads to high rates of perinatal mortality and neonatal morbidity. The phosphodiesterase 5 inhibitor, sildenafil, inhibits cyclic guanosine monophosphate hydrolysis, thereby activating the effects of nitric oxide, and might improve uteroplacental function and subsequent perinatal outcomes.

OBJECTIVE

To determine whether sildenafil reduces perinatal mortality or major morbidity.

DESIGN, SETTING, AND PARTICIPANTS

This placebo-controlled randomized clinical trial was conducted at 10 tertiary referral centers and 1 general hospital in the Netherlands from January 20, 2015, to July 16, 2018. Participants included pregnant women between 20 and 30 weeks of gestation with severe fetal growth restriction, defined as fetal abdominal circumference below the third percentile or estimated fetal weight below the fifth percentile combined with Dopplers measurements outside reference ranges or a maternal hypertensive disorder. The trial was stopped early owing to safety concerns on July 19, 2018, whereas benefit on the primary outcome was unlikely. Data were analyzed from January 20, 2015, to January 18, 2019. The prespecified primary analysis was an intention-to-treat analysis including all randomized participants.

INTERVENTIONS

Participants were randomized to sildenafil, 25 mg, 3 times a day vs placebo.

MAIN OUTCOMES AND MEASURES

The primary outcome was a composite of perinatal mortality or major neonatal morbidity until hospital discharge.

RESULTS

Out of 360 planned participants, a total of 216 pregnant women were included, with 108 women randomized to sildenafil (median gestational age at randomization, 24 weeks 5 days [interquartile range, 23 weeks 3 days to 25 weeks 5 days]; mean [SD] estimated fetal weight, 458 [160] g) and 108 women randomized to placebo (median gestational age, 25 weeks 0 days [interquartile range, 22 weeks 5 days to 26 weeks 3 days]; mean [SD] estimated fetal weight, 464 [186] g). In July 2018, the trial was halted owing to concerns that sildenafil may cause neonatal pulmonary hypertension, whereas benefit on the primary outcome was unlikely. The primary outcome, perinatal mortality or major neonatal morbidity, occurred in the offspring of 65 participants (60.2%) allocated to sildenafil vs 58 participants (54.2%) allocated to placebo (relative risk, 1.11; 95% CI, 0.88-1.40; P = .38). Pulmonary hypertension, a predefined outcome important for monitoring safety, occurred in 16 neonates (18.8%) in the sildenafil group vs 4 neonates (5.1%) in the placebo group (relative risk, 3.67; 95% CI, 1.28-10.51; P = .008).

CONCLUSIONS AND RELEVANCE

These findings suggest that antenatal maternal sildenafil administration for severe early onset fetal growth restriction did not reduce the risk of perinatal mortality or major neonatal morbidity. The results suggest that sildenafil may increase the risk of neonatal pulmonary hypertension.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT02277132.

Spontaneous progression of experimental peri-implantitis in augmented and pristine bone: A pre-clinical in vivo study

OBJECTIVE

To examine the progression of experimental peri-implantitis around different implants placed in augmented and pristine sites.

MATERIALS AND METHODS

Six labrador dogs were used. Three months after tooth extraction, four implants with different surface modifications were installed on each side of the mandible. A standard osteotomy was applied on one side, while on the contralateral side the osteotomy was modified, resulting in a gap between the implant and the bone wall. The gap was filled with a bone substitute and covered by a resorbable membrane. Three months after implant installation, implants were exposed and healing abutments were connected. Two months later, oral hygiene procedures were abandoned and a cotton ligature was placed in a submarginal position around the neck of all implants and kept in place for 4 weeks. Following ligature removal, plaque formation continued for 6 months (spontaneous progression period). Radiographs were obtained throughout the experiment, and biopsies were collected and prepared for histological evaluation at the end of the spontaneous progression period.

RESULTS

Differences in bone loss during the spontaneous progression period between pristine and augmented sites were small. The size and vertical dimension of the peri-implantitis lesion were larger at augmented than at pristine sites. Implants with non-modified surfaces exhibited smaller amounts of bone loss and smaller dimensions of peri-implantitis lesions than implants with modified surfaces.

CONCLUSION

Small differences in spontaneous progression of peri-implantitis were detected between pristine and augmented sites. Implants with modified surfaces exhibited more bone loss and larger lesions than implants with non-modified surfaces, irrespective of the type of surrounding bone.

Regeneration of alveolar ridge defects. Consensus report of group 4 of the 15th European Workshop on Periodontology on Bone Regeneration

BACKGROUND AND AIMS

Bone augmentation procedures to enable dental implant placement are frequently performed. The remit of this working group was to evaluate the current evidence on the efficacy of regenerative measures for the reconstruction of alveolar ridge defects.

MATERIAL AND METHODS

The discussions were based on four systematic reviews focusing on lateral bone augmentation with implant placement at a later stage, vertical bone augmentation, reconstructive treatment of peri-implantitis associated defects, and long-term results of lateral window sinus augmentation procedures.

RESULTS

A substantial body of evidence supports lateral bone augmentation prior to implant placement as a predictable procedure in order to gain sufficient ridge width for implant placement. Also, vertical ridge augmentation procedures were in many studies shown to be effective in treating deficient alveolar ridges to allow for dental implant placement. However, for both procedures the rate of associated complications was high. The adjunctive benefit of reconstructive measures for the treatment of peri-implantitis-related bone defects has only been assessed in a few RCTs. Meta-analyses demonstrated a benefit with regard to radiographic bone gain but not for clinical outcomes. Lateral window sinus floor augmentation was shown to be a reliable procedure in the long term for the partially and fully edentulous maxilla.

CONCLUSIONS

The evaluated bone augmentation procedures were proven to be effective for the reconstruction of alveolar ridge defects. However, some procedures are demanding and bear a higher risk for post-operative complications.

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

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.

Peri-implantitis

OBJECTIVES

This narrative review provides an evidence-based overview on peri-implantitis for the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions.

METHODS

A literature review was conducted addressing the following topics: 1) definition of peri-implantitis; 2) conversion from peri-implant mucositis to peri-implantitis, 3) onset and pattern of disease progression, 4) characteristics of peri-implantitis, 5) risk factors/indicators for peri-implantitis, and 6) progressive crestal bone loss in the absence of soft tissue inflammation.

CONCLUSIONS

1)Peri-implantitis is a pathological condition occurring in tissues around dental implants, characterized by inflammation in the peri-implant connective tissue and progressive loss of supporting bone. 2)The histopathologic and clinical conditions leading to the conversion from peri-implant mucositis to peri-implantitis are not completely understood. 3)The onset of peri-implantitis may occur early during follow-up and the disease progresses in a non-linear and accelerating pattern. 4a)Peri-implantitis sites exhibit clinical signs of inflammation and increased probing depths compared to baseline measurements. 4b)At the histologic level, compared to periodontitis sites, peri-implantitis sites often have larger inflammatory lesions. 4c)Surgical entry at peri-implantitis sites often reveals a circumferential pattern of bone loss. 5a)There is strong evidence that there is an increased risk of developing peri-implantitis in patients who have a history of chronic periodontitis, poor plaque control skills, and no regular maintenance care after implant therapy. Data identifying "smoking" and "diabetes" as potential risk factors/indicators for peri-implantitis are inconclusive. 5b)There is some limited evidence linking peri-implantitis to other factors such as: post-restorative presence of submucosal cement, lack of peri-implant keratinized mucosa and positioning of implants that make it difficult to perform oral hygiene and maintenance. 6)Evidence suggests that progressive crestal bone loss around implants in the absence of clinical signs of soft tissue inflammation is a rare event.

Peri-implantitis

OBJECTIVES

This narrative review provides an evidence-based overview on peri-implantitis for the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions.

METHODS

A literature review was conducted addressing the following topics: 1) definition of peri-implantitis; 2) conversion from peri-implant mucositis to peri-implantitis, 3) onset and pattern of disease progression, 4) characteristics of peri-implantitis, 5) risk factors/indicators for peri-implantitis, and 6) progressive crestal bone loss in the absence of soft tissue inflammation.

CONCLUSIONS

1)Peri-implantitis is a pathological condition occurring in tissues around dental implants, characterized by inflammation in the peri-implant connective tissue and progressive loss of supporting bone. 2)The histopathologic and clinical conditions leading to the conversion from peri-implant mucositis to peri-implantitis are not completely understood. 3)The onset of peri-implantitis may occur early during follow-up and the disease progresses in a non-linear and accelerating pattern. 4a)Peri-implantitis sites exhibit clinical signs of inflammation and increased probing depths compared to baseline measurements. 4b)At the histologic level, compared to periodontitis sites, peri-implantitis sites often have larger inflammatory lesions. 4c)Surgical entry at peri-implantitis sites often reveals a circumferential pattern of bone loss. 5a)There is strong evidence that there is an increased risk of developing peri-implantitis in patients who have a history of chronic periodontitis, poor plaque control skills, and no regular maintenance care after implant therapy. Data identifying "smoking" and "diabetes" as potential risk factors/indicators for peri-implantitis are inconclusive. 5b)There is some limited evidence linking peri-implantitis to other factors such as: post-restorative presence of submucosal cement, lack of peri-implant keratinized mucosa and positioning of implants that make it difficult to perform oral hygiene and maintenance. 6)Evidence suggests that progressive crestal bone loss around implants in the absence of clinical signs of soft tissue inflammation is a rare event.

P14.53 Deconstructing pathologically increased MEG network clustering in glioma patients

Introduction

Functional brain networks in glioma patients are characterized by higher global clustering than healthy controls, indicating stronger connectivity in triads of brain regions when averaging across the entire brain. However, this could be due to either primary increased local clustering of (peri)tumor regions or higher local clustering throughout the entire brain.

METHODS

Magnetoencephalography recordings of 71 glioma patients and 53 HCs were analyzed by calculating functional connectivity with the phase lag index between source-localized time series of 78 cortical regions of the automated anatomical labelling atlas. Per participant, we calculated (1) global average clustering, (2) local clustering of tumor and non-tumor regions, and (3) Euclidean distance between tumor centroids and of all other region centroids.

RESULTS

Glioma patients had higher global average clustering (p=0.002) than HCs. This increase was indeed global: there was no difference between tumor and non-tumor regions (p=0.154) and no association between distance and local clustering (p=0.759). When splitting patients into high (top 25%, n=18) and normal global clustering (other 75%, n=53) to more specifically pick up on the determinants of pathological global average clustering, again no localized or distance-dependent effects were found. High clustering patients were younger than patients with normal global clustering (p=0.027). Posthoc analysis into tumor localization preference for particular network regions in the entire patient cohort revealed greater tumor occurrence in regions with high clustering in HC (p<0.001), while patients with high global clustering showed tumors localized in regions with lower clustering in HC (p=0.032).

CONCLUSION

The functional brain network of a subset of (relatively young) glioma patients is disturbed on a global level, suggesting that treatment thereof might benefit patients. Moreover, our exploratory analyses suggest that gliomas occur more often in normally highly clustered regions, but that tumors occurring in less clustered regions are associated with more extensive global network alterations. These findings may speculatively indicate that patients with and without such pathologically altered global clustering represent distinct phenotypes (both in terms of age and tumor localization) and may also need to be treated as such.

Integrative and comparative genomic analyses identify clinically relevant pulmonary carcinoid groups and unveil the supra-carcinoids

The worldwide incidence of pulmonary carcinoids is increasing, but little is known about their molecular characteristics. Through machine learning and multi-omics factor analysis, we compare and contrast the genomic profiles of 116 pulmonary carcinoids (including 35 atypical), 75 large-cell neuroendocrine carcinomas (LCNEC), and 66 small-cell lung cancers. Here we report that the integrative analyses on 257 lung neuroendocrine neoplasms stratify atypical carcinoids into two prognostic groups with a 10-year overall survival of 88% and 27%, respectively. We identify therapeutically relevant molecular groups of pulmonary carcinoids, suggesting DLL3 and the immune system as candidate therapeutic targets; we confirm the value of OTP expression levels for the prognosis and diagnosis of these diseases, and we unveil the group of supra-carcinoids. This group comprises samples with carcinoid-like morphology yet the molecular and clinical features of the deadly LCNEC, further supporting the previously proposed molecular link between the low- and high-grade lung neuroendocrine neoplasms.

Biological aspects: Summary and consensus statements of group 2. The 5th EAO Consensus Conference 2018

OBJECTIVES

This publication reports the EAO Workshop group-2 discussions and consensus statements which provided the scientific evidence on the influence of biological parameters on implant-related clinical outcomes.

MATERIAL AND METHODS

The first publication was a systematic review on the biological effects of abutment material on the stability of peri-implant marginal bone levels and the second, a critical narrative review on how peri-implant diagnostic parameters correspond with long-term implant survival and success. The group evaluated the content of both publications, made corrections and recommendations to the authors and agreed on the consensus statements, clinical recommendations and recommendations for future research, which are described in this consensus report.

RESULTS

Tested abutment materials can be considered appropriate for clinical use according to the observation period studied (mean 3.5 years). Mean peri-implant bone loss and mean probing pocket depths are not adequate outcomes to study the prevalence of peri-implantitis, while the reporting of frequency distributions is considered more appropriate.

CONCLUSIONS

Titanium is currently considered the standard of care as abutment material, although other materials may be more suitable for aesthetic locations. Peri-implantitis should be diagnosed through composite evaluations of peri-implant tissue inflammation and assessment of marginal bone loss with different thresholds.

Dental implant register: Summary and consensus statements of group 2. The 5th EAO Consensus Conference 2018

OBJECTIVES

This publication reports the EAO Workshop group-2 and consensus plenary discussions and statements on a narrative review providing the background and possible facilities and importance of a dental implant register, to allow for a systematic follow-up of the clinical outcome of dental implant treatment in various clinical settings. It should be observed that the format of the review and the subsequent consensus report consciously departs from conventional consensus publications and reports.

MATERIAL AND METHODS

The publication was a narrative review on the presence and significance of quality registers regarding select medical conditions and procedures. The group discussed and evaluated the publication and made corrections and recommendations to the authors and agreed on the statements and recommendations described in this consensus report.

RESULTS

Possible registrations to be included in an implant register were discussed and agreed as a preliminary basis for further development, meaning that additional parameters be included or some be deleted.

CONCLUSIONS

It was agreed to bring the idea of an implant quality register, including the presented results of discussions and proposals by the group- and plenary sessions, to the EAO Board for further discussion and decision.

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

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.