Clinical Decision Making for Primary Peri-Implantitis Prevention: Practical Applications

Utilization of Low-Magnitude High-Frequency Vibration (LMHFV) as an Aid in Treating Peri-Implantitis: Case Presentations

Peri-implantitis is an inflammatory process initiating in the soft tissue and then progressing to the hard tissue surrounding dental implants leading to loss of osseous support and potential loss of the implant if not identified early in the process. This process initiates in the soft tissue, which become inflamed spreading to the underlying bone leading to decreases in bone density with subsequent crestal resorption and thread exposure. In the absence of treatment of the peri-implantitis, the bone loss at the osseous implant interface progresses with inflammatory mediated decrease in the bone density that moves apically, eventually leading to mobility of the implant and its failure. Low-magnitude high-frequency vibration (LMHFV) has been shown to improve bone density, stimulate osteoblastic activity, and arrest progression of peri-implantitis with improvement of the bone or graft around the affected implant with or without surgery as part of the treatment. Two cases are presented using LMHFV to augment treatment.

Peri-implantitis after 40 years: Evidence, mechanisms, and implications: A mapping review

STATEMENT OF PROBLEM

The high prevalence of peri-implantitis (PI) continues to plague patients and the disease is resistant to present treatment regimens. An analysis of the available research is lacking.

PURPOSE

Given the abundance and diversity of research on the topic of PI, the purpose of this mapping review was to synthesize the literature on the prevention of PI, the histopathology of the disease, the state of present therapeutics, and any emerging treatments.

MATERIAL AND METHODS

An extensive literature search was undertaken by using the electronic databases of PubMed, Web of Science, and Science Direct. The keyword strings were peri-implantitis, dental implant, risk assessment, histopathology, prosthesis design, and treatment. The filters applied were time interval from 2000 to 2002; language, English.

RESULTS

A total of 3635 articles were taken from PubMed, 3686 articles from Web of Science, and 2450 articles from Science Direct. After applying the inclusion and exclusion criteria to the titles and abstracts of selected investigations, 214 studies were retrieved.

CONCLUSIONS

The evidence reflects a concerning incidence of PI, without a predictable treatment protocol. An in-depth patient risk assessment considering risk modification, emphasis on surgical and restorative expertise, and strict recall and maintenance is essential to minimize PI.

Clinical Outcomes of Enamel Matrix Derivate Used in Surgical and Non-Surgical Treatment of Peri-Implantitis: A Systematic Review of Clinical Studies

Background and objectives: The aim of this systematic review was to assess the available evidence of using enamel matrix derivate in the treatment of peri-implantitis. Materials and methods: Three electronic databases (PubMed, Scopus, and Web of Science) were searched until August 2022 to identify relevant articles. The inclusion criteria consisted in human clinical studies that reported the use of enamel matrix derivate (EMD) in surgical and non-surgical treatment of peri-implantitis. The risk of bias was assessed using Cochrane risk of bias tool for randomized clinical trials (RCTs) and for non-RCTs ROBINS-I tool. Results: Clinical studies included were published between 2012 and 2022 and consisted of two randomized clinical trials (RCTs) for non-surgical therapy and two RCTs, three prospective cohort studies, and one retrospective case series in surgical therapy. Due to the heterogeneity of patients' characteristics and assessment of peri-implant therapy, statistical analysis could not be achieved. Conclusions: The use of EMD indicated a positive effect on both surgical and non-surgical therapy. However, the available literature is scarce, with low evidence in non-surgical approach and modest evidence in surgical approach using EMD. More RCTs with standardize protocols are necessary to evaluate the efficacy of using EMD in both therapies.

Does prophylactic application of doxycycline at the implant-abutment interface improve clinical outcomes of dental implants?

Design Randomised controlled clinical trial.Data sources Not applicable.Study aims This split-mouth randomised controlled clinical trial assessed the effects of placing doxycycline hyclate (Atridox) at the implant-abutment interface on the short-term clinical outcomes of dental implants.Methods The study sample included 20 patients; each patient had two mandibular implants placed, one on either side of the mandible, resulting in a total of 40 implants placed in the study sample. At the time of final prosthesis delivery, doxycycline hyclate (Atridox 10% doxycycline hyclate) was injected at the implant-abutment interface of 20 randomly selected implants on the test side (N = 20) while no intervention was done on the control side (N = 20). The primary outcome measure was changes in pocket probing depth while secondary outcome measures included the incidence of peri-implant mucositis, bleeding on probing, and changes in marginal bone levels on mesial and distal bone aspects of the implant. The outcome measures were assessed at baseline, 3 months, 6 months and 12 months.Results The results showed favourable effects of prophylactic doxycycline application. Marginal bone levels and pocket probing depths after 6 and 12 months on the test side were less compared to the control side and these differences were statistically significant. The test side also showed fewer implants with bleeding on probing and lower risk of peri-implant mucositis after 3, 6 and 12 months.Conclusion Prophylactic placement of doxycycline hyclate may reduce peri-implant bone loss and pocket probing depths, and may also reduce the risk of peri-implant mucositis.

C3-targeted host-modulation approaches to oral inflammatory conditions

Periodontitis is an inflammatory disease caused by biofilm accumulation and dysbiosis in subgingival areas surrounding the teeth. If not properly treated, this oral disease may result in tooth loss and consequently poor esthetics, deteriorated masticatory function and compromised quality of life. Epidemiological and clinical intervention studies indicate that periodontitis can potentially aggravate systemic diseases, such as, cardiovascular disease, type 2 diabetes mellitus, rheumatoid arthritis, and Alzheimer disease. Therefore, improvements in the treatment of periodontal disease may benefit not only oral health but also systemic health. The complement system is an ancient host defense system that plays pivotal roles in immunosurveillance and tissue homeostasis. However, complement has unwanted consequences if not controlled appropriately or excessively activated. Complement overactivation has been observed in patients with periodontitis and in animal models of periodontitis and drives periodontal inflammation and tissue destruction. This review places emphasis on a promising periodontal host-modulation therapy targeting the complement system, namely the complement C3-targeting drug, AMY-101. AMY-101 has shown safety and efficacy in reducing gingival inflammation in a recent Phase 2a clinical study. We also discuss the potential of AMY-101 to treat peri-implant inflammatory conditions, where complement also seems to be involved and there is an urgent unmet need for effective treatment.

Influence of clinician gender, age, and geographic work location on the relative rankings of risk factors for biological complications with dental implant therapy

STATEMENT OF PROBLEM

Clinician perceptions of risk factors influencing biologic complications with dental implants are poorly understood but are relevant to how clinicians manage conversations with patients seeking dental implant therapy.

PURPOSE

The purpose of this clinician survey was to assess the relative ranking of biologic risk factors with dental implants identified via the history, clinical examination, and clinical decisions and postimplant placement findings.

MATERIALS AND METHODS

A 10-item survey instrument was tested, refined, and distributed to past participants of the Future Leaders in Prosthodontics (FLIP) workshop series asking for their opinion on the relative ranking of commonly identified risk factors in the areas of patient history, clinical examination, and clinical decisions and postimplant placement findings. Descriptive statistics and frequency tables were developed to identify age groupings, geographic work location, and gender. Group differences with respect to risk factor rankings were identified by using Kruskal-Wallis H tests, and, if significant, paired comparisons were conducted using the Mann-Whitney U test with adjustments for Type I error (α=.05).

RESULTS

Significant differences were found by gender, age, and geographic work location. Women viewed "implant placement in site of previous implant loss" (P=.013) and "treated moderate or severe chronic periodontitis" (P=.021) as having significantly greater relative importance than did men, yet men ranked "implant position closer than 1.5 mm from adjacent tooth" (P=.023), "currently using selective serotonin reuptake inhibitor drugs (SSRI)" (P=.001), and "heavy plaque index (PI>50%)" (P=.023) as having significantly greater relative importance than did women. Significant differences were found by geographic work location of practice with respondents from Australasia viewing "treatment plan includes prostheses that limit access for cleaning resulting in an increase in bacterial load" as having greater relative importance than did respondents from Africa (P<.001) and from South America (P<.001). Respondents from South America viewed "implant lacks 2.0 mm of attached tissue around implants" as having greater relative importance than did respondents from Australasia (P<.002) or Asia (P<.001).

CONCLUSIONS

Clinicians viewed the relative importance of risk factors for biologic complications with dental implants differently, and those differences varied by clinicians' age, gender, and geographic location of practice.