Ibero-Panamerican Federation of Periodontics Delphi study on the trends in diagnosis and treatment of peri-implant diseases and conditions: A Latin American consensus

Effectiveness of antimicrobial photodynamic therapy in the treatment of peri-implantitis: systematic review and meta-analysis

The purpose of this study was to evaluate the current scientific evidence on the effectiveness of antimicrobial photodynamic therapy (aPDT) as an adjunctive treatment to mechanical debridement in the treatment of peri-implantitis. The Preferred Reporting Items for Systematic Reviews and Meta-analyses was followed. A protocol was registered in the International Prospective Registry of Systematic Reviews (PROSPERO #CRD42022361684). The search was carried out in seven databases, with no restrictions regarding language or year of publication. Our work included studies that compared clinical periodontal parameters between individuals treated with mechanical debridement associated with aPDT and a control group of patients who had undergone mechanical debridement alone. Study selection, data extraction, and risk of bias assessment (RoB 2.0) were performed by two review authors. Meta-analysis was performed. The mean difference (MD) and a 95% confidence interval (CI) were provided. Four hundred and seven-four studies were identified, of which five studies were included. The meta-analysis demonstrated that aPDT adjunctive to mechanical debridement in subjects with peri-implantitis resulted in greater reduction in probing depth 3 months after treatment than among subjects receiving treatment with mechanical debridement. Most of the included studies exhibit a low risk of bias. Adjunctive aPDT to mechanical debridement contributes to the improvement of peri-implant clinical parameters in individuals with peri-implantitis, in particular probing depth.

How can outdoor sports protect themselves against climate change-related health risks? - A prevention model based on an expert Delphi study

OBJECTIVES

To systematically develop an adaptation model to reduce climate change-related health risks for outdoor athletes.

DESIGN

Delphi Method study.

METHODS

A classic asynchronous Delphi study was conducted with a total of three survey rounds. 24 experts from the eight largest outdoor sport associations by membership in the German Olympic Sports Confederation were included as well as 24 medical experts with expertise in sport medicine, internal medicine, allergology, dermatology, infectiology, or toxicology. Based on open-ended questions, panelists were asked to consider prevention measures for sport organizations and clubs. Free text responses were analyzed by qualitative content analysis according to Mayring.

RESULTS

Experts recommended establishing the following eight fields of prevention measures: technical and structural measures; organizational measures; personalized measures; basic, advanced, and continuing education; concepts of action, warning concepts, and financial concepts; cooperation and coordination; campaigns; and evaluation measures.

CONCLUSIONS

The pyramid model presented in this study systematizes possible sport-specific adaptation measures on climate change by empirical aggregation of knowledge from scientists, sport organizations, clubs, trainers, and professional athletes. To assess the effectiveness of these prevention measures, sport organizations may incorporate them not only into broader operations but also everyday training routines.

Influence of macrophage polarization on the effectiveness of surgical therapy of peri-implantitis

Purpose

To evaluate the influence of macrophage expression and polarization on the effectiveness of surgical therapy of peri-implantitis over a 6 month follow-up.

Methods

A total of fourteen patients (n = 14 implants) diagnosed with peri-implantitis underwent access flap surgery, granulation tissue removal, implantoplasty, and augmentation at intra-bony components using a natural derived bone mineral and application of a native collagen membrane during a standardized surgical procedure. Granulation tissue biopsies were prepared for immunohistochemical characterization and macrophage polarization assessment. M1 and M2 phenotype expression was identified and quantified through immunohistochemical markers and histomorphometrical analyses. Clinical evaluation and data collection were performed initially and after a healing period of 6 months. Statistical analyses were performed to associate infiltrated area, macrophage, and M1/M2 phenotype influence on peri-implant tissue healing parameters after a 6-month follow-up.

Results

Mean infiltrated compartment (ICT) values occupied a total percentage of 70.3% ± 13.0 in the analyzed granulation tissue biopsies. Macrophages occupied a mean area of 15.3% ± 7.0. M1 and M2 phenotypes were present in 7.1 ± 4.1% and 5.5 ± 3.7%, respectively. No statistically significant difference was observed between M1 and M2% expression (p = 0.16). The mean M1/ M2 ratio amounted to 1.5 ± 0.8. Surgical therapy was associated with statistically significant reductions in mean bleeding on probing (BOP), probing depth (PD) and suppuration (SUPP) scores at 6 months (p < 0.05). Linear regression analyses revealed a significant correlation between macrophage expression (CD68%) and changes in PD scores and M1 (%) expression and changes in mucosal recession (MR) scores at 6 months.

Conclusions

The present data suggest that macrophages might influence peri-implant tissue healing mechanisms following surgical therapy of peri-implantitis over a short-term period. Particularly, changes in PD and MR scores were statistically significantly associated with macrophage expression and phenotype.

Graphical Abstract

Peri-Implant Diseases

Osseointegrated dental implants have become an increasingly popular modality of treatment for the replacement of absent or lost teeth because of its high rates of long-term survival when used to support various types of dental prostheses. However, complications and implant failure can still occur and are considered by many clinicians as a major obstacle for implant treatment. Biological complications mainly refer to inflammatory conditions of the soft tissues and bone surrounding implants and their restorative components, which are induced by the accumulation of bacterial biofilm. Two clinical varieties may be distinguished: peri-implant mucositis and peri-implantitis. Peri-implant mucositis is a reversible, plaque-induced inflammatory lesion confined to the peri-implant soft tissue unit, whereas peri-implantitis is an extension of peri-implant mucositis to involve the bone supporting the implant. Diagnosing and managing these biological complications is of utmost importance for the implant surgeon and dental practitioner. This review encompasses the etiology, diagnostic aspects, prevention, and management of biological complications.