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Pereira R, Maia P, Rios-Santos JV, Herrero-Climent M, Rios-Carrasco B, Aparicio C, Gil J. Influence of Titanium Surface Residual Stresses on Osteoblastic Response and Bacteria Colonization. MATERIALS (BASEL, SWITZERLAND) 2024; 17:1626. [PMID: 38612139 PMCID: PMC11012676 DOI: 10.3390/ma17071626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 03/27/2024] [Accepted: 03/28/2024] [Indexed: 04/14/2024]
Abstract
Grit basting is the most common process applied to titanium dental implants to give them a roughness that favors bone colonization. There are numerous studies on the influence of roughness on osseointegration, but the influence of the compressive residual stress associated with this treatment on biological behavior has not been determined. For this purpose, four types of surfaces have been studied using 60 titanium discs: smooth, smooth with residual stress, rough without stress, and rough with residual stress. Roughness was studied by optic interferometry; wettability and surface energy (polar and dispersive components) by contact angle equipment using three solvents; and residual stresses by Bragg-Bentano X-ray diffraction. The adhesion and alkaline phosphatase (ALP) levels on the different surfaces were studied using Saos-2 osteoblastic cultures. The bacterial strains Streptococcus sanguinis and Lactobacillus salivarius were cultured on different surfaces, determining the adhesion. The results showed that residual stresses lead to increased hydrophilicity on the surfaces, as well as an increase in surface energy, especially on the polar component. From the culture results, higher adhesion and higher ALP levels were observed in the discs with residual stresses when compared between smooth and roughened discs. It was also found that roughness was the property that mostly influenced osteoblasts' response. Bacteria colonize rough surfaces better than smooth surfaces, but no changes are observed due to residual surface tension.
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Affiliation(s)
- Rita Pereira
- Facultad de Odontología, Universidad de Sevilla, Calle Avicena s/n, 41009 Sevilla, Spain; (R.P.); (J.V.R.-S.); (B.R.-C.)
| | - Paulo Maia
- Facultade Ciências da Saúde, Universidad Europeia de Lisboa,1500-210 Lisboa, Portugal;
| | - Jose Vicente Rios-Santos
- Facultad de Odontología, Universidad de Sevilla, Calle Avicena s/n, 41009 Sevilla, Spain; (R.P.); (J.V.R.-S.); (B.R.-C.)
| | | | - Blanca Rios-Carrasco
- Facultad de Odontología, Universidad de Sevilla, Calle Avicena s/n, 41009 Sevilla, Spain; (R.P.); (J.V.R.-S.); (B.R.-C.)
| | - Conrado Aparicio
- Facultad de Odontología, Universitat Internacional de Catalunya, c/ Josep Trueta s/n, 08195 Sant Cugat del Vallés, Spain;
| | - Javier Gil
- Bioengineering Institute of Technology, Universidad Internacional de Catalunya, c/ Josep Trueta s/n, 08195 Sant Cugat del Vallés, Spain
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Ng E, Tay JRH, Mattheos N, Bostanci N, Belibasakis GN, Seneviratne CJ. A Mapping Review of the Pathogenesis of Peri-Implantitis: The Biofilm-Mediated Inflammation and Bone Dysregulation (BIND) Hypothesis. Cells 2024; 13:315. [PMID: 38391928 PMCID: PMC10886485 DOI: 10.3390/cells13040315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 02/04/2024] [Accepted: 02/07/2024] [Indexed: 02/24/2024] Open
Abstract
This mapping review highlights the need for a new paradigm in the understanding of peri-implantitis pathogenesis. The biofilm-mediated inflammation and bone dysregulation (BIND) hypothesis is proposed, focusing on the relationship between biofilm, inflammation, and bone biology. The close interactions between immune and bone cells are discussed, with multiple stable states likely existing between clinically observable definitions of peri-implant health and peri-implantitis. The framework presented aims to explain the transition from health to disease as a staged and incremental process, where multiple factors contribute to distinct steps towards a tipping point where disease is manifested clinically. These steps might be reached in different ways in different patients and may constitute highly individualised paths. Notably, factors affecting the underlying biology are identified in the pathogenesis of peri-implantitis, highlighting that disruptions to the host-microbe homeostasis at the implant-mucosa interface may not be the sole factor. An improved understanding of disease pathogenesis will allow for intervention on multiple levels and a personalised treatment approach. Further research areas are identified, such as the use of novel biomarkers to detect changes in macrophage polarisation and activation status, and bone turnover.
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Affiliation(s)
- Ethan Ng
- Department of Restorative Dentistry, National Dental Centre Singapore, Singapore 168938, Singapore;
| | - John Rong Hao Tay
- Department of Restorative Dentistry, National Dental Centre Singapore, Singapore 168938, Singapore;
| | - Nikos Mattheos
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chulalongkorn University, Bangkok 10330, Thailand;
- Division of Oral Health and Periodontology, Department of Dental Medicine, Karolinska Institute, 14152 Stockholm, Sweden; (N.B.); (G.N.B.)
| | - Nagihan Bostanci
- Division of Oral Health and Periodontology, Department of Dental Medicine, Karolinska Institute, 14152 Stockholm, Sweden; (N.B.); (G.N.B.)
| | - Georgios N. Belibasakis
- Division of Oral Health and Periodontology, Department of Dental Medicine, Karolinska Institute, 14152 Stockholm, Sweden; (N.B.); (G.N.B.)
| | - Chaminda Jayampath Seneviratne
- School of Dentistry, The University of Queensland, Brisbane, QLD 4006, Australia
- School of Dentistry, Center for Oral-Facial Regeneration, Rehabilitation and Reconstruction (COR3), The University of Queensland, Brisbane, QLD 4072, Australia
- National Dental Research Institute Singapore, National Dental Centre Singapore, Singapore 168938, Singapore
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Berglundh T, Mombelli A, Schwarz F, Derks J. Etiology, pathogenesis and treatment of peri-implantitis: A European perspective. Periodontol 2000 2024. [PMID: 38305506 DOI: 10.1111/prd.12549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 12/19/2023] [Accepted: 12/22/2023] [Indexed: 02/03/2024]
Abstract
Peri-implantitis is a plaque-associated pathological condition occurring in tissues around dental implants. It is characterized by inflammation in the peri-implant mucosa and progressive loss of supporting bone. Over the last 30 years, peri-implantitis has become a major disease burden in dentistry. An understanding of the diagnosis, etiology and pathogenesis, epidemiology, and treatment of peri-implantitis must be a central component in undergraduate and postgraduate training programs in dentistry. In view of the strong role of European research in periodontology and implant dentistry, the focus of this review was to address peri-implantitis from a European perspective. One component of the work was to summarize new and reliable data on patients with dental implants to underpin the relevance of peri-implantitis from a population perspective. The nature of the peri-implantitis lesion was evaluated through results presented in preclinical models and evaluations of human biopsy material together with an appraisal of the microbiological characteristics. An overview of strategies and outcomes presented in clinical studies on nonsurgical and surgical treatment of peri-implantitis is discussed with a particular focus on end points of therapy and recommendations presented in the S3 level Clinical Practice Guideline for the prevention and treatment of peri-implant diseases.
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Affiliation(s)
- Tord Berglundh
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Andrea Mombelli
- Division of Regenerative Dental Medicine and Periodontology, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Frank Schwarz
- Department of Oral Surgery and Implantology, Goethe University, Carolinum, Frankfurt, Germany
| | - Jan Derks
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Monje A, Pons R, Nart J, Miron RJ, Schwarz F, Sculean A. Selecting biomaterials in the reconstructive therapy of peri-implantitis. Periodontol 2000 2024; 94:192-212. [PMID: 37728141 DOI: 10.1111/prd.12523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/28/2023] [Accepted: 08/21/2023] [Indexed: 09/21/2023]
Abstract
Peri-implantitis is a pathogenic inflammatory condition characterized by progressive bone loss and clinical inflammation that may compromise the stability of dental implants. Therapeutic modalities have been advocated to arrest the disorder and to establish peri-implant health. Reconstructive therapy is indicated for bone defects exhibiting contained/angular components. This therapeutic modality is based upon the application of the biological and technical principles of periodontal regeneration. Nonetheless, the comparative efficacy of reconstructive therapy and nonreconstructive modalities remains unclear. Therefore, the aim of this narrative review is to address major clinical concerns regarding the efficacy, effectiveness, and feasibility of using biomaterials in peri-implantitis therapy. In particular, the use of bone grafting materials, barrier membranes, and biologics is comprehensively explored.
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Affiliation(s)
- Alberto Monje
- Department of Periodontology and Oral Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Department of Periodontology, Universitat Internacional de Catalunya, Barcelona, Spain
- Department of Periodontology, University of Bern, Bern, Switzerland
| | - Ramón Pons
- Department of Periodontology, Universitat Internacional de Catalunya, Barcelona, Spain
| | - José Nart
- Department of Periodontology, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Richard J Miron
- Department of Periodontology, University of Bern, Bern, Switzerland
| | - Frank Schwarz
- Department of Oral Surgery and Implantology, Goethe University, Frankfurt, Germany
| | - Anton Sculean
- Department of Periodontology, University of Bern, Bern, Switzerland
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Monje A, Pons R, Sculean A, Nart J, Wang HL. Defect angle as prognostic indicator in the reconstructive therapy of peri-implantitis. Clin Implant Dent Relat Res 2023; 25:992-999. [PMID: 37405662 DOI: 10.1111/cid.13244] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 06/10/2023] [Accepted: 06/18/2023] [Indexed: 07/06/2023]
Abstract
OBJECTIVE To analyze the influence of the characteristics of bone defects caused by peri-implantitis on the clinical resolution and radiographic bone gain following reconstructive surgery. METHODS This is a secondary analysis of a randomized clinical trial. Periapical x-rays of bone defects, caused by peri-implantitis exhibiting intrabony component, were analyzed at baseline and 12-month follow-up after reconstructive surgery. Therapy consisted of anti-infective therapy along with a mixture of allografts with or without a collagen barrier membrane. The association of defect configuration, defect angle (DA), defect width (DW), and baseline marginal bone level (MBL) with clinical resolution (based on a prior defined composite criteria) and radiographic bone gain was correlated by means of generalized estimating equations. RESULTS Overall, 33 patients with a total of 48 implants exhibiting peri-implantitis were included. None of the evaluated variables yielded statistical significance with disease resolution. Defect configuration demonstrated statistical significance when compared to class 1B and 3B, favoring radiographic bone gain for the former (p = 0.005). DW and MBL did not demonstrate statistical significance with radiographic bone gain. On the contrary, DA exhibited strong statistical significance with bone gain (p < 0.001) in the simple and multiple logistic regression analyses. Mean DA reported in this study was 40°, and this resulted in 1.85 mm radiographic bone gain. To achieve ≥1 mm of bone gain, DA must be <57°, while to attain ≥2 mm of bone gain, DA must be <30°. CONCLUSION Baseline DA of peri-implantitis intrabony components predicts radiographic bone gain in reconstructive therapy (NCT05282667-this clinical trial was not registered prior to participant recruitment and randomization).
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Affiliation(s)
- Alberto Monje
- Department of Periodontology and Oral Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Department of Periodontology, Universitat Internacional de Catalunya, Barcelona, Spain
- Department of Periodontology, University of Bern, Bern, Switzerland
| | - Ramón Pons
- Department of Periodontology, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Anton Sculean
- Department of Periodontology, University of Bern, Bern, Switzerland
| | - José Nart
- Department of Periodontology, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Hom-Lay Wang
- Department of Periodontology and Oral Medicine, University of Michigan, Ann Arbor, Michigan, USA
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Robles D, Brizuela A, Fernández-Domínguez M, Gil J. Corrosion Resistance and Titanium Ion Release of Hybrid Dental Implants. MATERIALS (BASEL, SWITZERLAND) 2023; 16:ma16103650. [PMID: 37241275 DOI: 10.3390/ma16103650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/02/2023] [Accepted: 05/09/2023] [Indexed: 05/28/2023]
Abstract
One of the strategies for the fight against peri-implantitis is the fabrication of titanium dental implants with the part close to the neck without roughness. It is well known that roughness favors osseointegration but hinders the formation of biofilm. Implants with this type of structure are called hybrid dental implants, which sacrifice better coronal osseointegration for a smooth surface that hinders bacterial colonization. In this contribution, we have studied the corrosion resistance and the release of titanium ions to the medium of smooth (L), hybrid (H), and rough (R) dental implants. All implants were identical in design. Roughness was determined with an optical interferometer and residual stresses were determined for each surface by X-ray diffraction using the Bragg-Bentano technique. Corrosion studies were carried out with a Voltalab PGZ301 potentiostat, using Hank's solution as an electrolyte at a temperature of 37 °C. Open-circuit potentials (Eocp), corrosion potential (Ecorr), and current density (icorr) were determined. Implant surfaces were observed by JEOL 5410 scanning electron microscopy. Finally, for each of the different dental implants, the release of ions into Hank's solution at 37 °C at 1, 7, 14, and 30 days of immersion was determined by ICP-MS. The results, as expected, show a higher roughness of R with respect to L and compressive residual stresses of -201.2 MPa and -20.2 MPa, respectively. These differences in residual stresses create a potential difference in the H implant corresponding to Eocp of -186.4 mV higher than for the L and R of -200.9 and -192.2 mV, respectively. The corrosion potentials and current intensity are also higher for the H implants (-223 mV and 0.069 μA/mm2) with respect to the L (-280 mV and 0.014 μA/mm2 and R (-273 mV and 0.019 μA/mm2). Scanning electron microscopy revealed pitting in the interface zone of the H implants and no pitting in the L and R dental implants. The titanium ion release values to the medium are higher in the R implants due to their higher specific surface area compared to the H and L implants. The maximum values obtained are low, not exceeding 6 ppb in 30 days.
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Affiliation(s)
- Daniel Robles
- Department of Translational Medicine CEU, San Pablo University, Urbanización Montepríncipe, Alcorcón, 28925 Madrid, Spain
- Facultad de Odontología, Universidad Europea Miguel de Cervantes, C/del Padre Julio Chevalier 2, 47012 Valladolid, Spain
| | - Aritza Brizuela
- Facultad de Odontología, Universidad Europea Miguel de Cervantes, C/del Padre Julio Chevalier 2, 47012 Valladolid, Spain
| | - Manuel Fernández-Domínguez
- Department of Oral and Maxillofacial Surgery, Hospital Monteprincipe, University CEU San Pablo, Av. de Montepríncipe s/n, Alcorcón, 28668 Madrid, Spain
| | - Javier Gil
- Bioengineering Institute of Technology, Facultad de Medicina y Ciencias de la Salud, Universidad Internacional de Catalunya, Josep Trueta s/n, Sant Cugat del Vallés, 08195 Barcelona, Spain
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Rodriguez-González R, Monsalve-Guil L, Jimenez-Guerra A, Velasco-Ortega E, Moreno-Muñoz J, Nuñez-Marquez E, Pérez RA, Gil J, Ortiz-Garcia I. Relevant Aspects of Titanium Topography for Osteoblastic Adhesion and Inhibition of Bacterial Colonization. MATERIALS (BASEL, SWITZERLAND) 2023; 16:ma16093553. [PMID: 37176435 PMCID: PMC10180273 DOI: 10.3390/ma16093553] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 04/27/2023] [Accepted: 05/04/2023] [Indexed: 05/15/2023]
Abstract
The influence of the surface topography of dental implants has been studied to optimize titanium surfaces in order to improve osseointegration. Different techniques can be used to obtain rough titanium, however, their effect on wettability, surface energy, as well as bacterial and cell adhesion and differentiation has not been studied deeply. Two-hundred disks made of grade 4 titanium were subjected to different treatments: machined titanium (MACH), acid-attacked titanium (AE), titanium sprayed with abrasive alumina particles under pressure (GBLAST), and titanium that has been treated with GBLAST and then subjected to AE (GBLAST + AE). The roughness of the different treatments was determined by confocal microscopy, and the wettability was determined by the sessile drop technique; then, the surface energy of each treatment was calculated. Osteoblast-like cells (SaOs-2) were cultured, and alkaline phosphatase was determined using a colorimetric test. Likewise, bacterial strains S. gordonii, S. oralis, A. viscosus, and E. faecalis were cultured, and proliferation on the different surfaces was determined. It could be observed that the roughness of the GBLAST and GBLAS + AE was higher, at 1.99 and 2.13 μm of Ra, with respect to the AE and MACH samples, which were 0.35 and 0.20 μm, respectively. The abrasive treated surfaces showed lower hydrophilicity but lower surface energy. Significant differences could be seen at 21 days between SaOS-2 osteoblastic cell adhesion for the blasted ones and higher osteocalcin levels. However, no significant differences in terms of bacterial proliferation were observed between the four surfaces studied, demonstrating the insensitivity of bacteria to topography. These results may help in the search for the best topographies for osteoblast behavior and for the inhibition of bacterial colonization.
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Affiliation(s)
- Raquel Rodriguez-González
- Bioengineering Institute of Technology, Faculty of Dentistry, Universitat Internacional de Catalunya, Sant Cugat del Vallé, 08198 Barcelona, Spain
| | | | | | | | | | | | - Roman A Pérez
- Bioengineering Institute of Technology, Faculty of Dentistry, Universitat Internacional de Catalunya, Sant Cugat del Vallé, 08198 Barcelona, Spain
| | - Javier Gil
- Bioengineering Institute of Technology, Faculty of Dentistry, Universitat Internacional de Catalunya, Sant Cugat del Vallé, 08198 Barcelona, Spain
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Effect of Implantoplasty on Roughness, Fatigue and Corrosion Behavior of Narrow Diameter Dental Implants. J Funct Biomater 2023; 14:jfb14020061. [PMID: 36826860 PMCID: PMC9967762 DOI: 10.3390/jfb14020061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 01/17/2023] [Accepted: 01/18/2023] [Indexed: 01/25/2023] Open
Abstract
Implantoplasty (IP) is used in dental implants with peri-implantitis and aims to remove threads and polish rough surfaces in order to prevent bacterial colonization. As a result of this procedure, implant strength might be compromised. We tested 20 tapered screw-shaped Ti6Al4V dental implants with a simulated bone loss of 50%. Ten implants underwent IP and 10 served as controls. Surface topography (Sa, Sz, Ssk, and Sdr) was analyzed with a confocal optical microscope. Subsequently, a minimum of four series of cyclic loads were applied with a servo-hydraulic mechanical testing machine (5 × 106 cycles at 15 Hz, between a maximal nominal value-starting at 529 N in the IP group and 735 N in the control group-and 10% of that force). We recorded the number of cycles until failure and the type of failure. Implant failure was analyzed by visual inspection and scanning electron microscopy. Open circuit potential and potenctiodynamic tests were carried out with high precision potentiostat using Hank's solution at 37 °C to evaluate the effect of the implantoplasty on the corrosion resistance. Implantoplasty significantly reduced the surface topography values (median) and interquartile range (IQR); Sa from 1.76 (IQR = 0.11) to 0.49 (IQR = 0.16), Sz from 20.98 (IQR = 8.14) to 8.19 (IQR = 4.16), Ssk from 0.01 (IQR = 0.34) to -0.74 (IQR = 0.53) and Sdr from 18.20 (IQR = 2.26) to 2.67 (IQR = 0.87). The fatigue limits of the control and implantoplasty groups were 551 N and 529 N, respectively. The scanning electron micrographs showed fatigue striations indicating fatigue failure. Besides, the fractographic analysis revealed a typical brittle intergranular fracture mechanism. The infinite life range of the dental implants evaluated was largely above the threshold of usual chewing forces. Implantoplasty seems to render a fairly smooth surface and has a limited impact on fatigue resistance. In addition, implantoplasty produces a decrease in the corrosion resistance of the implant. Corrosion current density from 0.019 μA/cm2 for as-received to 0.069 μA/cm2 in the interface smooth-roughened dental implant. These places between the machining and the rough area of the implant are the most susceptible, with the appearance of pitting.
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Monje A, Pons R, Vilarrasa J, Nart J, Wang HL. Significance of barrier membrane on the reconstructive therapy of peri-implantitis: A randomized controlled trial. J Periodontol 2022; 94:323-335. [PMID: 36399349 DOI: 10.1002/jper.22-0511] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 10/26/2022] [Accepted: 10/26/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND The objective of this trial was to investigate the clinical and radiographic significance of using a mixture of mineralized and demineralized allografts in combination (M) or not (NM) with a resorbable cross-linked barrier membrane in the reconstructive therapy of peri-implantitis defects. METHODS A two-arm randomized clinical trial was performed in patients diagnosed with peri-implantitis that exhibited contained defects. Clinical parameters were recorded at baseline (T0 ), 6 months (T1 ), and 12 months (T2 ). Radiographic parameters were recorded at T0 and T2 . A composite criterion for disease resolution was defined a priori. A generalized linear model of repeated measures with generalized estimation equation statistical methods was used. RESULTS Overall, 33 patients (nimplants = 48) completed the study. At T2 , mean disease resolution was 77.1%. The use of a barrier membrane did not enhance the probability of disease resolution at T2 (odds ratio [OR] = 1.55, p = 0.737). Conversely, the odds of disease resolution were statistically associated with the modified plaque index recorded at T0 (OR = 0.13, p = 0.006) and keratinized mucosa width (OR = 2.10, p = 0.035). Moreover, women exhibited greater odds to show disease resolution (OR = 5.56, p = 0.02). CONCLUSION Reconstructive therapy by means of a mixture of mineralized and demineralized allografts is effective in clinically resolving peri-implantitis and in gaining radiographic marginal bone level. The addition of a barrier membrane to reconstructive therapy of peri-implantitis does not seem to enhance the outcomes of contained bone defects (NCT05282667).
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Affiliation(s)
- Alberto Monje
- Department of Periodontology and Oral Medicine, University of Michigan, Ann Arbor, Michigan, USA.,Department of Periodontology, Universitat Internacional de Catalunya, Barcelona, Spain.,Department of Stomatology and Oral Surgery, University of Bern, Bern, Switzerland
| | - Ramón Pons
- Department of Periodontology, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Javi Vilarrasa
- Department of Periodontology, Universitat Internacional de Catalunya, Barcelona, Spain
| | - José Nart
- Department of Periodontology, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Hom-Lay Wang
- Department of Periodontology and Oral Medicine, University of Michigan, Ann Arbor, Michigan, USA
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10
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Shah SD, Zheng F, Seghi RR, Lee DJ. Strength of titanium-zirconium alloy implants with a conical connection after implantoplasty. J Prosthet Dent 2022:S0022-3913(22)00511-X. [PMID: 36150928 DOI: 10.1016/j.prosdent.2022.08.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 08/04/2022] [Accepted: 08/05/2022] [Indexed: 10/14/2022]
Abstract
STATEMENT OF PROBLEM Peri-implantitis occurs around dental implants, and implantoplasty has been used to address this ongoing disease; however, the changes to the physical properties of an implant after implantoplasty have not been well documented. PURPOSE The purpose of this in vitro study was to determine the effect of implantoplasty on fracture strength and the load required for plastic deformation after cyclic fatigue on dental implants. MATERIAL AND METHODS Twenty-six titanium/zirconium (TiZr) alloy implants (Roxolid Bone Level Implant; 4.1×10 mm) were embedded with 50% thread exposure and divided into 4 groups based on whether they had implantoplasty treatment by using different diamond rotary instruments and/or cyclic loading at 250 N for 2 million cycles: C0 (control, no cyclic loading), T0 (test, no cyclic loading), CM (control, cyclic loading), and TM (test, cyclic loading). After implantoplasty and/or cyclic loading, all implants underwent a load-to-failure test. The maximum fracture strength (FS) and load required for the onset of plastic deformation (PD) were recorded in Newtons. One-way ANOVA and nonparametric comparisons with control by using the Dunn and Wilcoxon method for joint ranking were used for statistical analysis. RESULTS The mean ±standard deviation FS for C0, CM, T0, and TM was 1465.2 ±86.4 N, 1480.7 ±64.1 N, 1299.3 ±123.8 N, and 1252.1 ±85.7 N, respectively. The mean ±standard deviation load for onset of PD for C0, CM, T0, and TM was 860.2 ±88.1 N, 797.0 ±130.5 N, 776.5 ±181.8 N, and 631.3 ±84.5 N, respectively. The TM group had a significantly lower FS and PD than the C0, CM, and T0 groups (P<.05) CONCLUSIONS: Both fracture strength (FS) and the onset of plastic deformation (PD) were significantly reduced after a TiZr alloy implant received implantoplasty and cyclic loading.
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Affiliation(s)
- Sweety D Shah
- Former Resident, Advanced Prosthodontics Program, Division of Restorative and Prosthetic Dentistry, The Ohio State University College of Dentistry, Columbus, Ohio; Private practice, Charlotte, NC
| | - Fengyuan Zheng
- Associate Clinical Professor and Director, Advanced Education in Prosthodontics Program, Department of Restorative Sciences, Division of Prosthodontics, University of Minnesota School of Dentistry; Minneapolis, Minn
| | - Robert R Seghi
- Professor Emeritus, Division of Restorative and Prosthetic Dentistry, The Ohio State University College of Dentistry, Columbus, Ohio
| | - Damian J Lee
- Associate Professor and Director, Advanced Prosthodontics Program, Division of Restorative and Prosthetic Dentistry, The Ohio State University College of Dentistry, Columbus, Ohio.
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11
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Physicochemical and Biological Characterization of Ti6Al4V Particles Obtained by Implantoplasty: An In Vitro Study. Part I. MATERIALS 2021; 14:ma14216507. [PMID: 34772034 PMCID: PMC8585232 DOI: 10.3390/ma14216507] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 10/15/2021] [Accepted: 10/25/2021] [Indexed: 02/07/2023]
Abstract
Implantoplasty is a mechanical decontamination technique that consists of polishing the supra-osseous component of the dental implant with peri-implantitis. This technique releases metal particles in the form of metal swarf and dust into the peri-implant environment. In the present in vitro study, the following physicochemical characterization tests were carried out: specific surface area, granulometry, contact angle, crystalline structure, morphology, and ion release. Besides, cytotoxicity was in turn evaluated by determining the fibroblastic and osteoblastic cell viability. As a result, the metal debris obtained by implantoplasty presented an equivalent diameter value of 159 µm (range 6–1850 µm) and a specific surface area of 0.3 m2/g on average. The particle had a plate-like shape of different sizes. The release of vanadium ions in Hank’s solution at 37 °C showed no signs of stabilization and was greater than that of titanium and aluminum ions, which means that the alloy suffers from a degradation. The particles exhibited cytotoxic effects upon human osteoblastic and fibroblastic cells in the whole extract. In conclusion, metal debris released by implantoplasty showed different sizes, surface structures and shapes. Vanadium ion levels were higher than that those of the other metal ions, and cell viability assays showed that these particles produce a significant loss of cytocompatibility on osteoblasts and fibroblasts, which means that the main cells of the peri-implant tissues might be injured.
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Monje A, Schwarz F. Principles of Combined Surgical Therapy for the Management of Peri-Implantitis. Clin Adv Periodontics 2021; 12:57-63. [PMID: 34569711 DOI: 10.1002/cap.10186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 09/19/2021] [Indexed: 01/17/2023]
Abstract
FOCUSED CLINICAL QUESTION The purpose of this technical note is to present the principles for combined therapy as well as to illustrate the step-by-step approach of this procedure to efficiently manage peri-implantitis. SUMMARY Peri-implantitis is the primary threat that compromises the longevity of dental implants. This entity is regarded as a biofilm-mediated inflammatory condition. As such, the arrestment of disease is conditioned by the elimination of the etiological factor and the clinical resolution of inflammation by eliminating pathogenic pockets. It was suggested that the therapy of peri-implantitis relies upon defect configuration. In this sense, defect configuration is, in part, conditioned by the dimensions of the alveolar bone and implant position. In the clinical basis, it is frequent to identify combined defects exhibiting area(s) where reconstructive therapy is inefficient due to uncontained defect morphology. These situations represent clinical indications for combined therapy. CONCLUSIONS This therapeutic modality is based on the combination of reconstructive therapy in the infraosseous defect component and surface modification for the area of the implant within the supracrestal component or outside the reparative potential.
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Affiliation(s)
- Alberto Monje
- Department of Periodontology, Universitat Internacional de Catalunya, Barcelona, Spain.,Department of Periodontology, School of Dental Medicine, University of Michigan, Ann Arbor, Michigan, USA
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- Department of Oral Surgery and Implantology, Carolinum Johann Wolfgang Goethe-University Frankfurt, Hesse, Frankfurt, Germany
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