Implant Surface Detoxification: A Comprehensive Review

Effect of bioceramic powder abrasion on different implant surfaces

PURPOSE

Bioceramic coatings have been shown to promote bone repair, which aids in the early integration of implants. This study aimed to evaluate the influence of air abrasion with a bioceramic abrasive on the surface characteristics of different implant materials and surfaces. The dissolution of the applied treatment from the surfaces over 3 weeks was also assessed.

MATERIALS AND METHODS

Discs of three alloys used for dental implants were studied and compared: two types of commercially pure titanium (CpTi)/ (CpTi SLActive) and titanium-zirconia (TiZr). The tested surfaces were: CpTi control (CpC), sandblasted (SB), sandblasted and acid-etched (SBE), and CpTi SLActive®, (TiZr) Roxolid®. Three discs from each group underwent air abrasion with apatite bioceramic powders, 95% hydroxyapatite (HA)/5% calcium oxide (CaO), and 90% hydroxyapatite (HA)/10% calcium oxide (CaO). The treated discs were surface characterized by optical profilometry to obtain surface roughness, scanning electron microscopy (SEM), and energy dispersive X-ray spectroscopy (EDS) to compare element weight percentages of titanium, calcium, and phosphate. Dissolution was assessed using inductively coupled plasma optic emission spectrometry (ICP-OES).

RESULTS

Bioceramic powders were deposited on all tested surfaces leading to changes in surface characteristics. The only statistically significant differences between the material groups for surface roughness were found with 95% HA/5% CaO powder in the Sp and Rp parameters (p = 0.03 and 0.04, respectively). There were no significant differences in the Ca and P wt% between all groups and powders 95% HA/5% CaO and 90% HA/10% CaO (p = 0.14, 0.18, and p = 0.15, 0.12, respectively). A non-uniform dispersion of the treatment on the surface layer was visible on all treated surfaces. The bioceramic powder continued to dissolute from the tested surfaces for 3 weeks.

CONCLUSION

Bioceramic abrasion modifies implant surface characteristics, although the change in surface characteristics resulting from such treatment was not influenced by the implant material or surface treatment. Air abrasion with hydroxyapatite and calcium oxide bioceramics leaves powder deposits on the treated implant surfaces that could potentially influence the healing of implants affected by peri-implantitis.

Correlation between Inflammasomes and Microbiota in Peri-Implantitis

The activation of inflammasomes is thought to induce the inflammatory process around dental implants. No information is available on the correlation between microbiota and inflammasomes in clinical samples from patients suffering peri-implantitis. For this cross-sectional study, 30 biofilm samples were obtained from 19 patients undergoing surgical treatment for peri-implantitis because of the presence of bleeding on probing, probing depth higher than 6 mm, and radiographic bone loss higher than 3 mm. Then, soft tissue samples from around the implant were also collected. The relative abundance of bacteria and alpha-diversity indexes were calculated after analyzing the 16S rRNA gene using next-generation sequencing. The soft-tissue samples were processed for evaluation of the inflammasomes NLRP3 and AIM2 as well as caspase-1 and IL-1β. The relative abundance (mean (SD)) of specific species indicated that the most abundant species were Porphyromonas gingivalis (10.95 (14.17)%), Fusobacterium vincentii (10.93 (13.18)%), Porphyromonas endodontalis (5.89 (7.23)%), Prevotella oris (3.88 (4.94)%), Treponema denticola (2.91 (3.19)%), and Tannerella forsythia (2.84 (4.15)%). Several correlations were found between the species and the immunohistochemical detection of the inflammasomes NLRP3 and AIM2 as well as caspase-1 and IL-1β, both in the epithelium and the lamina propria. A network analysis found an important cluster of variables formed by NLRP3 in the lamina propria and AIM2, caspase-1, and IL-1β in the lamina propria and the epithelium with Prevotella dentalis, Prevotella tannerae, Tannerella forsythia, or Selenomonas timonae. Thus, it could be concluded that inflammasomes NLRP3 and AIM2 and their downstream effectors caspase-1 and interleukin-1β can be significantly associated with specific bacteria.

Osteoblast Attachment on Bioactive Glass Air Particle Abrasion-Induced Calcium Phosphate Coating

Air particle abrasion (APA) using bioactive glass (BG) effectively decontaminates titanium (Ti) surface biofilms and the retained glass particles on the abraded surfaces impart potent antibacterial properties against various clinically significant pathogens. The objective of this study was to investigate the effect of BG APA and simulated body fluid (SBF) immersion of sandblasted and acid-etched (SA) Ti surfaces on osteoblast cell viability. Another goal was to study the antibacterial effect against Streptococcus mutans. Square-shaped 10 mm diameter Ti substrates (n = 136) were SA by grit blasting with aluminum oxide particles, then acid-etching in an HCl-H2SO4 mixture. The SA substrates (n = 68) were used as non-coated controls (NC-SA). The test group (n = 68) was further subjected to APA using experimental zinc-containing BG (Zn4) and then mineralized in SBF for 14 d (Zn4-CaP). Surface roughness, contact angle, and surface free energy (SFE) were calculated on test and control surfaces. In addition, the topography and chemistry of substrate surfaces were also characterized. Osteoblastic cell viability and focal adhesion were also evaluated and compared to glass slides as an additional control. The antibacterial effect of Zn4-CaP was also assessed against S. mutans. After immersion in SBF, a mineralized zinc-containing Ca-P coating was formed on the SA substrates. The Zn4-CaP coating resulted in a significantly lower Ra surface roughness value (2.565 μm; p < 0.001), higher wettability (13.35°; p < 0.001), and higher total SFE (71.13; p < 0.001) compared to 3.695 μm, 77.19° and 40.43 for the NC-SA, respectively. APA using Zn4 can produce a zinc-containing calcium phosphate coating that demonstrates osteoblast cell viability and focal adhesion comparable to that on NC-SA or glass slides. Nevertheless, the coating had no antibacterial effect against S. mutans.

Comprehensive treatment protocol for peri-implantitis: an up-to date narrative review of the literature

This narrative review describes up-to-date treatment options for peri-implantitis and proposes a treatment protocol and flowchart based on the current scientific evidence. Peri-implantitis treatment should be based on the phased treatment protocol for periodontitis, which is a continuous flow of decisions for extraction, nonsurgical and surgical treatments with step-by-step re-evaluation. The protocol's goals are to fulfill the success criteria for peri-implantitis treatment (probing depth of ≤5 mm, and absence of bleeding on probing, suppuration, and progressive bone loss) and to halt disease progression. Fixtures with peri-implantitis can initially be classified as failed or failing. A failed implant needs to be removed. In contrast, nonsurgical and surgical treatments can be applied to a failing implant. Nonsurgical treatment should be the initial treatment for failing implants; however, sole nonsurgical treatment was regarded as inefficient for peri-implantitis. Recent studies have found that the adjunctive use of antibiotics to nonsurgical debridement increased the success of nonsurgical treatment for peri-implantitis. Surgical treatments can be classified into resective, access, and reconstructive surgeries. The technique should be selected according to the patient's bone defect configuration, which relate to regenerative potential. Various combinations of decontamination methods (e.g., mechanical, chemical, and pharmacological approaches) are required to achieve absolute surface decontamination. Clinicians should select an appropriate surface decontamination strategy according to the purpose of surgery. After signs of disease disappear and its progression is halted through active peri-implantitis treatment, it is necessary to enroll patients into maintenance programs. Compliance of patients with the maintenance program reduces the recurrence of peri-implantitis and sustains clinical success after treatment. Maintenance visits should include professional plaque control and hygiene care reinforcement for patients, and their interval should be set according to individual peri-implantitis risk. Clinicians should remind that peri-implantitis treatment is not a single procedure, but rather a continuing cycle of treatment and re-evaluation.

Physical-chemical influences and cell behavior of natural compounds on titanium dental surfaces

The present study evaluated the influence of carvacrol, terpinene-4-ol, and chlorhexidine on the physical-chemical properties of titanium surfaces, cell viability, proliferation, adhesion, and spreading of fibroblasts and osteoblasts in vitro. Titanium surfaces (Ti) were treated with Carvacrol (Cvc), Terpinen-4-ol (T4ol), Chlorhexidine (CHX), DMSO, and ultrapure water (Control group). Physical-chemical modifications were evaluated by surface wettability, the surface free energy (SFE) calculated from the contact angle values using the Owens-Wendt-Rabel-Kaeble (OWRK) equation, scanning electron microscopy (SEM) and energy dispersive spectrometry probe (EDS) system. Cells were seeded onto Ti-treated surfaces and incubated for 24 h and 72 h, then evaluated by Alamar blue assay and fluorescence microscopy. Surfaces treated with Cvc and T4ol showed the presence of Na, O, and Cl. All surfaces showed hydrophilic characteristics and SFE values between 5.5 mN/m and 3.4 mN/m. On the other hand, EDS peaks demonstrated the presence of O and Cl after CHX treatment. A reduction of cell viability and adhesion was noted on titanium surfaces treated with CHX after 24 and 72h. In conclusion, the results indicate that the decontamination with Cvc and T4ol on Ti surfaces does not alter the surface proprieties and allows an adequate interaction with cells involved in the re-osseointegration process such as fibroblasts and osteoblasts.

A double lateral pedicle graft technique for palatal recession coverage on dental implants

Rough surfaces of dental implants, when exposed to the oral environment, are conducive to biofilm colonization and can predispose the affected implant to periimplantitis. Recession coverage using soft-tissue grafts is one of the treatment modalities used for the treatment of exposed implant threads. Recession coverage on the palatal aspect of maxillary implants is difficult due to the firm nature of the palatal mucosa and, consequently has not been widely documented in the literature. This case report documents a novel double-pedicle technique for palatal recession coverage on a dental implant. Two pedicle grafts were obtained from either side of the implant with the mucosal recession: a full-thickness lateral-pedicle graft from the distal aspect and a subepithelial connective tissue pedicle from the mesial aspect. The connective tissue pedicle was stabilized first on the area of mucosal recession and was then covered with the distal full-thickness lateral pedicle. Complete recession coverage was obtained, and the result was observed to be clinically stable after 18 months of follow-up. The technique demonstrated in this report can be a useful tool for the treatment of localized palatal recessions on dental implants.

Tracking soluble and nanoparticulated titanium released in vivo from metal dental implant debris using (single-particle)-ICP-MS

BACKGROUND

This work studies the presence of the Ti, Al and V metal ions and Ti nanoparticles released from the debris produced by the implantoplasty, a surgical procedure used in the clinic, in rat organs.

METHODS

The sample preparation for total Ti determination was carefully optimized using microsampling inserts to minimize the dilution during the acid attack of the lyophilized tissues by a microwave-assisted acid digestion method. An enzymatic digestion method was optimized and applied to the different tissue samples in order to extract the titanium nanoparticles for the single-particle ICP-MS analysis.

RESULTS

A statistically significant increase was found for Ti concentrations from control to experimental groups for several of the studied tissues, being and particularly significant in the case of brain and spleen. Al and V concentrations were detected in all tissues but they were not different when comparing control and experimental animals, except for V in brain. The possible presence of Ti-containing nanoparticles mobilized from the implantoplasty debris was tested using enzymatic digestions and SP-ICP-MS. The presence of Ti-containing nanoparticles was observed in all the analyzed tissues, however, differences on the Ti mass per particle were found between the blanks and the digested tissue and between control and experimental animals in some organs.

CONCLUSION

The developed methodologies, both for ionic and nanoparticulated metal contents in rat organs, have shown the possible increase in the levels of Ti both as ions and nanoparticles in rats subjected to implantoplasty.

Clinical applications of antimicrobial photodynamic therapy in dentistry

Given the emergence of resistant bacterial strains and novel microorganisms that globally threaten human life, moving toward new treatment modalities for microbial infections has become a priority more than ever. Antimicrobial photodynamic therapy (aPDT) has been introduced as a promising and non-invasive local and adjuvant treatment in several oral infectious diseases. Its efficacy for elimination of bacterial, fungal, and viral infections and key pathogens such as Streptococcus mutans, Porphyromonas gingivalis, Candida albicans, and Enterococcus faecalis have been investigated by many invitro and clinical studies. Researchers have also investigated methods of increasing the efficacy of such treatment modalities by amazing developments in the production of natural, nano based, and targeted photosensitizers. As clinical studies have an important role in paving the way towards evidence-based applications in oral infection treatment by this method, the current review aimed to provide an overall view of potential clinical applications in this field and summarize the data of available randomized controlled clinical studies conducted on the applications of aPDT in dentistry and investigate its future horizons in the dental practice. Four databases including PubMed (Medline), Web of Science, Scopus and Embase were searched up to September 2022 to retrieve related clinical studies. There are several clinical studies reporting aPDT as an effective adjunctive treatment modality capable of reducing pathogenic bacterial loads in periodontal and peri-implant, and persistent endodontic infections. Clinical evidence also reveals a therapeutic potential for aPDT in prevention and reduction of cariogenic organisms and treatment of infections with fungal or viral origins, however, the number of randomized clinical studies in these groups are much less. Altogether, various photosensitizers have been used and it is still not possible to recommend specific irradiation parameters due to heterogenicity among studies. Reaching effective clinical protocols and parameters of this treatment is difficult and requires further high quality randomized controlled trials focusing on specific PS and irradiation parameters that have shown to have clinical efficacy and are able to reduce pathogenic bacterial loads with sufficient follow-up periods.

Evaluation of the inflammatory and osteogenic response induced by titanium particles released during implantoplasty of dental implants

Implantoplasty is a mechanical decontamination technique that consists of removing the threads and polishing and smoothing the dental implant surface. During implantoplasty there is a large release of titanium metal particles that might provoke a proinflammatory response and reduce the viability of osteogenic cells. We analyze the inflammatory and osteogenic response induced by Ti6Al4V particles released during implantoplasty and by as-received commercially pure Ti particles. Macrophages stimulated with metal particles obtained by implantoplasty and with as-received Ti particles showed an increased proinflammatory expression of TNF-α and a decreased expression of TGF-β and CD206. Regarding cytokine release, there was an increase in IL-1β, while IL-10 decreased. The osteogenic response of Ti6Al4V extracts showed a significant decrease in Runx2 and OC expression compared to the controls and commercially pure Ti extracts. There were no relevant changes in ALP activity. Thus, implantoplasty releases metal particles that seems to induce a pro-inflammatory response and reduce the expression of osteogenic markers.

Strength of titanium-zirconium alloy implants with a conical connection after implantoplasty

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.

An Umbrella Review on Low-Abrasive Air Powder Water Jet Technology in Periodontitis and Peri-Implantitis Patients

This umbrella review was conducted to assess the existing literature and scientific evidence on air powder water jet technology (APWJT) in periodontal and peri-implantitis therapy. A systematic literature search for systematic reviews and meta-analyses of the last decade on the use of APWJT in periodontitis and implant patients was performed in the databases of MEDLINE/Ovid, Embase, Cochrane library and Scopus. An additional hand search on PubMed and Google Scholar was conducted. Ten articles that fit the inclusion criteria were selected after the full-text screening. Two systematic reviews, including one with a meta-analysis, investigated the use of APWJT in active periodontal therapy. The use of APWJT as an adjunct to conventional scaling and root planing (SRP) in active periodontal treatment showed improved results in the test group. Six articles, including two with a meta-analysis, reported on the use of APWJT as a stand-alone therapy or as an adjunct in supportive periodontal therapy. Similarly significant improved results were reported for the use of APWJT. Regarding the active treatment of peri-implant mucositis and peri-implantitis, four systematic reviews could not show an improved clinical outcome when APWJT was used as an adjunct to conventional treatment measures. Furthermore, one article investigated APWJT as a stand-alone therapy or as an adjunct in supportive peri-implant mucositis and peri-implantitis therapy. In systematic reviews that also investigated patient perception, APWJT was generally well-tolerated by the patient. Within the limitations of this umbrella review, it can be concluded that the use of APWJT with low-abrasive powders such as glycine, erythritol or trehalose as an adjunct in active periodontitis therapy shows similar clinical results compared to conventional SRP alone. In surgical peri-implantitis treatment, APWJT can be used adjunctively. It could be considered that the use of APWJT in supportive periodontal treatment results in a comparable clinical outcome and an enhanced patient perception, as well as a shorter clinical time.

Clinical considerations in the surgical management of peri-implantitis lesions in the esthetic zone

OBJECTIVE

The treatment of peri-implantitis is commonly associated to soft tissue changes as part of disease resolution. These changes may alter harmony in the esthetic area, and thus may negatively affect patient satisfaction. This technical note presents the key features that may lead to an unsatisfactory esthetic outcome when managing peri-implantitis in the anterior zone.

CLINICAL SIGNIFICANCE

It is essential to consider four pivotal elements in securing therapeutic success through the resolution of inflammation while maintaining esthetics: (1) patient-related factors, including patient willingness to treat and the smile line; (2) implant-related factors that influence implant position; (3) site-related factors related to defect configuration; and (4) prosthetic-related factors referred to the prosthetic emergence profile and the type of prosthesis. A comprehensive examination must be carried out preoperatively to assess the impact of the surgical treatment upon the esthetic outcomes.

CONCLUSION

The clinician must be aware of the key features that condition the esthetic outcome when managing peri-implantitis.

Non-submerged reconstructive approach for peri-implantitis osseous defect, with removal of implant crowns: 1-year outcomes of a prospective case series study

BACKGROUND & AIM

The aim of this study was to test a non-submerged reconstructive approach for peri-implantitis osseous defects, by removing the prosthetic components, augmenting of the infraosseous bony compartment, and flap re-adaptation around the replaced healing abutments, without obtaining a primary wound closure.

METHODS

Twenty-nine implants in 24 patients were treated. Implant suprastructures were removed at the time of the intervention, to aid with the debridement process which included curettage, implantoplasty, air-power driven devices, and locally delivered antibiotics. The infraosseous part of peri-implant defects were augmented using a composite bone graft and an absorbable membrane to be secured around the replaced healing abutments without attempting to submerge the implants. After 8 months, direct peri-implant defect measurements were obtained to serve as the primary outcome. Secondary outcomes included of radiographic bone changes, and probing depth (PD) and bleeding on probing (BOP) changes at 12 months.

RESULTS

At the time of the surgical re-entry (8 months), a statistically significant clinical and radiographic defect fill was observed (average of 2.33 mm, and 1.63 mm, respectively). Approximately 3 months after crown replacement, 12 months from the surgical intervention, a significant PD (1.51 mm) and BOP (65%) reduction were also noted.

CONCLUSIONS

Considering its limitations, the utilized non-submerged approach (with removal of implant crowns) led to significant improvements in clinical (defect fill, PD, BOP) and radiographic outcomes. This article is protected by copyright. All rights reserved.

Er:YAG laser irradiation enhances bacterial and lipopolysaccharide clearance and human gingival fibroblast adhesion on titanium discs

To investigate the effect of Er:YAG laser treatment on lipopolysaccharide (LPS) clearance and fibroblast adhesion on titanium disks. Grade IV titanium discs (n = 216) were used and allocated to 6 groups. Group 1 was the negative control without Porphyromonas gingivalis inoculation. Discs in Groups 2-6 were incubated with P. gingivalis to form a biofilm. Group 3 received 0.12% chlorhexidine irrigation and Group 4 received titanium curettage to remove the biofilm. Group 5 was treated with Er:YAG laser irradiation and Group 6 was treated with titanium curettage plus Er:YAG laser irradiation. The contact angle and surface roughness were measured after the various treatments. The surface microstructure and residual bacteria were examined using scanning electron microscopy and confocal laser scanning microscopy, respectively. Residual LPS was examined using a limulus amoebocyte lysate assay and human gingival fibroblast adhesion was quantified using fluorescent microscopy. Curettage plus Er:YAG laser irradiation was the most effective method for removing bacteria and LPS. No significant difference in the amount of fibroblast adhesion was found between the control and Group 6. Combined use of Er:YAG laser irradiation and curettage optimizes LPS clearance and fibroblast adhesion on titanium discs.

Overcoming Complications with Implants in the Esthetic Zone: An Innovative Approach

Owing to the satisfactory esthetic and functional outcomes of implant surgery for the anterior teeth, some dentists consider it the gold standard treatment. However, the risk of developing peri-implantitis is positively associated with the long-term use of the implant. This necessitates the development of an implant design that reduces the risk of peri-implantitis, especially considering the long-term use of implants in young patients. This case report describes a new approach for an implant surgery using a two-stage implant in a 28-year-old woman. Her clinical course was satisfactory during the 4-year postoperative follow-up period; no inflammation was noted in the surrounding tissues. The two-stage implants allow for the removal of an implant body from an infected area and its replacement with a new abutment if peri-implantitis develops in the future.

Principles of Combined Surgical Therapy for the Management of Peri-Implantitis

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.

Effect of implantoplasty on the elastic limit of dental implants of different diameters

BACKGROUND

Implantoplasty reduces both implant diameter and the thickness of its walls, subsequently reducing the ability of the implant to resist fracture in response to functional load. In combination with an increase in the crown-implant ratio due to bone loss, this could increase the lever effect, which in presence of high masticatory forces or parafunctional habits, could lead to complications such as fracture of the implant or loosening of the prosthetic screw.

OBJECTIVES

To determine the elastic limits of internal connection, dental implants of different designs and diameters after an implantoplasty.

MATERIALS AND METHODS

This in vitro study included 315 tapered internal connection titanium dental implants, the threads of which were removed with an industrial milling machine-for standardized implantoplasty (IMP1; n = 105)-or with the conventional approach-manually, using high-speed burs (IMP2; n = 105). The remaining 105 implants were used as controls. The final implant diameters were recorded. The quality of the newly polished surfaces was assessed by scanning electron microscopy. All implants were subjected to a mechanical pressure resistance test. A Tukey's test for multiple comparisons was used to detect differences in the elastic limit and final implant diameters between the implant groups.

RESULTS

There were statistically significant differences in the elastic limit between the IMP1, IMP2, and control groups (p < 0.05). Furthermore, the implant diameter was significantly smaller in the IMP1 and IMP2 groups (p < 0.05). Scanning electron microscopy revealed smooth implant surfaces in the IMP1 and IMP2 groups, with some titanium particles visible in the IMP1 group.

CONCLUSIONS

Implantoplasty significantly decreased the elastic limit of internal connection titanium dental implants, especially in those with a smaller diameter (3-3.5 mm).

Treatment of Periimplantitis with Electrolytic Cleaning versus Mechanical and Electrolytic Cleaning: 18-Month Results from a Randomized Controlled Clinical Trial

Aim of the study: This RCT assesses patients’ 18-month clinical outcomes after the regenerative therapy of periimplantitis lesions using either an electrolytic method (EC) to remove biofilms or a combination of powder spray and an electrolytic method (PEC). Materials and Methods: Twenty-four patients (24 implants) suffering from periimplantitis were randomly treated by EC or PEC followed by augmentation and submerged healing. Probing pocket depth (PPD), Bleeding on Probing (BoP), suppuration, and standardized radiographs were assessed before surgery (T0), 6 months after augmentation (T1), and 6 (T2) and 12 (T3) months after the replacement of the restoration. Results: The mean PPD changed from 5.8 ± 1.6 mm (T0) to 3.1 ± 1.4 mm (T3). While BoP and suppuration at T0 were 100%, BoP decreased at T2 to 36.8% and at T3 to 35.3%. Suppuration was found to be at a level of 10.6% at T2 and 11.8% at T3. The radiologic bone level measured from the implant shoulder to the first visible bone to the implant contact was 4.9 ± 1.9 mm at mesial sites and 4.4 ± 2.2 mm at distal sites at T0 and 1.7 ± 1.7 mm and 1.5 ± 17 mm at T3. Conclusions: Significant radiographic bone fill and the improvement of clinical parameters were demonstrated 18 months after therapy.

The Treatment of Peri-Implant Diseases: A New Approach Using HYBENX® as a Decontaminant for Implant Surface and Oral Tissues

Background: Peri-implantitis is a pathological condition characterized by an inflammatory process involving soft and hard tissues surrounding dental implants. The management of peri-implant disease has several protocols, among which is the chemical method HYBENX^®. The aim of this study is to demonstrate the efficacy of HYBENX^® in the treatment of peri-implantitis and to compare HYBENX^® with other chemical agents used in the surgical treatment of peri-implantitis. Methods: The present study included a population of ten subjects with severe peri-implantitis. The procedure used in the study involves the application of HYBENX^® after open-flap debridement. Each patient has been followed for 12 months after a single application of the decontaminant agent. Clinical and radiographical parameters were recorded at baseline, 3 months, and 12 months after treatment completion. Results: At baseline, a mean pocket probing depth (PPD) of 7.3 ± 0.5 mm and a mean clinical attachment level (CAL) of 8.8 ± 0.8 mm was recorded. An average residual PPD of 4.2 ± 0.5 mm and a mean CAL of 5.2 ± 0.8 mm were observed after 1 year. Additionally, the average of bone gain was about 3.4 mm, with a mean marginal bone level (MBL) change from 5.8 mm (baseline) to 2.4 mm (12 months). In total, 90% of the treated implants reached the success rate after the 1-year follow-up. Only in one case out of ten treated implants was resolution of the disease not achieved. Conclusion: Clinical improvements highlight that the procedure of open-flap debridement (OFD) + HYBENX^® may be considered an effective technique in the treatment of peri-implantitis. From the results obtained, it can be concluded that the use of HYBENX^® in the surgical treatment of peri-implantitis is promising. Overall, this protocol demands further studies to better understand the role and potential benefits of HYBENX^® in the treatment of peri-implantitis.

Resolution of peri-implantitis by means of implantoplasty as adjunct to surgical therapy: A retrospective study

BACKGROUND

There is a paucity of data on the effectiveness of implantoplasty as adjunct to the surgical management of peri-implantitis.

PURPOSE

To evaluate the resolution of peri-implantitis by means of implantoplasty as adjunct to surgical resective (RES) and reconstructive (REC) therapies and supportive maintenance.

METHODS

Patients that underwent surgical therapy to manage peri-implantitis with a follow-up of ≥12 months and enrolled in a regular peri-implant supportive care were recruited. RES group consisted of two interventions that included osseous recontouring and apically position flap (APF) and soft tissue conditioning (STC). REC was performed in the infra-osseous compartment of combined defects. Implant survival rate was recorded. Clinical and radiographic parameters were evaluated to define a "dogmatic" (case definition #1) and a "flexible" (case definition #2) therapeutic success. Univariate and multivariate multilevel backward logistic regression were applied for statistical analysis.

RESULTS

Overall, 43 patients (n_implants  = 135) were retrospectively assessed. Mean observational period was ∼24 months. Implant survival rate was 97.8%, being significantly higher for APF, STC, and APF + STC (RES) when compared with REC (P = 0.01) therapy, in particular for advanced lesions (>50% of bone loss). The overall therapeutic success rate at implant-level was 66% and 79.5% for case definition #1 and #2, respectively. APF group displayed more efficient disease resolution when considered success definition #1 (72%). Contrarily, when the data were adhered to success definition #2, STC group showed a slightly higher disease resolution rate (87%). For RES group, location, favoring anterior (P = 0.04) and defect type, favoring class II (P = 0.02) displayed statistical significance for therapeutic success. For REC group, implants exhibiting a wider band of keratinized mucosa (KM) demonstrated higher therapeutic success (P = 0.008).

CONCLUSION

Implantoplasty as an adjunct to surgical therapy proved effective in terms of disease resolution and implant survival rate. Implant location, defect morphology as well as the buccal width of KM are indicators of therapeutic success.

Effects of different decontaminating solutions used for the treatment of peri-implantitis on the growth of Porphyromonas gingivalis-an in vitro study

Implants have been considered the treatment of choice to replace missing teeth, unfortunately, peri-implant disease is still an unresolved issue. Contaminated implants may be decontaminated by physical debridement and chemical disinfectants; however, there is a lack of consensus regarding the ideal techniques/agents to be used for the decontamination. The objective of our study was to compare the decontaminating efficacy of different chemical agents on a titanium surface contaminated with Porphyromonas gingivalis, a typical representative of the bacterial flora associated with peri-implantitis. Commercially pure Ti grade 4 discs with a polished surface were treated with a mouthwash containing chlorhexidine digluconate (0.1%), povidone-iodine (PVP-iodine) solution (10%) or citric acid monohydrate (40%). Qualitative and quantitative assessment of cellular growth and survival were assessed by a 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) assay and scanning electron microscopy (SEM). Significant differences in the quantity of P. gingivalis could be observed after 6 days of incubation. A numerical, but not statistically significant (P = 0.066) decrease in the amount of living bacteria was observed in the group treated with the PVP-iodine solution as compared to the control group. The chlorhexidine (CHX)-treated group presented with significantly higher cell counts, as compared to the PVP-iodine-treated group (P = 0.032), while this was not observed compared to the control group and citric acid-treated group. Our results have also been verified by SEM measurements. Our results suggest that for P. gingivalis contamination on a titanium surface in vitro, PVP-iodine is a superior decontaminant, compared to citric acid and chlorhexidine-digulconate solution.

The Effectiveness of Chlorhexidine and Air Polishing System in the Treatment of Candida albicans Infected Dental Implants: An Experimental In Vitro Study

Background: Peri-implantitis is an inflammatory disease with an increasing diffusion rate which can affect the long-term survival of a prosthetic rehabilitation. The present study focused on the decontaminating efficacy of chlorhexidine and air polishing system with sodium bicarbonate powder against Candida albicans, a microorganism which seems to have a superinfecting opportunistic role in the pathology. The aim of the authors was to investigate and compare the effectiveness of these treatments, commonly used in clinical practice. Methods: An in vitro study was conducted to analyze the effects of two widely used therapeutic aids for the disinfection of affected titanium implants: chlorhexidine (CHX) and air polishing with sodium bicarbonate powder (P). A qualitative and quantitative comparative analysis of the residual biofilm was carried out using a colorimetric assay (XTT) and scanning electron microscopy (SEM) observation. The experiment was conducted both on machined titanium surfaces and on rough sandblasted ones with the aim of bringing out differences in the therapeutic outcomes concerning the superficial texture of the implant. The null hypothesis was that no difference could be detected between the samples, regarding both the treatments performed and the nano-structural features of titanium. Results: The best results (on both types of implant surfaces) were obtained when combining the use of chlorhexidine and air polishing (C + P). A linear decrease in the optical density (OD) values recorded at three different time points (30 s, 1 min, 5 min) was also observed passing from the first to the last one. When observed under scanning electron microscope rough surfaces showed an extensive and highly structured biofilm, more complex if compared to the one encountered when analyzing machined implants. Conclusions: the present pilot study showed that rough surfaces can promote fungal adhesion and eventually hinder the outcome of a decontaminating treatment. For this purpose, the physio-chemical technique is always more efficient if compared to a single-technique approach regardless of the surface characteristics.

The effect of surgical regenerative treatment for peri-implantitis: A systematic review

OBJECTIVES

The purpose of the present study was to systematically review literature on the effectiveness of surgical regenerative treatment for peri-implantitis.

METHODS

Different databases were searched including the Cochrane Central Register of Controlled Trials, EMBASE and MEDLINE. Primary outcomes were changes in probing pocket depth (PPD), bleeding on probing (BOP), radiographic marginal bone level (RBL) and signs of infection. Secondary outcomes were facial marginal recession, aesthetic outcomes and cost of treatment. Only randomised controlled trials (RCTs) with a minimum of 12 months follow-up period after regenerative surgical treatment were selected according to PRISMA guidelines.

MAIN RESULTS

Five studies were selected. The highest mean reduction of PPD was 3.1 mm in a bovine-derived xenograft (BDX) group. The highest percentage reduction of BOP occurred in patients treated with implantoplasty and saline (a reduction of 85.2%). The highest mean defect fill of RBL was reported in the porous titanium granules group (3.6 mm). Mean reductions of PPD, RBL and facial marginal soft tissue recession were statistically insignificant (p-value > 0.05) in the studies included. However, the mean reduction in BOP was statistically significant (p-value < 0.05) in four studies as compared to the baseline (before treatment). A high heterogeneity among the studies included, regarding surgical protocols, defects morphology and selection of biomaterials, was found.

CONCLUSION

All studies included showed an improvement in clinical conditions after surgical regenerative treatment for peri-implantitis. However, no study has shown any statistical significance in its approach. There is a lack of scientific evidence in literature regarding which type of bone substitute has superiority in the treatment of peri-implantitis, as well as the role of barrier membranes, methods for detoxification of implant surfaces and antimicrobial prescriptions. For these reasons further well-designed RCTs are recommended.

Management of peri-implantitis - A contemporary synopsis

Prevalence of peri-implant complication is expected to be on the rise with the increased number of implants being placed. Depending on the degree of osseous involvement, the clinician needs to decide if the treatment goal is to arrest the disease progression, regeneration or explantation and replacement. Host's medical status, defect configuration, aesthetic outcome, ability to access for plaque control post-treatment, and the patient's wishes are key factors to consider. The purpose of this review is to provide a contemporary synopsis on the management of peri-implantitis with emphasis on explantation. Guidance on the identification of factors/situations where salvaging an implant may be less favourable is discussed and the various techniques to remove a fractured, or peri-implantitis-affected non-mobile implant are described.

A simple and effective method for addition silicone impression disinfection

PURPOSE

Although dental impression disinfection is determinant to reduce the cross-infection risk, some studies have shown that, in real practice, the disinfection procedures vary considerably. Thus, the aim of this study was to evaluate the antimicrobial effectiveness and the impact on the dimensional stability of addition silicone' impressions of water wash and the most clinically used disinfection solutions: 3% hydrogen peroxide, commercial disinfectant MD520 (Durr) and 1% and 5.25% sodium hypochlorite.

MATERIALS AND METHODS

For this investigation, dental impressions were taken on 16 volunteer dental students. The antimicrobial effectiveness of each procedure was evaluated by pour plate method. The dimensional stability was evaluated using a standardized stainless-steel model, according to ANSI/ADA nº19 specification.

RESULTS

The study results showed that water wash does not alter the dimensional stability of addition silicone impressions but doesn't reduce the microbial load of the material (P>.05). On the other hand, addition silicone disinfection by immersion with 3% hydrogen peroxide, MD520 (Durr), or sodium hypochlorite at 1% and 5.25% does not alter the dimensional stability significantly but reduces > 99.9% of the microbial load of the impressions (P<.001).

CONCLUSION

Addition silicone impressions should always be disinfected after water wash in order to reduce effectively the cross-infection risk. All disinfectants tested showed high antimicrobial efficiency without significant changes in three-dimensional shape of impressions. Hydrogen peroxide and sodium hypochlorite are of particular importance because are easily accessible in dental setting. The less explored hydrogen peroxide could be a valuable alternative for silicone impressions disinfection.

Investigation of the antibacterial effect of laser irradiation and chemical agent on human oral biofilms contaminated titanium discs

INTRODUCTION

A main challenge in treatment of peri-implant disease is the effective decontamination of the implant surface. This challenge has always been a problem, associated with the treatment of these diseases with regard to the difficulty in removing and eliminating bacterial biofilm from the surface of dental implants, especially rough surfaces. The aim of this in-vivo study was to evaluate the effect of five different antimicrobial methods in reducing bacteria adhering to titanium surfaces.

MATERIALS AND METHODS

In the present in-vivo study, the contaminated discs, except for the negative control group, randomly underwent one of five treatments: Erbium: Yattrium Aluminum Garnet (Er-YAG) laser, plastic curette, 0.12% chlorhexidine, aPDT, and 810 nm diode laser. A pectrophotometer was used to measure Optical Density (OD) in case of aerobic microorganisms. Colony-Forming Units (CFUs) were used for anaerobic bacteria. Then, all the analyses were carried out at a significance level of α = 0.05 through SPSS software.

FINDINGS

One-way analysis of variance (ANOVA) of aerobic bacteria showed a significant difference among 6 groups in terms of OD variations during a 0-24 h time interval (P < 0.001). The results of Kruskal-Wallis test were used to investigate the effect of study methods on anaerobic bacteria after 48 h, and the results showed a significant difference among 6 groups in terms of CFUs (P < 0.001).

CONCLUSION

The results of the present study showed that all five mechanicals (plastic curette), chemical (CHX), laser (810 nm diode and Er: YAG), and aPDT methods could reduce oral biofilms from roughed surfaces of titanium discs. Er: YAG laser and plastic curette had the highest and the lowest effects respectively.

Characteristics of Local Delivery Agents for Treating Peri-Implantitis on Dental Implant Surfaces: A Preclinical Study

Local delivery agents (LDAs) are widely used in peri-implantitis treatments. The aim of this study was to identify LDAs remaining on the dental implant surfaces and to analyze the components of these residues after applying various cleaning methods. Implants were prepared with a sand-blasted, large-grit, acid-etched surface. Four kinds of LDAs were applied on the implant surfaces: chlorhexidine gel (group 2), tetracycline solution (group 3), and 2 kinds of minocycline hydrochloride agents (groups 4 and 5). Group 1 received normal saline as a control. Two cleaning methods were applied for different durations as follows: (1) running distilled water for 10 seconds (subgroup A), 5 minutes (subgroup B), and 15 minutes (subgroup C); and (2) water spray of a dental-unit chair for 10 seconds (subgroup D) and 5 minutes (subgroup E). Scanning electron microscopy and energy-dispersive x-ray spectroscopy were used to analyze the surface morphology and residue components for all implants. The amount of LDA removed from the implant surfaces in groups 1, 2, 3, and 5 increased with the cleaning duration and pressure. However, Minocline remained coated on the implant surfaces in group 4 under all cleaning conditions. Minocline could not be cleaned off well by water due to its hydrophobicity. Therefore, directly using this agent on implant surfaces with peri-implantitis should be carefully considered. The presence of LDA residues without drug efficacies on implant surfaces might interfere with reosseointegration and act as a reservoir of microorganisms.

The effects of ozone therapy as an adjunct to the surgical treatment of peri-implantitis

PURPOSE

The decontamination procedure is a challenging aspect of surgical regenerative therapy (SRT) of peri-implantitis that affects its success. The purpose of the present study was to determine the impact of additional topical gaseous ozone therapy on the decontamination of implant surfaces in SRT of peri-implantitis.

METHODS

A total of 41 patients (22 males, 19 females; mean age, 53.55±8.98 years) with moderate or advanced peri-implantitis were randomly allocated to the test group (ozone group) with the use of sterile saline with additional ozone therapy or the control group with sterile saline alone for decontamination of the implant surfaces in SRT of peri-implantitis. Clinical and radiographic outcomes were evaluated over a period of 12 months.

RESULTS

At the 12-month follow-up, the plaque and gingival index values were significantly better in the ozone group (P<0.05). Probing depth decreased from 6.27±1.42 mm and 5.73±1.11 mm at baseline to 2.75±0.7 mm and 3.34±0.85 mm at the end of the 12-month observation period in the ozone and control groups, respectively. Similarly, the clinical attachment level values changed from 6.39±1.23 mm and 5.89±1.23 mm at baseline to 3.23±1.24 mm and 3.91±1.36 mm at the 12-month follow-up in the ozone and control groups, respectively. According to the radiographic evidence, the defect fill between baseline and 12 months postoperatively was 2.32±1.28 mm in the ozone group and 1.17±0.77 mm in the control group, which was a statistically significant between-group difference (P<0.05).

CONCLUSIONS

Implant surface decontamination with the additional use of ozone therapy in SRT of peri-implantitis showed clinically and radiographically significant. Trial registry at ClinicalTrials.gov, NCT03018795.

Air-Abrasive Disinfection of Implant Surfaces in a Simulated Model of Periimplantitis

INTRODUCTION

This in vitro study aimed to evaluate the ability of air-powder abrasion to decontaminate dental implants.

MATERIALS AND METHODS

Twenty-six implants were inoculated with a Streptococcus sanguinis biofilm media in a novel periimplantitis defect model. Six implants served as controls, and 20 implants were disinfected with either the Cavitron JET Plus or the AIR-FLOW PERIO air-powder abrasion units. Residual bacteria were cultured, and colony forming units (CFUs) were totaled at 24 hours.

RESULTS

As expected, negative control implant cultures showed no evidence of viable bacteria. Bacterial growth was observed on all positive control cultures, whereas only 15% of the experimental cultures displayed evidence of viable bacteria. The average CFU per streak for the positive control was 104 compared with a maximum of 10 and 4 CFUs for the Cavitron JET Plus and AIR-FLOW PERIO, respectively. There was a 99.9% reduction in bacteria for both air-powder abrasion instruments.

CONCLUSION

Air-powder abrasion is an effective technique for the decontamination of dental implants, and the Cavitron JET Plus and AIR-FLOW PERIO are equally successful at eliminating viable bacteria from implant surfaces.

Peri-Implant Bone Loss and Peri-Implantitis: A Report of Three Cases and Review of the Literature

Dental implant supported restorations have been added substantially to the clinical treatment options presented to patients. However, complications with these treatment options also arise due to improper patient selection and inadequate treatment planning combined with poor follow-up care. The complications related to the presence of inflammation include perimucositis, peri-implant bone loss, and peri-implantitis. Prevalence rates of these complications have been reported to be as high as 56%. Treatment options that have been reported include nonsurgical therapy, the use of locally delivered and systemically delivered antibiotics, and surgical protocols aimed at regenerating the lost bone and soft tissue around the implants. The aim of this article is to report on three cases and review some of the treatment options used in their management.

Radiolucent inflammatory implant periapical lesions: a review of the literature

PURPOSE

To discuss the terminology, etiopathogenesis, and treatment of radiolucent inflammatory implant periapical lesions.

MATERIALS AND METHODS

An electronic search for relevant articles published in the English literature in the PubMed database.

RESULTS

Bacterial contamination of the apical portion of the implant either from a preexisting dental periapical infection or from a periapical lesion of endodontic origin of an adjacent tooth is the probable causative factor. Aseptic bone necrosis owing to overheating of the bone during preparation of osteotomies, or compression of the bone at the apex of the implant owing to excessive tightening, may also play a role. The histopathological features are of a mixed inflammatory cell infiltrate on a background of granulation tissue consistent with either a granuloma or an abscess as may be found at the apex of a nonvital tooth. Treatment consists of immediate and aggressive surgical debridement, chemical detoxification of the apical portion of the exposed implant surface, and systemic antibiotics with or without a bone regenerative procedure.

CONCLUSION

A radiolucent inflammatory implant periapical lesion is analogous to either a granuloma or an abscess as may be found at the apex of a nonvital tooth.

The effects of diode laser on Staphylococcus aureus biofilm and Escherichia coli lipopolysaccharide adherent to titanium oxide surface of dental implants. An in vitro study

Effective decontamination of biofilm and bacterial toxins from the surface of dental implants is a yet unresolved issue. This in vitro study aims at providing the experimental basis for possible use of diode laser (λ 808 nm) in the treatment of peri-implantitis. Staphylococcus aureus biofilm was grown for 48 h on titanium discs with porous surface corresponding to the bone-implant interface and then irradiated with a diode laser (λ 808 nm) in noncontact mode with airflow cooling for 1 min using a Ø 600-μm fiber. Setting parameters were 2 W (400 J/cm²) for continuous wave mode; 22 μJ, 20 kHz, 7 μs (88 J/cm²) for pulsed wave mode. Bactericidal effect was evaluated using fluorescence microscopy and counting the residual colony-forming units. Biofilm and titanium surface morphology were analyzed by scanning electron microscopy (SEM). In parallel experiments, the titanium discs were coated with Escherichia coli lipopolysaccharide (LPS), laser-irradiated and seeded with RAW 264.7 macrophages to quantify LPS-driven inflammatory cell activation by measuring the enhanced generation of nitric oxide (NO). Diode laser irradiation in both continuous and pulsed modes induced a statistically significant reduction of viable bacteria and nitrite levels. These results indicate that in addition to its bactericidal effect laser irradiation can also inhibit LPS-induced macrophage activation and thus blunt the inflammatory response. The λ 808-nm diode laser emerges as a valuable tool for decontamination/detoxification of the titanium implant surface and may be used in the treatment of peri-implantitis.

Can Periimplantitis Be Treated?

Over the past few decades, dental implants have been found to have high predictability and survival rates because of improvements in knowledge, clinical expertise, and implant designs. As such, dental implants are frequently integrated in the clinical management of fully or partially edentulous patients. It is prudent to realize that despite the high early survival rates, dental implants do have their fair share of long-term esthetic, biological, and mechanical complications. Therefore, this paper aims to review the current evidence on the management of peri-implant diseases in an attempt to answer the following question: Can periimplantitis be treated?

Erythritol-Enriched Air-Polishing Powder for the Surgical Treatment of Peri-Implantitis

Peri-implantitis represents a major complication that can compromise the success and survival of implant-supported rehabilitations. Both surgical and nonsurgical treatment protocols were proposed to improve clinical parameters and to treat implants affected by peri-implantitis. A systematic review of the literature was performed on electronic databases. The use of air-polishing powder in surgical treatment of peri-implantitis was investigated. A total of five articles, of different study designs, were included in the review. A meta-analysis could not be performed. The data from included studies reported a substantial benefit of the use of air-polishing powders for the decontamination of implant surface in surgical protocols. A case report of guided bone regeneration in sites with implants affected by peri-implantitis was presented. Surgical treatment of peri-implantitis, though demanding and not supported by a wide scientific literature, could be considered a viable treatment option if an adequate decontamination of infected surfaces could be obtained.

Treatment of peri-implantitis and the failing implant

Appropriate treatment of implants is becoming increasingly important for the general dentist as the number of implants placed per year continues to increase. Early diagnosis of peri-implantitis is imperative; initiating the correct treatment protocol depends on a proper diagnosis. Several risk factors exist for the development of peri-implantitis, which can guide patient selection and treatment planning. Treatment of peri-implantitis should be tailored to the severity of the lesion (as outlined by the cumulative interceptive supportive treatment protocol), ranging from mechanical debridement to explantation. Several surgical and nonsurgical treatment alternatives exist. There is little consensus on superior treatment methods.