Impact of local predisposing/precipitating factors and systemic drivers on peri‐implant diseases

Potential role of metal nanoparticles in treatment of peri-implant mucositis and peri-implantitis

Peri-implantitis (PI), a pathological condition associated with plaque, affects the tissues around dental implants. In addition, peri-implant mucositis (PIM) is a precursor to the destructive inflammatory PI and is an inflammation of the soft tissues surrounding the dental implant. It is challenging to eradicate and regulate the PI treatment due to its limited effectiveness. Currently, there is a significant interest in the development and research of additional biocompatible materials to prevent the failure of dental implants. Nanotechnology has the potential to address or develop solutions to the significant challenge of implant failure caused by cytotoxicity and biocompatibility in dentistry. Nanoparticles (NPs) may be used as carriers for the release of medicines, as well as to make implant coatings and supply appropriate materials for implant construction. Furthermore, the bioactivity and therapeutic efficacy of metal NPs in peri-implant diseases (PID) are substantiated by a plethora of in vitro and in vivo studies. Furthermore, the use of silver (Ag), gold (Au), zinc oxide, titanium oxide (TiO2), copper (Cu), and iron oxide NPs as a cure for dental implant infections brought on by bacteria that have become resistant to several medications is the subject of recent dentistry research. Because of their unique shape-dependent features, which enhance bio-physio-chemical functionalization, antibacterial activity, and biocompatibility, metal NPs are employed in dental implants. This study attempted to provide an overview of the application of metal and metal oxide NPs to control and increase the success rate of implants while focusing on the antimicrobial properties of these NPs in the treatment of PID, including PIM and PI. Additionally, the study reviewed the potential benefits and drawbacks of using metal NPs in clinical settings for managing PID, with the goal of advancing future treatment strategies for these conditions.

Disease recurrence during supportive therapy following peri-implantitis treatment: A retrospective study

AIM

Supportive therapy is key to prevent disease recurrence after peri-implantitis treatment. The primary objective was to quantify disease recurrence during supportive peri-implant therapy (SPIT) after peri-implantitis treatment. A secondary objective was to assess the success/failure of cumulative interceptive supportive therapy (CIST) after peri-implantitis treatment.

METHODS

Compliers (whether regular or erratic) with SPIT after peri-implantitis treatment during ≥12 months were retrospectively evaluated. CIST was prescribed whenever residual pockets ≥6 mm concomitant with profuse bleeding on probing (disease recurrence) were identified. Patient- and implant-related factors were analyzed to explore their associations with disease recurrence and the need for CIST.

RESULTS

Disease recurrence was considered in 28 patients (40 implants). Of these, 14 patients (23 implants) further demonstrated radiographic evidence of progressive bone loss (≥1 mm). This represented an overall disease recurrence following peri-implantitis treatment of ~20% and ~ 10% at patient and implant levels, respectively. Smokers, patients diagnosed at baseline with periodontitis grade C, and males were significantly more prone to exhibit recurrence. Patients undergoing CIST due to instability were not likely to respond favorably (~70% continued to exhibit residual pockets).

CONCLUSION

Disease recurrence during SPIT following peri-implantitis treatment on selected cases is ~20%. Patients undergoing CIST due to instability are not likely to respond favorably.

Patient and implant-related risk factors for implant failure of one-stage lateral sinus floor elevation: A 2- to 10-year retrospective study

OBJECTIVES

This retrospective study aimed to evaluate the early and late implant failure rates of one-stage lateral sinus floor elevation (LSFE) and to identify the patient and implant-related risk factors associated with these failures.

MATERIALS AND METHODS

All patients treated with one-stage LSFE from January 2014 to December 2021 were evaluated for inclusion. A total of 618 patients with 936 implants met the inclusion criteria. Clinical and radiographic information about patient and implants was collected. Univariate and multivariate Cox proportional hazards frailty regression models were performed to identify risk factors for early and late implant failure.

RESULTS

The cumulative implant survival rate was 95.62% (95% CI 93.90%-97.68%), with 16 early implant failures and 25 late implant failures. The Cox analysis indicated that ≤3 mm residual bone height (RBH) was associated with a higher early failure rate. For late implant failure, smoking habit, ≤3 mm RBH, and certain implant brand were independent risk factors. Narrow sinus ostium, long infundibulum, and flat thickening of Schneiderian membrane might be non-independent risk factors for late implant failure. No significance was found in other variables, including age, periodontitis history, implant characteristics (position, diameter, length, protrusion length, marginal bone loss), surgeon experience, healing time, opposing dentition, and prosthesis.

CONCLUSIONS

One-stage LSFE is a predictable treatment for patients with atrophic maxilla. ≤3 mm RBH increased the risk of early implant failure, while smoking habit, ≤3 mm RBH, and certain implant brand were independent risk factors for late implant failure.

Effect of supracrestal tissue height on marginal bone level changes at platform-switching dental implants placed crestally and subcrestally: A randomized clinical-trial

OBJECTIVES

The presence of insufficient peri-implant supracrestal tissue height (STH) may increase marginal bone resorption. This study aims to evaluate the effect of STH on marginal bone level changes (ΔMBC) in platform-switching posterior implants placed crestally and subcrestally.

METHODS

A total of 80 implants were included in this study. There were two main groups in the study; STH≤2 mm (A) and STH> 2 mm (B) and four subgroups according to the implant placement level, crestally (I) and subcrestally (II): A-I, A-II, B-I, and B-II. Intraoperatively, STH and placement depths of implants were measured from mesial and distal aspects. The mesial and distal peri-implant marginal bone levels were measured on periapical radiographs at immediately (T0), 6 months (T1), 9 months (T2), and 12 months (T3) after functional loading, and the difference between the marginal bone levels was calculated as the ΔMBC.

RESULTS

Statistically significantly more mesial ΔMBC was detected in the A-I than in the B-I at the time of T0-T1. In the group with STH greater than 2 mm, the difference in ΔMBC between the crestally and subcrestally placements was not statistically significant.

CONCLUSIONS

This study was found that STH is effective at protecting the marginal bone in the early period, and in cases where the STH is insufficient, subcrestally placement may increase long-term implant success by preventing marginal bone loss from occurring beyond the implant shoulder. The clinical trial number is NCT05595746.

CLINICAL SIGNIFICANCE

In this study, it was demonstrated that an STH greater than 2 mm is important for marginal bone stabilization, regardless of crestal and subcrestal levels, and that subcrestally placement is beneficial in cases of insufficient STH.

The influence of implant depth, abutment height and mucosal phenotype on peri‑implant bone levels: A 2-year clinical trial

OBJECTIVES

To evaluate the bone changes around equicrestal and subcrestal implants, analyzing the effect of abutment height [short abutments (SA < 2 mm) and long abutments (LA > 2 mm)] and the three components of the peri‑implant soft-tissue phenotype.

METHODS

Twenty-six patients received 71 implants that were placed according to supracrestal tissue height (STH) in an equicrestal (n = 17), shallow subcrestal ≈1 mm (n = 33), or deep subcrestal ≈2 mm (n = 21) position. After 3 months of healing, rehabilitation was completed using metal-ceramic crowns on multi-unit abutments of 1.5 mm, 2.5 mm, or 3.5 mm in height, depending on the prosthetic space and STH. Longitudinal clinical parameters (STH, mucosal thickness, and keratinized mucosa width) and radiographic data [bone remodelling and marginal bone loss (MBL)] were collected at 3, 6, 12, and 24 months postsurgery.

RESULTS

The gain in STH was significantly greater around the implants placed in a subcrestal ≈2 mm position. After 2 years, the mean change in bone remodelling in the SA group was significantly greater than in the LA group. According to the multiple linear regression, bone remodelling depends primarily on abutment height (β = -0.43), followed by crestal position (β = 0.34), and keratinized mucosa width (β = -0.22), while MBL depends on abutment height (β = -0.37), and the patient's age (β = -0.36).

CONCLUSIONS

Implants placed in an equicrestal or subcrestal ≈1 mm position with LA undergo less bone remodelling, while the lowest level of MBL occurs in subcrestal ≈2 mm implants with LA. Differing soft-tissue thicknesses combined with the use of either SA or LA produced significant intergroup differences in bone remodelling and MBL.

CLINICAL SIGNIFICANCE

Abutment height is the most powerful predictor variable affecting bone remodelling and MBL. Depending on the dimensions of the peri‑implant soft-tissue phenotype, placing the implants subcrestally may also be a viable option to decrease bone remodelling and, consequently, reduce MBL.

CLINICAL TRIAL REGISTRATION

identification number: NCT05670340.

Immediate Loading Implant-Supported Fixed Full-Arch Rehabilitation Using a New Clinical Decision-Support System: A Case Series

Background Implant-supported full-arch rehabilitation is an effective treatment for edentulous patients. It restores mastication, facial aesthetics, and psychological well-being. Patient-related outcome measures support the validity of this approach, emphasizing the importance of effective prosthodontic interventions for this patient population. This study aims to present a case series for fixed implant-supported full-arch rehabilitation using the new Carames classification (CC). Methods A total of seven patients with generalized periodontitis or non-restorable multiple teeth were indicated for extraction and replacement with a fixed full-arch implant-supported prosthesis. According to the Carames classification, most cases were categorized as CCI or CCII classes for both the upper and lower jaws. Before the surgery, screw-retained provisional complete dentures were constructed and adjusted for the vertical occlusal dimension and smile lines. After the extractions, 70 implants were immediately placed in one or both arches for the seven patients, followed by bone grafts with the dual-zone grafting technique. Multi-unit abutments were then placed and welded to a metal bar for stable fixation. The provisional denture was fitted snugly over the metal bar for immediate functional loading. After three months of healing, it was used as a biocopy to fabricate the final prosthesis. The implant loss and the peri-implant marginal tissue health status were assessed annually for three years. Statistical analysis compared the marginal bone loss as a change from the baseline over the year. Results No implant or prosthesis loss was reported over the three years. Peri-implant marginal tissue health showed promising results without bleeding and suppuration on probing and probing depths between 3 and 3.5 millimeters. Marginal bone loss was minimal over the three years, with some cases showing bone gain. Conclusion Using the Carames classification as a clinical decision support system in implant-supported full-arch rehabilitation showed promising results in peri-implant tissue health and no implant loss during three years of follow-up. The implant placement and prosthesis fabrication protocol in this study could be valuable for further research.

Ceramic conversion treated titanium implant abutments with gold for enhanced antimicrobial activity

INTRODUCTION

Peri-implantitis is an inflammatory process around dental implants that is characterised by bone loss that may jeopardize the long-term survival of osseo integrated dental implants. The aim of this study was to create a surface coating on titanium abutments that possesses cellular adhesion and anti-microbial properties as a post-implant placement strategy for patients at risk of peri-implantitis.

MATERIALS AND METHODSMETHODS

Titanium alloy Grade V stubs were coated with gold particles and then subjected to ceramic conversion treatment (CCT) at 620 °C for 3, 8 and 80 h. The surface characteristics and chemistry were assessed using scanning electron microscopy (SEM), energy dispersive spectroscopy (EDS), and X-ray diffraction (XRD) analysis. The leaching profile was investigated by inductively coupled plasma mass spectroscopy (ICP-MS) for all groups after 7, 14 and 28 days in contact with distilled water. A scratch test was conducted to assess the adhesion of the gold coating to the underlying titanium discs. Two bacterial species (Staphylococcus aureus (SA) & Fusobacterium nucleatum (FN)) were used to assess the antibacterial behaviour of the coated discs using a direct attachment assay test. The potential changes in surface chemistry by the bacterial species were investigated by grazing angle XRD.

RESULTS

The gold pre-coated titanium discs exhibited good stability of the coating especially after immersion in distilled water and after bacterial colonisation as evident by XRD analysis. Good surface adhesion of the coating was demonstrated for gold treated discs after scratch test analysis, especially titanium, following a 3-hour (3 H) ceramic conversion treatment. All coated discs exhibited significantly improved antimicrobial properties against both tested bacterial species compared to untreated titanium discs.

CONCLUSIONS

Ceramic conversion treated titanium with a pre-deposited gold layer showed improved antimicrobial properties against both SA and FN species than untreated Ti-C discs. Scratch test analysis showed good adherence properties of the coated discs the oxide layer formed is firmly adherent to the underlying titanium substrate, suggesting that this approach may have clinical efficacy for coating implant abutments.

Clinical and radiographic performance of late placed and early loaded dental implants with a conditioned hydrophilic surface in posterior mandible sites: A prospective case series with an 8.5- to 9.5-year follow-up

OBJECTIVE

To assess the clinical outcomes by means of implant and prosthetic survival of late placed and early loaded implants with a hydrophilic, moderately rough surface for partially edentulous patients after a follow-up of 8.5 to 9.5 years.

MATERIALS AND METHODS

A prospective case series study involving 15 patients with single, late placed and early loaded implants in the posterior mandible was performed. Clinical and radiographical parameters, including biological and technical complications and patient satisfaction, were assessed.

RESULTS

From an initial sample of 15 patients, 12 were included. A total of 16 implants were observed. After a mean follow-up of 9 years and 7 months (SD ± 3.8 months), implant success and survival rate were 100%. The prosthetic survival rate was 100%, and the prosthetic success rate was 93.8% since a major chipping was observed. No biological complications were observed, and the mean modified plaque index was 0.03 (SD ± 0.09) with a mean probing pocket depth of 2.95 mm (SD ± 0.09). A mean marginal bone level (MBL) of 0.04 mm (SD ± 0.88) and a mean VAS of 9.42 (SD ± 0.90) for patient satisfaction were recorded.

CONCLUSION

Late placed and early loaded implants with a moderately rough endosseal surface are a reliable option for rehabilitating partially edentulous patients. An implant survival rate of 100% and a prosthodontic success rate of 93.8% were observed. Patient satisfaction scores were high and peri-implant hard and soft tissues remained healthy. The study findings should be carefully interpreted because of the small sample.

Impact of smoking on cost-effectiveness of 10-48 years of periodontal care

The study aims were (1) to explore whether "periodontal treatment" consisting of surgical therapy (flap, resective, or regenerative) or scaling and root planing treatment with long-term periodontal maintenance treatment, is cost-effective in terms of preventing periodontitis-attributable tooth extraction and replacement by implant-supported crowns ("extraction/replacement"); (2) to assess the effect of cigarette smoking on this cost-effectiveness. Data for this observational retrospective study were collected from dental charts of patients who had received periodontal therapy and at least annual follow-up visits for >10 years were analyzed by linear regression generalized estimating equations and generalized linear models. Among 399 adults (199 males, 200 females), those with the least mean annual treatment cost experienced the greatest mean annual costs for extraction/replacement, indicating general cost-effectiveness. Cigarette smoking adversely impacted this cost-effectiveness, with current heavy smokers experiencing no cost-effectiveness. Former smokers with Grade C periodontitis benefitted most, whereas smoking did not influence cost-effectiveness for Grade B periodontitis. Assessed by mean annual costs of "extraction/replacement," periodontal treatment was cost-effective, which decreased in a dose-response manner by former and current smoking intensity. Cigarette smoking should be factored into treatment planning and cost-effective analyses of periodontal treatment. Smoking cessation should be encouraged.

Preliminary Evaluation of Bioactive Collagen-Polyphenol Surface Nanolayers on Titanium Implants: An X-ray Photoelectron Spectroscopy and Bone Implant Study

To endow an implant surface with enhanced properties to ensure an appropriate seal with the host tissue for inflammation/infection resistance, next-generation bone implant collagen-polyphenol nanolayers were built on conventional titanium surfaces through a multilayer approach. X-ray Photoelectron Spectroscopy (XPS) analysis was performed to investigate the chemical arrangement of molecules within the surface layer and to provide an estimate of their thickness. A short-term (2 and 4 weeks) in vivo test of bone implants in a healthy rabbit model was performed to check possible side effects of the soft surface layer on early phases of osteointegration, leading to secondary stability. Results show the building up of the different nanolayers on top of titanium, resulting in a final composite collagen-polyphenol surface and a layer thickness of about 10 nm. In vivo tests performed on machined and state-of-the-art microrough titanium implants do not show significant differences between coated and uncoated samples, as the surface microroughness remains the main driver of bone-to-implant contact. These results confirm that the surface nanolayer does not interfere with the onset and progression of implant osteointegration and prompt the green light for specific investigations of the potential merits of this bioactive coating as an enhancer of the device/tissue seal.

Clinical and radiographic outcomes around 4 mandibular implant-retained overdentures in individuals with type 2 diabetes: A long-term retrospective study

OBJECTIVES

To report the implant survival rates, clinical, and radiographic status after a period of more than 5 years in the function of 4 inter-foraminal implants retaining mandibular overdentures (OVDs) in individuals with T2DM.

METHODS

78 completely edentulous participants with type 2 diabetic mellitus (T2DM) who had worn mandibular OVDs retained by 4 inter-foraminal implants for long-term functional life were selected for this study. The participants were divided into 2 groups according to glycosylated haemoglobin A1c (HbA1c) levels before implant placement: group I with an HbA1c value > 6.5 % (inadequately controlled T2DM), and group II with an HbA1c value ≤6.5 % (well-controlled T2DM). The inadequately controlled T2DM was further subdivided into 2 groups: Group IA with an HbA1c value > 6.5 % and ≤8 % (moderately controlled), and Group IB has an HbA1c value > 8 % (poorly controlled). Implant survival rate, plaque index (PI), bleeding on probing (BOP), probing depth (PD), and radiographic crestal bone level (CBL) around implants were measured.

RESULTS

Among 312 implants, 6 failed, 4 in well-controlled diabetics, and 2 in inadequately controlled diabetics. The overall survival rate was 98.07 %. The mean PI in group Ι was 36.4 (group IA =37.76, group IB = 34.27), and in group ΙΙ it was 19. The mean BOP in group Ι was 45.5 (group IA =47.84, group IB = 41.76), and in group ΙΙ it was 22. The mean PD in group Ι was 4.1 (group IA =4.3, group IB = 3.85) and in group ΙΙ was 2.2. The mean radiographic CBL in group Ι was 3.4 (group IA =3.7, group IB = 2.9), and in group ΙΙ was 1.5. Group IA exhibited a significantly greater level of PI, BOP, PD, and CBL compared to group IB and group IΙ (P1=0.017, P2=0.001).

CONCLUSIONS

Individuals with T2DM can benefit from 4 inter-foraminal implants retained mandibular OVDs, and their inability to maintain proper glucose control may not exclude implant success.

CLINICAL SIGNIFICANCE

This study is a significant step toward improving knowledge of options available for treatment and anticipated outcomes for T2DM completely edentulous populations undergoing implant therapy.

The effect of one-time abutment placement on clinical and radiographic outcomes: A 5-year randomized clinical trial

OBJECTIVE

The aim of this study was to evaluate the long-term (5 years) clinical efficacy of the one-abutment one-time protocol (test) versus the standard of care by placing the definitive abutment on the day of the prosthetic delivery (control).

MATERIALS AND METHODS

In this study, 39 subjects with 60 implants were randomly allocated to either the test or the control group. Changes in the radiographic interproximal bone levels (DIB), modified sulcus bleeding index, probing depth, modified plaque index, papilla fill (Jemt score), incidence of peri-implantitis and peri-implant mucositis as well as patient-reported outcomes measures (PROMs) were collected and compared at 1, 3 and 5 years.

RESULTS

At 5 years, the control group showed a greater, although not statistically significant, change in mean DIB values (0.97 mm vs. 0.53 mm). Regarding the other clinical parameters evaluated, no statistically significant differences were observed between groups at any time point. At 5 years, 51% of the implants presented peri-implant mucositis (25.5% in the control and 23.5% in the test), and only one implant in the test group developed peri-implantitis.

CONCLUSIONS

The connection and disconnection of healing abutments during the healing period was not associated with higher long-term bone loss. Clinical outcomes and PROMs were similar between groups.

History of periodontitis as a risk factor for implant failure and incidence of peri-implantitis: A systematic review, meta-analysis, and trial sequential analysis of prospective cohort studies

INTRODUCTION

Dental implants are widely employed as dependable replacements for lost teeth. However, it is crucial to establish, solely through prospective cohort studies, whether a history of periodontitis indeed constitutes a significant risk factor for implant failure.

METHODS

A systematic literature search was conducted in October 2022 in several electronic databases with subsequent manual updates. Only original prospective cohort studies evaluating the implant (loss) rate ≥1 year after implant loading were included. Logarithmic risk ratio and weighted mean differences were calculated. Study results were summarized using random effects meta-analyses evaluated by trial sequential analyses. The Newcastle-Ottawa scale evaluated study bias and the GRADE approach assessed the certainty/quality of the evidence.

RESULTS

A total of 14 publications reporting on 12 prospective cohort studies were included. Low evidence certainty/quality evidence due to the absence of randomized clinical trials revealed significantly greater odds of failure in patients with a history of periodontitis at follow-ups both after ≤5 years (RR = 1.62; 95% CI: 1.71-2.37; p = 0.013) and >5 years (RR = 2.26; 95% CI: 1.12-4.53; p = 0.023). The incidence of peri-implantitis (RR = 4.09; 95% CI: 1.93-8.58; p < 0.001) and the weighted mean (WM) of marginal bone loss (WM difference = 0.75 mm; 95% CI: 0.18-1.31; p < 0.05) were statistically significantly greater in the periodontally compromised group, whereas there was no significant difference between the two groups for peri-implant probing depth.

CONCLUSION

A history of periodontitis can be considered a significant risk factor for incident implant failure, peri-implantitis, and greater marginal bone loss.

Radiographic evaluation of the distance between the restoration margin and the alveolar bone crest in dental implant patients: A retrospective study

OBJECTIVES

The recently introduced Implant Disease Risk Assessment (IDRA) identifies a restoration margin-alveolar bone crest (RM-AC) distance of less than 1.5 mm as a key risk factor for peri‑implant disease among eight major risk factors. This study evaluated the impact of the RM-AC distance on marginal bone loss (MBL) through radiographic analysis.

METHODS

This retrospective cross-sectional study included 77 partially edentulous patients (39 females and 38 males, aged 22 to 76 years) with 202 platform-switched conical connection implants, cement-retained, implant-supported fixed restorations, and bone-level implants placed between 2016 and 2021. Dental implants were followed for least 6 to 36 months at follow up functional loading. Study participants were categorized into Group A (RM-AC distance ≤ 1.5 mm, n = 69) and Group B (RM-AC distance > 1.5 mm, n = 133). Twelve patients in Group B and five patients in Group A had no history of periodontal disease. The MBL was measured radiographically from the most coronal point of the implant shoulder to the alveolar bone, and the RM-AC distance was measured from the restoration margin to the alveolar crest. Multinomial logistic regression analysis was used for statistical evaluation.

RESULTS

The incidence of MBL in Group A was statistically significant and 3.42 times higher than that in Group B. The rate of MBL in periodontitis Stage 4 was found to be 26.31 times higher than that in periodontitis Stage 2. The incidence of MBL was 6.097 and 5.02 times higher with increasing implant diameter and length, respectively.

CONCLUSION

This study conclusively demonstrates that RM-AC distance ≤ 1.5 significantly increases the risk of MBL, particularly in patients with a history of periodontal disease.

CLINICAL SIGNIFICANCE

This study highlights the critical role of maintaining an RM-AC distance greater than 1.5 mm in the prevention of MBL, particularly in patients with a history of periodontal disease. Since implant diameter and length have a significant impact on the risk of MBL, it emphasizes that implant demographics should also be carefully evaluated.

Peri-implantitis in patients without regular supportive therapy: Prevalence and risk indicators

OBJECTIVES

To determine the prevalence of peri-implant diseases in patients treated in a university setting without a regular peri-implant supportive therapy schedule, and to identify the risk indicators associated with peri-implantitis.

MATERIAL AND METHODS

A retrospective cohort study was made of patients with dental implants with at least 12 months of functional loading who did not receive regular peri-implant supportive therapy. Patient- and implant-related variables were retrieved, and clinical and radiological examinations were performed. Descriptive and bivariate analyses and multilevel logistic regression analyses were performed to identify factors associated with peri-implantitis.

RESULTS

A total of 213 implants in 88 patients were analyzed. The patient-level prevalence of peri-implantitis and peri-implant mucositis was 26.1% (95%CI: 16.7%-35.5%) and 44.3% (95%CI: 34.0%-54.6%), respectively. Peri-implant diseases were significantly more frequent when the width of the keratinized mucosa was < 2 mm (OR = 5.26; 95%CI: 1.24-22.26; p = 0.024), and when there was 12 month post-loading bone loss (OR = 2.96; 95%CI: 1.35-6.52; p = 0.007).

CONCLUSIONS

Peri-implantitis is a common finding in patients without regular peri-implant supportive therapy (prevalence 16.7-35.5%). A thin peri-implant keratinized mucosa (< 2 mm) and a higher degree of bone remodeling after loading seem to be the main risk factors for peri-implantitis in this patient profile.

CLINICAL RELEVANCE

Patients who do not engage in supportive peri-implant maintenance have a higher risk of peri-implantitis. A thin keratinized mucosa and bone loss during the first year of loading are predisposing factors for peri-implantitis.

Treatment of peri-implant mucositis: Adjunctive effect of glycine powder air polishing to professional mechanical biofilm removal. 12 months randomized clinical study

INTRODUCTION

To evaluate the adjunctive effect of glycine-powder air-polishing (GPAP) to full-mouth ultrasonic debridement (Fm-UD) in the treatment of peri-implant mucositis, and to determine the impact of implant and patient-level variables for disease resolution.

METHODS

Individuals with a diagnosis of peri-implant mucositis were consecutively included in this randomized parallel arm clinical study. All the participants received a session of Fm-UD. Only implants allocated to the test group were additionally treated with GPAP. Clinical assessments were recorded at baseline, at 3 and at 12 months following intervention. The primary outcomes were complete disease resolution (DR1), defined as absence of bleeding sites at probing per implants, and partial disease resolution (DR2), measured as the presence of less than two bleeding sites at probing per implant. A final logistic multivariate regression model was built to evaluate the predictive role of implant and patient-level variables on DR.

RESULTS

Fifty two patients and 157 implants were included. Both groups displayed significant reduction in the extent of bleeding on probing and plaque levels. At 12 months, DR1 was achieved in 16% and 27% of participants for the test and the control group respectively. IDR1 was best predicted by the number of bleeding sites (OR = 2.7, p = 0.04) and the greatest PPD value (OR = 2.7, p = 0.05), while IDR2 by the prosthetic connection (OR = 2.59, p = 0.02), the mean PPD (OR = 2.23, p = 0.04), the FMBS (OR = 4.09, p = 0.04), and number of implants (OR = 4.59, p = 0.02).

CONCLUSIONS

Despite significant improvements of clinical signs of peri-implant inflammation, the use of GPAP appears to have no adjunctive effect as compared with Fm-UD alone in the achievement of DR. Elevated initial levels of bleeding and PD predicted inferior likelihood of reaching disease resolution. The present randomized parallel arm clinical study was registered on Clinicaltrials.gov and received the following registration number: NCT05801315. This clinical trial was not registered prior to participant recruitment and randomization (https://register.

CLINICALTRIALS

gov/prs/app/action/SelectProtocol?sid=S0009965&selectaction=Edit&uid=U0004FXM&ts=2&cx=fje7l8).

Screw-retained ceramic-veneered/monolithic zirconia partial implant-supported fixed dental prostheses: A 5 to 10-year retrospective study on survival and complications

PURPOSE

To assess the clinical performance of screw-retained, ceramic-veneered, monolithic zirconia partial implant-supported fixed dental prostheses (ISFDP) over 5-10 years and to evaluate implant- and prosthesis-related factors influencing treatment failure and complications.

MATERIALS AND METHODS

Partially edentulous patients treated with screw-retained all-ceramic ISFDPs with 2-4 prosthetic units with a documented follow-up of ≥5 years after implant loading were included in this retrospective study. The outcomes analyzed included implant/prosthesis failure and biological/technical complications. Possible risk factors were identified using the mixed effects Cox regression analysis.

RESULTS

A screened sample of 171 participants with 208 prostheses (95% of the restorations were splinted crowns without a pontic) supported by 451 dental implants were enrolled in this study. The mean follow-up duration after prosthesis delivery was 82.4 ±17.2 months. By the end of the follow-up period, 431 (95.57%) of the 451 implants remained functional at the implant level. At the prosthesis level, 185 (88.94%) of the 208 partial ISFDPs remained functional. Biological complications were observed in 67 implants (14.86%), and technical complications were observed in 62 ISFDPs (29.81%). Analysis revealed only emergence profiles (over-contoured) as a significant risk factor for implant failure (P<0.001) and biological complications (P<0.001). Full-coverage ceramic-veneered zirconia prostheses had a significantly greater chance of chipping (P<0.001) compared with buccal-ceramic-veneered or monolithic zirconia prostheses.

CONCLUSIONS

Screw-retained ceramic-veneered, monolithic partial ISFDPs have a favorable long-term survival rate. Over-contoured emergence profile is a significant risk factor associated with implant failure and biological complications. Buccal-ceramic-veneered and monolithic zirconia partial ISFDPs lower the initial prevalence of chipping compared with a full-coverage veneered design.

Biofouling on titanium implants: a novel formulation of poloxamer and peroxide for in situ removal of pellicle and multi-species oral biofilm

Eradicating biofouling from implant surfaces is essential in treating peri-implant infections, as it directly addresses the microbial source for infection and inflammation around dental implants. This controlled laboratory study examines the effectiveness of the four commercially available debridement solutions '(EDTA (Prefgel®), NaOCl (Perisolv®), H2O2 (Sigma-Aldrich) and Chlorhexidine (GUM® Paroex®))' in removing the acquired pellicle, preventing pellicle re-formation and removing of a multi-species oral biofilm growing on a titanium implant surface, and compare the results with the effect of a novel formulation of a peroxide-activated 'Poloxamer gel (Nubone® Clean)'. Evaluation of pellicle removal and re-formation was conducted using scanning electron microscope (SEM), energy-dispersive X-ray spectroscopy and X-ray photoelectron spectroscopy to assess the surface morphology, elemental composition and chemical surface composition. Hydrophilicity was assessed through contact angle measurements. The multi-species biofilm model included Streptococcus oralis, Fusobacterium nucleatum and Aggregatibacter actinomycetemcomitans, reflecting the natural oral microbiome's complexity. Biofilm biomass was quantified using safranin staining, biofilm viability was evaluated using confocal laser scanning microscopy, and SEM was used for morphological analyses of the biofilm. Results indicated that while no single agent completely eradicated the biofilm, the 'Poloxamer gel' activated with 'H2O2' exhibited promising results. It minimized re-contamination of the pellicle by significantly lowering the contact angle, indicating enhanced hydrophilicity. This combination also showed a notable reduction in carbon contaminants, suggesting the effective removal of organic residues from the titanium surface, in addition to effectively reducing viable bacterial counts. In conclusion, the 'Poloxamer gel + H2O2' combination emerged as a promising chemical decontamination strategy for peri-implant diseases. It underlines the importance of tailoring treatment methods to the unique microbial challenges in peri-implant diseases and the necessity of combining chemical decontaminating strategies with established mechanical cleaning procedures for optimal management of peri-implant diseases.

Maxillary Sinus Augmentation with Xenogenic Collagen-Retained Heterologous Cortico-Cancellous Bone: A 3-Year Follow-Up Randomized Controlled Trial

Sinus augmentation procedures have become a valuable solution for patients with posterior maxillary edentulism. The objective of this study was to explore the efficacy and safety of porcine xenograft with collagen supplementation as a potential alternative to autologous bone grafts in lateral sinus augmentation over a three-year follow-up period. Twelve patients, each with bilateral posterior maxillary edentulism, were enrolled and randomly allocated to receive either a porcine xenograft or an autologous graft. Comprehensive assessments, including clinical and radiographic evaluations, were conducted at specific intervals, including implant stability, marginal bone loss, prosthetic and biological complications, and patient preferences. The results demonstrated no significant differences between the two graft materials in terms of implant survival, marginal bone loss, and patient preferences after three years of follow-up. Only one implant was affected by peri-implantitis, and prosthesis-related complications were present in one patient possibly due to bruxism. In conclusion, these findings suggest that a porcine xenograft with collagen supplementation may be a viable alternative to an autograft in lateral sinus augmentation procedures. The high implant survival rate, minimal complications, and patient satisfaction indicate the potential clinical relevance of this graft material and should be further investigated to confirm these promising results.

Emerging factors affecting peri-implant bone metabolism

Implant dentistry has evolved to the point that standard implant osseointegration is predictable. This is attributed in part to the advancements in material sciences that have led toward improvements in implant surface technology and characteristics. Nonetheless, there remain several cases where implant therapy fails (specifically at early time points), most commonly attributed to factors affecting bone metabolism. Among these patients, smokers are known to have impaired bone metabolism and thus be subject to higher risks of early implant failure and/or late complications related to the stability of the peri-implant bone and mucosal tissues. Notably, however, emerging data have unveiled other critical factors affecting osseointegration, namely, those related to the metabolism of bone tissues. The aim of this review is to shed light on the effects of implant-related factors, like implant surface or titanium particle release; surgical-related factors, like osseodensification or implanted biomaterials; various drugs, like selective serotonin reuptake inhibitors, proton pump inhibitors, anti-hypertensives, nonsteroidal anti-inflammatory medication, and statins, and host-related factors, like smoking, diet, and metabolic syndrome on bone metabolism, and aseptic peri-implant bone loss. Despite the infectious nature of peri-implant biological complications, these factors must be surveyed for the effective prevention and management of peri-implantitis.

Selecting biomaterials in the reconstructive therapy of peri-implantitis

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.

Dental Implant Placement in Medically Compromised Patients: A Literature Review

As a discipline of dentistry, oral implantology deals with the diagnosis, design, insertion, restoration, and/or management of alloplastic or autogenous oral structures for the purpose of regaining contour, function, aesthetics, and speech in a partially or completely edentulous patient. The present review aims to provide the currently available knowledge about the impact of certain systemic disorders and the usage of some medications on the survival rate of dental implant therapy and to highlight the importance of patient management under these conditions. Diabetes, osteoporosis, cardiovascular diseases, and the intake of some medications can increase the risk of the failure of a dental implant. Even though there are relatively few medical contraindications to dental implant treatment, certain conditions may increase the risk of failure or complications.

Current scientific evidence for why periodontitis should be included in diabetes management

This Perspective provides a brief summary of the scientific evidence for the two-way links between periodontal diseases and hyperglycemia (diabetes mellitus [DM] and pre-DM). It delivers in a nutshell current scientific evidence for manifestations of hyperglycemia on periodontal health status and effects of periodontal diseases on blood glucose levels and in turn incidence, progression, and complications of diabetes. Of outmost importance is presentation of scientific evidence for the potential of routine periodontal treatment to lower blood glucose levels, providing a novel, economical tool in DM management. Non-surgical periodontal treatment ("deep cleaning") can be provided by dental hygienists or dentists in general dental offices, although severe cases should be referred to specialists. Such therapy can decrease the costs of DM care and other health care costs for people with DM. The great importance of a healthy oral cavity free of infection and subsequent inflammation - especially periodontitis that if untreated will cause loosening and eventually loss of affected teeth - has largely gone unnoticed by the medical community as the health care curricula are largely void of content regarding the bi-directional links between oral health and systemic health, despite elevation of blood glucose levels being an integral part of the general systemic inflammation response. The importance of keeping disease-free, natural teeth for proper biting and chewing, smiling, self-esteem, and pain avoidance cannot be overestimated. Medical and dental professionals are strongly encouraged to collaborate in patient-centered care for their mutual patients with - or at risk for - hyperglycemia.

Influence of the level of compliance with preventive maintenance therapy upon the prevalence of peri-implant diseases

BACKGROUND

A study was made to evaluate peri-implant conditions in compliers and erratic compliers with peri-implant maintenance therapy (PIMT), and to assess the role of site-specific confounders.

METHODS

Erratic PIMT compliers (EC) were defined as presenting attendance < 2×/year, while regular compliers (RC) attended ≥ 2×/year. Generalized estimating equations (GEE) were employed to perform a multivariable multilevel analysis in which the peri-implant condition was established as dependent variable.

RESULTS

Overall, 86 non-smoker patients (42 RC and 44 EC) attending the Department of Periodontology of the Universitat Internacional de Catalunya were recruited consecutively on a cross-sectional basis. The mean period of loading was 9.5 year. An implant placed in an erratic patient has 88% higher probability of presenting peri-implant diseases versus RC. Furthermore, the probability of diagnosis of peri-implantitis was significantly higher in EC versus RC (odds ratio [OR] 5.26; p = 0.009). Among other factors, history of periodontitis, non-hygienic prosthesis, period of implant loading, and modified plaque index (mPI) at implant level were shown to significantly increase the risk of peri-implantitis diagnosis. Although not associated with peri-implantitis diagnosis risk, keratinized mucosa (KM) width, and vestibular depth (VD) were significantly associated to plaque accumulation (mPI).

CONCLUSIONS

Compliance with PIMT was found to be significantly associated with peri-implant condition. In this sense, attending PIMT < 2×/year may be ineffective to prevent peri-implantitis.

Esthetic reconstruction of a localized severely resorbed anterior maxilla associated with peri-implantitis: A clinical report

This clinical report described the esthetic reconstruction of a localized severely resorbed right anterior maxilla associated with peri-implantitis. For vertical bone augmentation, guided bone regeneration surgery was performed by raising a flap with the remote incision technique, followed by soft tissue grafting and vestibuloplasty. The biologically oriented preparation technique was used to improve the health and stability of the peri-implant tissues. The surgical treatment and a novel method of prosthetic rehabilitation provided excellent esthetic and functional outcomes.

Frequency of screw-retained angulated screw channel single crown following immediate implant placement and provisionalization in the esthetic zone: A cone beam computed tomography study

OBJECTIVE

The purpose of this cone beam computed tomography (CBCT) study was to determine the frequency percentage of screw-retained crown using angulated screw channel (ASC) abutment for single immediate implant placement and provisionalization (IIPP) in the esthetic zone.

METHODS

The CBCT images of 200 patients without disease and without metal restorations in maxillary anterior teeth were evaluated. The mid-sagittal-sectional CBCT images of maxillary anterior teeth (#6-#11) were created in an implant planning software, screen-captured, and transferred to a presentation program. Template of tapered implants with diameter of 3.5 mm (for central and lateral incisors) and 4.3 mm (for central incisors and canines) and lengths of 13, 15, and 18 mm were applied to the sagittal images to identify the IIPP cases. To qualify for IIPP, the implant must engage >35% bone with at least 1 mm of surrounding bone and no perforations. The IIPP cases were further divided into straight screw channel (IIPPSSC) abutment or 25-degree angulated screw channel abutment (IIPPASC), based upon its restorability. The frequency percentages of possible IIPP, IIPPSSC, and IIPPASC were reported and compared among all maxillary anterior teeth.

RESULTS

A total of 1200 maxillary anterior teeth sagittal images from 200 patients (88 male and 112 female) with a mean age of 51.3 years (range 20-83 years) were evaluated in this study. The overall frequency percentages of IIPP, IIPPSSC, and IIPPASC possibility were 84% (74%-92%), 14% (10%-24%), and 75% (66%-87%), respectively.

CONCLUSION

Within the limitations of this CBCT study, 90% of single IIPP in the esthetic zone can be restored with screw-retained crown when utilizing ASC. In addition, the possibility of using a screw-retained restoration following IIPP increases about five times with ASC abutment compared to the SSC abutment.

Evaluation of IL-4, MIP-1α, and MMP-9 gene expression levels in peri-implant tissues in peri-implantitis

This case-control study evaluated the gene expression levels of interleukin (IL)-4, macrophage inflammatory protein type 1 alpha (MIP-1α), and metalloproteinase (MMP)-9, factors involved in the formation of giant cells in healthy peri-implant tissue and peri-implantitis. Thirty-five subjects (15 healthy and 20 with peri-implantitis), who met the inclusion and exclusion criteria, were included in this study. The peri-implant tissue biopsies were subjected to total RNA extraction, DNAse treatment, and cDNA synthesis. Subsequently, the reaction of real-time PCR was performed to evaluate the gene expression levels of IL-4, MIP-1α, and MMP-9 concerning the reference gene. IL-4 gene expression showed higher (18-fold) values in the Peri-Implantitis Group of Patients when compared with the Healthy (Control) Group (p<0.0001). Although MIP- 1α and MMP-9 gene expression levels were higher in diseased implants, they showed no significant differences (p=0.06 and p=0.2337), respectively. Within the limitations of this study, the results showed that in tissues affected by peri-implantitis, only levels of Il-4 were increased when compared with tissues in the control group.

Interproximal implant thread exposure after initial bone remodeling as a risk indicator for peri-implantitis

BACKGROUND

Due to the clinical challenges involved in successfully treating peri-implantitis, it is imperative to identify patient- and implant-level risk factors for its prevention. The main goal of this retrospective longitudinal radiographic and clinical study was to investigate whether interproximal radiographic implant thread exposure after physiological bone remodeling may be a risk factor for peri-implantitis. The secondary goal was to evaluate several other potential risk indicators.

METHODS

Of 4325 active dental school patients having implants placed, 165 partially edentulous adults (77 men, 88 women) aged 30-91 with ≥2 years of follow-up upon implant restoration were included. Implants with ≥1 interproximal thread exposed (no bone-to-implant contact) (n = 98, 35%) constituted the test group and those without exposed threads (n = 182, 65%) the control group. Descriptive, binary, and multivariate regression analyses were evaluated for goodness of fit. Wald tests were used to evaluate for significance set at 0.05.

RESULTS

Of the 280 implants (98 test, 182 control), 8 (2.9%) failed over a mean follow-up period of 7.67 (±2.63) years, and 27 implants (19 test, 8 control) developed peri-implantitis, with the exposed group having eight-fold (7.82 times) adjusted greater odds than the non-exposed. The risk increased four-fold (3.77 times) with each thread exposed. No other patient- or implant-related potentially confounding risk factors were identified.

CONCLUSIONS

Exposed interproximal implant threads after physiologic bone remodeling may be an independent risk indicator for incident peri-implantitis. Hence, clinicians should closely monitor patients with implant threads that have no bone-to-implant contact for incident peri-implantitis.