Risk indicators for peri-implantitis. A narrative review

An Assessment of Periodontal Status and Oral Hygiene in Patients with Hypertension in the South-West Region of Romania

Background: This cross-sectional analytical study evaluates oral hygiene and periodontal status in patients with hypertension, given the established link between cardiovascular diseases and poor periodontal health. Methods: A total of 24 hypertensive patients (15 male; 9 female) and 30 healthy controls (19 male; 11 female) from Craiova, Romania, were assessed using Periodontal Probing Depth (PPD), the Plaque Index (PLQ), and the Bleeding on Probing Index (BPI). Results: The mean age was 62.2 years in the hypertensive group and 47.4 years in the control group. Oral hygiene was poorer in hypertensive patients (PLQ: 73% vs. 24.1% in controls), with higher PPD (5.2 mm vs. 3.7 mm) and BPI (82% vs. 23%). Among patients with dental implants, PLQ was 24% in hypertensive individuals vs. 15.6% in controls, PPD was 4.4 mm vs. 2.9 mm, and BPI was 44% vs. 15.5%. Conclusions: These findings indicate a higher risk of periodontal disease in hypertensive patients, though dental implants may decrease some adverse effects by improving oral hygiene and periodontal health in this population. In conclusion, our study highlights that patients with high blood pressure have a less favorable periodontal status compared to healthy controls.

Effect of cementation technique and cement type on the amount of excess cement in implant-supported cement-retained crown restorations: An in vitro study

STATEMENT OF PROBLEM

Excess cement in implant-supported restorations can lead to peri-implant diseases, and its removal remains a clinical challenge. The optimum method of minimizing excess cement is unclear.

PURPOSE

The purpose of this in vitro study was to compare 3 cementation techniques and 3 cement types and measure excess cement.

MATERIAL AND METHODS

A total of 63 metal crowns and universal straight abutments were divided into 3 groups according to cementation techniques: direct (DT), polytetrafluoroethylene tape (PTT), and extraoral replica (ERT). (n=21) In all groups, 3 different cement types were used: glass ionomer cement (Meron; Voco), polycarboxylate cement (Adhesor Carbofine; Pentron), and resin-modified glass ionomer cement (GC FujiCEM Evolve; GC Corp) (n=7). The cemented crown-abutment combination was examined under a ×10 magnification stereomicroscope, and the cement remaining on the surface was calculated by using a computer program (ImageJ and NIH Image Software; National Institutes of Health). The relationship between cementation techniques and cement type and residual cement was examined with a 2-way ANOVA test. A post hoc test was used for intragroup comparisons (α=.05).

RESULTS

Regardless of the cement type, the residual cement amount was found to be the lowest in the ERT group (P<.001). Regardless of the technique, the lowest residual cement was found in glass ionomer cement (1.55 ±1.05 mm², 95% CI: 1.07 to 2.02).

CONCLUSIONS

The extraoral replica technique was the most effective in reducing excess cement, and cement type influenced its amount, with the highest residual cement amounts observed with resin-modified glass ionomer cement among all techniques.

Clinical and radiographic outcomes of mini-implant-retained maxillary and mandibular overdentures: a systematic review and meta-analysis

OBJECTIVE

To assess the clinical and radiographic outcomes of overdentures and their retaining dental mini-implants, based on a single-arm systematic literature review.

METHODS

Electronic search was undertaken in three databases, last updated in October 2023, plus manual search of journals. Cumulative implant survival rate (CSR) and the estimated marginal bone loss (MBL) under different follow-up times were calculated.

RESULTS

Thirty-nine studies were included, with 3,787 mini-implants supporting 1,026 overdentures (109 maxilla, 896 mandible) in 1,005 patients, with a mean follow-up of 28.1 ± 19.8 months (min-max 0.3-84.0). 202 mini-implants failed, after a mean of 9.4 ± 11.8 months (7-year CSR 91.4%). The implant survival was lower in the maxilla in comparison to the mandible (p < 0.001), lower for early/delayed-loaded in comparison to immediately-loaded implants (p = 0.005) and lower for 2-mini-implant in comparison to 4-mini-implant-retained mandibular overdenture (p < 0.001; Log-rank test). A high rate of transversal fracture of the prosthesis and wear of the attachment parts was observed. The estimated mean MBL gradually increased from 0.518 (≤ 6 months) to 1.260 mm (58.8-90 months). There was an estimated MBL increase of 0.011 mm per additional month of follow-up.

CONCLUSION

Although presenting a high 7-year CSR, mini-implant-retained overdentures may require frequent maintenance follow-ups, due to the high rate of technical complications. The estimated MBL of mini-implants over 80 months is low.

CLINICAL RELEVANCE

The ability to anticipate outcomes is an essential part of risk management in clinical practice. The findings reported herein set some recommendations and potential strategies for minimizing failures and complications commonly associated with this mini-implant-retained overdentures.

Exploring AI-Driven Machine Learning Approaches for Optimal Classification of Peri-Implantitis Based on Oral Microbiome Data: A Feasibility Study

Background: Machine learning (ML) techniques have been recently proposed as a solution for aiding in the prevention and diagnosis of microbiome-related diseases. Here, we applied auto-ML approaches on real-case metagenomic datasets from saliva and subgingival peri-implant biofilm microbiomes to explore a wide range of ML algorithms to benchmark best-performing algorithms for predicting peri-implantitis (PI). Methods: A total of 100 metagenomes from the NCBI SRA database (PRJNA1163384) were used in this study to construct biofilm and saliva metagenomes datasets. Two AI-driven auto-ML approaches were used on constructed datasets to generate 100 ML-based models for the prediction of PI. These were compared with statistically significant single-microorganism-based models. Results: Several ML algorithms were pinpointed as suitable bespoke predictive approaches to apply to metagenomic data, outperforming the single-microorganism-based classification. Auto-ML approaches rendered high-performing models with Receiver Operating Characteristic-Area Under the Curve, sensitivities and specificities between 80% and 100%. Among these, classifiers based on ML-driven scoring of combinations of 2-4 microorganisms presented top-ranked performances and can be suitable for clinical application. Moreover, models generated based on the saliva microbiome showed higher predictive performance than those from the biofilm microbiome. Conclusions: This feasibility study bridges complex AI research with practical dental applications by benchmarking ML algorithms and exploring oral microbiomes as foundations for developing intuitive, cost-effective, and clinically relevant diagnostic platforms.

Submucosal Microbiome Profiles in Paired and Unpaired Samples From Healthy and Peri-Implantitis Dental Implants

BACKGROUND

This cross-sectional study aimed to compare the composition of the submucosal microbiome of peri-implantitis with paired and unpaired healthy implant samples.

METHODS

We evaluated submucosal plaque samples obtained in 39 cases, including 13 cases of peri-implantitis, 13 cases involving healthy implants from the same patient (paired samples), and 13 cases involving healthy implants from different individuals (unpaired samples). The patients were evaluated using next-generation genomic sequencing (Illumina) based on 16S rRNA gene amplification. The sequences were grouped according to the amplicon sequence variant (ASV) to define the taxonomic categories. Alpha diversity was analyzed using Shannon's and Simpson's indices, while beta diversity was evaluated using principal coordinate analysis, analysis of similarities, and permutational multivariate variance analysis. Additionally, UniFrac distances were evaluated using Quantitative Insights into Microbial Ecology 2. Finally, we evaluated between-group differences in the taxonomic components.

RESULTS

There were no significant between-group differences in alpha diversity. The average bacterial ratios of Filifactor alocis, Porphyromona endodontalis, Tannerella forsythia, Treponema denticola, Peptostreptococcaceae [Eubacterium nodatum], Desulfobulbus sp. HTM 041, and Mogibacterium timidum significantly differed between peri-implantitis samples and unpaired samples from the healthy implants (p < 0.05). However, there were few differences in the microbiota between peri-implantitis samples and those paired with healthy implants in the same patient.

CONCLUSIONS

Future studies comparing the microbiome compositions using sequencing techniques between healthy implants and implants with peri-implantitis should focus on retrieving samples from the same patient, especially in individuals with a history of periodontitis.

Unraveling the Applicability of LbL Coatings for Drug Delivery in Dental Implant-Related Infection Treatment

Peri-implantitis is an inflammatory condition caused by bacterial biofilms adhered on dental implant surfaces that cause progressive tissue destruction from the host's inflammatory response. The adverse effects of peri-implantitis progression can go beyond just losing the implant. This highlights the importance of implementing strategies to stabilize disease in the short term. Layer-by-layer (LbL) assembly is a promising avenue in the field of peri-implantitis management due to its applicability with a variety of substances, in addition to being an easy, versatile, and flexible process for multilayer formation to act directly in the affected site. In this Review, our objective is to offer comprehensive chemical and biological insights into the LbL system, clarifying its specific application as antimicrobial coatings, with concern for the physical site and purpose. Additionally, we delve deeper into the concepts of onset and progression of peri-implantitis, aiming to elucidate the precise indications for employing the LbL system as a coating for implant abutments in peri-implantitis treatment. Finally, we correlate the chemical composition of the LbL system with its functionality while also addressing the challenges posed by the uncontrolled environment of the oral cavity, which ultimately restricts its clinical applicability.

The Decontamination Effect of an Oscillating Chitosan Brush Compared With an Ultrasonic PEEK-Tip: An In Vitro Study Using a Dynamic Biofilm Model

OBJECTIVES

This study aimed to assess the effect of an oscillating chitosan brush (OCB) compared with an ultrasonic device with PEEK tip (US-PEEK) for mechanical implant surface decontamination using an in vitro model combining 3D models and a validated dynamic multispecies biofilm.

MATERIALS AND METHODS

A multispecies biofilm using six bacterial strains (Streptococcus oralis, Veillonella parvula, Actinomyces naeslundii, Fusobacterium nucleatum, Porphyromonas gingivalis, and Aggregatibacter actinomycetemcomitans) was seeded on dental implants with machined and sandblasted, large-grit and acid-etched (SLA) surfaces. These were installed in 3D models depicting peri-implant defect. Mechanical decontamination was performed for 120 s using either an OCB or a US-PEEK. A negative control group received no treatment. Scanning electron microscopy (SEM) was used to evaluate the bacterial composition and quantitative PCR (qPCR) analyzed the number of each bacterial species [colony-forming units per milliliter (CFU/mL)].

RESULTS

Well-structured biofilms with a dense microbial distribution were observed on the negative control implants after 72 h. qPCR following mechanical decontamination showed a scarce bacterial reduction in the OCB group. The US-PEEK group exhibited a significant decrease in bacterial species compared to both OCB and control groups (p < 0.05). A biofilm removal effect was also observed in the OCB group for the machined implant surfaces.

CONCLUSION

In vitro assessment using an anatomical 3D model showed that mechanical decontamination effectively reduced biofilm. The US-PEEK group demonstrated biofilm reduction on the SLA surface, while the OCB group showed a reduction on the machined implant surface. Additionally, the US-PEEK group demonstrated greater efficacy in reducing bacterial numbers.

May dental implant macro and microgeometry modifications influence peri-implant bone repair in smokers? A randomized clinical trial

BACKGROUND

This split-mouth, double-masked, randomized clinical trial aimed at evaluating the impact of different macro geometries and nano topographical modifications on peri-implant bone repair in smokers.

METHODS

Thirty-two patients who smoked at least ten cigarettes/day, with the need of a single maxillary or mandibular implant bilaterally, received two implants randomly assigned to DA - Dual Acid-Etched implants (n = 32); HCAN - healing chambers and activated nano surface (n = 32). Implant stability quotient (ISQ) was evaluated 07, 30, 60, 90, and 120 days after implant placement. Levels of bone and angiogenic markers were quantified in the peri-implant fluid after 07, 15, 30, 90, and 120 days of implant insertion. HCAN implants have a higher ISQ than DA implants at 60 days (p < 0.05).

RESULTS

PLGF levels were lower for HCAN implants than for DA implants at 07-day period (p < 0.05). Besides, HCAN implants presented higher levels of OPG at 30 days and OPN, BMP-9, FGF-1, PLGF, and VEGF at 90 days, compared to DA implants (p < 0.05). The levels of EGF were higher for HCAN implants at 15, 90, and 120 days compared with DA implants (p < 0.05). HCAN implants also showed lower levels of TNF-α at 07 days in comparison to DA implants (p < 0.05) but had higher levels of DKK1 at 30 days, while DA implants presented higher levels of this marker at 90 days (p < 0.05).

CONCLUSION

Macro geometry and nano topographical modifications positively modulated the bone and angiogenic factors, resulting in higher production of these markers during early peri-implant bone healing and having a positive effect on implant stabilization in smokers.

TRIAL REGISTRATION

RBR-10gjvcyt; date of registration: 06/12/2023 (Retrospectively registered).

Treatment strategies for dental implant removal: A literature review

Dental implants have been widely used with success, but long-term usage sometimes leads to implant loss. The purpose of this review was to summarize the etiology of early and late failure requiring dental implant removal and the treatment strategies for the removal of failed implants and reimplantation. Early failures are often caused by patient-related factors, such as smoking, diabetes, radiotherapy, bone quality, and periodontitis of the remaining natural teeth. The most common cause of late failure is peri-implantitis, followed by implant fracture and implant malpositioning. Implants should be removed if they are mobile or if their superstructure cannot be maintained (e.g., implant fracture). For peri-implantitis, implant removal should be determined based on the patient's age and esthetic needs, the implant site, and the severity of bone loss. Many reports have been published on implant removal techniques. The reverse torque technique should always be the first choice because of its low invasiveness. The weighted survival rate for the replacement of failed implants is 86.3%, with a much lower survival rate after the second or subsequent implantations. Therefore, patient-specific problems, such as smoking habits and bruxism, should be checked before reimplantation and controlled to the greatest extent possible.

Albumin nanoparticles are a promising drug delivery system in dentistry

Periodontal infection is a long-lasting inflammatory condition caused by the growth and development of an abnormal and harmful community of microorganisms. This destructive illness leads to the loss of the tissues that support the teeth, degradation of the bone surrounding the teeth, and eventually tooth loss. To treat oral infections, it is necessary to use nonsurgical methods such as antibiotics. However, the indiscriminate and incorrect use of antibiotics results in drug resistance. Among these alternate therapeutic options, using nanoparticles to treat infectious dental disease was particularly significant. Consequently, researchers have worked to develop an effective and satisfactory drug delivery method for treating periodontal and dental illnesses. Albumin nanoparticles serve a considerable function as carriers in the drug delivery of chemical and biomolecular medications, such as anticancer treatments; they have several advantages, including biocompatibility and biodegradability, and they are well-tolerated with no adverse effects. Albumin nanoparticles have several benefits over other nanomaterials. Protein nanocarriers provide advantages such as biocompatibility, biodegradability, reduced immunogenicity, and lower cytotoxicity. Furthermore, this nanoparticle demonstrated significant intrinsic antibacterial properties without being loaded with antibiotic medicines. As a medication and antibacterial nanoparticle delivery method, albumin nanoparticles have substantial applications in periodontal and dental infectious disorders such as periodontal infection, apical periodontitis, and peri-implantitis. As a result, in this article, we studied the usage of albumin nanoparticles in dental disorders.

Antimicrobial Effects of Metal Coatings or Physical, Chemical Modifications of Titanium Dental Implant Surfaces for Prevention of Peri-Implantitis: A Systematic Review of In Vivo Studies

Introduction: Peri-implantitis poses a significant challenge for implant dentistry due to its association with bacterial colonization on implant surfaces and the complexity of its management. This systematic review aims to assess evidence from in vivo studies regarding the antimicrobial efficacy of titanium (Ti) dental implant surfaces following physical/chemical modifications or the application of various metal element coatings in preventing bacterial growth associated with peri-implantitis. Materials and Methods: A literature review was conducted across four scientific databases (PubMed, Embase, Scopus, Web of Science), encompassing in vivo studies published between 2013 and 2024, and 18 reports were included in the systematic review. Results: The findings suggest that titanium dental implant surfaces, following physical/chemical modifications and metal element coatings, exhibit antimicrobial effects against bacteria associated with peri-implantitis in humans and various animal models. Conclusions: The reviewed studies indicated a reduction in bacterial colonization, diminished biofilm formation, and decreased signs of inflammation in the peri-implant tissues, which provides evidence that physical/chemical alterations on titanium dental implant surfaces or metal element coatings, like silver (Ag), zinc (Zn), magnesium (Mg), and copper (Cu), demonstrate antimicrobial properties in in vivo studies. However, caution is warranted when translating findings to clinical practice due to methodological disparities and high bias risks. Further larger-scale clinical trials are imperative to assess their long-term efficacy and validate their clinical applicability.

Histological and immunohistochemical soft-tissue response to cylindrical and concave abutments: Multicenter randomized clinical trial

BACKGROUND

This study aimed to analyze the influence of concave and cylindrical abutments on peri-implant soft tissue. Dimensions, collagen fiber orientation, and immunohistochemical data were assessed.

METHODS

A multicenter, split-mouth, double-blind randomized clinical trial was conducted. Two groups were analyzed: cylindrical abutments and concave abutments. After a 12-week healing period, peri-implant soft tissue samples were collected, processed, and evaluated for dimensions, collagen fiber orientation, and immunohistochemical data. Inflammatory infiltration and vascularization were assessed, and the abutment surfaces were analyzed using scanning electron microscopy. The statistical analysis was performed using the SPSS version 20.0 statistical package.

RESULTS

A total of 74 samples in 37 patients were evaluated. Histological evaluation of peri-implant soft tissue dimensions revealed significant differences between concave and cylindrical abutments. Concave abutments exhibited greater total height (concave: 3.57 ± 0.28 - cylindrical: 2.95 ± 0.27) and barrier epithelium extension (concave: 2.46 ± 0.17 - cylindrical: 1.89 ± 0.21) (p < 0.05), while the supracrestal connective tissue extension (concave: 1.11 ± 0.17 - cylindrical: 1.03 ± 0.16) was slightly greater (p > 0.05). Collagen fiber orientation favored concave abutments (23.76 ± 5.86), with significantly more transverse/perpendicular fibers than for cylindrical abutments (15.68 ± 4.57). The immunohistochemical analysis evidenced greater inflammatory and vascular intensity in the lower portion for both abutments, though concave abutments showed lower overall intensity (concave: 1.05 ± 0.78 - cylindrical: 1.97 ± 0.68) (p < 0.05). The abutment surface analysis demonstrated a higher percentage of tissue remnants on concave abutments (42.47 ± 1.32; 45.12 ± 3.03) (p < 0.05).

CONCLUSIONS

Within the limitations of this study, concave abutments presented significantly greater peri-implant tissue height, linked to an extended barrier epithelium, versus cylindrical abutments in thick tissue phenotype. This enhanced soft tissue sealing, favoring a greater percentage of transversely oriented collagen fibers. The concave design reduced chronic inflammatory exudation with T and B cells, thus minimizing the risk of chronic inflammation.

PLAIN LANGUAGE SUMMARY

This study looked at how 2 different shapes of dental implant abutments (the parts that connect the implant to the crown), specifically concave and cylindrical, affect the soft tissue around the implants. We wanted to see how these shapes influenced the tissue's size, structure, and health. We conducted a clinical trial with 37 patients, comparing the 2 types of abutments in the same mouth over 12 weeks. Our findings showed that the concave abutments led to a taller and more extensive layer of protective tissue around the implant compared to the cylindrical ones. This protective tissue had more favorable collagen fiber orientation, which is important for the strength and health of the tissue. Additionally, the concave abutments resulted in less inflammation and better tissue integration. In conclusion, concave abutments may provide better support and health for the soft tissue around dental implants, reducing the risk of chronic inflammation and potentially leading to better long-term outcomes for patients with dental implants.

Realizing the clinical utility of saliva for monitoring oral diseases

In the era of personalized/precision health care, additional effort is being expended to understand the biology and molecular mechanisms of disease processes. How these mechanisms are affected by individual genetics, environmental exposures, and behavioral choices will encompass an expanding role in the future of optimally preventing and treating diseases. Considering saliva as an important biological fluid for analysis to inform oral disease detection/description continues to expand. This review provides an overview of saliva as a diagnostic fluid and the features of various biomarkers that have been reported. We emphasize the use of salivary biomarkers in periodontitis and transport the reader through extant literature, gaps in knowledge, and a structured approach toward validating and determine the utility of biomarkers in periodontitis. A summation of the findings support the likelihood that a panel of biomarkers including both host molecules and specific microorganisms will be required to most effectively identify risk for early transition to disease, ongoing disease activity, progression, and likelihood of response to standard periodontal therapy. The goals would be to develop predictive algorithms that serve as adjunctive diagnostic tools which provide the clinician and patient important information for making informed clinical decisions.

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.

Sustained Release of Salicylic Acid for Halting Peri-Implantitis Progression in Healthy and Hyperglycemic Systemic Conditions: A Gottingen Minipig Model

To develop a peri-implantitis model in a Gottingen minipig and evaluate the effect of local application of salicylic acid poly(anhydride-ester) (SAPAE) on peri-implantitis progression in healthy, metabolic syndrome (MS), and type-2 diabetes mellitus (T2DM) subjects. Eighteen animals were allocated to three groups: (i) control, (ii) MS (diet for obesity induction), and (iii) T2DM (diet plus streptozotocin for T2DM induction). Maxillary and mandible premolars and first molar were extracted. After 3 months of healing, four implants per side were placed in both jaws of each animal. After 2 months, peri-implantitis was induced by plaque formation using silk ligatures. SAPAE polymer was mixed with mineral oil (3.75 mg/μL) and topically applied biweekly for up to 60 days to halt peri-implantitis progression. Periodontal probing was used to assess pocket depth over time, followed by histomorphologic analysis of harvested samples. The adopted protocol resulted in the onset of peri-implantitis, with healthy minipigs taking twice as long to reach the same level of probing depth relative to MS and T2DM subjects (∼3.0 mm), irrespective of jaw. In a qualitative analysis, SAPAE therapy revealed decreased levels of inflammation in the normoglycemic, MS, and T2DM groups. SAPAE application around implants significantly reduced the progression of peri-implantitis after ∼15 days of therapy, with ∼30% lower probing depth for all systemic conditions and similar rates of probing depth increase per week between the control and SAPAE groups. MS and T2DM conditions presented a faster progression of the peri-implant pocket depth. SAPAE treatment reduced peri-implantitis progression in healthy, MS, and T2DM groups.

An introduction to dental implants

The use of implants to replace missing teeth is now commonplace and practised by clinicians worldwide in both general and specialist practice. There is an abundance of evidence on the general success of implant treatment. As well as reviewing the history of dental implants, this narrative review will discuss the merits and successful placement of tissue-level verses bone-level implants. Furthermore, the article will evaluate the concept and benefits of platform switching for implant treatment. Finally, with the increased placement of implants, this narrative paper will review how different titanium surfaces impact on the risk of peri-implantitis.

Saliva exposure reduces gingival keratinocyte growth on TiO2-coated titanium

Bioactive, nanoporous TiO2-coating has been shown to enhance cell attachment on titanium implant surface. The aim of this study was to evaluate, whether the saliva proteins affect the epithelial cell adhesion on TiO2-coated and non-coated titanium. Grade V titanium discs were polished. Half of the discs were provided with TiO2-coating produced in sol with polycondensation method. Half of the TiO2-coated and non-coated discs were treated with pasteurized saliva for 30 min. After saliva treatment, the total protein amounts on surfaces were measured. Next, the hydrophilicity of discs were measured with water contact angle measurements. Further, the gingival keratinocyte adhesion strength was measured after 2 and 6 h of cultivation using serial trypsinization. In addition, cell growth and proliferation were measured after 1, 3, and 7 days of cell culture. Finally, cell morphology, spreading and adhesion protein signals were detected with high resolution confocal microscopy. As a result, in sol coated TiO2-surface had significantly higher hydrophilicity when compared to non-coated titanium, meanwhile both non-coated and TiO2-coated surfaces with saliva treatment had a significant increase in hydrophilicity. Importantly, the amounts of adhered saliva proteins were equal between TiO2-coated and non-coated surfaces. Adhesion strength against enzymatic detachment was weakest on non-coated titanium after saliva exposure. Cell proliferation and cell spreading were highest on TiO2-coated titanium, but saliva exposure significantly decreased cell proliferation and spreading on TiO2-coated surface. To conclude, even though saliva exposure makes titanium surfaces more hydrophilic, it seems to neutralize the bioactive TiO2-coating and decrease cell attachment to TiO2-coated surface.

Efficacy of adjunctive photodynamic therapy to conventional mechanical debridement for peri-implant mucositis

OBJECTIVE

This meta-analysis was conducted to assess the effectiveness of photodynamic therapy (PDT) as an adjunct to conventional mechanical debridement (CMD) for the management of peri-implant mucositis (p-iM).

METHODS

We systematically searched four databases (PubMed, Embase, Web of Science, and Cochrane Library) for randomized controlled trials (RCTs) investigating PDT + CMD for p-iM from their inception to March 13, 2023. Meta-analysis was performed using RevMan 5.4 software.

RESULTS

Seven RCTs met the inclusion criteria. The meta-analysis revealed that PDT + CMD treatment was more effective than CMD alone in reducing probing depth (PD) (Mean Difference [MD]: -1.09, 95% Confidence Interval [CI]: -1.99 to -0.2, P = 0.02) and plaque index (PI) (MD: -2.06, 95% CI: -2.81 to -1.31, P < 0.00001). However, there was no statistically significant difference in the improvement of bleeding on probing (BOP) between the PDT + CMD groups and CMD groups (MD: -0.97, 95% CI: -2.81 to 0.88, P = 0.31).

CONCLUSIONS

Based on the current available evidence, this meta-analysis indicates that the addition of PDT to CMD significantly improves PD and PI compared to CMD alone in the treatment of p-iM. However, there is no significant difference in improving BOP.

The effect of individuals' oral hygiene habits and knowledge levels on peri-implant health and disease: a questionnaire-based observational study

BACKGROUND

Peri-implant disease and health are associated with microbial dental plaque. Therefore, oral hygiene plays a role in preventing and treating these diseases. This study aimed to determine the relationships among knowledge of peri-implant status, oral hygiene habits, and peri-implant disease and health.

METHODS

A total of 144 implants in nonsmokers with controlled systemic disease were included in the study. Peri-implant disease and the conditions of the implants were determined with periodontal indices and radiographs based on the 2017 World Workshop on the Classification of Periodontal and Peri-implant Diseases and Conditions and The EFP S3 level clinical practice guideline. Individuals were asked 66 questions regarding demographic information, oral hygiene habits and history, and knowledge of peri-implant diseases. One-way ANOVA was used to compare the three peri-implant disease and condition categories.

RESULTS

There was a significant difference between groups regarding toothpaste type (p < 0.05). Gum protection toothpaste was greater in the peri-implant health group. Patients' use of interdental products was very low; often, no products were used for implant prosthesis. There was no significant difference among the groups regarding oral hygiene product use or oral hygiene habits (p > 0.05). There was a significant difference between groups regarding frequency of visit (p < 0.05). The frequency of visits to the dentist for pain was greater for individuals with peri-implantitis. There is a significant difference between the groups' answers for the causative and initiating factors of peri-implant disease (p < 0.05). The peri-implant health group answered that microbial dental plaque is the most crucial initiating factor of peri-implant diseases, and bleeding on probing is the most critical determinant of peri-implant diseases at a higher rate than the other groups.

CONCLUSIONS

Patients' oral hygiene habits and knowledge levels are almost similar according to peri-implant status. Knowledge does not reflect a patient's oral hygiene behavior. Clinicians should ensure that individuals' oral hygiene practices align with their increased awareness regarding peri-implant illnesses.

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.

Diagnosis and Treatment of Periimplant Mucositis and Periimplantitis: An Overview and Related Controversial Issues

Periimplant mucositis and periimplantitis are common complications of dental implant. This article provides a comprehensive overview of the 2017 World Workshop's new definition, clinical and radiographic presentation, pathogenesis, risk factors, and classification of periimplant diseases. Also, the authors discuss various types of instruments, materials, and techniques commonly used for treatment of nonsurgical and surgical periimplantitis. Lastly, the authors include some controversial topics surrounding this subject.

The Influence of History of Severe Periodontitis on Estimated Long-Term Marginal Bone Loss around Implants Restored with Fixed Segmented Full-Arch Rehabilitation

The aim of this study was to analyze the long-term marginal bone level (MBL) of implants supporting fixed full-arch restoration in patients who had previously lost their dentition due to severe periodontitis. This retrospective study included 35 patients in whom 342 implants with internal tapered conical connections were placed. MBL was analyzed radiographically over time and a long-term estimation of MBL was calculated. A mixed linear model with abutment height, graft, diameter and location (maxilla/mandible) as factors and gender, age, implant length and prosthetic variables as covariates was used to evaluate the influence on MBL. MBL in these patients showed an estimator of predictions at 4108 days after loading of -0.307 mm, SE = 0.042. Only 0.15% of implants were radiographically affected with MBL of 3 mm or more. The mixed linear model results showed a main effect of the type of opposing dentition, gender, implant diameter, and abutment height. Particularly, an abutment height of 1 mm had associated larger MBL than the remaining heights. Thus, it can be concluded that dental implants restored with fixed segmented full-arch rehabilitation in patients with a history of severe periodontal disease do not suffer important marginal bone loss if some specific factors are considered, mainly the use of long transmucosal abutments (≥2 mm).

Plaque accumulation on the fitting surface of full-arch implant-supported fixed prostheses with contact or noncontact pontics: A split mouth randomized controlled trial

OBJECTIVE

To explore the differences in plaque accumulation on the fitting surface of full-arch implant-supported fixed prostheses with contact or noncontact pontics.

MATERIALS AND METHODS

Nineteen patients (20 prostheses, 7 in the maxilla, and 13 in the mandible) intending to undergo full-arch implant-supported immediate function prostheses were recruited. During immediate restoration and using the midline as the boundary, one side was restored as a pontic and mucosa noncontact type (the test group), and the opposite side was restored as a pontic and mucosa contact type (the control group). In a follow-up 6 months after the surgery, the cleanliness of the fitting surface of the immediate prosthesis was evaluated by plaque staining and debris index determination. Patient satisfaction was investigated by questionnaire.

RESULTS

Twenty prostheses from 19 patients included in the randomized controlled trial were followed up. Among the 20 prostheses, the percentage of area covered with plaque was significantly lower in the test group compared with that in the control group (31.5 ± 15.8% vs. 43.7 ± 15.3%; p < 0.001). The debris index in the test group was lower than that in the control group, although the difference was not statistically significant (2.77 ± 0.73 vs. 3.15 ± 0.90; p > 0.05). In the patient satisfaction survey, most of the patients were satisfied with most aspects of the prostheses, however, nearly half of the patients were not satisfied with the cleaning.

CONCLUSIONS

The pontic and mucosa noncontact prosthetic design reduces plaque accumulation on the fitting surface, which is beneficial for maintaining oral cleanliness. However, the majority of study samples were mandible and conclusions may not be fully applicable to maxilla.

TRIAL REGISTRATION

www.chictr.org.cn (ChiCTR1900028576).

CLINICAL SIGNIFICANCE

The noncontact design in full-arch implant-supported fixed prostheses may be an effective measure of improving oral hygiene promotion. There is need for more research that can further improve oral hygiene of patients with full-arch implant-supported prostheses.

Influence of abutment shape on peri-implant tissue conditions: A randomized clinical trial

OBJECTIVE

To analyze the influence of 3-mm high abutments with different shapes (cylindrical abutment vs. wide abutment) on marginal bone-level changes (bone loss and bone remodeling). The influence of abutment shape on implant success, probing pocket depth (PPD), and bleeding on probing (BoP) was studied as secondary objectives.

MATERIALS AND METHODS

Patients with a partially edentulous area requiring fixed dental prostheses by two implants in the posterior mandible or maxilla were included. The implants were 1 mm subcrestally placed, and osseointegration healing was submerged. Three-mm high abutments with two different shapes were randomly placed in second-stage surgery: cylindrical abutments (cylindrical group) and wide abutments (wide group). Marginal bone-level changes were measured using parallelized periapical radiographs at abutment placement, at definitive prosthesis placement, and at 1, 3, 6, and 12 months after loading. PPD and BoP were likewise measured at the control visits.

RESULTS

Sixty-four dental implants in 25 patients were included. Statistically significant differences were found in bone-level changes. The cylindrical group exhibited less mean marginal bone remodeling (MBR) and marginal bone loss (MBL) than the wide group (p < .05). Moreover, the cylindrical group showed significantly less BoP (p < .05).

CONCLUSION

Abutment shape had a significant influence upon marginal bone-level changes during the first 12 months. Cylindrical abutments caused less MBR and MBL than wide abutments. More clinical studies involving longer follow-ups and analyzing other abutment modifications are needed to improve our understanding of how abutments can affect peri-implant tissue stability.

Long-Term Efficacy of Chlorhexidine Gel in Single-Crown Implant Rehabilitation: A Five-Year Follow-Up Study

Chlorhexidine digluconate (CHX) has shown the ability to significantly reduce inflammation and marginal bone loss (MBL) at the 1-year follow-up but limited data exist regarding its long-term efficacy in peri-implant stability. The objective was to compare the long-term effects (5 years of follow-up) of a placebo gel (16 patients in Group A) or a 0.20% CHX gel (15 patients in Group B) used at each previous surgical and prosthetic stage. Control visits were conducted in 2022, investigating the long-term effects by biological, radiological, and clinical evaluation. The data were statistically analyzed. The research achieved a 96.7% implant success rate over five years, but 41.9% of patients did not attend annual oral hygiene check-ups. The average MBL was 1.04 ± 0.39 mm, with no significant differences between the two groups. Notably, patients who attended regular periodontal check-ups experienced significantly less MBL than those who did not (p < 0.05). At five years, direct effects of CHX were absent, with both groups showing moderate bone loss. However, the results suggest that early disinfection could enhance both short- and long-term outcomes. In fact, patients with initial minor MBL due to use of CHX, preserve this advantage also after 5 years of follow-up. Additionally, the data underscore the importance of annual check-ups in early detection and management of biological complications.

Assessment of titanium release following non-surgical peri-implantitis treatment: A randomized clinical trial

BACKGROUND

Peri-implantitis is a frequent finding. Initial treatment involves non-surgical debridement of the implant surface. Recent studies have found a correlation between titanium (Ti) particle release and peri-implantitis, yet there is a dearth of information regarding the effect of various non-surgical instrumentation on particle release or peri-implantitis resolution.

METHODS

Patients with peri-implantitis were recruited for a randomized, blinded, parallel-group clinical trial. The implants were randomized to treatment composed of Ti curettes ("Mech" group) or implant-specific treatment composed of rotary polymer microbrushes ("Imp" group). Ti release in submucosal peri-implant plaque pre- and 8 weeks posttreatment was assessed as the primary outcome. Peri-implant probing depth, bleeding on probing, and suppuration on probing were evaluated and compared between groups.

RESULTS

Thirty-four participants completed treatment; 18 were randomized to the Mech group and 16 to the Imp group. The groups were comparable for Ti levels and probing depths at baseline. A trend was noted for 10-fold greater Ti dissolution in the Mech group posttreatment compared to the Imp group (p = 0.069). The Imp group had a significant reduction in probing depth posttreatment (p = 0.006), while the Mech group reduction was not significant.

CONCLUSION

Peri-implantitis treated non-surgically with implant-specific instruments (Imp group) had a significantly greater decrease in probing depth versus the Mech treatment group. This improvement was linked with a trend for less Ti release to the peri-implant plaque by the non-abrasive treatment.

The integration of peri-implant soft tissues around zirconia abutments: Challenges and strategies

Stable soft tissue integration around the implant abutment attenuates pathogen penetration, protects underlying bone tissue, prevents peri-implantitis and is essential in maintaining long-term implant stability. The desire for "metal free" and "aesthetic restoration" has favored zirconia over titanium abutments, especially for implant restorations in the anterior region and for patients with thin gingival biotype. Soft tissue attachment to the zirconia abutment surface remains a challenge. A comprehensive review of advances in zirconia surface treatment (micro-design) and structural design (macro-design) affecting soft tissue attachment is presented and strategies and research directions are discussed. Soft tissue models for abutment research are described. Guidelines for development of zirconia abutment surfaces that promote soft tissue integration and evidence-based references to inform clinical choice of abutment structure and postoperative maintenance are presented.

Clinical and Radiographic Outcomes of Adjunctive Photodynamic Therapy for Treating Peri-Implant Mucositis Among Cigarette Smokers and Diabetics: A Systematic Review and Meta-Analysis

Objective: This systematic review aimed to assess the influence of antimicrobial photodynamic therapy (aPDT) as an adjunct to mechanical debridement (MD) on peri-implant clinical and radiographic outcomes among cigarette smokers and diabetics with peri-implant mucositis (piM). Methods: Randomized controlled trials, assessing the clinical and radiographic parameters of aPDT versus MD alone among smokers and diabetics with piM, were included in the study. Meta-analyses were conducted to calculate the standard mean difference with a 95% confidence interval. The methodological quality of the included studies was assessed utilizing the modified Jadad quality scale. Results: The meta-analyses found statistically significant differences between the impact of adjunct aPDT and MD alone on the peri-implant plaque index (PI), probing depth (PD), and bleeding on probing among smokers and diabetics with piM at the final follow-up visit. However, no significant differences were found between the impact of adjunct aPDT and MD alone on the peri-implant crestal bone loss among smokers and diabetics with piM at the final follow-up. Conclusions: The application of aPDT as an adjunctive to MD demonstrated improved scores of the peri-implant clinical parameters among smokers and diabetics with piM in comparison with MD alone.

The Impact of Smoking on Peri-implant Microbiota: A Systematic Review

OBJECTIVES

Peri-implantitis is associated with bacterial plaque biofilms and with patients who have a history of periodontitis. Smoking is a risk factor for periodontitis, but the relationship between smoking and peri-implantitis is unclear. The aim of this systematic review was to assess evidence ascertaining the relationship between smoking and peri-implant microbiota.

DATA SOURCES

An electronic search was conducted in the MEDLINE/PubMed, Embase and Scopus® databases in duplicate up to January 2023 without language restrictions. Studies were considered eligible for inclusion if they involved evaluation of the peri-implant microbiota of smokers and nonsmokers. Methodological quality was assessed with the adapted Newcastle-Ottawa scale.

STUDY SELECTION

Fourteen studies were identified for inclusion in the present study, and 85.7% of the studies were defined as medium to high methodological quality. Overall, the evidence presented in this review was limited to medium to high methodological quality. The data indicates that significantly higher frequencies of anaerobic pathogens are detectable in healthy peri-implant tissues of smokers. A lower diversity of microbiota was observed in healthy peri-implant sites of smokers. In the transition from clinically healthy to a diseased status, smoking shaped a reduced peri-implant microbiota by depleting commensal and enriching pathogenic species.

CONCLUSIONS

The composition of peri-implant microbiota may be influenced by smoking. More studies are needed to determine the impact of smoking on peri-implant microbiota.

CLINICAL SIGNIFICANCE

In the transition from clinically healthy to a diseased status, smoking shaped a reduced peri-implant microbiota by depleting commensal and enriching pathogenic species. The composition of peri-implant microbiota may be influenced by smoking.

Comparison of In Vitro Biofilm Formation on Titanium and Zirconia Implants

Background

Peri-implant diseases are emerging issues in contemporary implant dentistry. As biofilms play a critical role in peri-implant diseases, the characteristic of resisting bacterial adhesion would be ideal for dental implants. The aims of the study were to compare titanium (Ti) and zirconia (Zr) implants regarding the amount of biofilm formation at different time frames and assess the distribution of biofilm on different aspects of dental implants.

Methods

Biofilm was developed on Ti and Zr dental implants with a peri-implant-related multispecies model with Streptococcus oralis, Actinomyces naeslundii, Veillonella dispar, and Porphyromonas gingivalis, for 3 and 14 days. Quantitative assessment was performed with the measurement of total bacterial viability (colony forming units, CFU/mg). Scanning electron microscopy (SEM) was used to evaluate biofilm formation on different aspects of the implants.

Results

Three-day-old biofilm on Ti implants was significantly higher than that on Zr implants (p < 0.001). The Ti and Zr groups were not significantly different for 14-day-old biofilm. SEM images demonstrated that 3-day-old biofilm on Zr implants was sparse while biofilm growth was more pronounced for 3-day-old biofilm on Ti implants and 14-day-old biofilm groups. It appeared that less biofilm formed on the valley compared to the thread top for 3-day-old biofilm on Zr implants. Differences between the valley and the thread top became indistinguishable with the development of mature biofilm.

Conclusion

While early formed biofilms show greater accumulation on Ti implants compared to Zr implants, older biofilms between the two groups are comparable. The distribution of biofilms was not uniform on different areas of implant threads during early biofilm development.

Assessment of the content and quality of YouTube videos related zygomatic implants: A content-quality analysis

INTRODUCTION

This study aimed to evaluate the content and quality of YouTube videos of zygomatic implants.

METHODS

According to Google Trends (2021), "zygomatic implant" was the most preferred keyword related to the topic. Therefore, in this study "zygomatic implant" was used as a keyword for the video search. Demographic characteristics such as the number of views, likes/dislikes, comments, video duration, number of days after upload, uploaders, and target audiences of the videos were evaluated. To evaluate the accuracy and content quality of videos (available from YouTube), the video information and quality index (VIQI) and global quality scale (GQS) were used. Statistical analyses were performed using the Kruskal-Wallis test, Mann-Whitney U test, chi-square test, Fisher's exact chi-square test, Yates continuity correction, and Spearman correlation analysis (p < 0.05).

RESULTS

A total of 151 videos were searched; 90 met all inclusion criteria. According to the video content score, 78.9% of the videos were identified as low content, 20% as moderate, and 1.1% as high content. There was no statistical difference between the groups in video demographic characteristics (p > 0.001). Conversely, information flow, accuracy of information, video quality and precision, and total VIQI scores were statistically different between the groups. The moderate-content group had a higher GQS score than the low-content group (p < 0.001). The videos were mainly uploaded (40%) from hospitals and universities. Most videos were targeted toward professionals (46.75%). Low-content videos had higher ratings than the moderate- and high-content videos.

CONCLUSIONS

Most YouTube videos on zygomatic implants showed low-content quality. This implies that YouTube is not a reliable source of information on zygomatic implants. Dentists, prosthodontists, and oral and maxillofacial surgeons should be aware of the content of video-sharing platforms and take responsibility for enriching video content.

Primordial and primary prevention of peri-implant diseases: A systematic review and meta-analysis

AIM

This systematic review and meta-analysis aims to assess the efficacy of risk factor control to prevent the occurrence of peri-implant diseases (PIDs) in adult patients awaiting dental implant rehabilitation (primordial prevention) or in patients with dental implants surrounded by healthy peri-implant tissues (primary prevention).

MATERIALS AND METHODS

A literature search was performed without any time limit on different databases up to August 2022. Interventional and observational studies with at least 6 months of follow-up were considered. The occurrence of peri-implant mucositis and/or peri-implantitis was the primary outcome. Pooled data analyses were performed using random effect models according to the type of risk factor and outcome.

RESULTS

Overall, 48 studies were selected. None assessed the efficacy of primordial preventive interventions for PIDs. Indirect evidence on the primary prevention of PID indicated that diabetic patients with dental implants and good glycaemic control have a significantly lower risk of peri-implantitis (odds ratio [OR] = 0.16; 95% confidence interval [CI]: 0.03-0.96; I² : 0%), and lower marginal bone level (MBL) changes (OR = -0.36 mm; 95% CI: -0.65 to -0.07; I² : 95%) compared to diabetic patients with poor glycaemic control. Patients attending supportive periodontal/peri-implant care (SPC) regularly have a lower risk of overall PIDs (OR = 0.42; 95% CI: 0.24-0.75; I² : 57%) and peri-implantitis compared to irregular attendees. The risk of dental implant failure (OR = 3.76; 95% CI: 1.50-9.45; I² : 0%) appears to be greater under irregular or no SPC than regular SPC. Implants sites with augmented peri-implant keratinized mucosa (PIKM) show lower peri-implant inflammation (SMD = -1.18; 95% CI: -1.85 to -0.51; I² : 69%) and lower MBL changes (MD = -0.25; 95% CI: -0.45 to -0.05; I² : 62%) compared to dental implants with PIKM deficiency. Studies on smoking cessation and oral hygiene behaviors were inconclusive.

CONCLUSIONS

Within the limitations of available evidence, the present findings indicate that in patients with diabetes, glycaemic control should be promoted to avoid peri-implantitis development. The primary prevention of peri-implantitis should involve regular SPC. PIKM augmentation procedures, where a PIKM deficiency exists, may favour the control of peri-implant inflammation and the stability of MBL. Further studies are needed to assess the impact of smoking cessation and oral hygiene behaviours, as well as the implementation of standardized primordial and primary prevention protocols for PIDs.

Levels of peri-implant sulcular fluid levels of soluble urokinase plasminogen activator receptor and TNF-α among cigarette smokers and non-smokers with peri-implantitis

BACKGROUND

Soluble urokinase plasminogen activator receptor (suPAR) and tumor necrosis factor-alpha (TNF-α) are inflammatory biomarkers. No studies have yet assessed the suPAR levels in relation with TNF-α in the peri-implant sulcular fluid (PISF) among cigarette smokers and non-smokers with peri-implantitis.

OBJECTIVE

The aim was to evaluate PISF levels of suPAR, and TNF-α among cigarette smokers and non-smokers with and without peri-implantitis.

METHODS

Sixty male patients with peri-implantitis were included. There were 20 cigarette smokers and 20 and non-smokers with peri-implantitis (Groups 1 and 2), and 20 non-smokers without peri-implantitis (Group 3). Demographic data and information related to cigarette smoking was recorded. Peri-implant clinicoradiographic parameters (plaque index [PI], gingival index [GI], probing depth [PD] and crestal bone loss [CBL]) were assessed. The PISF samples were collected and levels of suPAR and TNF-α were measured. Sample-size estimation was performed and all parameters were statistically assessed. Level of significance was set at P< 0.05.

RESULTS

Sixty individuals were included in Groups 1, 2 and 3 (20 in each). Peri-implant PI (P< 0.01), PD (P< 0.01) and mesial (P< 0.01) and distal (P< 0.01) CBL were significantly higher in Group 1 than in Groups 2 and 3. The PISF volume (P< 0.01) and suPAR (P< 0.01) and TNF-α levels (P< 0.01) were significantly higher in Groups 1 and 2 than in Group 3. There was no difference in PISF volume and suPAR and TNF-α levels between patients in Groups 1 and 2. In Group 2, there was a statistically significant correlation between peri-implant PD and PISF suPAR and TNF-α levels (P< 0.01). The suPAR and TNF-α levels are expressed in high concentrations in the PISF of smokers and non-smokers with peri-implantitis compared with non-smokers without peri-implantitis.

CONCLUSION

In non-smokers, PISF suPAR and TNF-α levels are correlated with peri-implant PD.

Antibacterial Electrodeposited Copper-Doped Calcium Phosphate Coatings for Dental Implants

Dental implants provide a good solution for the replacement of tooth roots. However, the full restoration of tooth functions relies on the bone-healing period before positioning the abutment and the crown on the implant, with the associated risk of post-operative infection. This study aimed at developing a homogeneous and adherent thin calcium phosphate antibacterial coating on titanium dental implants by electrodeposition to favor both implant osseointegration and to limit peri-implantitis. By combining global (XRD, FTIR-ATR, elemental titration) and local (SEM, Raman spectroscopy on the coating surface and thickness) characterization techniques, we determined the effect of electrodeposition time on the characteristics and phases content of the coating and the associated mechanism of its formation. The 1-min-electrodeposited CaP coating (thickness: 2 ± 1 μm) was mainly composed of nano-needles of octacalcium phosphate. We demonstrated its mechanical stability after screwing and unscrewing the dental implant in an artificial jawbone. Then, we showed that we can reach a high copper incorporation rate (up to a 27% Cu/(Cu+Ca) molar ratio) in this CaP coating by using an ionic exchange post-treatment with copper nitrate solution at different concentrations. The biological properties (antibiofilm activity and cytotoxicity) were tested in vitro using a model of mixed bacteria biofilm mimicking peri-implantitis and the EN 10993-5 standard (direct contact), respectively. An efficient copper-doping dose was determined, providing an antibiofilm property to the coating without cytotoxic side effects. By combining the electrodeposition and copper ionic exchange processes, we can develop an antibiofilm calcium phosphate coating on dental implants with a tunable thickness and phases content.

GUIDED PERI-IMPLANT AUTOGENOUS SOFT TISSUE GRAFTING: CASE REPORT

This case report showed the proof-of-concept of a guided free gingival graft around a dental implant. A 65-year-old male presented to replace his 30 and 31. Once the osseointegration of the 2 implants placed by guided surgery has been achieved, a free gingival graft was indicated. The surgical planning of this graft was performed using the Cone Beam Computed Tomography and archs digital scanning already used for implant placement. The greater palatine foramen and gutter were radiologically located to protect their arterial content. Two surgical guides were designed, one for the palatal donor site and one for the recipient site. The first one will serve both as an incision guide and as a post-operative protective plate. The procedure was free of adverse events. At the 1-year recall, the average gain in keratinized tissue width amounted 2.5 mm. This guided surgery could be used in a patient with insufficient amount of keratinized tissue around a posterior implant. For the first time, it makes it possible to anticipate, accelerate and secure the intervention, to improve the practitioner's comfort and potentially the outcomes of free gingival grafts. Further research and clinical are needed to validate this protocol and to assess its long-term impact on peri-implant health.

Association of Peri-Implant Health Status With COVID-19

OBJECTIVE

The aim of this research was to evaluate peri-implant health status in patients infected with COVID-19 and control patients (individuals without COVID-19).

METHODS

This observational investigation was performed in adults with (test group) and without (control group) COVID-19 infection having at least 1 functional dental implant. Self-reported education status and daily frequency of toothbrushing and flossing was determined. A questionnaire was administered to record demographic data, brushing/flossing frequency, and education status. Periodontal examination comprised full-mouth assessment of clinical attachment loss (CAL), plaque index (PI), probing depth (PD), and gingival index (GI). Peri-implant PD, modified PI, and modified gingival index were recorded. Loss of marginal and crestal bone around teeth and implants was also measured. Significance level was established for P < .05.

RESULTS

Seventy-three (41 males) and 71 (44 males) individuals were included in the test and control groups, respectively. Average ages of patients and controls were 44.6 ± 5.2 and 40.1 ± 3.1 years, respectively. University-level education was attained by 52 (75.3%) and 50 (70.4%) individuals in the test and control groups, respectively. Seventy (95.9%) and 68 (95.7%) patients and controls were brushing twice a day. Once-daily interproximal flossing was reported by 44 (60.3%) and 48 (67.6%) individuals in test and control groups. All participants had healthy periodontal and peri-implant tissues.

CONCLUSIONS

The study indicated that there are no short-term adverse effects on the peri-implant tissues due to acute COVID-19 infection, and further well-controlled longitudinal studies are needed to evaluate the long-term effect of the infection on these tissues.

In vivo measurement of three-dimensional load exerted on dental implants: a literature review

Background

For biomechanical consideration of dental implants, an understanding of the three-dimensional (3D) load exerted on the implant is essential, but little information is available on the in vivo load, including the measuring devices.

Purpose

This review aimed to evaluate studies that used specific load-measuring devices that could be mounted on an implant to measure the functional load in vivo.

Materials and methods

An electronic search utilizing the internet research databases PubMed, Google Scholar, and Scopus was performed. The articles were chosen by two authors based on the inclusion and exclusion criteria.

Results

In all, 132 studies were selected from the database search, and 16 were selected from a manual search. Twenty-three studies were finally included in this review after a complete full-text evaluation. Eleven studies were related to the force measurements using the strain gauges, and 12 were related to the piezoelectric force transducer. The principles of the two types of devices were completely different, but the devices produced comparable outcomes. The dynamics of the load magnitude and direction on the implant during function were clarified, although the number of participants in each study was small.

Conclusions

The load exerted on the implant during function was precisely measured in vivo using specific measuring devices, such as strain gauges or piezoelectric force transducers. The in vivo load data enable us to determine the actual biomechanical status in more detail, which might be useful for optimization of the implant prosthetic design and development of related materials. Due to the limited data and difficulty of in vivo measurements, the development of a new, simpler force measurement device and method might be necessary.

Impact of Smoking Habit on Peri-Implant Indicators following Different Therapies: A Systematic Review

Peri-implant disease and its treatment is becoming a major concern for clinicians as the number of implants placed each year is rising. Smoking is a common habit, and it is associated with an increased risk of developing peri-implant disease. The role of smoking in the response to peri-implant treatment has never been investigated. Searches were conducted in electronic databases to screen articles published until August 2021. The included studies had at least two groups of patients: peri-implant disease only or peri-implant disease and smoking status. Outcomes of interest included plaque index (PI), probing depth (PD), bleeding on probing (BoP), radiographic crestal bone loss (CBL), and analysis of peri-implant sulcular fluid. Seven hundred and forty-nine articles were found in the databases, only 71 articles potentially qualified. A total of seven studies with a minimum follow-up of six months were included. There is no homogeneity in the diagnosis, smoker definition and treatment proposed. All surgical and non-surgical treatment have statistically significantly different outcomes in smokers and nonsmokers. Recognizing this study’s limitations, we conclude that smoking might play a significant role on the outcome of peri-implant disease treatment. None of the proposed treatments appear to be significantly more effective.

Early marginal bone loss around dental implants to define success in implant dentistry: A retrospective study

PURPOSE

The aim of this study was to establish an objective criterion in terms of marginal bone level (MBL) to know the prognosis of an implant.

MATERIALS AND METHODS

A group of 176 patients in whom 590 implants were placed were included in this retrospective study. Patients older than 18 years, presenting either Kennedy class I or II edentulous section, or totally edentulous at least in one of the dental arches were included in this study. Those with any type of disturbance able to alter bone metabolism or with nontreated periodontal disease were excluded. Data on radiographic MBL at loading, 6 and 18 months later, age, gender, smoking habits, history of periodontitis, bone substratum, implant, and prosthetic features were recorded. Nonparametric receiver operating curves (ROC) were constructed for the MBL at 18 months in order to establish a distinction among high bone loser (HBL) and low bone loser (LBL) implants. Differences as a function of main variables were also determined, particularly abutment height and periodontal disease.

RESULTS

HBL implants lost at least 0.48 mm of MBL 6 months after loading; they reached at least 2 mm of MBL 18 months after loading. MBL rate followed a nonlinear trend, except in implants restored over long prosthetic abutments and in patients with history of severe periodontitis; in whom the rate of MBL over the time was nearly zero.

CONCLUSION

Implants that lose more than 0.5 mm of marginal bone 6 months after loading are at great risk of not being radiographically successful anymore. Therefore, 0.5 mm of MBL is proposed as a distinctive and objective criterion of success in Implant Dentistry within a 6-month follow-up period. A prosthetic abutment height ≥2 mm resulted the most protective factor in the peri-implant bone maintenance.

Periodontitis and implant complications in diabetes

Epidemiologic evidence indicates that periodontitis is more frequent in patients with uncontrolled diabetes mellitus than in healthy controls, suggesting that it could be considered the "sixth complication" of diabetes. Actually, diabetes mellitus and periodontitis are two extraordinarily prevalent chronic diseases that share a number of comorbidities all converging toward an increased risk of cardiovascular disease. Periodontal treatment has recently been shown to have the potential to improve the metabolic control of diabetes, although long-term studies are lacking. Uncontrolled diabetes also seems to affect the response to periodontal treatment, as well as the risk to develop peri-implant diseases. Mechanisms of associations between diabetes mellitus and periodontal disease include the release of advanced glycation end products as a result of hyperglycemia and a range of shared predisposing factors of genetic, microbial, and lifestyle nature. This review discusses the evidence for the risk of periodontal and peri-implant disease in diabetic patients and the potential role of the dental professional in the diabetes-periodontal interface.

Psychological risk indicators for peri-implantitis: A cross-sectional study

AIM

The aim of this analytical cross-sectional study was to evaluate the association between peri-implantitis and psychological distress, and potentially related/mediating factors such as general health, bruxism, and lifestyle factors.

MATERIALS AND METHODS

Patients who received dental implants at a private practice in the Netherlands between January 2011 and January 2014 were recalled on a 5-year clinical and radiographic follow-up examination. Presence of peri-implantitis was examined, and patients completed questionnaires measuring psychological distress (Symptom Checklist [SCL]-90), bruxism, general health, and lifestyle factors. Associations between the self-reported factors and peri-implantitis were analysed with univariate and multivariate logistic regression models.

RESULTS

A total of 230 patients (with 347 implants) were included in the analysis. Prevalence of (mild to severe) peri-implantitis was 30% (69 patients). Variables that showed a significant univariable association with peri-implantitis (p < .10) were the SCL-90 subdomain depression, smoking, current medical treatment, and lung problems. In the multivariate regression analysis, depression was the only variable that was significantly associated with peri-implantitis (p < .05).

CONCLUSIONS

The presence of depressive symptoms is a risk indicator for peri-implantitis. Recognizing the potential negative impact of depressive symptoms may allow for better identification of high-risk patients.

A Retrospective Analysis of Biological Complications of Dental Implants

Methods

A retrospective analysis of patients aged ≥18 years and having dental implants placed at Dubai Health Authority in 2010. Relevant information related to systemic-, patient-, implant-, site-, surgical- and prosthesis-related factors were collected. The strength of association between the prevalence of peri-implant mucositis and peri-implantitis and each variable was measured by chi-square analysis. A binary logistic regression analysis was performed to identify possible risk factors.

Results

A total of 162 patients with 301 implant-supported restorations were included in the study. The age of the patients ranged between 19 and 72 with a mean age of 46.4 ± 11.7 years. The prevalence of peri-implant mucositis at the patient and implant levels were 44.4% and 38.2%, respectively. For peri-implantitis, the prevalence at the patient level was 5.6%, while the prevalence at the implant level was 4.0%. The binary logistic regression identified three risk factors (smoking habits, histories of treated periodontitis and lack of peri-implant maintenance) for peri-implantitis.

Conclusion

Within the limitations of this study, smoking habits, history of treated periodontitis and lack of peri-implant maintenance were significant risk factors for peri-implantitis. Early detection of these factors would ensure appropriate planning and care of patients at high risk of developing peri-implant diseases.

Clinical, Microbiological, and Biochemical Impact of the Surgical Treatment of Peri-Implantitis-A Prospective Case Series

Background: The aim of this study, a prospective case series, was to evaluate the clinical, microbiological, and biochemical impact of the surgical treatment of peri-implantitis. Methods: Thirty subjects with diagnosis of peri-implantitis were treated following a surgical protocol including access flaps, surface decontamination with ultrasonics and glycine powder air-polishing, and systemic antibiotics. Disease resolution was defined by the composite outcome including presence of probing depths (PD) ≤5 mm, absence of bleeding on probing (BoP)/suppuration, and no additional radiographic bone loss (>1 mm). Regression analysis was used to evaluate the patient-, implant-, and prosthetic-related factors possibly influencing treatment outcomes. Results: Patients were evaluated at 6 months post treatment, demonstrating statistically significant reductions in PD (2.14 ± 1.07 mm) and increase in mucosal recession (1.0 ± 0.77 mm). Plaque, BoP, and suppuration were also reduced by 40.56%, 62.22%, and 7.78%, respectively. Disease resolution was achieved in 56.67% of patients. No significant changes were detected in microbiological parameters except for a significant reduction in proportions of Parvimonas micra. Similarly, the levels of the biomarker interleukin-8 in crevicular fluid were significantly lower at 6 months. Conclusions: The proposed surgical treatment of peri-implantitis demonstrated statistically significant clinical improvements although the impact on microbiological and biochemical parameters was scarce.

Platelet-Rich Fibrin Reduces IL-1β Release from Macrophages Undergoing Pyroptosis

Background: Pyroptosis is a catabolic process relevant to periodontal disorders for which interleukin-1β (IL-1β) inflammation is central to the pathophysiology of the disease. Despite platelet-rich fibrin (PRF) anti-inflammatory properties and its application to support periodontal regeneration, the capacity of PRF to modulate pyroptosis, specifically the production and release of IL-1β, remains unknown. The question arises whether PRF could regulate IL-1β release from macrophages in vitro. Methods: To answer this question, RAW 264.7 macrophages and primary macrophages obtained from murine bone marrow were primed with PRF before being challenged by lipopolysaccharide (LPS). Cells were then analysed for the pyroptosis signalling components by gene expression analyses and IL-1β secretion at the protein level. The release of mitochondrial reactive oxygen species (ROS) was also detected. Results: PRF lowered the LPS-induced expression of IL-1β and NLRP3 inflammasome, caspase-11 and IL-18 in primary macrophages, and IL-1β and caspase-11 in RAW 264.7 cells. Additionally, PRF diminished the secretion of IL-1β at the protein level in LPS-induced RAW 264.7 cells. This was shown through immunoassays performed with the supernatant and further confirmed by analysing the lysates of permeabilised cells. Furthermore, PRF reduced the ROS release provoked by LPS in RAW 264.7 cells. Finally, to enhance IL-1β release from the LPS-primed macrophages, we introduced a second signal with adenosine triphosphate (ATP). In this setting, PRF significantly reduced IL-1β release in RAW 264.7 cells and a trend to diminish IL-1β release in primary macrophages. Conclusion: These findings suggest that PRF can reduce IL-1β release and, at least in part, inhibit pyroptosis-related factors in LPS-challenged macrophages.

Photodynamic Therapy for Peri-Implant Diseases

Peri-implant diseases are frequently presented in patients with dental implants. This category of inflammatory infections includes peri-implant mucositis and peri-implantitis that are primarily caused by the oral bacteria that colonize the implant and the supporting soft and hard tissues. Other factors also contribute to the pathogenesis of peri-implant diseases. Based on established microbial etiology, mechanical debridement has been the standard management approach for peri-implant diseases. To enhance the improvement of therapeutic outcomes, adjunctive treatment in the form of antibiotics, probiotics, lasers, etc. have been reported in the literature. Recently, the use of photodynamic therapy (PDT)/antimicrobial photodynamic therapy (aPDT) centered on the premise that a photoactive substance offers benefits in the resolution of peri-implant diseases has gained attention. Herein, the reported role of PDT in peri-implant diseases, as well as existing observations and opinions regarding PDT, are discussed.

Longitudinal study on the effect of keratinized mucosal augmentation surrounding dental implants in preventing peri-implant bone loss

Background

Dental implant therapy is a well-established method of prosthetic rehabilitation of missing teeth. To maintain the health of the surrounding tissue, management of risk factors/indicators and daily maintenance are important. It still remains controversial whether a certain amount of keratinized mucosal width is essential for maintaining the health of peri-implant tissue. The purpose of this multicenter retrospective study was to assess the correlation between bone loss around dental implant and the amount of keratinized tissue width.

Methods

A total of 1,644 implants were evaluated. Data was collected about participants' general and dental history, as well as implant details. Bone resorption around implant was calculated from intra-oral radiographs taken after 1 year and more than 3 years of function. Implants were classified into three groups; received free gingival graft or apically repositioned flap surgery for increasing the keratinized mucosa ≥2 mm width (group A), keratinized mucosa width ≥2 mm (group B), and keratinized mucosa width <2 mm (group C). These data were analyzed by propensity score analysis and a generalized linear regression analysis was performed to compare the bone resorption among groups.

Results

Mean functional time was 55.8 months (SD = 20.5) in group A, 67.6 months (SD = 28.1) in group B, and 74.5 months (SD = 32.9) in group C. Mean bone resorption of groups A, B, and C were 0.08 mm (SD = 0.40), 0.18 mm (SD = 0.66), and 0.44 mm (SD = 0.40). Groups A and B had significantly lower bone resorption than group C.

Conclusion

The results in this study show the importance of keratinized mucosa in maintaining the peri-implant bone. Our findings also suggest that mucosal transplantation is useful, as opposed to narrowing of the keratinized mucosa.

Multi-omics analysis of oral bacterial biofilm on titanium oxide nanostructure modified implant surface: In vivo sequencing-based pilot study in beagle dogs

Peri-implantitis, the major cause of implant failure, is an inflammatory destructive disease due to the dysbiotic polymicrobial communities at the peri-implant sites. Therefore, it is highly warranted to develop the implant materials with antimicrobial properties and investigate their effects on oral microbiota. However, most of the relevant studies were performed in vitro, and insufficient to provide the comprehensive assessment of the antimicrobial capacity of the implant materials in vivo. Herein, we introduce an innovative approach to evaluate the in vivo antibacterial properties of the most commonly used implant materials, titanium with different nanostructured surfaces, and investigate their antibacterial mechanism via the next-generation sequencing (NGS) technology. We firstly prepared the titanium implants with three different surfaces, i) mechanical polishing (MP), ii) TiO₂ nanotubes (NT) and iii) nanophase calcium phosphate embedded to TiO₂ nanotubes (NTN), and then characterized them using scanning electron microscopy (SEM), energy-dispersive X-ray spectrometer (EDS), X-ray photoelectron spectroscopy (XPS), confocal laser scanning microscopy (CLSM) and surface hydrophilicity analysis. Afterwards, the implants were placed in the beagle dogs’ mouths to replace the pre-extracted premolar and molar teeth for eight weeks through implant surgery. The supra- and sub-mucosal plaques were collected and subjected to 16S rRNA gene/RNA sequencing and data analysis. It was found that the nanostructured surfaces in NT and NTN groups showed significantly increased roughness and decreased water contact angles compared to the MP group, while the XPS data further confirmed the successful modifications of TiO₂ nanotubes and the subsequent deposition of nanophase calcium phosphate. Notably, the nanostructured surfaces in NT and NTN groups had limited impact on the diversity and community structure of oral microbiota according to the 16S rRNA sequencing results, and the nanostructures in NTN group could down-regulate the genes associated with localization and locomotion based on Gene Ontology (GO) terms enrichment analysis. Moreover, the differentially expressed genes (DEGs) were associated with microbial metabolism, protein synthesis and bacterial invasion of epithelial cells. Taken together, this study provides a new strategy to evaluate the antibacterial properties of the biomedical materials in vivo via the high-throughput sequencing and bioinformatic approaches, revealing the differences of the composition and functional gene expressions in the supra- and sub-mucosal microbiome.

Prognostic factors associated with implant loss, disease progression or favorable outcomes after peri-implantitis surgical therapy

BACKGROUND

The treatment of the peri-implantitis remains complex and challenging with no consensus on which is the best treatment approach.

PURPOSE

To examine the key local and systemic factors associated with implant loss, disease progression, or favorable outcomes after surgical peri-implantitis therapy.

MATERIALS AND METHODS

Records of patients treated for peri-implantitis were screened. Patient-, implant- and surgery-related variables on and prior to the day of the surgery were collected (T0: time of peri-implantitis treatment). If the treated implant was still in function when the data was collected, the patient invited to participate for a recall study visit (T1, longest follow-up after treatment). Impacts of the variables on the implant survival, success, and peri-implant bone change after treatment were investigated.

RESULTS

Eighty patients with 121 implants with a mean follow-up of 42.6 ± 26.3 months were included. A total of 22 implants (18.2%) were removed during the follow-up period. When relative bone loss (%) was in range 25%-50%, risk for implant removal increased 15 times compared to lower bone loss <25% (OR = 15.2; CI: 2.06-112.7; p = 0.008). Similarly, relative bone loss of >50% increased 20 times the risk of implant failure compared to the <25% (OR = 20.2; CI: 2.42-169.6; p = 0.006). For post-treatment success rate, history of periodontitis significantly increased the risk of unsuccess treatment (OR = 3.07; p = 0.04) after resective surgery).

CONCLUSION

Severe bone loss (>50%) poses significantly higher risk of treatment failure.

Association between cumulative smoking exposure, span since smoking cessation, and peri-implantitis: a cross-sectional study

OBJECTIVES

To investigate the association of cumulative smoking exposure and span since smoking cessation with the occurrence of peri-implantitis.

METHODS

A sample of 350 individuals aged ≥ 35 years, with the presence of at least one osseointegrated implant functioning for > 5 years, were enrolled in the study. According to smoking habits, participants were categorized into 3 groups: non-smokers (NS; n = 212), former smokers (FC; n = 66), and current smokers (CS; n = 72). Complete peri-implant and periodontal examinations were evaluated. Associations between the occurrence of peri-implantitis and smoking habits, as well as potential confounders, were evaluated through univariate and multivariate analyses.

RESULTS

The occurrence of peri-implantitis in the NS, FS, and CS groups was 18.2%, 19.7%, and 30.5%, respectively. A high prevalence of the overall number of cases with periodontitis (54.2%) was observed in the CS group when compared to the FS and NS groups. After adjusting for confounders, the odds ratio (OR) for the occurrence of peri-implantitis was 2.63 (1.39-6.77; p < 0.001) for CS compared to NS. There was a significant dose-response relationship between pack/year of smoking and the occurrence of peri-implantitis, as well as a significant decrease in the risk as the years of smoking cessation increased.

CONCLUSIONS

The occurrence of peri-implantitis among CS was high. The cumulative smoking exposure in an incremental manner and the shorter smoking cessation span was directly associated with a higher risk for peri-implantitis.

CLINICAL RELEVANCE

Educational and preventive strategies in general health services must attempt to reduce the adverse effects of cumulative smoking exposure and to explore the beneficial effects of smoking cessation on peri-implant status.

Retrospective Evaluation of Implants Placed in Iliac Crest Autografts and Pristine Bone

Objective: Iliac crest autografts can compensate for severe mandibular atrophy before implant placement. However, the implant success in the augmented bone is not entirely predictable. Here we performed a retrospective cohort study to determine the success and related parameters of implants placed in augmented bone and pristine bone for up to 11 years. Material and Methods: We analyzed 18 patients where 72 implants were placed six months after iliac crest transplantation and 19 patients where 76 implants were placed in pristine bone. The primary endpoint was implant loss. Secondary endpoints were the implant success, peri-implant bone loss, and the clinical parameters related to peri-implantitis. Moreover, we evaluated the oral-health-related quality of life (OHIP). Results: Within a mean follow-up of 5.8 ± 2.2 and 7.6 ± 2.8 years, six but no implants were lost when placed in augmented and pristine bone, respectively. Among those implants remaining in situ, 58% and 68% were rated as implant success (p = 0.09). A total of 11% and 16% of the implants placed in the augmented and the pristine bone were identified as peri-implantitis (p = 0.08). Bone loss was similar in both groups, with a mean of 2.95 ± 1.72 mm and 2.44 ± 0.76 mm. The mean OHIP scores were 16.36 ± 13.76 and 8.78 ± 7.21 in the augmentation and the control group, respectively (p = 0.35). Conclusions: Implants placed in iliac crest autografts have a higher risk for implant loss and lower implant success rates compared to those placed in the pristine bone.