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Isler SC, Romandini M, Akca G, Bakirarar B, Unsal B, Romanos G, Sculean A. Soft-Tissue Phenotype as a Risk Indicator of Peri-Implantitis and Peri-Implant Soft-Tissue Dehiscence-A Cross-Sectional Study. J Clin Periodontol 2024. [PMID: 39189550 DOI: 10.1111/jcpe.14059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 07/23/2024] [Accepted: 08/06/2024] [Indexed: 08/28/2024]
Abstract
AIM To investigate the association, as well as to characterize the associated panel of pro- and anti-inflammatory markers, between the different components of the peri-implant phenotype and the presence of peri-implantitis/peri-implant soft-tissue dehiscence (PISTD). MATERIALS AND METHODS A total of 324 implants in 112 patients were included. The following components of the peri-implant phenotype were clinically measured through the use of a manual periodontal probe or a digital calliper: keratinized mucosa width (PIKM-W), mucosal thickness (MT), attached mucosa (AM) and vestibulum depth (VD). The presence of peri-implantitis and PISTD was assessed through clinical and radiographic examination. Mixed-models logistic regression analyses were performed to analyse the association between peri-implant phenotype and the presence of peri-implantitis or PISTD, adjusting for relevant confounders. Multiplex immunoassays were employed to evaluate the peri-implant crevicular fluid levels of a panel of pro- and anti-inflammatory markers. RESULTS Peri-implant health, peri-implant mucositis and peri-implantitis were diagnosed in 36.6%, 21.4% and 42% of the patients (classified according to their worst implant) and 35.2%, 34.3%, and 30.5% of the implants, respectively. In the multi-level multiple regression model, the absence of PIKM-W (odds ratio [OR] = 9.24; 95% CI: 2.73-31.28), the absence of attached mucosa (OR = 19.58; 95% CI: 6.12-62.56) and a reduced (<4 mm) vestibulum depth (OR = 2.61; 95% CI: 1.05-6.48) were associated with peri-implantitis. Similarly, the absence of PIKM-W (OR = 6.32; 95% CI: 1.67-23.83), a thin (<2 mm) mucosa (OR = 157.75; 95% CI: 14.06-1769.9) and a reduced vestibulum depth (OR = 3.32; 95% CI: 1.02-10.84) were associated with the presence of PISTD. Implants with PIKM-W = 0 mm showed statistically significantly higher levels of interferon-γ in both regular (≥2 maintenance/year) and irregular (<2 maintenance/year) compliers (p = 0.046 and p = 0.012). In irregular compliers, the absence of PIKM-W was also associated with statistically significantly higher levels of interleukin (IL)-1β and IL-21 (p = 0.016, p = 0.046). These associations were independent of the effect of relevant confounders (e.g., plaque, compliance with maintenance, etc.). CONCLUSIONS Within their limits, the present findings indicate that (a) peri-implant soft-tissue phenotype appears to be associated with the presence of peri-implantitis and PISTD, and (b) in the absence of PIKM-W, the inflammatory response seems to be dysregulated and the soft-tissue remodelling up-regulated.
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Affiliation(s)
- Sila Cagri Isler
- Department of Periodontology, Faculty of Dentistry, Gazi University, Ankara, Turkey
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Mario Romandini
- Department of Periodontology, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Gulcin Akca
- Department of Medical Microbiology, Faculty of Dentistry, Gazi University, Ankara, Turkey
| | - Batuhan Bakirarar
- Department of Biostatistics, Process Management Coordinator, ADO Group, Antalya, Turkey
| | - Berrin Unsal
- Department of Periodontology, Faculty of Dentistry, Gazi University, Ankara, Turkey
| | - Georgios Romanos
- Department of Periodontics and Endodontics, Stony Brook University, Stony Brook, New York, USA
| | - Anton Sculean
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
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Tastan Eroglu Z, Ozkan Sen D, Oncu E. Association of Peri-Implant Keratinized Mucosa Width and Mucosal Thickness with Early Bone Loss: A Cross-Sectional Study. J Clin Med 2024; 13:1936. [PMID: 38610701 PMCID: PMC11012309 DOI: 10.3390/jcm13071936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 03/21/2024] [Accepted: 03/23/2024] [Indexed: 04/14/2024] Open
Abstract
Objective: The objective of this study was to evaluate the effects of keratinized mucosa width (KMW) and mucosal thickness (MT) around dental implants on marginal bone loss (MBL). The evaluation was performed one year after loading by comparing clinical, radiographic, and biochemical parameters. Methods: The study included 87 implants in 87 patients undergoing regular follow-ups without hard or soft tissue augmentation one year after loading. Clinical measurements included plaque index (PI), gingival index (GI), bleeding on probing (BoP), probing depth (PD), KMW, and MT. MBL was assessed with periapical radiography. The peri-implant crevicular fluid (PICF) was analyzed for tumor necrosis factor-alpha (TNF-α), receptor activator of nuclear factor-kB ligand (RANKL), osteoprotegerin (OPG), and microRNA-27a. Results: The MBL of implants with thin MT (<2 mm) was higher than that of implants with thick MT (≥2 mm) (p < 0.05). A significant negative correlation (r: -0.217) was established between MT and MBL. No significant association was found between KMW and MBL (p > 0.05). No significant associations was found between KMW and MT with TNF-α, RANKL, OPG and RANKL/OPG (p > 0.05), with the exception of increased microRNA-27a levels in implants with KMW ≥ 2 mm (p < 0.05). Conclusions: Implants with a thick MT had a lower MBL. There may be an association between adequate KMW and high miRNA-27a levels. The relationship between MBL and miRNA-27a remains unclear.
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Affiliation(s)
- Zeynep Tastan Eroglu
- Department of Periodontology, Faculty of Dentistry, Necmettin Erbakan University, Beyşehir Caddesi, Bağlarbaşı Sk., 42090 Konya, Turkey;
| | - Dilek Ozkan Sen
- Department of Periodontology, Faculty of Dentistry, Necmettin Erbakan University, Beyşehir Caddesi, Bağlarbaşı Sk., 42090 Konya, Turkey;
| | - Elif Oncu
- Panoroma Ankara Private Oral and Dental Health Clinic, 06510 Ankara, Turkey;
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Morón-Conejo B, Sanz-Sánchez I, Salido MP, Martínez-Rus F, Pradíes G. The effect of a convergent transmucosal neck on soft tissues and radiographic outcomes: a 1-year follow-up randomized controlled trial. Clin Oral Investig 2023; 27:2923-2933. [PMID: 36749412 PMCID: PMC10264266 DOI: 10.1007/s00784-023-04892-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 02/01/2023] [Indexed: 02/08/2023]
Abstract
PURPOSE The aim of this randomized controlled clinical trial was to evaluate peri-implant marginal bone levels (MBLs) and soft tissue dimension changes 1 year after loading. Patients in the control group received bone-level implants, whereas in the test group, tissue-level implants with a convergent transmucosal neck were used. MATERIAL AND METHODS MBLs were calculated by measuring the distance from the implant shoulder to the first visible bone-to-implant contact using standardized periapical digital radiographs. Baseline (day of loading) and follow-up digital models obtained with an intraoral scanner were used to quantify the changes in the peri-implant soft tissue dimensions with a best-fit algorithm. RESULTS The difference between final and baseline MBLs showed a mean bone loss of 0.16 ± 0.01 mm in the test group (n = 15) and 0.45 ± 0.09 mm in the control group (n = 14) (p > 0.05). Soft tissue contour at the level of the gingival margin (GM) increased by 1.96 ± 2.69 mm in the test group and 0.65 ± 0.42 mm in the control group (p = 0.167). Both groups showed a coronal displacement of the gingival margin with no significant differences among them. CONCLUSIONS The present study demonstrated peri-implant hard and soft tissues stability at both implant designs with no significant differences 12 months after loading. CLINICAL RELEVANCE There is still insufficient scientific evidence to demonstrate the role and advantages of the convergent transmucosal neck on the behavior of the peri-implant soft and hard tissues stability compared to a straight neck in bone-level implants 12 months after loading.
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Affiliation(s)
- Belén Morón-Conejo
- Analysis of Techniques, Material and Instruments Applied to Digital Dentistry and CAD/CAM Procedures Research Group, University Complutense, Madrid, Spain
| | - Ignacio Sanz-Sánchez
- ETEP (Etiology and Therapy of Periodontal and Peri-Implant Diseases) Research Group, University Complutense, Madrid, Spain
| | - Maria Paz Salido
- Analysis of Techniques, Material and Instruments Applied to Digital Dentistry and CAD/CAM Procedures Research Group, University Complutense, Madrid, Spain.
- Department of Conservative and Prosthetic Dentistry, Faculty of Dentistry, University Complutense of Madrid, Plaza Ramón Y Cajal S/N. 28040, Madrid, Spain.
| | - Francisco Martínez-Rus
- Analysis of Techniques, Material and Instruments Applied to Digital Dentistry and CAD/CAM Procedures Research Group, University Complutense, Madrid, Spain
| | - Guillermo Pradíes
- Analysis of Techniques, Material and Instruments Applied to Digital Dentistry and CAD/CAM Procedures Research Group, University Complutense, Madrid, Spain
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Abu Hussien H, Machtei EE, Khutaba A, Gabay E, Zigdon Giladi H. Palatal soft tissue thickness around dental implants and natural teeth in health and disease: A cross sectional study. Clin Implant Dent Relat Res 2022; 25:215-223. [PMID: 36537536 DOI: 10.1111/cid.13171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 12/06/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Previous studies focused on the influence of buccal mucosa thickness on peri-implant bone loss and inflammation, with inconclusive results. We observed substantially thicker palatal mucosal tissues at peri-implantitis sites. Therefore, we hypothesize that thick palatal peri-implant mucosa may be associated with deeper pockets and disease severity. PURPOSE To compare the thickness of the palatal tissue between natural teeth and implants in periodontal health and disease. METHODS Adult, non-smoker, healthy patients who visited our department for periodontal examination or treatment with restored implants in the posterior maxilla were recruited. Probing depth (PD), plaque index (PI), gingival index (GI) and radiographic measurements were recorded around implant and the contralateral tooth. Palatal tissue thickness was measured using a 30G needle that was inserted perpendicular into the mucosa at the bottom of the periodontal/peri-implant pocket and 3 mm coronally. Differences in the palatal tissue thickness between teeth and implants (in the same patient) was performed using t-test; as well as between peri-implantitis and non-peri-implantitis sites (among patients). RESULTS Sixty patients were included. Thirty-four implants were diagnosed with peri-implantitis and 26 healthy/mucositis implants with corresponding 24 healthy/gingivitis teeth and 36 teeth with attachment loss. Mean PD was higher around implants (4.47 ± 1.57 mm) than teeth (3.61 ± 1.23 mm, p = 0.001). The thickness of implants' palatal mucosa was higher than in teeth, at the base of the pocket and 3 mm coronally (4.58 ± 1.38 mm vs. 3.01 ± 1.11, p = 0.000; 3.58 ± 2.15 vs. 1.89 ± 1.11, p = 0.000, respectively). Mean palatal tissue thickness was 4.32 ± 2.35 mm for the peri-implantitis group while only 2.61 ± 1.39 in healthy implants, 3 mm coronal to the base of the pocket (p = 0.001). Palatal thickness at peri-implantitis sites was higher (4.32 ± 2.35) compared to periodontitis sites (2.23 ± 0.93), p = 0.000. Implant sites with palatal mucosa >4 mm (n = 32) had deeper mean pockets (5.58 ± 1.98) compared with thinner (≤4 mm) sites (n = 28) (4.48 ± 1.18, p = 0.018). CONCLUSION Thicker palatal tissue around implants is associated with deeper palatal pockets. Thick palatal tissue was found around implants diagnosed with peri-implantitis.
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Affiliation(s)
- Hiba Abu Hussien
- Department of Periodontology, School of Graduate Dentistry Rambam Health Care Campus Haifa Israel
| | - Eli E. Machtei
- Department of Periodontology, School of Graduate Dentistry Rambam Health Care Campus Haifa Israel
- Faculty of Medicine Technion – Israeli Institute of Technology Haifa Israel
| | - Alaa Khutaba
- Department of Periodontology, School of Graduate Dentistry Rambam Health Care Campus Haifa Israel
| | - Eran Gabay
- Department of Periodontology, School of Graduate Dentistry Rambam Health Care Campus Haifa Israel
- Faculty of Medicine Technion – Israeli Institute of Technology Haifa Israel
| | - Hadar Zigdon Giladi
- Department of Periodontology, School of Graduate Dentistry Rambam Health Care Campus Haifa Israel
- Faculty of Medicine Technion – Israeli Institute of Technology Haifa Israel
- Laboratory for Bone Repair CRIR Institute, Rambam Health Care Campus Haifa Israel
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Fürhauser R, Fürhauser L, Fürhauser N, Pohl V, Pommer B, Haas R. Bucco‐palatal implant position and its impact on soft tissue level in the maxillary esthetic zone. Clin Oral Implants Res 2022; 33:1125-1134. [DOI: 10.1111/clr.13995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 04/16/2022] [Accepted: 06/28/2022] [Indexed: 11/29/2022]
Affiliation(s)
| | | | | | - V. Pohl
- Academy of Oral Implantology Vienna/ Austria
| | - B. Pommer
- Academy of Oral Implantology Vienna/ Austria
| | - R. Haas
- Academy of Oral Implantology Vienna/ Austria
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Obreja K, Galarraga-Vinueza ME, Müller K, Begic A, Ramanauskaite A, Schwarz F. Volumetric tissue changes following combined surgical therapy of peri-implantitis: A 2-year follow-up analysis. A prospective case series. Clin Implant Dent Relat Res 2022; 24:267-275. [PMID: 35349765 DOI: 10.1111/cid.13081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/24/2022] [Accepted: 02/24/2022] [Indexed: 12/12/2022]
Abstract
AIM To assess volumetric tissue changes following combined surgical therapy of peri-implantitis over a follow-up period of 24 months. MATERIALS AND METHODS A total of 20 patients (n = 28 implants) were diagnosed with peri-implantitis and underwent access flap surgery, implantoplasty, and augmentative therapy at intrabony components (ie, combined therapy) using a natural bone mineral and a native collagen membrane. The peri-implant region of interest (ROI) was intraorally scanned pre-operatively (S0), and after 12 (S3) and 24 (S4) months. Digital files were superimposed for the assessment of volumetric changes between the referred time points. The change in thickness was assessed at a standardized ROI, segmented into two equidistant sections (ie, marginal and apical). RESULTS Peri-implant tissues exhibited a nonsignificant mean thickness loss of 0.16 (95% CI: -4 to 0.06) and 0.17 mm (95% CI: -0.05 to 0.4) at S3 and S4, respectively. S0-S3 dimensional thickness changes at marginal and apical areas were -0.24 (95% CI: -0.48 to 0.002) and -0.19 mm (95% CI: -0.36 to -0.2), respectively. Dimensional changes from S0 to S4 amounted to -0.22 mm (95% CI: -0.46 to 0.02) and -0.07 mm (95% CI: -0.09 to 0.2), respectively. The thickness changes at marginal and apical ROIs were significant from S0 to S3. Clinical parameters (ie, plaque index, bleeding on probing, and probing depth) significantly improved over the 24-month follow-up period. Linear regression analyses revealed no significant association between baseline bone loss (%), width of keratinized mucosa, and mucosal recession scores and thickness changes. CONCLUSIONS Peri-implant tissues revealed minor volumetric changes at 12 and 24 months after combined surgical therapy.
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Affiliation(s)
- Karina Obreja
- Department of Oral Surgery and Implantology, Johann Wolfgang Goethe-University Frankfurt, Carolinum, Frankfurt, Germany
| | - Maria Elisa Galarraga-Vinueza
- Department of Oral Surgery and Implantology, Johann Wolfgang Goethe-University Frankfurt, Carolinum, Frankfurt, Germany.,Post-Graduate Program in Implant Dentistry (PPGO), Federal University of Santa Catarina (UFSC), Florianópolis, Santa Catarina, Brazil.,School of Dentistry, Universidad de las Américas (UDLA), Quito, Ecuador
| | - Katharina Müller
- Department of Oral Surgery and Implantology, Johann Wolfgang Goethe-University Frankfurt, Carolinum, Frankfurt, Germany
| | - Amira Begic
- Department of Oral Surgery and Implantology, Johann Wolfgang Goethe-University Frankfurt, Carolinum, Frankfurt, Germany
| | - Ausra Ramanauskaite
- Department of Oral Surgery and Implantology, Johann Wolfgang Goethe-University Frankfurt, Carolinum, Frankfurt, Germany
| | - Frank Schwarz
- Department of Oral Surgery and Implantology, Johann Wolfgang Goethe-University Frankfurt, Carolinum, Frankfurt, Germany
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Abstract
Esthetic complications in implant dentistry have become a significant consideration for patients and practitioners. This review presents an appraisal on the current knowledge of the physiological peri-implant soft-tissue dimensions and factors that may compromise peri-implant tissue esthetics. Factors such as papilla fill adjacent to the implant and midfacial mucosal height are critical parameters that determine the esthetic success of implant-supported restorations. Papilla fill adjacent to a single dental implant appears to depend upon the clinical attachment level of the neighboring tooth. A horizontal inter-implant distance of at least 3 mm is necessary to ensure optimal interproximal mucosal embrasure between two adjacent implants in the anterior maxilla. In cases where implants cannot be placed at least 3 mm apart, a single implant with a cantilever bridge should be considered. Buccolingual implant positioning plays a major role in midfacial mucosal height. Soft-tissue volume grafting following immediate implant placement in the presence of a thin soft-tissue phenotype or simultaneous to surgical peri-implantitis therapy might help to overcome facial mucosa recession.
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Affiliation(s)
- Ausra Ramanauskaite
- Department of Oral Surgery and Implantology, Johann Wolfgang Goethe-University, Carolinum, Frankfurt am Main, Germany
| | - Robert Sader
- Department for Oral, Cranio-Maxillofacial and Facial Plastic Surgery, Madical Center of the Johann Wolfgang Goethe-University, Frankfurt am Main, Germany
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Variations in vertical mucosal thickness at edentulous ridge according to site and gender measured by cone-beam computed tomography. Int J Implant Dent 2021; 7:34. [PMID: 33977359 PMCID: PMC8113432 DOI: 10.1186/s40729-021-00319-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 03/12/2021] [Indexed: 12/01/2022] Open
Abstract
Background The vertical thickness of the peri-implant mucosa is associated with the amount of post treatment marginal bone loss. However, the variations in mucosal thickness at the different edentulous sites have been sparsely documented. The purpose of the study was to conduct a survey of the frequency distribution of variations in mucosal thickness at the different sites of the edentulous alveolar ridge and to compare them according to gender. Our study included 125 partially edentulous patients having a total of 296 implant sites. Cone-beam computed tomography (CBCT) scans were obtained by placing a diagnostic template with a radiopaque crown indicator on the ridge to determine the mucosal thickness at the crest of the alveolar ridge. Results The mucosal thickness was 3.0±1.3 mm in the maxilla, which was significantly greater than the mucosal thickness of 2.0±1.0 mm in the mandible (p<0.001). In both the maxilla and the mandible, the mucosa was the thickest in the anterior region, followed by the premolar and molar regions. Sites were further classified into two groups based on whether the mucosal thickness was greater than 2 mm. In the mandible, more than half of the sites showed a mucosal thickness of 2 mm or less. Conclusions Although this study was a limited preoperative study, the vertical mucosal thickness at the edentulous ridge differed between the maxillary and mandibular regions. The majority of sites in the mandibular molar region had a mucosal thickness of less than 2 mm. Practitioners might be able to develop an optimal dental implant treatment plan for long-term biologic and esthetic stability by considering these factors.
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Obreja K, Ramanauskaite A, Begic A, Galarraga-Vinueza ME, Parvini P, Schwarz F. The influence of soft-tissue volume grafting on the maintenance of peri-implant tissue health and stability. Int J Implant Dent 2021; 7:15. [PMID: 33619644 PMCID: PMC7900372 DOI: 10.1186/s40729-021-00295-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 01/25/2021] [Indexed: 11/13/2022] Open
Abstract
Background To investigate the influence of soft-tissue volume grafting employing autogenous connective tissue graft (CTG) simultaneous to implant placement on peri-implant tissue health and stability. Material and methods This cross-sectional observational study enrolled 19 patients (n = 29 implants) having dental implants placed with simultaneous soft-tissue volume grafting using CTG (test), and 36 selected controls (n = 55 implants) matched for age and years in function, who underwent conventional implant therapy (i.e., without soft-tissue volume grafting). Clinical outcomes (i.e., plaque index (PI), bleeding on probing (BOP), probing depth (PD), and mucosal recession (MR)) and frequency of peri-implant diseases were evaluated in both groups after a mean follow-up period of 6.15 ± 4.63 years. Results Significant differences between test and control groups at the patient level were noted for median BOP (0.0 vs. 25.0%; p = 0.023) and PD scores (2.33 vs. 2.83 mm; p = 0.001), respectively. The prevalence of peri-implant mucositis and peri-implantitis amounted to 42.1% and 5.3% in the test and to 52.8% and 13.9% in the control group, respectively. Conclusion Simultaneous soft-tissue grafting using CTG had a beneficial effect on the maintenance of peri-implant health.
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Affiliation(s)
- Karina Obreja
- Department of Oral Surgery and Implantology, Johann Wolfgang Goethe-University Frankfurt, Carolinum, Theodor-Stern-Kai 7; Building 29, 60596, Frankfurt, Germany
| | - Ausra Ramanauskaite
- Department of Oral Surgery and Implantology, Johann Wolfgang Goethe-University Frankfurt, Carolinum, Theodor-Stern-Kai 7; Building 29, 60596, Frankfurt, Germany.
| | - Amira Begic
- Department of Oral Surgery and Implantology, Johann Wolfgang Goethe-University Frankfurt, Carolinum, Theodor-Stern-Kai 7; Building 29, 60596, Frankfurt, Germany
| | | | - Puria Parvini
- Department of Oral Surgery and Implantology, Johann Wolfgang Goethe-University Frankfurt, Carolinum, Theodor-Stern-Kai 7; Building 29, 60596, Frankfurt, Germany
| | - Frank Schwarz
- Department of Oral Surgery and Implantology, Johann Wolfgang Goethe-University Frankfurt, Carolinum, Theodor-Stern-Kai 7; Building 29, 60596, Frankfurt, Germany
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Kuralt M, Fidler A. Assessment of reference areas for superimposition of serial 3D models of patients with advanced periodontitis for volumetric soft tissue evaluation. J Clin Periodontol 2021; 48:765-773. [PMID: 33576011 DOI: 10.1111/jcpe.13445] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 01/25/2021] [Accepted: 02/08/2021] [Indexed: 12/16/2022]
Abstract
AIM This study aimed to determine the optimal reference area for superimposition of serial 3D dental models of patients with advanced periodontitis. MATERIALS AND METHODS Ten pre- and post-periodontal treatment 3D models (median time lapse: 13.1 months) of patients with advanced periodontitis were acquired by intraoral scanning. Superimposition was performed with the iterative closest point algorithm using four reference areas: (A) all stable teeth, (B) all teeth, (C) third palatal rugae and (D) the whole model. The superimposition accuracy was evaluated at two stable evaluation regions using the mean absolute distance and evaluated with two-way ANOVA and post-hoc multivariate model. The intra- and inter-operator reproducibility was calculated by intraclass correlation coefficient (ICC). RESULTS Superimposition accuracy evaluated at stable tooth evaluation region were 71 ± 29 μm, 73 ± 21 μm, 127 ± 52 μm and 113 ± 53 μm for areas A, B, C and D, respectively. All reference areas showed similarly high ICC values >0.990, except for reference area C showing ICC of 0.821 (intra-operator) and 0.767 (inter-operator) for tooth evaluation area. CONCLUSIONS Area A and B provide the highest accuracy for superimposition of serial 3D dental models acquired by intraoral scanning of patients with advanced periodontitis.
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Affiliation(s)
- Marko Kuralt
- Department of Restorative Dentistry and Endodontics, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Aleš Fidler
- Department of Restorative Dentistry and Endodontics, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Faculty of Medicine, Department of Endodontics and Operative Dentistry, University of Ljubljana, Ljubljana, Slovenia
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Ramanauskaite A, Obreja K, Sader R, Becker J, Schwarz F. Assessment of soft and hard tissue dimensions following different treatment approaches of ligature-induced peri-implantitis defects. Clin Oral Implants Res 2021; 32:394-400. [PMID: 33421206 DOI: 10.1111/clr.13709] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 12/01/2020] [Accepted: 01/03/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To evaluate peri-implant tissue dimensions following nonsurgical (NS) and surgical therapy (S) employing different decontamination protocols of advanced ligature-induced peri-implantitis in dogs. MATERIAL & METHODS Peri-implantitis defects (n = 5 dogs, n = 30 implants) were randomly and equally allocated in a split-mouth design to NS or S treatment using either an Er:YAG laser (ERL), an ultrasonic device (VUS), or plastic curettes + local application of metronidazole gel (PCM), respectively. Horizontal bone thickness (hBT) and soft tissue thickness (hMT) were measured at different reference points: (v0) at the marginal portion of the peri-implant mucosa (PM); (v1) at 50% of the distance from PM to bone crest (BC); (v2) at the BC; (v3) at the most coronal extension of the bone-to-implant contact. Vertical peri-implant tissue height was calculated from PM to BC. RESULTS All of the treatment groups showed a gradual hMT increase from v0 to the v2 reference point, followed by a reduction from v2 to the v3 region. The S-VUS subgroup tended to be associated with higher hMT values at the v0 region than the NS-VUS subgroup (0.44 mm versus 0.31 mm). PM-BC distance varied from 2.22 to 2.83 mm in the NS group, and from 2.07 to 2.38 in the S group. CONCLUSION Vertical and horizontal peri-implant tissue dimensions were similar in different treatment groups.
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Affiliation(s)
- Ausra Ramanauskaite
- Department of Oral Surgery and Implantology, Goethe University, Carolinum, Frankfurt, Germany
| | - Karina Obreja
- Department of Oral Surgery and Implantology, Goethe University, Carolinum, Frankfurt, Germany
| | - Robert Sader
- Department for Oral, Cranio-Maxillofacial and Facial Plastic Surgery, Medical Center of the Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Jürgen Becker
- Department of Oral Surgery, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Frank Schwarz
- Department of Oral Surgery and Implantology, Goethe University, Carolinum, Frankfurt, Germany
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12
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Belák Š, Žižka R, Starosta M, Zapletalová J, Šedý J, Štefanatný M. The influence of gingival phenotype on the morphology of the maxillary central papilla. BMC Oral Health 2021; 21:43. [PMID: 33485351 PMCID: PMC7825197 DOI: 10.1186/s12903-021-01400-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 01/14/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Preservation of the interdental papilla is an essential part of the functional and esthetic rehabilitation of dental treatment. It has been described that thicker gingival tissues are more resistant to recession. The main objective of this investigation was to analyze whether a thin gingival phenotype represents a potential risk indicator affecting interdental papilla fill, height, or width in an esthetic region between maxillary central incisors. The secondary goals were: (1) to analyze parameters describing the papilla-fill, height, width, and effect of papilla base width on the vertical papillary dimension; (2) to determine correlation between different non-invasive measurements of gingival thickness; (3) to compare both sexes. METHODS A total of 54 periodontally healthy students (20-30 years old) were included in the study. Gingival thickness was measured using Pirop Ultrasonic Biometer. Gingival phenotype was also assessed by gingival probe transparency. Papilla height and width were measured, and the degree of papilla recession was classified. RESULTS No significant relationship between papilla fill, height, width and gingival probe transparency or gingival thickness was found. Gingival thickness and gingival probe transparency showed a significant relationship (P < 0.001). There was a significant relationship between papilla height and papilla fill (P = 0.028). A papilla which filled the interdental space completely seemed to be shorter. A strong positive correlation between papilla height and papilla width was found (P < 0.0001). The papilla between maxillary central incisors was significantly higher in males (P = 0.01). CONCLUSION The appearance of the interdental papilla may be influenced by various factors. Within the limitations of this study, the results showed that the thin gingival phenotype alone is no potential risk indicator affecting interdental papilla fill, height, or width. It seems that there may be some effect of papilla base width on its vertical dimension. Gingival probe transparency is a simple reliable method of assessment of gingival thickness with a threshold value of 1-mm gingival thickness between the thick and thin phenotypes.
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Affiliation(s)
- Šimon Belák
- Department of Periodontology and Oral Medicine, Institute of Dentistry and Oral Sciences, Palacký University, Palackého 12, Olomouc, 779 00, Czech Republic.
| | - Radovan Žižka
- Department of Periodontology and Oral Medicine, Institute of Dentistry and Oral Sciences, Palacký University, Palackého 12, Olomouc, 779 00, Czech Republic.,Czech Educational and Dental Research Innovative Group (CEDRIG), Brno, Czech Republic
| | - Martin Starosta
- Department of Periodontology and Oral Medicine, Institute of Dentistry and Oral Sciences, Palacký University, Palackého 12, Olomouc, 779 00, Czech Republic
| | - Jana Zapletalová
- Department of Medical Biophysics, Faculty of Medicine and Dentistry, Palacký University, Hnevotínská 3, Olomouc, 775 15, Czech Republic
| | - Jiří Šedý
- Department of Anatomy, Faculty of Medicine and Dentistry, Palacký University, Olomouc, Czech Republic
| | - Michal Štefanatný
- Department of Periodontology and Oral Medicine, Institute of Dentistry and Oral Sciences, Palacký University, Palackého 12, Olomouc, 779 00, Czech Republic
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13
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Ramanauskaite A, Schwarz F, Sader R, Becker J, Obreja K. Assessment of peri-implant tissue dimensions following surgical therapy of advanced ligature-induced peri-implantitis defects. Int J Implant Dent 2021; 7:4. [PMID: 33426617 PMCID: PMC7797391 DOI: 10.1186/s40729-020-00282-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 12/17/2020] [Indexed: 11/25/2022] Open
Abstract
Background To evaluate peri-implant tissue dimensions following implantoplasty and/or regenerative therapy of advanced ligature-induced peri-implantitis in dogs. Material and methods At all defect sites (n = 6 dogs, n = 48 implants), the intrabony component was filled with a particulate bovine-derived natural bone mineral (NBM). The supracrestal component was treated by either the application of an equine bone block (EB) or implantoplasty. In a split-mouth design, NBM and EB were soak-loaded with rhBMP-2 or sterile saline. All sites were covered using a native collagen membrane and left to heal in a submerged position for 12 weeks. The horizontal mucosal thickness (hMT) and bone thickness (hBT) were measured at four reference points: (v0) at the level of implant shoulder (IS), (v1) 50% of the distance IS-bone crest (BC), (v2) at the BC, and (v3) at the most coronal extension of the bone-to-implant contact. Results The general tendency indicated a gradual increase in hMT from the IS (v0) toward BC (v2), which was more pronounced at implant sites treated with the regenerative approach. The hBT values increased from v2 to v3, with the highest values at the v3 region measured for implant sites treated with adjunctive rhBMP-2. For sites treated with implantoplasty, the linear regression model demonstrated an inverse correlation between hMT and hBT, whereas a positive correlation was observed at those sites treated with the regenerative approach. Conclusion Horizontal soft and hard tissue dimensions were similar among different treatment groups.
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Affiliation(s)
- Ausra Ramanauskaite
- Department of Oral Surgery and Implantology, Johann Wolfgang Goethe-University Frankfurt, Carolinum, 60596, Frankfurt am Main, Germany
| | - Frank Schwarz
- Department of Oral Surgery and Implantology, Johann Wolfgang Goethe-University Frankfurt, Carolinum, 60596, Frankfurt am Main, Germany.
| | - Robert Sader
- Department for Oral, Cranio-Maxillofacial and Facial Plastic Surgery, Medical Center of the Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Jürgen Becker
- Department of Oral Surgery, Westdeutsche Kieferklinik, Universitätsklinikum Düsseldorf, 40225, Düsseldorf, Germany
| | - Karina Obreja
- Department of Oral Surgery and Implantology, Johann Wolfgang Goethe-University Frankfurt, Carolinum, 60596, Frankfurt am Main, Germany
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14
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Sanz-Martín I, Paeng K, Park H, Cha JK, Jung UW, Sanz M. Significance of implant design on the efficacy of different peri-implantitis decontamination protocols. Clin Oral Investig 2020; 25:3589-3597. [PMID: 33170374 DOI: 10.1007/s00784-020-03681-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 11/04/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To assess the efficacy of three mechanical decontamination methods in four types of commercially available implants. MATERIAL AND METHODS Ninety-six implants of four commercial brands with different designs (regarding thread depth and thread pitch) were soaked in a surrogate biofilm (ink) and air-dried. Circumferential standardized peri-implant defects with 6 mm in depth and 1.55 mm in width were custom-made with a 3D printer. Stained implants were inserted in the defects and instrumented with three different methods: a titanium brush (TNB), a metallic ultrasonic tip (IST) and an air abrasive (PF). Standardized photographs were taken vertically to the implant axis (flat view), and with angulations of 60° (upper view) and 120° (lower view) to the implant long axis. The percentage of residual stain (PRS) was calculated with the image analysis software. Scanning electron microscope evaluations were performed on the buccal aspect of the implants at the central level of the defect. RESULTS The efficacy of PF was significantly inferior to the TNB and IST in all implant designs, while there were no significant differences between TNB and IST. IST showed significantly higher PRS in the implant with the highest thread pitch, while the TNB had the highest PRS in the implant with a marked reverse buttress-thread design. The micro-thread design had the lowest values of PRS for all decontamination methods. The apically facing threads represented the areas with highest PRS for all implant designs and decontamination methods. CONCLUSION Thread geometry influenced the access of the decontamination devices and in turn its efficacy. Implants with lower thread pitch and thread depth values appeared to have less residual staining. CLINICAL RELEVANCE Clinicians must be aware of the importance of thread geometry in the decontamination efficacy.
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Affiliation(s)
- Ignacio Sanz-Martín
- Section of graduate Periodontology, Faculty of Odontology, Complutense University of Madrid, Madrid, Spain
- Department of Periodontology, Research Institute for Periodontal Regeneration, Yonsei University College of Dentistry, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea
| | - Kyeongwon Paeng
- Department of Periodontology, Research Institute for Periodontal Regeneration, Yonsei University College of Dentistry, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea
| | - Hyobin Park
- Department of Periodontology, Research Institute for Periodontal Regeneration, Yonsei University College of Dentistry, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea
| | - Jae-Kook Cha
- Department of Periodontology, Research Institute for Periodontal Regeneration, Yonsei University College of Dentistry, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea.
| | - Ui-Won Jung
- Department of Periodontology, Research Institute for Periodontal Regeneration, Yonsei University College of Dentistry, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea
| | - Mariano Sanz
- Section of graduate Periodontology, Faculty of Odontology, Complutense University of Madrid, Madrid, Spain
- ETEP (Etiology and Therapy of Periodontal Diseases) Research Group, University Complutense of Madrid, Madrid, Spain
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15
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Padhye NM, Mehta LK, Yadav N. Buccally displaced flap versus sub-epithelial connective tissue graft for peri-implant soft tissue augmentation: a pilot double-blind randomized controlled trial. Int J Implant Dent 2020; 6:48. [PMID: 32869135 PMCID: PMC7459078 DOI: 10.1186/s40729-020-00244-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 07/08/2020] [Indexed: 11/23/2022] Open
Abstract
Background This article describes a novel surgical technique, the buccally displaced flap, for keratinized mucosa (KM) augmentation during implant uncovering. Furthermore, it clinically compares this technique with sub-epithelial connective tissue graft (SCTG) for peri-implant KM augmentation. Twelve weeks following implant placement, subjects were randomly divided for KM augmentation into group A (buccally displaced flap) and group B (SCTG). The width (WKM) and thickness (TKM) of the KM were assessed prior to the implant uncovering, 4 weeks and 1 year after implant loading. Post-operative pain assessment was performed using the Numeric Rating Scale. Results The study comprised of 20 implants that were uncovered in 20 subjects. For group A, the mean WKM increased from 0.98 (± 0.23 mm) to 3.01 mm (± 0.18 mm), and the mean TKM increased from 1.45 (± 0.13 mm) to 2.21 mm (± 0.16 mm) at 1 year. For group B, the mean WKM increased from 0.93 (± 0.18 mm) to 3.28 mm (± 0.13 mm), and the mean TKM increased from 1.41 (± 0.15 mm) to 2.25 mm (± 0.11 mm) at 1 year. Post-operative pain was significantly higher for group B 4.15 (± 1.35) as compared to group A 2.6 (± 1.22) (p < 0.001). Conclusion The buccally displaced flap increased the WKM and TKM during implant uncovering, with results comparable to SCTG. The main advantages of the technique were lack of sutures, maintenance of blood supply, reducing number of surgical sites, and it was relatively atraumatic with lesser post-operative pain. Trial registration Clinical trials registry—India CTRI/2019/09/021059. Date of registration—September 4, 2019, retrospectively registered.
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Affiliation(s)
| | | | - Naveeta Yadav
- Mahatma Gandhi Postgraduate Institute of Dental Sciences, Pondicherry, India
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16
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Galarraga‐Vinueza ME, Obreja K, Magini R, Sculean A, Sader R, Schwarz F. Volumetric assessment of tissue changes following combined surgical therapy of peri‐implantitis: A pilot study. J Clin Periodontol 2020; 47:1159-1168. [DOI: 10.1111/jcpe.13335] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 05/20/2020] [Accepted: 06/13/2020] [Indexed: 01/20/2023]
Affiliation(s)
- Maria Elisa Galarraga‐Vinueza
- Department of Oral Surgery and Implantology Johann Wolfgang Goethe‐University, Carolinum Frankfurt Germany
- Post‐Graduate Program in Implant Dentistry (PPGO) Federal University of Santa Catarina (UFSC) Florianópolis Brazil
| | - Karina Obreja
- Department of Oral Surgery and Implantology Johann Wolfgang Goethe‐University, Carolinum Frankfurt Germany
| | - Ricardo Magini
- Post‐Graduate Program in Implant Dentistry (PPGO) Federal University of Santa Catarina (UFSC) Florianópolis Brazil
| | - Anton Sculean
- Department of Periodontology School of Dental Medicine University of Bern Bern Switzerland
| | - Robert Sader
- Department for Oral Cranio‐Maxillofacial and Facial Plastic Surgery Medical Center of the Goethe University Frankfurt Frankfurt am Main Germany
| | - Frank Schwarz
- Department of Oral Surgery and Implantology Johann Wolfgang Goethe‐University, Carolinum Frankfurt Germany
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17
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Barry O, Wang Y, Wahl G. Determination of baseline alveolar mucosa perfusion parameters using laser Doppler flowmetry and tissue spectrophotometry in healthy adults. Acta Odontol Scand 2020; 78:31-37. [PMID: 31349769 DOI: 10.1080/00016357.2019.1645353] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objectives: To determine the baseline perfusion parameters of the alveolar mucosa using laser Doppler flowmetry and tissue spectrophotometry (LDF-TS) in healthy adults.Material and methods: Forty-two healthy adult subjects of either sex were tested. The perfusion of the alveolar mucosa was evaluated using a laser Doppler flowmetry and tissue spectrophotometry using O2C 'oxygen to see' device. The measurements encompassed the maxillary and mandibular mucosa at 20 different points.Results: The O2C device is a reliable method for noninvasive measurement of different perfusion parameters of the oral mucosa. The hemoglobin saturation values (So2 in %), as well as relative amount of hemoglobin in arbitrary units (AU) of the maxillary mucosa demonstrated lower values of that in the mandible. The flow value (AU) exhibited a significant difference in the posterior molar region only, while the velocity value (AU) showed a significant difference across all points except for the anterior region.Conclusion: the present study provides a set of brand-new perfusion parameters of the microcirculation of the alveolar mucosa using LDF-TS. The study suggests a variation of the perfusion parameters between the maxilla and the mandible. Differences in the anatomy of the blood supply, the thickness of the mucosa and the cortical bone, may be attributed to this variation. Further studies using different probes and a combination of ultrasonic measurements and SDF imaging will aid in giving a better overview of the perfusion in the oral mucosa.
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Affiliation(s)
- Obada Barry
- Department of Oral Surgery, Bonn University Dental Clinic, Bonn, Germany
| | - Ying Wang
- Department of Oral Surgery, Bonn University Dental Clinic, Bonn, Germany
| | - Gerhard Wahl
- Department of Oral Surgery, Bonn University Dental Clinic, Bonn, Germany
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18
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Schwarz F, Derks J, Monje A, Wang HL. Peri-implantitis. J Periodontol 2019; 89 Suppl 1:S267-S290. [PMID: 29926957 DOI: 10.1002/jper.16-0350] [Citation(s) in RCA: 406] [Impact Index Per Article: 81.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 09/14/2017] [Accepted: 09/24/2017] [Indexed: 12/28/2022]
Abstract
OBJECTIVES This narrative review provides an evidence-based overview on peri-implantitis for the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. METHODS A literature review was conducted addressing the following topics: 1) definition of peri-implantitis; 2) conversion from peri-implant mucositis to peri-implantitis, 3) onset and pattern of disease progression, 4) characteristics of peri-implantitis, 5) risk factors/indicators for peri-implantitis, and 6) progressive crestal bone loss in the absence of soft tissue inflammation. CONCLUSIONS 1)Peri-implantitis is a pathological condition occurring in tissues around dental implants, characterized by inflammation in the peri-implant connective tissue and progressive loss of supporting bone. 2)The histopathologic and clinical conditions leading to the conversion from peri-implant mucositis to peri-implantitis are not completely understood. 3)The onset of peri-implantitis may occur early during follow-up and the disease progresses in a non-linear and accelerating pattern. 4a)Peri-implantitis sites exhibit clinical signs of inflammation and increased probing depths compared to baseline measurements. 4b)At the histologic level, compared to periodontitis sites, peri-implantitis sites often have larger inflammatory lesions. 4c)Surgical entry at peri-implantitis sites often reveals a circumferential pattern of bone loss. 5a)There is strong evidence that there is an increased risk of developing peri-implantitis in patients who have a history of chronic periodontitis, poor plaque control skills, and no regular maintenance care after implant therapy. Data identifying "smoking" and "diabetes" as potential risk factors/indicators for peri-implantitis are inconclusive. 5b)There is some limited evidence linking peri-implantitis to other factors such as: post-restorative presence of submucosal cement, lack of peri-implant keratinized mucosa and positioning of implants that make it difficult to perform oral hygiene and maintenance. 6)Evidence suggests that progressive crestal bone loss around implants in the absence of clinical signs of soft tissue inflammation is a rare event.
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Affiliation(s)
- Frank Schwarz
- Department of Oral Surgery and Implantology, Carolinum, Johann Wolfgang Goethe-University Frankfurt, Frankfurt, Germany
| | - Jan Derks
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Alberto Monje
- Department of Oral Surgery and Stomatology, ZMK School of Dentistry, University of Bern, Bern, Switzerland.,Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Hom-Lay Wang
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
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19
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Schwarz F, Derks J, Monje A, Wang HL. Peri-implantitis. J Clin Periodontol 2019; 45 Suppl 20:S246-S266. [PMID: 29926484 DOI: 10.1111/jcpe.12954] [Citation(s) in RCA: 384] [Impact Index Per Article: 76.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 09/14/2017] [Accepted: 09/24/2017] [Indexed: 01/14/2023]
Abstract
OBJECTIVES This narrative review provides an evidence-based overview on peri-implantitis for the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. METHODS A literature review was conducted addressing the following topics: 1) definition of peri-implantitis; 2) conversion from peri-implant mucositis to peri-implantitis, 3) onset and pattern of disease progression, 4) characteristics of peri-implantitis, 5) risk factors/indicators for peri-implantitis, and 6) progressive crestal bone loss in the absence of soft tissue inflammation. CONCLUSIONS 1)Peri-implantitis is a pathological condition occurring in tissues around dental implants, characterized by inflammation in the peri-implant connective tissue and progressive loss of supporting bone. 2)The histopathologic and clinical conditions leading to the conversion from peri-implant mucositis to peri-implantitis are not completely understood. 3)The onset of peri-implantitis may occur early during follow-up and the disease progresses in a non-linear and accelerating pattern. 4a)Peri-implantitis sites exhibit clinical signs of inflammation and increased probing depths compared to baseline measurements. 4b)At the histologic level, compared to periodontitis sites, peri-implantitis sites often have larger inflammatory lesions. 4c)Surgical entry at peri-implantitis sites often reveals a circumferential pattern of bone loss. 5a)There is strong evidence that there is an increased risk of developing peri-implantitis in patients who have a history of chronic periodontitis, poor plaque control skills, and no regular maintenance care after implant therapy. Data identifying "smoking" and "diabetes" as potential risk factors/indicators for peri-implantitis are inconclusive. 5b)There is some limited evidence linking peri-implantitis to other factors such as: post-restorative presence of submucosal cement, lack of peri-implant keratinized mucosa and positioning of implants that make it difficult to perform oral hygiene and maintenance. 6)Evidence suggests that progressive crestal bone loss around implants in the absence of clinical signs of soft tissue inflammation is a rare event.
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Affiliation(s)
- Frank Schwarz
- Department of Oral Surgery and Implantology, Carolinum, Johann Wolfgang Goethe-University Frankfurt, Frankfurt, Germany
| | - Jan Derks
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Alberto Monje
- Department of Oral Surgery and Stomatology, ZMK School of Dentistry, University of Bern, Bern, Switzerland.,Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Hom-Lay Wang
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
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20
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Monje A, Insua A, Wang HL. Understanding Peri-Implantitis as a Plaque-Associated and Site-Specific Entity: On the Local Predisposing Factors. J Clin Med 2019; 8:E279. [PMID: 30823574 PMCID: PMC6406659 DOI: 10.3390/jcm8020279] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 02/20/2019] [Accepted: 02/21/2019] [Indexed: 12/22/2022] Open
Abstract
The prevalence of implant biological complications has grown enormously over the last decade, in concordance with the impact of biofilm and its byproducts upon disease development. Deleterious habits and systemic conditions have been regarded as risk factors for peri-implantitis. However, little is known about the influence of local confounders upon the onset and progression of the disease. The present narrative review therefore describes the emerging local predisposing factors that place dental implants/patients at risk of developing peri-implantitis. A review is also made of the triggering factors capable of inducing peri-implantitis and of the accelerating factors capable of interfering with the progression of the disease.
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Affiliation(s)
- Alberto Monje
- Department of Periodontology, Universitat Internacional de Catalunya, 08195 Barcelona, Spain.
- Division of Periodontics, CICOM Periodoncia, 06011 Badajoz, Badajoz, Spain Santiago de Compostela, Spain.
| | - Angel Insua
- Division of Periodontics, CICOM Periodoncia, 06011 Badajoz, Badajoz, Spain Santiago de Compostela, Spain.
| | - Hom-Lay Wang
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI 48109, USA.
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