Regenerative surgical therapy for peri-implantitis using deproteinized bovine bone mineral with 10% collagen, enamel matrix derivative and Doxycycline-A prospective 3-year cohort study

Efficacy of a Surgical versus a Nonsurgical Approach in the Treatment of Peri-Implant Diseases: A Systematic Review and Meta-Analysis

The objective of the study was to compare the surgical vs. the nonsurgical techniques in the treatment of peri-implant diseases and to obtain a comprehensive analysis of the effects on BOP/probing depths when applying either the surgical technique vs. a nonsurgical technique. Twenty-seven articles with a total of 29 trials were selected from PubMed, Medline, Embase and Cochrane library. The articles were published in the past 10 years and complied with the inclusion criteria. Three metanalyses were performed evaluating the effects of surgical and nonsurgical treatments on the reduction in probing depths as well as on bleeding on probing. Fifteen studies involved the treatment of peri-implant diseases with the surgical approach and 14 studies involved the application of the nonsurgical protocol (6 treating peri-implantitis and 8 treating mucositis). A mean reduction in probing depths of 2.31 mm were obtained when the surgical approach was applied for peri-implantitis and a mean of 57% reduction in bleeding on probing was obtained with the surgical protocols. Inflammation was significantly reduced when nonsurgical protocols were applied for mucositis. The highest reduction in probing depths and bleeding on probing was found when emdogain was used with allograft and resorbable membranes. Nonsurgical treatments with extensive hygiene measures were mainly indicated in the treatment of mucositis and do not present bone gain but lowers or maintains probing depths and reduced bleeding on probing. Further studies should be performed with a standardized definition of peri-implantitis with the same surgical or nonsurgical protocol applied as well as the same follow-up period in order to correctly identify the ideal treatment of choice.

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

AIM

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

METHODS

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

RESULTS

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

CONCLUSION

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

Reconstructive surgical therapy of peri-implant defects with ribose cross-linked collagen matrix and crosslinked hyaluronic acid - a prospective case series

OBJECTIVE

To investigate the efficacy of ribose-crosslinked collagen (RCLC) matrices functionalized by crosslinked hyaluronic acid (xHya) for reconstructive treatment of class I and III (b-c) peri-implantitis lesions in a transmucosal healing mode.

MATERIALS AND METHODS

Thirteen patients presenting with 15 implants were included in this prospective case series. Upon flap reflection, the implants were thoroughly decontaminated employing glycine powder air polishing and adjunctive sodium hypochlorite. For defect augmentation, xHyA was administered to the bony defect walls, exposed implant surfaces, and the RCLC matrix before defect grafting. The full-thickness flap was readapted and sutured around the implant neck for transmucosal healing. Baseline and respective values at the 12 months post-op evaluation were recorded for the clinical parameters peri-implant probing depth (PPD), buccal soft tissue dehiscence (BSTD) and bleeding on probing (BoP). Furthermore, two independent investigators analyzed radiographic changes in the defect area. The mean changes for all variables were analyzed with a paired t-test.

RESULTS

The initial mean PPD was 7.2 ± 1.9 mm, and BoP was present in 63% of sites. After 12 months, PPD at the latest visit was 3.2 ± 0.66 mm, which amounted to a respective 3.9 ± 1.85 mm reduction, while the BoP frequency dropped to 10% at all sites. Radiographic bone fill was accomplished for 62.8% of the former defect area, accompanied by a mean MBL gain of 1.02 mm around the treated implants (all p < 0.001).

CONCLUSIONS

Within the limits of this case series, we conclude that the proposed treatment sequence substantially improved peri-implant defects and offered a simplified but predictive technique.

CLINICAL RELEVANCE

Reconstructive treatment approaches for peri-implantitis are effective but remain non-superior to open flap debridement. Further research on novel biomaterial combinations that may improve reconstructive treatment outcomes are warranted. Ribose-crosslinked collagen matrices biofunctionalized by hyaluronic acid used in this study yield improved clinical and radiographic peri-implant conditions after 12 months.

Surgical treatment of peri-implantitis

As utilisation of dental implants continues to rise, so does the incidence of biological complications. When peri-implantitis has already caused extensive bone resorption, the dentist faces the dilemma of which therapy is the most appropriate to maintain the implant. Since non-surgical approaches of peri-implantitis have shown limited effectiveness, the present paper describes different surgical treatment modalities, underlining their indications and limitations. The primary goal in the management of peri-implantitis is to decontaminate the surface of the infected implant and to eliminate deep peri-implant pockets. For this purpose, access flap debridement, with or without resective procedures, has shown to be effective in a large number of cases. These surgical treatments, however, may be linked to post-operative recession of the mucosal margin. In addition to disease resolution, reconstructive approaches also seek to regenerate the bone defect and to achieve re-osseointegration.

Selecting biomaterials in the reconstructive therapy of peri-implantitis

Peri-implantitis is a pathogenic inflammatory condition characterized by progressive bone loss and clinical inflammation that may compromise the stability of dental implants. Therapeutic modalities have been advocated to arrest the disorder and to establish peri-implant health. Reconstructive therapy is indicated for bone defects exhibiting contained/angular components. This therapeutic modality is based upon the application of the biological and technical principles of periodontal regeneration. Nonetheless, the comparative efficacy of reconstructive therapy and nonreconstructive modalities remains unclear. Therefore, the aim of this narrative review is to address major clinical concerns regarding the efficacy, effectiveness, and feasibility of using biomaterials in peri-implantitis therapy. In particular, the use of bone grafting materials, barrier membranes, and biologics is comprehensively explored.

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 Use of Enamel Matrix Derivative during Surgical Therapy for Peri-Implantitis: A Case Series

Peri-implantitis is a growing concern and currently, there is no agreement on the best method for treating this condition. This study looked at surgical intervention with the use of enamel matrix derivative (EMD) for treating this condition. A cohort of 25 (34 implants) consecutive patients treated with EMD for peri-implantitis was followed for up to 6.4 years. The survival of the implants as well as changes in clinical parameters are reported. Statistical analysis was performed using paired t tests and general estimating equations. The mean length of time implants were followed post-surgery was 3.05 ± 1.53 years. All but two of the treated implants survived in function (94%). Both failed implants were lost in the same patient, who was a heavy smoker. The changes in mean probing depth (1.94 ± 1.18 mm), change in deepest probing depth (3.12 ± 1.45 mm), and reduction in bleeding on probing (73.6 ± 43.9%) according to patient means were all highly significant (p < 0.001 for all changes). When EMD is used during surgical treatment of peri-implantitis, there is a high survival rate of implants and significant improvements in clinical parameters.

The effect of reconstructive techniques as treatment modality for peri-implant osseous defects - a systematic review and meta-analysis

OBJECTIVES

The aim of this systematic review is to compare conventional peri-implant flap surgery and reconstructive surgical techniques regarding evidence of remission from peri-implantitis.

MATERIAL AND METHODS

Searches were made among randomized controlled trials evaluating clinical aspects and the changes in marginal bone level before and after surgical treatment of peri-implantitis, with and without bone substitute.

RESULTS

Nine published articles and 442 patients were eligible for inclusion in the study. Reconstructive techniques exhibited a greater extent of defect fill than conventional surgical techniques alone. No significant differences could be found for clinical measures of peri-implant disease (bleeding on probing and reduction of probing depth) from baseline to the 12-month follow-up.

CONCLUSIONS

With regards to the clinical measures of disease, our review shows that there are no differences between open flap debridement and regenerative surgery. From an esthetic standpoint, it may however be that regenerative measures may lead to improvement but further publications with this focus will be necessary to verify this.

A Systematic Review and Meta-Analysis of Systemic and Local Antibiotic Therapy in the Surgical Treatment of Peri-Implantitis

(1) Background: Given the existing controversy regarding the use of antibiotics in the treatment of peri-implantitis, this systematic review and meta-analysis aim to ascertain how beneficial the role of systemic and local antibiotics is in peri-implant surgical therapy, considering the harmful effects that they represent and the abuse of antibiotics in terms of global health. (2) Methods: To determine the therapeutic efficacy of the administration of antibiotics in the surgical treatment of peri-implantitis in terms of probing pocket depth (PPD) and bleeding on probing (BoP), electronic and manual bibliographic searches were carried out in the Embase and PubMed databases, collecting data that related to before and after treatment. (3) Results: The adjunctive use of local antibiotics provides significant improvements in PPD (MD = 1.29; 95% CI: 0.56 to 2.02; p ≤ 0.0006; I² = 0%) when compared with surgical treatment alone. No significant differences were found in the other subgroup; that is, the use of systemic antibiotics did not significantly improve PPD changes in the surgical treatment of peri-implantitis (MD = 0.40; 95% CI: -0.15 to 0.95; p = 0.15; I² = 0). (4) Conclusions: The use of local antibiotics in the surgical treatment of peri-implantitis seems to offer treatment improvements in terms of PPD and BoP, unlike that observed with the use of systemic antibiotics. However, these results should be taken with caution as they also depend on the type of surgical technique used, whether regenerative or resective. More research is needed on this topic to understand the role of local and systemic antibiotics in the treatment of peri-implantitis.

Supportive care for the prevention of disease recurrence/progression following peri-implantitis treatment: A systematic review

OBJECTIVES

This systematic review aimed to evaluate the efficacy of supportive care provision, frequency and protocol in patients treated for peri-implantitis, as reported in prospective and retrospective studies of at least 3-years duration.

MATERIALS AND METHODS

A systematic search of three electronic databases was undertaken up to 21 July 2022 and supplemented by hand-search to identify studies that included participants treated for peri-implantitis and followed for at least 3 years. Owing to high heterogeneity, a meta-analysis was not appropriate, and therefore, data and risk of bias were explored qualitatively. PRISMA guidelines for reporting were followed.

RESULTS

The search identified 2596 studies. Of 270 records selected during screening, 255 were excluded through independent review and 15 studies (10 prospective and 5 retrospective, with at least 20 patients) were retained for qualitative assessments. Study designs, population characteristics, supportive care protocols and reported outcomes varied markedly. Thirteen of the 15 studies had low risk of bias. Supportive peri-implant care (SPIC) following different surgical peri-implantitis treatment protocols and with recall intervals varying between 2 months and annually resulted in peri-implant tissue stability (no disease recurrence or progression) ranging from 24.4% to 100% at patient level and from 28.3% to 100% at implant level. Sevenhundred and eighty-five patients with 790 implants were included in this review.

CONCLUSIONS

Provision of SPIC following peri-implantitis therapy may prevent disease recurrence or progression. Insufficient evidence is available to identify (i) a specific supportive care protocol for secondary prevention of peri-implantitis, (ii) the effect of adjunctive local antiseptic agents in the secondary prevention of peri-implantitis and (iii) the impact of frequency of supportive care measures. Prospective, randomised, controlled studies designed to evaluate supportive care protocols are needed in future.

Effect of laser-assisted reconstructive surgical therapy of peri-implantitis on protein biomarkers and bacterial load

OBJECTIVES

This randomized clinical trial assessed changes in protein biomarker levels and bacterial profiles after surgical reconstructive therapy of peri-implantitis and investigated whether the adjunctive use of Er:YAG laser impacts protein biomarker and microbial outcomes.

MATERIALS AND METHODS

Twenty-four patients received surgical reconstructive therapy for peri-implantitis with guided bone regeneration following mechanical debridement with (test) or without (control) the adjunctive irradiation of Er:YAG laser. Bacterial and peri-implant crevicular fluid (PICF) samples were collected over 6 months and analyzed with bacterial qPCR and luminex multiplex assays.

RESULTS

Surgical reconstructive treatment significantly affected the concentration of PICF protein biomarkers, including a 50% reduction in IL-1β between 2 and 4 weeks (p < .0001). Both MMP-9 (p < .001) and VEGF (p < .05) levels steadily decreased after treatment. In the laser group, the peak increase in IL-1β was attenuated at 2 weeks, followed by significant reduction in MMP-9 (p < .01) and VEGF (p < .05) across all follow-up appointments compared with the control nonlaser group. The total bacterial load was reduced 2 weeks after treatment, especially in the laser group, but recolonized to presurgical levels after 4 weeks in both groups (p < .01). The composition of selective pathogens varied significantly over the follow-up, but recolonization patterns did not differ between groups.

CONCLUSIONS

Reconstructive therapy of peri-implantitis significantly altered PICF protein biomarker and microbial levels during the healing process. The adjunctive use of Er:YAG laser significantly modulated the inflammatory response through reduced levels of MMP-9 and VEGF during the postsurgical period. The bacterial load was reduced immediately after therapy, but recolonization was observed by 4 weeks in both groups.

Adjunctive locally and systemically delivered antimicrobials during surgical treatment of peri-implantitis: A systematic review

AIM

To answer the following PICOS question: "In patients with peri-implantitis, what is the efficacy of surgical therapy with adjunctive systemic or local antimicrobials, in comparison with surgical therapy alone, in terms of pocket probing depth reduction, as assessed in randomized controlled trials (RCTs) with at least 6 months of follow-up?"

MATERIALS AND METHODS

A systematic literature search was conducted. Reduction in mean probing pocket depth (PPD) was the primary outcome. Secondary clinical outcomes were changes in suppuration (%), changes in bleeding on probing (BOP) (%), marginal bone level changes (mm), disease resolution (%), and implant/prosthesis loss (%). Patient-reported outcome measures, possible adverse effects, and oral-health-related quality of life were also extracted if such data were available.

RESULTS

Four RCTs assessing the use of locally (two RCTs) and systemically (two RCTs) administered antimicrobial adjuncts to surgical treatment of peri-implantitis, with 6-36-month follow-up, were included. Because of the substantial heterogeneity of interventions between the studies, meta-analysis could not be performed. A reduction in the mean PPD was observed following all the involved surgical treatments, irrespective of the addition of antimicrobials. Except for the effect of systemic antimicrobials on marginal bone level changes and local antimicrobials on BOP, the effect of systemic and local antimicrobials was equivocal for all secondary outcome measures.

CONCLUSIONS

Based on the limited available evidence, the adjunctive use of the currently tested systemic or local antimicrobials during surgical therapy, in comparison with surgical therapy alone, in patients with peri-implantitis does not seem to improve the clinical efficacy. With regard the use of systemic antimicrobials, only 50% of the cases showed disease resolution after 1 year. There is a lack of studies that consider the sole use of local antimicrobials. Therefore, their true effect remains unclear.

The efficacy of bone reconstructive therapies in the management of peri-implantitis. A systematic review and meta-analysis

AIM

To evaluate the efficacy of bone reconstructive procedures for the reduction of probing pocket depth (PPD), bleeding on probing (BOP), and suppuration in peri-implantitis-related bone defects at ≥12-month follow-up.

MATERIALS AND METHODS

Three databases were searched for randomized controlled trials (RCTs) and controlled clinical trials (CCTs) that compared bone reconstructive therapies to access flap surgery (AFS) (Focused Question-FQ 1), and RCTs, CCTs, and prospective case series that assessed the efficacy of reconstructive therapies (FQ 2). Meta-analysis was performed for FQ1 when more than three studies were identified, while for FQ2 a network was drawn based on RCTs with common treatment arms.

RESULTS

Seven RCTs were identified for FQ1 while five RCTs and six prospective case series for FQ2. There was no significant difference in PPD change between AFS and reconstructive surgery (-0.387; p = .325) at 12 months. Furthermore, no clear differences in terms of PPD and BOP changes resulted from the different reconstructive therapies included in the network. Only a small percentage of treated cases with any modality achieved peri-implantitis resolution, as defined by different composite outcomes.

CONCLUSIONS

Reconstructive surgery does not offer significant improvements in peri-implant clinical parameters as compared to AFS at 12 months. It was not possible to establish a hierarchy of efficacy among the different biomaterials employed for reconstructive surgery.

Clinical Outcomes of Enamel Matrix Derivate Used in Surgical and Non-Surgical Treatment of Peri-Implantitis: A Systematic Review of Clinical Studies

Background and objectives: The aim of this systematic review was to assess the available evidence of using enamel matrix derivate in the treatment of peri-implantitis. Materials and methods: Three electronic databases (PubMed, Scopus, and Web of Science) were searched until August 2022 to identify relevant articles. The inclusion criteria consisted in human clinical studies that reported the use of enamel matrix derivate (EMD) in surgical and non-surgical treatment of peri-implantitis. The risk of bias was assessed using Cochrane risk of bias tool for randomized clinical trials (RCTs) and for non-RCTs ROBINS-I tool. Results: Clinical studies included were published between 2012 and 2022 and consisted of two randomized clinical trials (RCTs) for non-surgical therapy and two RCTs, three prospective cohort studies, and one retrospective case series in surgical therapy. Due to the heterogeneity of patients' characteristics and assessment of peri-implant therapy, statistical analysis could not be achieved. Conclusions: The use of EMD indicated a positive effect on both surgical and non-surgical therapy. However, the available literature is scarce, with low evidence in non-surgical approach and modest evidence in surgical approach using EMD. More RCTs with standardize protocols are necessary to evaluate the efficacy of using EMD in both therapies.

Tetracycline impregnated bone grafts in the management of peri-implantitis and guided bone regeneration around dental implants: A systematic review

Background

Rehabilitation of dental arches with the help of dental implants has been revolutionary and a significant part of research is devoted to increasing its success rate. One of the most common causes of failure of dental implants is peri-implantitis caused due to microbial invasion. Newer strategies are being adapted for the treatment of peri-implantits and recent surgical management with the help of antibiotic-impregnated bone grafts shows a promising future.

Aim and objectives

This study aimed to test the efficacy of bone grafts incorporating tetracycline and its derivatives in the treatment of peri-implantits and guided bone regeneration with the estimation of clinical and radiographic parameters.

Methods

A thorough search was made on eminent databases such as PubMed, Embase, Scopus, and Cochrane Library database for published literature on tetracycline impregnated bone grafts used either in the management of peri-implantitis or for guided bone regeneration around dental implants.The measures of outcome were clinical attachment loss or probing depth around dental implants and radiographic bone height.

Results

Nine potentially eligible full-text published articles including case reports, case series, observational studies, and randomized controlled trials were selected for review. Most of the studies reviewed; reported a reduction in probing depth and an increase in bone height and density after placement of tetracycline bone grafts around the dental implant.

Conclusion

The incorporation of tetracycline into the bone grafts shows promising results as an agent of local delivery around dental implants in the management of peri-implantitis and for guided bone regeneration. Future trials are required to produce a body of evidence and to facilitate the translation of this procedure into clinical practice.

Surgical interventions for the treatment of peri-implantitis

BACKGROUND

Peri-implantitis constitutes one of the most frequent late dental implant complications. The disease is initiated by bacterial infection; therefore, anti-infective peri-implantitis treatment strategies are required to arrest the progressive marginal bone loss and maintain the affected implant in function. Although nonsurgical treatment strategies appear to be of limited predictability, treatment outcomes have been frequently improved following surgical interventions.

PURPOSE

The present narrative review describes various surgical peri-implantitis treatment modalities, with respect to their indications, performance, and effectiveness.

MATERIALS AND METHODS

The present narrative review considered the most relevant studies in the field published in the English language.

RESULTS

Surgical peri-implantitis treatment approaches can be categorized as nonreconstrucive therapy, reconstructive therapy, and combined therapy (ie, reconstructive and resective therapy). In addition to disease resolution, reconstructive approaches also seek to regenerate the bone defect and achieve reosseointegration.

CONCLUSIONS

The severity of the disease, the regenerative potential of the defetc and esthetic demands of the patient are the factors determining the surgical peri-implantitis treatment modality.

Reconstructive treatment of peri-implant defects-Results after three and five years

OBJECTIVES

The aim of this study was to assess the long-term efficacy of reconstructive treatment of peri-implantitis intraosseous defects.

MATERIAL AND METHODS

Peri-implant intraosseous defects were augmented using either an autogenous bone graft (AB) or a bovine-derived xenograft (BDX) in combination with a collagen membrane. Maintenance was provided every third month.

RESULTS

In the AB group, 16 patients with 25 implants remained at year five. In the BDX group, 23 patients with 38 implants remained. Between baseline and year 5, bleeding on probing (BOP) and probing pocket depth (PPD) scores were reduced in both groups (p < .001). In the AB and BDX groups, mean PPD between baseline and year five was reduced by 1.7 and 2.8 mm, respectively. The difference between groups was significant (p < .001). In the AB group, the mean bone level change at implant level between baseline and years three and five was-0,2 and -0.7 mm, respectively. In the BDX group, the mean bone level change at implant level between baseline and years three and five was 1.6 and 1.6 mm, respectively. The difference between the groups was significant (p < .001). Successful treatment (no bone loss, no probing pocket depth (PPD) > 5 mm, no suppuration, maximum one implant surface with bleeding on probing (BOP) at year five) was obtained in 9/25 implants (36%) in the AB group and in 29/37 implants (78.3%) in the BDX group.

CONCLUSIONS

Reconstructive surgical treatment of peri-implant defects using BDX resulted in more predictable outcomes than using autogenous bone over 5 years.

Case Report: One alternative surgical treatment of retrograde peri-implantitis

Background

Retrograde peri-implantitis is an infection at the apex of an implant, leading to progressive bone loss. We present a surgical technique that is an alternative to implant removal or “implantoplasty.”

Case

A 47-year-old patient developed retrograde peri-implantitis 18 months after implant placement. As the infection was localized to the apex of the implant, an apicoectomy was performed on the implant. Post-operative serial periapical radiographs showed reparative tissue within 4 months, and a follow up radiograph showed complete bone restoration 2 years later.

Practical Implications

The findings of this case suggest a viable alternative to condemnation and removal of an implant with a periapical infection. It may be viable to resect the contaminated portion of the implant, graft the defect, and gain long term retention and service of the implant.

Minimal invasiveness in the reconstructive treatment of peri-implantitis defects

Peri-implantitis is a plaque-associated pathologic condition occurring in tissues around dental implants, clinically characterized by increased peri-implant probing pocket depth and progressive loss of supporting bone. Consequently, to arrest further disease progression and to increase the chance to obtain re-osseointegration, surgical reconstructive procedures have been adopted. In particular, following a paradigm gathered from periodontal therapy, recent protocols have underlined the importance of a minimally invasive approach to optimize the outcomes of therapy while minimizing the risks of postoperative complications. The present review summarizes the level of evidence on the surgical reconstructive protocols focusing on the new approaches aiming to minimize surgical trauma and patients' postoperative discomfort, underlining the pros and cons of each treatment modality.

Efficacy of concentrated growth factor versus collagen membrane in reconstructive surgical therapy of peri-implantitis: 3-year results of a randomized clinical trial

Objectives

To compare the 3-year clinical and radiographic outcomes of two different reconstructive surgical management of peri-implantitis using a bone substitute in combination with either concentrated growth factor (CGF) or collagen membrane (CM).

Material and methods

Fifty-one patients who had at least one implant presenting peri-implantitis with an intrabony defect were filled with a xenogenic bone grafting material and covered either CGF or CM. Clinical and radiographic assessments were carried out at baseline and postoperative years 1 and 3. Three different composite outcomes were defined to evaluate treatment success at a 3-year follow-up. The effects of possible prognostic indicators on treatment success were identified by using multilevel regression analysis.

Results

The changes in probing depth (PD) and radiographic vertical defect depth (VDD) between baseline and year 1 and baseline and year 3 presented significantly greater decreases for the CM group in comparison with the CGF group (p < 0.05). No significant differences between the two treatment modalities were demonstrated regarding treatment success outcomes. History of periodontitis, VDD at baseline, and the number of intrabony defect walls revealed significant impacts on treatment success (p = 0.033; OR = 3.50, p = 0.039; OR = 0.975, and p = 0.024; OR = 7.0 and p = 0.019;OR = 6.0, respectively).

Conclusions

CM in combination with a bone substitute seems to have slightly better outcomes compared to the CGF membranes in reconstructive surgical therapy of peri-implantitis. The history of periodontitis, baseline VDD, and peri-implant bone defect configuration could be possible predictors influencing treatment success.

Trial registration

ClinicalTrials.gov NCT04769609.

Clinical relevance

For the reconstruction of peri-implant bone defects, using a bone substitute in combination with a collagen membrane may show more favorable outcomes.

Enamel Matrix Derivatives for Periodontal Regeneration: Recent Developments and Future Perspectives

In the era of the growing population, the demand for dental care is increasing at a fast pace for both older and younger people. One of the dental diseases that has attracted significant research is periodontitis. Periodontal therapy aims to regenerate tissues that are injured by periodontal disease. During recent decades, various pioneering strategies and products have been introduced for restoring or regeneration of periodontal deficiencies. One of these involves the regeneration of tissues under guidance using enamel matrix derivatives (EMDs) or combinations of these. EMDs are mainly comprised of amelogenins, which is one of the most common biological agents used in periodontics. Multiple studies have been reported regarding the role of EMD in periodontal tissue regeneration; however, the extensive mechanism remains elusive. The EMDs could promote periodontal regeneration mainly through inducing periodontal attachment during tooth formation. EMD mimics biological processes that occur during periodontal tissue growth. During root development, enamel matrix proteins are formed on the root surface by Hertwig's epithelial root sheath cells, initiating the process of cementogenesis. This article reviews the challenges and recent advances in preclinical and clinical applications of EMDs in periodontal regeneration. Moreover, we discuss the current evidence on the mechanisms of action of EMDs in the regeneration of periodontal tissues.

Implantoplasty- provoking or reducing inflammation? - a systematic scoping review

OBJECTIVES

To evaluate clinical parameters associated with inflammation after adjunctive implantoplasty in conjunction with surgical treatment of peri-implantitis.

MATERIALS AND METHODS

A systematic literature search was performed in 2 databases until 29. December 2020 to find publications that report on clinical parameters after surgical peri-implantitis treatment which included adjunctive implantoplasty. Clinical studies on implantoplasty reporting on BoP as outcome were included, but other clinical or radiographic outcomes were also considered.

RESULTS

The search resulted in 18 articles that fulfilled the inclusion criteria. The results indicated improvements of BoP and clinical parameters following surgical peri-implantitis treatment with adjunctive implantoplasty.

CONCLUSIONS

Within its limits, the findings of the present scoping review indicated that BoP is reduced following surgical peri-implantitis treatment with adjunctive implantoplasty, and that this improvement is in line with surgical peri-implantitis treatment without adjunctive implantoplasty.

Surgical therapy of peri-implantitis

Peri-implantitis is caused by a bacterial challenge; therefore, anti-infective treatment strategies should be employed to manage the disease. As nonsurgical approaches demonstrate limited efficacy in most cases of peri-implantitis, surgical interventions are often required. Treatment outcomes improve following access flap surgery, with or without adjunctive resective and/or augmentation measures. Whereas nonaugmentative therapies (ie, access flap surgery and resective techniques) primarily aim to resolve inflammation and arrest further disease progression, augmentation approaches also seek to regenerate the bony defect and achieve reosseointegration. Currently, limited evidence supports the superiority of augmentative surgical techniques for peri-implantitis treatment over nonaugmentation methods, and human histologic evidence for reosseointegration is sparse. For patients involved in regular postoperative maintenance programs, success of peri-implantitis surgical treatment based on various definitions of success was obtained in over half of the cases after 5-7 years. Despite surgical treatment, cases of further disease progression that required retreatment or led to implant loss were reported.

The efficacy of systemic antibiotics as an adjunct to surgical treatment of peri-implantitis: a systematic review

BACKGROUND

Microbial biofilm accumulation is the main cause of peri-implantitis. The majority of surgical peri-implantitis treatment protocols suggests adjunctive use of systemic antibiotics to target specific putative bacteria. The aim of this systematic review was to critically evaluate the adjunctive use of systemically administered antibiotics in surgical treatment of peri-implantitis by reviewing previously published systematic reviews and primary studies.

METHODS

A systematic literature search was conducted in four electronic databases (MEDLINE, The Cochrane Library, EMBASE, and Web of Science) for randomised controlled trials, cohort studies, case-control studies, and systematic reviews reporting surgical treatment of peri-implantitis with and without adjunctive systemically administered antibiotic therapy. The included systematic reviews and primary studies were qualitatively assessed using AMSTAR and GRADE, respectively. No restrictions were set for date of publication, journal, or language.

RESULTS

The literature search identified 681 papers. Only seven systematic reviews and two primary studies met the inclusion criteria. Four out of seven included systematic reviews concluded that no evidence exists for use of systemic antibiotics to improve the clinical outcomes in surgical treatment of peri-implantitis. One review did not estimate the level of evidence, one did not clearly state any beneficial effect, whereas one reported a limited adjunctive effect. Further, the two included primary studies did not show a long-term significant benefit of adjunctive use of systemically administrated antibiotics. However, one study reported a short-term adjunctive effect in patients with modified surface implants. Due to heterogeneity in study design, low number of included primary studies, and grade of bias, no meta-analysis was performed.

CONCLUSION

The use of systemically administered antibiotics as an adjunct to surgical interventions of peri-implantitis cannot be justified as a part of a standard treatment protocol. A pervasive problem is the lack of uniform diagnosis criteria for peri-implantitis, deficient information about patient characteristics, absence of high quality long-term randomised controlled trials, and authors' declaration on conflict of interest.

Peri-Implantitis: Application of a Protocol for the Regeneration of Deep Osseous Defects. A Retrospective Case Series

Background and aims: Peri-implantitis is a complex pathology, both in its diagnosis and in the identification of etiological causes. Although we have been studying more and more over the years to try to answer the many questions that remain regarding everything that circulates around this disease which affects implants, nothing has yet been taken as an official consensus regarding its surgical treatment. There are still many proposed protocols, each of which has been shown to have comforting results and promising prospects, but no total predictability. The aim of this case series is to assess the clinical outcomes of a mixed protocol for the regeneration of deep osseous defects. Materials and methods: The data and clinical records of 23 patients, with 29 implants affected by peri-implantitis treated surgically in private practice, were analyzed retrospectively. The method used for the surgical treatment was a mixed protocol of mechanical–chemical decontamination and bone regeneration with bovine xenograft. Results: All patients were followed for at least 2 years, averaging 28.9 months (a range of 24–38 months) with a reduction in the probing depth (PD) at one year from the initial 8.14 ± 1.156 mm to 3.72 ± 0.649 mm, and to 4.14 ± 1.093 mm at the final assessment. The differences between assessment time points were always statistically significant. The data regarding bleeding on probing (BoP) and suppuration also showed a statistically significant reduction at the final time point compared to the baseline. Only one patient, at 24 months, still showed BoP, suppuration, and a PD deeper than 5 mm, indicating a recurrence of the disease compared to the initial improvement of the PD (5 mm) at one year. Conclusions: In conclusion, within the limits of this retrospective analysis, it can be affirmed that this combined mechanical–chemical and regenerative decontamination therapy is effective in the treatment of peri-implantitis.

Surgical approach combining implantoplasty and reconstructive therapy with locally delivered antibiotic in the treatment of peri-implantitis: A prospective clinical case series

BACKGROUND

Nonsurgical treatment, resective surgery, reconstructive surgery, or combined approaches have been proposed for the treatment of peri-implantitis, with variable results.

PURPOSE

To evaluate the 1-year clinical and radiographic outcomes following combined resective and reconstructive surgical treatment with topical piperacillin/tazobactam antibiotic in the management of peri-implantitis.

MATERIAL AND METHODS

Forty-three patients diagnosed with peri-implantitis were included. Surgical treatment consisted of implantoplasty of the supra-crestal component of the defect, the application of a topical antibiotic solution over the implant surface, and subsequent reconstruction of the intra-osseous component of the peri-implant defect. The primary outcome was disease resolution, defined as the absence of bleeding on probing (BoP) and/or suppuration on probing (SoP), a peri-implant pocket probing depth (PPD) ≤5 mm, and no bone loss >0.5 mm 1 year after surgery. Secondary outcomes included changes in BoP, PPD, SoP, and peri-implant marginal bone levels. One implant per patient was included in the analysis.

RESULTS

The treatment success rate of the 43 dental implants included in the study was 86% at 1 year after surgery. Mean PPD and BoP decreased from 6.41 ± 2.11 mm and 100% at baseline to 3.19 ± 0.99 mm (p < 0.001) and 14% (p < 0.001) at 1 year, respectively. SoP was significantly reduced from 48.8% at baseline to 0% 1 year after surgery (p < 0.001). Radiographically, a mean defect fill of 2.64 ± 1.59 mm was recorded (p < 0.001).

CONCLUSIONS

The combination of a resective and reconstructive surgical approach together with locally delivered antibiotic achieved a high disease resolution rate after 1 year of follow-up and constitutes a viable option for the management of peri-implantitis.

Efficacy of local antibiotic therapy in the treatment of peri-implantitis: A systematic review and meta-analysis

OBJECTIVES

The aim of this systematic review and meta-analysis was to state the efficacy of local administration of antibiotics in the treatment of peri-implantitis in terms of peri-implant probing depth (PPD) and bleeding on probing (BoP) reduction.

DATA, SOURCES AND STUDY SELECTION

Electronic and manual literature searches were conducted. Screening process was done using the National Library of Medicine (MEDLINE by PubMed), Embase and the Cochrane Oral Health. Included articles were randomized controlled trials and observational studies. Weighted means were calculated. Heterogeneity was determined using Higgins (I2). Due to the encountered heterogeneity between the studies being combined, random-effects models were applied in order to analyze effect sizes. Twelve studies (365 patients and 463 implants) were included in the systematic review. After peri-implantitis treatment with local antibiotics, PPD was reduced 1.40 mm (95% confidence interval: 0.82-1.98). When local antibiotics were applied, a 0.30 mm higher reduction of PPD was obtained than in the control group (95% confidence interval: 0.07-0.53). BoP attained an odds ratio value of 1.82 (95% confidence interval: 1.09-3.04), indicating that the likehood of bleeding is almost two-fold when antibiotics are not locally administrated. Adverse effects were not found after applying local antibiotics.

CONCLUSIONS

The local antibiotic administration does reduce, without adverse effects, both peri-implant probing depths and bleeding on probing in patients affected by peri-implantitis, if compared to control groups without local antibiotic application.

CLINICAL SIGNIFICANCE

Patients with dental implants frequently suffer from peri-implantitis. Clinical features of peri-implantitis lesions include the presence of bleeding on probing and increased peri-implant probing depths. Both BoP and PPD have become reduced after local administration of antibiotics.

Reconstructive treatment of peri-implantitis infrabony defects of various configurations: 5-year survival and success

Aim

To present the 5 years outcomes of a reconstructive surgical protocol for peri‐implantitis defects with different morphologies, by means of deproteinized bovine bone mineral with 10% collagen (DBBMC).

Material and Methods

The original population of this case series consisted of 75 patients with one crater‐like defect and probing depth (PD) ≥6 mm. After flap elevation, defects were assigned to one characteristic class and treated by means of DBBMC. Following healing, patients were enrolled in an individualized supportive periodontal/peri‐implant (SPT) program.

Results

Fifty‐one patients reached the 5 years examination, as 11 patients were lost to follow‐up and 13 implants were removed. Overall treatment success was registered in 29 patients (45.3%). Mean PD and BOP significantly decreased at one year and remained stable for the rest of observation period. No correlation was found between implant survival rate and defect configuration (p = 0.213). Patients, who did not fully adhere to the SPT, experienced more complications and implant loss than those who regularly attended recall appointments (p = 0.009).

Conclusions

The proposed reconstructive treatment resulted in a high 5 years implant survival rate in patients who fully adhered to SPT. The resolution of the peri‐implantitis defect does not seem significantly associated with the defect configuration at the time of treatment.

Methods of Topical Administration of Drugs and Biological Active Substances for Dental Implants-A Narrative Review

Dental implants are, nowadays, established surgical devices for the restoration of lost teeth. Considered as an alternative for traditional prosthetic appliances, dental implants surpass them in reliability and patient feedback. Local drug delivery around the implants promotes osseointegration and reduces peri-implantitis. However, there are currently no methods of a multiple, precise topical administration of drugs to the implant area. Engineering coatings on the implants, drug application on carriers during implantation, or gingival pockets do not meet all requirements of dental surgeons. Therefore, there is a need to create porous implants and other medical devices that will allow a multiple drug delivery at a controlled dose and release profile without traumatic treatment. Due to the growing demand for the use of biologically active agents to support dental implant treatment at its various stages (implant placement, long-term use of dental superstructures, treatment of the peri-implant conditions) and due to the proven effectiveness of the topical application of pharmacological biologically active agents to the implant area, the authors would like to present a review and show the methods and devices that can be used by clinicians for local drug administration to facilitate dental implant treatment. Our review concludes that there is a need for research in the field of inventions such as new medical devices or implants with gradient solid-porous structures. These devices, in the future, will enable to perform repeatable, controllable, atraumatic, and repeatable injections of active factors that may affect the improvement of osteointegration and the longer survival of implants, as well as the treatment of peri-implantitis.

Surgical treatment of peri-implantitis with or without a deproteinized bovine bone mineral and a native bilayer collagen membrane: A randomized clinical trial

AIM

To assess whether the use of deproteinized bovine bone mineral (DBBM) and native bilayer collagen membrane (NBCM) improved healing of peri-implantitis-related bone defects at 12 months.

MATERIALS AND METHODS

In a multi-centre, randomized clinical trial, 32 individuals received surgical debridement (control group [CG]), and 34 received adjunct use of DBBM and NBCM (test group [TG]). Radiographic defect fill (RDF), probing pocket depth (PPD), bleeding on probing (BOP), suppuration (SUP), recession (REC), cytokines (IL-1β, IL-1RA, IL-6, IL-8, IL-12, IP10, PDGF-BB, TNF-α, VEGF), and patient-reported outcomes (PROs) were evaluated at 3, 6, 9, and 12 months.

RESULTS

RDF at the deepest site amounted 2.7 ± 1.3 mm in TG and 1.4 ± 1.2 mm in CG (p <.0001). PPD was reduced by 1.9 mm in TG and 2.3 mm in CG (p = .5783). There were no significant differences between groups regarding reductions of BOP, SUP, REC, cytokines levels, or oral health impact profile (OHIP)-14 scores at 12 months. Successful treatment (RDF ≥ 1.0 mm, PPD ≤5 mm, ≤1/4 site with BOP grade 1, no SUP) was identified in 32% in TG and 21% in CG.

CONCLUSIONS

DBBM and NBCM resulted in significantly more RDF than debridement alone. No difference was found in any clinical parameters or PROs between the groups. ClinicalTrials.gov Identifier: NCT02375750.

Enamel matrix derivative promotes new bone formation in xenograft assisted maxillary anterior ridge preservation-A randomized controlled clinical trial

OBJECTIVES

To compare the effectiveness of deproteinized bovine bone mineral with 10% collagen alone (DBBMC) or with enamel matrix derivative (DBBMC-EMD) in ridge preservation.

METHODS

42 maxillary anterior teeth were extracted and received either a DBBMC (control) or DBBMC-EMD (test) treatment protocol. CBCT taken before and 4 months after the extraction procedure was used to measure changes in alveolar ridge width (RW), buccal bone height (BH) and palatal bone height (PH). Bone cores were harvested during implant osteotomy preparation, and the samples processed histomorphometrically to assess the fraction of new bone (%NB), residual graft (%RG) and soft tissue matrix (%STM).

RESULTS

Overall, both treatment groups showed significant reductions in mean RW from baseline to 4 months after extraction, but no significant change in either mean BH or PH over this time. When CBCT measurements were analysed according to the initial thickness of the buccal wall (BT < 1 mm vs. BT ≥ 1 mm), significant reductions in all ridge dimensions (RW, BH and PH) were noted in the <1 mm BT group. Histomorphometrically, the DBBMC-EMD test group showed significantly increased new bone formation (%NB): (control = 16.5 ± 6.9% cf.; test = 45.1 ± 8.8%) with less residual graft (%RG): (control = 36.8 ± 8.8% cf.; test = 20.3 ± 7.2%) compared to the DBBMC control group.

CONCLUSIONS

Both DBBMC alone and DBBMC-EMD treated sites 4 months after extraction lost RW but showed no significant change in BH or PH. Irrespective of treatment, maxillary anterior teeth with thick initial buccal walls (≥1 mm) exhibited less alveolar ridge reduction 4 months after treatment. The addition of EMD to DBBMC resulted in more new bone formation in the test group.

Targeting implant-associated infections: titanium surface loaded with antimicrobial

Implant devices have = proven a successful treatment modality in reconstructive surgeries. However, increasing rates of peri-implant diseases demand further examination of their pathogenesis. Polymicrobial biofilm formation on titanium surfaces has been considered the main risk factor for inflammatory processes on tissues surrounding implant devices, which often lead to implant failure. To overcome microbial accumulation on titanium surfaces biofilm targeting strategies have been developed to modify the surface and incorporate antimicrobial coatings. Because antibiotics are widely used to treat polymicrobial infections, these agents have recently started to be incorporated on titanium surface. This review discusses the biofilm formation on titanium dental implants and key factors to be considered in therapeutic and preventative strategies. Moreover, a systematic review was conducted on coatings developed for titanium surfaces using different antibiotics. This review will also shed light on potential alternative strategies aiming to reduce microbial loads and control polymicrobial infection on implanted devices.

Current and future trends in periodontal tissue engineering and bone regeneration

Periodontal tissue engineering involves a multi-disciplinary approach towards the regeneration of periodontal ligament, cementum and alveolar bone surrounding teeth, whereas bone regeneration specifically applies to ridge reconstruction in preparation for future implant placement, sinus floor augmentation and regeneration of peri-implant osseous defects. Successful periodontal regeneration is based on verifiable cementogenesis on the root surface, oblique insertion of periodontal ligament fibers and formation of new and vital supporting bone. Ultimately, regenerated periodontal and peri-implant support must be able to interface with surrounding host tissues in an integrated manner, withstand biomechanical forces resulting from mastication, and restore normal function and structure. Current regenerative approaches utilized in everyday clinical practice are mainly guided tissue/bone regeneration-based. Although these approaches have shown positive outcomes for small and medium-sized defects, predictability of clinical outcomes is heavily dependent on the defect morphology and clinical case selection. In many cases, it is still challenging to achieve predictable regenerative outcomes utilizing current approaches. Periodontal tissue engineering and bone regeneration (PTEBR) aims to improve the state of patient care by promoting reconstitution of damaged and lost tissues through the use of growth factors and signaling molecules, scaffolds, cells and gene therapy. The present narrative review discusses key advancements in PTEBR including current and future trends in preclinical and clinical research, as well as the potential for clinical translatability.

Peri-Implant Diseases: Diagnosis, Clinical, Histological, Microbiological Characteristics and Treatment Strategies. A Narrative Review

Since the use of dental implants is continuously increasing, it is imperative for dental practitioners to understand the nature and treatment of peri-implant diseases. The purpose of this manuscript is to comprehensively review peri-implant diseases, their characteristics, as well as their non-surgical and surgical treatment. To that end, the current literature was searched and a narrative review was conducted. It is essential that the case definitions described in the 2017 World Workshop on the Classification of Periodontal and Peri-implant Diseases and Conditions are used to diagnose and classify peri-implant health, peri-implant mucositis and peri-implantitis. While recent epidemiologic studies on peri-implant diseases exist, there is great heterogeneity in the definition of these conditions. Several risk factors and indicators are reported in the literature, with smoking and diabetes being the most universally accepted. In peri-implant mucositis, non-surgical treatment seems to be sufficient. However, for the treatment of peri-implantitis, a surgical approach, which includes open-flap debridement, apically positioned flap and guided bone regeneration, is considered more appropriate. A great variety of adjuncts to mechanical treatment have been reported with controversial results. Finally, studies comparing results from different peri-implantitis treatments are warranted in randomized controlled clinical trials in order to provide stronger evidence-based approaches.

Laser-assisted regenerative surgical therapy for peri-implantitis: A randomized controlled clinical trial

BACKGROUND

Different surgical approaches have been proposed to treat peri-implantitis defects with limited effectiveness and predictability. Laser has been proposed as an effective tool to assist in bacterial decontamination and modulating peri-implant tissue inflammation. The aim of this pilot clinical trial was to evaluate the adjunctive benefits of Er:YAG laser irradiation for regenerative surgical therapy of peri-implantitis-associated osseous defects.

METHODS

Twenty-four patients diagnosed with peri-implantitis with a radiographic infrabony defect were randomized into two groups. Both test and control groups received the following treatment: open flap mechanical debridement, supracrestal implantoplasty, bone grafting using a mixture of human allograft with demineralized bone matrix human allograft putty, and then covered with acellular dermal matrix membrane. The only difference in the test group was the adjunctive use of Er:YAG laser to modulate and remove inflammatory tissue as well as to decontaminate the implant surface. Clinical assessments, including pocket depth (PD), clinical attachment level (CAL), and gingival index (GI) were performed by calibrated masked examiners for up to 6 months following surgery. Standardized radiographs were also taken to evaluate linear bone gain and defect bone fill. Student t-tests were used to analyze those clinical parameters.

RESULTS

Both groups showed significant reductions in PD, GI, and CAL gain overtime. The test group demonstrated significantly higher PD reductions at the site level compared to the control group (2.65 ± 2.14 versus 1.85 ± 1.71 mm; test versus control, P = 0.014). There were no statistical differences found in CAL gain (1.90 ± 2.28 versus 1.47 ± 1.76 mm; test versus control), GI reduction (-1.14 ± 1.15 versus -1.04 ± 0.89; test versus control), radiographic linear bone gain (1.27 ± 1.14 versus 1.08 ± 1.04 mm; test versus control) or proportional defect size reduction (- 24.46 ± 19.00% versus -15.19 ± 23.56%; test versus control). There was a positive trend for test patients on PD reduction and CAL gain found in narrow infrabony defects. Major membrane exposure negatively impaired the overall treatment outcome of CAL gain (2.47 ± 1.84 versus 1.03 ± 1.48 mm; no/minor versus major exposure, P = 0.051) and PD reduction in the test group (-3.63 ± 2.11 versus -1.66 ± 1.26 mm, P = 0.049).

CONCLUSION

This pilot study indicated using laser irradiation during peri-implantitis regenerative therapy may aid in better probing PD reduction. Nonetheless, a larger sample size and longer follow-up is needed to confirm if Er:YAG laser irradiation provides additional clinical benefits for peri-implantitis regenerative therapy (Clinicaltrials.gov: NCT03127228).

Impact of bone defect morphology on the outcome of reconstructive treatment of peri-implantitis

OBJECTIVES

To assess if (I) the alveolar bone defect configuration at dental implants diagnosed with peri-implantitis is related to clinical parameters at the time of surgical intervention and if (II) the outcome of surgical intervention of peri-implantitis is dependent on defect configuration at the time of treatment.

MATERIALS AND METHODS

In a prospective study, 45 individuals and 74 dental implants with ≥ 2 bone wall defects were treated with either an autogenous bone transplant or an exogenous bone augmentation material. Defect fill was assessed at 1 year.

RESULTS

At baseline, no significant study group differences were identified. Most study implants (70.7%, n = 53) had been placed in the maxilla. Few implants were placed in molar regions. The mesial and distal crestal width at surgery was greater at 4-wall defects than at 2-wall defects (p = 0.001). Probing depths were also greater at 4-wall defects than at 2-wall defects (p = 0.01). Defect fill was correlated to initial defect depth (p < 0.001). Defect fill at 4-wall defects was significant (p < 0.05).

CONCLUSIONS

(I) The buccal-lingual width of the alveolar bone crest was explanatory to defect configuration, (II) 4-wall defects demonstrated more defect fill, and (III) deeper defects resulted in more defect fill.

Electrochemical Disinfection of Dental Implants Experimentally Contaminated with Microorganisms as a Model for Periimplantitis

Despite several methods having been described for disinfecting implants affected by periimplantitis, none of these are universally effective and may even alter surfaces and mechanical properties of implants. Boron-doped diamond (BDD) electrodes were fabricated from niobium wires and assembled as a single instrument for implant cleaning. Chemo-mechanical debridement and air abrasion were used as control methods. Different mono-species biofilms, formed by bacteria and yeasts, were allowed to develop in rich medium at 37 °C for three days. In addition, natural multi-species biofilms were treated. Implants were placed in silicone, polyurethane foam and bovine ribs for simulating different clinical conditions. Following treatment, the implants were rolled on blood agar plates, which were subsequently incubated at 37 °C and microbial growth was analyzed. Complete electrochemical disinfection of implant surfaces was achieved with a maximum treatment time of 20 min for Candida albicans, Candida dubliniensis, Enterococcus faecalis, Roseomonas mucosa, Staphylococcus epidermidis and Streptococcus sanguinis, while in case of spore-forming Bacillus pumilus and Bacillus subtilis, a number of colonies appeared after BDD electrode treatment indicating an incomplete disinfection. Independent of the species tested, complete disinfection was never achieved when conventional techniques were used. During treatment with BDD electrodes, only minor changes in temperature and pH value were observed. The instrument used here requires optimization so that higher charge quantities can be applied in shorter treatment times.

Is Peri-Implantitis Curable?

Peri-implant mucositis and peri-implantitis are clinically associated with inflammation of soft tissue around implants; however, peri-implantitis is associated with radiographic bone loss. Recently a new classification scheme-peri-implant health, peri-implant mucositis, peri-implantitis, and peri-implant soft-tissue and hard-tissue deficiencies-was introduced. Although various clinical interventions to treat peri-implant diseases have been suggested, early diagnosis and treatment is the key to successful outcomes. Clinicians can select nonsurgical or surgical techniques according to the clinical parameters present, although surgical intervention seems to be more effective in treating peri-implantitis. The best approach to treat peri-implantitis remains controversial.

Influence of Implant Material and Surface on Differentiation and Proliferation of Human Adipose-Derived Stromal Cells

For the guided regeneration of periimplant hard and soft tissues, human adipose-derived stromal cells (hADSC) seem to be a promising source for mesenchymal stromal cells. For this, the proliferation and differentiation of hADSC were evaluated on titanium and zirconia dental implants with different surface treatments. Results were compared to edaphic cells as human osteoblasts (hOB) and human gingival fibroblasts (HGF). Primary cells were cultured on (1) titanium implants with a polished surface (Ti-PT), (2) sandblasted and acid-etched titanium (Ti-SLA), (3) sandblasted and alkaline etched zirconia (ZrO₂-ZLA) and (4) machined zirconia (ZrO₂-M). The cell proliferation and differentiation on osteogenic lineage were assessed after 1, 7 and 14 days. Statistical analysis was performed by one-way ANOVA and a modified Levene test with a statistical significance at p = 0.05. PostHoc tests were performed by Bonferroni-Holm. Zirconia dental implants with rough surface (ZrO₂-ZLA) showed the highest proliferation rates (p = 0.048). The osteogenic differentiation occurred early for zirconia and later for titanium implants, and it was enhanced for rough surfaces in comparison to polished/machined surfaces. Zirconia was more effective to promote the proliferation and differentiation of hADSCs in comparison to titanium. Rough surfaces were able to improve the biological response for both zirconia and titanium.

Application of enamel matrix derivative and deproteinized bovine bone for the treatment of peri-implantitis after decontamination with an ultrasonic scaler: A case report

RATIONALE

The purpose of this report is to present a case of peri-implantitis with successful regeneration. The surface of the affected dental implant was decontaminated with an ultrasonic scaler and treated with bovine-derived hydroxyapatite and enamel matrix derivative.

PATIENT CONCERNS

A 52-year-old male was referred for evaluation of a dental implant placed in the mandibular right second premolar area.

DIAGNOSIS

The radiographic evaluation showed the loss of supporting bone around the dental implant. Bleeding upon probing and suppuration were observed, with the deepest probing depth at 6 mm.

INTERVENTIONS

The area was firstly treated with a nonsurgical approach. After re-evaluation, a full-thickness flap was elevated. The area was well debrided using various instruments, including curettes and an ultrasonic scaler. The defect area was grafted with bovine-derived hydroxyapatite and enamel matrix derivative.

OUTCOMES

Histopathologic evaluation revealed chronic inflammation with fibrosis and calcification. The evaluation at 2 years and 3 months after surgery showed that the prosthesis was functioning well. Bleeding upon probing and suppuration was not noted, and reduction of probing depth was seen, with the deepest depth at 4 mm. The area showed maintenance of graft material with increased radiopacity around the dental implant.

LESSONS

In conclusion, a case of peri-implantitis can be successfully treated with bovine-derived hydroxyapatite and enamel matrix derivative after surface decontamination with an ultrasonic scaler.