Peri-implantitis and its prevention

Outcomes of implants placed in sites of previously failed implants: a systematic review and meta-analysis

The survival rate of implants placed at sites of previous failures including the best treatment strategies remain unclear. This systematic review was performed to assess implant survival and peri-implant health for such cases, including subgroup analyses of immediate versus delayed implant placement and augmentation. Four electronic databases were searched. Meta-analyses including subgroup analyses were performed (PROSPERO CRD42024548610). Out of 1798 records identified, 24 studies were included. The 1-year implant survival rate after replacement was 96.7% (95% confidence interval (CI) 92.8-99.3%), with no significant difference between immediate and delayed placement (P = 0.31) or immediate and delayed augmentation (P = 0.85). Immediate augmentation showed higher overall implant survival (97.6%, 95% CI 93.4-99.9%) compared to delayed augmentation (91.7%, 95% CI 83.4-97.5%), although not statistically significant (P = 0.26). Peri-implant health outcomes, including marginal bone loss, were similar across subgroups. Second implant replacements had lower survival rates than first replacements. Replacement of the failed implant is an appealing treatment option for failed implants, although the implant survival is lower compared to initially placed implants. Immediate implant placement can be done if sufficient bone is present. If insufficient bone remains after removal, immediate augmentation followed by delayed implant placement is recommended.

Human Umbilical Cord Mesenchymal Stem Cells-Derived Extracellular Vesicles for Rat Jawbone Regeneration in Periapical Periodontitis

Extracellular vesicles derived from mesenchymal stem cells (MSCs-EVs) have great potential for bone remodeling and anti-inflammatory therapy. For the repair and reconstruction of inflammatory jawbone defects caused by periapical periodontitis, bone meal filling after debridement is commonly used in the clinic. However, this treatment has disadvantages such as large individual differences and the need for surgical operation. Therefore, it is of great significance to search for other bioactive substances that can promote jawbone regeneration in periapical periodontitis. Herein, it is found that CT results showed that local injection of human umbilical cord mesenchymal stem cells-derived extracellular vesicles (HUC-MSCs-EVs) and bone meal filling into the alveolar bone defect area could promote bone tissue regeneration using a rat model of a jawbone defect in periapical periodontitis. Histologically, the new periodontal tissue in the bone defect area was thicker, and the number of blood vessels was higher by local injection of HUC-MSCs-EVs, and fewer inflammatory cells and osteoclasts were formed compared to bone meal filling. In vitro, HUC-MSCs-EVs can be internalized by rat bone marrow mesenchymal stem cells (BMSCs), enhancing the ability for proliferation and migration of BMSCs. Additionally, 20 μg/mL HUC-MSCs-EVs can facilitate the expression of osteogenic genes and proteins including runt-related transcription factor 2 (RUNX2), alkaline phosphatase (ALP), and osteopontin (OPN). In summary, in vivo and in vitro experiments showed that HUC-MSCs-EVs can promote bone regeneration in periapical periodontitis, and the effect of tissue regeneration is better than that of traditional bone meal treatment. Therefore, local injection of HUC-MSCs-EVs may be an effective method to promote jawbone regeneration in periapical periodontitis.

Applications of Machine Learning in Periodontology and Implantology: A Comprehensive Review

Machine learning (ML) has led to significant advances in dentistry, easing the workload of professionals and improving the performance of various medical processes. The fields of periodontology and implantology can profit from these advances for tasks such as determining periodontally compromised teeth, assisting doctors in the implant planning process, determining types of implants, or predicting the occurrence of peri-implantitis. The current paper provides an overview of recent ML techniques applied in periodontology and implantology, aiming to identify popular models for different medical tasks, to assess the impact of the training data on the success of the automatic algorithms and to highlight advantages and disadvantages of various approaches. 48 original research papers, published between 2016 and 2023, were selected and divided into four classes: periodontology, implant planning, implant brands and types, and success of dental implants. These papers were analyzed in terms of aim, technical details, characteristics of training and testing data, results, and medical observations. The purpose of this paper is not to provide an exhaustive survey, but to show representative methods from recent literature that highlight the advantages and disadvantages of various approaches, as well as the potential of applying machine learning in dentistry.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

PLAIN LANGUAGE SUMMARY

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

Intracellular infection of Cutibacterium acnes in macrophages of extensive peri-implantitis lesions: A clinical case series

Cutibacterium acnes is a facultative anaerobic, gram-positive rod, and a commensal bacterium of the body surface including oral cavity. A causal relationship between C. acnes and chronic granulomatous diseases, such as sarcoidosis and orthopedic implant-associated infections, has been previously reported. Typically, C. acnes has been observed inside macrophages, allowing evasion of host immunity, and triggering a persistent inflammatory response. However, such findings have not been reported in peri-implantitis lesions. In this case series, we collected inflamed tissues from extensive peri-implantitis lesions of eight patients. Out of the eight samples, seven tested positive for the 16 s rRNA gene of C. acnes by polymerase chain reaction, and six were positive by immunohistochemistry. Immunohistochemical staining revealed the presence of C. acnes in the cytoplasm of macrophages, suggesting a role in lesion formation. This finding may enhance our understanding of the pathophysiology of persistent peri-implantitis lesions and provide implications for future therapy.

Treatment of peri-implantitis with a flapless surgical access combined with implant surface decontamination and adjunctive systemic antibiotics: A retrospective case series study

AIM

To evaluate the effectiveness of a flapless surgical approach in the treatment of peri-implantitis and to explore the factors influencing its outcome.

MATERIALS AND METHODS

The present retrospective study evaluated patients with at least one implant diagnosed with peri-implantitis and treated with a flapless surgical access, with or without systemic antimicrobials, curettage and, when needed, prostheses modification. Clinical and radiographic parameters were assessed at baseline and at 3 months and at least 12 months. The primary outcome was disease resolution (≤1 bleeding sites, probing depth [PD] ≤5 mm, no bone loss >0.5 mm). Multilevel regression analyses were used to identify predictors influencing the probability of attaining disease resolution.

RESULTS

One hundred and seventeen patients with 338 implants were included. Disease resolution was attained in 54.4% of the 338 implants receiving flapless surgical access. At the end of the follow-up period, 111 patients (94.9%) with 295 implants (87.3%) did not require any further treatment, with 81.4% of these implants presenting PD ≤ 5 mm. History of periodontitis and PD at baseline were identified as negative predictors, while compliance with supportive peri-implant care, a machined surface and the adjunctive use of systemic azithromycin or metronidazole were identified as positive predictive factors for disease resolution.

CONCLUSIONS

A flapless surgical approach led to disease resolution in 54.4% of the implants with peri-implantitis. Several risk/protective predictors for disease resolution were identified.

Microbial Leakage through Three Different Implant-Abutment Interfaces on Morse Taper Implants In Vitro

The objective of this study was to evaluate microbial leakage by means of genome counts, through the implant-abutment interface in dental implants with different Morse taper abutments. Fifty-six samples were prepared and divided in four groups: CMC TB (14 Cylindrical Implants-14 TiBase Abutments), CMX TB (14 Conical Implants-14 TiBase Abutments), CMX PU (14 Conical Implants-14 Universal Abutment) and CMX U (14 Tapered Implants-14 UCLA Abutments). Assemblies had their interface submerged in saliva as the contaminant. Samples were subjected either to thermomechanical cycling (2 × 106 mechanical cycles with frequency of 5 Hz and load of 120 N simultaneously with thermal cycles of 5-55 °C) or thermal cycling (5-55 °C). After cycling, the contents from the inner parts of assemblies were collected and analyzed using the Checkerboard DNA-DNA hybridization technique. Significant differences in the total genome counts were found after both thermomechanical or thermal cycling: CMX U > CMX PU > CMX TB > CMC TB. There were also significant differences in individual bacterial counts in each of the groups (p < 0.05). Irrespective of mechanical cycling, the type of abutment seems to influence not only the total microbial leakage through the interface, but also seems to significantly reflect differences considering individual target species.

Risk factors for Peri-implantitis: An umbrella review of meta-analyses of observational studies and assessment of biases

OBJECTIVES

To perform a comprehensive quantitative and qualitative analysis of the findings from previously published meta-analyses and to assess existing biases.

DATA/SOURCES

A search was conducted for meta-analyses of observational studies investigating the association between any risk factor and peri‑implantitis in PubMed, Scopus, Cochrane Database of Systematic Reviews, and Epistemonikos, from inception until October 2023 (PROSPERO: CRD42024512408).

STUDY SELECTION

From a total of 5002 publications, 51 full-text articles were evaluated for eligibility, and 12 articles that described 41 unique meta-analyses evaluating the association between risk factors and periimplantitis were selected. Among 41 associations, 24 associations were significant. None of the associations were graded as convincing evidence. Two associations, presence of periodontitis (OR = 3.84 [95 % CI 2.58,5.72]) and cigarette smoking (RR=2.07 [95 % CI 1.41,3.04]) were graded as highly suggestive. Eight associations, diabetes mellitus, hyperglycaemia, lack of prophylaxis, history of chronic periodontal disease, ongoing or history of periodontal disease, implants located in the anterior region of the jaw (maxillary and mandibular), osteoprotegerin (OPG) gene polymorphisms, and lack of keratinized mucosal width were graded as suggestive evidence.

CONCLUSIONS

Periodontitis and cigarette smoking are highly suggestive risk factors for peri‑implantitis. The remaining risk factors which are suggestive require more high-quality studies to be performed to upgrade the level of evidence.

CLINICAL SIGNIFICANCE

The highly suggestive and suggestive risk factors for peri‑implantitis summarized in this umbrella review should be rigorously assessed, monitored and managed by clinicians to reduce the risk peri‑implantitis, as well as to form part of the preoperative consent process.

Correlation between short-chain fatty acids and peri-implant disease: A cross-sectional study

BACKGROUND

To explore the correlation between short-chain fatty acids (SCFAs) in the peri-implant sulcular fluid (PISF) and peri-implant diseases.

METHODS

PISF samples were obtained from implants that have been placed for at least 5 years, and peri-implant clinical parameters were examined. Gas chromatography-mass spectrometry and high-performance liquid chromatography were used to detect SCFAs in PISF. The correlation between SCFAs and clinical parameters was analyzed by Spearman's correlation. SCFAs related to peri-implant disease were identified by logistic regression and ranked by random forest analysis.

RESULTS

Eighty-six implants were divided into a peri-implant health group (PIH-group, 35 implants), peri-implant mucositis group (PIM-group, 25 implants), and peri-implantitis group (PI-group, 26 implants) according to clinical and radiographic examination results. The PIM-group had significantly lower formic acid detection rate than the other two groups (p < 0.001). The PIM-group had significantly higher levels of acetic, propionic, and isovaleric acids than the PIH-group (p < 0.05). The PI-group had significantly higher levels of propionic, butyric, isobutyric, valeric, and isovaleric acids than the PIH-group (p < 0.05). The PI-group had significantly higher levels of butyric, isobutyric, and isovaleric acids than the PIM-group (p < 0.05). SCFAs (apart from hexanoic and succinic acids) were significantly and positively correlated with clinical parameters (p < 0.05). SCFAs related to peri-implant disease were ranked as follows: butyric, isovaleric, isobutyric, propionic, acetic, formic, and lactic acids.

CONCLUSIONS

Elevated specific SCFAs are correlated with peri-implant disease. Recognition of this correlation may help in early identification of peri-implant disease and guide further clinical interventions.

Experimental models for peri-implant diseases: a narrative review

OBJECTIVES

Peri-implant diseases, being the most common implant-related complications, significantly impact the normal functioning and longevity of implants. Experimental models play a crucial role in discovering potential therapeutic approaches and elucidating the mechanisms of disease progression in peri-implant diseases. This narrative review comprehensively examines animal models and common modeling methods employed in peri-implant disease research and innovatively summarizes the in vitro models of peri-implant diseases.

MATERIALS AND METHODS

Articles published between 2015 and 2023 were retrieved from PubMed/Medline, Web of Science, and Embase. All studies focusing on experimental models of peri-implant diseases were included and carefully evaluated.

RESULTS

Various experimental models of peri-implantitis have different applications and advantages. The dog model is currently the most widely utilized animal model in peri-implant disease research, while rodent models have unique advantages in gene knockout and systemic disease induction. In vitro models of peri-implant diseases are also continuously evolving to meet different experimental purposes.

CONCLUSIONS

The utilization of experimental models helps simplify experiments, save time and resources, and promote advances in peri-implant disease research. Animal models have been proven valuable in the early stages of drug development, while technological advancements have brought about more predictive and relevant in vitro models.

CLINICAL RELEVANCE

This review provides clear and comprehensive model selection strategies for researchers in the field of peri-implant diseases, thereby enhancing understanding of disease pathogenesis and providing possibilities for developing new treatment strategies.

The effects of diode and Er:YAG laser applications on the surface topography of titanium grade 4 and titanium zirconium discs with sand-blasted and acid-etched (SLA) surfaces

BACKGROUND

Laser application for the treatment of peri‑implantitis provides a variety of advantages; however, depending on the laser type and parameters, it may also have adverse effects on the implant surface qualities. This study's objective is to assess the effects of laser type and parameters on the surface properties of two different titanium-based implant materials: titanium Grade 4 (Ti-Grade 4) and titanium zirconium (Ti-Zr) discs with sand-blasted and acid-etched (SLA) surfaces under in vitro conditions.

MATERIAL & METHOD

Sand-blasted and acid-etched discs made of titanium grade 4 (Ti-Grade 4) and titanium zirconium (Ti-Zr) were treated using 808 nm AlGaAs (diode) and 2940 nm Er:YAG lasers with varying parameters (i.e., diode laser in continuous wave mode, Er:YAG in short pulse mode, and Er:YAG in variable square pulse mode with four different doses). Then, the surface morphology and topography of the treated discs were characterized using scanning electron microscopy and optical profilometry.

RESULTS

The 3D surface topographies of discs treated with a high power Er:YAG laser displayed irregular peaks and deep valleys, indicating surface deterioration. The average surface roughness values (Sa) of both discs varied with laser type and parameters (3.55-4.80 µm for Ti-Grade 4 versus 3.25-4.5 µm for Ti-Zr). With diode laser applications, the topography features of the discs were preserved despite a small number of irregular valleys and peaks. However, the surface morphologies of the discs were dramatically altered by erosion and local melting because of the Er:YAG laser treatment.

CONCLUSION

Diode laser application appears to be the most reliable method for treating peri‑implantitis, as diode laser-treated implants retained their overall surface quality despite a small number of irregular peaks and valleys.

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

INTRODUCTION

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

METHODS

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

RESULTS

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

CONCLUSION

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

Prevalence, risk indicators, and clinical characteristics of peri-implant mucositis and peri-implantitis for an internal conical connection implant system: A multicenter cross-sectional study

BACKGROUND

Peri-implant disease prevalence is associated with a multifactorial etiology and distinct clinical characteristics of inflammation.

METHODS

The present study aimed to assess the prevalence of peri-implant diseases, identify related risk indicators, and associate specific clinical characteristics to peri-implant biological complications in the medium term. Peri-implant diseases were classified according to established case criteria. Patients' data, implant and/or prosthetic features, and maintenance records were collected. Clinical characteristics such as bleeding on probing (BOP), suppuration (SUPP), keratinized mucosa (KM), probing depth (PD), marginal recession (MR), and modified plaque index (mPI) were recorded.

RESULTS

Ninety-nine patients with 266 implants with a mean functional duration of 30.26 months were evaluated. Peri-implant mucositis and peri-implantitis prevalence totaled to 49.5% and 15.15% (patient level), respectively. Peri-implant mucositis was associated with osteoporosis (odds ratio [OR] 6.09), age (OR 0.97), diabetes mellitus (OR 3.09), cemented-retained prosthesis (OR 3.81), and partial prosthesis (OR 2.21). Peri-implantitis was associated with osteoporosis (OR 7.74) and periodontitis (OR 2.74), cemented prosthesis (OR 10.12), partial and full arch prostheses (OR 12.35 and 19.86), implant diameter (OR 3.64), abutment transmucosal height (OR 3.39), and hygiene difficulty (OR 3.14). Furthermore, mPI score 3 (OR 3.27) and PD scores (OR 1.64) were associated with peri-implant mucositis, while mPI score 3 (OR 16.42), KM (OR 1.53), PD (OR 1.81), MR (OR 2.61), and the relationship between KM and PD (OR 0.63) were associated with peri-implantitis.

CONCLUSION

In the medium term, peri-implant diseases were correlated with factors inherent to the patient's conditions, presurgical treatment plan, and hygiene maintenance care. The knowledge of the mentioned factors and featured clinical characteristics can be crucial for disease prevention and establishment of a superior implant therapy prognosis.

Comparative proteomics analysis of biofilms and planktonic cells of Enterococcus faecalis and Staphylococcus lugdunensis with contrasting biofilm-forming ability

Biofilms make it difficult to eradicate bacterial infections through antibiotic treatments and lead to numerous complications. Previously, two periprosthetic infection-related pathogens, Enterococcus faecalis and Staphylococcus lugdunensis were reported to have relatively contrasting biofilm-forming abilities. In this study, we examined the proteomics of the two microorganisms' biofilms using LC-MS/MS. The results showed that each microbe exhibited an overall different profile for differential gene expressions between biofilm and planktonic cells as well as between each other. Of a total of 929 proteins identified in the biofilms of E. faecalis, 870 proteins were shared in biofilm and planktonic cells, and 59 proteins were found only in the biofilm. In S. lugdunensis, a total of 1125 proteins were identified, of which 1072 proteins were found in common in the biofilm and planktonic cells, and 53 proteins were present only in the biofilms. The functional analysis for the proteins identified only in the biofilms using UniProt keywords demonstrated that they were mostly assigned to membrane, transmembrane, and transmembrane helix in both microorganisms, while hydrolase and transferase were found only in E. faecalis. Protein-protein interaction analysis using STRING-db indicated that the resulting networks did not have significantly more interactions than expected. GO term analysis exhibited that the highest number of proteins were assigned to cellular process, catalytic activity, and cellular anatomical entity. KEGG pathway analysis revealed that microbial metabolism in diverse environments was notable for both microorganisms. Taken together, proteomics data discovered in this study present a unique set of biofilm-embedded proteins of each microorganism, providing useful information for diagnostic purposes and the establishment of appropriately tailored treatment strategies. Furthermore, this study has significance in discovering the target candidate molecules to control the biofilm-associated infections of E. faecalis and S. lugdunensis.

A sono-responsive antibacterial nanosystem co-loaded with metformin and bone morphogenetic protein-2 for mitigation of inflammation and bone loss in experimental peri-implantitis

Background

Dental implants have become an increasingly popular option for replacing missing teeth, and the prevalence of peri-implantitis has also increased, which is expected to become a public health problem worldwide and cause high economic and health burdens. This scenario highlights the need for new therapeutic options to treat peri-implantitis.

Methods

In this study, we proposed a novel sono-responsive antibacterial nanosystem co-loaded with metformin (Met) and bone morphogenetic protein-2 (BMP-2) to promote efficacy in treating peri-implantitis. We introduced the zeolitic imidazolate framework-8 (ZIF-8) as a carrier for hematoporphyrin monomethyl ether (HMME) to enhance the antibacterial effect of sonodynamic antibacterial therapy and tested its reactive oxygen species (ROS) production efficiency and bactericidal effect in vitro. Afterward, HMME-loaded ZIF-8, BMP-2-loaded polylactic acid-glycolic acid (PLGA), and Met were incorporated into gelatin methacryloyl (GelMA) hydrogels to form HMME@ZIF-8/Met/BMP-2@PLGA/GelMA composite hydrogels, and the biocompatibility of which was determined in vitro and in vivo. A bacterial-induced peri-implantitis model in the maxilla of rats was established to detect the effects of the composite hydrogels with adjunctive use of ultrasound on regulating inflammation and promoting bone tissue repair in vivo.

Results

The results indicated that HMME@ZIF-8 with ultrasound stimulation demonstrated more better ROS production efficiency and antimicrobial efficacy. The composite hydrogels had good biocompatibility. Ultrasound-assisted application of the composite hydrogels reduced the release of the inflammatory factors IL-6 and TNF-α and reduced bone loss around the implant in rats with bacterial-induced peri-implantitis.

Conclusion

Our observations suggest that HMME@ZIF-8 may be a new good sonosensitizer material for sonodynamic antibacterial therapy. The use of HMME@ZIF-8/Met/BMP-2@PLGA/GelMA composite hydrogels in combination with ultrasound can provide a novel option for treating peri-implantitis in the future.

Zirconia Dental Implants Surface Electric Stimulation Impact on Staphylococcus aureus

Tooth loss during the lifetime of an individual is common. A strategy to treat partial or complete edentulous patients is the placement of dental implants. However, dental implants are subject to bacterial colonization and biofilm formation, which cause an infection named peri-implantitis. The existing long-term treatments for peri-implantitis are generally inefficient. Thus, an electrical circuit was produced with zirconia (Zr) samples using a hot-pressing technique to impregnate silver (Ag) through channels and holes to create a path by LASER texturing. The obtained specimens were characterized according to vitro cytotoxicity, to ensure ZrAg non-toxicity. Furthermore, samples were inoculated with Staphylococcus aureus using 6.5 mA of alternating current (AC). The current was delivered using a potentiostat and the influence on the bacterial concentration was assessed. Using AC, the specimens displayed no bacterial adhesion (Log 7 reduction). The in vitro results presented in this study suggest that this kind of treatment can be an alternative and promising strategy to treat and overcome bacterial adhesion around dental implants that can evolve to biofilm.

Biomaterials science and surface engineering strategies for dental peri-implantitis management

Peri-implantitis is a bacterial infection that causes soft tissue inflammatory lesions and alveolar bone resorption, ultimately resulting in implant failure. Dental implants for clinical use barely have antibacterial properties, and bacterial colonization and biofilm formation on the dental implants are major causes of peri-implantitis. Treatment strategies such as mechanical debridement and antibiotic therapy have been used to remove dental plaque. However, it is particularly important to prevent the occurrence of peri-implantitis rather than treatment. Therefore, the current research spot has focused on improving the antibacterial properties of dental implants, such as the construction of specific micro-nano surface texture, the introduction of diverse functional coatings, or the application of materials with intrinsic antibacterial properties. The aforementioned antibacterial surfaces can be incorporated with bioactive molecules, metallic nanoparticles, or other functional components to further enhance the osteogenic properties and accelerate the healing process. In this review, we summarize the recent developments in biomaterial science and the modification strategies applied to dental implants to inhibit biofilm formation and facilitate bone-implant integration. Furthermore, we summarized the obstacles existing in the process of laboratory research to reach the clinic products, and propose corresponding directions for future developments and research perspectives, so that to provide insights into the rational design and construction of dental implants with the aim to balance antibacterial efficacy, biological safety, and osteogenic property.

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

OBJECTIVES

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

MATERIAL AND METHODS

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

RESULTS

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

CONCLUSIONS

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

CLINICAL RELEVANCE

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

Comparative effectiveness of interventions for the treatment of peri-implantitis: A systematic review with network meta-analysis

STATEMENT OF PROBLEM

Extensive research has been carried out on the various aspects of diagnosing and treating peri-implantitis. However, clinical guidelines for the management of peri-implantitis based on high quality evidence are lacking.

PURPOSE

The purpose of this systematic review with network meta-analysis was to analyze the current evidence on nonsurgical and surgical interventions for the treatment of peri-implantitis and synthesize clinical guidelines based on high quality evidence.

MATERIAL AND METHODS

A search was conducted for trials published in Medline, Scopus, PubMed, and Cochrane Central Register of Controlled Trials from inception until July 2023. The study was registered with the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42023451056). A network meta-analysis was performed on data from randomized controlled trials that assessed nonsurgical and surgical interventions for the treatment of peri-implantitis. The interventions were ranked according to their efficacy using surface under the cumulative ranking (SUCRA) system. The grading of recommendations, assessment, development, and evaluations (GRADE) approach was used to assess the level of certainty of evidence.

RESULTS

A total of 45 articles were included in the quantitative analysis. The GRADE approach determined a moderate to high level of certainty of evidence. Among the nonsurgical interventions, mechanical debridement with adjunctive systemic antibiotics was significant in improving probing depth at 3 months and beyond 6 months, clinical attachment loss at 3 months, and clinical attachment loss beyond 6 months. Mechanical debridement with adjunctive topical antibiotics was significant in improving probing depth beyond 6 months, clinical attachment loss at 3 months, clinical attachment loss beyond 6 months, and radiographic bone loss beyond 6 months. Mechanical debridement with adjunctive photodynamic therapy was significant in improving probing depth beyond 6 months, clinical attachment loss at 3 months, clinical attachment loss beyond 6 months, and radiographic bone loss beyond 6 months. Mechanical debridement with adjunctive systemic antibiotics and photodynamic therapy was significant in improving probing depth beyond 6 months. Among surgical interventions, open flap debridement with implant surface decontamination and open flap debridement with decontamination and adjunctive photodynamic therapy were significant in improving probing depth at 3 months.

CONCLUSIONS

Mechanical debridement with adjunctive systemic antibiotics or photodynamic therapy results in improved clinical outcomes.

Topological insight of immune-vascular distribution in peri-implantitis lesions

OBJECTIVE

To characterize the distribution of macrophages, neutrophils, NK cells, and blood vessels in peri-implantitis compared to healthy aged gingiva samples.

MATERIALS AND METHODS

This observational study included eight gingival samples from peri-implantitis and eight from periodontally healthy individuals. By immunofluorescence were identified neutrophils, NK cells, macrophages, and their pro-inflammatory or pro-healing phenotypes, and blood vessels. Two ROIs were designated as zone 1, connective tissue closest to the epithelium and zone 2, connective tissue over 200 microns from the rete ridges. Immune cells and vascular structures were quantified and characterized according to their distribution in both zones.

RESULTS

Two peri-implantitis zones were characterized by unique macrophage phenotypes and blood vessel architecture. Blood vessels were larger in zone 2 in peri-implantitis. A greater number of NK cells and macrophages were found in peri-implantitis compared to healthy aged samples. A higher presence of pro-inflammatory macrophages was found in zone 1 compared to zone 2. A similar proportion of pro-inflammatory and pro-healing macrophages were found in zone 2.

CONCLUSION

A specific distribution for pro-inflammatory macrophages and vascular architecture is observed in peri-implantitis. TNF-α colocalizes with macrophages in the connective tissue near rete ridges. NK cells are more abundant in peri-implantitis than in healthy samples.

Randomized controlled multi-centre study comparing shorter dental implants (6 mm) to longer dental implants (11-15 mm) in combination with sinus floor elevation procedures: 10-year data

AIM

To compare implant survival and complication rates between shorter and standard-length implants with sinus augmentation and restored with single crowns, at 10 years of loading.

MATERIALS AND METHODS

One-hundred and one patients (137 implants) with a ridge height of 5-7 mm in the posterior maxilla were randomly assigned to two treatment modalities: shorter implants (6 mm) (group short [GS]) or standard-length implants (11-15 mm) with sinus grafting (group graft [GG]). Following the insertion of final restorations, patients were regularly recalled for up to 10 years. Assessed outcomes encompassed implant survival, marginal bone levels (MBLs), biological and technical parameters and patient-reported outcome measures (OHIP-49 = Oral Health Impact Profile). Non-parametric statistical analysis was used to analyse the data.

RESULTS

For the 5- to 10-year follow-up period, 77 patients with 105 implants (GS: 36 patients/48 implants; GG: 41/57) were available for re-examination (drop-out rate 21%). Implant survival rates at the patient level were 96.0% (GS; 2 failures) and 100% (GG) (inter-group p = .24). Median MBLs amounted to 0.00 mm (min 0.00; max 3.25; GS) and 0.00 mm (min 0.00; max 4.55; GG) (inter-group p = .73). Technical complications predominantly occurred within the first 5 years (inter-group p > .05). Peri-implantitis rates were 4.2% (GS) and 13.3% (GG) (intergroup p = .37). Median OHIP-49 scores were 7.00 (0.00; 39.00; GS) and 9.00 (0.00; 196; GG) (inter-group p = .61) at 10 years.

CONCLUSIONS

Based on similar 10-year implant survival rates, reduced patient morbidity and lower costs, the use of shorter dental implants might well serve as an alternative treatment concept to longer implants placed in conjunction with sinus grafting for patients with a limited ridge height in the posterior maxilla. Study register: https://clinicaltrials.gov/ct2/show/NCT01030523.

Association analysis between CD14 gene polymorphisms and peri-implantitis susceptibility in a Chinese population

OBJECTIVE

The goal of the study was to examine the genetic correlation of cluster of differentiation 14 (CD14) gene polymorphisms with peri-implantitis (PI) predisposition in a Chinese Han population.

METHODS

In the case-control study, blood samples were collected from PI patients and healthy individuals (n = 120/group), who were admitted to the Affiliated Hospital of Yangzhou University from 2021 to 2023. One-way analysis of variance (ANOVA) was applied to compare differences of continuous variables among different groups. Genotype and allele distributions of CD14 gene rs2569190 and rs2915863 polymorphisms were analyzed between groups via χ2 test.

RESULTS

A high percentage of rs2569190 GG genotype or G allele carriers were identified in PI group compared with control group (p < .01). Rs2569190 GG genotype carriers had high risk to develop PI (odds ratio: 2.545, 95% confidence interval: 1.257-5.156, p = .009). The rs2569190 AA genotype carriers had the lowest values of gingival index, plaque index, calculus index, peri-implant pocket depth, and clinical attachment level, which were the highest in cases with GG genotype.

CONCLUSION

Rs2569190 polymorphism of CD14 gene was significantly associated with PI predisposition in the Chinese Han population, and the GG genotype and G allele were risk factors for the development of PI.

Enhanced osteogenic and antibacterial properties of titanium implant surface modified with Zn-incorporated nanowires: Preclinical in vitro and in vivo investigations

OBJECTIVE

This study aimed to synthesize zinc-incorporated nanowires structure modified titanium implant surface (Zn-NW-Ti) and explore its superior osteogenic and antibacterial properties in vitro and in vivo.

MATERIALS AND METHODS

Zn-NW-Ti was synthesized via displacement reactions between zinc sulfate solutions and the titanium (Ti) surface, which was pretreated by hydrofluoric acid etching and hyperthermal alkalinization. The physicochemical properties of the Zn-NW-Ti surface were examined. Moreover, the biological effects of Zn-NW-Ti on MC3T3-E1 cells and its antibacterial property against oral pathogenic bacteria (Staphylococcus aureus, Porphyromonas gingivalis, and Actinobacillus actinomycetemcomitans) compared with sandblasted and acid-etched Ti (SLA-Ti) and nanowires modified Ti (NW-Ti) surface were assessed. Zn-NW-Ti and SLA-Ti modified implants were inserted into the anterior extraction socket of the rabbit mandible with or without exposure to the mixed bacterial solution (S. aureus, P. gingivalis, and A. actinomycetemcomitans) to investigate the osteointegration and antibacterial performance via radiographic and histomorphometric analysis.

RESULTS

The Zn-NW-Ti surface was successfully prepared. The resultant titanium surface appeared as a nanowires structure with hydrophilicity, from which zinc ions were released in an effective concentration range. The Zn-NW-Ti surface performed better in facilitating the adhesion, proliferation, and differentiation of MC3T3-E1 cells while inhibiting the colonization of bacteria compared with SLA-Ti and NW-Ti surface. The Zn-NW-Ti implant exhibited enhanced osseointegration in vivo, which was attributed to increased osteogenic activity and reduced bacterial-induced inflammation compared with the SLA-Ti implant.

CONCLUSIONS

The Zn-incorporated nanowires structure modified titanium implant surface exhibited improvements in osteogenic and antibacterial properties, which optimized osteointegration in comparison with SLA titanium implant surface.

Cuprorivaite/hardystonite/alginate composite hydrogel with thermionic effect for the treatment of peri-implant lesion

Peri-implant lesion is a grave condition afflicting numerous indi-viduals with dental implants. It results from persistent periodontal bacteria accumulation causing inflammation around the implant site, which can primarily lead to implant loosening and ultimately the implant loss. Early-stage peri-implant lesions exhibit symptoms akin to gum disease, including swelling, redness and bleeding of the gums surrounding the implant. These signs indicate infection and inflammation of the peri-implant tissues, which may result in bone loss and implant failure. To address this problem, a thermionic strategy was applied by designing a cuprorivaite-hardystonite bioceramic/alginate composite hydrogel with photothermal and Cu/Zn/Si multiple ions releasing property. This innovative approach creates a thermionic effect by the release of bioactive ions (Cu2+ and Zn2+ and SiO 3 2 - ) from the composite hydrogel and the mild heat environment though the photothermal effect of the composite hydrogel induced by near-infrared light irradiation. The most distinctive advantage of this thermionic effect is to substantially eliminate periodontal pathogenic bacteria and inhibit inflammation, while simultaneously enhance peri-implant osseointegration. This unique attribute renders the use of this composite hydrogel highly effective in significantly improving the survival rate of implants after intervention in peri-implant lesions, which is a clinical challenge in periodontics. This study reveals application potential of a new biomaterial-based approach for peri-implant lesion, as it not only eliminates the infection and inflammation, but also enhances the osteointegration of the dental implant, which provides theoretical insights and practical guidance to prevent and manage early-stage peri-implant lesion using bioactive functional materials.

Evaluation of Survival Rates of Dental Implants and the Risk Factors: A Retrospective Follow-Up Study

Introduction The current research sets out to assess implant early survival rates and identify relevant parameters. Methods The research spanned the years 2021 and 2022 and included all individuals who had dental implants. Various criteria, such as age, sex, maxilla/mandible, implant location, immediate implant, implant diameter, implant length, and others, were used to determine the implant survival rate in the research. A multiple logistic regression model was used to show the risk variables for early survival rates of implants, and components with p < 0.05 were further included after the Chi-square test was employed to filter them. Results The current research included 128 patients who had a single implant procedure, including 70 males and 58 females. The early survival rate was 91.40%, and 117 implants were retained after implantation. Risk variables that were shown to be associated with early survival rates were patients aged 30-60 years (OR: 2.542), immediate implant placement (OR: 3.742), and implant length less than 10 mm (OR: 3.972). Conclusions Age, tooth location, implant length, and immediate implantation were risk variables that contributed to our subjects' above 91% early survival rate of implants.

Implications of graphene-based materials in dentistry: present and future

Since the advent of nanoscience, nanobiomaterials have been applied in the dental industry. Graphene and its derivatives have attracted the most interest of all of them due to their exceptional look, biocompatibility, multiplication differential, and antibacterial capabilities. We outlined the most recent developments about their applications to dentistry in our review. There is discussion of the synthesis processes, architectures, and characteristics of materials based on graphene. The implications of graphene and its counterparts are then meticulously gathered and described. Finally, in an effort to inspire more excellent research, this paper explores the obstacles and potential of graphene-based nanomaterials for dental aspects.

Comparative study of the effect of different exposure parameters of 635nm diode laser and toluidine blue O in eliminating Aggregatibacter actinomycetemcomitans biofilm from titanium implant surfaces

BACKGROUND

The aim of this study was to investigate the effects of antimicrobial photodynamic therapy (PDT) using 635 nm diode laser irradiation with an energy density of 6 to 30 J/cm2 and toluidine blue O (TBO) as a photosensitizer on the viability of Aggregatibacter actinomycetemcomitans attached to the surface of titanium implants.

MATERIALS AND METHODS

Titanium implants contaminated with A. actinomycetemcomitans were treated with TBO alone or in combination with different exposure parameters (light doses of 6 - 30 J/cm2 at 635 nm) and 0.2 % chlorhexidine (CHX). After treatment, colony forming units (CFUs)/ml were determined to assess PDT efficacy. The structure of the biofilm of A. actinomycetemcomitans was analyzed by field emission scanning electron microscopy (FESEM).

RESULTS

Under optimal conditions, the colony count was reduced by ∼90 %. Treatment with CHX was somewhat more effective (colony formation was reduced by ∼95 %), but this agent has adverse effects that can be avoided with PDT.

CONCLUSION

This study confirms the efficacy of PDT against A. actinomycetemcomitans depending on the light dose. Treatment with TBO + 635 nm diode laser has an effect that may be equivalent to that of CHX, but perhaps with fewer adverse effects.

Investigating the Long-Term Success and Complication Rates of Zirconia Dental Implants: A Prospective Clinical Study

This study addresses the durability and complications of zirconia dental implants through a prospective clinical investigation. Zirconia implants are increasingly utilized in dental implantation, and a comprehensive understanding of their long-term performance is essential.

Background

Zirconia dental implants have gained attention due to their biocompatibility and aesthetics. However, research on their extended success and complication rates is limited.

Materials and Methods

A prospective clinical study involved the placement of 30 zirconia dental implants in patients requiring tooth replacement. The implants were followed up for five years. Success was defined as the implant remaining stable and functional. Complications, including peri-implant mucositis and peri-implantitis, were monitored. Statistical analysis included descriptive statistics, Chi-square test, and P-values were set at P < 0.05.

Results

The long-term success rate of zirconia dental implants was found to be 93.3%. Among the 30 implants, only 2 exhibited failure. The most common complication was peri-implant mucositis, occurring in 16.7% of implants. Notably, the incidence of peri-implantitis was limited, observed in 6.7% of implants. Statistical analysis showed significant associations between implant failure and smoking (P = 0.021).

Conclusion

Zirconia dental implants demonstrated a high long-term success rate of 93.3% over five years. Peri-implant mucositis was the predominant complication, with a relatively low occurrence of peri-implantitis. The findings underscore the potential of zirconia implants for reliable dental implantation. Addressing modifiable risk factors, such as smoking, could further enhance implant success. Continued research is recommended to validate and expand upon these outcomes.

Multifunctional nanocoating for enhanced titanium implant osseointegration

Preventing bacterial infection and promoting osseointegration are essential for the long-term success of titanium (Ti) implants. In this study, we developed a multifunctional nanocoating on Ti mini-implants to simultaneously address these challenges. The nanocoating consists of self-assembled antimicrobial peptides GL13K and silver nanoparticles, referred to as Ag-GL. Our results showed that the Ag-GL coating did not alter the surface morphology of the mini-implants. Ag-GL coated mini-implants demonstrated a two orders of magnitude reduction in colony-forming unit (CFU) values compared to the noncoated eTi group, resulting in minimal inflammation and no apparent bone destruction in a bacterial infection in vivo model. When evaluating osseointegration properties, micro-CT analysis, histomorphometric analysis, and pull-out tests revealed that the Ag-GL coating significantly enhanced osseointegration and promoted new bone formation in vivo.

Efficient titanium surface modified using bifunctional chimeric peptides to prevent biofilm formation by multiple microorganisms

It is still a challenge to prevent the formation of bacterial biofilms on the surfaces of oral implants. A chemical peptide with binding and antibacterial properties may be a promising agent if used to modify titanium (Ti) surfaces to inhibit biofilm formation. In this study, peptides were designed by linking the antimicrobial sequence derived from human β-defensin-3 (hBD-3) to the Ti-binding peptide-1 (TBP-1) sequence by using a triple glycine (G) linker. The antimicrobial activity and biocompatibility characteristics of the chemical-peptide-modified Ti surface were then evaluated and the potential antibacterial mechanism was investigated. This study demonstrated that the chemical-peptide-modified surface exhibited satisfactory bactericidal activities against Streptococcus gordonii, Fusobacterium nucleatum, and Porphyromonas gingivalis. In addition to its potent bacteria-killing efficacy, the surface-immobilised chemical peptide also demonstrated excellent biocompatibility to L929 cells. Moreover, the disruption of the integrity of the bacterial membrane partially revealed the antibacterial mechanism of the peptide. This study demonstrated the potential of chemical-peptide-modified Ti surfaces for preventing the occurrence of peri-implant diseases, thereby providing a promising approach to improving the survival rate of oral implants.

Bone tissue regeneration in peri-implantitis: A systematic review of randomized clinical trials

Objectives

The goal of this systematic review was to analyze, in randomized controlled clinical trials (RCTs), regenerative techniques used to treat peri-implantitis (PI).

Methods

Three databases (PubMed/Medline, EMBASE, and On-Line Knowledge Library) were accessed, applying the PICO strategy (Population [P], Intervention [I], Comparison [C], and Outcomes [O]), with the following focused questions: (i) "In patients who received regenerative treatments for peri-implantitis (P), is the regenerative surgical treatment (I) clinically effective and predictable compared to non-regenerative (C) to treat PI (O)?"; and (ii) "In patients who received regenerative treatments for peri-implantitis (P), the regenerative approach (I), compared to non-regenerative (C), significantly increase the prognosis and implant survival rate in the mid- and long-term (O)?" The inclusion criteria were RCTs published in English between 2012 and 2022, with at least a one-year follow-up, which applied regenerative techniques to treat peri-implantitis. Cochrane's collaboration tool for assessing the risk of bias was used.

Main results

Nine articles were included with 404 patients (225 females and 179 males; mean age of 60.44 years). One study evaluated patients after 48 months and another after 88 months. The techniques and devices used were: (i) implantoplasty with Er:YAG laser, (ii) blood concentrate (growth factors), and (iii) EMD, with no statistically significant outcome. Two studies considered the use of titanium granules with a significant increase in radiographic bone identification, whereas regenerative techniques with bone graft (autogenous, alloplastic, and xenograft) were the majority chosen, associated or not, with a collagen membrane. Xenograft had better results radiographically when compared to the autogenous bone graft and presented better results for bone level. There was an overall decrease in bleeding on probing, independent of the control or test group, and a reduction in pocket depth in the groups analyzed. Titanium granules, EMD, Er:YAG laser, and CGF had non-significant results; better results were observed when using bone grafts. The RoB showed a low risk in four studies (44.44%), three with moderate (33.33%), and two with high risk (22.23%).

Conclusion

Surgical regenerative treatment was a predictable option in the management of PI and in improving the clinical parameters of peri-implant tissues in the short term, mainly when using porous titanium granules, alloplastic bone grafts, and xenografts.

Influence of abutment macro- and micro-geometry on morphologic and morphometric features of peri-implant connective tissue

OBJECTIVES

The aim of the present human observational study is to provide morphologic and morphometric analysis of peri-implant connective tissue next to abutments with divergent or convergent macro-geometry and different surface micro-characteristics.

MATERIALS AND METHODS

Thirty patients were rehabilitated with single implants in the posterior area and one out of three different healing abutments with a one-stage technique: machined divergent abutment (DIV-MAC), machined convergent abutment (CONV-MAC) or convergent abutment with ultrathin threaded surface (CONV-UTM). At 3 months postimplant insertion, peri-implant soft tissue was harvested; the following outcomes were investigated: histomorphometry (vertical width of connective and epithelial components) as detected by histology and polarized light; and connective tissue vertical width and 3D organization as detected by synchrotron-based high-resolution phase-contrast-based tomography (PhC-μCT).

RESULTS

Significant differences in connective tissue vertical dimension (aJE-AM) were found between DIV-MAC and both CONV-MAC and CONV-UTM, both by histology and PhC-μCT, with significantly higher values for the last two groups. Moreover, 2D histological analysis did not find significant differences in the junctional epithelium vertical dimension (PM-aJE). Importantly, PhC-μCT analysis revealed, at 3D level, significant greater amount and density of collagen bundles for CONV-UTM compared with the other two groups.

CONCLUSIONS

Convergent abutment profiles, regardless of their surface micro-geometry, seem to favor axial development of peri-implant connective tissue. Moreover, ultrathin threaded surfaces seem associated with denser and greater connective tissue organization, which might improve peri-implant soft tissue seal.

Prevention of internal bacterial colonization of dental implants: A comparative longitudinal observational study

OBJECTIVES

Previous studies have indicated a progressive internal bacterial colonization of implants and possible implications for peri-implant bone loss. The aim of this study was to evaluate a decontamination protocol, two disinfectants, and a sealant for their ability to prevent such a colonization.

MATERIALS AND METHODS

Bacterial samples were harvested from the peri-implant sulcus (external) and following abutment removal from the implant cavity (internal) during routine supportive peri-implant care in 30 edentulous patients 2 years after they had obtained two implants. In a split-mouth design, implants were randomly assigned to receive either internal decontamination alone (10% H2 O2 , brush) or additional placement of either sealant (GS), disinfectant agent (CHX-varnish) or disinfectant gel (1% CHX-gel), in the internal cavity before remounting of abutment/suprastructure. Twelve months later, internal and external sampling was repeated. Total bacterial counts (TBCs) were determined using real-time PCR in a total of 240 samples (eight per patient).

RESULTS

Total bacterial counts in the internal cavity significantly reduced overall treatment modalities 1 year after the treatments (4.0 [2.3-6.9]-fold reduction; p = .000). No significant differences between the four treatment types were found (p = .348). Comparison of internal and external sampling points revealed significant correlation (R2  = .366; p = .000) with systematically higher TBC counts in external samples.

CONCLUSIONS

Within the limitations of the present study, it can be concluded that the use of disinfectant agents or a sealant did not show an additional benefit in the prevention of internal bacterial colonization of implants compared to a decontamination protocol alone.

The efficacy of different implant surface decontamination methods using spectrophotometric analysis: an in vitro study

PURPOSE

Various methods have been proposed to achieve the nearly complete decontamination of the surface of implants affected by peri-implantitis. We investigated the in vitro debridement efficiency of multiple decontamination methods (Gracey curettes [GC], glycine air-polishing [G-Air], erythritol air-polishing [E-Air] and titanium brushes [TiB]) using a novel spectrophotometric ink-model in 3 different bone defect settings (30°, 60°, and 90°).

METHODS

Forty-five dental implants were stained with indelible ink and mounted in resin models, which simulated standardised peri-implantitis defects with different bone defect angulations (30°, 60°, and 90°). After each run of instrumentation, the implants were removed from the resin model, and the ink was dissolved in ethanol (97%). A spectrophotometric analysis was performed to detect colour remnants in order to measure the cumulative uncleaned surface area of the implants. Scanning electron microscopy images were taken to assess micromorphological surface changes.

RESULTS

Generally, the 60° bone defects were the easiest to debride, and the 30° defects were the most difficult (ink absorption peak: 0.26±0.04 for 60° defects; 0.32±0.06 for 30° defects; 0.27±0.04 for 90° defects). The most effective debridement method was TiB, independently of the bone defect type (TiB vs. GC: P<0.0001; TiB vs. G-Air: P=0.0017; TiB vs. GE-Air: P=0.0007). GE-Air appeared to be the least efficient method for biofilm debridement.

CONCLUSIONS

T-brushes seem to be a promising decontamination method compared to the other techniques, whereas G-Air was less aggressive on the implant surface. The use of a spectrophotometric model was shown to be a novel but promising assessment method for in vitro ink studies.

Marginal bone level changes around dental implants with one or two adjacent teeth - A clinical and radiographic retrospective study with a follow-up of at least 10 years

AIM

To compare mean bone level (mBL) changes around dental implants with one or two adjacent teeth after a function time of ≥10 years.

MATERIALS AND METHODS

One hundred thirty three periodontally compromised patients (PCPs) with 551 implants enrolled in supportive periodontal care (SPC) were screened. Implants were categorized either into group TIT (tooth-implant-tooth) or into group TIG (tooth-implant-gap). MBL changes from delivery of restoration (i.e., baseline) to follow-up were calculated in millimeters and compared between implants and adjacent teeth. Survival rates and the need for surgical interventions during SPC were recorded.

RESULTS

Eighty seven patients with 142 implants were re-evaluated after a mean observation time of 14.5 ± 3.5 years. The mBL at mesial implant sites in the TIT group increased -0.07 ± 0.92 mm and decreased in the TIG group 0.52 ± 1.34 mm, respectively (95% CI: 0.04/1.14, p = .037). At distal implant sites, the mBL in the TIT group increased -0.08 ± 0.84 mm and decreased 0.03 ± 0.87 in the TIG group, respectively (95% CI: -0.20/0.42, p = .48). The overall implant loss rate was 3.5% (n = 5; 2 TIT, 3 TIG), without a statistically significant difference between the two groups (95% CI: 0.18/7.07, p = .892). Tooth loss rates (TIT: 12.3%, TIG: 12.3%) were not statistically significantly different (OR = 1.00, p = .989).

CONCLUSION

High tooth and implant survival rates were observed in PCPs. The presence of one or two adjacent teeth seemed to have no impact on marginal bone level changes.

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

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

SEM Evaluation of Thermal Effects Produced by a 445 nm Laser on Implant Surfaces

The aim of this in vitro study was to evaluate thermal effects on implant surfaces using a 445 nm diode laser (Eltech K-Laser Srl, Treviso, Italy) with different power settings and irradiation modalities. Fifteen new implants (Straumann, Basel, Switzerland) were irradiated to evaluate surface alteration. Each implant was divided into two zones: the anterior and posterior areas. The anterior coronal areas were irradiated with a distance of 1 mm between the optical fiber and the implant; the anterior apical ones were irradiated with the fiber in contact with the implant. Instead, the posterior surfaces of all of the implants were not irradiated and used as control surfaces. The protocol comprised two cycles of laser irradiation, lasting 30 s each, with a one-minute pause between them. Different power settings were tested: a 0.5 W pulsed beam (T-on 25 ms; T-off 25 ms), a 2 W continuous beam and a 3 W continuous beam. Lastly, through a scanning electron microscopy (SEM) analysis, dental implants' surfaces were evaluated to investigate surface alterations. No surface alterations were detected using a 0.5 W laser beam with a pulsed mode at a distance of 1 mm. Using powers of irradiation of 2 W and 3 W with a continuous mode at 1 mm from the implant caused damage on the titanium surfaces. After the irradiation protocol was changed to using the fiber in contact with the implant, the surface alterations increased highly compared to the non-contact irradiation modality. The SEM results suggest that a power of irradiation of 0.5 W with a pulsed laser light emission mode, using an inactivated optical fiber placed 1 mm away from the implant, could be used in the treatment of peri-implantitis, since no implant surface alterations were detected.

Efficacy of mechanical/physical approaches for implant surface decontamination in non-surgical submarginal instrumentation of peri-implantitis. A systematic review

AIM

To evaluate the efficacy of non-surgical submarginal peri-implant instrumentation with mechanical/physical decontamination compared to non-surgical submarginal instrumentation alone or with placebo decontamination in patients with peri-implantitis.

MATERIALS AND METHODS

Three focused questions were addressed, and a systematic search for randomized controlled clinical trials (RCTs), controlled clinical trials, and prospective cohort studies with definitions of peri-implantitis and a minimal follow-up of 6 months was conducted. The main outcome variables were reduction in pocket probing depth (PD) and bleeding on probing (BOP). Suppuration on probing, marginal peri-implant bone level changes, patient-related outcomes and adverse events, implant survival, treatment success, and disease resolution were assessed as secondary outcomes.

RESULTS

Out of 239 findings, full-text articles were assessed for eligibility, and 9 (n = 9 RCTs) were included in the present review. Five studies evaluated the effects of various laser types, and in four studies efficacy of air-abrasive mechanisms and of a novel ultrasonic device was determined. At 6 months, PD reductions were observed in nine studies but only Er, Cr:YSGG laser-treated group showed statistically significant higher reductions compared to the control group. BOP was statistically significantly reduced at 6 months in two studies following the application of Er:YAG laser compared to controls. One study reported statistically significant reduction in BOP following application of air-polishing device compared to control treatment. No statistically significant differences between treatment groups were reported for the secondary outcome variables. Owing to the large heterogeneity of study designs, no meta-analysis was performed.

CONCLUSIONS

Available evidence on the efficacy of non-surgical submarginal peri-implant instrumentation with mechanical/physical decontamination is limited by the small number of controlled studies and the high heterogeneity of study protocols. Clinical and patient-reported benefits remain to be demonstrated.

Advanced and Readily-Available Wireless-Powered Blue-Light-Implant for Non-Invasive Peri-Implant Disinfection

Non-invasive light-based antibacterial therapy has a good prospect in non-surgical treatment of peri-implant infections. However, its applications are severely limited by poor penetration of light into human tissues, leading to unsatisfying outcomes. Moreover, as an essential prerequisite for traditional light therapy, lasers can no longer meet the patients' needs for convenient treatment at any time. To break through the spatial and temporal limitations of traditional light therapy, a wireless-powered blue-light zirconia implant for readily available treatment of peri-implant infection is proposed. In space, complete irradiation to complex peri-implant structure is realized by the built-in wireless-powered light source, thus improving the efficacy. In time, wireless-powering allows timely and controllable anti-infection treatment. Blue micro-light emitting diodes are used as therapeutic light sources, which effectively kill peri-implant infection-related bacteria without exogenous photosensitive agents. Porphyromonas gingivalis biofilm on implant surface can be completely killed after 20 min irradiation in vitro. The bactericidal rate of peri-implant methicillin-resistant Staphylococcus aureus infection reaches 99.96 ± 0.03% under 30 min per day blue light exposure in vivo. Within the scope of this study, the treatment of peri-implant infection with blue-light implant has preliminary feasibility, giving a new approach to non-invasive treatment of deep oral infections, including peri-implant infections.

Efficacy of surgical methods for peri-implantitis: a systematic review and network meta-analysis

BACKGROUND

Peri-implantitis is the most difficult biological complication associated with dental implants, often requiring surgical treatments in advanced stages. This study compares the effectiveness of different surgical methods for peri-implantitis.

METHODS

Randomized controlled trials (RCTs) of different surgical treatments for peri-implantitis were extracted from EMBASE, Web of Science, Cochrane Library databases, and PubMed systematically. Pairwise comparisons and network meta-analyses (NMA) were conducted to analyze the effect of surgical treatments on probing depth (PD), radiographic bone fill (RBF), mucosal recession (MR), bleeding on probing (BOP), and clinical attachment level (CAL). In addition, risk of bias, quality of evidence, and statistical heterogeneity of the selected studies were evaluated. A total of 13 articles were included in this study, involving open flap debridement (OFD), resective therapy (RT), and augmentative therapy (AT) with and without adjunctive treatments (laser therapy, photodynamic therapy, local antibiotics, phosphoric acid, and ozone therapy).

RESULTS

AT improved RBF and CAL more than OFD, but does not outperform OFD in reducing peri-implant soft-tissue inflammation. AT, OFD and RT did not significantly alter the levels of MR. Addition of ozone therapy improved the effect of AT, but addition of photodynamic therapy did not affect PD reduction and CAL gain significantly. Similarly, adjuvant treatment with phosphoric acid during RT did not significantly change the outcome of BOP.

CONCLUSIONS

Within the limitation of this systematic review and NMA, AT was superior to OFD in improving peri-implantitis outcomes. While adjunct use of ozone therapy may further improve the efficacy of AT, the limited evidence supporting this combination therapy argues for cautionary interpretation of these results.

Effect of Er,Cr:YSGG laser with a side-firing tip on decontamination of titanium disc surface: an in vitro and in vivo study

PURPOSE

To evaluate the effectiveness of an erbium, chromium:yttrium-scandium-gallium-garnet (Er,Cr:YSGG) laser with side-firing tip in decontamination of titanium (Ti) disc.

METHODS

In the first test series, 29 Ti-discs were contaminated with Staphylococcus aureus and treated as follows: positive control (no treatment); Perioflow; Laser A (0.75 W, 100 Hz), Laser B (1.5 W, 30 Hz); Laser C (no radiation, 60% water); and Laser D (no radiation, 50% water). For bacterial quantification, colony forming units (CFU, vital cells only) and quantitative PCR (qPCR, vital and devital cells) were performed. In a second test series, 92 Ti-discs were used, contaminated with in vivo-grown biofilm and treated as follows: positive control (no treatment); Perioflow; Laser E (1.5 W, 30 Hz), and Laser F (no radiation, 50% water). Considering the different and unknown culture conditions, quantification of bacteria was performed by broad-spectrum bacterial qPCR only. Based on the assumption that all cells of an organism contain an equivalent complement of genetic information, genome equivalent (GE) determination ensured the detection of the different intact and semi-intact genomes, regardless of type of bacterial species and vitality, circumvent the inherent bias of cultures.

RESULTS

The GE values were significantly reduced by all interventions in both test series, compared to the positive control group (p < 0.001). In the first test series with S. aureus as model organism, Perioflow yielded a lower GE than the Laser groups A-D (all p < 0.025). The number of CFUs was significantly reduced in the intervention groups compared to the positive control (p < 0.001), except for Laser A (p = 0.157) and Laser D (p = 0.393). In the second test series, none of the pairwise comparisons of the intervention conditions showed a significant difference (Perioflow vs. Laser E: p = 0.732; Perioflow vs. Laser F: p = 0.590; Laser E vs. Laser F: p = 0.379).

CONCLUSION

The Er,Cr:YSGG laser with side-firing tip and Perioflow were equally capable of effectively decontaminating a Ti-disc surface. It is assumed that the bacterial reduction was largely due to the mechanical effect of the air and water stream.

Dental Implant Surface Decontamination and Surface Change of an Electrolytic Method versus Mechanical Approaches: A Pilot In Vitro Study

Dental implants are the preferred fixed oral rehabilitation for replacing lost teeth. When peri-implant tissues become inflamed, the removal of plaque accumulating around the implant becomes imperative. Recently, several new strategies have been developed for this purpose, with electrolytic decontamination showing increased potential compared to traditional mechanical strategies. In this in vitro pilot study, we compare the efficacy of an electrolytic decontaminant (Galvosurge^®) with an erythritol jet system (PerioFlow^®) and two titanium brushes (R-Brush™ and i-Brush™) in removing Pseudomonas aeruginosa PAO1 biofilms from implants. Changes in the implant surface after each approach were also evaluated. Twenty titanium SLA implants were inoculated with P. aeruginosa and then randomly assigned to each treatment group. After treatment, decontamination efficacy was assessed by quantifying colony-forming units (log10 CFU/cm²) from each implant surface. Scanning electron microscopy was used to analyse changes in the implant surface. With the exception of R-Brush, all treatment strategies were similarly effective in removing P. aeruginosa from implants. Major surface changes were observed only in implants treated with titanium brushes. In conclusion, this pilot study suggests that electrolytic decontamination, erythritol-chlorhexidine particle jet system and i-Brush™ brushing have similar performance in removing P. aeruginosa biofilm from dental implants. Further studies are needed to evaluate the removal of more complex biofilms. Titanium brushes caused significant changes to the implant surface, the effects of which need to be evaluated.

Ozonized Hydrogels vs. 1% Chlorhexidine Gel for the Clinical and Domiciliary Management of Peri-Implant Mucositis: A Randomized Clinical Trial

Peri-implant mucositis consists of a reversible inflammation of peri-implant tissues characterized by bleeding on gentle probing in the absence of bone loss. Ozone therapy is being extensively studied for its efficacy in treating different dental conditions. To date, few studies have evaluated ozone as an adjunct to the oral hygiene measures of peri-implant mucositis patients. The aim of the present study is to assess the efficacy of an ozonized gel (Trial group) compared to chlorhexidine (Control group) after a domiciliary protocol of oral hygiene in a 6-month study. According to a split-mouth study design, patients were divided into Group 1 for the application of chlorhexidine gel in peri-implant mucositis sites of quadrants Q1 and Q3, whereas in quadrants Q2 and Q4, the ozonized gel was in-office administered. For Group 2, the quadrants were inverted. At baseline (T0), and after 1 (T1), 2 (T2), and 3 (T3) months, Probing Depth (PD), Plaque Index (PI), SI Suppuration Index (SI), Bleeding Score (BS) and Marginal Mucosa Condition (MMC) were measured. A statistically significant decrease was found for all the variables assessed in each group (p < 0.05), whereas significant intergroup differences were found only for PI, BoP, and BS. Accordingly, both agents tested in this study showed an efficacy in treating peri-implant mucositis. The ozonized gel deserves particular attention, considering the better outcome than chlorhexidine on specific clinical periodontal parameters, as well as its lesser shortcomings.

The use of autologous bone for augmentation procedures leads to low prevalence of peri-implantitis-a retrospective study over a 20-year period

The aim of this study was to compare the prevalence of peri-implantitis in implants inserted into pristine bone (control) to implants where autologous bone was used for grafting procedures (study). All patients who underwent implant surgery during a 20 years interval by one maxillofacial implant surgeon and received a prosthodontic rehabilitation afterwards were eligible for inclusion in the study. Periimplant bone resorption and periimplant disease were assessed. Of 421 patients 384 (91.2%) patients responded to a recall after having been treated over a 20-year period by one maxillofacial surgeon and several dentists. A total of 110 patients had 239 implants in pristine bone, and 274 patients had 607 implants placed in combination with autologous bone grafting procedures. Mean time in function was 74 months (range 15-236 months). In all, 342 implants (34.8%) were in function for longer than 7 years. A total of 64 implant sites (7.6%) in 39 patients (10.2%) showed signs of peri-implant mucositis. In addition, 17 implants (2.0%) in 14 patients (3.6%) revealed signs of peri-implantitis, of which five implants were in the control group (2.09%) whereas 12 implants were in the study group (1.98%), with no statistically significant difference (p = 0.8405). More than half of the patients with peri-implantitis had a history of periodontitis. Three implants were lost due to peri-implantitis and four implants failed for other reasons, resulting in an overall success rate of 99.2% in 846 implants. CONCLUSIONS: Within the limitations of the study it seems that the use of autologous bone still is a relevant option when performing augmentation procedures because of the low prevalence of peri-implantitis.

In Vivo Biofilm Formation on Novel PEEK, Titanium, and Zirconia Implant Abutment Materials

The formation of biofilms on the surface of dental implants and abutment materials may lead to peri-implantitis and subsequent implant failure. Recently, innovative materials such as polyether-ether-ketone (PEEK) and its modifications have been used as abutment materials. However, there is limited knowledge on microbial adhesion to PEEK materials. The aim of this in vivo study was to investigate biofilm formation on the surface of conventional (titanium and zirconia) and PEEK implant abutment materials. Split specimens of titanium, zirconia, PEEK, and modified PEEK (PEEK-BioHPP) were manufactured, mounted in individual removable acrylic upper jaw splints, and worn by 20 healthy volunteers for 24 h. The surface roughness was determined using widefield confocal microscopy. Biofilm accumulation was investigated by fluorescence microscopy and quantified by imaging software. The surface roughness of the investigated materials was <0.2 µm and showed no significant differences between the materials. Zirconia showed the lowest biofilm formation, followed by titanium, PEEK, and PEEK-BioHPP. Differences were significant (p < 0.001) between the investigated materials, except for the polyether-ether-ketones. Generally, biofilm formation was significantly higher (p < 0.05) in the posterior region of the oral cavity than in the anterior region. The results of the present study show a material-dependent susceptibility to biofilm formation. The risk of developing peri-implantitis may be reduced by a specific choice of abutment material.

Enhanced Antibacterial Effect on Zirconia Implant Abutment by Silver Linear-Beam Ion Implantation

Peri-implant lesions, such as peri-implant mucositis and peri-implantitis, are bacterial-derived diseases that happen around dental implants, compromising the long-term stability and esthetics of implant restoration. Here, we report a surface-modification method on zirconia implant abutment using silver linear-beam ion implantation to reduce the bacterial growth around the implant site, thereby decreasing the prevalence of peri-implant lesions. The surface characteristics of zirconia after ion implantation was evaluated using energy dispersive spectroscopy, X-ray photoelectron spectroscopy, and a contact-angle device. The antibacterial properties of implanted zirconia were evaluated using Streptococcus mutans and Porphyromonas gingivalis. The biocompatibility of the material surface was evaluated using human gingival fibroblasts. Our study shows that the zirconia surface was successfully modified with silver nanoparticles by using the ion-implantation method. The surface modification remained stable, and the silver-ion elution was below 1 ppm after one-month of storage. The modified surface can effectively eliminate bacterial growth, while the normal gingiva's cell growth is not interfered with. The results of the study demonstrate that a silver-ion-implanted zirconia surface possesses good antibacterial properties and good biocompatibility. The surface modification using silver-ion implantation is a promising method for future usage.

Metabolic Conditions and Peri-Implantitis

Dental implants to replace lost teeth are a common dentistry practice nowadays. Titanium dental implants display a high success rate and improved safety profile. Nevertheless, there is an increasing peri-implantitis (PI), an inflammatory disease associated with polymicrobial infection that adversely affects the hard and soft tissues around the implant. The present review highlights the contribution of different metabolic conditions to PI. The considerations of both local and systemic metabolic conditions are crucial for planning successful dental implant procedures and during the treatment course of PI. Un- or undertreated PI can lead to permanent jaw bone suffering and dental implant losses. The common mediators of PI are inflammation and oxidative stress, which are also the key mediators of most systemic metabolic disorders. Chronic periodontitis, low-grade tissue inflammation, and increased oxidative stress raise the incidence of PI and the underlying systemic metabolic conditions, such as obesity, diabetes mellitus, or harmful lifestyle factors (cigarette smoking, etc.). Using dental biomaterials with antimicrobial effects could partly solve the problem of pathogenic microbial contamination and local inflammation. With local dentistry considering factors, including oral microbiota and implant quality control, the inclusion of the underlying systemic metabolic conditions into the pre-procedure planning and during the treatment course should improve the chances of successful outcomes.

Calcium phosphate cement with icariin-loaded gelatin microspheres as a local drug delivery system for bone regeneration

BACKGROUND

Icariin (ICA), a main active ingredient of Herba Epimedium, could promote bone formation, inhibit bone resorption and alleviate inflammatory responses. The aim of this study was to investigate the effect of ICA on the inhibition of bacteria associated with peri-implantitis, and fabricate a calcium phosphate cement (CPC) with ICA-loaded gelatin microspheres (GMs) as a local drug delivery system efficiently promoting bone formation and alleviating inflammation.

RESULTS

In this study, ICA exhibited antibacterial activity against P. gingivalis with a MIC value of 1 × 10^-4 mol/L. When the concentration of ICA was 0.5 mM, the encapsulation efficiency of GMs reached the maximum value of 76.26 ± 3.97%. GMs with ICA revealed a controlled release profile, 0.5 mM ICA exhibited a higher ICA release profile than the other groups during a 21 d monitoring span. The results of SEM and XRD demonstrated successful fabrication of a calcium phosphate cement with ICA-loaded GMs. ICA released from CPC/GMs (ICA) was slower than ICA released from GMs within 10 days. CPC/GMs (ICA) exhibited antibacterial activity against P. gingivalis, but the antibacterial rate of CPC/GMs (ICA) was only 17.15 ± 6.06%. In addition, CPC/GMs (ICA) promoted the proliferation of BMSCs and significantly stimulated the differentiation and maturation of BMSCs. In vivo, H&E and Masson staining experiments demonstrated that CPC/GMs (ICA) exhibited better capacity for bone regeneration than CPC/GMs and CPC, and the expression of TNF-α and IL-1β in the tissue around CPC/GMs (ICA) was significantly lower than CPC/GMs and CPC in IHC staining (P < 0.05).

CONCLUSION

In this study, ICA exhibited limited antibacterial activity against bacteria associated with peri-implantitis. A composite material of calcium phosphate cement with ICA-loaded gelatin microspheres was developed, which not only promoting osteoinductivity and bone formation, but also alleviating inflammation, demonstrating its potential as a promising bone substitute material for treatment of peri-implantitis.