Mechanical and biological complications after implantoplasty—A systematic review

Implant-supported prostheses following the biologically oriented preparation technique (BOPT) after implantoplasty procedures: A dental technique

Esthetic concerns may appear on implant-supported prostheses after peri-implantitis treatment, such as implantoplasty procedures that includes the thread removal and surface smoothening. A technique for restoring implants that have been treated for peri-implantitis using an implantoplasty procedure combined with the detoxification of the implant surfaces is described. The technique involves the fabrication of an implant-supported prosthesis following the biologically oriented preparation technique (BOPT) and aims to solve esthetic complications after this peri-implantitis treatment approach.

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.

Clinical and radiographic outcomes of a combined surgery approach to treat peri-implantitis

Peri-implant infra-bony defects are difficult to treat, and data on the management of peri-implantitis are lacking. The aim of this study was to evaluate the effect of a combined surgical approach to manage peri-implantitis: implantoplasty with xenogeneic bone grafting and a concentrated growth factor membrane. Two independent examiners analysed the medical records and radiographs taken before surgery and at the last follow-up. Data were analysed at the implant level; some patient-level data (age, sex, smoking habit) were also considered. Linear regression analysis with generalized estimating equations (GEE) was used to explore the effect of variables of interest (including marginal bone level (MBL)) on implantitis treatment success and resolution rates. The effect of the prosthesis type on postoperative clinical and radiographic parameters was also explored by GEE, with adjustment for age, sex, tooth site, location, follow-up duration, and implant length (model IV including all). Thirty patients with 72 implants were investigated. The implant survival rate was 100% over a mean observation period of 3.3 years (range 2-11 years). The treatment success rate (bone loss <0.5 mm, no bleeding on probing (BOP), no suppuration, probing depth (PD) < 5 mm) was higher in females than males (50% vs 19.0%; P = 0.008). At the last postoperative follow-up, the MBL (1.51 ± 1.07 vs 4.01 ± 1.13 mm), PD (3.61 ± 0.84 vs 6.54 ± 1.01 mm), and BOP (23.38 ± 23.18% vs 79.17 ± 15.51%) were significantly reduced when compared to pre-surgery values (all P < 0.001). Furthermore, a significantly higher PD reduction (β = -1.10 mm, 95% confidence interval -1.97 to -0.23 mm, P = 0.014) was observed for implants with a single crown than a full-arch prosthesis (GEE model IV). Preliminary clinical and radiographic data indicate that implantoplasty in combination with surgery could be an effective treatment option for peri-implantitis.

In vitro pilot study comparing a novel implantoplasty sonic instrumentation protocol with a conventional protocol using burs

BACKGROUND AND OBJECTIVES

The aim of implantoplasty (IP) is to remove titanium implant layers that have been contaminated and to smoothen the implant surfaces so they retain less plaque. However, existing IP methods are very invasive and reduce implant wall thickness.

AIM

To investigate the suitability of novel sonic tips in IP and to compare this novel protocol with conventional abrasive procedures.

MATERIALS AND METHODS

Thirty dental implants (Ø 4.1 mm, 10 mm length) were distributed in three groups and investigated according to the protocol of Sivolella et al., with modifications to the instrument's feed rate, the applied contact force, and the speed of implant rotations per minute. The upper third of the implant was processed with a diamond-coated bur (BUR) or novel non-diamond-coated sonic tips (AIRSCALER). After standardized IP, the surfaces were analyzed by tactile profilometry and scanning electron microscopy (SEM). Changes in implant weight, implant material loss, and implant fracture strength were assessed.

RESULTS

The mean roughness (Ra , Sa ), implant material loss, and change in implant weight were significantly lower in the AIRSCALER group than in the BUR group, whereas the mean compression resistance values were significantly higher in the AIRSCALER group than in the BUR group.

CONCLUSIONS

IP with uncoated sonic tips smoothes the surfaces and reduces structural loss of the implant in the area of microthreads. This new IP method could be of great clinical importance, especially for implants with microthreads and reduced diameter or wall thickness.

Implantoplasty and the risk of fracture of narrow implants with advanced bone loss: A laboratory study

OBJECTIVES

To assess the impact of implantoplasty (IP) on maximum implant failure strength of narrow diameter implants of different type/design and material, with simulated advanced bone loss.

MATERIALS AND METHODS

Narrow, parallel-walled implants (3.3 mm in diameter × 10 mm long) with an internal connection of different type/design [bone level (BL), tissue level (TL)] and material [Titanium grade IV (Ti), Titanium-Zirconium alloy (TiZr)] from one specific manufacturer were used. Half of the implants were subjected to IP in their coronal 5 mm; the remaining were used as controls (seven implants per group). Dynamic loading prior to maximum load strength testing was included.

RESULTS

During dynamic loading, the fracture rate of BL implants was low and independent of IP, while that of TL implants increased significantly with IP compared with controls (p = .001). Maximum implant failure strength reduction (in %) due to IP, was 1.3%-25.4%; TiZr BL implants were least affected. Implants subjected to IP compared to those without IP as well as TL implants compared to BL implants showed a significantly lower maximum implant failure strength (p < .002); implant material was not significant (p = .845).

CONCLUSIONS

Based on data from implants of one specific manufacturer, IP has a significant negative impact on the fracture strength of narrow implants suffering from advanced peri-implantitis. TL implants have been more severely affected compared to BL implants and presented an increased risk for failure during normal chewing forces. In addition, this negative impact of IP on TL implants was independent of the implant material (i.e., Ti or TiZr).

CLINICAL RELEVANCE

Narrow single TL implants with advanced horizontal bone loss (e.g., 5 mm), when subjected to IP, appear to have an increased fracture risk during normal function.

Efficacy of implantoplasty in management of peri-implantitis: A systematic review

Aim

Peri-implantitis causes progressive loss of the supporting bony structure around the dental implant. Implantoplasty mechanically removes contaminated threads to achieve smoother implant surface thus reducing the bacterial load enabling fibroblastic growth to stimulate the healing effect. This Systematic review is done to appraise the outcome of implantoplasty on surface quality of Implant (roughness), biocompatibility of implants in peri-implantitis cases.

Settings and Design

The Settings of the studies are major online databases like PubMed, Scopus, and Cochrane online library. The design of the current study is systematic review of published qualitative studies.

Materials and Method

37 articles were identified for the present review and systematic electronic literature search was done from August 2022 to January 2023, via PubMed, Scopus, Medline, and The Cochrane Library (Wiley) databases [PRISMA guidelines]. In vitro studies on implantoplasty for peri-implantitis were included for the review. 2 examiners independently selected based on the inclusion criteria and recorded the necessary data.

Statistical Analysis Used

Risk of bias assessment tool was evaluated with Newcastle Ottawa scale (NOS) and screened based on Selection, Comparability, and Outcome with the following categories: - maximum of 4, 2 and 4 points respectively. The observations were tabulated and analysed.

Results

Among the 8 selected studies, two studies reported no statistical difference between implantoplasty and control, one study proposed carbide burs were better than diamond burs, another study also suggested multilaminar burs were better than diamond and carbide. The Newcastle Ottawa scale (NOS) score for the quality of the included studies ranged from 6 to 8. Two of the studies had score of 6 points, eight had 7 points and one had 8 points.

Conclusion

Implantoplasty has been recommended as an efficacious treatment protocol for peri-implantitis that helps to diminish the inflammation and accompanied by a high success rate.

Peri-implantitis management by resective surgery combined with implantoplasty and Er:YAG laser irradiation, accompanied by free gingival graft: a case report

The optimal method for decontamination of implant surfaces for peri-implantitis treatment remains controversial. In recent years, erbium-doped yttrium aluminum garnet (Er:YAG) laser irradiation and implantoplasty (IP) (i.e. mechanical modification of the implant) have been reported to be effective in decontaminating implant surfaces during the surgical treatment. Also, a lack of adequate keratinized mucosa (KM) around the implant is known to be associated with more plaque accumulation, tissue inflammation, attachment loss, and mucosal recession, increasing the risk of peri-implantitis. Therefore, free gingival graft (FGG) has been recommended for gaining adequate KM around the implant. However, the necessity of acquiring KM for the treatment of peri-implantitis using FGG remains unclear. In this report, we applied the apically positioned flap (APF) as resective surgery for peri-implantitis treatment in conjunction with IP and Er:YAG laser irradiation to polish/clean the implant surface. Furthermore, FGG was conducted simultaneously to create additional KM, which increased the tissue stability and contributed to the positive results. The two patients were 64 and 63 years old with a history of periodontitis. The removal of granulation tissue and debridement of contaminated implant surfaces were performed with Er:YAG laser irradiation post flap elevation and then modified smooth surfaces mechanically using IP. Er:YAG laser irradiation was also utilized to remove the titanium particles. In addition, we performed FGG to increase the width of KM as a vestibuloplasty. Peri-implant tissue inflammation and progressive bone resorption were not observed, and both patients maintained good oral hygiene conditions until the 1-year follow-up appointment. Bacterial analysis via high-throughput sequencing revealed proportional decreases in bacteria associated with periodontitis (Porphyromonas, Treponema, and Fusobacterium). To the best of our knowledge, this study is the first to describe peri-implantitis management and bacterial change before and after procedures by resective surgery combined with IP and Er:YAG laser irradiation for peri-implantitis treatment, accompanied by FGG for increasing KM around the implants.

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.

Short versus standard implants at sinus augmented sites: a systematic review and meta-analysis

BACKGROUND

Short implants are proposed as a less invasive alternative with fewer complications than standard implants in combination with sinus lift. The aim of this systematic review and meta-analysis was to state the efficacy of placing short implants (≤ 6 mm) compared to standard-length implants (≥ 8 mm) performing sinus lift techniques in patients with edentulous posterior atrophic jaws. Efficacy will be evaluated through analyzing implant survival (IS) and maintenance of peri-implant bone (MBL).

METHODS

Screening process was done using the National Library of Medicine (MEDLINE by PubMed), EMBASE, the Cochrane Oral Health, and Web of Science (WOS). The articles included were randomized controlled trials. Risk of bias was evaluated according to The Cochrane Collaboration's tool. Weighted means were calculated. Heterogeneity was determined using Higgins (I²). A random-effects model was applied. Secondary outcomes such as surgical time, patient satisfaction, mucositis and peri-implantitis, pain, and swelling were analyzed.

RESULTS

Fourteen studies (597 patients and 901 implants) were evaluated. IS was 1.02 risk ratio, ranging from 1.00 to 1.05 (CI 95%) (p = 0.09), suggesting that IS was similar when both techniques were used. MBL was higher in patients with standard-length implants plus sinus lift elevation (p = 0.03). MBL was 0.11 (0.01-0.20) mm (p = 0.03) and 0.23 (0.07-0.39) mm (p = 0.005) before and after 1 year of follow-up, respectively, indicating that the marginal bone loss is greater for standard-length implants.

DISCUSSION

Within the limitations of the present study, as relatively small sample size, short dental implants can be used as an alternative to standard-length implants plus sinus elevation in cases of atrophic posterior maxilla. Higher MBL was observed in the groups where standard-length implants were used, but implant survival was similar in both groups. Moreover, with short implants, it was observed a reduced postoperative discomfort, minimal invasiveness, shorter treatment time, and reduced costs.

CLINICAL CLINICAL RELEVANCE

The low MBL promoted by short implants does contribute to a paradigm shift from sinus grafting with long implants to short implants. Further high-quality long-term studies are required to confirm these findings.

Titanium implant surface roughness after different implantoplasty protocols: A laboratory study

OBJECTIVE

To compare the surface roughness of sandblasted, large grit, acid-etched (SLA) surfaced titanium discs, after implantoplasty (IP) with different combinations of rotating instruments without or with the subsequent use of a silicone polisher.

METHODS

Titanium discs (n = 12 per group) with an SLA surface were treated with the following IP protocols: (1) Tungsten carbide bur sequence from company 1 (Komet Dental) without or with polishing (P) with a silicone polisher (Brownie®), (2) tungsten carbide bur sequence from company 2 (Hager & Meisinger GmbH) without or with P, and (3) diamond bur sequence (125, 40, 15-μm grit) without or with P. Pristine turned (T) and SLA titanium discs were used as negative and positive controls, respectively. Surface roughness measurements were taken with a contact profilometer rendering R_a and R_z values.

RESULTS

All IP protocols, even without P, resulted in significantly reduced surface roughness compared to the SLA group. The tungsten carbide bur protocols, even without P, resulted in a surface roughness similar to or significantly lower than that in the T group in terms of R_a and R_z , respectively. IP with the diamond bur sequence resulted in a significantly rougher surface compared to that achieved with the carbide burs. In all IP groups, P with a silicone polisher resulted in a significantly smoother surface.

CONCLUSIONS

IP with dedicated tungsten carbide burs without or with the subsequent use of a silicone polisher resulted in a surface roughness similar to or significantly lower than that of commercially available turned surfaces. IP with a diamond bur sequence required additional polishing to achieve a comparable surface roughness to that of commercially available turned surfaces.

The Effect of Microcosm Biofilm Decontamination on Surface Topography, Chemistry, and Biocompatibility Dynamics of Implant Titanium Surfaces

Since the inception of dental implants, a steadily increasing prevalence of peri-implantitis has been documented. Irrespective of the treatment protocol applied for the management of peri-implantitis, this biofilm-associated pathology, continues to be a clinical challenge yielding unpredictable and variable levels of resolution, and in some cases resulting in implant loss. This paper investigated the effect of microcosm biofilm in vitro decontamination on surface topography, wettability, chemistry, and biocompatibility, following decontamination protocols applied to previously infected implant titanium (Ti) surfaces, both micro-rough -Sandblasted, Large-grit, Acid-etched (SLA)-and smooth surfaces -Machined (M). Microcosm biofilms were grown on SLA and M Ti discs. These were treated with TiBrushes (TiB), combination of TiB and photodynamic therapy (PDT), combination of TiB and 0.2%CHX/1%NaClO, plus or minus Ultraviolet-C (UV-C) radiation. Surface topography was evaluated by Scanning Electron Microscopy (SEM) and Laser Surface Profilometry. Surface function was analysed through wettability analysis. Surface chemistry evaluation of the discs was performed under SEM/Energy-dispersive X-ray spectroscopy (EDX) and X-ray photoelectron spectroscopy (XPS). Biocompatibility was tested with the cytocompatibility assay using human osteoblast-like osteosarcoma cell line (MG-63) cells. Elemental analysis of the discs disclosed chemical surface alterations resulting from the different treatment modalities. Titanium, carbon, oxygen, sodium, aluminium, silver, were identified by EDX as the main components of all the discs. Based on the data drawn from this study, we have shown that following the decontamination of Ti surfaces the biomaterial surface chemistry and topography was altered. The type of treatment and Ti surface had a significant effect on cytocompatibility (p = 0.0001). Although, no treatment modality hindered the titanium surface biocompatibility, parameters such as the use of chemical agents and micro-rough surfaces had a higher cytotoxic effect in MG-63 cells. The use of smooth surfaces, and photofunctionalisation of the TiO₂ layer had a beneficial effect on cytocompatibility following decontamination.

The Effect of an Er, Cr: YSGG Laser Combined with Implantoplasty Treatment on Implant Surface Roughness and Morphologic Analysis: A Pilot In Vitro Study

Although laser irradiation and implantoplasty (IP) are both treatment options for peri-implantitis, no studies have yet combined these two treatment solutions. The aim of this study was to identify the effect of an Er, Cr: YSGG laser on the IP surface. In experiment 1, TiUnite anodized surface implants were treated with an Er, Cr: YSGG laser at 0.5 to 2 W on the panel energy setting and 20 Hz under water irrigation. In experiment 2, all implant surfaces were treated with the IP procedure first, then irradiated with the Er, Cr: YSGG laser. All samples were analyzed by stereomicroscopy, scanning electron microscopy (SEM), energy dispersive X-ray spectroscopy (EDS), and surface topography. Stereomicroscopy and SEM revealed no obvious surface change at any energy setting once the surface was polished with the IP procedure, whereas damage was caused to the TiUnite original implant surface when the Er, Cr: YSGG laser panel energy was set at 1 W or higher. EDS showed no significant difference in element composition once the surface was polished with the IP procedure, while a compositional change was detected when the Er, Cr: YSGG laser panel energy was set to 0.5 W or higher to irradiate the original TiUnite surface. Surface roughness may be related to laser irradiation energy, but no significant changes occurred following IP. These results indicated that the Er, Cr: YSGG laser may have little effect on the post-IP surface compared with the virgin TiUnite surface.

Is attention branch network effective in classifying dental implants from panoramic radiograph images by deep learning?

Attention mechanism, which is a means of determining which part of the forced data is emphasized, has attracted attention in various fields of deep learning in recent years. The purpose of this study was to evaluate the performance of the attention branch network (ABN) for implant classification using convolutional neural networks (CNNs). The data consisted of 10191 dental implant images from 13 implant brands that cropped the site, including dental implants as pretreatment, from digital panoramic radiographs of patients who underwent surgery at Kagawa Prefectural Central Hospital between 2005 and 2021. ResNet 18, 50, and 152 were evaluated as CNN models that were compared with and without the ABN. We used accuracy, precision, recall, specificity, F1 score, and area under the receiver operating characteristics curve as performance metrics. We also performed statistical and effect size evaluations of the 30-time performance metrics of the simple CNNs and the ABN model. ResNet18 with ABN significantly improved the dental implant classification performance for all the performance metrics. Effect sizes were equivalent to “Huge” for all performance metrics. In contrast, the classification performance of ResNet50 and 152 deteriorated by adding the attention mechanism. ResNet18 showed considerably high compatibility with the ABN model in dental implant classification (AUC = 0.9993) despite the small number of parameters. The limitation of this study is that only ResNet was verified as a CNN; further studies are required for other CNN models.

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.

Overcoming Complications with Implants in the Esthetic Zone: An Innovative Approach

Owing to the satisfactory esthetic and functional outcomes of implant surgery for the anterior teeth, some dentists consider it the gold standard treatment. However, the risk of developing peri-implantitis is positively associated with the long-term use of the implant. This necessitates the development of an implant design that reduces the risk of peri-implantitis, especially considering the long-term use of implants in young patients. This case report describes a new approach for an implant surgery using a two-stage implant in a 28-year-old woman. Her clinical course was satisfactory during the 4-year postoperative follow-up period; no inflammation was noted in the surrounding tissues. The two-stage implants allow for the removal of an implant body from an infected area and its replacement with a new abutment if peri-implantitis develops in the future.

Peri-Implant Health and the Knowing-Doing Gap—A Digital Survey on Procedures and Therapies

Objectives: Peri-implant tissue maintenance and treatment is becoming a serious challenge in implantology. With increasing numbers of implants being placed, more cases of peri-implant mucositis and peri-implantitis is seen. A digital survey on peri-implant disease management was issued to experts in periodontology and implantology to identify the tools and procedures most commonly used today to treat peri-implant diseases and successfully manage peri-implant health. The primary aim was to assess whether there is consensus in the choice of treatment to manage peri-implant diseases and to prevent their recurrence once treated. The secondary aim was to obtain insight into future protocols and /or devices, and the research and development needed.

Materials and Methods: Participants in this digital survey were professionals specialising in periodontology, oral surgery, and implant dentistry. The questionnaire included both a series of closed- and open-ended questions. A total of 16 countries participated. The survey was sent by e-mail to 70 individuals, 66 received the survey and 37 of receivers responded, two of the participants were excluded due to insufficient filling of the survey. In the end 35 respondents completed the survey.

Results: Respondents agree that the efficacy of mechanical and chemical decontamination of implant surfaces needs to be improved and better documented. It is a common opinion that the current remedies, mostly adapted from periodontal practises, do not provide effective and reliable clinical outcomes when treating peri-implant ailments. There is a general agreement amongst experts that regularly scheduled (3–6-month intervals) maintenance treatments are essential for maintaining peri-implant health in patients experiencing implant complications. Respondents are also concerned about unnecessary use of systemic antibiotics for managing peri-implant health.

Conclusion: Regardless of agreements in parts, there was no observed consensus on the most effective treatment options for treating peri-implantitis. The experts all agree it is an urgent need for well-designed, long-term follow-up randomised and controlled clinical trials comparing interventions to provide an evidence-based strategy for peri-implant health management.

Polyetheretherketone versus titanium CAD-CAM framework for implant-supported fixed complete dentures: a retrospective study with up to 5-year follow-up

PURPOSE

To evaluate the performance of polyetheretherketone (PEEK) versus titanium computer-aided designed and manufactured (CAD-CAM) framework for implant-supported fixed complete dentures (ISFCDs) with a follow-up for a duration of up to 5 years.

METHODS

Consecutively edentulous patients who underwent ISFCDs with a PEEK framework or titanium framework at one dental specialist center were included in this retrospective study. Implant/prosthesis survival rates, mechanical/biological complications, and bone and soft tissue parameters were analyzed. Overall survival was analyzed using Kaplan-Meier survival curves and the log-rank test.

RESULTS

Sixty ISFCDs (29 PEEK, 31 titanium) performed on 43 edentulous patients (331 implants) were included. An implant survival rate of 100% was obtained. There was no significant difference in the cumulative prosthesis survival rate between the PEEK (93.1%) and titanium groups (93.5%). The most common mechanical complications were fracture of the artificial veneer in both the PEEK (13.8%) and titanium (16.7%) groups. Bruxers had a higher prevalence of mechanical complications than non-bruxers (p<0.05). The biological complications included bleeding upon probing (13.8% for the PEEK group; 16.1% for the titanium group), soft tissue inflammation (3.4% for the PEEK group; 3.2% for the titanium group), and temporomandibular disorders (6.5% for the titanium group). The vertical bone loss was significantly lower in the PEEK group (0.70 mm) than in the titanium group (0.96 mm). Smokers had a significantly higher prevalence of biological complications than non-smokers.

CONCLUSIONS

Within the limitations of this study, ISFCDs with PEEK frameworks can provide good prognosis for edentulous patients, still requiring longer-term validation.

Effect of implantoplasty on the elastic limit of dental implants of different diameters

BACKGROUND

Implantoplasty reduces both implant diameter and the thickness of its walls, subsequently reducing the ability of the implant to resist fracture in response to functional load. In combination with an increase in the crown-implant ratio due to bone loss, this could increase the lever effect, which in presence of high masticatory forces or parafunctional habits, could lead to complications such as fracture of the implant or loosening of the prosthetic screw.

OBJECTIVES

To determine the elastic limits of internal connection, dental implants of different designs and diameters after an implantoplasty.

MATERIALS AND METHODS

This in vitro study included 315 tapered internal connection titanium dental implants, the threads of which were removed with an industrial milling machine-for standardized implantoplasty (IMP1; n = 105)-or with the conventional approach-manually, using high-speed burs (IMP2; n = 105). The remaining 105 implants were used as controls. The final implant diameters were recorded. The quality of the newly polished surfaces was assessed by scanning electron microscopy. All implants were subjected to a mechanical pressure resistance test. A Tukey's test for multiple comparisons was used to detect differences in the elastic limit and final implant diameters between the implant groups.

RESULTS

There were statistically significant differences in the elastic limit between the IMP1, IMP2, and control groups (p < 0.05). Furthermore, the implant diameter was significantly smaller in the IMP1 and IMP2 groups (p < 0.05). Scanning electron microscopy revealed smooth implant surfaces in the IMP1 and IMP2 groups, with some titanium particles visible in the IMP1 group.

CONCLUSIONS

Implantoplasty significantly decreased the elastic limit of internal connection titanium dental implants, especially in those with a smaller diameter (3-3.5 mm).

Peri-Implantitis Regenerative Therapy: A Review

Simple Summary

Regenerative therapies are one of the options to treat peri-implantitis diseases that cause peri-implant bone loss. This review reports classic and current literature to describe the available knowledge on regenerative peri-implant techniques.

Abstract

The surgical techniques available to clinicians to treat peri-implant diseases can be divided into resective and regenerative. Peri-implant diseases are inflammatory conditions affecting the soft and hard tissues around dental implants. Despite the large number of investigations aimed at identifying the best approach to treat these conditions, there is still no universally recognized protocol to solve these complications successfully and predictably. This review will focus on the regenerative treatment of peri-implant osseous defects in order to provide some evidence that can aid clinicians in the approach to peri-implant disease treatment.

Will Zirconia Implants Replace Titanium Implants?

This review aims to discuss the advantages and disadvantages of zirconia implants compared with titanium implants. Moreover, it intends to review the relevant available long-term literature of these two materials regarding osteointegration, soft-tissue, microbiota, and peri-implantitis, focusing on clinical results. Briefly, titanium implants are a reliable alternative for missing teeth; however, they are not incapable of failure. In an attempt to provide an alternative implant material, implants made from ceramic-derivate products were developed. Owing to its optimal osseointegration competence, biocompatibility, and esthetic proprieties, zirconium dioxide (ZrO2), also known as zirconia, has gained popularity among researchers and clinicians, being a metal-free alternative for titanium implants with its main use in the anterior esthetic zones. This type of implant may present similar osseointegration as those noted on titanium implants with a greater soft-tissue response. Furthermore, this material does not show corrosion as its titanium analog, and it is less susceptible to bacterial adhesion. Lastly, even presenting a similar inflammatory response to titanium, zirconia implants offer less biofilm formation, suggesting less susceptibility to peri-implantitis. However, it is a relatively new material that has been commercially available for a decade; consequently, the literature still lacks studies with long follow-up periods.

Comparative study of bacterial microfiltration in the implant-abutment interface, with straight and conical internal connections, in vitro

OBJECTIVE

to determine the presence of marginal bacterial microfiltration in the IAI in different implant/abutment systems, in vitro.

MATERIAL AND METHODS

Fifty-six implants from seven different brand names, 4 with cone and 3 with straight connections were used, implant and abutment were connected using the Ncm tightening as indicated by each of the manufacturers and then were sealed. The samples were subjected occlusal load and thermal cycling, a first sample of each group was observed by micro CT and in a second sample (both samples randomly selected) length of connection was measured, while the rest of the samples were mounted on devices according to the bacterial microfiltration model with Porphyromonas gingivalis.

RESULTS

Two of the conical connection system groups did not present bacterial microfiltration, one of the three straight connection groups only microfiltered in one sample, while the other two conical as well as the two straight connection samples showed different and important levels of bacterial microfiltration, all groups presented a direct relationship between the implant-abutment adjustment determined by micro-CT and bacterial microfiltration levels, not related to the connection length.

CONCLUSION

Only two conical connection systems presented no bacterial microfiltration.

Surface attrition of zirconia and hybrid composite resin superstructure during implant therapy

PURPOSE

The purpose of this study was to examine morphological changes in the superstructure of implants in relation to the degree of attrition of the implant superstructure and its antagonists.

METHODS

Thirty-three patients participated. The implant superstructures of the first molar and its antagonists were scanned with an intraoral scanner every 3 months. The amount of attrition was calculated in relation to the various materials used for the superstructure, and differences were analyzed statistically (P < 0.05).

RESULTS

Attrition of the implant superstructure was 110 ± 30 µm for monolithic zirconia and 105 ± 27 µm for resin-veneered metal after 12 months. No statistically significant difference was found between the two groups. In contrast, attrition of the antagonists was 75 ± 25 µm for zirconia and 105 ± 20 µm for resin-veneered metal after 12 months. A statistically significant difference in the attrition levels between the two groups was observed after 9 and 12 months.

CONCLUSION

During the 12-month observation period, there was no difference in superstructure attrition between zirconia and resin-veneered metal. Attrition of the antagonists was higher for hybrid composite resin-veneered metal than for zirconia, suggesting that surface roughness affected the degree of attrition.

Is Implantoplasty Efficacious at Treating Peri-Implantitis? A Systematic Review and Meta-Analysis

PURPOSE

Peri-implantitis is an inflammatory disease, characterized by the progressive loss of the peri-implant support bone tissue. The objective of this study was to assess whether implantoplasty is efficacious in promoting peri-implant health.

METHODS

In this systematic review and meta-analysis, a search without restrictions regarding language or date of publication was conducted across different databases. Grey literature search, Google Scholar search and manual searches were also carried out. Studies evaluating periimplant clinical parameters of individuals with peri-implantitis who had been submitted to implantoplasty were included. Study selection, data extraction, and risk of bias assessment were conducted. The outcome variables were implant probing depth, the percentage of implants with bleeding on probing or suppuration on probing, and the success rate of implants after implantoplasty. The predictor variable was implantoplasty and the follow-up time after implantoplasty. Data on sample size, implant location, implant diameter, and diagnostic criteria for peri-implantitis were also collected during data extraction. Meta-analysis, sensitivity analysis, and analysis of the probability of implant success after implantoplasty with the Kalan-Meier method were performed.

RESULTS

Ninety-four studies were assessed. Eight articles were included and 7 were incorporated into quantitative analyses. Subjects' mean age ranged between 50 to 70.7 years. The studies demonstrated that implantoplasty contributed to a significant improvement in the peri-implant condition, reducing the probing depth, bleeding and suppuration on probing. Overall, the included studies exhibited low risk of bias. Meta-analysis demonstrated that probing depth before implantoplasty was significantly higher than after implantoplasty (mean difference = -3.37 mm, confidence interval = -4.74; -2.00). This result was confirmed in the sensitivity analysis. The probability of success of implants at 6 months of follow-up after implantoplasty was 97.5% and at 24 months of follow-up was 94.7%.

CONCLUSIONS

There is some evidence in the literature to recommend implantoplasty as a potential treatment for periimplantitis.

Resolution of peri-implantitis by means of implantoplasty as adjunct to surgical therapy: A retrospective study

BACKGROUND

There is a paucity of data on the effectiveness of implantoplasty as adjunct to the surgical management of peri-implantitis.

PURPOSE

To evaluate the resolution of peri-implantitis by means of implantoplasty as adjunct to surgical resective (RES) and reconstructive (REC) therapies and supportive maintenance.

METHODS

Patients that underwent surgical therapy to manage peri-implantitis with a follow-up of ≥12 months and enrolled in a regular peri-implant supportive care were recruited. RES group consisted of two interventions that included osseous recontouring and apically position flap (APF) and soft tissue conditioning (STC). REC was performed in the infra-osseous compartment of combined defects. Implant survival rate was recorded. Clinical and radiographic parameters were evaluated to define a "dogmatic" (case definition #1) and a "flexible" (case definition #2) therapeutic success. Univariate and multivariate multilevel backward logistic regression were applied for statistical analysis.

RESULTS

Overall, 43 patients (n_implants  = 135) were retrospectively assessed. Mean observational period was ∼24 months. Implant survival rate was 97.8%, being significantly higher for APF, STC, and APF + STC (RES) when compared with REC (P = 0.01) therapy, in particular for advanced lesions (>50% of bone loss). The overall therapeutic success rate at implant-level was 66% and 79.5% for case definition #1 and #2, respectively. APF group displayed more efficient disease resolution when considered success definition #1 (72%). Contrarily, when the data were adhered to success definition #2, STC group showed a slightly higher disease resolution rate (87%). For RES group, location, favoring anterior (P = 0.04) and defect type, favoring class II (P = 0.02) displayed statistical significance for therapeutic success. For REC group, implants exhibiting a wider band of keratinized mucosa (KM) demonstrated higher therapeutic success (P = 0.008).

CONCLUSION

Implantoplasty as an adjunct to surgical therapy proved effective in terms of disease resolution and implant survival rate. Implant location, defect morphology as well as the buccal width of KM are indicators of therapeutic success.

A Mini Review on Non-augmentative Surgical Therapy of Peri-Implantitis—What Is Known and What Are the Future Challenges?

Non-augmentative surgical therapy of peri-implantitis is indicated for cases with primarily horizontal bone loss or wide defects with limited potential for bone regeneration and/or re-osseointegration. This treatment approach includes a variety of different techniques (e.g., open flap debridement, resection of peri-implant mucosa, apically positioned flaps, bone re-contouring, implantoplasty, etc.) and various relevant aspects should be considered during treatment planning. The present mini review provides an overview on what is known for the following components of non-augmentative surgical treatment of peri-implantitis and on potential future research challenges: (1) decontamination of the implant surface, (2) need of implantoplasty, (3) prescription of antibiotics, and (4) extent of resective measures.

Peri-Implantitis: A Clinical Update on Prevalence and Surgical Treatment Outcomes

Dental implants may be considered a reliable routine procedure in clinical practice for the replacement of missing teeth. Results from long-term studies indicate that implant-supported dental prostheses constitute a predictable treatment method for the management of fully and partially edentulous patients. Implants and their restorations, however, are not free from biological complications. In fact, peri-implantitis, defined as progressive bone loss associated to clinical inflammation, is not a rare finding nowadays. This constitutes a concern for clinicians and patients given the negative impact on the quality of life and the sequelae originated by peri-implantitis lesions. The purpose of this narrative review is to report on the prevalence of peri-implantitis and to overview the indications, contraindications, complexity, predictability and effectiveness of the different surgical therapeutic modalities to manage this disorder.

Artificial Intelligence in Fractured Dental Implant Detection and Classification: Evaluation Using Dataset from Two Dental Hospitals

Fracture of a dental implant (DI) is a rare mechanical complication that is a critical cause of DI failure and explantation. The purpose of this study was to evaluate the reliability and validity of a three different deep convolutional neural network (DCNN) architectures (VGGNet-19, GoogLeNet Inception-v3, and automated DCNN) for the detection and classification of fractured DI using panoramic and periapical radiographic images. A total of 21,398 DIs were reviewed at two dental hospitals, and 251 intact and 194 fractured DI radiographic images were identified and included as the dataset in this study. All three DCNN architectures achieved a fractured DI detection and classification accuracy of over 0.80 AUC. In particular, automated DCNN architecture using periapical images showed the highest and most reliable detection (AUC = 0.984, 95% CI = 0.900–1.000) and classification (AUC = 0.869, 95% CI = 0.778–0.929) accuracy performance compared to fine-tuned and pre-trained VGGNet-19 and GoogLeNet Inception-v3 architectures. The three DCNN architectures showed acceptable accuracy in the detection and classification of fractured DIs, with the best accuracy performance achieved by the automated DCNN architecture using only periapical images.

Implantoplasty: Carbide burs vs diamond sonic tips. An in vitro study

OBJECTIVES

Implantoplasty (IP) is a treatment option for peri-implantitis. Mechanical concerns were raised on fracture resistance of implants subjected to this procedure. This study aimed to compare two methods of IP in terms of implant wear and fracture resistance, and of surface topography.

MATERIAL AND METHODS

Eighteen cylindrical screw-shaped dental implants (4 mm diameter, 13 mm length) with an external hexagonal connection were used. IP was performed on the first 6-mm implant surface with a sequence of burs or diamond sonic tips, both followed by an Arkansas finishing. IP duration and implant weight variation were recorded. Micro-computed tomography (micro-CT) was used to evaluate material loss. Implant fracture resistance was assessed by static compression test. Surface topography analysis was performed with a stylus profilometer. Scanning electron microscopy-energy dispersive X-ray spectroscopy (SEM-EDS) was applied for implant surface morphology and elemental characterization.

RESULTS

Micro-CT showed less material loss in sonic compared to burs. No statistically significant difference was found between the mean fracture resistance values reached in bur and sonic, both followed by Arkansas, and with respect to control. IP performed with burs led to a smoother surface compared to sonic. Equivalent final surface roughness was found after Arkansas in both IP procedures. SEM-EDS showed a deburring effect associated to sonic and revealed carbon and aluminum peaks attributable to contamination with sonic diamond tips and Arkansas bur, respectively.

CONCLUSIONS

IP with sonic diamond tips was found to be more conservative in terms of structure loss. This could have a clinical relevance in case of narrow-diameter implants.

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.

Effect of crown to implant ratio and implantoplasty on the fracture resistance of narrow dental implants with marginal bone loss: an in vitro study

Background

Peri-implantitis is a biological complication that affects soft and hard tissues around dental implants. Implantoplasty (IP) polishes the exposed implant surface, to decontaminate it and make it less prone to bacterial colonization. This study investigates whether a higher clinical crown-to-implant-ratio (CIR) reduces implant fracture resistance and whether implants are more fracture-prone after IP in the presence of 50% of bone loss.

Methods

Forty-eight narrow platform (3.5 mm) 15 mm long titanium dental implants with a rough surface and hexagonal external connection were placed in standardized bone-like resin casts leaving 7.5 mm exposed. Half were selected for IP. The IP and control groups were each divided into 3 subgroups with different clinical CIRs (2:1, 2.5:1 and 3:1). The implant wall width measurements were calculated using the software ImageJ v.1.51 through the analysis of plain x-ray examination of all the samples using standardized mounts. A fracture test was performed and scanning electron microscopy was used to evaluate maximum compression force (F_max) and implant fractures.

Results

IP significantly reduced the implant wall width (P < 0.001) in all reference points of each subgroup. F_max was significantly higher in the 2:1 subgroup (control = 1276.16 N ± 169.75; IP = 1211.70 N ± 281.64) compared with the 2.5:1 (control = 815.22 N ± 185.58, P < 0.001; IP = 621.68 N ± 186.28, P < 0.001) and the 3:1 subgroup (control = 606.55 N ± 111.48, P < 0.001; IP = 465.95 N ± 68.57, P < 0.001). Only the 2.5:1 subgroup showed a significant reduction (P = 0.037) of the F_max between the controls and the IP implants. Most fractures were located in the platform area. Only 5 implants with IP of the 2:1 CIR subgroup had a different fracture location (4 fractures in the implant body and 1 in the prosthetic screw).

Conclusions

IP significantly reduces the fracture resistance of implants with a 2.5:1 CIR. The results also suggest that the CIR seems to be a more relevant variable when considering the resistance to fracture of implants, since significant reductions were observed when unfavorable CIR subgroups (2.5:1 and 3:1 CIR) were compared with the 2:1 CIR samples.

Does implantoplasty affect the failure strength of narrow and regular diameter implants? A laboratory study

Objective

To assess whether the impact of implantoplasty (IP) on the maximum implant failure strength depends on implant type/design, diameter, or material.

Methods

Fourteen implants each of different type/design [bone (BL) and tissue level (TL)], diameter [narrow (3.3 mm) and regular (4.1 mm)], and material [titanium grade IV (Ti) and titanium-zirconium alloy (TiZr)] of one company were used. Half of the implants were subjected to IP in a computerized torn. All implants were subjected to dynamic loading prior to loading until failure to simulate regular mastication. Multiple linear regression analyses were performed with maximum implant failure strength as dependent variable and IP, implant type/design, diameter, and material as predictors.

Results

Implants subjected to IP and TL implants showed statistically significant reduced implant failure strength irrespective of the diameter compared with implants without IP and BL implants, respectively. Implant material had a significant impact for TL implants and for regular diameter implants, with TiZr being stronger than Ti. During dynamic loading, 1 narrow Ti TL implant without IP, 4 narrow Ti TL implants subjected to IP, and 1 narrow TiZr TL implant subjected to IP were fractured.

Conclusion

IP significantly reduced the maximum implant failure strength, irrespective implant type/design, diameter, or material, but the maximum implant failure strength of regular diameter implants and of narrow BL implants remained high.

Clinical Relevance

IP seems to have no clinically relevant impact on the majority of cases, except from those of single narrow Ti TL implants, which may have an increased risk for mechanical complications. This should be considered for peri-implantitis treatment planning (e.g., communication of potential complications to the patient), but also in the planning of implant installation (e.g., choosing TiZr instead of Ti for narrow implants).

Annual review of selected scientific literature: A report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry

This comprehensive review of the 2019 restorative dental literature is offered to inform busy dentists regarding remarkable publications and noteworthy progress made in the profession. Developed by the Scientific Investigation Committee of the American Academy of Restorative Dentistry, each author brings discipline-specific expertise to 1 of 8 sections of the report: (1) prosthodontics; (2) periodontics, alveolar bone, and peri-implant tissues; (3) implant dentistry; (4) dental materials and therapeutics; (5) occlusion and temporomandibular disorders; (6) sleep-related breathing disorders; (7) oral medicine and oral and maxillofacial surgery; and (8) dental caries and cariology. The report targets important information likely to influence day-to-day dental treatment decisions. Each review is not intended to stand alone but to update interested readers so that they may visit source material when greater detail is desired. As the profession moves toward evidence-based clinical decision-making, an incredible volume of potentially valuable dental literature continues to increase. It is the intention of this review and its authors to provide assistance in negotiating the extensive dental literature published in 2019. It is our hope that readers find this work useful in the clinical management of dental patients.

Lack of Clinical Benefit of Implantoplasty to Improve Implant Survival Rate

The objective of this study was to compare postsurgical outcomes of resective treatment for peri-implantitis with and without implant surface modification (implantoplasty [IP]). This was accomplished by a retrospective analysis with data from patients with ≥1 implant who were surgically treated for peri-implantitis by resective therapy. Patients were divided into 2 groups regarding treatment approach: IP (test) and no IP (control). Retrospective data were obtained after implant placement (T0) and the day of peri-implantitis surgical treatment (T1). Patients were then recalled (≥1 y after T1) for clinical and radiographic examination (T2). The findings were conclusive. A total of 41 patients (68 implants; mean ± SD follow-up, 41.6 ± 24.4 mo) were included in this study. The survival rate at the implant level was 90% in the test group and 81.6% in the control group ( P > 0.05). Multilevel regression analysis showed that the probability of implant failure was influenced by marginal bone loss (MBL) at T1 and not surgical modality. For example, peri-implantitis defects ≥50% and 25% to 50% MBL were 18.6 and 8.86 times more likely to lose the implant, respectively, when compared with <25% MBL. Nonetheless, MBL changes were similar in the test and control groups ( P = 0.592). Similarly, changes in bleeding on probing, probing pocket depth, and suppuration at T2 did not differ between groups ( P > 0.05). Multilevel regression analysis indicated that clinical improvement of these parameters was influenced by the number of supportive peri-implant therapy visits ( P < 0.01). The results demonstrate little difference between the procedures. Regardless of the implant surface modification (IP) being performed or not, the survival rate of implants treated for peri-implantitis was primarily influenced by the amount of bone loss at the time of treatment. Other clinical parameters (MBL, probing pocket depth, bleeding on probing, suppuration) were influenced by the frequency of supportive peri-implant therapy visits and not by the IP procedure (ClinicalTrials.gov NCT04259840).

Experimental implantoplasty outcomes correlate with fibroblast growth in vitro

BACKGROUND

Implantoplasty is an option in peri-implantitis treatment, but little is known about the effect on the soft tissue. The aim of the study was to characterize surface roughness following experimental implantoplasty and to examine its effect on human fibroblast growth and secretion of selected proteins.

METHODS

Titanium grade IV coins were mechanically treated with six different rotating bur sequences; diamond burs or carbide burs alone, or followed by either Arkansas stone bur or silicone burs. Machined and rough-surface sandblasted, acid-etched (SLA) coins were used as control. The surface topography was characterized by scanning electron microscope and profilometer. Human gingival fibroblasts from two donors were cultured on the coins to quantify the effect on cell morphology, growth, and protein secretion by confocal microscopy and multiplex immunoassay.

RESULTS

All surface roughness parameters were lower for the surfaces treated with experimental implantoplasty than for the SLA surface, and the sequence of carbide burs followed by silicone burs rendered the least rough surface of the test groups. The implantoplasty procedures changed the elemental composition of the titanium surface. High surface roughness showed a weak to moderate negative correlation to fibroblast growth, but induced a higher secretion of VEGF, IL-6 and MCP-3 to the cell medium compared to the least rough surfaces of the test groups. At day 30 fibronectin levels were higher in the SLA group.

CONCLUSIONS

The surface roughness following implantoplasty demonstrated a weak to moderate negative correlation with the growth of fibroblasts. The addition of Arkansas stone and silicon burs to the experimental implantoplasty bur protocol rendered an initial increase in fibroblast growth. Implantoplasty altered the elemental composition of the titanium surface, and had an effect on the fibroblast cytokine secretion and fibronectin levels.