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Pabst A, Becker P, Götz W, Heimes D, Thiem DGE, Blatt S, Kämmerer PW. A comparative analysis of particulate bovine bone substitutes for oral regeneration: a narrative review. Int J Implant Dent 2024; 10:26. [PMID: 38801622 PMCID: PMC11130110 DOI: 10.1186/s40729-024-00544-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 05/21/2024] [Indexed: 05/29/2024] Open
Abstract
PURPOSE Particulate bovine bone substitutes (BS) are commonly used in oral regeneration. However, more literature is needed focusing on comparative analyses among various particulate bovine BS. This study evaluates pre-clinical and clinical data of different particulate bovine BS in oral regeneration. METHODS A narrative review was conducted by screening the PubMed database Included in the review were pre-clinical and clinical studies until 2024 comparing a minimum of two distinct particulate bovine BS. In addition to examining general data concerning manufacturing and treatment processes, biological safety, physical and chemical characteristics, and graft resorption, particular emphasis was placed on assessing pre-clinical and clinical data related to ridge preservation, sinus floor elevation, peri-implant defects, and various forms of alveolar ridge augmentation utilizing particulate bovine BS. RESULTS Various treatment temperatures ranging from 300 to 1,250 °C and the employment of chemical cleaning steps were identified for the manufacturing process of particulate bovine BS deemed to possess biosecurity. A notable heterogeneity was observed in the physical and chemical characteristics of particulate bovine BS, with minimal or negligible graft resorption. Variations were evident in particle and pore sizes and the porosity of particulate bovine BS. Pre-clinical assessments noted a marginal inclination towards favorable outcomes for particulate bovine BS subjected to higher treatment temperatures. However, clinical data are insufficient. No distinctions were observed regarding ridge preservation, while slight advantages were noted for high-temperature treated particulate bovine BS in sinus floor elevation. CONCLUSIONS Subtle variances in both pre-clinical and clinical outcomes were observed in across various particulate bovine BS. Due to inadequate data, numerous considerations related to diverse particulate bovine BS, including peri-implant defects, must be more conclusive. Additional clinical studies are imperative to address these knowledge gaps effectively.
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Affiliation(s)
- Andreas Pabst
- Department of Oral and Maxillofacial Surgery, German Armed Forces Central Hospital, Rübenacherstraße 170, 56072, Koblenz, Germany
- Department of Oral and Maxillofacial Surgery - Plastic Operations, University Medical Center Mainz, Augustusplatz 2, 55131, Mainz, Germany
| | - Philipp Becker
- Department of Oral and Maxillofacial Surgery, German Armed Forces Central Hospital, Rübenacherstraße 170, 56072, Koblenz, Germany
- Department of Oral and Maxillofacial Surgery - Plastic Operations, University Medical Center Mainz, Augustusplatz 2, 55131, Mainz, Germany
| | - Werner Götz
- Department of Orthodontics, University Hospital Bonn, Welschnonnenstr. 17, 53111, Bonn, Germany
| | - Diana Heimes
- Department of Oral and Maxillofacial Surgery - Plastic Operations, University Medical Center Mainz, Augustusplatz 2, 55131, Mainz, Germany
| | - Daniel G E Thiem
- Department of Oral and Maxillofacial Surgery - Plastic Operations, University Medical Center Mainz, Augustusplatz 2, 55131, Mainz, Germany
| | - Sebastian Blatt
- Department of Oral and Maxillofacial Surgery - Plastic Operations, University Medical Center Mainz, Augustusplatz 2, 55131, Mainz, Germany
| | - Peer W Kämmerer
- Department of Oral and Maxillofacial Surgery - Plastic Operations, University Medical Center Mainz, Augustusplatz 2, 55131, Mainz, Germany.
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2
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Giok KC, Veettil SK, Menon RK. Comparative effectiveness of interventions for the treatment of peri-implantitis: A systematic review with network meta-analysis. J Prosthet Dent 2024:S0022-3913(24)00219-1. [PMID: 38632026 DOI: 10.1016/j.prosdent.2024.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 03/15/2024] [Accepted: 03/18/2024] [Indexed: 04/19/2024]
Abstract
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.
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Affiliation(s)
- Koay Chun Giok
- Predoctoral student, School of Dentistry, International Medical University, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Sajesh K Veettil
- Associate Professor, Department of Pharmacy Practice, School of Pharmacy, College of Pharmacy, International Medical University, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Rohit Kunnath Menon
- Assistant Professor, Prosthodontics, College of Dentistry, Ajman University, Ajman, United Arab Emirates.
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Berglundh T, Mombelli A, Schwarz F, Derks J. Etiology, pathogenesis and treatment of peri-implantitis: A European perspective. Periodontol 2000 2024. [PMID: 38305506 DOI: 10.1111/prd.12549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 12/19/2023] [Accepted: 12/22/2023] [Indexed: 02/03/2024]
Abstract
Peri-implantitis is a plaque-associated pathological condition occurring in tissues around dental implants. It is characterized by inflammation in the peri-implant mucosa and progressive loss of supporting bone. Over the last 30 years, peri-implantitis has become a major disease burden in dentistry. An understanding of the diagnosis, etiology and pathogenesis, epidemiology, and treatment of peri-implantitis must be a central component in undergraduate and postgraduate training programs in dentistry. In view of the strong role of European research in periodontology and implant dentistry, the focus of this review was to address peri-implantitis from a European perspective. One component of the work was to summarize new and reliable data on patients with dental implants to underpin the relevance of peri-implantitis from a population perspective. The nature of the peri-implantitis lesion was evaluated through results presented in preclinical models and evaluations of human biopsy material together with an appraisal of the microbiological characteristics. An overview of strategies and outcomes presented in clinical studies on nonsurgical and surgical treatment of peri-implantitis is discussed with a particular focus on end points of therapy and recommendations presented in the S3 level Clinical Practice Guideline for the prevention and treatment of peri-implant diseases.
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Affiliation(s)
- Tord Berglundh
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Andrea Mombelli
- Division of Regenerative Dental Medicine and Periodontology, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Frank Schwarz
- Department of Oral Surgery and Implantology, Goethe University, Carolinum, Frankfurt, Germany
| | - Jan Derks
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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4
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Monje A, Pons R, Nart J, Miron RJ, Schwarz F, Sculean A. Selecting biomaterials in the reconstructive therapy of peri-implantitis. Periodontol 2000 2024; 94:192-212. [PMID: 37728141 DOI: 10.1111/prd.12523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/28/2023] [Accepted: 08/21/2023] [Indexed: 09/21/2023]
Abstract
Peri-implantitis is a pathogenic inflammatory condition characterized by progressive bone loss and clinical inflammation that may compromise the stability of dental implants. Therapeutic modalities have been advocated to arrest the disorder and to establish peri-implant health. Reconstructive therapy is indicated for bone defects exhibiting contained/angular components. This therapeutic modality is based upon the application of the biological and technical principles of periodontal regeneration. Nonetheless, the comparative efficacy of reconstructive therapy and nonreconstructive modalities remains unclear. Therefore, the aim of this narrative review is to address major clinical concerns regarding the efficacy, effectiveness, and feasibility of using biomaterials in peri-implantitis therapy. In particular, the use of bone grafting materials, barrier membranes, and biologics is comprehensively explored.
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Affiliation(s)
- Alberto Monje
- Department of Periodontology and Oral Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Department of Periodontology, Universitat Internacional de Catalunya, Barcelona, Spain
- Department of Periodontology, University of Bern, Bern, Switzerland
| | - Ramón Pons
- Department of Periodontology, Universitat Internacional de Catalunya, Barcelona, Spain
| | - José Nart
- Department of Periodontology, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Richard J Miron
- Department of Periodontology, University of Bern, Bern, Switzerland
| | - Frank Schwarz
- Department of Oral Surgery and Implantology, Goethe University, Frankfurt, Germany
| | - Anton Sculean
- Department of Periodontology, University of Bern, Bern, Switzerland
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5
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Risolo M, Cevik-Aras H, Sayardoust S. The effect of reconstructive techniques as treatment modality for peri-implant osseous defects - a systematic review and meta-analysis. Acta Odontol Scand 2023; 81:569-577. [PMID: 37551914 DOI: 10.1080/00016357.2023.2243325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 07/27/2023] [Indexed: 08/09/2023]
Abstract
OBJECTIVES The aim of this systematic review is to compare conventional peri-implant flap surgery and reconstructive surgical techniques regarding evidence of remission from peri-implantitis. MATERIAL AND METHODS Searches were made among randomized controlled trials evaluating clinical aspects and the changes in marginal bone level before and after surgical treatment of peri-implantitis, with and without bone substitute. RESULTS Nine published articles and 442 patients were eligible for inclusion in the study. Reconstructive techniques exhibited a greater extent of defect fill than conventional surgical techniques alone. No significant differences could be found for clinical measures of peri-implant disease (bleeding on probing and reduction of probing depth) from baseline to the 12-month follow-up. CONCLUSIONS With regards to the clinical measures of disease, our review shows that there are no differences between open flap debridement and regenerative surgery. From an esthetic standpoint, it may however be that regenerative measures may lead to improvement but further publications with this focus will be necessary to verify this.
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Affiliation(s)
- Massimo Risolo
- Department of Periodontology, Institute for Postgraduate Dental Education, Jönköping, Sweden
| | - Hülya Cevik-Aras
- Department of Oral Pathology and Medicine, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- NÄL Hospital, Trollhättan, Sweden
| | - Shariel Sayardoust
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Center for Oral Rehabilitation, Linköping, Sweden
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Donos N, Calciolari E, Ghuman M, Baccini M, Sousa V, Nibali L. The efficacy of bone reconstructive therapies in the management of peri-implantitis. A systematic review and meta-analysis. J Clin Periodontol 2023. [PMID: 36635029 DOI: 10.1111/jcpe.13775] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 01/06/2023] [Accepted: 01/09/2023] [Indexed: 01/14/2023]
Abstract
AIM To evaluate the efficacy of bone reconstructive procedures for the reduction of probing pocket depth (PPD), bleeding on probing (BOP), and suppuration in peri-implantitis-related bone defects at ≥12-month follow-up. MATERIALS AND METHODS Three databases were searched for randomized controlled trials (RCTs) and controlled clinical trials (CCTs) that compared bone reconstructive therapies to access flap surgery (AFS) (Focused Question-FQ 1), and RCTs, CCTs, and prospective case series that assessed the efficacy of reconstructive therapies (FQ 2). Meta-analysis was performed for FQ1 when more than three studies were identified, while for FQ2 a network was drawn based on RCTs with common treatment arms. RESULTS Seven RCTs were identified for FQ1 while five RCTs and six prospective case series for FQ2. There was no significant difference in PPD change between AFS and reconstructive surgery (-0.387; p = .325) at 12 months. Furthermore, no clear differences in terms of PPD and BOP changes resulted from the different reconstructive therapies included in the network. Only a small percentage of treated cases with any modality achieved peri-implantitis resolution, as defined by different composite outcomes. CONCLUSIONS Reconstructive surgery does not offer significant improvements in peri-implant clinical parameters as compared to AFS at 12 months. It was not possible to establish a hierarchy of efficacy among the different biomaterials employed for reconstructive surgery.
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Affiliation(s)
- Nikos Donos
- Centre for Oral Clinical Research, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Elena Calciolari
- Centre for Oral Clinical Research, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.,Centro di Odontoiatria, Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italy
| | - Mandeep Ghuman
- Centre for Host-Microbiome Interactions, Faculty of Dentistry, Oral and Craniofacial Sciences, Kings College London, Guy's Hospital, London, UK
| | - Michela Baccini
- Dipartimento di Statistica, Informatica, Applicazioni 'G. Parenti' (DiSIA), University of Florence, Florence, Italy
| | - Vanessa Sousa
- Centre for Host-Microbiome Interactions, Faculty of Dentistry, Oral and Craniofacial Sciences, Kings College London, Guy's Hospital, London, UK
| | - Luigi Nibali
- Centre for Host-Microbiome Interactions, Faculty of Dentistry, Oral and Craniofacial Sciences, Kings College London, Guy's Hospital, London, UK
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Romandini M, Laforí A, Pedrinaci I, Baima G, Ferrarotti F, Lima C, Paternó Holtzman L, Aimetti M, Cordaro L, Sanz M. Effect of sub-marginal instrumentation before surgical treatment of peri-implantitis: A multi-centre randomized clinical trial. J Clin Periodontol 2022; 49:1334-1345. [PMID: 36085409 PMCID: PMC9826024 DOI: 10.1111/jcpe.13713] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 07/28/2022] [Accepted: 08/01/2022] [Indexed: 01/11/2023]
Abstract
AIM The present multi-centre randomized clinical trial with 12 months of follow-up aimed at studying the added effect of sub-marginal instrumentation before surgical treatment of peri-implantitis. MATERIALS AND METHODS Forty-two patients diagnosed with peri-implantitis were recruited. After a behavioural intervention phase including oral hygiene instructions, patients were randomized to either receiving supra- and sub-marginal instrumentation on their affected implants (control group: 21 patients and 29 implants) or only supra-marginal instrumentation (test group: 21 patients and 24 implants), before undergoing surgery. Changes in the deepest probing pocket depth (PPD) with respect to baseline and a composite outcome of treatment success (no implant loss, no bone loss > 0.5 mm, no bleeding or suppuration on probing [BoP/SoP], and PPD ≤ 5 mm) at the 12-month examination were regarded as the primary outcomes of the trial. RESULTS At the 12-month examination, changes in the deepest PPD with respect to baseline amounted to -2.96 mm in the control group and to -3.11 mm in the test one (MD = -0.16; SE = 0.56; p = .769), while 21.4% of the implants in the control group and 33.3% in the test group presented treatment success (OR = 1.83; SE = 1.15; p = .338). With the exception of a longer non-surgical treatment duration in the control group (differences in = -14.29 min; SE = 2.91; p < .001), no other secondary (e.g., soft-tissue recession, keratinized mucosa height, and bone level changes, as well as BoP, SoP, profuse bleeding and implant loss rates) or exploratory (i.e., early wound healing, aesthetics, surgical and total treatment duration, surgery difficulty, intra-operative bleeding, and adverse events) outcome demonstrated statistically significant differences between groups. CONCLUSIONS The present multi-centre randomized clinical trial did not demonstrate an added effect of performing sub-marginal instrumentation 6 weeks before the surgical treatment of peri-implantitis. Larger clinical trials are however needed to confirm the present findings (Clinicaltrials.gov: NCT03620331).
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Affiliation(s)
- Mario Romandini
- Section of Post‐graduate Periodontology, Faculty of OdontologyUniversity ComplutenseMadridSpain,ETEP (Etiology and Therapy of Periodontal and Peri‐implant Diseases) Research GroupUniversity ComplutenseMadridSpain
| | - Andreina Laforí
- Department of Periodontology and Prosthodontics, “George Eastman” Dental HospitalUniversity Policlinic “Umberto I”RomeItaly,Division of Fixed Prosthodontics and Biomaterials, Clinic of Dental MedicineUniversity of GenevaGenevaSwitzerland
| | - Ignacio Pedrinaci
- Section of Post‐graduate Periodontology, Faculty of OdontologyUniversity ComplutenseMadridSpain,Department of Restorative Dentistry and Biomaterials Science, Harvard School of Dental MedicineHarvard UniversityBostonMassachusettsUSA
| | - Giacomo Baima
- Department of Surgical Sciences, C.I.R. Dental SchoolUniversity of TurinTurinItaly
| | - Francesco Ferrarotti
- Department of Surgical Sciences, C.I.R. Dental SchoolUniversity of TurinTurinItaly
| | - Cristina Lima
- Section of Post‐graduate Periodontology, Faculty of OdontologyUniversity ComplutenseMadridSpain
| | - Lucrezia Paternó Holtzman
- Department of Periodontology and Prosthodontics, “George Eastman” Dental HospitalUniversity Policlinic “Umberto I”RomeItaly
| | - Mario Aimetti
- Department of Surgical Sciences, C.I.R. Dental SchoolUniversity of TurinTurinItaly
| | - Luca Cordaro
- Department of Periodontology and Prosthodontics, “George Eastman” Dental HospitalUniversity Policlinic “Umberto I”RomeItaly
| | - Mariano Sanz
- Section of Post‐graduate Periodontology, Faculty of OdontologyUniversity ComplutenseMadridSpain,ETEP (Etiology and Therapy of Periodontal and Peri‐implant Diseases) Research GroupUniversity ComplutenseMadridSpain
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8
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Ramanauskaite A, Cafferata EA, Begic A, Schwarz F. Surgical interventions for the treatment of peri-implantitis. Clin Implant Dent Relat Res 2022. [PMID: 36419243 DOI: 10.1111/cid.13162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 11/01/2022] [Indexed: 11/25/2022]
Abstract
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.
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Affiliation(s)
- Ausra Ramanauskaite
- Department of Oral Surgery and Implantology, Johann Wolfgang Goethe-University, Carolinum, Frankfurt, Germany
| | - Emilio A Cafferata
- Department of Oral Surgery and Implantology, Johann Wolfgang Goethe-University, Carolinum, Frankfurt, Germany
| | - Amira Begic
- Department of Oral Surgery and Implantology, Johann Wolfgang Goethe-University, Carolinum, Frankfurt, Germany
| | - Frank Schwarz
- Department of Oral Surgery and Implantology, Johann Wolfgang Goethe-University, Carolinum, Frankfurt, Germany
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9
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Montero E, Roccuzzo A, Molina A, Monje A, Herrera D, Roccuzzo M. Minimal invasiveness in the reconstructive treatment of peri-implantitis defects. Periodontol 2000 2022; 91:199-216. [PMID: 35899987 DOI: 10.1111/prd.12460] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 05/30/2022] [Accepted: 06/05/2022] [Indexed: 11/30/2022]
Abstract
Peri-implantitis is a plaque-associated pathologic condition occurring in tissues around dental implants, clinically characterized by increased peri-implant probing pocket depth and progressive loss of supporting bone. Consequently, to arrest further disease progression and to increase the chance to obtain re-osseointegration, surgical reconstructive procedures have been adopted. In particular, following a paradigm gathered from periodontal therapy, recent protocols have underlined the importance of a minimally invasive approach to optimize the outcomes of therapy while minimizing the risks of postoperative complications. The present review summarizes the level of evidence on the surgical reconstructive protocols focusing on the new approaches aiming to minimize surgical trauma and patients' postoperative discomfort, underlining the pros and cons of each treatment modality.
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Affiliation(s)
- Eduardo Montero
- ETEP (Etiology and Therapy of Periodontal and Peri-Implant Diseases) Research Group, University Complutense, Madrid, Spain
| | - Andrea Roccuzzo
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland.,Department of Oral and Maxillofacial Surgery, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - Ana Molina
- ETEP (Etiology and Therapy of Periodontal and Peri-Implant Diseases) Research Group, University Complutense, Madrid, Spain
| | - Alberto Monje
- Department of Periodontology, Universitat Internacional de Catalunya, Barcelona, Spain.,Department of Periodontics and Oral Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - David Herrera
- ETEP (Etiology and Therapy of Periodontal and Peri-Implant Diseases) Research Group, University Complutense, Madrid, Spain
| | - Mario Roccuzzo
- Department of Periodontics and Oral Medicine, University of Michigan, Ann Arbor, Michigan, USA.,Division of Maxillofacial Surgery, University of Torino, Torino, Italy
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10
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Li ZB, Li K, Du M, Ren SB, Yu Y. Surgical treatment of peri-implantitis with or without adjunctive graft material: a systematic review and meta-analysis of randomized controlled trials. Int J Oral Maxillofac Surg 2022; 52:107-117. [PMID: 35717280 DOI: 10.1016/j.ijom.2022.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 05/18/2022] [Accepted: 05/19/2022] [Indexed: 10/18/2022]
Abstract
This systematic review and meta-analysis was performed to compare the clinical effect of surgical treatment of peri-implantitis alone or in combination with graft material. Literature searches were conducted up to June 20, 2020. Randomized controlled trials (RCTs) comparing the clinical effects of open flap debridement (OFD) alone and OFD with adjunctive graft materials for the treatment of peri-implantitis were included. Probing depth (PD) changes and marginal bone level (MBL) changes were assessed and expressed as the standardized mean difference (SMD) with 95% confidence interval (CI). Subgroup analyses and sensitivity analyses were conducted. The search yielded 7419 articles, five of which were analysed quantitatively. The adjunctive use of graft materials in OFD did not provide additional PD improvements (SMD 0.46, 95% CI -0.13 to 1.05; P = 0.13), but did yield additional MBL improvements (SMD 1.04, 95% CI 0.71-1.37; P < 0.01). The degradability of the material, number of implants included per patient, and risk of bias did not have significant effects on the results, but the origin of the material may affect the PD improvements. Based on the available evidence, the adjunctive use of graft materials in the surgical treatment of peri-implantitis can significantly improve MBL changes but not PD changes.
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Affiliation(s)
- Z-B Li
- Department of Periodontology, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University and Shandong Key Laboratory of Oral Tissue Regeneration and Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Jinan, Shandong, China; State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Diseases, School of Stomatology, Fourth Military Medical University, Xi'an, Shaanxi, China; Department of Periodontology, Jinan Stomatological Hospital, Jinan, China
| | - K Li
- Department of Periodontology, Jinan Stomatological Hospital, Jinan, China
| | - M Du
- School of Public Health, The University of Adelaide and Robinson Research Institute, The University of Adelaide, Adelaide, Australia
| | - S-B Ren
- Department of Stomatology, Medical Team of 66081 Troop of PLA, Zhangjiakou, China
| | - Y Yu
- Department of Periodontology, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University and Shandong Key Laboratory of Oral Tissue Regeneration and Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Jinan, Shandong, China.
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11
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Efficacy of concentrated growth factor versus collagen membrane in reconstructive surgical therapy of peri-implantitis: 3-year results of a randomized clinical trial. Clin Oral Investig 2022; 26:5247-5260. [PMID: 35618961 PMCID: PMC9381616 DOI: 10.1007/s00784-022-04493-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 04/13/2022] [Indexed: 11/29/2022]
Abstract
Objectives To compare the 3-year clinical and radiographic outcomes of two different reconstructive surgical management of peri-implantitis using a bone substitute in combination with either concentrated growth factor (CGF) or collagen membrane (CM). Material and methods Fifty-one patients who had at least one implant presenting peri-implantitis with an intrabony defect were filled with a xenogenic bone grafting material and covered either CGF or CM. Clinical and radiographic assessments were carried out at baseline and postoperative years 1 and 3. Three different composite outcomes were defined to evaluate treatment success at a 3-year follow-up. The effects of possible prognostic indicators on treatment success were identified by using multilevel regression analysis. Results The changes in probing depth (PD) and radiographic vertical defect depth (VDD) between baseline and year 1 and baseline and year 3 presented significantly greater decreases for the CM group in comparison with the CGF group (p < 0.05). No significant differences between the two treatment modalities were demonstrated regarding treatment success outcomes. History of periodontitis, VDD at baseline, and the number of intrabony defect walls revealed significant impacts on treatment success (p = 0.033; OR = 3.50, p = 0.039; OR = 0.975, and p = 0.024; OR = 7.0 and p = 0.019;OR = 6.0, respectively). Conclusions CM in combination with a bone substitute seems to have slightly better outcomes compared to the CGF membranes in reconstructive surgical therapy of peri-implantitis. The history of periodontitis, baseline VDD, and peri-implant bone defect configuration could be possible predictors influencing treatment success. Trial registration ClinicalTrials.gov NCT04769609. Clinical relevance For the reconstruction of peri-implant bone defects, using a bone substitute in combination with a collagen membrane may show more favorable outcomes.
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Čandrlić M, Tomas M, Karl M, Malešić L, Včev A, Perić Kačarević Ž, Matijević M. Comparison of Injectable Biphasic Calcium Phosphate and a Bovine Xenograft in Socket Preservation: Qualitative and Quantitative Histologic Study in Humans. Int J Mol Sci 2022; 23:ijms23052539. [PMID: 35269686 PMCID: PMC8910217 DOI: 10.3390/ijms23052539] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 02/21/2022] [Accepted: 02/24/2022] [Indexed: 02/04/2023] Open
Abstract
This study is the first histologic evaluation of an injectable biphasic calcium phosphate (IBCP) in humans six months after socket preservation according to the principles of guided bone regeneration. After tooth extraction, the alveolar ridge of 21 patients was augmented with IBCP (maxresorb® inject) in the test group, while 20 patients in the control group received a bovine xenograft (BX) (cerabone®). Six months after augmentation, a reentry procedure was performed to collect biopsies of regenerated bone for qualitative and quantitative histologic analysis. A total of 20 biopsies were taken for analysis. Qualitative histologic analysis showed complete integration of the biomaterial and no inflammatory tissue reaction, indicating the biocompatibility of the bone grafts and the surrounding tissue in both groups. Histomorphometric analysis showed comparable results in terms of newly formed bone (IBCP: 26.47 ± 14.71%, BX: 30.47 ± 16.39%) and residual biomaterial (IBCP: 13.1 ± 14.07%, BX: 17.89 ± 11.81%), with no significant difference found across groups (p > 0.05, Mann—Whitney U test). Statistical significance between groups was found in the result of soft tissue percentage (IBCP: 60.43 ± 12.73%, BX: 51.64 ± 14.63%, p = 0.046, Mann—Whitney U test). To conclude, IBCP and BX showed good osteoconductivity and biocompatibility with comparable new bone formation six months after alveolar ridge preservation.
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Affiliation(s)
- Marija Čandrlić
- Department of Dental Medicine, Faculty of Dental Medicine and Health Osijek, J. J. Strossmayer University of Osijek, 31000 Osijek, Croatia; (M.Č.); (M.T.); (M.K.)
- Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Matej Tomas
- Department of Dental Medicine, Faculty of Dental Medicine and Health Osijek, J. J. Strossmayer University of Osijek, 31000 Osijek, Croatia; (M.Č.); (M.T.); (M.K.)
| | - Matej Karl
- Department of Dental Medicine, Faculty of Dental Medicine and Health Osijek, J. J. Strossmayer University of Osijek, 31000 Osijek, Croatia; (M.Č.); (M.T.); (M.K.)
- Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, 31000 Osijek, Croatia
- Private Dental Practice Matej Karl, Prilaz Vilka Ivekovića 1, 31511 Belišće, Croatia
| | - Lucija Malešić
- Department of Anatomy, Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia;
| | - Aleksandar Včev
- Department of Pathophysiology, Physiology and Immunology, Faculty of Dental medicine and Health Osijek, J. J. Strossmayer University of Osijek, 31000 Osijek, Croatia;
| | - Željka Perić Kačarević
- Department of Anatomy, Histology, Embriology, Pathology Anatomy and Pathology Histology, Faculty of Dental Medicine and Health Osijek, J. J. Strossmayer University of Osijek, 31000 Osijek, Croatia
- Correspondence: (Ž.P.K.); (M.M.)
| | - Marko Matijević
- Community Healthcare Center of Osijek-Baranja County, 31000 Osijek, Croatia
- Correspondence: (Ž.P.K.); (M.M.)
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Ramanauskaite A, Fretwurst T, Schwarz F. Efficacy of alternative or adjunctive measures to conventional non-surgical and surgical treatment of peri-implant mucositis and peri-implantitis: a systematic review and meta-analysis. Int J Implant Dent 2021; 7:112. [PMID: 34779939 PMCID: PMC8593130 DOI: 10.1186/s40729-021-00388-x] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 10/06/2021] [Indexed: 12/26/2022] Open
Abstract
Purpose To evaluate the efficacy of alternative or adjunctive measures to conventional non-surgical or surgical treatment of peri-implant mucositis and peri-implantitis. Material and methods Prospective randomized and nonrandomized controlled studies comparing alternative or adjunctive measures, and reporting on changes in bleeding scores (i.e., bleed0ing index (BI) or bleeding on probing (BOP)), probing depth (PD) values or suppuration (SUPP) were searched. Results Peri-implant mucositis: adjunctive use of local antiseptics lead to greater PD reduction (weighted mean difference (WMD) = − 0.23 mm; p = 0.03, respectively), whereas changes in BOP were comparable (WMD = − 5.30%; p = 0.29). Non-surgical treatment of peri-implantitis: alternative measures for biofilm removal and systemic antibiotics yielded higher BOP reduction (WMD = − 28.09%; p = 0.01 and WMD = − 17.35%; p = 0.01, respectively). Surgical non-reconstructive peri-implantitis treatment: WMD in PD amounted to − 1.11 mm favoring adjunctive implantoplasty (p = 0.02). Adjunctive reconstructive measures lead to significantly higher radiographic bone defect fill/reduction (WMD = 56.46%; p = 0.01 and WMD = − 1.47 mm; p = 0.01), PD (− 0.51 mm; p = 0.01) and lower soft-tissue recession (WMD = − 0.63 mm; p = 0.01), while changes in BOP were not significant (WMD = − 11.11%; p = 0.11). Conclusions Alternative and adjunctive measures provided no beneficial effect in resolving peri-implant mucositis, while alternative measures were superior in reducing BOP values following non-surgical treatment of peri-implantitis. Adjunctive reconstructive measures were beneficial regarding radiographic bone-defect fill/reduction, PD reduction and lower soft-tissue recession, although they did not improve the resolution of mucosal inflammation. Supplementary Information The online version contains supplementary material available at 10.1186/s40729-021-00388-x.
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Affiliation(s)
- Ausra Ramanauskaite
- Department of Oral Surgery and Implantology, Johann Wolfgang Goethe-University Frankfurt, Carolinum, 60596, Frankfurt am Main, Germany
| | - Tobias Fretwurst
- Department of Oral- and Maxillofacial Surgery, Medical Center, Faculty of Medicine, University of Freiburg, University of Freiburg, Frankfurt, Germany
| | - Frank Schwarz
- Department of Oral Surgery and Implantology, Goethe University, Carolinum, Frankfurt, Germany.
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Canellas JVDS, Drugos L, Ritto FG, Fischer RG, Medeiros PJD. Xenograft materials in maxillary sinus floor elevation surgery: a systematic review with network meta-analyses. Br J Oral Maxillofac Surg 2021; 59:742-751. [PMID: 34120778 DOI: 10.1016/j.bjoms.2021.02.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 02/16/2021] [Indexed: 12/12/2022]
Abstract
A systematic review and network meta-analysis was conducted to compare different commercially available xenograft materials used in maxillary sinus floor elevation surgery (MSFES). Embase, PubMed, the Cochrane Library, Web of Science, Scopus, LILACS, and grey literature were searched up to 13 July 2020. Only randomised controlled trials (RCTs) were included. A frequentist network meta-analysis using a random effects model compared different commercially available xenograft materials. The primary outcomes were the percentage of newly-formed bone and residual bone-substitute rate. Both were measured by histomorphometric analysis from bone biopsies obtained during preparation of the implant site. Of the 659 studies initially identified, 11 involving 242 MSFES were included in the quantitative analyses. A total of six bone-substitute materials were analysed (Bio-Oss® (Geistlich Pharma), InduCera® Dual Coat, Lumina-Bone Porous® (Critéria), Osseous® (SIN - Sistema de Implantes Nacional), THE Graft® (Purgo Biologics), and Osteoplant Osteoxenon® (Bioteck)). The P-score estimation showed that Osteoplant Osteoxenon® produced the most newly-formed bone and reabsorbed faster than other xenograft materials after six months. The combination of Bio-Oss® plus bone marrow aspirate concentrate (BMAC) significantly increased the percentage of newly-formed bone compared with Bio-Oss® alone. In contrast, the addition of Emdogain® (Straumann) and leucocyte and platelet-rich fibrin (L-PRF) to Bio-Oss® did not significantly improve the amount of regenerated bone. Study-level data indicated that the percentage of newly-formed bone differs among commercially available xenograft materials. Osteoplant Osteoxenon® seems to result in the highest amount of new bone in MSFES.
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Affiliation(s)
- J V D S Canellas
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Rio de Janeiro State University, Rua Boulevard 28 de Setembro, 157 Vila Isabel, Rio de Janeiro, RJ 20551-030, Brazil.
| | - L Drugos
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Rio de Janeiro State University, Rua Boulevard 28 de Setembro, 157 Vila Isabel, Rio de Janeiro, RJ 20551-030, Brazil
| | - F G Ritto
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Rio de Janeiro State University, Rua Boulevard 28 de Setembro, 157 Vila Isabel, Rio de Janeiro, RJ 20551-030, Brazil
| | - R G Fischer
- Department of Periodontology, Faculty of Dentistry, Rio de Janeiro State University, Rua Boulevard 28 de Setembro, 157 Vila Isabel, Rio de Janeiro, RJ 20551-030, Brazil
| | - P J D Medeiros
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Rio de Janeiro State University, Rua Boulevard 28 de Setembro, 157 Vila Isabel, Rio de Janeiro, RJ 20551-030, Brazil
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Polymeri A, Anssari-Moin D, van der Horst J, Wismeijer D, Laine ML, Loos BG. Surgical treatment of peri-implantitis defects with two different xenograft granules: A randomized clinical pilot study. Clin Oral Implants Res 2020; 31:1047-1060. [PMID: 32803798 PMCID: PMC7693249 DOI: 10.1111/clr.13651] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 06/03/2020] [Accepted: 08/10/2020] [Indexed: 12/24/2022]
Abstract
Objectives To investigate whether xenograft EB (EndoBon) is non‐inferior to xenograft BO (Bio‐Oss) when used in reconstructive surgery of peri‐implant osseous defects. Materials and methods Dental patients with one implant each demonstrating peri‐implantitis were randomized to receive surgical debridement and defect fill with either BO or EB. Changes in bone level (BL) and intrabony defect depth (IDD) evaluated radiographically were the primary outcomes. The secondary outcomes included changes in probing pocket depth (PPD), bleeding on probing (BoP), and suppuration on probing (SoP). All outcomes were recorded before treatment and at 6 and 12 months post‐treatment. Results Twenty‐four patients (n = 11 BO, n = 13 EB) completed the study. Both groups demonstrated significant within‐group improvements in all clinical and radiographic parameters at 6 and 12 months (p ≤ .001). At 12 months, both groups presented with IDD reductions of 2.5–3.0 mm on average. The inter‐group differences were not statistically significant at all time points and for all the examined parameters (p > .05). While the radiographic defect fill in both groups exceeded > 1 mm and can be considered treatment success, successful treatment outcomes as defined by Consensus Reporting (no further bone loss, PPD ≤ 5 mm, no BOP, and no SoP) were identified in 2/11 (18%) BO and 0/13 (0%) EB individuals (Fisher's exact test, p = .199). Conclusions Within the limitations of this pilot study, the application of xenograft EB showed to be non‐inferior to xenograft BO when used in reconstructive surgery of peri‐implant osseous defects.
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Affiliation(s)
- Angeliki Polymeri
- Department of Periodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit, Amsterdam, The Netherlands
| | - David Anssari-Moin
- Department of Periodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit, Amsterdam, The Netherlands
| | - Joyce van der Horst
- Department Oral Implantology and Prosthodontics, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit, Amsterdam, The Netherlands
| | - Daniel Wismeijer
- Department Oral Implantology and Prosthodontics, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit, Amsterdam, The Netherlands
| | - Marja L Laine
- Department of Periodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit, Amsterdam, The Netherlands
| | - Bruno G Loos
- Department of Periodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit, Amsterdam, The Netherlands
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