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West N, Chapple I, Culshaw S, Donos N, Needleman I, Suvan J, Nibali L, Patel A, Preshaw PM, Kebschull M. BSP Implementation of prevention and treatment of peri-implant diseases - The EFP S3 level clinical practice guideline. J Dent 2024; 149:104980. [PMID: 38697506 DOI: 10.1016/j.jdent.2024.104980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 03/28/2024] [Indexed: 05/05/2024] Open
Abstract
OBJECTIVES to adapt the supranational European Federation of Periodontology (EFP) Prevention and Treatment of Peri-implant Diseases - The EFP S3 Level Clinical Practice Guideline for UK healthcare environment, taking into account a broad range of views from stakeholders and patients. SOURCES This UK version, based on the supranational EFP guideline [1] published in the Journal of Clinical Periodontology, was developed using S3-level methodology, combining assessment of formal evidence from 13 systematic reviews with a moderated consensus process of a representative group of stakeholders, and accounts for health equality, environmental factors and clinical effectiveness. It encompasses 55 clinical recommendations for the Prevention and Treatment of Peri-implant Diseases, based on the classification for periodontal and peri‑implant diseases and conditions [2]. METHODOLOGY The UK version was developed from the source guideline using a formal process called the GRADE ADOLOPMENT framework. This framework allows for adoption (unmodified acceptance), adaptation (acceptance with modifications) and the de novo development of clinical recommendations. Using this framework, following the S3-process, the underlying evidence was updated and a representative guideline group of 111 delegates from 26 stakeholder organisations was assembled into four working groups. Following the formal S3-process, all clinical recommendations were formally assessed for their applicability to the UK and adoloped accordingly. RESULTS AND CONCLUSION Using the ADOLOPMENT protocol, a UK version of the EFP S3-level clinical practice guideline for the Prevention and Treatment of Peri-implant Diseases was developed. This guideline delivers evidence- and consensus-based clinical recommendations of direct relevance to the UK healthcare community including the public. CLINICAL SIGNIFICANCE The S3-level-guidelines combine evaluation of formal evidence, grading of recommendations and synthesis with clinical expertise of a broad range of stakeholders. The international S3-level-guideline was implemented for direct clinical applicability in the UK healthcare system, facilitating a consistent, interdisciplinary, evidence-based approach with public involvement for the prevention and treatment of peri‑implant diseases.
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Affiliation(s)
- Nicola West
- Restorative Dentistry, Bristol Dental School, University of Bristol, Bristol BS1 2LY, UK; Restorative Dentistry, Bristol Dental Hospital, University Hospitals Bristol and Weston NHS Foundation Trust, Marlborough Street, Bristol BS1 3NU, UK; Secretary General, European Federation of Periodontology, 4 rue de la Presse, 1000, Brussels, Belgium.
| | - Iain Chapple
- Birmingham NIHR Biomedical Research Centre in Inflammation. The University of Birmingham, Birmingham, UK; Birmingham Community Healthcare NHS Foundation Trust, Birmingham, UK
| | - Shauna Culshaw
- University of Glasgow Dental School, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Nikos Donos
- Centre for Oral Clinical Research, Institute of Dentistry, Faculty of Medicine and Dentistry, Queen Mary University of London (AMUL), Turner Street, London, E1 2AD, UK
| | - Ian Needleman
- Unit of Periodontology, UCL Eastman Dental Institute, Bloomsbury Campus, Rockefeller Building, 21 University Street, London, WC1E 6DE, UK
| | - Jeanie Suvan
- Unit of Periodontology, UCL Eastman Dental Institute, Bloomsbury Campus, Rockefeller Building, 21 University Street, London, WC1E 6DE, UK
| | - Luigi Nibali
- Periodontology Unit, Centre for Host-Microbiome Interactions, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, Guys Hospital, Great Maze Pond, London, SE1 9RT, UK
| | - Amit Patel
- Birmingham Dental Specialists, President of the Association of Dental Implantology, University of Birmingham, Birmingham, UK
| | - Philip M Preshaw
- School of Dentistry, University of Dundee, Dundee UK; School of Dental Sciences, University of Newcastle, Newcastle upon Tyne, UK
| | - Moritz Kebschull
- Birmingham NIHR Biomedical Research Centre in Inflammation. The University of Birmingham, Birmingham, UK; Birmingham Community Healthcare NHS Foundation Trust, Birmingham, UK; Division of Periodontics, Section of Oral, Diagnostic and Rehabilitation Sciences, College of Dental Medicine, Columbia University, New York, NY, USA; School of Dentistry, University of Birmingham, President-Elect of the European Federation of Periodontology, Birmingham B5 7EG, UK.
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Matsuura T, Komatsu K, Suzumura T, Stavrou S, Juanatas ML, Park W, Ogawa T. Enhanced functionality and migration of human gingival fibroblasts on vacuum ultraviolet light-treated titanium: An implication for mitigating cellular stress to improve peri-implant cellular reaction. J Prosthodont Res 2024:JPR_D_24_00071. [PMID: 39198200 DOI: 10.2186/jpr.jpr_d_24_00071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2024]
Abstract
PURPOSE The maintenance of peri-implant health relies significantly on the integrity of the peri-implant seal, particularly vulnerable at the interface between implant abutment and soft tissue. Early healing stages around implants involve cellular exposure to oxidative stress. This study aimed to investigate whether vacuum ultraviolet (VUV)-treated titanium augments the growth and functionality of human gingival fibroblasts while mitigating cellular stress. METHODS Machined titanium plates underwent treatment with 172 nm VUV light for one minute, with untreated plates as controls. Human gingival fibroblasts were cultured on treated and untreated plates, and their behavior, growth, and functionality were assessed. Functionally impaired fibroblasts, treated with hydrogen peroxide, were also cultured on these titanium plates, and plate-to-plate transmigration ability was evaluated. RESULTS Fibroblasts on VUV-treated titanium exhibited a 50% reduction in intracellular reactive oxygen species production compared to controls. Additionally, glutathione, an antioxidant, remained undepleted in cells on VUV-treated titanium. Furthermore, the expression levels of inflammatory cytokines IL-1β and IL-8 decreased by 40-60% on VUV-treated titanium. Consequently, fibroblast attachment and proliferation doubled on VUV-treated titanium compared to those in the controls, leading to enhanced cell retention. Plate-to-plate transmigration assays demonstrated that fibroblasts migrated twice as far on VUV-treated surfaces compared to those in the controls. In particular, the transmigration ability, impaired in functionally impaired fibroblasts on the controls, was preserved on VUV-treated titanium. CONCLUSIONS VUV-treated titanium promotes the growth, function, and migration of human gingival fibroblasts by reducing cellular stress and enhancing antioxidative capacity. Notably, the transmigration ability significantly improved on VUV-treated titanium.
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Affiliation(s)
- Takanori Matsuura
- Weintraub Center for Reconstructive Biotechnology, UCLA School of Dentistry, Los Angeles, USA
- Department of Periodontology, Graduated School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Keiji Komatsu
- Weintraub Center for Reconstructive Biotechnology, UCLA School of Dentistry, Los Angeles, USA
| | - Toshikatsu Suzumura
- Weintraub Center for Reconstructive Biotechnology, UCLA School of Dentistry, Los Angeles, USA
| | - Stella Stavrou
- Division of Regenerative and Reconstructive Sciences, UCLA School of Dentistry, Los Angeles, USA
| | - Mary Lou Juanatas
- Division of Regenerative and Reconstructive Sciences, UCLA School of Dentistry, Los Angeles, USA
| | - Wonhee Park
- Weintraub Center for Reconstructive Biotechnology, UCLA School of Dentistry, Los Angeles, USA
- Department of Dentistry, College of Medicine, Hanyang University, Seoul, Korea
| | - Takahiro Ogawa
- Weintraub Center for Reconstructive Biotechnology, UCLA School of Dentistry, Los Angeles, USA
- Division of Regenerative and Reconstructive Sciences, UCLA School of Dentistry, Los Angeles, USA
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3
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Riben Grundström C, Lund B, Kämpe J, Belibasakis GN, Hultin M. Systemic antibiotics in the surgical treatment of peri-implantitis: A randomized placebo-controlled trial. J Clin Periodontol 2024; 51:981-996. [PMID: 38699828 DOI: 10.1111/jcpe.13994] [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: 09/22/2023] [Revised: 03/22/2024] [Accepted: 04/16/2024] [Indexed: 05/05/2024]
Abstract
AIM To study the clinical, radiographic and microbiological outcomes after surgical treatment of peri-implantitis, with or without adjunctive systemic antibiotics. MATERIALS AND METHODS Eighty-four patients (113 implants) with peri-implantitis were randomized into three groups (A, amoxicillin and metronidazole; B, phenoxymethylpenicillin and metronidazole; or C, placebo). Treatment included resective surgery and implant surface decontamination with adjunctive antibiotics or placebo. Primary outcomes were probing pocket depth (PPD) reduction and marginal bone level (MBL) stability. Secondary outcomes were treatment success (defined as PPD ≤ 5 mm, bleeding on probing [BOP] ≤ 1site, absence of suppuration on probing [SOP] and absence of progressive bone loss of >0.5 mm), changes in BOP/SOP, mucosal recession (REC), clinical attachment level (CAL), bacterial levels and adverse events. Outcomes were evaluated for up to 12 months. The impact of potential prognostic indicators on treatment success was evaluated using multilevel logistic regression analysis. RESULTS A total of 76 patients (104 implants) completed the study. All groups showed clinical and radiological improvements over time. Statistically significant differences were observed between groups for MBL stability (A = 97%, B = 89%, C = 76%), treatment success (A = 68%, B = 66%, C = 28%) and bacterial levels of Aggregatibacter actinomycetemcomitans and Tannerella forsythia, favouring antibiotics compared to placebo. Multiple regression identified antibiotic use as potential prognostic indicator for treatment success. Gastrointestinal disorders were the most reported adverse events in the antibiotic groups. CONCLUSIONS Adjunctive systemic antibiotics resulted in additional improvements in MBL stability. However, the potential clinical benefits of antibiotics need to be carefully balanced against the risk of adverse events and possible antibiotic resistance.
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Affiliation(s)
- Caroline Riben Grundström
- Department of Periodontology, Specialist Clinic Kaniken, Public Dental Health Service, Uppsala, Sweden
- Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden
| | - Bodil Lund
- Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden
- Medical Unit of Plastic Surgery and Oral and Maxillofacial Surgery, Department for Oral and Maxillofacial Surgery and Jaw Orthopedics, Karolinska University Hospital, Stockholm, Sweden
| | - Johan Kämpe
- Department of Plastic and Oral and Maxillofacial Surgery, Uppsala University Hospital, Uppsala, Sweden
| | | | - Margareta Hultin
- Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden
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Grodner B, Wu DT, Hahm S, Takayasu L, Wen N, Kim DM, Chen CY, De Vlaminck I. Microscale Spatial Dysbiosis in Oral biofilms Associated with Disease. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.07.24.604873. [PMID: 39211202 PMCID: PMC11360903 DOI: 10.1101/2024.07.24.604873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
Microbiome dysbiosis has largely been defined using compositional analysis of metagenomic sequencing data; however, differences in the spatial arrangement of bacteria between healthy and diseased microbiomes remain largely unexplored. In this study, we measured the spatial arrangement of bacteria in dental implant biofilms from patients with healthy implants, peri-implant mucositis, or peri-implantitis, an oral microbiome-associated inflammatory disease. We discovered that peri-implant biofilms from patients with mild forms of the disease were characterized by large single-genus patches of bacteria, while biofilms from healthy sites were more complex, mixed structures. Based on these findings, we propose a model of peri-implant dysbiosis where changes in biofilm spatial architecture allow the colonization of new community members. This model indicates that spatial structure could be used as a potential biomarker for community stability and has implications in diagnosis and treatment of peri-implant diseases. These results enhance our understanding of peri-implant disease pathogenesis and may be broadly relevant for spatially structured microbiomes.
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Cabanes-Gumbau G, Padulles-Roig E, Kois JC, Revilla-León M. Implant-supported prostheses following the biologically oriented preparation technique (BOPT) after implantoplasty procedures: A dental technique. J Prosthet Dent 2024:S0022-3913(24)00376-7. [PMID: 39004573 DOI: 10.1016/j.prosdent.2024.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 05/10/2024] [Accepted: 05/13/2024] [Indexed: 07/16/2024]
Abstract
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.
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Affiliation(s)
- Guillermo Cabanes-Gumbau
- Co-Director, Program in Pathology in Implant Dentistry, Implantology Department, La Salle University, EDE Formación, Madrid, Spain; and Private practice, Vila Real, Spain
| | - Esteban Padulles-Roig
- Co-Director, Program in Pathology in Implant Dentistry, Implantology Department, La Salle University, EDE Formación, Madrid, Spain
| | - John C Kois
- Founder and Director, Kois Center, Seattle, Wash.; Affiliate Professor, Graduate Prosthodontics, Department of Restorative Dentistry, University of Washington, Seattle, Wash.; and Private practice, Seattle, Wash
| | - Marta Revilla-León
- Affiliate Assistant Professor, Graduate Prosthodontics, Department of Restorative Dentistry, School of Dentistry, University of Washington, Seattle, Wash.; Faculty and Director, Research and Digital Dentistry, Kois Center, Seattle, Wash.; and Adjunct Professor, Department of Prosthodontics, School of Dental Medicine, Tufts University, Boston, Mass.
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6
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Monje A, Salvi GE. Diagnostic methods/parameters to monitor peri-implant conditions. Periodontol 2000 2024. [PMID: 38923148 DOI: 10.1111/prd.12584] [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: 02/06/2024] [Revised: 05/18/2024] [Accepted: 05/31/2024] [Indexed: 06/28/2024]
Abstract
The diagnostic accuracy of clinical parameters, including visual inspection and probing to monitor peri-implant conditions, has been regarded with skepticism. Scientific evidence pointed out that primary diagnostic tools (chairside) seem to be highly specific, while their sensitivity is lower compared with their use in monitoring periodontal stability. Nonetheless, given the association between pocket depth at teeth and implant sites and the aerobic/anaerobic nature of the microbiome, it seems plausible for pocket probing depth to be indicative of disease progression or tissue stability. In addition, understanding the inflammatory nature of peri-implant diseases, it seems reasonable to advocate that bleeding, erythema, ulceration, and suppuration might be reliable indicators of pathology. Nevertheless, single spots of bleeding on probing may not reflect peri-implant disease, since implants are prone to exhibit bleeding related to probing force. On the other side, bleeding in smokers lacks sensitivity owing to the decreased angiogenic activity. Hence, the use of dichotomous scales on bleeding in the general population, in contrast to indices that feature profuseness and time after probing, might lead to false positive diagnoses. The definitive distinction between peri-implant mucositis and peri-implantitis, though, relies upon the radiographic evidence of progressive bone loss that can be assessed by means of two- and three-dimensional methods. Accordingly, the objective of this review is to evaluate the existing clinical and radiographic parameters/methods to monitor peri-implant conditions.
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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
| | - Giovanni E Salvi
- Department of Periodontology, University of Bern, Bern, Switzerland
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Matthes R, Jablonowski L, Pitchika V, Holtfreter B, Eberhard C, Gerling T, Wagner J, Flörke C, Eisenbeiß AK, Cosgarea R, Jepsen K, Bunke J, Ramanauskaite A, Begić A, Obreja K, Mksoud M, Kocher T. Training in the use of the water jet and cold atmospheric plasma jet for the decontamination of dental implants. Clin Oral Investig 2024; 28:355. [PMID: 38833072 PMCID: PMC11150293 DOI: 10.1007/s00784-024-05749-5] [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: 01/03/2024] [Accepted: 05/27/2024] [Indexed: 06/06/2024]
Abstract
OBJECTIVES Clinical trials testing new devices require prior training on dummies to minimize the "learning curve" for patients. Dentists were trained using a novel water jet device for mechanical cleaning of dental implants and with a novel cold plasma device for surface functionalisation during a simulated open flap peri-implantitis therapy. The hypothesis was that there would be a learning curve for both devices. MATERIALS AND METHODS 11 dentists instrumented 44 implants in a dummy-fixed jaw model. The effect of the water jet treatment was assessed as stain removal and the effect of cold plasma treatment as surface wettability. Both results were analysed using photographs. To improve treatment skills, each dentist treated four implants and checked the results immediately after the treatment as feedback. RESULTS Water jet treatment significantly improved from the first to the second implant from 62.7% to 75.3% stain removal, with no further improvement up to the fourth implant. The wettability with cold plasma application reached immediately a high level at the first implant and was unchanged to the 4th implant (mean scores 2.7 out of 3). CONCLUSION A moderate learning curve was found for handling of the water jet but none for handling of the cold plasma. CLINICAL RELEVANCE Scientific rational for study: Two new devices were developed for peri-implantitis treatment (Dental water jet, cold plasma). Dentists were trained in the use of these devices prior to the trial to minimize learning effects. PRINCIPAL FINDINGS Experienced dentists learn the handling of the water jet very rapidly and for cold plasma they do not need much training. PRACTICAL IMPLICATIONS A clinical study is in process. When the planned clinical study will be finished, we will find out, if this dummy head exercise really minimised the learning curve for these devices.
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Grants
- 13N14478, 13N14479, 13N14480 Bundesministerium für Bildung und Forschung
- 13N14478, 13N14479, 13N14480 Bundesministerium für Bildung und Forschung
- 13N14478, 13N14479, 13N14480 Bundesministerium für Bildung und Forschung
- 13N14478, 13N14479, 13N14480 Bundesministerium für Bildung und Forschung
- 13N14478, 13N14479, 13N14480 Bundesministerium für Bildung und Forschung
- 13N14478, 13N14479, 13N14480 Bundesministerium für Bildung und Forschung
- Universitätsmedizin Greifswald (8976)
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Affiliation(s)
- Rutger Matthes
- Department of Restorative Dentistry, Periodontology, Endodontology, Preventive Dentistry and Pedodontics, Dental School, University Medicine Greifswald, Fleischmannstr. 42, 17475, Greifswald, Germany
| | - Lukasz Jablonowski
- Department of Restorative Dentistry, Periodontology, Endodontology, Preventive Dentistry and Pedodontics, Dental School, University Medicine Greifswald, Fleischmannstr. 42, 17475, Greifswald, Germany
| | - Vinay Pitchika
- Department of Restorative Dentistry, Periodontology, Endodontology, Preventive Dentistry and Pedodontics, Dental School, University Medicine Greifswald, Fleischmannstr. 42, 17475, Greifswald, Germany
- Department of Oral Diagnostics, Digital Health and Health Services Research, Charité-Universitätsmedizin Berlin, Aßmannshauser Str. 4-6, 14197, Berlin, Germany
| | - Birte Holtfreter
- Department of Restorative Dentistry, Periodontology, Endodontology, Preventive Dentistry and Pedodontics, Dental School, University Medicine Greifswald, Fleischmannstr. 42, 17475, Greifswald, Germany
| | | | - Torsten Gerling
- Leibniz-Institute for Plasma Science and Technology e.V. (INP), ZIK plasmatis, Greifswald, Germany
| | - Juliane Wagner
- Department of Oral and Maxillofacial Surgery, Christian-Albrechts University Kiel, Kiel, Germany
| | - Christian Flörke
- Department of Oral and Maxillofacial Surgery, Christian-Albrechts University Kiel, Kiel, Germany
| | - Anne-Katrin Eisenbeiß
- Department of Oral and Maxillofacial Surgery, Christian-Albrechts University Kiel, Kiel, Germany
| | - Raluca Cosgarea
- Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, Bonn, Germany
- Clinic for Periodontology and Peri-implant Diseases, University of Marburg, Marburg, Germany
- Iuliu-Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Karin Jepsen
- Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, Bonn, Germany
| | - Jennifer Bunke
- Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, Bonn, Germany
| | - Ausra Ramanauskaite
- Department of Oral Surgery and Implantology, Johann Wolfgang Goethe-University, Carolinum, Frankfurt, Germany
| | - Amira Begić
- Department of Oral Surgery and Implantology, Johann Wolfgang Goethe-University, Carolinum, Frankfurt, Germany
| | - Karina Obreja
- Department of Oral Surgery and Implantology, Johann Wolfgang Goethe-University, Carolinum, Frankfurt, Germany
| | - Maria Mksoud
- Department of Oral and Maxillofacial Surgery/Plastic Surgery, University Medicine Greifswald, Greifswald, Germany
| | - Thomas Kocher
- Department of Restorative Dentistry, Periodontology, Endodontology, Preventive Dentistry and Pedodontics, Dental School, University Medicine Greifswald, Fleischmannstr. 42, 17475, Greifswald, Germany.
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Hu B, Qiao W, Cao Y, Fu X, Song J. A sono-responsive antibacterial nanosystem co-loaded with metformin and bone morphogenetic protein-2 for mitigation of inflammation and bone loss in experimental peri-implantitis. Front Bioeng Biotechnol 2024; 12:1410230. [PMID: 38854857 PMCID: PMC11157067 DOI: 10.3389/fbioe.2024.1410230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Accepted: 05/06/2024] [Indexed: 06/11/2024] Open
Abstract
Background Dental implants have become an increasingly popular option for replacing missing teeth, and the prevalence of peri-implantitis has also increased, which is expected to become a public health problem worldwide and cause high economic and health burdens. This scenario highlights the need for new therapeutic options to treat peri-implantitis. Methods In this study, we proposed a novel sono-responsive antibacterial nanosystem co-loaded with metformin (Met) and bone morphogenetic protein-2 (BMP-2) to promote efficacy in treating peri-implantitis. We introduced the zeolitic imidazolate framework-8 (ZIF-8) as a carrier for hematoporphyrin monomethyl ether (HMME) to enhance the antibacterial effect of sonodynamic antibacterial therapy and tested its reactive oxygen species (ROS) production efficiency and bactericidal effect in vitro. Afterward, HMME-loaded ZIF-8, BMP-2-loaded polylactic acid-glycolic acid (PLGA), and Met were incorporated into gelatin methacryloyl (GelMA) hydrogels to form HMME@ZIF-8/Met/BMP-2@PLGA/GelMA composite hydrogels, and the biocompatibility of which was determined in vitro and in vivo. A bacterial-induced peri-implantitis model in the maxilla of rats was established to detect the effects of the composite hydrogels with adjunctive use of ultrasound on regulating inflammation and promoting bone tissue repair in vivo. Results The results indicated that HMME@ZIF-8 with ultrasound stimulation demonstrated more better ROS production efficiency and antimicrobial efficacy. The composite hydrogels had good biocompatibility. Ultrasound-assisted application of the composite hydrogels reduced the release of the inflammatory factors IL-6 and TNF-α and reduced bone loss around the implant in rats with bacterial-induced peri-implantitis. Conclusion Our observations suggest that HMME@ZIF-8 may be a new good sonosensitizer material for sonodynamic antibacterial therapy. The use of HMME@ZIF-8/Met/BMP-2@PLGA/GelMA composite hydrogels in combination with ultrasound can provide a novel option for treating peri-implantitis in the future.
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Affiliation(s)
- Bo Hu
- College of Stomatology, Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Oral Diseases, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Wang Qiao
- Department of Stomatology, Shapingba Hospital Affiliated to Chongqing University, Chongqing, China
| | - Yang Cao
- Chongqing Key Laboratory of Ultrasound Molecular Imaging, Institute of Ultrasound Imaging, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaoming Fu
- College of Stomatology, Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Oral Diseases, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Jinlin Song
- College of Stomatology, Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Oral Diseases, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
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9
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Haude S, Matthes R, Pitchika V, Holtfreter B, Schlüter R, Gerling T, Kocher T, Jablonowski L. In-vitro biofilm removal from TiUnite® implant surface with an air polishing and two different plasma devices. BMC Oral Health 2024; 24:558. [PMID: 38741081 DOI: 10.1186/s12903-024-04230-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 04/04/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND We investigated the efficacy of two different cold atmospheric pressure jet plasma devices (CAP09 and CAPmed) and an air polishing device with glycine powder (AP) either applied as monotherapies or combined therapies (AP + CAP09; AP + CAPmed), in microbial biofilm removal from discs with anodised titanium surface. METHODS Discs covered with 7-day-old microbial biofilm were treated either with CAP09, CAPmed, AP, AP + CAP09 or AP + CAPmed and compared with negative and positive controls. Biofilm removal was assessed with flourescence and electron microscopy immediately after treatment and after 5 days of reincubation of the treated discs. RESULTS Treatment with CAP09 or CAPmed did not lead to an effective biofilm removal, whereas treatment with AP detached the complete biofilm, which however regrew to baseline magnitude after 5 days of reincubation. Both combination therapies (AP + CAP09 and AP + CAPmed) achieved a complete biofilm removal immediately after cleaning. However, biofilm regrew after 5 days on 50% of the discs treated with the combination therapy. CONCLUSION AP treatment alone can remove gross biofilm immediately from anodised titanium surfaces. However, it did not impede regrowth after 5 days, because microorganisms were probably hidden in holes and troughs, from which they could regrow, and which were inaccessible to AP. The combination of AP and plasma treatment probably removed or inactivated microorganisms also from these hard to access spots. These results were independent of the choice of plasma device.
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Affiliation(s)
- Sandra Haude
- Department of Restorative Dentistry, Periodontology, Endodontology, Preventive Dentistry and Paediatric Dentistry, Dental School, University Medicine Greifswald, Walther-Rathenau-Str. 42a, Greifswald, D - 17475, Germany
| | - Rutger Matthes
- Department of Restorative Dentistry, Periodontology, Endodontology, Preventive Dentistry and Paediatric Dentistry, Dental School, University Medicine Greifswald, Walther-Rathenau-Str. 42a, Greifswald, D - 17475, Germany
| | - Vinay Pitchika
- Department of Restorative Dentistry, Periodontology, Endodontology, Preventive Dentistry and Paediatric Dentistry, Dental School, University Medicine Greifswald, Walther-Rathenau-Str. 42a, Greifswald, D - 17475, Germany
| | - Birte Holtfreter
- Department of Restorative Dentistry, Periodontology, Endodontology, Preventive Dentistry and Paediatric Dentistry, Dental School, University Medicine Greifswald, Walther-Rathenau-Str. 42a, Greifswald, D - 17475, Germany
| | - Rabea Schlüter
- Imaging Center of the Department of Biology, University of Greifswald, Greifswald, Germany
| | - Torsten Gerling
- ZIK Plasmatis, Leibniz-Institute for Plasma Science and Technology e.V. (INP), a member of the Leibniz Research Alliance Leibniz Health Technology, Greifswald, Germany
| | - Thomas Kocher
- Department of Restorative Dentistry, Periodontology, Endodontology, Preventive Dentistry and Paediatric Dentistry, Dental School, University Medicine Greifswald, Walther-Rathenau-Str. 42a, Greifswald, D - 17475, Germany
| | - Lukasz Jablonowski
- Department of Restorative Dentistry, Periodontology, Endodontology, Preventive Dentistry and Paediatric Dentistry, Dental School, University Medicine Greifswald, Walther-Rathenau-Str. 42a, Greifswald, D - 17475, Germany.
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Saleh MHA, Dias DR, Kumar P. The economic and societal impact of periodontal and peri-implant diseases. Periodontol 2000 2024. [PMID: 38693603 DOI: 10.1111/prd.12568] [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: 02/01/2024] [Accepted: 03/26/2024] [Indexed: 05/03/2024]
Abstract
Periodontal and peri-implant diseases result from a chronic inflammatory response to dysbiotic microbial communities and are characterized by inflammation in the soft tissue and the ensuing progressive destruction of supporting bone, resulting in tooth or implant loss. These diseases' high prevalence, multifactorial etiology, extensive treatment costs, and significant detriment to patients' quality-of-life underscore their status as a critical public health burden. This review delineates the economic and sociocultural ramifications of periodontal and peri-implant diseases on patient welfare and healthcare economics. We delve into the implications of diagnosis, treatment, supportive care, and managing destructive tissue consequences, contrasting these aspects with healthy patients.
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Affiliation(s)
- Muhammad H A Saleh
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Debora R Dias
- Department of Dentistry, State University of Maringá, Maringá, Paraná, Brazil
| | - Purnima Kumar
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
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11
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Roccuzzo M, Mirra D, Roccuzzo A. Surgical treatment of peri-implantitis. Br Dent J 2024; 236:803-808. [PMID: 38789758 PMCID: PMC11126382 DOI: 10.1038/s41415-024-7405-9] [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: 02/13/2024] [Revised: 04/22/2024] [Accepted: 04/22/2024] [Indexed: 05/26/2024]
Abstract
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.
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Affiliation(s)
- Mario Roccuzzo
- Private Practice, Torino, Italy; Division of Maxillofacial Surgery, University of Torino, Italy; Department of Periodontics and Oral Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | | | - 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.
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12
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Halstenbach T, Topitsch A, Schilling O, Iglhaut G, Nelson K, Fretwurst T. Mass spectrometry-based proteomic applications in dental implants research. Proteomics Clin Appl 2024; 18:e2300019. [PMID: 38342588 DOI: 10.1002/prca.202300019] [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: 07/21/2023] [Revised: 12/07/2023] [Accepted: 12/21/2023] [Indexed: 02/13/2024]
Abstract
Dental implants have been established as successful treatment options for missing teeth with steadily increasing demands. Today, the primary areas of research in dental implantology revolve around osseointegration, soft and hard tissue grafting as well as peri-implantitis diagnostics, prevention, and treatment. This review provides a comprehensive overview of the current literature on the application of MS-based proteomics in dental implant research, highlights how explorative proteomics provided insights into the biology of peri-implant soft and hard tissues and how proteomics facilitated the stratification between healthy and diseased implants, enabling the identification of potential new diagnostic markers. Additionally, this review illuminates technical aspects, and provides recommendations for future study designs based on the current evidence.
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Affiliation(s)
- Tim Halstenbach
- Department of Oral- and Craniomaxillofacial Surgery/Translational Implantology, Division of Regenerative Oral Medicine, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, Germany
| | - Annika Topitsch
- Department of Oral- and Craniomaxillofacial Surgery/Translational Implantology, Division of Regenerative Oral Medicine, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, Germany
- Institute of Surgical Pathology, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg, Germany
- Spemann Graduate School of Biology and Medicine (SGBM), University of Freiburg, Freiburg, Germany
- Faculty of Biology, University of Freiburg, Freiburg, Germany
| | - Oliver Schilling
- Institute of Surgical Pathology, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg, Germany
| | - Gerhard Iglhaut
- Department of Oral- and Craniomaxillofacial Surgery/Translational Implantology, Division of Regenerative Oral Medicine, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, Germany
| | - Katja Nelson
- Department of Oral- and Craniomaxillofacial Surgery/Translational Implantology, Division of Regenerative Oral Medicine, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, Germany
| | - Tobias Fretwurst
- Department of Oral- and Craniomaxillofacial Surgery/Translational Implantology, Division of Regenerative Oral Medicine, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, Germany
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13
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Romandini M, Bougas K, Alibegovic L, Hosseini S, Carcuac O, Berglundh T, Derks J. Long-term outcomes and prognostic factors of surgical treatment of peri-implantitis - A retrospective study. Clin Oral Implants Res 2024; 35:321-329. [PMID: 38112108 DOI: 10.1111/clr.14228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 11/27/2023] [Accepted: 12/08/2023] [Indexed: 12/20/2023]
Abstract
AIM To evaluate long-term outcomes and prognostic factors of non-reconstructive surgical treatment of peri-implantitis. MATERIALS AND METHODS One hundred forty-nine patients (267 implants) were surgically treated for peri-implantitis and followed for an average of 7.0 (SD: 3.6) years. The primary outcome was implant loss. Additional bone loss and surgical retreatment were secondary outcomes. Patient/implant characteristics, as well as clinical and radiographic parameters collected prior to initial surgery, were evaluated as potential predictors of implant loss. Flexible parametric survival models using restricted cubic spline functions were used; 5- and 10-year predicted rates of implant loss were calculated according to different scenarios. RESULTS Fifty-three implants (19.9%) in 35 patients (23.5%) were lost during the observation period. Implant loss occurred after a mean period of 4.4 (SD: 3.0) years and was predicted by implant surface characteristics (modified surface; HR 4.5), implant length (HR 0.8 by mm), suppuration at baseline (HR 2.7) and disease severity (baseline bone loss: HR 1.2 by mm). Estimates of 5- and 10-year implant loss ranged from 1% (best prognostic scenario; initial bone loss <40% of implant length, turned implant surface and absence of suppuration on probing (SoP)) to 63% (worst prognostic scenario; initial bone loss ≥60% of implant length, modified implant surface and SoP) and from 3% to 89%, respectively. Surgical retreatment was performed at 65 implants (24.3%) in 36 patients (24.2%) after a mean time period of 4.5 (3.1) years. In all, 59.5% of implants showed additional bone loss, were surgically retreated or lost. CONCLUSIONS Recurrence of disease is common following surgical treatment of peri-implantitis. The strongest predictor for implant loss was implant surface characteristics. Implant length as well as suppuration and disease severity at baseline were also relevant factors.
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Affiliation(s)
- Mario Romandini
- Department of Periodontology, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Kostas Bougas
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Public Dental Service, Region Västra Götaland, Vanersborg, Sweden
| | - Lamija Alibegovic
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Public Dental Service, Region Västra Götaland, Vanersborg, Sweden
| | - Sara Hosseini
- Public Dental Service, Region Västra Götaland, Vanersborg, Sweden
| | - Olivier Carcuac
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Tord Berglundh
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Jan Derks
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Public Dental Service, Region Västra Götaland, Vanersborg, Sweden
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14
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Kong J, Cheng W, Chang L, Yu J, Wang R, Xie J. Effects of HMGB1/TLR4 on secretion IL-10 and VEGF in human jaw bone-marrow mesenchymal stem cells. J Appl Oral Sci 2024; 32:e20230304. [PMID: 38359267 PMCID: PMC10984578 DOI: 10.1590/1678-7757-2023-0304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/20/2023] [Accepted: 12/13/2023] [Indexed: 02/17/2024] Open
Abstract
OBJECTIVE We aimed to investigate the regulatory effects of HMGB1/TLR4 signaling pathway on the expression of IL-10 and VEGF in human bone marrow mesenchymal stem cells. METHODOLOGY Human JBMSCs were isolated and cultured. Then, HMGB1 was added into the JBMSCs culture medium, and the protein and mRNA expression levels of IL-10 and VEGF were assessed. Moreover, cells were pretreated with a specific TLR4 inhibitor (TAK-242), and the expression changes of IL-10 and VEGF were compared. RESULTS Compared with the control group, exposure to HMGB1 in human JBMSCs up-regulated TLR4, IL-10, and VEGF secretion at both protein and mRNA levels (P<0. 05). In addition, the increased expression of IL-10 and VEGF could be restrained in TAK-242 group compared with the HMGB1 group (P<0.05). CONCLUSIONS The results indicated that HMGB1 activate TLR4 signaling pathway in Human JBMSCs, which plays a regulatory role in cytokines expression.
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Affiliation(s)
- Jingjing Kong
- Jinan Stomatological HospitalDepartment of ProsthodonticsChinaJinan Stomatological Hospital, Department of Prosthodontics, Shandong Province, China.
| | - Wei Cheng
- Jinan Stomatological HospitalDepartment of ProsthodonticsChinaJinan Stomatological Hospital, Department of Prosthodontics, Shandong Province, China.
| | - Lianzhen Chang
- Jinan Stomatological HospitalDepartment of PeriodontistChinaJinan Stomatological Hospital, Department of Periodontist, Shandong Province, China.
| | - Jingyi Yu
- Jinan Stomatological HospitalDepartment of ProsthodonticsChinaJinan Stomatological Hospital, Department of Prosthodontics, Shandong Province, China.
| | - Ronglin Wang
- Jinan Stomatological HospitalDepartment of ProsthodonticsChinaJinan Stomatological Hospital, Department of Prosthodontics, Shandong Province, China.
| | - Jianli Xie
- Jinan Stomatological HospitalDepartment of ProsthodonticsChinaJinan Stomatological Hospital, Department of Prosthodontics, Shandong Province, China.
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15
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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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16
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Wang CW, Di Gianfilippo R, Kaciroti N, Ou A, Feng SW, Wang HL. Stability of peri-implantitis surgical reconstructive therapy-a (> 2 years) follow-up of a randomized clinical trial. Clin Oral Investig 2023; 28:30. [PMID: 38147180 DOI: 10.1007/s00784-023-05457-6] [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: 08/07/2023] [Accepted: 12/18/2023] [Indexed: 12/27/2023]
Abstract
OBJECTIVES This follow-up study aimed to report the 24- and 30-month outcomes of a cohort previously enrolled in a randomized clinical trial on surgical reconstructive treatment of peri-implantitis. METHODS Twenty-four patients were diagnosed with peri-implantitis and treated with surgical reconstructive therapy with or without the adjunctive use of Er:YAG laser. Within-group and between-group comparisons were tested with mixed model with repeated measures. RESULTS Regarding peri-implant pocket depth (PPD) reduction (control vs. laser test group) between 6 months (- 1.85 vs. - 2.65 mm) and 30 months (- 1.84 vs. - 3.04 mm), the laser group showed statistically significant changes but not the control group. In terms of radiographic marginal bone loss (RMBL) at 6 months (- 1.1 vs. - 1.46 mm) to 24 months (- 1.96 vs. - 2.82 mm), both groups showed statistical difference compared to baseline. The six explanted implants all were featured by severe peri-implantitis and mostly with no or limited keratinized tissue (< 2 mm) at baseline and membrane exposure after surgery. Among the 15 retained cases, eight cases achieved more than 50% peri-implant bone level gain. CONCLUSIONS Within the limitation and follow-up time frame of this trial, the outcome of the surgical reconstructive therapy sustained or improved in most of the cases. However, 25% of the implants with severe peri-implantitis failed 2 years after the surgical reconstructive therapy. The use of Er:YAG laser favors PPD reduction in the longer term up to 30 months. CLINICAL RELEVANCE Longer-term follow-up on reconstructive therapy of peri-implantitis revealed sustained or improved stability in certain cases, but the survival of implants with severe peri-implantitis has its limitation, especially when there is limited keratinized tissue (< 2 mm or no KT). TRIAL REGISTRATION Clinical Trials Registration Number: NCT03127228 and HUM00160290.
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Affiliation(s)
- Chin-Wei Wang
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA.
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan.
- Department of Dentistry, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan.
| | - Riccardo Di Gianfilippo
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Niko Kaciroti
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
| | - Alice Ou
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Sheng-Wei Feng
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Dentistry, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan
| | - Hom-Lay Wang
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
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17
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Ramanauskaite A, Becker K, Cafferata EA, Schwarz F. Clinical efficacy of guided bone regeneration in peri-implantitis defects. A network meta-analysis. Periodontol 2000 2023; 93:236-253. [PMID: 37490412 DOI: 10.1111/prd.12510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 05/17/2023] [Accepted: 06/19/2023] [Indexed: 07/27/2023]
Abstract
Guided bone regeneration (GBR) at peri-implantitis-related bone defects involves the placement of bone-filler particles in the intrabony defects and the application of a barrier membrane. The efficacy of different GBR-supported reconstructive measures as well as their potential superiority compared to non-GBR-supported treatment strategies for bone defects at peri-implantitis sites, however, remains unclear. Therefore, this analysis was designed to evaluate the long-term (≥12 months) clinical efficacy of GBR-supported reconstructive surgical therapy for peri-implantitis-related bone defects. In terms of resolving inflammation, the implementation of GBR protocols applying xenogenic bone substitutes yielded a higher reduction of bleeding on probing and probing depth value compared to the GBR protocol applying autogenous bone. Furthermore, for the changes in bleeding on probing and probing depths, GBR approaches using xenogenic bone showed superiority over the non-GBR treatments. Xenogenic bone with or without a barrier membrane was associated with improved radiographic bone levels and less soft tissue recession compared to the use of a GBR protocol implementing autogenous bone. Nonetheless, when interpreting this findings, the limited number of available studies with low to serious risk of bias and the short follow-up periods limited to 12 months should be considered.
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Affiliation(s)
- Ausra Ramanauskaite
- Department of Oral Surgery and Implantology, Goethe University, Carolinum, Frankfurt, Germany
| | - Kathrin Becker
- Department of Orthodontics, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Emilio A Cafferata
- Department of Oral Surgery and Implantology, Goethe University, Carolinum, Frankfurt, Germany
- Department of Periodontology, School of Dentistry, Universidad Científica del Sur, Lima, Peru
| | - Frank Schwarz
- Department of Oral Surgery and Implantology, Goethe University, Carolinum, Frankfurt, Germany
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18
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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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Ichioka Y, Trullenque-Eriksson A, Ortiz-Vigón A, Guerrero A, Donati M, Bressan E, Ghensi P, Schaller D, Tomasi C, Karlsson K, Abrahamsson I, Dionigi C, Regidor E, Berglundh T, Derks J. Factors influencing outcomes of surgical therapy of peri-implantitis: A secondary analysis of 1-year results from a randomized clinical study. J Clin Periodontol 2023; 50:1282-1304. [PMID: 37461197 DOI: 10.1111/jcpe.13848] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 06/15/2023] [Accepted: 06/24/2023] [Indexed: 09/14/2023]
Abstract
AIM To identify predictors of treatment outcomes following surgical therapy of peri-implantitis. MATERIALS AND METHODS We performed a secondary analysis of data from a randomized controlled trial (RCT) comparing access flap with or without bone replacement graft. Outcomes at 12 months were probing pocket depth (PPD), bleeding on probing (BOP), soft-tissue recession (REC) and marginal bone level (MBL) change. Multilevel regression analyses were used to identify predictors. We also built an explanatory model for residual signs of inflammation. RESULTS Baseline PPD was the most relevant predictor, showing positive associations with final PPD, REC and MBL gain, and negative association with probability of pocket closure. Smokers presented higher residual PPD. Absence of keratinized mucosa at baseline increased the probability of BOP but was otherwise not indicative of outcomes. Plaque at 6 weeks was detrimental in terms of residual PPD and BOP. Treatment allocation had an effect on REC. Final BOP was explained by residual PPD ≥6 mm and plaque at more than two sites. CONCLUSIONS Baseline PPD was the most relevant predictor of the outcomes of surgical therapy of peri-implantitis. Pocket closure should be a primary goal of treatment. Bone replacement grafts may be indicated in aesthetically demanding cases to reduce soft-tissue recession. The importance of smoking cessation and patient-performed plaque control is also underlined.
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Affiliation(s)
- Yuki Ichioka
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Anna Trullenque-Eriksson
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Alberto Ortiz-Vigón
- Clínica Ortiz-Vigón, PerioCentrum, Bilbao, Spain
- ETEP Research Group, Faculty of Odontology, University Complutense of Madrid, Madrid, Spain
| | | | - Mauro Donati
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Eriberto Bressan
- Department of Neuroscience, Faculty of Odontology, University of Padua, Padua, Italy
| | - Paolo Ghensi
- Department CIBIO, University of Trento, Trento, Italy
| | | | - Cristiano Tomasi
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Karolina Karlsson
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Clinic of Periodontics, Public Dental Service, Region Västra Götaland, Gothenburg, Sweden
| | - Ingemar Abrahamsson
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Clinic of Periodontics, Public Dental Service, Region Västra Götaland, Gothenburg, Sweden
| | - Carlotta Dionigi
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Erik Regidor
- Clínica Ortiz-Vigón, PerioCentrum, Bilbao, Spain
| | - Tord Berglundh
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Clinic of Periodontics, Public Dental Service, Region Västra Götaland, Gothenburg, Sweden
| | - Jan Derks
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Clinic of Periodontics, Public Dental Service, Region Västra Götaland, Gothenburg, Sweden
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20
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Baus-Domínguez M, Bakkali S, Hermida-Cabrera P, Serrera-Figallo MA, Gutiérrez-Pérez JL, Torres-Lagares D. A Systematic Review and Meta-Analysis of Systemic and Local Antibiotic Therapy in the Surgical Treatment of Peri-Implantitis. Antibiotics (Basel) 2023; 12:1223. [PMID: 37508319 PMCID: PMC10376060 DOI: 10.3390/antibiotics12071223] [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: 06/26/2023] [Revised: 07/12/2023] [Accepted: 07/20/2023] [Indexed: 07/30/2023] Open
Abstract
(1) Background: Given the existing controversy regarding the use of antibiotics in the treatment of peri-implantitis, this systematic review and meta-analysis aim to ascertain how beneficial the role of systemic and local antibiotics is in peri-implant surgical therapy, considering the harmful effects that they represent and the abuse of antibiotics in terms of global health. (2) Methods: To determine the therapeutic efficacy of the administration of antibiotics in the surgical treatment of peri-implantitis in terms of probing pocket depth (PPD) and bleeding on probing (BoP), electronic and manual bibliographic searches were carried out in the Embase and PubMed databases, collecting data that related to before and after treatment. (3) Results: The adjunctive use of local antibiotics provides significant improvements in PPD (MD = 1.29; 95% CI: 0.56 to 2.02; p ≤ 0.0006; I2 = 0%) when compared with surgical treatment alone. No significant differences were found in the other subgroup; that is, the use of systemic antibiotics did not significantly improve PPD changes in the surgical treatment of peri-implantitis (MD = 0.40; 95% CI: -0.15 to 0.95; p = 0.15; I2 = 0). (4) Conclusions: The use of local antibiotics in the surgical treatment of peri-implantitis seems to offer treatment improvements in terms of PPD and BoP, unlike that observed with the use of systemic antibiotics. However, these results should be taken with caution as they also depend on the type of surgical technique used, whether regenerative or resective. More research is needed on this topic to understand the role of local and systemic antibiotics in the treatment of peri-implantitis.
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Affiliation(s)
- María Baus-Domínguez
- Departamento de Estomatología, Facultad de Odontología, Universidad de Sevilla, 41009 Sevilla, Spain
| | - Sara Bakkali
- Departamento de Estomatología, Facultad de Odontología, Universidad de Sevilla, 41009 Sevilla, Spain
| | - Paula Hermida-Cabrera
- Departamento de Estomatología, Facultad de Odontología, Universidad de Sevilla, 41009 Sevilla, Spain
| | | | - José-Luis Gutiérrez-Pérez
- Departamento de Estomatología, Facultad de Odontología, Universidad de Sevilla, 41009 Sevilla, Spain
- Hospital Universitario Virgen del Rocío, Universidad de Sevilla, 41013 Sevilla, Spain
| | - Daniel Torres-Lagares
- Departamento de Estomatología, Facultad de Odontología, Universidad de Sevilla, 41009 Sevilla, Spain
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Halstenbach T, Nelson K, Iglhaut G, Schilling O, Fretwurst T. Impact of peri-implantitis on the proteome biology of crevicular fluid: A pilot study. J Periodontol 2023; 94:835-847. [PMID: 36585920 DOI: 10.1002/jper.22-0461] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 11/22/2022] [Accepted: 12/15/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND The proteome of the peri-implant crevicular fluid (PICF) has not been systematically investigated. The aim of the present study was to reveal the proteome biology of dental implants affected with peri-implantitis. METHODS Patients with at least one diseased implant were included (probing depth ≥6 mm, ≥3 mm peri-implant radiological bone loss). Using sterile paper strips, samples were collected from healthy implants (I), healthy teeth (T) and peri-implantitis affected implants (P). Proteome analysis was performed using liquid chromatography - tandem mass spectrometry (LC-MS/MS) and data independent acquisition, allowing the identification and quantification of human and bacterial proteins as well as semi-specific peptides. RESULTS A total of 38 samples from 14 patients were included in the study; 2332 different human proteins were identified across all samples. No differentially expressed proteins between T and I were found. Comparing P to I, 59 proteins were found upregulated and 31 downregulated in P with significance. Upregulated proteins included proinflammatory proteins such as immunoglobulins, dysferlin, and S100P, as well as antimicrobial proteins, for example, myeloperoxidase or azurocidin. Gene ontology analysis further revealed higher activity of immunological pathways. Proteolytic patterns indicated the activity of inflammatory proteins such as cathepsin G. A total of 334 bacterial proteins were identified and quantified. Peri-implantitis showed elevated proteolytic activity. CONCLUSION I and T share similarities in their proteome, while diseased implants deviate strongly from healthy conditions. The PICF proteome of peri-implantitis affected sites exhibits an inflammatory fingerprint, dominated by neutrophil activity when compared with healthy implants.
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Affiliation(s)
- Tim Halstenbach
- Department of Oral- and Craniomaxillofacial Surgery/Translational Implantology, Division of Regenerative Oral Medicine, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg im Breisgau, Germany
- Institute of Surgical Pathology, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg im Breisgau, Germany
| | - Katja Nelson
- Department of Oral- and Craniomaxillofacial Surgery/Translational Implantology, Division of Regenerative Oral Medicine, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg im Breisgau, Germany
| | - Gerhard Iglhaut
- Department of Oral- and Craniomaxillofacial Surgery/Translational Implantology, Division of Regenerative Oral Medicine, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg im Breisgau, Germany
| | - Oliver Schilling
- Institute of Surgical Pathology, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg im Breisgau, Germany
| | - Tobias Fretwurst
- Department of Oral- and Craniomaxillofacial Surgery/Translational Implantology, Division of Regenerative Oral Medicine, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg im Breisgau, Germany
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22
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Stiesch M, Grischke J, Schaefer P, Heitz-Mayfield LJA. Supportive care for the prevention of disease recurrence/progression following peri-implantitis treatment: A systematic review. J Clin Periodontol 2023. [PMID: 37339881 DOI: 10.1111/jcpe.13822] [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: 10/20/2022] [Revised: 04/05/2023] [Accepted: 04/11/2023] [Indexed: 06/22/2023]
Abstract
OBJECTIVES This systematic review aimed to evaluate the efficacy of supportive care provision, frequency and protocol in patients treated for peri-implantitis, as reported in prospective and retrospective studies of at least 3-years duration. MATERIALS AND METHODS A systematic search of three electronic databases was undertaken up to 21 July 2022 and supplemented by hand-search to identify studies that included participants treated for peri-implantitis and followed for at least 3 years. Owing to high heterogeneity, a meta-analysis was not appropriate, and therefore, data and risk of bias were explored qualitatively. PRISMA guidelines for reporting were followed. RESULTS The search identified 2596 studies. Of 270 records selected during screening, 255 were excluded through independent review and 15 studies (10 prospective and 5 retrospective, with at least 20 patients) were retained for qualitative assessments. Study designs, population characteristics, supportive care protocols and reported outcomes varied markedly. Thirteen of the 15 studies had low risk of bias. Supportive peri-implant care (SPIC) following different surgical peri-implantitis treatment protocols and with recall intervals varying between 2 months and annually resulted in peri-implant tissue stability (no disease recurrence or progression) ranging from 24.4% to 100% at patient level and from 28.3% to 100% at implant level. Sevenhundred and eighty-five patients with 790 implants were included in this review. CONCLUSIONS Provision of SPIC following peri-implantitis therapy may prevent disease recurrence or progression. Insufficient evidence is available to identify (i) a specific supportive care protocol for secondary prevention of peri-implantitis, (ii) the effect of adjunctive local antiseptic agents in the secondary prevention of peri-implantitis and (iii) the impact of frequency of supportive care measures. Prospective, randomised, controlled studies designed to evaluate supportive care protocols are needed in future.
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Affiliation(s)
- Meike Stiesch
- Clinic of Prosthetic Dentistry and Biomedical Materials Science, Hanover Medical School, Hanover, Germany
| | - Jasmin Grischke
- Clinic of Prosthetic Dentistry and Biomedical Materials Science, Hanover Medical School, Hanover, Germany
| | - Paula Schaefer
- Clinic of Prosthetic Dentistry and Biomedical Materials Science, Hanover Medical School, Hanover, Germany
| | - Lisa J A Heitz-Mayfield
- International Research Collaborative Oral Health and Equity, School of Anatomy and Biology, The University of Western Australia, Crawley, Western Australia, Australia
- Discipline of Periodontics, School of Dentistry, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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23
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Papamanoli E, Kyriakidou K, Philippou A, Koutsilieris M, Karoussis IK. Free titanium particles and P. gingivalis lipopolysaccharide create a potentially synergistical effect in a periimplantitis model. Arch Oral Biol 2023; 153:105739. [PMID: 37392698 DOI: 10.1016/j.archoralbio.2023.105739] [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: 01/28/2023] [Revised: 05/29/2023] [Accepted: 06/02/2023] [Indexed: 07/03/2023]
Abstract
OBJECTIVE Our aim was to examine the effect of titanium particles and lipopolysaccharide (LPS) from P. gingivalis on the inflammatory profile expression of human gingival fibroblasts (hGFs), cultured on rough titanium discs, in an in vitro peri-implantitis simulation. DESIGN Human gingival fibroblasts cultured on SLA and TCP surfaces were challenged with LPS, titanium particles or both. At 24, 48 and 72 h after treatment, MTT assay was performed to assess cell proliferation. FDA/PI staining was performed for the same time periods, in order to evaluate cell viability/apoptosis. At 5 and 7 days after the treatment, qPCR was performed to assess gene expressions of IL-6, IL-8 and COL1A1, as well as SEM on titanium discs. RESULTS All groups presented a significant increase of their population between the time periods of examination. Regarding the interleukin gene expression, the combination of LPS and particles significantly increased the levels of Interleukin-8. Treatment with LPS and particles also induced a significant increase of Interleukin-6 and collagen. FDA/PI microscopy has revealed several apoptotic cells in the treatment groups. SEM micrographs have shown the difficulty of hGFs to adhere on rough surfaces. CONCLUSIONS The combination of titanium particles and LPS significantly upregulated the expression of IL-6, IL-8 and Col-1a. It appears that particles may arouse similar reactions to the endotoxin, while synergistically intensifying it.
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24
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Barbato L, Cavalcanti R, Rupe C, Scartabelli D, Serni L, Chambrone L, Cairo F. Clinical efficacy of adjunctive methods for the non-surgical treatment of peri-implantitis: a systematic review and meta-analysis. BMC Oral Health 2023; 23:375. [PMID: 37296382 PMCID: PMC10251565 DOI: 10.1186/s12903-023-03058-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 05/18/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND The aim of this systematic review (SR) was to evaluate the clinical efficacy of different adjunctive methods/therapies to the non-surgical treatment (NST) of peri-implantitis. MATERIALS AND METHODS The protocol of the review was registered in PROSPERO database (CRD42022339709) and was designed according to PRISMA statement. Electronic and hand searches were performed to identify randomized clinical trials (RCTs) comparing non-surgical treatment of peri-implantitis alone versus NST plus any adjunctive method/treatment. The primary outcome was probing pocket depth (PPD) reduction. RESULTS Sixteen RCTs were included. Only 2 out of 1189 implants were lost and follow-up ranged from 3 to 12 months. PPD reduction across the studies varied from 0.17 to 3.1 mm, while defect resolution from 5.3% to 57.1%. Systemic antimicrobials were associated to higher PPD reduction (1.56 mm; [95% CI 0.24 to 2.89]; p = 0.02) with high heterogeneity, and treatment success (OR = 3.23; [95% CI 1.17 to 8.94]; p = 0.02), compared to NST alone. No differences were found with adjunctive local antimicrobials and lasers for PPD and bleeding on probing (BoP) reduction. CONCLUSIONS Non-surgical treatment with or without adjunctive methods may reduce PPD and BoP even if complete resolution of the pocket is unpredictable. Among possible adjunctive methods, only systemic antibiotics seems to provide further benefits, but their usage should be considered with caution.
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Affiliation(s)
- Luigi Barbato
- Department of Clinical and Experimental Medicine, Research Unit in Periodontology and Periodontal Medicine, University of Florence (Italy), Via Casentino, 29, Florence, Italy.
| | - Raffaele Cavalcanti
- Department of General Surgery and Surgical-Medical Specialties, University of Catania (Italy), Catania, Italy
| | - Cosimo Rupe
- Department of Clinical and Experimental Medicine, Research Unit in Periodontology and Periodontal Medicine, University of Florence (Italy), Via Casentino, 29, Florence, Italy
| | - Daniele Scartabelli
- Department of Clinical and Experimental Medicine, Research Unit in Periodontology and Periodontal Medicine, University of Florence (Italy), Via Casentino, 29, Florence, Italy
| | - Lapo Serni
- Department of Clinical and Experimental Medicine, Research Unit in Periodontology and Periodontal Medicine, University of Florence (Italy), Via Casentino, 29, Florence, Italy
| | - Leandro Chambrone
- Evidence-Based Hub, Egas Moniz Center for Interdisciplinary Research, Egas Moniz School of Health & Science, Almada, Portugal
- Unit of Basic Oral Investigation (UIBO), Universidad El Bosque, Bogotá, Colombia
- Department of Periodontics, School of Dental Medicine, The University of Pennsylvania, Philadelphia, PA, USA
| | - Francesco Cairo
- Department of Clinical and Experimental Medicine, Research Unit in Periodontology and Periodontal Medicine, University of Florence (Italy), Via Casentino, 29, Florence, Italy
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25
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Cosgarea R, Roccuzzo A, Jepsen K, Sculean A, Jepsen S, Salvi GE. Efficacy of mechanical/physical approaches for implant surface decontamination in non-surgical submarginal instrumentation of peri-implantitis. A systematic review. J Clin Periodontol 2023; 50 Suppl 26:188-211. [PMID: 36550060 DOI: 10.1111/jcpe.13762] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 11/02/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022]
Abstract
AIM To evaluate the efficacy of non-surgical submarginal peri-implant instrumentation with mechanical/physical decontamination compared to non-surgical submarginal instrumentation alone or with placebo decontamination in patients with peri-implantitis. MATERIALS AND METHODS Three focused questions were addressed, and a systematic search for randomized controlled clinical trials (RCTs), controlled clinical trials, and prospective cohort studies with definitions of peri-implantitis and a minimal follow-up of 6 months was conducted. The main outcome variables were reduction in pocket probing depth (PD) and bleeding on probing (BOP). Suppuration on probing, marginal peri-implant bone level changes, patient-related outcomes and adverse events, implant survival, treatment success, and disease resolution were assessed as secondary outcomes. RESULTS Out of 239 findings, full-text articles were assessed for eligibility, and 9 (n = 9 RCTs) were included in the present review. Five studies evaluated the effects of various laser types, and in four studies efficacy of air-abrasive mechanisms and of a novel ultrasonic device was determined. At 6 months, PD reductions were observed in nine studies but only Er, Cr:YSGG laser-treated group showed statistically significant higher reductions compared to the control group. BOP was statistically significantly reduced at 6 months in two studies following the application of Er:YAG laser compared to controls. One study reported statistically significant reduction in BOP following application of air-polishing device compared to control treatment. No statistically significant differences between treatment groups were reported for the secondary outcome variables. Owing to the large heterogeneity of study designs, no meta-analysis was performed. CONCLUSIONS Available evidence on the efficacy of non-surgical submarginal peri-implant instrumentation with mechanical/physical decontamination is limited by the small number of controlled studies and the high heterogeneity of study protocols. Clinical and patient-reported benefits remain to be demonstrated.
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Affiliation(s)
- Raluca Cosgarea
- Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, Bonn, Germany
- Department of Periodontology and Peri-implant Diseases, University of Marburg, Marburg, Germany
- School of Dental Medicine, University Iuliu-Hatieganu, Cluj-Napoca, Romania
| | - Andrea Roccuzzo
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Karin Jepsen
- Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, Bonn, Germany
| | - Anton Sculean
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Søren Jepsen
- Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, Bonn, Germany
| | - Giovanni E Salvi
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
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26
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Karlsson K, Trullenque-Eriksson A, Tomasi C, Derks J. Efficacy of access flap and pocket elimination procedures in the management of peri-implantitis: A systematic review and meta-analysis. J Clin Periodontol 2023; 50 Suppl 26:244-284. [PMID: 36217689 DOI: 10.1111/jcpe.13732] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/16/2022] [Accepted: 10/04/2022] [Indexed: 11/28/2022]
Abstract
AIM To evaluate the efficacy of access flap and pocket elimination procedures in the surgical treatment of peri-implantitis. MATERIALS AND METHODS Systematic electronic searches (Central/MEDLINE/EMBASE) up to March 2022 were conducted to identify prospective clinical studies evaluating surgical therapy (access flap or pocket elimination procedures) of peri-implantitis. Primary outcome measures were reduction of probing depth (PD) and bleeding on probing (BOP). Risk of bias was evaluated according to study design. Meta-analysis and meta-regression were performed. Results were expressed as standardized mean effect with 95% confidence interval (CI). RESULTS Evidence from studies directly comparing surgical with non-surgical therapy is lacking. Based on pre-post data originating from 13 prospective patient cohorts, pronounced reductions of PD (standardized mean effect: 2.2 mm; 95% CI 1.8-2.7) and BOP% (27.0; 95% CI 19.8-34.2) as well as marginal bone level gain (0.2 mm; 95% CI -0.0 to 0.5) were observed at evaluation time points ranging from 1 to 5 years. Wide prediction intervals suggested a high degree of heterogeneity. Reduction of mean PD increased by 0.7 mm (95% CI 0.5-0.9) for every millimetre in increase of mean PD at baseline. During the follow-up period ranging from 1 to 5 years, disease recurrence occurred frequently and implant loss was not uncommon. CONCLUSIONS Access flap and pocket elimination surgery are effective procedures in the management of peri-implantitis, although rates of disease recurrence during 5 years were high. Treatment outcomes were affected by baseline conditions.
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Affiliation(s)
- Karolina Karlsson
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Anna Trullenque-Eriksson
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Cristiano Tomasi
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Jan Derks
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
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27
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Malheiros SS, Nagay BE, Bertolini MM, de Avila ED, Shibli JA, Souza JGS, Barão VAR. Biomaterial engineering surface to control polymicrobial dental implant-related infections: focusing on disease modulating factors and coatings development. Expert Rev Med Devices 2023:1-17. [PMID: 37228179 DOI: 10.1080/17434440.2023.2218547] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 04/29/2023] [Accepted: 05/23/2023] [Indexed: 05/27/2023]
Abstract
INTRODUCTION Peri-implantitis is the leading cause of dental implant loss and is initiated by a polymicrobial dysbiotic biofilm formation on the implant surface. The destruction of peri-implant tissue by the host immune response and the low effectiveness of surgical or non-surgical treatments highlight the need for new strategies to prevent, modulate and/or eliminate biofilm formation on the implant surface. Currently, several surface modifications have been proposed using biomolecules, ions, antimicrobial agents, and topography alterations. AREAS COVERED Initially, this review provides an overview of the etiopathogenesis and host- and material-dependent modulating factors of peri-implant disease. In addition, a critical discussion about the antimicrobial surface modification mechanisms and techniques employed to modify the titanium implant material is provided. Finally, we also considered the future perspectives on the development of antimicrobial surfaces to narrow the bridge between idea and product and favor the clinical application possibility. EXPERT OPINION Antimicrobial surface modifications have demonstrated effective results; however, there is no consensus about the best modification strategy and in-depth information on the safety and longevity of the antimicrobial effect. Modified surfaces display recurring challenges such as short-term effectiveness, the burst release of drugs, cytotoxicity, and lack of reusability. Stimulus-responsive surfaces seem to be a promising strategy for a controlled and precise antimicrobial effect, and future research should focus on this technology and study it from models that better mimic clinical conditions.
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Affiliation(s)
- Samuel S Malheiros
- Department of Prosthodontics and Periodontology, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo 13414-903, Brazil
| | - Bruna E Nagay
- Department of Prosthodontics and Periodontology, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo 13414-903, Brazil
| | - Martinna M Bertolini
- Department of Periodontics and Preventive Dentistry, School of Dental Medicine, University of Pittsburgh, Pittsburgh, PA 15106, USA
| | - Erica D de Avila
- Department of Dental Materials and Prosthodontics, School of Dentistry at Araçatuba, São Paulo State University (UNESP), Araçatuba, Sao Paulo 16015-050, Brazil
| | - Jamil A Shibli
- Dental Research Division, Guarulhos University, Guarulhos, São Paulo 07023-070, Brazil
| | - João Gabriel S Souza
- Dental Research Division, Guarulhos University, Guarulhos, São Paulo 07023-070, Brazil
- Dental Science School (Faculdade de Ciências Odontológicas - FCO), Montes Claros, Minas Gerais39401-303, Brazil
| | - Valentim A R Barão
- Department of Prosthodontics and Periodontology, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo 13414-903, Brazil
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28
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Scarano A, Khater AGA, Gehrke SA, Serra P, Francesco I, Di Carmine M, Tari SR, Leo L, Lorusso F. Current Status of Peri-Implant Diseases: A Clinical Review for Evidence-Based Decision Making. J Funct Biomater 2023; 14:jfb14040210. [PMID: 37103300 PMCID: PMC10142594 DOI: 10.3390/jfb14040210] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 03/25/2023] [Accepted: 04/06/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND the prevalence of peri-implant diseases is constantly growing, particularly with the increasing use of dental implants. As such, achieving healthy peri-implant tissues has become a key challenge in implant dentistry since it considers the optimal success paradigm. This narrative review aims to highlight the current concepts regarding the disease and summarize the available evidence on treatment approaches clarifying their indications for usage following the World Workshop on the Classification of Periodontal and Peri-implant Diseases (2017). METHODS we reviewed the recent literature and conducted a narrative synthesis of the available evidence on peri-implant diseases. RESULTS scientific evidence on case definitions, epidemiology, risk factors, microbiological profile, prevention, and treatment approaches for peri-implant diseases were summarized and reported. CONCLUSIONS although there are numerous protocols for managing peri-implant diseases, they are diverse and nonstandardized, with no consensus on the most effective, leading to treatment confusion.
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Affiliation(s)
- Antonio Scarano
- Department of Innovative Technologies in Medicine and Dentistry, University of Chieti-Pescara, 66100 Chieti, Italy
| | - Ahmad G A Khater
- Health Affairs Directorate, Egyptian Ministry of Health and Population, Banisuif 62511, Egypt
| | - Sergio Alexandre Gehrke
- Department of Research, Bioface/PgO/UCAM, Calle Cuareim 1483, Montevideo 11100, Uruguay
- Department of Biotecnology, Universidad Católica de Murcia (UCAM), 30107 Murcia, Spain
| | - Paola Serra
- Department of Innovative Technologies in Medicine and Dentistry, University of Chieti-Pescara, 66100 Chieti, Italy
| | - Inchingolo Francesco
- Department of Interdisciplinary Medicine, Section of Dental Medicine, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Mariastella Di Carmine
- Department of Innovative Technologies in Medicine and Dentistry, University of Chieti-Pescara, 66100 Chieti, Italy
| | - Sergio Rexhep Tari
- Department of Innovative Technologies in Medicine and Dentistry, University of Chieti-Pescara, 66100 Chieti, Italy
| | - Lucia Leo
- Department of Innovative Technologies in Medicine and Dentistry, University of Chieti-Pescara, 66100 Chieti, Italy
| | - Felice Lorusso
- Department of Innovative Technologies in Medicine and Dentistry, University of Chieti-Pescara, 66100 Chieti, Italy
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29
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Sadowsky SJ. Peri-implantitis after 40 years: Evidence, mechanisms, and implications: A mapping review. J Prosthet Dent 2023:S0022-3913(23)00114-2. [PMID: 36935269 DOI: 10.1016/j.prosdent.2023.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 02/16/2023] [Accepted: 02/16/2023] [Indexed: 03/19/2023]
Abstract
STATEMENT OF PROBLEM The high prevalence of peri-implantitis (PI) continues to plague patients and the disease is resistant to present treatment regimens. An analysis of the available research is lacking. PURPOSE Given the abundance and diversity of research on the topic of PI, the purpose of this mapping review was to synthesize the literature on the prevention of PI, the histopathology of the disease, the state of present therapeutics, and any emerging treatments. MATERIAL AND METHODS An extensive literature search was undertaken by using the electronic databases of PubMed, Web of Science, and Science Direct. The keyword strings were peri-implantitis, dental implant, risk assessment, histopathology, prosthesis design, and treatment. The filters applied were time interval from 2000 to 2002; language, English. RESULTS A total of 3635 articles were taken from PubMed, 3686 articles from Web of Science, and 2450 articles from Science Direct. After applying the inclusion and exclusion criteria to the titles and abstracts of selected investigations, 214 studies were retrieved. CONCLUSIONS The evidence reflects a concerning incidence of PI, without a predictable treatment protocol. An in-depth patient risk assessment considering risk modification, emphasis on surgical and restorative expertise, and strict recall and maintenance is essential to minimize PI.
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Affiliation(s)
- Steven J Sadowsky
- Professor, Preventive and Restorative Department, University of the Pacific Arthur A. Dugoni School of Dentistry, San Francisco, Calif.
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30
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Mahardawi B, Jiaranuchart S, Damrongsirirat N, Arunjaroensuk S, Mattheos N, Somboonsavatdee A, Pimkhaokham A. The lack of keratinized mucosa as a risk factor for peri-implantitis: a systematic review and meta-analysis. Sci Rep 2023; 13:3778. [PMID: 36882495 PMCID: PMC9992510 DOI: 10.1038/s41598-023-30890-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 03/02/2023] [Indexed: 03/09/2023] Open
Abstract
This study aimed to investigate the effect of the lack of keratinized mucosa on the risk of peri-implantitis, while also accounting for possible confounding factors. A literature search was conducted in PubMed and Scopus, including human studies that assessed the presence and width of keratinized mucosa in relation to the occurrence of peri-implantitis. Twenty-two articles were included, and 16 cross-sectional studies we meta-analyzed. The prevalence of peri-implantitis was 6.68-62.3% on patient-level and 4.5-58.1% on implant-level. The overall analysis indicated that the lack of keratinized mucosa was associated with a higher prevalence of peri-implantitis (OR = 2.78, 95% CI 2.07-3.74, p < 0.00001). Similar results were shown when subgroup analyses were performed, including studies with a similar case definition of peri-implantitis (Marginal Bone Loss, MBL ≥ 2 mm) (OR = 1.96, 95% CI 1.41-2.73, p < 0.0001), fixed prostheses only (OR = 2.82, 95% CI 1.85-4.28, p < 0.00001), patients under regular implant maintenance (OR = 2.08, 95% CI 1.41-3.08, p = 0.0002), and studies adjusting for other variables (OR = 3.68, 95% CI 2.32-5.82, p = 0.007). Thus, the lack of keratinized mucosa is a risk factor that increases the prevalence of peri-implantitis and should be accounted for when placing dental implants.
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Affiliation(s)
- Basel Mahardawi
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chulalongkorn University, 34 Henri Dunant Road, Wangmai, Patumwan, Bangkok, 10330, Thailand
| | - Sirimanas Jiaranuchart
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chulalongkorn University, 34 Henri Dunant Road, Wangmai, Patumwan, Bangkok, 10330, Thailand
| | - Napat Damrongsirirat
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chulalongkorn University, 34 Henri Dunant Road, Wangmai, Patumwan, Bangkok, 10330, Thailand
| | - Sirida Arunjaroensuk
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chulalongkorn University, 34 Henri Dunant Road, Wangmai, Patumwan, Bangkok, 10330, Thailand
| | - Nikos Mattheos
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chulalongkorn University, 34 Henri Dunant Road, Wangmai, Patumwan, Bangkok, 10330, Thailand
- Department of Dental Medicine, Karolinska Institute, Stockholm, Sweden
| | - Anupap Somboonsavatdee
- Department of Statistics, Chulalongkorn Business School, Chulalongkorn University, Bangkok, Thailand
| | - Atiphan Pimkhaokham
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chulalongkorn University, 34 Henri Dunant Road, Wangmai, Patumwan, Bangkok, 10330, Thailand.
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31
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Di Gianfilippo R, Wang CW, Xie Y, Kinney J, Sugai J, Giannobile WV, Wang HL. Effect of laser-assisted reconstructive surgical therapy of peri-implantitis on protein biomarkers and bacterial load. Clin Oral Implants Res 2023; 34:393-403. [PMID: 36856540 DOI: 10.1111/clr.14059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 07/13/2022] [Accepted: 09/03/2022] [Indexed: 03/02/2023]
Abstract
OBJECTIVES This randomized clinical trial assessed changes in protein biomarker levels and bacterial profiles after surgical reconstructive therapy of peri-implantitis and investigated whether the adjunctive use of Er:YAG laser impacts protein biomarker and microbial outcomes. MATERIALS AND METHODS Twenty-four patients received surgical reconstructive therapy for peri-implantitis with guided bone regeneration following mechanical debridement with (test) or without (control) the adjunctive irradiation of Er:YAG laser. Bacterial and peri-implant crevicular fluid (PICF) samples were collected over 6 months and analyzed with bacterial qPCR and luminex multiplex assays. RESULTS Surgical reconstructive treatment significantly affected the concentration of PICF protein biomarkers, including a 50% reduction in IL-1β between 2 and 4 weeks (p < .0001). Both MMP-9 (p < .001) and VEGF (p < .05) levels steadily decreased after treatment. In the laser group, the peak increase in IL-1β was attenuated at 2 weeks, followed by significant reduction in MMP-9 (p < .01) and VEGF (p < .05) across all follow-up appointments compared with the control nonlaser group. The total bacterial load was reduced 2 weeks after treatment, especially in the laser group, but recolonized to presurgical levels after 4 weeks in both groups (p < .01). The composition of selective pathogens varied significantly over the follow-up, but recolonization patterns did not differ between groups. CONCLUSIONS Reconstructive therapy of peri-implantitis significantly altered PICF protein biomarker and microbial levels during the healing process. The adjunctive use of Er:YAG laser significantly modulated the inflammatory response through reduced levels of MMP-9 and VEGF during the postsurgical period. The bacterial load was reduced immediately after therapy, but recolonization was observed by 4 weeks in both groups.
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Affiliation(s)
- Riccardo Di Gianfilippo
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Chin-Wei Wang
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei City, Taiwan
- Division of Periodontics, Department of Dentistry, Taipei Medical University Hospital, Taipei City, Taiwan
| | - Yuying Xie
- Department of Computational Mathematics, Science, and Engineering, Michigan State University, East Lansing, Michigan, USA
- Department of Statistics and Probability, Michigan State University, East Lansing, Michigan, USA
| | - Janet Kinney
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - James Sugai
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - William V Giannobile
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
- Department of Biomedical Engineering, University of Michigan College of Engineering, Ann Arbor, Michigan, USA
- Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Hom-Lay Wang
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
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Regidor E, Ortiz-Vigón A, Romandini M, Dionigi C, Derks J, Sanz M. The adjunctive effect of a resorbable membrane to a xenogeneic bone replacement graft in the reconstructive surgical therapy of peri-implantitis: A randomized clinical trial. J Clin Periodontol 2023; 50:765-783. [PMID: 36802084 DOI: 10.1111/jcpe.13796] [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: 11/14/2022] [Revised: 01/17/2023] [Accepted: 02/14/2023] [Indexed: 02/22/2023]
Abstract
AIM To evaluate the potential adjunctive effect of a resorbable collagen membrane covering a xenogeneic bone replacement graft in the reconstructive surgical therapy of peri-implantitis. MATERIALS AND METHODS Forty-three patients (43 implants) diagnosed with peri-implantitis associated with intra-bony defects were treated with a surgical reconstructive approach that included a xenogeneic bone substitute material. Additionally, resorbable collagen membranes were placed over the grafting material at sites randomly allocated to the test group; conversely, no membranes were placed in the control group. Clinical outcomes, namely probing pocket depth (PPD), bleeding and suppuration on probing (BoP and SoP), marginal mucosal level (REC) and keratinized mucosa width (KMW), were recorded at baseline and 6 and 12 months after surgery. Radiographic marginal bone levels (MBLs) and patient-reported outcomes (PROs) were assessed at baseline and 12 months. A composite outcome (success) was evaluated at 12 months, which included the absence of BoP/SoP, PPD ≤5 mm and reduction of buccal marginal mucosal level (buccal REC) of ≤1 mm. RESULTS At 12 months, no implants were lost and treatment success was observed at 36.8% and 45.0% of implants in the test and control groups, respectively (p = .61). Similarly, there were no significant differences between groups in terms of changes of PPD, BoP/SoP, KMW, MBL or buccal REC. Post-surgical complications were observed in the test group only (e.g., soft tissue dehiscence, exposure of particulate bone graft and/or resorbable membrane). Longer surgical times (~10 min; p < .05) and higher levels of self-reported pain at 2 weeks (p < .01) were observed in the test group. CONCLUSIONS This study failed to demonstrate the presence of added clinical or radiographic benefits of the use of a resorbable membrane to cover a bone substitute material within the reconstructive surgical therapy of peri-implantitis associated with intra-bony defects.
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Affiliation(s)
- Erik Regidor
- Thinking Perio Research, Clínica Ortiz-Vigón PerioCentrum Bilbao, Bilbao, Spain
| | - Alberto Ortiz-Vigón
- Thinking Perio Research, Clínica Ortiz-Vigón PerioCentrum Bilbao, Bilbao, Spain.,Faculty of Odontology, University Complutense of Madrid, Madrid, Spain
| | - Mario Romandini
- Faculty of Odontology, University Complutense of Madrid, Madrid, Spain
| | - Carlotta Dionigi
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Jan Derks
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Mariano Sanz
- Faculty of Odontology, University Complutense of Madrid, Madrid, Spain
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Carls PF, Bernasconi M, Carinci F, Lawrence M, Lambrecht JT. The use of autologous bone for augmentation procedures leads to low prevalence of peri-implantitis-a retrospective study over a 20-year period. J Craniomaxillofac Surg 2023; 51:130-138. [PMID: 36774308 DOI: 10.1016/j.jcms.2022.12.004] [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: 11/09/2021] [Revised: 11/11/2022] [Accepted: 12/27/2022] [Indexed: 02/02/2023] Open
Abstract
The aim of this study was to compare the prevalence of peri-implantitis in implants inserted into pristine bone (control) to implants where autologous bone was used for grafting procedures (study). All patients who underwent implant surgery during a 20 years interval by one maxillofacial implant surgeon and received a prosthodontic rehabilitation afterwards were eligible for inclusion in the study. Periimplant bone resorption and periimplant disease were assessed. Of 421 patients 384 (91.2%) patients responded to a recall after having been treated over a 20-year period by one maxillofacial surgeon and several dentists. A total of 110 patients had 239 implants in pristine bone, and 274 patients had 607 implants placed in combination with autologous bone grafting procedures. Mean time in function was 74 months (range 15-236 months). In all, 342 implants (34.8%) were in function for longer than 7 years. A total of 64 implant sites (7.6%) in 39 patients (10.2%) showed signs of peri-implant mucositis. In addition, 17 implants (2.0%) in 14 patients (3.6%) revealed signs of peri-implantitis, of which five implants were in the control group (2.09%) whereas 12 implants were in the study group (1.98%), with no statistically significant difference (p = 0.8405). More than half of the patients with peri-implantitis had a history of periodontitis. Three implants were lost due to peri-implantitis and four implants failed for other reasons, resulting in an overall success rate of 99.2% in 846 implants. CONCLUSIONS: Within the limitations of the study it seems that the use of autologous bone still is a relevant option when performing augmentation procedures because of the low prevalence of peri-implantitis.
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Affiliation(s)
- Peter F Carls
- Oxford University Hospitals & Oral & Maxillofacial Surgery Practice, Oxford, United Kingdom.
| | - Marco Bernasconi
- Zurich University Dental School & Private Dental Practice, Zurich, Switzerland
| | - Francesco Carinci
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Italy
| | - Mark Lawrence
- Private Dental Practice, Wallingford, Oxfordshire, United Kingdom
| | - J Thomas Lambrecht
- Department of Oral Surgery, Oral Radiology and Oral Medicine, University Center for Dental Medicine Basel, University of Basel, Switzerland
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Ramanauskaite A, Schwarz F, Cafferata EA, Sahrmann P. Photo/mechanical and physical implant surface decontamination approaches in conjunction with surgical peri-implantitis treatment: A systematic review. J Clin Periodontol 2023. [PMID: 36709953 DOI: 10.1111/jcpe.13783] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 12/14/2022] [Accepted: 01/23/2023] [Indexed: 01/31/2023]
Abstract
AIM To evaluate the efficacy of adjunctive/alternative photo/mechanical and physical implant-surface decontamination approaches compared to standard instrumentation in conjunction with surgical peri-implantitis treatment. MATERIALS AND METHODS Randomized controlled clinical trials (RCTs) and controlled clinical trials investigating the efficacy of adjunctive or alternative photo/mechanical/physical measures for implant surface decontamination in conjunction with surgical peri-implantitis treatment without (PICOS 1) or with (PICOS 2) additional decontamination methods performed in test and control groups with changing inflammation parameters were covered. Changes in bleeding scores (i.e., bleeding index, or bleeding on probing [BOP]), suppuration, and probing depth (PD) were considered the primary outcomes. RESULTS Six articles describing five original RCTs were eligible for analysis. Based on two RCTs, the adjunctive/alternative use of air polishing with glycine or erythritol powder did not improve BOP reduction compared to standard instrumentation (PICOS 1). Based on one RCT, alternative use of titanium brushes resulted in significantly higher BOP reduction compared to either air polishing or standard instrumentation (PICOS 1). During reconstructive therapy and as an adjunct to implantoplasty, use of a titanium brush did not have any benefit on the BOP and mean PD reductions compared to the control group (i.e., implantoplasty + mechanical and chemical implant surface decontamination; one RCT; PICOS 2). Use of the Er:YAG laser resulted in significantly higher PD reduction after 6 months (one RCT), whereas no difference between the test and respective controls could be detected after 1 and 2 years (one RCT). Additionally, the use of the Er:YAG laser was not associated with improved BOP reductions over respective controls (two RCTs; PICOS 2). CONCLUSIONS Owing to the limited available data, clinical efficacy of photo/mechanical and physical implant surface decontamination in conjunction with surgical peri-implantitis therapy is inconclusive. However, titanium brushes may be beneficial in reducing signs of inflammation.
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Affiliation(s)
- Ausra Ramanauskaite
- 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
| | - Emilio Alfredo Cafferata
- Department of Oral Surgery and Implantology, Johann Wolfgang Goethe-University, Carolinum, Frankfurt, Germany
| | - Philipp Sahrmann
- Department of Periodontology, Cariology and Endodontology, University of Basel, Basel, Switzerland
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Abrahamsson I, Almohandes A, Dionigi C, Berglundh T. Early bone healing to implants with different surface characteristics. A pre-clinical in vivo study. Clin Oral Implants Res 2023; 34:312-319. [PMID: 36702795 DOI: 10.1111/clr.14041] [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: 08/25/2022] [Revised: 12/15/2022] [Accepted: 01/12/2023] [Indexed: 01/28/2023]
Abstract
AIM To examine early bone healing around implants with non-modified and modified surfaces. MATERIAL & METHODS Four implants with 4 different surface characteristics were installed in one side of the mandible following tooth extraction in 6 dogs. Implants in group A had a non-modified, turned surface, while implants in group B had a surface modification consisting of TiO-blasting and sequential acid-etching in oxalic and hydrofluoric acid. The surface modification of implants in group C was confined to sequential acid-etching in oxalic and hydrofluoric acid and Group D implants had a surface modification of TiO-blasting and acid-etching in hydrofluoric acid. The implant installation procedures were repeated in the opposite side of the mandible 4 weeks later. Biopsies were obtained and prepared for histological analysis 2 weeks later. RESULTS B and C implants had a higher degree of bone-to-implant contact (BIC%) than A and D implants at 2 weeks of healing. At 6 weeks of healing, the BIC% was higher at B than at A, C and D implants, and higher at C implants than at A implants. The amount of newly formed bone in contact with the implant within the defect area at 2 weeks was higher at implants with modified surfaces (groups B, C and D) than at implants with a non-modified surface (group A). Corresponding results at 6 weeks were superior at B implants. CONCLUSION It is suggested that an implant surface modification with acid-etching in oxalic and hydrofluoric acid promotes early formation of bone-to-implant contact.
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Affiliation(s)
- Ingemar Abrahamsson
- Department of Periodontology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ahmed Almohandes
- Department of Periodontology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Carlotta Dionigi
- Department of Periodontology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Tord Berglundh
- Department of Periodontology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Khan SN, Koldsland OC, Roos-Jansåker AM, Wohlfahrt JC, Verket A, Mdala I, Magnusson A, Salvesen E, Hjortsjö C. Non-surgical treatment of mild to moderate peri-implantitis using an oscillating chitosan brush or a titanium curette-A randomized multicentre controlled clinical trial. Clin Oral Implants Res 2022; 33:1254-1264. [PMID: 36207993 PMCID: PMC10092542 DOI: 10.1111/clr.14007] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 08/16/2022] [Accepted: 09/06/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES This prospective, parallel-group, examiner-blinded, multicentre, randomized, controlled clinical trial aimed to assess the efficacy of an oscillating chitosan brush (OCB) versus titanium curettes (TC) on clinical parameters in the non-surgical treatment of peri-implantitis. MATERIAL AND METHODS In five dental specialist clinics, 39 patients with one implant with mild to moderate peri-implantitis, defined as 2-4 mm radiographic reduced bone level, bleeding index (BI) ≥ 2, and probing pocket depth (PPD) ≥ 4 mm were randomly allocated to test and control groups, receiving OCB or TC debridement, respectively. Treatment was performed at baseline and three months. PPD, BI, and Plaque index (PI) were measured at six sites per implant and recorded by five blinded examiners at baseline, one, three, and six month(s). Pus was recorded as present/not present. Changes in PPD and BI were compared between groups and analysed using multilevel partial ordinal and linear regression. RESULTS Thirty-eight patients completed the study. Both groups showed significant reductions in PPD and BI at six months compared with baseline (p < .05). There was no statistically significant difference in PPD and BI changes between the groups. Eradication of peri-implant disease as defined was observed in 9.5% of cases in the OCB group and 5.9% in the TC group. CONCLUSIONS Within the limitations of this six-month multicentre clinical trial, non-surgical treatment of peri-implantitis with OCB and TC showed no difference between the interventions. Eradication of disease was not predictable for any of the groups.
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Affiliation(s)
- Sadia N Khan
- Department of Prosthetics and Oral Function, Institute of Clinical Dentistry, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Odd Carsten Koldsland
- Department of Periodontology, Institute of Clinical Dentistry, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Ann-Marie Roos-Jansåker
- Department of Periodontology, Public Dental Health Services, Kristianstad, Sweden.,Department of Periodontology, Blekinge Hospital, Karlskrona, Sweden
| | - Johan Caspar Wohlfahrt
- Department of Periodontology, Institute of Clinical Dentistry, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Anders Verket
- Department of Periodontology, Institute of Clinical Dentistry, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Ibrahimu Mdala
- Department of General Practice, University of Oslo, Oslo, Norway
| | - Anna Magnusson
- Department of Periodontology, Public Dental Health Services, Örebro, Sweden
| | | | - Carl Hjortsjö
- Department of Prosthetics and Oral Function, Institute of Clinical Dentistry, Faculty of Dentistry, University of Oslo, Oslo, Norway
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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: 13] [Impact Index Per Article: 6.5] [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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Galarraga‐Vinueza ME, Tavelli L. Soft tissue features of peri‐implant diseases and related treatment. Clin Implant Dent Relat Res 2022. [PMID: 36444772 DOI: 10.1111/cid.13156] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 11/01/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND The need for soft tissue grafting at implant sites for preventing and treating peri-implant diseases is a currently investigated and debated topic. PURPOSE The aim of this manuscript is to explore the inflammatory mechanisms at the peri-implant soft tissue compartment, to distinguish the structural components of the peri-implant soft tissue phenotype and their role on peri-implant health, and to appraise the clinical indications and expected outcomes of soft tissue augmentation procedures at peri-implant diseased sites. MATERIALS AND METHODS This narrative review depicts the inflammatory biomarkers and mediators in the peri-implant crevicular fluid utilized to diagnose peri-implant disease and that have been shown to be associated with peri-implant soft tissue phenotype modification and disease resolution. The impact of the peri-implant soft tissue phenotype, involving keratinized mucosa (KM) width, attached mucosa (AM), mucosal thickness (MT), and supracrestal tissue height (STH), on peri-implant health, esthetic, patient's comfort and disease prevention are discussed. The manuscript also illustrates the use of ultrasonography for the detection of peri-implant health/disease and the evaluation of the treatment outcomes following surgical therapies. RESULTS Current evidence indicates that soft tissue phenotype modification at implant sites with inadequate KM width, AM and MT can be beneficial for promoting peri-implant health and improving patient's comfort and hygiene procedures. Treatment approaches and outcomes from the available literature on soft tissue phenotype modification in combination with conventional techniques at sites with peri-implant mucositis or peri-implantitis are presented and discussed in detail. CONCLUSIONS Soft tissue grafting can be beneficial in preventing and treating peri-implant diseases. Clinical recommendations based on the disease, soft tissue phenotype characteristics and bone defect morphology are provided for a comprehensive hard- and soft-tissue-oriented treatment of peri-implant disease.
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Affiliation(s)
- Maria Elisa Galarraga‐Vinueza
- Department of Prosthodontics Tufts University School of Dental Medicine Boston Massachusetts USA
- School of Dentistry Universidad de las Américas (UDLA) Quito Ecuador
| | - Lorenzo Tavelli
- Department of Oral Medicine, Infection, and Immunity, Division of Periodontology Harvard School of Dental Medicine Boston Massachusetts USA
- Center for Clinical Research and Evidence Synthesis in Oral TissuE RegeneratION (CRITERION) Boston Massachusetts USA
- Department of Periodontics and Oral Medicine University of Michigan School of Dentistry Ann Arbor Michigan USA
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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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Aghazadeh A, Persson GR, Stavropoulos A, Renvert S. Reconstructive treatment of peri-implant defects-Results after three and five years. Clin Oral Implants Res 2022; 33:1114-1124. [PMID: 36062917 PMCID: PMC9826427 DOI: 10.1111/clr.13994] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 07/06/2022] [Accepted: 08/18/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVES The aim of this study was to assess the long-term efficacy of reconstructive treatment of peri-implantitis intraosseous defects. MATERIAL AND METHODS Peri-implant intraosseous defects were augmented using either an autogenous bone graft (AB) or a bovine-derived xenograft (BDX) in combination with a collagen membrane. Maintenance was provided every third month. RESULTS In the AB group, 16 patients with 25 implants remained at year five. In the BDX group, 23 patients with 38 implants remained. Between baseline and year 5, bleeding on probing (BOP) and probing pocket depth (PPD) scores were reduced in both groups (p < .001). In the AB and BDX groups, mean PPD between baseline and year five was reduced by 1.7 and 2.8 mm, respectively. The difference between groups was significant (p < .001). In the AB group, the mean bone level change at implant level between baseline and years three and five was-0,2 and -0.7 mm, respectively. In the BDX group, the mean bone level change at implant level between baseline and years three and five was 1.6 and 1.6 mm, respectively. The difference between the groups was significant (p < .001). Successful treatment (no bone loss, no probing pocket depth (PPD) > 5 mm, no suppuration, maximum one implant surface with bleeding on probing (BOP) at year five) was obtained in 9/25 implants (36%) in the AB group and in 29/37 implants (78.3%) in the BDX group. CONCLUSIONS Reconstructive surgical treatment of peri-implant defects using BDX resulted in more predictable outcomes than using autogenous bone over 5 years.
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Affiliation(s)
| | - G. Rutger Persson
- Department of Oral SciencesKristianstad UniversityKristianstadSweden,Department of Periodontics and Oral MedicineUniversity of WashingtonSeattleWAUSA
| | - Andreas Stavropoulos
- Department of PeriodontologyMalmö UniversityMalmöSweden,Division of Regenerative Dental Medicine and Periodontology, CUMDUniversity of GenevaGenevaSwitzerland
| | - Stefan Renvert
- Department of Oral SciencesKristianstad UniversityKristianstadSweden,Blekinge Institute of TechnologyKarlskronaSweden,Faculty of DentistryThe University of Hong KongHong KongSARChina
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Efficacy of the autogenous dentin graft for implant placement: a systematic review and meta-analysis of randomized controlled trials. Int J Oral Maxillofac Surg 2022; 52:604-612. [PMID: 36328864 DOI: 10.1016/j.ijom.2022.10.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 10/21/2022] [Accepted: 10/24/2022] [Indexed: 11/07/2022]
Abstract
The aim of this study was to determine whether the autogenous dentin graft (ADG) shows comparable results and similar clinical performance to other graft materials when utilized for implant placement. Four databases were searched, and controlled human studies that applied autogenous dentin for implant surgery, comparing it with other bone grafts, were included. Nine articles met the inclusion criteria, five of which were randomized controlled trials and were included in the meta-analysis. ADG showed equivalent primary and secondary implant stability when compared to Bio-Oss (primary: mean difference -0.74, 95% confidence interval (CI) - 3.36 to 1.88, P = 0.58; secondary: mean difference - 1.29, 95% CI - 5.69 to 3.11, P = 0.57). The standardized mean difference (SMD) of marginal bone loss at 6 months and at the final follow-up (18 months) showed the two grafts to be similar (6 months: SMD -0.26, 95% CI -0.64 to 0.12, P = 0.18; final follow-up: SMD -0.12, 95% CI -0.50 to 0.26, P = 0.53), and survival after immediate implant placement was the same in the two groups: 97.37% and 97.30%, respectively. Incidences of complications with the autogenous dentin particles or blocks were in line with those of Bio-Oss or autogenous bone blocks, respectively. This meta-analysis indicates that the autogenous dentin graft is an effective option for bone augmentation around dental implants, with acceptable implant stability, marginal bone loss, and incidences of complications and failure.
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Sousa V, Mardas N, Spratt D, Hassan IA, Walters NJ, Beltrán V, Donos N. The Effect of Microcosm Biofilm Decontamination on Surface Topography, Chemistry, and Biocompatibility Dynamics of Implant Titanium Surfaces. Int J Mol Sci 2022; 23:ijms231710033. [PMID: 36077428 PMCID: PMC9456268 DOI: 10.3390/ijms231710033] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 08/10/2022] [Accepted: 08/16/2022] [Indexed: 11/16/2022] Open
Abstract
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.
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Affiliation(s)
- Vanessa Sousa
- Periodontology and Periodontal Medicine, Centre for Host-Microbiome Interactions, Faculty of Dentistry, Oral and Craniofacial Sciences, Kings College London, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 9RT, UK
- Correspondence:
| | - Nikos Mardas
- Centre for Oral Clinical Research, Centre for Oral Immunobiology & Regenerative Medicine, Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University London, London E1 2AD, UK
| | - Dave Spratt
- Microbial Diseases, Eastman Dental Institute, University College London, London WC1E 6BT, UK
| | - Iman A. Hassan
- Materials Chemistry Centre, Department of Chemistry, University College London, 20 Gordon Street, London WC1H 0AJ, UK
| | - Nick J. Walters
- Natural Resources Institute Finland, Latokartanonkaari 9, 00790 Helsinki, Finland
| | - Víctor Beltrán
- Clinical Investigation and Dental Innovation Center, Dental School and Center for Translational Medicine, Universidad de La Frontera, Temuco 4780000, Chile
| | - Nikolaos Donos
- Centre for Oral Clinical Research, Centre for Oral Immunobiology & Regenerative Medicine, Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University London, London E1 2AD, UK
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Derks J, Ortiz‐Vigón A, Guerrero A, Donati M, Bressan E, Ghensi P, Schaller D, Tomasi C, Karlsson K, Abrahamsson I, Ichioka Y, Dionigi C, Regidor E, Berglundh T. Reconstructive surgical therapy of peri-implantitis: A multicenter randomized controlled clinical trial. Clin Oral Implants Res 2022; 33:921-944. [PMID: 35804491 PMCID: PMC9544523 DOI: 10.1111/clr.13972] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/29/2022] [Accepted: 07/04/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To evaluate the potential benefit of the use of a bone substitute material in the reconstructive surgical therapy of peri-implantitis. METHODS In this multicenter randomized clinical trial, 138 patients (147 implants) with peri-implantitis were treated surgically, randomized by coin toss to either a control (access flap surgery) or a test group (reconstructive surgery using bone substitute material). Clinical assessments, including probing pocket depth (PPD), bleeding and suppuration on probing (BOP & SOP) as well as soft tissue recession (REC), were recorded at baseline, 6 and 12 months. Marginal bone levels (MBL), measured on intra-oral radiographs, and patient-reported outcomes (PROs) were recorded at baseline and 12 months. No blinding to group allocation was performed. The primary outcome at 12 months was a composite measure including (i) implant not lost, (ii) absence of BOP/SOP at all aspects, (iii) PPD ≤5 mm at all aspects and (iv) ≤1 mm recession of mucosal margin on the buccal aspect of the implant. Secondary outcomes included (i) changes of MBL, (ii) changes of PPD, BOP%, and buccal KM, (iii) buccal REC and (iv) patient-reported outcomes. RESULTS During follow-up, four implants (one in the test group, three in the control group) in four patients were removed due to disease progression. At 12 months, a total of 69 implants in the test and 68 implants in the control group were examined. Thus, 16.4% and 13.5% of implants in the test and control group, respectively, met all predefined criteria of the composite outcome. PPD reduction and MBL gain were 3.7 mm and about 1.0 mm in both groups. Reduction in mean BOP% varied between 45% (test) and 50% (control), without significant differences between groups. Buccal REC was less pronounced in the test group (M = 0.7, SD = 0.9 mm) when compared to controls (M = 1.1, SD = 1.5 mm). PROs were favorable in both groups without significant differences. One case of allergic reaction to the antibiotic therapy was recorded. No other adverse events were noted. CONCLUSIONS Surgical therapy of peri-implantitis effectively improved the clinical and radiographic status at 12 months. While the use of a bone substitute material did not improve reductions of PPD and BOP, buccal REC was less pronounced in the test group. Patient satisfaction was high in both groups.
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Affiliation(s)
- Jan Derks
- Department of Periodontology, Institute of OdontologyThe Sahlgrenska Academy at University of GothenburgGothenburgSweden,Clinic of Periodontics, Public Dental ServiceRegion Västra GötalandGothenburgSweden
| | - Alberto Ortiz‐Vigón
- Clínica Ortiz‐VigónPerioCentrumBilbaoSpain,ETEP Research Group, Faculty of OdontologyUniversity Complutense of MadridMadridSpain
| | | | - Mauro Donati
- Department of Periodontology, Institute of OdontologyThe Sahlgrenska Academy at University of GothenburgGothenburgSweden
| | - Eriberto Bressan
- Department of Neuroscience, Faculty of OdontologyUniversity of PaduaPaduaItaly
| | | | | | - Cristiano Tomasi
- Department of Periodontology, Institute of OdontologyThe Sahlgrenska Academy at University of GothenburgGothenburgSweden
| | - Karolina Karlsson
- Department of Periodontology, Institute of OdontologyThe Sahlgrenska Academy at University of GothenburgGothenburgSweden,Clinic of Periodontics, Public Dental ServiceRegion Västra GötalandGothenburgSweden
| | - Ingemar Abrahamsson
- Department of Periodontology, Institute of OdontologyThe Sahlgrenska Academy at University of GothenburgGothenburgSweden,Clinic of Periodontics, Public Dental ServiceRegion Västra GötalandGothenburgSweden
| | - Yuki Ichioka
- Department of Periodontology, Institute of OdontologyThe Sahlgrenska Academy at University of GothenburgGothenburgSweden
| | - Carlotta Dionigi
- Department of Periodontology, Institute of OdontologyThe Sahlgrenska Academy at University of GothenburgGothenburgSweden
| | | | - Tord Berglundh
- Department of Periodontology, Institute of OdontologyThe Sahlgrenska Academy at University of GothenburgGothenburgSweden,Clinic of Periodontics, Public Dental ServiceRegion Västra GötalandGothenburgSweden
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Roccuzzo A, Klossner S, Stähli A, Imber JC, Eick S, Sculean A, Salvi GE. Non-surgical mechanical therapy of peri-implantitis with or without repeated adjunctive diode laser application. A 6-month double-blinded randomized clinical trial. Clin Oral Implants Res 2022; 33:900-912. [PMID: 35775311 PMCID: PMC9546299 DOI: 10.1111/clr.13969] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 06/14/2022] [Accepted: 06/24/2022] [Indexed: 11/27/2022]
Abstract
Objectives The objective of this study is to investigate the outcomes following non‐surgical therapy of peri‐implantitis (PI) with or without adjunctive diode laser application. Materials and methods A double‐blinded randomized controlled clinical trial was carried out in 25 subjects with 25 implants diagnosed with PI. Following curettage of granulation tissue, test implants (T) were treated with adjunctive application of a diode laser for 90 s (settings: 810 nm, 2.5 W, 50 Hz, 10 ms), while at control implants (C) non‐activated adjunctive diode laser was applied. The entire treatment procedure was performed at days 0 (i.e., baseline), 7 and 14. The primary outcome measure was change in mean pocket probing depth (PPD). Clinical and microbiological outcomes, as well as host‐derived inflammatory markers were evaluated at baseline, 3 and 6 months, while radiographic outcomes were assessed at baseline and at the 6‐month follow‐up. Results No statistically significant differences with respect to baseline patient characteristic were observed. After 6 months, both test and control implants yielded statistically significant PPD changes compared with baseline (T: 1.28 and C: 1.47 mm) but without statistically significant difference between groups (p = .381). No statistically significant changes in peri‐implant marginal bone levels were detected (p = .936). No statistically significant differences between test and control implants were observed with respect to microbiological and host‐derived parameters (p > .05). At the 6‐month follow‐up, treatment success was observed in 41.7% (n = 5) of test and 46.2% (n = 6) of control patients, respectively (p = .821). Conclusion Repeated adjunctive application of diode laser in the non‐surgical management of PI failed to provide significant benefits compared with mechanical instrumentation alone.
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Affiliation(s)
- Andrea Roccuzzo
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Sabrina Klossner
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Alexandra Stähli
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Jean-Claude Imber
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Sigrun Eick
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Anton Sculean
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Giovanni E Salvi
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
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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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46
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Matthes R, Jablonowski L, Pitchika V, Holtfreter B, Eberhard C, Seifert L, Gerling T, Vilardell Scholten L, Schlüter R, Kocher T. Efficiency of biofilm removal by combination of water jet and cold plasma: an in-vitro study. BMC Oral Health 2022; 22:157. [PMID: 35524324 PMCID: PMC9074283 DOI: 10.1186/s12903-022-02195-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 04/25/2022] [Indexed: 11/10/2022] Open
Abstract
Background Peri-implantitis therapy is a major problem in implantology. Because of challenging rough implant surface and implant geometry, microorganisms can hide and survive in implant microstructures and impede debridement. We developed a new water jet (WJ) device and a new cold atmospheric pressure plasma (CAP) device to overcome these problems and investigated aspects of efficacy in vitro and safety with the aim to create the prerequisites for a clinical pilot study with these medical devices. Methods We compared the efficiency of a single treatment with a WJ or curette and cotton swab (CC) without or with adjunctive use of CAP (WJ + CAP, CC + CAP) to remove biofilm in vitro from rough titanium discs. Treatment efficacy was evaluated by measuring turbidity up to 72 h for bacterial re-growth or spreading of osteoblast-like cells (MG-63) after 5 days with scanning electron microscopy. With respect to application safety, the WJ and CAP instruments were examined according to basic regulations for medical devices. Results After 96 h of incubation all WJ and CC treated disks were turbid but 67% of WJ + CAP and 46% CC + CAP treated specimens were still clear. The increase in turbidity after WJ treatment was delayed by about 20 h compared to CC treatment. In combination with CAP the cell coverage significantly increased to 82% (WJ + CAP) or 72% (CC + CAP), compared to single treatment 11% (WJ) or 10% (CC). Conclusion The newly developed water jet device effectively removes biofilm from rough titanium surfaces in vitro and, in combination with the new CAP device, biologically acceptable surfaces allow osteoblasts to grow. WJ in combination with CAP leads to cleaner surfaces than the usage of curette and cotton swabs with or without subsequent plasma treatment. Our next step will be a clinical pilot study with these new devices to assess the clinical healing process. Supplementary Information The online version contains supplementary material available at 10.1186/s12903-022-02195-1.
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Affiliation(s)
- Rutger Matthes
- Department of Restorative Dentistry, Periodontology, Endodontology, Preventive Dentistry and Pedodontics, Dental School, University Medicine Greifswald, Fleischmannstr. 42, 17475, Greifswald, Germany
| | - Lukasz Jablonowski
- Department of Restorative Dentistry, Periodontology, Endodontology, Preventive Dentistry and Pedodontics, Dental School, University Medicine Greifswald, Fleischmannstr. 42, 17475, Greifswald, Germany
| | - Vinay Pitchika
- Department of Restorative Dentistry, Periodontology, Endodontology, Preventive Dentistry and Pedodontics, Dental School, University Medicine Greifswald, Fleischmannstr. 42, 17475, Greifswald, Germany
| | - Birte Holtfreter
- Department of Restorative Dentistry, Periodontology, Endodontology, Preventive Dentistry and Pedodontics, Dental School, University Medicine Greifswald, Fleischmannstr. 42, 17475, Greifswald, Germany
| | | | - Leo Seifert
- Sirona Dental Systems GmbH, Bensheim, Germany
| | - Torsten Gerling
- ZIK Plasmatis, Leibniz-Institute for Plasma Science and Technology e.V. (INP), Greifswald, Germany
| | - Laura Vilardell Scholten
- ZIK Plasmatis, Leibniz-Institute for Plasma Science and Technology e.V. (INP), Greifswald, Germany
| | - Rabea Schlüter
- Imaging Center of the Department of Biology, University of Greifswald, Greifswald, Germany
| | - Thomas Kocher
- Department of Restorative Dentistry, Periodontology, Endodontology, Preventive Dentistry and Pedodontics, Dental School, University Medicine Greifswald, Fleischmannstr. 42, 17475, Greifswald, Germany.
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Derks J, Ichioka Y, Dionigi C, Trullenque Eriksson A, Berglundh J, Tomasi C, Graziani F. Prevention and management of peri-implant mucositis and peri-implantitis: a systematic review of outcome measures used in clinical studies in the last 10 years. Clin Oral Implants Res 2022; 34 Suppl 25:55-67. [PMID: 35343614 DOI: 10.1111/clr.13925] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 02/17/2022] [Accepted: 02/21/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate outcome measures, methods of assessment and analysis in clinical studies on the prevention and management of peri-implant mucositis and peri-implantitis. METHODS Systematic electronic searches (CENTRAL/MEDLINE/SCOPUS) up to April 2021 were conducted to identify longitudinal clinical studies with ≥10 patients on either the prevention or management of peri-implant diseases. Outcome measures of this analysis were the choice of outcome measures, methods of assessment and analytical methods. Risk of Bias was evaluated according to study design. Data were extracted into evidence tables and outcomes were analyzed in a descriptive manner. RESULTS The analysis of the 159 selected studies revealed that probing pocket depth (PPD) and bleeding/suppuration on probing (BOP) were reported in 89% and 87% of all studies, respectively. Additional outcome measures included plaque scores (reported in 64% of studies), radiographic outcomes (49%), soft tissue dimensions (34%) and composite outcomes (26%). Adverse events (8%) and patient-reported outcomes (6%) were only rarely mentioned. A total of 36% of studies clearly defined a primary outcome measure. Data on PPD, radiographic outcomes and soft tissue dimensions were primarily reported as mean values and rarely as frequency distributions. For radiographic outcomes and soft tissue dimensions, it was frequently unclear how clustered data were handled. CONCLUSIONS PPD and BOP were routinely reported in studies on prevention and management of peri-implant mucositis and peri-implantitis, while composite outcomes, adverse events and patient-reported outcomes were infrequently described.
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Affiliation(s)
- Jan Derks
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Yuki Ichioka
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Carlotta Dionigi
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Anna Trullenque Eriksson
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Jessica Berglundh
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Cristiano Tomasi
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
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Ravidà A, Siqueira R, Di Gianfilippo R, Kaur G, Giannobile A, Galindo-Moreno P, Wang CW, Wang HL. Prognostic factors associated with implant loss, disease progression or favorable outcomes after peri-implantitis surgical therapy. Clin Implant Dent Relat Res 2022; 24:222-232. [PMID: 35320880 DOI: 10.1111/cid.13074] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 01/10/2022] [Accepted: 02/01/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND The treatment of the peri-implantitis remains complex and challenging with no consensus on which is the best treatment approach. PURPOSE To examine the key local and systemic factors associated with implant loss, disease progression, or favorable outcomes after surgical peri-implantitis therapy. MATERIALS AND METHODS Records of patients treated for peri-implantitis were screened. Patient-, implant- and surgery-related variables on and prior to the day of the surgery were collected (T0: time of peri-implantitis treatment). If the treated implant was still in function when the data was collected, the patient invited to participate for a recall study visit (T1, longest follow-up after treatment). Impacts of the variables on the implant survival, success, and peri-implant bone change after treatment were investigated. RESULTS Eighty patients with 121 implants with a mean follow-up of 42.6 ± 26.3 months were included. A total of 22 implants (18.2%) were removed during the follow-up period. When relative bone loss (%) was in range 25%-50%, risk for implant removal increased 15 times compared to lower bone loss <25% (OR = 15.2; CI: 2.06-112.7; p = 0.008). Similarly, relative bone loss of >50% increased 20 times the risk of implant failure compared to the <25% (OR = 20.2; CI: 2.42-169.6; p = 0.006). For post-treatment success rate, history of periodontitis significantly increased the risk of unsuccess treatment (OR = 3.07; p = 0.04) after resective surgery). CONCLUSION Severe bone loss (>50%) poses significantly higher risk of treatment failure.
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Affiliation(s)
- Andrea Ravidà
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Rafael Siqueira
- Department of Periodontics, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Riccardo Di Gianfilippo
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Gurpreet Kaur
- University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Anthony Giannobile
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Pablo Galindo-Moreno
- Oral Surgery and Implant Dentistry Department, School of Dentistry, University of Granada, Granada, Spain
| | - Chin-Wei Wang
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Hom-Lay Wang
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
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Derks J, Ichioka Y, Dionigi C, Trullenque Eriksson A, Berglundh J, Tomasi C, Graziani F. Prevention and management of peri-implant mucositis and peri-implantitis: a systematic review of outcome measures used in clinical studies in the last 10 years. J Clin Periodontol 2022; 50 Suppl 25:55-66. [PMID: 35246865 DOI: 10.1111/jcpe.13608] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 02/17/2022] [Accepted: 02/21/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To evaluate outcome measures, methods of assessment and analysis in clinical studies on the prevention and management of peri-implant mucositis and peri-implantitis. METHODS Systematic electronic searches (CENTRAL/MEDLINE/SCOPUS) up to April 2021 were conducted to identify longitudinal clinical studies with ≥10 patients on either the prevention or management of peri-implant diseases. Outcome measures of this analysis were the choice of outcome measures, methods of assessment and analytical methods. Risk of Bias was evaluated according to study design. Data were extracted into evidence tables and outcomes were analyzed in a descriptive manner. RESULTS The analysis of the 159 selected studies revealed that probing pocket depth (PPD) and bleeding/suppuration on probing (BOP) were reported in 89% and 87% of all studies, respectively. Additional outcome measures included plaque scores (reported in 64% of studies), radiographic outcomes (49%), soft tissue dimensions (34%) and composite outcomes (26%). Adverse events (8%) and patient-reported outcomes (6%) were only rarely mentioned. A total of 36% of studies clearly defined a primary outcome measure. Data on PPD, radiographic outcomes and soft tissue dimensions were primarily reported as mean values and rarely as frequency distributions. For radiographic outcomes and soft tissue dimensions, it was frequently unclear how clustered data were handled. CONCLUSIONS PPD and BOP were routinely reported in studies on prevention and management of peri-implant mucositis and peri-implantitis, while composite outcomes, adverse events and patient-reported outcomes were infrequently described. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Jan Derks
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Yuki Ichioka
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Carlotta Dionigi
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Anna Trullenque Eriksson
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Jessica Berglundh
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Cristiano Tomasi
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
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Wen SC, Barootchi S, Wang HL, Huang WX. Non-submerged reconstructive approach for peri-implantitis osseous defect, with removal of implant crowns: 1-year outcomes of a prospective case series study. J Periodontol 2022; 93:1250-1261. [PMID: 35170752 DOI: 10.1002/jper.21-0502] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 01/24/2022] [Accepted: 01/29/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND & AIM The aim of this study was to test a non-submerged reconstructive approach for peri-implantitis osseous defects, by removing the prosthetic components, augmenting of the infraosseous bony compartment, and flap re-adaptation around the replaced healing abutments, without obtaining a primary wound closure. METHODS Twenty-nine implants in 24 patients were treated. Implant suprastructures were removed at the time of the intervention, to aid with the debridement process which included curettage, implantoplasty, air-power driven devices, and locally delivered antibiotics. The infraosseous part of peri-implant defects were augmented using a composite bone graft and an absorbable membrane to be secured around the replaced healing abutments without attempting to submerge the implants. After 8 months, direct peri-implant defect measurements were obtained to serve as the primary outcome. Secondary outcomes included of radiographic bone changes, and probing depth (PD) and bleeding on probing (BOP) changes at 12 months. RESULTS At the time of the surgical re-entry (8 months), a statistically significant clinical and radiographic defect fill was observed (average of 2.33 mm, and 1.63 mm, respectively). Approximately 3 months after crown replacement, 12 months from the surgical intervention, a significant PD (1.51 mm) and BOP (65%) reduction were also noted. CONCLUSIONS Considering its limitations, the utilized non-submerged approach (with removal of implant crowns) led to significant improvements in clinical (defect fill, PD, BOP) and radiographic outcomes. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Shih-Cheng Wen
- Lecturer, Taipei Medical University, Taipei, Taiwan.,Private Practice, Taipei County, Taiwan
| | - Shayan Barootchi
- Resident, Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Hom-Lay Wang
- Professor and program director, Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Wen-Xia Huang
- Professor and Dean, Periodontics Department, Stomatological Hospital of Xiamen Medical College, Xiamen, China
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