Association between periodontitis treatment outcomes and peri-implantitis: A long-term retrospective cohort study

No association between periodontitis extent, severity, and progression rate with dental implant failure

OBJECTIVE

To analyze the relationship between extent, severity, and rate of progression of periodontitis with the implant outcome.

METHODS

Dental records of adult patients who had attended the dental clinics of the universities contributing data to the BigMouth network between 2011 and 2022 seeking implant therapy were evaluated. Patients' records were furthered examined for a periodontal diagnosis based on the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. Patients were further categorized based on extent (generalized/localized), severity (stage I, II, III, IV), and rate of progression (grade A, B, C). Information including demographic characteristics, self-reported medical conditions, as well as the number of missing teeth were extracted from patients' electronic health records.

RESULTS

Records of 50,312 dental implants placed in 20,842 patients over a 12-year period were screened. Three hundred twenty-two records of implants were placed in patients with a recorded periodontitis diagnosis based on the 2017 periodontal classification. The mean age of the cohort was 57.53±12.95 years which consisted of 52.2 % males, 74.2 % non-Hispanic, 55.9 % white individuals, 9 % diabetics, 3.4 % tobacco users. The univariate analysis demonstrated that periodontitis extent, severity, and rate of progression were not significantly associated with the treatment outcome. The implant failure rate was estimated to be 5.6 %.

CONCLUSIONS

Within the limitations of this retrospective study that utilized records of dental implants placed in institutions in the United States contributing data to the BigMouth network, the implant failure rate was estimated to be 5.6 %. Periodontitis extent, severity, and rate of progression were not significantly associated with the implant treatment outcome.

Periodontal conditions of teeth adjacent to dental implants with or without peri-implantitis after non-surgical therapy in patients treated for periodontitis: A retrospective study

OBJECTIVES

To retrospectively assess the periodontal conditions of teeth adjacent to and contralateral to implants presenting with or without peri-implantitis, following non-surgical periodontal and peri-implant mechanical therapy.

MATERIALS AND METHODS

One hundred and one patients with existing dental implants and chronic periodontitis, who underwent non-surgical periodontal and peri-implant mechanical therapy, were included. The periodontal clinical probing depth (PPD), gingival recession (GR), and bleeding on probing (BOP) were recorded at six sites around the adjacent (Adj-) teeth and the contralateral (CL-) teeth relative to the implant. The potential factors influencing the periodontal conditions of 316 teeth were analyzed by multivariate linear regression models with generalized estimating equation methods and α = .05.

RESULTS

The PPD of Adj-teeth was significantly different from that of CL-teeth before and after non-surgical therapy when the implant was diagnosed with peri-implantitis (PI) (p < .05). The PPD of teeth was shown to be affected by neighboring implants diagnosed with peri-implantitis (β = .825 mm, p < .001), teeth adjacent to implants (β = .245 mm, p = .004), a molar tooth type (β = .435 mm, p = .019), and non-surgical therapy (β = -.522 mm, p < .001).

CONCLUSIONS

Relatively compromised periodontal conditions at Adj-teeth after non-surgical PI therapy were detected. Therefore, clinicians should be aware that non-surgical therapy may be less successful at teeth adjacent to implants with PI.

Implant Health in Treated Periodontitis Patients: A Systematic Review and Meta-Analysis

BACKGROUND

The aim of this meta-analysis was to evaluate the role of a history of periodontitis on implant failure. The two main judgment criteria studied are peri-implantitis and the survival rate. The two secondary judgment criteria studied are the mean pocket depth and the mean peri-implant bone loss.

METHODS

An electronic search was performed via five databases (MEDLINE, Embase, ScienceDirect, LILACS and the Cochrane Library) and was supplemented by manual searching. The search was undertaken in June 2024.

RESULTS

Of 10 775 potentially eligible articles, 8 were included in the qualitative analysis and 10 in the quantitative synthesis.

CONCLUSIONS

This meta-analysis suggests that a history of periodontitis has a significant impact on the rate of peri-implantitis, survival rate, mean bone loss and pocket depth.

The Critical Role of Pyroptosis in Peri-Implantitis

Background

Peri-implantitis (PI) is a prevalent complication of implant treatment. Pyroptosis, a distinctive inflammatory programmed cell death, is crucial to the pathophysiology of PI. Despite its importance, the pyroptosis-related genes (PRGs) influencing PI's progression remain largely unexplored.

Methods

This study conducted histological staining and transcriptome analyze from three datasets. The intersection of differentially expressed genes (DEGs) and PRGs was identified as pyroptosis-related differentially expressed genes (PRDEGs). Functional enrichment analyses were conducted to shed light on potential underlying mechanisms. Weighted Gene Co-expression Network Analysis (WGCNA) and a pyroptotic macrophage model were utilized to identify and validate hub PRDEGs. Immune cell infiltration in PI and its relationship with hub PRDEGs were also examined. Furthermore, consensus clustering was performed to identify new PI subtypes. Protein-protein interaction (PPI) network, competing endogenous RNA (ceRNA) network, mRNA-mRNA binding protein regulatory (RBP) network, and mRNA-drugs regulatory network of hub PRDEGs were also analyzed.

Results

Eight hub PRDEGs were identified: PGF, DPEP1, IL36B, IFIH1, TCEA3, RIPK3, NET7, and TLR3, which are instrumental in the PI's progression. Two PI subtypes were distinguished, with Cluster 1 exhibiting higher immune cell activation. The exploration of regulatory networks provided novel mechanisms and therapeutic targets in PI.

Conclusion

Our research highlights the critical role of pyroptosis and identifies eight hub PRDEGs in PI's progression, offering insights into novel immunotherapy targets and laying the foundation for advanced diagnostic and treatment strategies. This contributes to our understanding of PI and underscores the potential for personalized clinical management.

One-Stage Approach to Rehabilitate a Hopeless Tooth in the Maxilla by Means of Immediate Dentoalveolar Restoration: Surgical and Prosthetic Considerations

Contemporary dentistry has increased the demand for predictable functional and esthetic results in a short period of time without compromising the long-term success of rehabilitation. Recent advances in surgical techniques have provided alternatives that allow the prosthetic rehabilitation of complex implant-supported cases through minimally invasive techniques. In this context, immediate dentoalveolar restoration (IDR) was described aiming at restoring function and esthetics through the reconstruction of lost periodontal tissues followed by immediate implant placement in order to minimize treatment time and surgical morbidity in a one-stage approach. Therefore, the aim of this clinical case is to describe the reconstruction and rehabilitation of a hopeless tooth in the maxillary region in a one-stage approach by means of IDR. The proposed steps to rehabilitate the case involved atraumatic dental extraction, immediate implant placement, and hard tissue augmentation by means of cortical-medullary bone graft harvested from the maxillary tuberosity. Afterwards, a provisional restoration was manufactured and installed to the implant allowing immediate prosthesis provisionalization and function in the same operatory time. Six months after the surgical procedure, the final prosthesis was manufactured and installed. The follow-up of nine years demonstrated the preservation of hard and soft tissue without tissue alteration and a successful esthetic outcome. The surgical protocol used allowed the ideal three-dimensional placement of the implant with the restoration of the bone buccal wall, favoring the esthetic and functional outcome of the case with harmony between white and pink esthetics. In conclusion, the employed treatment validated immediate implant-supported restoration of the missing tooth with high predictability. Furthermore, this protocol resulted in fewer surgical interventions, regeneration, and preservation of peri-implant tissues reaching the patient's expectations.

Identification of immunological bioprocesses involved in peri-implantitis using weighted gene co-expression network analysis

BACKGROUND

Peri-implantitis is an irreversible infectious disease that occurs with high incidence. Exploring the immune responses of peri-implantitis is key to developing targeted treatment strategies. However, there is limited research on the immune response of peri-implantitis.

METHODS

This study performed a weighted gene co-expression network analysis to identify the peri-implantitis related gene network and conducted a functional enrichment analysis of the gene network. Thereafter, the candidate hub genes were selected by constructing a protein-protein interaction network and drawing an upset plot. The hub genes were identified through their significant associations with disease condition and validated using quantitative reverse transcription-polymerase chain reaction (qRT-PCR) analysis. Using the gene set variation analysis, the hub genes were further used to explore infiltrating immunocytes and immune factors in peri-implantitis. Finally, the immunocytes and immune factor related hub genes were intersected to obtain the therapeutic target, which was validated using histological staining.

RESULTS

The peri-implantitis related gene network was enriched in innate and adaptive immune response. Subsequently, interleukin (IL)1B, IL10, ITGAM, ITGB1, STAT3, and TLR4 were identified as hub genes. Plasmacytoid dendritic cells, macrophages, myeloid-derived suppressor cells, natural killer T cells, and immature B cells were positively and significantly related to the hub genes IL1B, TLR4, ITGAM, and ITGB1 (correlation coefficient > 0.80). While immune factors CXCL10, IL6, and CXCL12 and hub genes IL10 and IL1B held the highest degree in the immune factors network. IL1B may be a promising therapeutic target.

CONCLUSION

This study provides new insights into the hub genes, immunocytes, and immune factors underlying peri-implantitis immunological bioprocess.

Effect of the implant apical exposure and coverage < or ≥ 2 mm bone graft on transcrestal sinus floor elevation: a 1- to 7-year retrospective cohort study

OBJECTIVES

This study aimed to analyze the effect of the apex coverage by the bone graft, including exposure and coverage less than or greater than 2 mm on implant survival rate and peri-implant bone and soft tissue remodeling.

MATERIALS AND METHODS

A total of 264 implants in 180 patients who had undergone transcrestal sinus floor elevation (TSFE) with simultaneous implant placement were included in this retrospective cohort study. Radiographic assessment was used to categorize the implants into three groups based on apical implant bone height (ABH): ≤ 0 mm, < 2 mm, or ≥ 2 mm. The implant survival rate, peri-implant marginal bone loss (MBL) during short-term (1-3 years) and mid- to long-term (4-7 years) follow-up, and clinical parameters were used to evaluate the effect of implant apex coverage after TSFE.

RESULTS

Group 1 had 56 implants (ABH ≤ 0 mm), group 2 had 123 implants (ABH > 0 mm, but < 2 mm), and group 3 had 85 implants (ABH ≥ 2 mm). There was no significant difference in the implant survival rate between groups 2 and 3 compared to group 1 (p = 0.646, p = 0.824, respectively). The MBL during short-term and mid- to long-term follow-up indicated that apex coverage could not be considered a risk factor. Furthermore, apex coverage did not have a significant effect on other clinical parameters.

CONCLUSIONS

Despite limitations, our study found that implant apex coverage by the bone graft, including exposure and coverage levels less than or greater than 2 mm, did not significantly affect implant survival, short-term or mid- to long-term MBL, or peri-implant soft tissue outcomes.

CLINICAL RELEVANCE

Based on 1- to 7-year data, the study suggests that implant apical exposure and coverage levels of less than or greater than 2 mm bone graft are both valid options for TSFE cases.

Long‐term impact of patients' compliance to peri‐implant maintenance therapy on the incidence of peri‐implant diseases: An 11‐year prospective follow‐up clinical study

OBJECTIVE

To prospectively evaluate the incidence of peri-implant diseases and the associated risk factors during 11 years of peri-implant maintenance therapy (PIMT).

MATERIAL AND METHODS

A sample of 80 partially edentulous individuals rehabilitated with dental implants was invited to participate in a PIMT program (T1-prior to entering the PIMT program). After 11 years, 51 individuals remained regularly or irregularly adherent to PIMT (T2-last recall after 11 years) and were classified as regular (RC; n = 27) or irregular (IC; n = 24) compliers. Data of interest were analyzed using univariate and multivariate logistic regression analyses.

RESULTS

The incidence of peri-implant mucositis and peri-implantitis observed at T2 in the IC group (70.8% and 37.5%, respectively) were significantly higher than those observed in the RC group (37.0% and 11.1%, respectively). The incidence of peri-implant diseases was mostly attributable to potentially modifiable risk factors, as such: RC group-PM (p = 0.013); IC group-high plaque index (p < 0.001), irregular compliance (p < 0.001), the presence of PM (p = 0.015) and periodontitis (p < 0.039).

CONCLUSION

Regular compliance during PIMT had a strong effect in minimizing the incidence of peri-implant diseases. Increasing regular dental visits and improving oral hygiene would provide benefits for preventing peri-implant diseases.

The Stages and Grades of Periodontitis Are Risk Indicators for Peri-Implant Diseases-A Long-Term Retrospective Study

The aim of this study is to evaluate the factors of implant failure in patients with periodontitis and their impact on the prognosis of having a peri-implant disease and/or implant failure. Data regarding 325 implants among 84 patients with periodontitis were retrospectively examined. Patients were classified by Stage (I, II, III, IV) and Grade (A, B, C), implant failures for peri-implant disease and lack of osseointegration. Clinical data, including implant- and patient-related variables were evaluated by principal components analysis (PCA) and two-step cluster analysis (CA). Survival and success rates were 96.3% and 87.1%, respectively. Prevalence of peri-implant disease was significantly higher in Stage IV patients (p < 0.05), and incidence of lost implant due to peri-implantitis was significantly higher in patients with bone augmentation (BA) (p < 0.05). PCA and CA revealed five of eleven variables and four clusters at patient level, and six of fourteen variables and three clusters at implant level. Stage and Grade are useful indicators for the development of peri-implant diseases in which BA and the number of implants are involved.

Association between cumulative smoking exposure, span since smoking cessation, and peri-implantitis: a cross-sectional study

OBJECTIVES

To investigate the association of cumulative smoking exposure and span since smoking cessation with the occurrence of peri-implantitis.

METHODS

A sample of 350 individuals aged ≥ 35 years, with the presence of at least one osseointegrated implant functioning for > 5 years, were enrolled in the study. According to smoking habits, participants were categorized into 3 groups: non-smokers (NS; n = 212), former smokers (FC; n = 66), and current smokers (CS; n = 72). Complete peri-implant and periodontal examinations were evaluated. Associations between the occurrence of peri-implantitis and smoking habits, as well as potential confounders, were evaluated through univariate and multivariate analyses.

RESULTS

The occurrence of peri-implantitis in the NS, FS, and CS groups was 18.2%, 19.7%, and 30.5%, respectively. A high prevalence of the overall number of cases with periodontitis (54.2%) was observed in the CS group when compared to the FS and NS groups. After adjusting for confounders, the odds ratio (OR) for the occurrence of peri-implantitis was 2.63 (1.39-6.77; p < 0.001) for CS compared to NS. There was a significant dose-response relationship between pack/year of smoking and the occurrence of peri-implantitis, as well as a significant decrease in the risk as the years of smoking cessation increased.

CONCLUSIONS

The occurrence of peri-implantitis among CS was high. The cumulative smoking exposure in an incremental manner and the shorter smoking cessation span was directly associated with a higher risk for peri-implantitis.

CLINICAL RELEVANCE

Educational and preventive strategies in general health services must attempt to reduce the adverse effects of cumulative smoking exposure and to explore the beneficial effects of smoking cessation on peri-implant status.

Comparison of Two Risk Assessment Scores in Predicting Peri-Implantitis Occurrence during Implant Maintenance in Patients Treated for Periodontal Diseases: A Long-Term Retrospective Study

Background: There is a need for reliable risk assessment tools to better predict peri-implantitis occurrence. This study compared the long-term prognosis value of two models of risk assessment scoring in predicting peri-implantitis. Methods: Seventy-three patients with treated periodontitis representing 232 implants and attending long-term implant maintenance were evaluated. The Periodontal Risk Assessment (PRA) score, which combines only periodontal risk factors/indicators, and the Implant Risk Assessment (IRA) score, which combines both periodontal and implant risk factors/indicators, were calculated during implant maintenance. Peri-implantitis was defined by the presence of probing depth ≥6 mm with bleeding on probing/suppuration and bone level ≥3 mm. Analyses were performed at the patient level. Results: The mean implant follow-up was 6.5 years. Peri-implantitis incidence was 17.8%, and high-risk PRA and IRA percentages were 36.9% and 27.3%, respectively. High-risk PRA and IRA were significantly associated with peri-implantitis incidence, with hazard ratio (HR) = 4.8 and 3.65, respectively. Risk factors/indicators considered separately showed reduced associations with peri-implantitis. Conclusions: The PRA score combining periodontal parameters and IRA score combining both periodontal and implant parameters have comparable value in predicting peri-implantitis. These scores could allow practicians to intercept the risk of peri-implantitis and to manage follow-up modalities in patients with treated periodontitis.

Influence of Periodontitis, Implant, and Prosthesis Characteristics on the Peri-Implant Status: A Cross-Sectional Study

Background

The association between peri-implant diseases and the periodontal, implant, and prosthesis characteristics has been characterized in various ways.

Purpose

The aim of this study was to evaluate the link between the peri-implant and periodontal status and the influence of implant and prosthesis parameters during implant follow-up.

Materials and Methods

One hundred and seven patients with a total of 310 implants that had at least one year of function who were attending periodontal and implant maintenance at a university clinic setting were included in this cross-sectional study. The demographic, periodontal, peri-implant tissue, implant, and prosthesis parameters were recorded. A pocket depth > 4 mm with bleeding on probing defined periodontal/peri-implant soft tissue diseased sites. Analyses were performed at the patient and implant levels using univariable and multivariable mixed regression analysis.

Results

The mean implant follow-up was 7.22 years. At the patient level, the bleeding on probing and pocket depth measurements were more pronounced around the implant than around the teeth. The opposite was observed for plaque and the clinical attachment levels. At the implant level, multivariable analysis showed that the periodontal and corresponding peri-implant tissue parameters, such as diseased sites, were closely related. The implant location, bone level, and number were selectively associated with the implant bone level, while cemented retention and emergence restoration profile influenced the implant pocket depth.

Conclusions

The present study suggested that clinical peri-implant and periodontal soft tissue statuses were different, which could be a consequence of the initial implant and prosthesis healing process. However, during implant follow-up, the peri-implant parameters were predominantly associated with their corresponding periodontal parameters regardless of an association with the implant and prosthesis characteristics. This trial is registered with ClinicalTrials.gov ID: NCT03841656.

Microbiota analysis of peri-implant mucositis in patients with periodontitis history

OBJECTIVES

To investigate the bacterial diversity in peri-implant plaques and the effect of periodontitis history on the occurrence of peri-implant mucositis.

MATERIALS AND METHODS

Three groups of subgingival plaques were collected from peri-implant sulci in the first molar area. The three groups included healthy implants in patients without periodontitis (NH implant), healthy implants in patients with periodontitis history (PH implant), and peri-implant mucositis implants in patients with periodontitis history (PM implant). Subgingival plaques in periodontal pockets of contralateral natural first molars were also collected. Bacterial DNA was extracted and the V4 region of the 16S rDNA sequence was amplified and sequenced on an Illumina HiSeq platform. The operational taxonomic units obtained from amplicon sequencing were used to analyze the prevalence and identity of bacteria based on public databases and advanced techniques.

RESULTS

Analysis of similarities indicated a significant difference in bacterial structures between the NH implant and PM implant groups. Additionally, a significantly higher relative abundance of the genera Actinomyces and Streptococcus was found in the samples of the NH implant group. The genera Fusobacterium and Prevotella could be considered as potential biomarkers for peri-implant mucositis. Moreover, more gram-negative anaerobic bacteria (Porphyromonas and Prevotella) were detected in the samples from patients with periodontitis history.

CONCLUSIONS

The increased accumulation of Fusobacterium and Prevotella is associated with a higher risk of peri-implant mucositis. In addition, patients with periodontal history may be more likely to develop peri-implant mucositis.

CLINICAL RELEVANCE

The increase in periodontal pathogens and the decrease in health-associated bacteria in patients with periodontitis history may be more likely to develop peri-implant mucositis. These results provide a bacteriological basis for the prevention and treatment of peri-implant mucositis in patients with periodontitis history.