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Isler SC, Romandini M, Akca G, Bakirarar B, Unsal B, Romanos G, Sculean A. Soft-Tissue Phenotype as a Risk Indicator of Peri-Implantitis and Peri-Implant Soft-Tissue Dehiscence-A Cross-Sectional Study. J Clin Periodontol 2024; 51:1443-1457. [PMID: 39189550 DOI: 10.1111/jcpe.14059] [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: 02/26/2024] [Revised: 07/23/2024] [Accepted: 08/06/2024] [Indexed: 08/28/2024]
Abstract
AIM To investigate the association, as well as to characterize the associated panel of pro- and anti-inflammatory markers, between the different components of the peri-implant phenotype and the presence of peri-implantitis/peri-implant soft-tissue dehiscence (PISTD). MATERIALS AND METHODS A total of 324 implants in 112 patients were included. The following components of the peri-implant phenotype were clinically measured through the use of a manual periodontal probe or a digital calliper: keratinized mucosa width (PIKM-W), mucosal thickness (MT), attached mucosa (AM) and vestibulum depth (VD). The presence of peri-implantitis and PISTD was assessed through clinical and radiographic examination. Mixed-models logistic regression analyses were performed to analyse the association between peri-implant phenotype and the presence of peri-implantitis or PISTD, adjusting for relevant confounders. Multiplex immunoassays were employed to evaluate the peri-implant crevicular fluid levels of a panel of pro- and anti-inflammatory markers. RESULTS Peri-implant health, peri-implant mucositis and peri-implantitis were diagnosed in 36.6%, 21.4% and 42% of the patients (classified according to their worst implant) and 35.2%, 34.3%, and 30.5% of the implants, respectively. In the multi-level multiple regression model, the absence of PIKM-W (odds ratio [OR] = 9.24; 95% CI: 2.73-31.28), the absence of attached mucosa (OR = 19.58; 95% CI: 6.12-62.56) and a reduced (<4 mm) vestibulum depth (OR = 2.61; 95% CI: 1.05-6.48) were associated with peri-implantitis. Similarly, the absence of PIKM-W (OR = 6.32; 95% CI: 1.67-23.83), a thin (<2 mm) mucosa (OR = 157.75; 95% CI: 14.06-1769.9) and a reduced vestibulum depth (OR = 3.32; 95% CI: 1.02-10.84) were associated with the presence of PISTD. Implants with PIKM-W = 0 mm showed statistically significantly higher levels of interferon-γ in both regular (≥2 maintenance/year) and irregular (<2 maintenance/year) compliers (p = 0.046 and p = 0.012). In irregular compliers, the absence of PIKM-W was also associated with statistically significantly higher levels of interleukin (IL)-1β and IL-21 (p = 0.016, p = 0.046). These associations were independent of the effect of relevant confounders (e.g., plaque, compliance with maintenance, etc.). CONCLUSIONS Within their limits, the present findings indicate that (a) peri-implant soft-tissue phenotype appears to be associated with the presence of peri-implantitis and PISTD, and (b) in the absence of PIKM-W, the inflammatory response seems to be dysregulated and the soft-tissue remodelling up-regulated.
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Affiliation(s)
- Sila Cagri Isler
- Department of Periodontology, Faculty of Dentistry, Gazi University, Ankara, Turkey
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Mario Romandini
- Department of Periodontology, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Gulcin Akca
- Department of Medical Microbiology, Faculty of Dentistry, Gazi University, Ankara, Turkey
| | - Batuhan Bakirarar
- Department of Biostatistics, Process Management Coordinator, ADO Group, Antalya, Turkey
| | - Berrin Unsal
- Department of Periodontology, Faculty of Dentistry, Gazi University, Ankara, Turkey
| | - Georgios Romanos
- Department of Periodontics and Endodontics, Stony Brook University, Stony Brook, New York, USA
| | - Anton Sculean
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
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Krebs M, Greilich L, Weigl P, Hess P, Dahmer I, Begić A. Influence of repeated implant-abutment manipulation on the prevalence of peri-implant diseases in complete arch restorations. A retrospective analysis. Clin Implant Dent Relat Res 2024. [PMID: 39257298 DOI: 10.1111/cid.13381] [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: 11/02/2023] [Revised: 07/12/2024] [Accepted: 08/05/2024] [Indexed: 09/12/2024]
Abstract
PURPOSE To evaluate the effects of repeated abutment manipulation on the prevalence of peri-implant diseases. MATERIALS AND METHODS A total of 27 edentulous patients (n = 108 implants) immediately restored with double-crown retained implant-supported prostheses were identified for this retrospective study. The test included the one-abutment, one-time care concept (n = 18 patients, n = 72 implants, OAOT) and the control abutment replacement (n = 9 patients, n = 36 implants, AR). A mixed effects model regression was conducted for the variable diagnosis (healthy, peri-implant mucositis, and peri-implantitis) with predictors abutment replacement (presence/absence), number of abutment replacement, category of keratinized mucosa (KM) (2 < KM ≥2 mm), and radiographic bone loss (BL). RESULTS After 3-15 years (mean 10.2 ± 2.8 years), the prevalence of peri-implant mucositis and peri-implantitis in patients in the AR group was 11.1% and 88.9%, corresponding to 22.2% and 55.6% at the implant level, respectively. In OAOT group, none of the implants showed peri-implant mucositis, whereas the prevalence for peri-implantitis at patient and implant level amounted to 5.6% and 5.6%, respectively. The increased number of abutment replacements was significantly associated with the increased probability to diagnose peri-implant mucositis and peri-implantitis (OR: 6.13; 95% CI [2.61, 14.39]) (p < 0.001), whereas the presence of keratinized mucosa was not founded as a significant cofounder. The estimated mean BL in AR group was 1.38 mm larger than in OAOT group (p = 0.0190). CONCLUSIONS The OAOT concept was associated with a lower prevalence of peri-implant diseases.
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Affiliation(s)
- M Krebs
- Department of Postgraduate Education, Goethe University, Carolinum, Frankfurt, Germany
- Privat Practice Dr. Krebs & Colleagues, Alzey, Germany
| | - L Greilich
- Department of Postgraduate Education, Goethe University, Carolinum, Frankfurt, Germany
| | - P Weigl
- Department of Postgraduate Education, Goethe University, Carolinum, Frankfurt, Germany
| | - P Hess
- Department of Oral Surgery and Implantology, Goethe University, Carolinum, Frankfurt, Germany
| | - I Dahmer
- Institute of Biostatistics and Mathematical Modeling, Goethe University, Carolinum, Frankfurt, Germany
- Center of Dentistry and Oral Medicine, Goethe University, Frankfurt, Germany
| | - A Begić
- Department of Oral Surgery and Implantology, Goethe University, Carolinum, Frankfurt, Germany
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Isler SC, Soysal F, Tunc S, Kaymaz Ö, Unsal B, Roccuzzo A. Impact of peri-implant keratinized mucosa width on the long-term reconstructive outcomes of peri-implantitis: A retrospective analysis with a follow-up up to 10 years. Clin Implant Dent Relat Res 2024; 26:819-831. [PMID: 38923667 DOI: 10.1111/cid.13358] [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: 04/16/2024] [Revised: 06/09/2024] [Accepted: 06/11/2024] [Indexed: 06/28/2024]
Abstract
PURPOSE To investigate the effect of mid-buccal peri-implant keratinized mucosa width (KMW) ≥2 mm or peri-implant KMW >0 mm and <2 mm on the long-term outcomes of peri-implantitis reconstructive treatment. MATERIALS AND METHODS Twenty-nine patients (40 implants; mean follow-up: 9.2 ± 1.4 years) with at least one implant affected by peri-implantitis and surgically treated through a reconstructive procedure followed by a submerged healing were included. Patients were categorized according to their initial KMW: Group 1 (KMW ≥2 mm) and Group 2 (KMW >0 mm and <2 mm). Peri-implant clinical and radiographic parameters and a dedicated composite outcome were assessed at different follow-up visits during supportive peri-implant therapy for up to 10 years. Regression analyses were utilized to identify possible risk/predictive indicators for probing pocket depth (PPD) change and treatment success at the latest follow-up. RESULTS The mean PPD did not exhibit any statistical difference from the baseline to the latest follow-up between the groups at both patient and implant levels. Long-term treatment success was 46.6% (Group 1) and 42.6% (Group 2) at patient level, it was 42.8% (Group 1) and 33.3% (Group 2), respectively, at implant level (p > 0.05). Group 1 demonstrated significantly higher vertical defect depth reduction than Group 2 (p = 0.018). Presence of buccal bony wall and mean PPD at the baseline were found to be associated with mean PPD change, while KMW at 6 months following surgery was identified as the only significant indicator for treatment success (p < 0.05). CONCLUSION Implants with KMW ≥2 mm did not present significantly better long-term clinical outcomes following reconstructive therapy than those exhibiting KMW >0 mm and <2 mm. However, KMW values at the end of healing phase following a submerged approach had a significant impact on long-term treatment success.
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Affiliation(s)
- Sila Cagri Isler
- Department of Periodontology, Faculty of Dentistry, Gazi University, Ankara, Turkey
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Fatma Soysal
- Department of Periodontology, Faculty of Dentistry, Ankara Medipol University, Ankara, Turkey
| | - Seher Tunc
- Department of Periodontology, Faculty of Dentistry, Gazi University, Ankara, Turkey
| | - Özlem Kaymaz
- Department of Statistics, Faculty of Science, Ankara University, Ankara, Turkey
| | - Berrin Unsal
- Department of Periodontology, Faculty of Dentistry, Gazi University, Ankara, Turkey
| | - Andrea Roccuzzo
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
- Department of Oral and Maxillofacial Surgery, Copenhagen University Hospital, Copenhagen, Denmark
- Unit for Practice-based Research, School of Dental Medicine, University of Bern, Bern, Switzerland
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Mancini L, Strauss FJ, Lim HC, Tavelli L, Jung RE, Naenni N, Thoma DS. Impact of keratinized mucosa on implant-health related parameters: A 10-year prospective re-analysis study. Clin Implant Dent Relat Res 2024; 26:554-563. [PMID: 38419210 DOI: 10.1111/cid.13314] [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: 10/28/2023] [Revised: 01/30/2024] [Accepted: 02/07/2024] [Indexed: 03/02/2024]
Abstract
AIM To investigate whether the lack of keratinized mucosa (KM) affects peri-implant health after 10 years of loading. MATERIALS AND METHODS Data from 74 patients with 148 implants from two randomized controlled studies comparing different implant systems were included and analyzed. Clinical parameters including bleeding on probing (BOP), probing depth (PD), plaque index, marginal bone loss (MBL), and KM width (KMW) at buccal sites were collected at baseline (time of the final prosthesis insertion), 5-year and 10 years postloading. Multivariable logistic and linear regression models by means of a generalized estimated equation (GEE) were used to evaluate the influence of buccal KM on peri-implant clinical parameters; BOP, MBL, PD, and adjusted for implant type (one-piece or two-piece) and compliance. RESULTS A total of 35 (24.8%) implants were healthy, 67 (47.5%) had mucositis and 39 (27.6%) were affected by peri-implantitis. In absence of buccal KM (KM = 0 mm), 75% of the implants exhibited mucositis, while in the presence of KM (KMW >0 mm) 41.2% exhibited mucositis. Regarding peri-implantitis, the corresponding percentages were 20% (KM = 0 mm) and 26.7% (KM >0 mm). Unadjusted logistic regression showed that the presence of buccal KM tended to reduce the odds of showing BOP at buccal sites (OR: 0.28 [95% CI, 0.07 to 1.09], p = 0.06). The adjusted logistic regression model revealed that having buccal KM (OR: 0.21 [95% CI, 0.05 to 0.85], p = 0.02) and using two-piece implants (OR: 0.34 [95% CI, 0.15 to 0.75], p = 0.008) significantly reduced the odds of showing BOP. Adjusted linear regression by means of GEE showed that KM and two-piece implants were associated with reduced MBL and MBL changes (p < 0.05). CONCLUSION The lack of buccal KM appears to be linked with peri-implant parameters such as BOP and MBL, but the association is weak. The design of one-piece implants may account for their increased odds of exhibiting BOP.
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Affiliation(s)
- Leonardo Mancini
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
- Center for Clinical Research and Evidence Synthesis in Oral Tissue Regeneration (CRITERION), Boston, Massachusetts, USA
| | - Franz J Strauss
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
- Faculty of Dentistry, Universidad Finis Terrae, Santiago, Chile
- Department of Conservative Dentistry, Faculty of Dentistry, University of Chile, Santiago, Chile
| | - Hyun-Chang Lim
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
- Department of Periodontology, Periodontal-Implant Clinical Research Institute, Kyung Hee University School of Dentistry, Seoul, Korea
| | - Lorenzo Tavelli
- Center for Clinical Research and Evidence Synthesis in Oral Tissue Regeneration (CRITERION), Boston, Massachusetts, USA
- Department of Oral Medicine, Infection, and Immunity, Division of Periodontology, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Ronald E Jung
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Nadja Naenni
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Daniel S Thoma
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
- Department of Periodontology, Research Institute for Periodontal Regeneration, Yonsei University College of Dentistry, Seoul, Korea
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Ruiz-Romero V, Figueiredo R, Toledano-Serrabona J, Abdelazim Y, Camps-Font O, Salazar-Salazar Y, Plana-Soler A, Subirà-Pifarré C, Valmaseda-Castellón E. Peri-implantitis in patients without regular supportive therapy: Prevalence and risk indicators. Clin Oral Investig 2024; 28:278. [PMID: 38671152 PMCID: PMC11052890 DOI: 10.1007/s00784-024-05673-8] [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: 10/10/2023] [Accepted: 04/21/2024] [Indexed: 04/28/2024]
Abstract
OBJECTIVES To determine the prevalence of peri-implant diseases in patients treated in a university setting without a regular peri-implant supportive therapy schedule, and to identify the risk indicators associated with peri-implantitis. MATERIAL AND METHODS A retrospective cohort study was made of patients with dental implants with at least 12 months of functional loading who did not receive regular peri-implant supportive therapy. Patient- and implant-related variables were retrieved, and clinical and radiological examinations were performed. Descriptive and bivariate analyses and multilevel logistic regression analyses were performed to identify factors associated with peri-implantitis. RESULTS A total of 213 implants in 88 patients were analyzed. The patient-level prevalence of peri-implantitis and peri-implant mucositis was 26.1% (95%CI: 16.7%-35.5%) and 44.3% (95%CI: 34.0%-54.6%), respectively. Peri-implant diseases were significantly more frequent when the width of the keratinized mucosa was < 2 mm (OR = 5.26; 95%CI: 1.24-22.26; p = 0.024), and when there was 12 month post-loading bone loss (OR = 2.96; 95%CI: 1.35-6.52; p = 0.007). CONCLUSIONS Peri-implantitis is a common finding in patients without regular peri-implant supportive therapy (prevalence 16.7-35.5%). A thin peri-implant keratinized mucosa (< 2 mm) and a higher degree of bone remodeling after loading seem to be the main risk factors for peri-implantitis in this patient profile. CLINICAL RELEVANCE Patients who do not engage in supportive peri-implant maintenance have a higher risk of peri-implantitis. A thin keratinized mucosa and bone loss during the first year of loading are predisposing factors for peri-implantitis.
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Affiliation(s)
- Víctor Ruiz-Romero
- Oral Surgery and Implantology, Faculty of Medicine and Health Sciences of the University of Barcelona, Barcelona, Spain
| | - Rui Figueiredo
- Oral Surgery and Implantology, Faculty of Medicine and Health Sciences of the University of Barcelona, Barcelona, Spain
- Dental and Maxillofacial Pathology and Therapeutics Research Group, IDIBELL Research Institute, Barcelona, Spain
| | - Jorge Toledano-Serrabona
- Oral Surgery and Implantology, Faculty of Medicine and Health Sciences of the University of Barcelona, Barcelona, Spain
- Dental and Maxillofacial Pathology and Therapeutics Research Group, IDIBELL Research Institute, Barcelona, Spain
| | - Yehia Abdelazim
- Oral Surgery and Implantology, Faculty of Medicine and Health Sciences of the University of Barcelona, Barcelona, Spain
| | - Octavi Camps-Font
- Oral Surgery and Implantology, Faculty of Medicine and Health Sciences of the University of Barcelona, Barcelona, Spain.
- Dental and Maxillofacial Pathology and Therapeutics Research Group, IDIBELL Research Institute, Barcelona, Spain.
| | - Yamil Salazar-Salazar
- Oral Surgery and Implantology, Faculty of Medicine and Health Sciences of the University of Barcelona, Barcelona, Spain
| | - Aina Plana-Soler
- Master of Adult Dental Comprehensive Dentistry, Faculty of Medicine and Health Sciences of the University of Barcelona, Barcelona, Spain
| | - Carles Subirà-Pifarré
- Dental and Maxillofacial Pathology and Therapeutics Research Group, IDIBELL Research Institute, Barcelona, Spain
- Master of Adult Dental Comprehensive Dentistry, Faculty of Medicine and Health Sciences of the University of Barcelona, Barcelona, Spain
| | - Eduard Valmaseda-Castellón
- Oral Surgery and Implantology, Faculty of Medicine and Health Sciences of the University of Barcelona, Barcelona, Spain
- Dental and Maxillofacial Pathology and Therapeutics Research Group, IDIBELL Research Institute, Barcelona, Spain
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Tastan Eroglu Z, Ozkan Sen D, Oncu E. Association of Peri-Implant Keratinized Mucosa Width and Mucosal Thickness with Early Bone Loss: A Cross-Sectional Study. J Clin Med 2024; 13:1936. [PMID: 38610701 PMCID: PMC11012309 DOI: 10.3390/jcm13071936] [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: 03/05/2024] [Revised: 03/21/2024] [Accepted: 03/23/2024] [Indexed: 04/14/2024] Open
Abstract
Objective: The objective of this study was to evaluate the effects of keratinized mucosa width (KMW) and mucosal thickness (MT) around dental implants on marginal bone loss (MBL). The evaluation was performed one year after loading by comparing clinical, radiographic, and biochemical parameters. Methods: The study included 87 implants in 87 patients undergoing regular follow-ups without hard or soft tissue augmentation one year after loading. Clinical measurements included plaque index (PI), gingival index (GI), bleeding on probing (BoP), probing depth (PD), KMW, and MT. MBL was assessed with periapical radiography. The peri-implant crevicular fluid (PICF) was analyzed for tumor necrosis factor-alpha (TNF-α), receptor activator of nuclear factor-kB ligand (RANKL), osteoprotegerin (OPG), and microRNA-27a. Results: The MBL of implants with thin MT (<2 mm) was higher than that of implants with thick MT (≥2 mm) (p < 0.05). A significant negative correlation (r: -0.217) was established between MT and MBL. No significant association was found between KMW and MBL (p > 0.05). No significant associations was found between KMW and MT with TNF-α, RANKL, OPG and RANKL/OPG (p > 0.05), with the exception of increased microRNA-27a levels in implants with KMW ≥ 2 mm (p < 0.05). Conclusions: Implants with a thick MT had a lower MBL. There may be an association between adequate KMW and high miRNA-27a levels. The relationship between MBL and miRNA-27a remains unclear.
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Affiliation(s)
- Zeynep Tastan Eroglu
- Department of Periodontology, Faculty of Dentistry, Necmettin Erbakan University, Beyşehir Caddesi, Bağlarbaşı Sk., 42090 Konya, Turkey;
| | - Dilek Ozkan Sen
- Department of Periodontology, Faculty of Dentistry, Necmettin Erbakan University, Beyşehir Caddesi, Bağlarbaşı Sk., 42090 Konya, Turkey;
| | - Elif Oncu
- Panoroma Ankara Private Oral and Dental Health Clinic, 06510 Ankara, Turkey;
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Oliveira CAB, Pereira VL, Dos Santos JN, Araujo NS, Cury PR. Influence of keratinized mucosa on peri-implant diseases: a retrospective cohort study in humans. Oral Maxillofac Surg 2024; 28:331-336. [PMID: 36847879 DOI: 10.1007/s10006-023-01144-8] [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: 11/14/2022] [Accepted: 02/19/2023] [Indexed: 03/01/2023]
Abstract
OBJECTIVE The present study aimed to assess the relationship between keratinized mucosa width and peri-implant diseases, namely peri-implant mucositis and peri-implantitis. MATERIALS AND METHODS Ninety-one dental implants in function for ≥ 6 months from 40 partially or completely edentulous non-smoker subjects (24 females and 16 males) were evaluated clinically and radiographically. The width of keratinized mucosa, probing depth, plaque index, bleeding on probing, and marginal bone levels were assessed. Keratinized mucosa width was categorized as ≥ 2 mm or < 2 mm. RESULTS There was no statistically significant association between keratinized buccal mucosa width and peri-implant mucositis or peri-implantitis (p ≥ 0.37). In the regression analysis, peri-implantitis was associated with longer implant function time (RR: 2.55, 95% CI: 1.25-11.81, p = 0.02) and implants in the maxilla (RR: 3.15, 95% CI: 1.61-14.93, p = 0.003). Mucositis was not associated with any of the factors analyzed. CONCLUSION In conclusion, in the present sample, keratinized buccal mucosa width was not associated with peri-implant diseases, suggesting that a band of keratinized mucosa may not be necessary to maintain peri-implant health. Prospective studies are required to better understand its role in the maintenance of peri-implant health.
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Affiliation(s)
- Caroline Argolo Brito Oliveira
- Dentistry and Health, School of Dentistry, Federal University of Bahia, Salvador, Bahia, Brazil.
- , Feira de Santana, Bahia, Brazil.
| | | | - Jean Nunes Dos Santos
- Department of Oral Pathology, School of Dentistry, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Nara Santos Araujo
- Federal University of Bahia, Salvador, Bahia, Brazil
- Department of Periodontics, School of Dentistry, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Patricia Ramos Cury
- Department of Periodontics, School of Dentistry, Federal University of Bahia, Salvador, Bahia, Brazil
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Carvalhaes JM, Ponzoni D, Tonini KR, de Carvalho PSP. Clinical study on the association between keratinized mucosa and peri-implant health when external hexagon implants are installed in the posterior region of the maxilla and mandible: a cohort study. Int J Oral Maxillofac Surg 2024; 53:231-238. [PMID: 37468344 DOI: 10.1016/j.ijom.2023.06.007] [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: 09/13/2022] [Revised: 06/25/2023] [Accepted: 06/28/2023] [Indexed: 07/21/2023]
Abstract
This study evaluated the association between keratinized mucosa (KM) and peri-implant health of external hexagon implants in the posterior region in 84 patients with 242 implants. Modified plaque index (MPI), modified sulcular bleeding index (MSBI), probing depth (PD), keratinized mucosa (KM) width, and peri-implant bone loss were evaluated. The implants were divided according to the KM: (1) absence of KM, (2) KM width >0 and <2 mm, and (3) KM width ≥2 mm. Of the 242 implants evaluated, 63 (26.0%) had no KM band, 56 (23.1%) had KM width <2 mm, and 123 (50.8%) had KM width ≥2 mm. One hundred and sixty-seven (69.0%) were used in multiple unit restorations and 75 (31.0%) in single tooth restorations; 66.9% were placed in the mandible and 33.1% in the maxilla. For single tooth and multiple unit implant restorations, MPI (P=0.069 and P=0.387, respectively), MSBI (P=0.695 and P=0.947, respectively), PD (P=0.270 and P=0.258, respectively), and mesial bone loss (P=0.121 and P=0.239, respectively) were not affected by the KM width. On the distal surface, bone loss was influenced by the absence of KM when single tooth implant restorations were used (P=0.032). No association was found between KM width and the peri-implant tissue health.
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Affiliation(s)
- J M Carvalhaes
- Brazilian Association of Dentistry, Maceió, Alagoas, Brazil
| | - D Ponzoni
- Department of Diagnosis and Surgery, São Paulo State University (UNESP), School of Dentistry, Araçatuba, São Paulo, Brazil.
| | - K R Tonini
- Department of Diagnosis and Surgery, São Paulo State University (UNESP), School of Dentistry, Araçatuba, São Paulo, Brazil
| | - P S P de Carvalho
- Bauru School of Dentistry, University of São Paulo - USP, Bauru, São Paulo, Brazil
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Hoffmann KJ, Büsch C, Moratin J, Ristow O, Hoffmann J, Mertens C. Peri-implant health after microvascular head and neck reconstruction-A retrospective analysis. Clin Oral Implants Res 2024; 35:187-200. [PMID: 38010660 DOI: 10.1111/clr.14214] [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: 04/21/2023] [Revised: 10/04/2023] [Accepted: 11/09/2023] [Indexed: 11/29/2023]
Abstract
INTRODUCTION Prosthodontic rehabilitation after reconstruction with microvascular revascularized free flaps following ablative tumor surgery is challenging due to the altered anatomical and functional conditions. The aim of this retrospective study was to determine whether the type of graft and the type of peri-implant tissue have an effect on peri-implant inflammatory parameters and implant survival. MATERIALS AND METHODS Patients who received a free flap reconstruction with subsequent implant-prosthetic rehabilitation between 2010 and 2022 were retrospectively included. The primary outcome variable was the probing depth (PPD) at a minimum of 1 year after completion of prosthetic restoration. Predictive variables were type of free flap, emergence profile, and history of radiation. RESULTS Seventy-one patients after free flap reconstruction were included in the analysis. At a minimum of 24 months after implant insertion the primary outcome, PPD showed no clinically relevant differences between the types of free flaps used. The emergence profile through a skin island resulted in an increase in BOP compared to native mucosa in the descriptive analysis (p-value > .05). The analysis showed a 5-year implant survival of 96.2% (95% CI: 0.929-0.996) in cases without irradiation and 87.6% (95% CI: 0.810-0.948) with irradiation of the region evaluated (p-value .034). CONCLUSION Flap and associated soft tissue type had no significant effect on 5-year implant survival or peri-implant inflammatory parameters. However, the large heterogeneity of the patient population indicates that further prolonged studies are required for a more differentiated assessment of the long-term success.
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Affiliation(s)
- Korbinian Jochen Hoffmann
- Department of Oral- and Cranio-Maxillofacial Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Christopher Büsch
- Institute of Medical Biometry, University of Heidelberg, Heidelberg, Germany
| | - Julius Moratin
- Department of Oral- and Cranio-Maxillofacial Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Oliver Ristow
- Department of Oral- and Cranio-Maxillofacial Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Jürgen Hoffmann
- Department of Oral- and Cranio-Maxillofacial Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Christian Mertens
- Department of Oral- and Cranio-Maxillofacial Surgery, Heidelberg University Hospital, Heidelberg, Germany
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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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11
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Gurbuz E, Ceylan E, Yurttas M. Evaluation of the significance of keratinized mucosa on peri-implant tissue health: a prospective clinical trial. Aust Dent J 2023. [PMID: 36856539 DOI: 10.1111/adj.12955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2023] [Indexed: 03/02/2023]
Abstract
BACKGROUND The effect of keratinized mucosa on peri-implant tissue health is still inconclusive. This study aimed to evaluate the importance of keratinized mucosa and investigate the impact of the free gingival graft procedure on peri-implant health. METHODS At prosthesis delivery, the implants were allocated into three groups, based on the width of keratinized mucosa (KM) and patients' agreement on the free gingival graft procedure: KMS (KM ≥2 mm), KMD (KM <2 mm), and FGG (KM <2 mm initially and having surgically increased keratinized mucosa). Modified plaque index (mPI), probing depth (PD), modified bleeding index (mBI), KM, and marginal bone loss (MBL) were assessed at the baseline, 6-, 12-, and 24-month follow-up periods. RESULTS Of the 47 patients, 17 belonged to the KMS group, 17 belonged to the KMD, and the remaining 13 patients belonged to the FGG. KMD demonstrated significantly fewer mPI and higher mBI than KMS and FGG at 6 and 12 months. At 24 months, MBL did not differ between the groups; however, PD was significantly greater in the KMD group. CONCLUSIONS Implants with inadequate keratinized mucosa had higher bleeding and pocket depth values despite less plaque accumulation. According to the results, soft tissue grafting should be performed as early as possible. © 2023 Australian Dental Association.
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Affiliation(s)
- E Gurbuz
- Faculty of Dentistry, Department of Periodontology, Kutahya Health Sciences University, Kutahya, Turkey
| | - E Ceylan
- Faculty of Dentistry, Department of Periodontology, Kutahya Health Sciences University, Kutahya, Turkey
| | - M Yurttas
- Faculty of Dentistry, Department of Oral and Maxillofacial Radiology, Kutahya Health Sciences University, Kutahya, Turkey
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12
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Monje A, González-Martín O, Ávila-Ortiz G. Impact of peri-implant soft tissue characteristics on health and esthetics. J ESTHET RESTOR DENT 2023; 35:183-196. [PMID: 36650691 DOI: 10.1111/jerd.13003] [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: 10/21/2022] [Revised: 12/13/2022] [Accepted: 12/13/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To review the impact of key peri-implant soft tissue characteristics on health and esthetics. MAIN CONSIDERATIONS The keratinized mucosa width (KMW), the mucosal thickness (MT), and the supracrestal tissue height (STH) are essential components of the peri-implant soft tissue phenotype. An inadequate KMW (<2 mm) has been associated with local discomfort upon oral hygiene performance and increased risk for the onset of peri-implant diseases. A minimum buccal MT (≥2 mm) is generally required to prevent esthetic issues related to the effect of transmucosal prosthetic elements on the color of the mucosa and can also contribute to long-term mucosal stability. STH is directly related to marginal bone remodeling patterns during the early healing process that follows the connection of transmucosal prosthetic components. Short STH, generally defined as <3 mm, has been consistently associated with marginal bone loss resulting from the physiologic establishment of the mucosal seal. Insufficient STH may also derive into the fabrication of unfavorable transmucosal prosthetic contours, which frequently results in unpleasing esthetic outcomes and predisposes to submarginal biofilm accumulation. Peri-implant soft tissue dehiscences (PISTDs) are a type of peri-implant deformity that are associated with esthetic issues and often occur in sites presenting KMW, MT, and/or STH deficiencies. PISTDs should be correctly diagnosed and treated accordingly, usually by means of multidisciplinary therapy. CONCLUSION Understanding the impact of different dimensional and morphologic features of the peri-implant mucosa on health and esthetic outcomes is fundamental to make appropriate clinical decisions in the context of tooth replacement therapy with implant-supported prostheses.
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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
| | - Oscar González-Martín
- Private Practice, Atelier Dental Madrid, Madrid, Spain.,Department of Periodontology, Complutense University of Madrid, Madrid, Spain
| | - Gustavo Ávila-Ortiz
- Private Practice, Atelier Dental Madrid, Madrid, Spain.,Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, USA.,Department of Periodontics, University of Iowa College of Dentistry, Iowa City, Iowa, USA
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13
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Abu Hussien H, Machtei EE, Khutaba A, Gabay E, Zigdon Giladi H. Palatal soft tissue thickness around dental implants and natural teeth in health and disease: A cross sectional study. Clin Implant Dent Relat Res 2022; 25:215-223. [PMID: 36537536 DOI: 10.1111/cid.13171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 12/06/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Previous studies focused on the influence of buccal mucosa thickness on peri-implant bone loss and inflammation, with inconclusive results. We observed substantially thicker palatal mucosal tissues at peri-implantitis sites. Therefore, we hypothesize that thick palatal peri-implant mucosa may be associated with deeper pockets and disease severity. PURPOSE To compare the thickness of the palatal tissue between natural teeth and implants in periodontal health and disease. METHODS Adult, non-smoker, healthy patients who visited our department for periodontal examination or treatment with restored implants in the posterior maxilla were recruited. Probing depth (PD), plaque index (PI), gingival index (GI) and radiographic measurements were recorded around implant and the contralateral tooth. Palatal tissue thickness was measured using a 30G needle that was inserted perpendicular into the mucosa at the bottom of the periodontal/peri-implant pocket and 3 mm coronally. Differences in the palatal tissue thickness between teeth and implants (in the same patient) was performed using t-test; as well as between peri-implantitis and non-peri-implantitis sites (among patients). RESULTS Sixty patients were included. Thirty-four implants were diagnosed with peri-implantitis and 26 healthy/mucositis implants with corresponding 24 healthy/gingivitis teeth and 36 teeth with attachment loss. Mean PD was higher around implants (4.47 ± 1.57 mm) than teeth (3.61 ± 1.23 mm, p = 0.001). The thickness of implants' palatal mucosa was higher than in teeth, at the base of the pocket and 3 mm coronally (4.58 ± 1.38 mm vs. 3.01 ± 1.11, p = 0.000; 3.58 ± 2.15 vs. 1.89 ± 1.11, p = 0.000, respectively). Mean palatal tissue thickness was 4.32 ± 2.35 mm for the peri-implantitis group while only 2.61 ± 1.39 in healthy implants, 3 mm coronal to the base of the pocket (p = 0.001). Palatal thickness at peri-implantitis sites was higher (4.32 ± 2.35) compared to periodontitis sites (2.23 ± 0.93), p = 0.000. Implant sites with palatal mucosa >4 mm (n = 32) had deeper mean pockets (5.58 ± 1.98) compared with thinner (≤4 mm) sites (n = 28) (4.48 ± 1.18, p = 0.018). CONCLUSION Thicker palatal tissue around implants is associated with deeper palatal pockets. Thick palatal tissue was found around implants diagnosed with peri-implantitis.
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Affiliation(s)
- Hiba Abu Hussien
- Department of Periodontology, School of Graduate Dentistry Rambam Health Care Campus Haifa Israel
| | - Eli E. Machtei
- Department of Periodontology, School of Graduate Dentistry Rambam Health Care Campus Haifa Israel
- Faculty of Medicine Technion – Israeli Institute of Technology Haifa Israel
| | - Alaa Khutaba
- Department of Periodontology, School of Graduate Dentistry Rambam Health Care Campus Haifa Israel
| | - Eran Gabay
- Department of Periodontology, School of Graduate Dentistry Rambam Health Care Campus Haifa Israel
- Faculty of Medicine Technion – Israeli Institute of Technology Haifa Israel
| | - Hadar Zigdon Giladi
- Department of Periodontology, School of Graduate Dentistry Rambam Health Care Campus Haifa Israel
- Faculty of Medicine Technion – Israeli Institute of Technology Haifa Israel
- Laboratory for Bone Repair CRIR Institute, Rambam Health Care Campus Haifa Israel
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14
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Monje A, Kan JY, Borgnakke W. Impact of local predisposing/precipitating factors and systemic drivers on peri‐implant diseases. Clin Implant Dent Relat Res 2022. [PMID: 36533411 DOI: 10.1111/cid.13155] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 11/01/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Strong evidence suggests the infectious nature of peri-implant diseases occurring in susceptible hosts. Epidemiological reports, though, indicate that peri-implantitis is a site-specific entity. Hence, the significance of local factors that may predispose/precipitate plaque accumulation and the impact of systemic drivers that alter the immune response are relevant in the prevention and management of peri-implant disorders. PURPOSE The purpose of the present review is to shed light on the significance of local and systemic factors on peri-implant diseases, making special emphasis on the associations with peri-implantitis. METHODS The biologic plausibility and supporting evidence aiming at providing a concluding remark were explored in the recent scientific literature for local predisposing/precipitating factors and systemic drivers related to peri-implant diseases. RESULTS Local predisposing factors such as soft tissue characteristics, implant position and prosthetic design proved being strongly associated with the occurrence of peri-implant diseases. Hard tissue characteristics, however, failed to demonstrate having a direct association with peri-implant diseases. Robust data points toward the strong link between residual sub-mucosal cement and peri-implant diseases, while limited data suggests the impact of residual sub-mucosal floss and peri-implantitis. Systemic drivers/habits such as hyperglycemia and smoking showed a strong negative impact on peri-implantitis. However, there is insufficient evidence to claim for any link between metabolic syndrome, atherosclerotic cardiovascular disease, and obesity and peri-implant diseases. CONCLUSION Local predisposing/precipitating factors and systemic drivers may increase the risk of peri-implant diseases. Therefore, comprehensive anamnesis of the patients, educational/motivational programs and exhaustive prosthetically-driven treatment planning must be fostered aiming at reducing the rate of biological complications in implant dentistry.
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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, ZMK University of Bern Bern CH Switzerland
| | - Joseph Y. Kan
- Department of Implantology Loma Linda University Loma Linda California USA
| | - Wenche Borgnakke
- Department of Periodontology and Oral Medicine University of Michigan Ann Arbor Michigan USA
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15
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Crauste E, Struillou X, Lanoiselee E, Cloitre A. GUIDED PERI-IMPLANT AUTOGENOUS SOFT TISSUE GRAFTING: CASE REPORT. J ORAL IMPLANTOL 2022; 48:489035. [PMID: 36473180 DOI: 10.1563/aaid-joi-d-21-00201] [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: 07/01/2021] [Revised: 06/22/2022] [Accepted: 07/12/2022] [Indexed: 02/17/2024]
Abstract
This case report showed the proof-of-concept of a guided free gingival graft around a dental implant. A 65-year-old male presented to replace his 30 and 31. Once the osseointegration of the 2 implants placed by guided surgery has been achieved, a free gingival graft was indicated. The surgical planning of this graft was performed using the Cone Beam Computed Tomography and archs digital scanning already used for implant placement. The greater palatine foramen and gutter were radiologically located to protect their arterial content. Two surgical guides were designed, one for the palatal donor site and one for the recipient site. The first one will serve both as an incision guide and as a post-operative protective plate. The procedure was free of adverse events. At the 1-year recall, the average gain in keratinized tissue width amounted 2.5 mm. This guided surgery could be used in a patient with insufficient amount of keratinized tissue around a posterior implant. For the first time, it makes it possible to anticipate, accelerate and secure the intervention, to improve the practitioner's comfort and potentially the outcomes of free gingival grafts. Further research and clinical are needed to validate this protocol and to assess its long-term impact on peri-implant health.
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Affiliation(s)
- Eleonore Crauste
- Nantes University: Universite de Nantes Faculté d'odontologie 1, place Alexis Ricordeau FRANCE NANTES Loire Atlantique 44000
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16
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Montero E, Molina A, Matesanz P, Monje A, Sanz-Sánchez I, Herrera D. Efficacy of soft tissue substitutes, in comparison with autogenous grafts, in surgical procedures aiming to increase the peri-implant keratinized mucosa: A systematic review. Clin Oral Implants Res 2022; 33 Suppl 23:32-46. [PMID: 35763018 DOI: 10.1111/clr.13751] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/22/2021] [Accepted: 03/01/2021] [Indexed: 12/30/2022]
Abstract
OBJECTIVES The aim of this systematic review was to evaluate the efficacy of soft tissue substitutes compared to autogenous gingival grafts in surgical procedures aimed at increasing the width of keratinized mucosa (KM) around dental implants. MATERIALS AND METHODS Two focused questions were developed: PICOS #1) "What is the efficacy of surgical procedures using soft tissue substitutes, as compared to autogenous grafts, to increase the amount of peri-implant keratinized mucosa, in randomized clinical trials (RCTs) and controlled clinical trials (CCTs)?"; and PICOS #2) "What is the effectiveness of soft tissue substitutes to increase the amount of peri-implant keratinized mucosa, in RCTs, CCTs, cohort studies or case series?". Besides KM augmentation, other relevant outcomes such as clinical and radiographic peri-implant outcomes, incidence of biological complications, surgical time, or patient-reported outcome measures (PROMs) were collected. Meta-analyses were performed whenever possible. RESULTS Ten publications and an unpublished study were included. KM augmentation was significantly greater for autogenous grafts (n = 6; weighted mean difference (WMD) = -0.9 mm; 95% confidence interval (CI) [-1.4; -0.3]; p = .001). However, no significant differences between autogenous grafts and soft tissue substitutes were observed when exclusively xenografts were considered (n = 5; WMD=-0.8 mm; 95% CI [-1.6; 0.0]; p = .062). Surgical time and postsurgical pain seemed to be reduced by the use of soft tissue substitutes. CONCLUSIONS Free gingival grafts (FGG) are more effective in the augmentation of KM mucosa around dental implants than soft tissue substitutes. However, substitutes of xenogeneic origin may be an alternative to autogenous tissues.
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Affiliation(s)
- Eduardo Montero
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases), Research Group, University Complutense of Madrid, Madrid, Spain
| | - Ana Molina
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases), Research Group, University Complutense of Madrid, Madrid, Spain
| | - Paula Matesanz
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases), Research Group, University Complutense of Madrid, Madrid, Spain
| | - Alberto Monje
- Department of Periodontology, Universidad Internacional de Catalunya, Barcelona, Spain.,Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - Ignacio Sanz-Sánchez
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases), Research Group, University Complutense of Madrid, Madrid, Spain
| | - David Herrera
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases), Research Group, University Complutense of Madrid, Madrid, Spain
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17
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Ramanauskaite A, Schwarz F, Sader R. Influence of width of keratinized tissue on the prevalence of peri-implant diseases: A systematic review and meta-analysis. Clin Oral Implants Res 2022; 33 Suppl 23:8-31. [PMID: 35763022 DOI: 10.1111/clr.13766] [Citation(s) in RCA: 49] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 03/25/2021] [Accepted: 05/03/2021] [Indexed: 12/16/2022]
Abstract
AIM To evaluate the influence of the width of keratinized tissue (KT) on the prevalence of peri-implant diseases, and soft- and hard-tissue stability. MATERIALS AND METHODS Clinical studies reporting on the prevalence of peri-implant diseases (primary outcome), plaque index (PI), modified plaque index (mPI), bleeding index (mBI), bleeding on probing (BOP), probing pocket depths (PD), mucosal recession (MR), and marginal bone loss (MBL) and/or patient-reported outcomes (PROMs; secondary outcomes) were searched. The weighted mean differences (WMD) were estimated for the assessed clinical and radiographic parameters by employing a random-effect model that considered different KT widths (i.e., <2 and ≥2 mm). RESULTS Twenty-two articles describing 21 studies (15 cross-sectional, five longitudinal comparative studies, and one case series with pre-post design) with an overall high to low risk of bias were included. Peri-implant mucositis and peri-implantitis affected 20.8% to 42% and at 10.5% to 44% of the implants with reduced or absent KT (i.e., <2 mm or 0 mm). The corresponding values at the implant sites with KT width of ≥2 mm or >0 mm were 20.5% to 53% and 5.1% to 8%, respectively. Significant differences between implants with KT < 2 mm and those with KT ≥ 2 mm were revealed for WMD for BOP, mPI, PI, MBL, and MR all favoring implants with KT ≥ 2 mm. CONCLUSION Reduced KT width is associated with an increased prevalence of peri-implantitis, plaque accumulation, soft-tissue inflammation, mucosal recession, marginal bone loss, and greater patient discomfort.
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Affiliation(s)
- Ausra Ramanauskaite
- Department of Oral Surgery and Implantology, Johann Wolfgang Goethe-University, Carolinum, Frankfurtam am Main, Germany
| | - Frank Schwarz
- Department of Oral Surgery and Implantology, Johann Wolfgang Goethe-University, Carolinum, Frankfurtam am Main, Germany
| | - Robert Sader
- Department for Oral, Cranio-Maxillofacial and Facial Plastic Surgery, Medical Center of the Goethe University Frankfurt, Frankfurtam am Main, Germany
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18
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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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19
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Ravidà A, Arena C, Tattan M, Caponio VCA, Saleh MHA, Wang HL, Troiano G. The role of keratinized mucosa width as a risk factor for peri-implant disease: A systematic review, meta-analysis, and trial sequential analysis. Clin Implant Dent Relat Res 2022; 24:287-300. [PMID: 35298862 PMCID: PMC9311272 DOI: 10.1111/cid.13080] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 02/23/2022] [Accepted: 02/24/2022] [Indexed: 11/29/2022]
Abstract
Background Studies have examined the benefit of having keratinized peri‐implant mucosa width with mixed results. Purpose This study examines whether the lack of a prespecified (2 mm) amount of keratinized mucosa width (KMW) is a risk factor for peri‐implant diseases. Methods A systematic electronic and manual search of randomized or nonrandomized controlled or noncontrolled clinical trials was conducted. Qualitative review, quantitative meta‐analysis, and trial sequence analysis (TSA) of implants inserted at sites with <2 mm or ≥2 mm of KMW were analyzed to compare all the predetermined outcome variables. The level of evidence concerning the role of KMW in peri‐implant health was evaluated via the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system guide. Results Nine studies were included in the qualitative analysis and four in the meta‐analysis and TSA. No significant inter‐group difference (p > 0.05) and a low power of evidence were found for probing depth, soft‐tissue recession, and marginal bone loss. A significant difference favoring ≥2 mm KMW had a lower mean plaque index (MD = 0.37, 95% CI: [0.16, 0.58], p = 0.002) (3 studies, 430 implants, low‐quality evidence). GRADE system showed very low and low quality of evidence for all other outcome measures. Conclusion Based on the available studies, the impact of amount of KMW (either <2 mm or ≥ 2 mm) as a risk factor for developing peri‐implant disease remains low. Future control studies with proper sample size and longer follow‐up are needed to further validate current findings.
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Affiliation(s)
- Andrea Ravidà
- Department of Periodontics and Oral Medicine, The University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Claudia Arena
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Mustafa Tattan
- Department of Periodontics, College of Dentistry, University of Iowa, Iowa City, Iowa, USA.,Department of Pharmaceutical Sciences & Experimental Therapeutics, College of Pharmacy, University of Iowa, Iowa City, Iowa, USA
| | | | - Muhammad H A Saleh
- Department of Periodontics, University of Louisville School of Dentistry, Louisville, Kentucky, USA
| | - Hom-Lay Wang
- Department of Periodontics and Oral Medicine, The University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Giuseppe Troiano
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
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20
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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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Park JS, Herr Y, Chung JH, Shin SI, Lim HC. Retrospective analysis of keratinized tissue augmentation using a xenogeneic collagen matrix for resolving peri-implant mucositis and peri-implantitis. J Periodontal Implant Sci 2022; 53:145-156. [PMID: 36468478 PMCID: PMC10133816 DOI: 10.5051/jpis.2200700035] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 04/17/2022] [Accepted: 05/17/2022] [Indexed: 11/08/2022] Open
Abstract
PURPOSE The significance of keratinized tissue for peri-implant health has been emphasized. However, there is an absence of clinical evidence for the use of a xenogeneic collagen matrix (XCM) to manage peri-implant mucositis and peri-implantitis. Therefore, the purpose of this study was to investigate outcomes after keratinized tissue augmentation using an XCM for the management of peri-implant diseases. METHODS Twelve implants (5 with peri-implant mucositis and 7 with peri-implantitis) in 10 patients were included in this study. Non-surgical treatments were first performed, but inflammation persisted in all implant sites. The implant sites all showed a lack of keratinized mucosa (KM) and vestibular depth (VD). Apically positioned flaps with XCM application were performed. Bone augmentation was simultaneously performed on peri-implantitis sites with an intrabony defect (>3 mm). The following clinical parameters were measured: the probing pocket depth (PPD), modified sulcular bleeding index (mSBI), suppuration (SUP), keratinized mucosal height (KMH), and VD. RESULTS There were no adverse healing events during the follow-up visits (18±4.6 months). The final KMHs and VDs were 4.34±0.86 mm and 8.0±4.05 mm, respectively, for the sites with peri-implant mucositis and 3.29±0.86 mm and 6.5±1.91 mm, respectively, for the sites with peri-implantitis. Additionally, the PPD and mSBI significantly decreased, and none of the implants presented with SUP. CONCLUSIONS Keratinized tissue augmentation using an XCM for sites with peri-implant mucositis and peri-implantitis was effective for increasing the KMH and VD and decreasing peri-implant inflammation.
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Affiliation(s)
- Jung Soo Park
- Department of Periodontology, Korea University Anam Hospital, Seoul, Korea
| | - Yeek Herr
- Department of Periodontology, Periodontal-Implant Clinical Research Institute, College of Dentistry, Kyung Hee University, Seoul, Korea
| | - Jong-Hyuk Chung
- Department of Periodontology, Periodontal-Implant Clinical Research Institute, College of Dentistry, Kyung Hee University, Seoul, Korea
| | - Seung-Il Shin
- Department of Periodontology, Periodontal-Implant Clinical Research Institute, College of Dentistry, Kyung Hee University, Seoul, Korea
| | - Hyun-Chang Lim
- Department of Periodontology, Periodontal-Implant Clinical Research Institute, College of Dentistry, Kyung Hee University, Seoul, Korea
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Mainas G, Ruiz Magaz V, Valles C, Mora J, Candiago J, Pascual A, Nart J. Keratinized mucosa changes around one-stage implants: A prospective case series. Clin Implant Dent Relat Res 2021; 24:34-42. [PMID: 34939306 DOI: 10.1111/cid.13053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 09/05/2021] [Accepted: 10/18/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND The need of an adequate band of keratinized tissue (KT) to maintain periodontal health around teeth as well as around implants has been a debated topic over many years but still no conclusions have been drawn. OBJECTIVES This prospective case series evaluates the changes undergone by the keratinized mucosa (KM) and the soft tissue volume around non-submerged implants before the prosthetic rehabilitation. MATERIAL AND METHODS A total of 40 patients were included. The primary outcome was to analyze the width of the KM at both buccal and lingual aspects compared to the pre-existing KT in the edentulous ridge only in mandibular (pre)molar area. The mucogingival line was marked with a surgical pen and an intra-oral scanner was used to take the impression of the implant area the day of the surgery (T0, baseline) and before the crown placement (T1, 3 months). Buccal soft tissue volume was measured at 1, 3, and 5 mm apical to the healing abutment position and a comparison between T0 and T1 was performed. Student t-test was used according to the distribution of the data (Shapiro-Wilk). RESULTS The mean KT width at baseline was 4.54 ± 1.31 mm at buccal side and 5.04 ± 1.88 mm at lingual side. After 3 months, the mean KM values were 3.15 ± 1.03 mm and 3.72 ± 1.56 mm at the buccal and lingual aspects, respectively. The differences, 30.6% of KM reduction buccally and 26.1% of reduction lingually, were statistically significant for both sides. CONCLUSIONS Within the limitations of this investigation, it was observed that the KM width from the baseline to the 3 months follow up presented a significant dimensional change in both the buccal and lingual aspects, whereas buccal soft tissue volume showed an increase between baseline and follow up.
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Affiliation(s)
- Giuseppe Mainas
- Department of Periodontology, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Vanessa Ruiz Magaz
- Department of Periodontology, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Cristina Valles
- Department of Periodontology, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Javier Mora
- Department of Periodontology, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Jacopo Candiago
- Department of Periodontology, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Andres Pascual
- Department of Periodontology, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Jose Nart
- Department of Periodontology, Universitat Internacional de Catalunya, Barcelona, Spain
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Toia M, Stocchero M, Corrà E, Becktor JP, Wennerberg A, Cecchinato D. Fixed full-arch maxillary prostheses supported by four versus six implants with a titanium CAD/CAM milled framework: 3-year multicentre RCT. Clin Oral Implants Res 2020; 32:44-59. [PMID: 33222296 DOI: 10.1111/clr.13679] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 09/23/2020] [Accepted: 10/20/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES This RCT compares marginal bone level (MBL) change and the clinical parameters after a 3-year function in maxillary implant-supported fixed complete dentures (FCDs) treated with four-implants (4-I) or six-implants (6-I). MATERIAL AND METHOD Three centres treated 56 patients with 280 implants allocated to the 4-I or 6-I group. Radiographic and clinical examinations were performed. The primary outcome was to investigate MBL change between the groups. RESULTS Implant survival rates were 100% and 99% in the 4-I and 6-I groups, respectively. Considering the clustering effects, the MBL change was not significantly different between the groups over the 3-year follow-up. The MBL in the 4-I group was 0.30 ± 0.50 mm at baseline, 0.24 ± 0.31 mm at 1 year and 0.24 ± 0.38 mm at 3 years. In the 6-I group, MBL was 0.14 ± 0.32 mm at baseline, 0.16 ± 0.35 mm at 1 year and 0.12 ± 0.26 mm at 3 years. There was a statistically significant difference between the groups at BL and 3Y. No significant differences between the groups were reported for clinical parameters at each time point as well as in between the visits. The technical and biological complications rates were 1.6% and 6.0%, respectively. Prosthetic complications affected 25 FCDs (47.2%). CONCLUSION Marginal bone level change revealed a stable condition in the 3-year period in the two groups. Few technical and biological complications occurred apart from the chipping/fracture of the prosthetic teeth. Four-implant is a feasible solution if the rehabilitation is oriented towards the most cost-effective treatment and towards avoiding bone augmentation procedures. Clinicians have to consider the potential required visits for prosthetic maintenance.
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Affiliation(s)
- Marco Toia
- Department of Oral and Maxillofacial Surgery and Oral Medicine, Faculty of Odontology, Malmö University, Malmö, Sweden
| | - Michele Stocchero
- Department of Oral and Maxillofacial Surgery and Oral Medicine, Faculty of Odontology, Malmö University, Malmö, Sweden
| | | | - Jonas P Becktor
- Department of Oral and Maxillofacial Surgery and Oral Medicine, Faculty of Odontology, Malmö University, Malmö, Sweden
| | - Ann Wennerberg
- Department of Prosthodontics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Kissa J, El Kholti W, Chemlali S, Kawtari H, Laalou Y, Albandar JM. Prevalence and risk indicators of peri-implant diseases in a group of Moroccan patients. J Periodontol 2020; 92:1096-1106. [PMID: 33306841 DOI: 10.1002/jper.20-0549] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 12/01/2020] [Accepted: 12/03/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND To report the prevalence of peri-implant diseases in a North African patient population, and to assess the concurrent associations of patient- and implant-level characteristics with probing depth and bone loss around dental implants METHODS: A total of 642 implants in 145 subjects were followed up for a mean 6.4 years. At the last follow-up visit the subjects were examined clinically and radiographically to assess the status of peri-implant tissues and teeth. Data analysis used the generalized linear mixed models RESULTS: The prevalence of peri-implant mucositis and peri-implantitis were 82.1% and 41.4% at the subject level, and 68.4% and 22.7% at the implant level, respectively. Inadequate plaque control, peri-implant inflammation, history of previous implant failures, and pain/discomfort at the implant site were significantly associated with both outcomes (increased probing depth and bone loss). Diabetes mellitus, inadequate implant restoration, single restorations (versus multi-unit), cement-retained restorations, and presence of occlusal wear facets on teeth were significantly associated with one of the two outcomes. Implants placed in the lower anterior jaw region had the most favorable outcome. Smoking, history of periodontitis, and type of implant surface did not show significant associations with higher frequency of peri-implant diseases in the multivariable analysis. CONCLUSIONS Peri-implant diseases are prevalent in this North African patient population. Multiple subject- and implant-level variables were associated with peri-implant diseases. Risk assessment of these effects should consist of a concurrent inclusion of these factors in multivariable analyses that also adjust for the complex variance structure of the oral environment.
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Affiliation(s)
- Jamila Kissa
- Department of Periodontology, University of Hassan II of Casablanca, Casablanca, Morocco
| | - Wafa El Kholti
- Department of Periodontology, University of Hassan II of Casablanca, Casablanca, Morocco
| | - Sihame Chemlali
- Department of Periodontology, University of Hassan II of Casablanca, Casablanca, Morocco
| | | | | | - Jasim M Albandar
- Department of Periodontology and Oral Implantology, School of Dentistry, Temple University, Philadelphia, PA, USA
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Wehner C, Bertl K, Durstberger G, Arnhart C, Rausch-Fan X, Stavropoulos A. Characteristics and frequency distribution of bone defect configurations in peri-implantitis lesions-A series of 193 cases. Clin Implant Dent Relat Res 2020; 23:178-188. [PMID: 33174377 PMCID: PMC8246974 DOI: 10.1111/cid.12961] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 09/16/2020] [Accepted: 10/05/2020] [Indexed: 12/27/2022]
Abstract
Background Knowledge on peri‐implantitis bone defect characteristics and predictors is still limited. Purpose To describe peri‐implantitis bone defect characteristics and identify possible predictors. Methods Various parameters at patient‐ (age, gender, smoking, and supra‐structure), implant‐ (surface, type, connection, platform, and misfit), and site level (region, alveolar ridge position, defect characteristics, neighboring structure) were recorded retrospectively. Results Among 193 implants, the most prevalent defects were class Ic (25.4%), and Id (23.8%); a previously non‐described category “class Id with only one bone wall” was frequently observed (11.9%). Mean intrabony defect depth and width ranged from 4.5 to 6.2 mm and from 2.7 to 2.9 mm, respectively; mean dehiscence extent ranged from 2.8 to 7.0 mm. A total of 37.8% of the defects presented horizontal bone loss and an intrabony component; in 52.7% of the implants, total defect extent was >6 mm. Jaw region, implant position within the alveolar ridge, and implant/abutment misfit showed significant associations either to defect configuration and/or defect extent. Conclusion (a) Most common peri‐implantitis defects exhibited a combination of intrabony component and a buccal/oral dehiscence, while purely circumferential defects were relatively seldom; (b) implants with defects with bone dehiscence were placed more frequently closer to the lateral aspect of the ridge harboring the dehiscence; (c) implants placed in the lower anterior region had the highest risk for more severe peri‐implant bone loss; and (d) peri‐implant bone defects with only a single bone wall appropriate for regenerative procedure were relatively frequent.
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Affiliation(s)
- Christian Wehner
- Division of Conservative Dentistry and Periodontology, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Kristina Bertl
- Department of Periodontology, Faculty of Odontology, University of Malmö, Malmö, Sweden.,Division of Oral Surgery, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Gerlinde Durstberger
- Division of Conservative Dentistry and Periodontology, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Christoph Arnhart
- Division of Oral Surgery, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Xiaohui Rausch-Fan
- Division of Conservative Dentistry and Periodontology, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Andreas Stavropoulos
- Division of Conservative Dentistry and Periodontology, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria.,Department of Periodontology, Faculty of Odontology, University of Malmö, Malmö, Sweden.,Division of Regenerative Dental Medicine and Periodontology, University Clinics of Dental Medicine (CUMD), University of Geneva, Geneva, Switzerland
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26
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Parvini P, Obreja K, Becker K, Galarraga ME, Schwarz F, Ramanauskaite A. The prevalence of peri-implant disease following immediate implant placement and loading: a cross-sectional analysis after 2 to 10 years. Int J Implant Dent 2020; 6:63. [PMID: 33073302 PMCID: PMC7569077 DOI: 10.1186/s40729-020-00259-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 08/31/2020] [Indexed: 11/16/2022] Open
Abstract
Background To evaluate the prevalence of peri-implant disease after immediate implant placement and loading. Material and methods This cross-sectional analysis included a total of 47 patients with 64 implants exhibiting a mean loading time of 2 to 10 years (4.23 ± 1.7 years). The surgical and prosthetic procedures were standardized in all patients. Peri-implant health and disease was assessed based on the established case definitions. Results The prevalence of peri-implant health, peri-implant mucositis, and peri-implantitis amounted to 38.3%, 57.5%, and 4.2% of the patients, respectively. Mucosal recession of 1 mm was present at 4 (6%) implants. No suppuration, pain, or implant failures were reported. Ordinal logistic regression revealed that reduced keratinized mucosa height was significantly associated with the diagnosis of peri-implant mucositis and peri-implantitis (OR = 0.514, P = 0.0125). Conclusion Immediate implant placement and loading was associated with high success rates at 2 to 10 years.
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Affiliation(s)
- Puria Parvini
- Department of Oral Surgery and Implantology, Johann Wolfgang Goethe-University, Carolinum, Frankfurt am Main, Germany
| | - Karina Obreja
- Department of Oral Surgery and Implantology, Johann Wolfgang Goethe-University, Carolinum, Frankfurt am Main, Germany
| | - Kathrin Becker
- Department of Orthodontics, Westdeutsche Kieferklinik, Universitätsklinikum Düsseldorf, Düsseldorf, Germany.
| | | | - Frank Schwarz
- Department of Oral Surgery and Implantology, Johann Wolfgang Goethe-University, Carolinum, Frankfurt am Main, Germany
| | - Ausra Ramanauskaite
- Department of Oral Surgery and Implantology, Johann Wolfgang Goethe-University, Carolinum, Frankfurt am Main, Germany
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27
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Song YW, Yoon SW, Cha JK, Jung UW, Jung RE, Thoma DS. Soft Tissue Dimensions Following Tooth Extraction in the Posterior Maxilla: A Randomized Clinical Trial Comparing Alveolar Ridge Preservation to Spontaneous Healing. J Clin Med 2020; 9:jcm9082583. [PMID: 32784997 PMCID: PMC7464084 DOI: 10.3390/jcm9082583] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/07/2020] [Accepted: 08/07/2020] [Indexed: 12/13/2022] Open
Abstract
Background: To assess the soft tissue dimension following tooth extraction and alveolar ridge preservation in the posterior maxilla compared to spontaneous healing. Methods: Thirty-five patients randomly assigned to alveolar ridge preservation (ARP) and spontaneous healing (SH) after maxillary molar extraction. The crestal, buccal, and palatal gingival thickness at 6 months was measured around virtually placed implant fixtures using superimposed cone-beam computed tomography and intraoral scan taken at 6 months. Buccal mucogingival junction (MGJ) level change over 6 months was estimated using intraoral scans obtained at suture-removal and 6 months. Results: The crestal gingiva was significantly thinner in group ARP (−1.16 mm) compared to group SH (p < 0.05). The buccal and palatal gingiva was significantly thinner at the implant shoulder (IS) level in group ARP (buccal: −0.75 mm; palatal: −0.85 mm) compared to group SH (p < 0.05). The thickness at 2 mm below the IS of both sides and the buccal MGJ level change were similar in both groups (p > 0.05). Conclusions: ARP in the posterior maxilla resulted in a thinner soft tissue on top of and at the prospective level of the implant shoulder at 6 months. The buccal MGJ level changed minimal for 6 months in both groups.
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Affiliation(s)
- Young Woo Song
- Department of Periodontology, Research Institute for Periodontal Regeneration, Yonsei University College of Dentistry, Seoul 03722, Korea; (Y.W.S.); (S.-W.Y.); (J.-K.C.); (D.S.T.)
| | - Sung-Wook Yoon
- Department of Periodontology, Research Institute for Periodontal Regeneration, Yonsei University College of Dentistry, Seoul 03722, Korea; (Y.W.S.); (S.-W.Y.); (J.-K.C.); (D.S.T.)
| | - Jae-Kook Cha
- Department of Periodontology, Research Institute for Periodontal Regeneration, Yonsei University College of Dentistry, Seoul 03722, Korea; (Y.W.S.); (S.-W.Y.); (J.-K.C.); (D.S.T.)
| | - Ui-Won Jung
- Department of Periodontology, Research Institute for Periodontal Regeneration, Yonsei University College of Dentistry, Seoul 03722, Korea; (Y.W.S.); (S.-W.Y.); (J.-K.C.); (D.S.T.)
- Correspondence: ; Tel.: +82-2-2228318
| | - Ronald E. Jung
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, 8032 Zurich, Switzerland;
| | - Daniel S. Thoma
- Department of Periodontology, Research Institute for Periodontal Regeneration, Yonsei University College of Dentistry, Seoul 03722, Korea; (Y.W.S.); (S.-W.Y.); (J.-K.C.); (D.S.T.)
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, 8032 Zurich, Switzerland;
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Kungsadalpipob K, Supanimitkul K, Manopattanasoontorn S, Sophon N, Tangsathian T, Arunyanak SP. The lack of keratinized mucosa is associated with poor peri-implant tissue health: a cross-sectional study. Int J Implant Dent 2020; 6:28. [PMID: 32671594 PMCID: PMC7363759 DOI: 10.1186/s40729-020-00227-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 05/14/2020] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES The aim of this cross-sectional study is to determine the association between the absence of keratinized mucosa and peri-implant tissue health. METHODS AND MATERIALS This cross-sectional study comprised 412 implants from 200 patients from faculty-based clinics. Demographic, medical, and clinical information were collected. The modified sulcus bleeding index, modified plaque index, mucosal recession, probing depth, bone level, the width of keratinized mucosa, and implant status were evaluated by three calibrated examiners. Each implant was categorized into either of two peri-implant mucosa groups: keratinized mucosa (KM) or non-keratinized mucosa (NKM). The chi-square test was performed to the association between the keratinized mucosa groups and peri-implant clinical parameters and peri-implant status. Multiple logistic regression models were analyzed to test potential associations between peri-implant clinical parameters and the presence or absence of keratinized mucosa. RESULTS Thirty-two implants (7.8%) were categorized into the NKM group. The prevalence of peri-implantitis was 12.5% and 8.3% at the subject level and implant level, respectively. The NKM group was associated with more plaque accumulation, mucosal recession, interproximal bone level ≥ 3 mm, and peri-implantitis (p < 0.05). After controlling for confounding factors, the NKM group demonstrated higher plaque accumulation, mucosal recession, and interproximal bone level ≥ 3 mm with adjusted odds ratios of 2.98 (1.33-6.66), 3.20 (95% CI, 1.03-9.90), and 4.62 (1.70-12.58), respectively. CONCLUSION Within the limitation of this study, the lack of keratinized mucosa around the dental implants was significantly associated with more plaque accumulation, mucosal recession, interproximal bone level ≥ 3 mm, and peri-implantitis.
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Affiliation(s)
- Kajorn Kungsadalpipob
- Department of Periodontology, Faculty of Dentistry, Chulalongkorn University, 34 Henry Dunant Rd., Wangmai, Patumwan, Bangkok, 10330, Thailand
| | - Kakanang Supanimitkul
- Department of Periodontology, Faculty of Dentistry, Chulalongkorn University, 34 Henry Dunant Rd., Wangmai, Patumwan, Bangkok, 10330, Thailand
| | - Sukuma Manopattanasoontorn
- Department of Periodontology, Faculty of Dentistry, Chulalongkorn University, 34 Henry Dunant Rd., Wangmai, Patumwan, Bangkok, 10330, Thailand
| | - Navawan Sophon
- Department of Periodontology, Faculty of Dentistry, Chulalongkorn University, 34 Henry Dunant Rd., Wangmai, Patumwan, Bangkok, 10330, Thailand
| | - Teerawut Tangsathian
- Department of Periodontology, Faculty of Dentistry, Chulalongkorn University, 34 Henry Dunant Rd., Wangmai, Patumwan, Bangkok, 10330, Thailand
| | - Sirikarn P Arunyanak
- Department of Periodontology, Faculty of Dentistry, Chulalongkorn University, 34 Henry Dunant Rd., Wangmai, Patumwan, Bangkok, 10330, Thailand.
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Kabir L, Stiesch M, Grischke J. The effect of keratinized mucosa on the severity of peri-implant mucositis differs between periodontally healthy subjects and the general population: a cross-sectional study. Clin Oral Investig 2020; 25:1183-1193. [PMID: 32607828 PMCID: PMC7878216 DOI: 10.1007/s00784-020-03422-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 06/18/2020] [Indexed: 12/25/2022]
Abstract
Objective The study aims to investigate the effect of reduced keratinized mucosa (KM) and other risk indicators on the severity of peri-implant mucositis in (i) the general population, (ii) in periodontally healthy patients, and (iii) in periodontally healthy patients without a history of periodontitis. Materials and methods Anamnesis and the following clinical parameters were taken: mucosal-index, bleeding on probing, local plaque index, oral hygiene-index, and width of KM. Mucositis severity score was determined for each implant. Multi-level and subgroup analysis was performed on the patient and implant level. Results Six hundred twelve implants in 130 patients were analyzed. Subgroup analysis showed significant associations between KM < 2 mm and the severity score in (ii) periodontally healthy patients (p = 0.014) and in (iii) patients without history of periodontitis (p = 0.017). Secondary outcome showed higher severity scores for patients with insufficient oral hygiene or without residual teeth (p ≤ 0.001), in maxillary implants (p = 0.04), and for the number of implants per patient (p ≤ 0.001). Conclusion Within the limits of the study, one may conclude that a reduced width of KM is a risk indicator for the severity of peri-implant mucositis in periodontally healthy patients and patients without a history of periodontitis. Clinical relevance The results indicate a band of ≥ 2 mm KM to reduce the severity of peri-implant mucositis in periodontally healthy patients.
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Affiliation(s)
- Laila Kabir
- Department of Prosthetic Dentistry and Biomedical Materials Research, Hannover Medical School, Hannover, Germany
| | - Meike Stiesch
- Department of Prosthetic Dentistry and Biomedical Materials Research, Hannover Medical School, Hannover, Germany
| | - Jasmin Grischke
- Department of Prosthetic Dentistry and Biomedical Materials Research, Hannover Medical School, Hannover, Germany.
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Gunpinar S, Meraci B, Karas M. Analysis of risk indicators for prevalence of peri-implant diseases in Turkish population. Int J Implant Dent 2020; 6:19. [PMID: 32430762 PMCID: PMC7237556 DOI: 10.1186/s40729-020-00215-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 03/31/2020] [Indexed: 02/07/2023] Open
Abstract
Background The aim of this cross-sectional study was (1) to determine the prevalence of peri-implant mucositis and peri-implantitis and (2) to reveal the risk indicators associated with peri-implant diseases. The second point was to investigate the role of keratinized mucosa on peri-implant health. Materials and methods Three hundred and eighty-two subjects who were treated with 1415 dental implants between 2011–2017 were clinically evaluated. Patients’ medical and dental history, as well as implant details, were recorded. Peri-implant examination included probing pocket depth (PPD), bleeding on probing (BoP), plaque index (PI), gingival index (GI), and keratinized tissue width. Furthermore, the patient (sex, age, and smoking) and implant/prosthesis-related factors (surface characteristic, time in function, design of prosthesis etc.) were evaluated. Implants were classified into three groups: healthy, peri-implant mucositis, and peri-implantitis. Uni- and multi-variate regression analyses were utilized for statistics. Results 41.1% (n = 157) and 36.9% (n = 84) of patients had mucositis and peri-implantitis, respectively. 53.6% (n = 758) of implants (95%CI 80.2–90.4) had mucositis, and 21.7% (n = 307) had peri-implantitis. Patients with a maintenance < 2/year (OR = 2.576), having periodontitis (OR = 3.342) and higher PI (OR = 3.046) had significant associations with the development of peri-implant mucositis. Significant ORs were determined for peri-implantitis with patients having maintenance < 2/year (OR = 2.048), having number of implants ≥ 4 (OR = 2.103), diagnosed with periodontitis (OR = 3.295), and higher PI (OR = 7.055). Keratinized tissue width < 2 mm (ORs = 5389/8.013), PPD (ORs = 1.570/8.338), PI (ORs = 6.726/5.205), and BoP (ORs = 3.645/4.353) independent variables were significantly associated with both peri-implant mucositis and peri-implantitis at implant level, respectively. Conclusions Within the limits of this study, the prevalence of mucositis and peri-implantitis was shown to be high in Turkish population. Furthermore, increased risk for peri-implantitis was identified in patients having maintenance < 2/year, presence of periodontitis, poor plaque control, and having number of implants ≥ 4. Less keratinized tissue (< 2 mm), PPD, and BoP were also risk indicators for peri-implantitis development.
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Affiliation(s)
- Sadiye Gunpinar
- Department of Periodontology, Faculty of Dentistry, Bolu Abant Izzet Baysal University, Bolu, Turkey.
| | - Bilge Meraci
- Department of Periodontology, Faculty of Dentistry, Bolu Abant Izzet Baysal University, Bolu, Turkey
| | - Mert Karas
- Department of Periodontology, Faculty of Dentistry, Bolu Abant Izzet Baysal University, Bolu, Turkey
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Efficacy of growth factors for the treatment of peri-implant diseases: a systematic review and meta-analysis. Clin Oral Investig 2020; 24:2141-2161. [PMID: 32418012 DOI: 10.1007/s00784-020-03240-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 02/11/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The aim of this study was to conduct a systematic review and meta-analysis on the efficacy of growth factors (GF) on clinical outcomes after treatment (surgical/non-surgical) of peri-implant diseases (peri-implant mucositis and peri-implantitis). MATERIALS AND METHODS A protocol was developed to answer the following focused question: Is there any difference for the use of GF for treatment of peri-implant diseases versus comparative GF treatment or without GF? Electronic database and manual searches were independently conducted to identify randomized controlled trials (RCTs). Publications were selected based on eligibility criteria and then assessed for risk-of-bias using the Cochrane Handbook. The primary outcome was probing depth (PD) and bleeding on probing (BOP) reduction along with changes in vertical defect depth (VDD). Changes in clinical attachment level, gingival recession, and plaque index, among others, were studied as secondary outcomes. Based on primary outcomes, random-effects meta-analysis was conducted. RESULTS A total of five RCTs were included. GF enhance the reduction of PD (standardized mean difference (SMD) = - 1.28; 95% confidence interval (CI) - 1.75, - 0.79; p = < 0.0001) and BOP (SMD = - 1.23; 95% CI - 1.70, - 0.76; p = < 0.0001) in the management of peri-implant mucositis. For the treatment of peri-implantitis, the use of GF yielded to significantly greater improvement in VDD (SMD = 0.68; 95% CI 0.22, 1.14; p = 0.004); however, there were no significant differences in terms of PD (SMD = 0.08; 95% CI - 1.08, 1.26; p = 0.887) and BOP (SMD = 0.211; 95% CI - 0.20, 0.63; p = 0.317). The overall risk of bias of the included studies was low to unclear. CONCLUSION The results of the present systematic review suggest that the addition of GF might enhance the outcomes in the treatment of peri-implant mucositis. However, there is a lack of evidence for supporting additional benefit of GF managing peri-implantitis. CLINICAL RELEVANCE Within the limitations of the current systematic review and based on the meta-analyses, (1) the addition of GF for the treatment peri-implant mucositis might be associated with better outcomes in terms of PD and BOP, and (2) an additional benefit of GF for the treatment peri-implantitis could not be determined on the basis of the selected evidence.
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Ravidà A, Saleh I, Siqueira R, Garaicoa‐Pazmiño C, Saleh MHA, Monje A, Wang H. Influence of keratinized mucosa on the surgical therapeutical outcomes of peri‐implantitis. J Clin Periodontol 2020; 47:529-539. [DOI: 10.1111/jcpe.13250] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 12/02/2019] [Accepted: 01/04/2020] [Indexed: 12/16/2022]
Affiliation(s)
- Andrea Ravidà
- Department of Periodontics and Oral Medicine University of Michigan School of Dentistry Ann Arbor MI USA
| | - Islam Saleh
- Department of Periodontics and Oral Medicine University of Michigan School of Dentistry Ann Arbor MI USA
| | - Rafael Siqueira
- Department of Periodontics and Oral Medicine University of Michigan School of Dentistry Ann Arbor MI USA
| | - Carlos Garaicoa‐Pazmiño
- Department of Periodontology School of Dentistry Oregon Health & Science University Portland OR USA
| | - Muhammad H. A. Saleh
- Department of Periodontics and Oral Medicine University of Michigan School of Dentistry Ann Arbor MI USA
- Department of Periodontics University of Louisville School of Dentistry Louisville KY USA
| | - Alberto Monje
- Department Periodontology Universitat Internacional de Catalunya Barcelona Spain
| | - Hom‐Lay Wang
- Department of Periodontics and Oral Medicine University of Michigan School of Dentistry Ann Arbor MI USA
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Lim HC, Shin HS, Cho IW, Koo KT, Park JC. Ridge preservation in molar extraction sites with an open-healing approach: A randomized controlled clinical trial. J Clin Periodontol 2019; 46:1144-1154. [PMID: 31444908 DOI: 10.1111/jcpe.13184] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 08/03/2019] [Accepted: 08/21/2019] [Indexed: 12/27/2022]
Abstract
AIM To determine the effect of alveolar ridge preservation (ARP) in molar sites without primary flap closure. MATERIALS AND METHODS Three groups were established: extraction sockets grafted with deproteinized bovine bone mineral containing 10% collagen (DBBM-C) and covered by a native bilayer collagen membrane (NBCM) (test group 1), sockets grafted with DBBM-C only (test group 2), and sockets that healed naturally (control group). Primary flap closure was not attempted. Conebeam computed tomography scans were obtained immediately and then 4 months after ARP. A biopsy was performed. The change of the marginal bone level was measured. RESULTS There was significantly less horizontal resorption in test group 1 than in the control group at levels 1 mm (-1.02 ± 0.88 [mean ± SD] vs. -4.44 ± 3.71 mm) and 3 mm (-0.31 ± 1.51 vs. -2.27 ± 1.15 mm) below the crest, and significantly less vertical reduction in the midcrestal area in test group 1 than in test group 2 (-0.25 ± 0.95 vs. -1.15 ± 1.63 mm) (p < .05). There were no significant differences between test groups in clinical and histomorphometric measurements. All groups exhibited stable marginal bone levels after 1 year of loading. CONCLUSION Alveolar ridge preservation without primary flap closure in molar areas was effective in minimizing ridge resorption and facilitated implant treatment.
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Affiliation(s)
- Hyun-Chang Lim
- Department of Periodontology, School of Dentistry, Periodontal-Implant Clinical Research Institute, Kyung Hee University, Seoul, South Korea
| | - Hyun-Seung Shin
- Department of Periodontology, Dankook University College of Dentistry, Cheonan-si, South Korea
| | - In-Woo Cho
- Department of Periodontology, Dankook University College of Dentistry, Cheonan-si, South Korea
| | - Ki-Tae Koo
- Department of Periodontology, College of Dentistry, Seoul National University, Seoul, South Korea
| | - Jung-Chul Park
- Department of Periodontology, Dankook University College of Dentistry, Cheonan-si, South Korea
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Thoma DS, Lim HC, Paeng KW, Kim MJ, Jung RE, Hämmerle CHF, Jung UW. Augmentation of keratinized tissue at tooth and implant sites by using autogenous grafts and collagen-based soft-tissue substitutes. J Clin Periodontol 2019; 47:64-71. [PMID: 31518443 DOI: 10.1111/jcpe.13194] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 07/15/2019] [Accepted: 09/09/2019] [Indexed: 10/26/2022]
Abstract
AIM To investigate the effect of three treatment modalities on the gain of keratinized tissue (KT) at tooth and implant sites in dogs. MATERIALS AND METHODS In five dogs, the distal roots of the mandibular second, third and fourth premolars were extracted, while the mesial roots were maintained. After 2 months of healing, implants were placed with KT excision. After another 2 months of healing, free gingival grafts, collagen-based matrices and apically positioned flap only were applied. The height of KT was measured during implant placement, immediately before soft-tissue grafting and after 10, 30 and 60 days. RESULTS Two months after KT excision, spontaneous KT regrowth was greater at tooth sites than at implant sites (median, 2.0 mm vs. 1.1 mm). The outcomes of soft-tissue grafting at implant sites favoured the free gingival graft treatment, with a greater final median height (5.0-5.5 mm) and increase in KT (4.0-4.2 mm). Locations of the recipient sites significantly influenced KT regeneration at both tooth and implant sites. CONCLUSIONS At implant sites, the free gingival graft treatment led to higher KT regeneration. At tooth sites, however, the differences between the three treatment modalities seemed clinically irrelevant.
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Affiliation(s)
- Daniel S Thoma
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, University of Zurich, Zurich, Switzerland
| | - Hyun-Chang Lim
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, University of Zurich, Zurich, Switzerland.,Department of Periodontology, Periodontal-Implant Clinical Research Institute, School of Dentistry, Kyung Hee University, Seoul, Korea
| | - Kyeong-Won Paeng
- Department of Periodontology, Research Institute for Periodontal Regeneration, Yonsei University College of Dentistry, Seoul, Korea
| | - Myong Ji Kim
- Department of Periodontology, Research Institute for Periodontal Regeneration, Yonsei University College of Dentistry, Seoul, Korea
| | - Ronald E Jung
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, University of Zurich, Zurich, Switzerland
| | - Christoph H F Hämmerle
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, University of Zurich, Zurich, Switzerland
| | - Ui-Won Jung
- Department of Periodontology, Research Institute for Periodontal Regeneration, Yonsei University College of Dentistry, Seoul, Korea
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