Smokers have a higher risk of inflammatory peri-implant disease than non-smokers

Prosthetic Design Factors Influencing Peri-Implant Disease: A Comprehensive Review

Peri-implant disease, encompassing peri-implant mucositis and peri-implantitis, presents a growing challenge in implant dentistry. This comprehensive review explores the intricate interplay between prosthetic design factors and the development of peri-implant disease. By analyzing the impact of prosthetic components on microbial colonization, mechanical stress, and soft tissue health, the review highlights their crucial role in disease prevention and management. Additionally, it emphasizes the significance of maintenance protocols, prosthetic adjustments, and patient education in ensuring favorable long-term outcomes. The review underscores the potential for future advancements in prosthetic design, including innovative materials and digital technologies, and stresses the importance of interdisciplinary collaboration in optimizing patient care. Overall, the review underscores the critical role of prosthetic design in addressing the complexities of peri-implant disease, offering insights for clinicians and researchers to enhance the success and longevity of implant-supported restorations.

Influence of Smoking on Periodontal and Implant Therapy: A Narrative Review

BACKGROUND

smoking is considered the most modifiable risk factor for periodontal disease.

OBJECTIVE

the aim of this narrative review is to emphasize the effect of smoking on periodontal and implant therapy.

METHODS

The authors reviewed the literature reporting the clinical outcomes of smoking on periodontal surgical and nonsurgical treatment. The impact of smoking on implant therapy and sinus lifting procedures were also reviewed.

RESULTS

Periodontal and implant therapy outcomes are adversely affected by smoking. Smokers respond less favorably to periodontal therapy and periodontal flap procedures as compared to nonsmokers. Clinical outcomes for smokers are 50-75% worse than for nonsmokers. Studies reveal that smokers experience a significantly lower reduction in pocket depth compared to nonsmokers as well as less bone growth after treating infra-bony defects with guided tissue regeneration. The relative risk of implant failure is significantly higher in patients who smoke 20 cigarettes or more per day compared to nonsmokers. Additionally, smoking has also been shown to increase postoperative wound dehiscence and infection rates following sinus floor elevation. Longitudinal studies on smoke cessation have shown a reduction in bone loss and probing depths for periodontitis patients after cessation compared to those who smoke.

CONCLUSION

Smoking cessation can reduce probing depths and improve clinical attachment after nonsurgical periodontal therapy. There is insufficient evidence regarding the effect of smoking on peri-implantitis, as well as the loss of implants in the long-term.

Diagnosis of Biofilm-Associated Peri-Implant Disease Using a Fluorescence-Based Approach

Dental implants have become a routine component of daily dental practice and the demand for dental implants is expected to increase significantly in the future. Despite the high success rates of dental implants, failures do occur, resulting in discomfort, rampant destruction of the oral health, or painful and costly surgical replacement of a failed implant. Peri-implant diseases are inflammatory conditions affecting the soft/hard tissues surrounding a functional dental implant. Plenty of experimental evidence indicates that the accumulation of dental plaque at the soft tissue-implant interface and the subsequent local inflammatory response seems to be key in the pathogenesis of the peri-implant mucositis. Such peri-implant-soft tissue interface is less effective than natural teeth in resisting bacterial invasion, enhancing vulnerability to subsequent peri-implant disease. Furthermore, in certain individuals, it will progress to peri-implantitis, resulting in alveolar bone loss and implant failure. Although early diagnosis and accurate identification of risk factors are extremely important to effectively prevent peri-implant diseases, current systematic reviews revealed that a uniform classification and diagnostic methodology for peri-implantitis are lacking. Recent progress on fluorescence-based technology enabled rapid diagnosis of the disease and effective removal of plaques. Here, we briefly review biofilm-associated peri-implant diseases and propose a fluorescence-based approach for more accurate and objective diagnoses. A fluorescence-based diagnosis tool through headlights combined with special-filtered dental loupes may serve as a hands-free solution for both precise diagnosis and effective removal of plaque-biofilms.

Peri-Implant Diseases: Diagnosis, Clinical, Histological, Microbiological Characteristics and Treatment Strategies. A Narrative Review

Since the use of dental implants is continuously increasing, it is imperative for dental practitioners to understand the nature and treatment of peri-implant diseases. The purpose of this manuscript is to comprehensively review peri-implant diseases, their characteristics, as well as their non-surgical and surgical treatment. To that end, the current literature was searched and a narrative review was conducted. It is essential that the case definitions described in the 2017 World Workshop on the Classification of Periodontal and Peri-implant Diseases and Conditions are used to diagnose and classify peri-implant health, peri-implant mucositis and peri-implantitis. While recent epidemiologic studies on peri-implant diseases exist, there is great heterogeneity in the definition of these conditions. Several risk factors and indicators are reported in the literature, with smoking and diabetes being the most universally accepted. In peri-implant mucositis, non-surgical treatment seems to be sufficient. However, for the treatment of peri-implantitis, a surgical approach, which includes open-flap debridement, apically positioned flap and guided bone regeneration, is considered more appropriate. A great variety of adjuncts to mechanical treatment have been reported with controversial results. Finally, studies comparing results from different peri-implantitis treatments are warranted in randomized controlled clinical trials in order to provide stronger evidence-based approaches.

Breaking the wave of peri-implantitis

Peri-implant diseases are prevalent with a weighted mean prevalence rate of 43% across Europe and 22% across South and North America. Although the main etiologic agent is bacterial biofilm, a myriad of factors influence the initiation and progression of the disease. Unfortunately, the treatment of peri-implant diseases is at best favorable in the short term with a high rate of persistent inflammation and recurrence. Therefore, it is sensible to consider and control all potential factors that may predispose an implant to peri-implant tissue inflammation in an attempt to avoid the disease. This paper reviews recent evidence on factors that may predispose implants to peri-implantitis and measures that can be taken to prevent it.

Clinical peri-implant health and biological bone marker levels in tobacco users treated with photodynamic therapy

BACKGROUND

What impact does tobacco smoking have on photodynamic therapy (PDT) outcome is still unknown. The aim of the present clinical trial was to evaluate the clinical, radiographic, and biological bone markers after provision of PDT in cigarette, e-cigarette, and never-smokers with peri-implantitis (PI) at 6 months post treatment.

MATERIALS AND METHODS

Twenty-five healthy patients with PI were divided into three groups: Group I: cigarette smokers; Group II: e-cigarettes users; Group III: never-smokers. Full-mouth mechanical debridement with adjunctive methylene blue-mediated PDT was performed. Clinical recordings included peri-implant plaque index (Pi), bleeding on probing (BOP) and probing depth (PD). Peri-implant sulcular fluid was collected for the assessment of biological bone biomarkers including receptor activator of nuclear factor-ligand (RANK-L) and osteoprotegrin (OPG). All assessments were performed at baseline, 3 months and 6 months. P-value of <0.05 was considered significant.

RESULTS

BOP in Group II and III significantly reduced at 3 months (p < 0.05). Group I showed significant reduction only at 6 months (p < 0.05). Mean PD showed no statistically significant difference between the groups at any time-point. Inter-group comparison showed Group III demonstrating statistically significantly reduced mean RANK-L levels at both 3 and 6 months (p < 0.05). A slight increase in the OPG levels were observed at 3 months and followed by a slight decrease at 6 months for all the study groups when compared with baseline values, however, these values did not show statistical significance (p > 0.05).

CONCLUSION

Adjunctive PDT helped in reducing the clinical peri-implant inflammation. However, no significant change was observed for biological bone biomarkers among tobacco smokers.

Clinical peri-implant parameters and inflammatory cytokine profile among smokers of cigarette, e-cigarette, and waterpipe

BACKGROUND

To date, there has been no study identified that assessed peri-implant parameters and local levels of proinflammatory cytokines between waterpipe smokers (WS) and electronic cigarette users (VS). To evaluate the true effect of the risk indicator (WS and VS), a positive control (cigarette smokers [CS]) was added in the study design.

PURPOSE

To compare clinical and radiographic peri-implant parameters and proinflammatory cytokine profile in the peri-implant sulcular fluid (PISF) among CS, WS, VS, and nonsmokers (NS).

MATERIALS AND METHODS

Forty CS, WS, VS, and NS were included. Details regarding demographics, duration of implants, and habits were recorded. Clinical examination for periodontal and peri-implant plaque index (PI), bleeding on probing (BOP), and probing depth (PD ≥ 4 mm) were assessed. Radiographic bone loss (RBL) was assessed using digital periapical radiographs and viewed on a calibrated computer screen using an image analyzer. Levels of tumor necrosis factor-alpha (TNF-α), interleukin (IL)-6, and IL-1β in PISF were evaluated using enzyme-linked immunosorbent assay.

RESULTS

Mean peri-implant PI (P < .05), PD ≥ 4 mm (P < .05), and total RBL (P < .01) was significantly higher among CS, WS, and VS compared with NS. Statistical differences in BOP were observed in NS (P < .01) compared to CS, WS, and VS. CS and WS showed significantly higher PD ≥ 4 mm and RBL compared with VS (P < .05). Levels of TNF-α, IL-6, and IL-1β were significantly higher in CS, WS, and VS compared to NS. There were no statistical differences in the mean levels of all proinflammatory cytokines among individuals in CS and WS.

CONCLUSION

Tobacco smoking is associated with poor peri-implant health. The effect of waterpipe smoking was of largely the same extent as that of cigarette smoking. Higher levels of inflammatory cytokines in tobacco smokers may propose increased peri-implant inflammatory process which could play a principal role in the progression of peri-implant tissue damage.