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Carrillo de Albornoz A, Montero E, Alonso-Español A, Sanz M, Sanz-Sánchez I. Treatment of peri-implantitis with a flapless surgical access combined with implant surface decontamination and adjunctive systemic antibiotics: A retrospective case series study. J Clin Periodontol 2024; 51:968-980. [PMID: 38690660 DOI: 10.1111/jcpe.13993] [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: 11/25/2023] [Revised: 03/26/2024] [Accepted: 04/16/2024] [Indexed: 05/02/2024]
Abstract
AIM To evaluate the effectiveness of a flapless surgical approach in the treatment of peri-implantitis and to explore the factors influencing its outcome. MATERIALS AND METHODS The present retrospective study evaluated patients with at least one implant diagnosed with peri-implantitis and treated with a flapless surgical access, with or without systemic antimicrobials, curettage and, when needed, prostheses modification. Clinical and radiographic parameters were assessed at baseline and at 3 months and at least 12 months. The primary outcome was disease resolution (≤1 bleeding sites, probing depth [PD] ≤5 mm, no bone loss >0.5 mm). Multilevel regression analyses were used to identify predictors influencing the probability of attaining disease resolution. RESULTS One hundred and seventeen patients with 338 implants were included. Disease resolution was attained in 54.4% of the 338 implants receiving flapless surgical access. At the end of the follow-up period, 111 patients (94.9%) with 295 implants (87.3%) did not require any further treatment, with 81.4% of these implants presenting PD ≤ 5 mm. History of periodontitis and PD at baseline were identified as negative predictors, while compliance with supportive peri-implant care, a machined surface and the adjunctive use of systemic azithromycin or metronidazole were identified as positive predictive factors for disease resolution. CONCLUSIONS A flapless surgical approach led to disease resolution in 54.4% of the implants with peri-implantitis. Several risk/protective predictors for disease resolution were identified.
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Affiliation(s)
- Ana Carrillo de Albornoz
- Etiology and Therapy of Periodontal and Peri-implant Diseases (ETEP) Research Group, Faculty of Dentistry, University Complutense of Madrid, Madrid, Spain
- Section of Graduate Periodontology, University Complutense, Madrid, Spain
| | - Eduardo Montero
- Etiology and Therapy of Periodontal and Peri-implant Diseases (ETEP) Research Group, Faculty of Dentistry, University Complutense of Madrid, Madrid, Spain
- Section of Graduate Periodontology, University Complutense, Madrid, Spain
| | | | - Mariano Sanz
- Etiology and Therapy of Periodontal and Peri-implant Diseases (ETEP) Research Group, Faculty of Dentistry, University Complutense of Madrid, Madrid, Spain
- Section of Graduate Periodontology, University Complutense, Madrid, Spain
| | - Ignacio Sanz-Sánchez
- Etiology and Therapy of Periodontal and Peri-implant Diseases (ETEP) Research Group, Faculty of Dentistry, University Complutense of Madrid, Madrid, Spain
- Section of Graduate Periodontology, University Complutense, Madrid, Spain
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Riben Grundström C, Lund B, Kämpe J, Belibasakis GN, Hultin M. Systemic antibiotics in the surgical treatment of peri-implantitis: A randomized placebo-controlled trial. J Clin Periodontol 2024; 51:981-996. [PMID: 38699828 DOI: 10.1111/jcpe.13994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 03/22/2024] [Accepted: 04/16/2024] [Indexed: 05/05/2024]
Abstract
AIM To study the clinical, radiographic and microbiological outcomes after surgical treatment of peri-implantitis, with or without adjunctive systemic antibiotics. MATERIALS AND METHODS Eighty-four patients (113 implants) with peri-implantitis were randomized into three groups (A, amoxicillin and metronidazole; B, phenoxymethylpenicillin and metronidazole; or C, placebo). Treatment included resective surgery and implant surface decontamination with adjunctive antibiotics or placebo. Primary outcomes were probing pocket depth (PPD) reduction and marginal bone level (MBL) stability. Secondary outcomes were treatment success (defined as PPD ≤ 5 mm, bleeding on probing [BOP] ≤ 1site, absence of suppuration on probing [SOP] and absence of progressive bone loss of >0.5 mm), changes in BOP/SOP, mucosal recession (REC), clinical attachment level (CAL), bacterial levels and adverse events. Outcomes were evaluated for up to 12 months. The impact of potential prognostic indicators on treatment success was evaluated using multilevel logistic regression analysis. RESULTS A total of 76 patients (104 implants) completed the study. All groups showed clinical and radiological improvements over time. Statistically significant differences were observed between groups for MBL stability (A = 97%, B = 89%, C = 76%), treatment success (A = 68%, B = 66%, C = 28%) and bacterial levels of Aggregatibacter actinomycetemcomitans and Tannerella forsythia, favouring antibiotics compared to placebo. Multiple regression identified antibiotic use as potential prognostic indicator for treatment success. Gastrointestinal disorders were the most reported adverse events in the antibiotic groups. CONCLUSIONS Adjunctive systemic antibiotics resulted in additional improvements in MBL stability. However, the potential clinical benefits of antibiotics need to be carefully balanced against the risk of adverse events and possible antibiotic resistance.
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Affiliation(s)
- Caroline Riben Grundström
- Department of Periodontology, Specialist Clinic Kaniken, Public Dental Health Service, Uppsala, Sweden
- Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden
| | - Bodil Lund
- Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden
- Medical Unit of Plastic Surgery and Oral and Maxillofacial Surgery, Department for Oral and Maxillofacial Surgery and Jaw Orthopedics, Karolinska University Hospital, Stockholm, Sweden
| | - Johan Kämpe
- Department of Plastic and Oral and Maxillofacial Surgery, Uppsala University Hospital, Uppsala, Sweden
| | | | - Margareta Hultin
- Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden
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Haude S, Matthes R, Pitchika V, Holtfreter B, Schlüter R, Gerling T, Kocher T, Jablonowski L. In-vitro biofilm removal from TiUnite® implant surface with an air polishing and two different plasma devices. BMC Oral Health 2024; 24:558. [PMID: 38741081 DOI: 10.1186/s12903-024-04230-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 04/04/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND We investigated the efficacy of two different cold atmospheric pressure jet plasma devices (CAP09 and CAPmed) and an air polishing device with glycine powder (AP) either applied as monotherapies or combined therapies (AP + CAP09; AP + CAPmed), in microbial biofilm removal from discs with anodised titanium surface. METHODS Discs covered with 7-day-old microbial biofilm were treated either with CAP09, CAPmed, AP, AP + CAP09 or AP + CAPmed and compared with negative and positive controls. Biofilm removal was assessed with flourescence and electron microscopy immediately after treatment and after 5 days of reincubation of the treated discs. RESULTS Treatment with CAP09 or CAPmed did not lead to an effective biofilm removal, whereas treatment with AP detached the complete biofilm, which however regrew to baseline magnitude after 5 days of reincubation. Both combination therapies (AP + CAP09 and AP + CAPmed) achieved a complete biofilm removal immediately after cleaning. However, biofilm regrew after 5 days on 50% of the discs treated with the combination therapy. CONCLUSION AP treatment alone can remove gross biofilm immediately from anodised titanium surfaces. However, it did not impede regrowth after 5 days, because microorganisms were probably hidden in holes and troughs, from which they could regrow, and which were inaccessible to AP. The combination of AP and plasma treatment probably removed or inactivated microorganisms also from these hard to access spots. These results were independent of the choice of plasma device.
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Affiliation(s)
- Sandra Haude
- Department of Restorative Dentistry, Periodontology, Endodontology, Preventive Dentistry and Paediatric Dentistry, Dental School, University Medicine Greifswald, Walther-Rathenau-Str. 42a, Greifswald, D - 17475, Germany
| | - Rutger Matthes
- Department of Restorative Dentistry, Periodontology, Endodontology, Preventive Dentistry and Paediatric Dentistry, Dental School, University Medicine Greifswald, Walther-Rathenau-Str. 42a, Greifswald, D - 17475, Germany
| | - Vinay Pitchika
- Department of Restorative Dentistry, Periodontology, Endodontology, Preventive Dentistry and Paediatric Dentistry, Dental School, University Medicine Greifswald, Walther-Rathenau-Str. 42a, Greifswald, D - 17475, Germany
| | - Birte Holtfreter
- Department of Restorative Dentistry, Periodontology, Endodontology, Preventive Dentistry and Paediatric Dentistry, Dental School, University Medicine Greifswald, Walther-Rathenau-Str. 42a, Greifswald, D - 17475, Germany
| | - Rabea Schlüter
- Imaging Center of the Department of Biology, University of Greifswald, Greifswald, Germany
| | - Torsten Gerling
- ZIK Plasmatis, Leibniz-Institute for Plasma Science and Technology e.V. (INP), a member of the Leibniz Research Alliance Leibniz Health Technology, Greifswald, Germany
| | - Thomas Kocher
- Department of Restorative Dentistry, Periodontology, Endodontology, Preventive Dentistry and Paediatric Dentistry, Dental School, University Medicine Greifswald, Walther-Rathenau-Str. 42a, Greifswald, D - 17475, Germany
| | - Lukasz Jablonowski
- Department of Restorative Dentistry, Periodontology, Endodontology, Preventive Dentistry and Paediatric Dentistry, Dental School, University Medicine Greifswald, Walther-Rathenau-Str. 42a, Greifswald, D - 17475, Germany.
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West N, Chapple I, Culshaw S, Donos N, Needleman I, Suvan J, Nibali L, Patel A, Preshaw PM, Kebschull M. BSP Implementation of Prevention and Treatment of Peri-implant Diseases - The EFP S3 Level Clinical Practice Guideline. J Dent 2024:104980. [PMID: 38697506 DOI: 10.1016/j.jdent.2024.104980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 03/28/2024] [Indexed: 05/05/2024] Open
Abstract
OBJECTIVES to adapt the supranational European Federation of Periodontology (EFP) Prevention and Treatment of Peri-implant Diseases - The EFP S3 Level Clinical Practice Guideline for UK healthcare environment, taking into account a broad range of views from stakeholders and patients. SOURCES This UK version, based on the supranational EFP guideline [1] published in the Journal of Clinical Periodontology, was developed using S3-level methodology, combining assessment of formal evidence from 13 systematic reviews with a moderated consensus process of a representative group of stakeholders, and accounts for health equality, environmental factors and clinical effectiveness. It encompasses 55 clinical recommendations for the Prevention and Treatment of Peri-implant Diseases, based on the classification for periodontal and peri-implant diseases and conditions [2]. METHODOLOGY The UK version was developed from the source guideline using a formal process called the GRADE ADOLOPMENT framework. This framework allows for adoption (unmodified acceptance), adaptation (acceptance with modifications) and the de novo development of clinical recommendations. Using this framework, following the S3-process, the underlying evidence was updated and a representative guideline group of 111 delegates from 26 stakeholder organisations was assembled into four working groups. Following the formal S3-process, all clinical recommendations were formally assessed for their applicability to the UK and adoloped accordingly. RESULTS AND CONCLUSION Using the ADOLOPMENT protocol, a UK version of the EFP S3-level clinical practice guideline for the Prevention and Treatment of Peri-implant Diseases was developed. This guideline delivers evidence- and consensus-based clinical recommendations of direct relevance to the UK healthcare community including the public. CLINICAL SIGNIFICANCE The S3-level-guidelines combine evaluation of formal evidence, grading of recommendations and synthesis with clinical expertise of a broad range of stakeholders. The international S3-level-guideline was implemented for direct clinical applicability in the UK healthcare system, facilitating a consistent, interdisciplinary, evidence-based approach with public involvement for the prevention and treatment of peri-implant diseases.
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Affiliation(s)
- Nicola West
- Restorative Dentistry, Bristol Dental School, University of Bristol, Bristol BS1 2LY, UK; Restorative Dentistry, Bristol Dental Hospital, University Hospitals Bristol and Weston NHS Foundation Trust, Marlborough Street, Bristol, BS1 3NU, Secretary General of the European Federation of Periodontology.
| | - Iain Chapple
- Birmingham NIHR Biomedical Research Centre in Inflammation. The University of Birmingham, Birmingham, United Kingdom; Birmingham Community Healthcare NHS Foundation Trust, Birmingham, United Kingdom
| | - Shauna Culshaw
- University of Glasgow Dental School, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Nikos Donos
- Centre for Oral Clinical Research, Institute of Dentistry, Faculty of Medicine and Dentistry, Queen Mary University of London (AMUL), Turner Street, London, E1 2AD
| | - Ian Needleman
- Unit of Periodontology, UCL Eastman Dental Institute, Bloomsbury Campus, Rockefeller Building, 21 University Street, London, WC1E 6DE
| | - Jeanie Suvan
- Unit of Periodontology, UCL Eastman Dental Institute, Bloomsbury Campus, Rockefeller Building, 21 University Street, London, WC1E 6DE
| | - Luigi Nibali
- Periodontology Unit, Centre for Host-Microbiome Interactions, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, Guys Hospital, Great Maze Pond, London, SE1 9RT
| | - Amit Patel
- Birmingham Dental Specialists, Associate Professor, University of Birmingham, Birmingham, UK, President of the Association of Dental Implantology
| | - Philip M Preshaw
- School of Dentistry, University of Dundee, Dundee UK; School of Dental Sciences, University of Newcastle, Newcastle upon Tyne, UK
| | - Moritz Kebschull
- Birmingham NIHR Biomedical Research Centre in Inflammation. The University of Birmingham, Birmingham, United Kingdom; Birmingham Community Healthcare NHS Foundation Trust, Birmingham, United Kingdom; Division of Periodontics, Section of Oral, Diagnostic and Rehabilitation Sciences, College of Dental Medicine, Columbia University, New York, NY, USA; School of Dentistry, University of Birmingham, Birmingham B5 7EG, UK, President-Elect of the European Federation of Periodontology.
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Guo J, Chen X, Xie H, Li T. Efficacy of adjunctive photodynamic therapy to conventional mechanical debridement for peri-implant mucositis. BMC Oral Health 2024; 24:464. [PMID: 38627721 PMCID: PMC11020816 DOI: 10.1186/s12903-024-04198-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 03/28/2024] [Indexed: 04/19/2024] Open
Abstract
OBJECTIVE This meta-analysis was conducted to assess the effectiveness of photodynamic therapy (PDT) as an adjunct to conventional mechanical debridement (CMD) for the management of peri-implant mucositis (p-iM). METHODS We systematically searched four databases (PubMed, Embase, Web of Science, and Cochrane Library) for randomized controlled trials (RCTs) investigating PDT + CMD for p-iM from their inception to March 13, 2023. Meta-analysis was performed using RevMan 5.4 software. RESULTS Seven RCTs met the inclusion criteria. The meta-analysis revealed that PDT + CMD treatment was more effective than CMD alone in reducing probing depth (PD) (Mean Difference [MD]: -1.09, 95% Confidence Interval [CI]: -1.99 to -0.2, P = 0.02) and plaque index (PI) (MD: -2.06, 95% CI: -2.81 to -1.31, P < 0.00001). However, there was no statistically significant difference in the improvement of bleeding on probing (BOP) between the PDT + CMD groups and CMD groups (MD: -0.97, 95% CI: -2.81 to 0.88, P = 0.31). CONCLUSIONS Based on the current available evidence, this meta-analysis indicates that the addition of PDT to CMD significantly improves PD and PI compared to CMD alone in the treatment of p-iM. However, there is no significant difference in improving BOP.
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Affiliation(s)
- Jincai Guo
- Changsha Stomatological Hospital, No. 389 Youyi road, Tianxin district Changsha, Changsha, Hunan, 410006, China
- School of Stomatology, Hunan University of Chinese Medicine, Changsha, 410006, China
| | - Xueru Chen
- Changsha Stomatological Hospital, No. 389 Youyi road, Tianxin district Changsha, Changsha, Hunan, 410006, China
- School of Stomatology, Hunan University of Chinese Medicine, Changsha, 410006, China
| | - Hui Xie
- Changsha Stomatological Hospital, No. 389 Youyi road, Tianxin district Changsha, Changsha, Hunan, 410006, China.
- School of Stomatology, Hunan University of Chinese Medicine, Changsha, 410006, China.
| | - Tongjun Li
- Changsha Stomatological Hospital, No. 389 Youyi road, Tianxin district Changsha, Changsha, Hunan, 410006, China.
- School of Stomatology, Hunan University of Chinese Medicine, Changsha, 410006, China.
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Romandini M, Bougas K, Alibegovic L, Hosseini S, Carcuac O, Berglundh T, Derks J. Long-term outcomes and prognostic factors of surgical treatment of peri-implantitis - A retrospective study. Clin Oral Implants Res 2024; 35:321-329. [PMID: 38112108 DOI: 10.1111/clr.14228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 11/27/2023] [Accepted: 12/08/2023] [Indexed: 12/20/2023]
Abstract
AIM To evaluate long-term outcomes and prognostic factors of non-reconstructive surgical treatment of peri-implantitis. MATERIALS AND METHODS One hundred forty-nine patients (267 implants) were surgically treated for peri-implantitis and followed for an average of 7.0 (SD: 3.6) years. The primary outcome was implant loss. Additional bone loss and surgical retreatment were secondary outcomes. Patient/implant characteristics, as well as clinical and radiographic parameters collected prior to initial surgery, were evaluated as potential predictors of implant loss. Flexible parametric survival models using restricted cubic spline functions were used; 5- and 10-year predicted rates of implant loss were calculated according to different scenarios. RESULTS Fifty-three implants (19.9%) in 35 patients (23.5%) were lost during the observation period. Implant loss occurred after a mean period of 4.4 (SD: 3.0) years and was predicted by implant surface characteristics (modified surface; HR 4.5), implant length (HR 0.8 by mm), suppuration at baseline (HR 2.7) and disease severity (baseline bone loss: HR 1.2 by mm). Estimates of 5- and 10-year implant loss ranged from 1% (best prognostic scenario; initial bone loss <40% of implant length, turned implant surface and absence of suppuration on probing (SoP)) to 63% (worst prognostic scenario; initial bone loss ≥60% of implant length, modified implant surface and SoP) and from 3% to 89%, respectively. Surgical retreatment was performed at 65 implants (24.3%) in 36 patients (24.2%) after a mean time period of 4.5 (3.1) years. In all, 59.5% of implants showed additional bone loss, were surgically retreated or lost. CONCLUSIONS Recurrence of disease is common following surgical treatment of peri-implantitis. The strongest predictor for implant loss was implant surface characteristics. Implant length as well as suppuration and disease severity at baseline were also relevant factors.
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Affiliation(s)
- Mario Romandini
- Department of Periodontology, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Kostas Bougas
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Public Dental Service, Region Västra Götaland, Vanersborg, Sweden
| | - Lamija Alibegovic
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Public Dental Service, Region Västra Götaland, Vanersborg, Sweden
| | - Sara Hosseini
- Public Dental Service, Region Västra Götaland, Vanersborg, Sweden
| | - Olivier Carcuac
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Tord Berglundh
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Jan Derks
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Public Dental Service, Region Västra Götaland, Vanersborg, Sweden
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Berglundh T, Mombelli A, Schwarz F, Derks J. Etiology, pathogenesis and treatment of peri-implantitis: A European perspective. Periodontol 2000 2024. [PMID: 38305506 DOI: 10.1111/prd.12549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 12/19/2023] [Accepted: 12/22/2023] [Indexed: 02/03/2024]
Abstract
Peri-implantitis is a plaque-associated pathological condition occurring in tissues around dental implants. It is characterized by inflammation in the peri-implant mucosa and progressive loss of supporting bone. Over the last 30 years, peri-implantitis has become a major disease burden in dentistry. An understanding of the diagnosis, etiology and pathogenesis, epidemiology, and treatment of peri-implantitis must be a central component in undergraduate and postgraduate training programs in dentistry. In view of the strong role of European research in periodontology and implant dentistry, the focus of this review was to address peri-implantitis from a European perspective. One component of the work was to summarize new and reliable data on patients with dental implants to underpin the relevance of peri-implantitis from a population perspective. The nature of the peri-implantitis lesion was evaluated through results presented in preclinical models and evaluations of human biopsy material together with an appraisal of the microbiological characteristics. An overview of strategies and outcomes presented in clinical studies on nonsurgical and surgical treatment of peri-implantitis is discussed with a particular focus on end points of therapy and recommendations presented in the S3 level Clinical Practice Guideline for the prevention and treatment of peri-implant diseases.
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Affiliation(s)
- Tord Berglundh
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Andrea Mombelli
- Division of Regenerative Dental Medicine and Periodontology, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Frank Schwarz
- Department of Oral Surgery and Implantology, Goethe University, Carolinum, Frankfurt, Germany
| | - Jan Derks
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Shiba T, Komatsu K, Takeuchi Y, Koyanagi T, Taniguchi Y, Takagi T, Maekawa S, Nagai T, Kobayashi R, Matsumura S, Katagiri S, Izumi Y, Aoki A, Iwata T. Novel Flowchart Guiding the Non-Surgical and Surgical Management of Peri-Implant Complications: A Narrative Review. Bioengineering (Basel) 2024; 11:118. [PMID: 38391604 PMCID: PMC10885994 DOI: 10.3390/bioengineering11020118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 01/04/2024] [Accepted: 01/22/2024] [Indexed: 02/24/2024] Open
Abstract
Peri-implant diseases, such as peri-implant mucositis and peri-implantitis, are induced by dysbiotic microbiota resulting in the inflammatory destruction of peri-implant tissue. Nonetheless, there has yet to be an established protocol for the treatment of these diseases in a predictable manner, although many clinicians and researchers have proposed various treatment modalities for their management. With the increase in the number of reports evaluating the efficacy of various treatment modalities and new materials, the use of multiple decontamination methods to clean infected implant surfaces is recommended; moreover, the use of hard tissue laser and/or air abrasion techniques may prove advantageous in the future. Limited evidence supports additional effects on clinical improvement in antimicrobial administration for treating peri-implantitis. Implantoplasty may be justified for decontaminating the implant surfaces in the supracrestal area. Surgical treatment is employed for advanced peri-implantitis, and appropriate surgical methods, such as resection therapy or combination therapy, should be selected based on bone defect configuration. This review presents recent clinical advances in debridement methods for contaminated implant surfaces and regenerative materials for treating peri-implant bone defects. It also proposes a new flowchart to guide the treatment decisions for peri-implant disease.
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Affiliation(s)
- Takahiko Shiba
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8549, Japan
- Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, MA 02115, USA
| | - Keiji Komatsu
- Department of Lifetime Oral Health Care Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8549, Japan
- Weintraub Center for Reconstructive Biotechnology, UCLA School of Dentistry, Los Angeles, CA 90095, USA
| | - Yasuo Takeuchi
- Department of Lifetime Oral Health Care Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8549, Japan
| | - Tatsuro Koyanagi
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8549, Japan
| | - Yoichi Taniguchi
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8549, Japan
| | - Toru Takagi
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8549, Japan
| | - Shogo Maekawa
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8549, Japan
| | - Takahiko Nagai
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8549, Japan
| | - Ryota Kobayashi
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8549, Japan
| | - Shunsuke Matsumura
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8549, Japan
| | - Sayaka Katagiri
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8549, Japan
| | - Yuichi Izumi
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8549, Japan
- Oral Care Periodontics Center, Southern TOHOKU Research Institute for Neuroscience, Southern TOHOKU General Hospital, Koriyama 963-8052, Japan
| | - Akira Aoki
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8549, Japan
| | - Takanori Iwata
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8549, Japan
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Zhu Y, Lu H, Yang S, Liu Y, Zhu P, Li P, Waal YCMD, Visser A, Tjakkes GHE, Li A, Xu S. Predictive factors for the treatment success of peri-implantitis: a protocol for a prospective cohort study. BMJ Open 2024; 14:e072443. [PMID: 38199627 PMCID: PMC10806708 DOI: 10.1136/bmjopen-2023-072443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 11/30/2023] [Indexed: 01/12/2024] Open
Abstract
INTRODUCTION Peri-implantitis, a common biological complication of dental implant, has attracted considerable attention due to its increasing prevalence and limited treatment efficacy. Previous studies have reported several risk factors associated with the onset of peri-implantitis (eg, history of periodontitis, poor plaque control and smoking). However, inadequate data are available on the association between these risk factors and successful outcome after peri-implantitis therapy. This prospective cohort study aims to identify the local and systemic predictive factors for the treatment success of peri-implantitis. METHODS AND ANALYSIS A single-centre cohort study will be conducted by recruiting 275 patients diagnosed with peri-implantitis. Sociodemographic variables, healthy lifestyles and systemic disorders will be obtained using questionnaires. In addition, clinical and radiographic examinations will be conducted at baseline and follow-up visits. Treatment success is defined as no bleeding on probing on more than one point, no suppuration, no further marginal bone loss (≥0.5 mm) and probing pocket depth ≤5 mm at the 12-month follow-up interval. After adjustment for age, sex and socioeconomic status, potential prognostic factors related to treatment success will be identified using multivariable logistic regression models. ETHICS AND DISSEMINATION This cohort study in its current version (2.0, 15 July 2022) is in accordance with the Declaration of Helsinki and was approved by the Ethics Committee of Stomatological Hospital, Southern Medical University (EC-CT-(2022)34). The publication will be on behalf of the study site. TRIAL REGISTRATION NUMBER ChiCTR2200066262.
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Affiliation(s)
- Yuanxi Zhu
- Center of Oral Implantology, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, China
| | - Hongye Lu
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Dental Biomaterials and Devices for Zhejiang Provincial Engineering Research Center, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Zhejiang University, Hangzhou, China
| | - Shuo Yang
- Center of Oral Implantology, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, China
| | - Yang Liu
- Department of Oral Medicine, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, China
| | - Peijun Zhu
- Center of Oral Implantology, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, China
| | - Ping Li
- Center of Oral Implantology, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, China
| | - Yvonne C M De Waal
- Center for Dentistry and Oral Hygiene, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Anita Visser
- Center for Dentistry and Oral Hygiene, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department for Gerodontology, College of Dental Sciences, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Geerten-Has E Tjakkes
- Center for Dentistry and Oral Hygiene, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - An Li
- Center of Oral Implantology, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, China
- Center for Dentistry and Oral Hygiene, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Shulan Xu
- Center of Oral Implantology, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, China
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10
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Chan MH, Kang J. Diagnosis and Treatment of Periimplant Mucositis and Periimplantitis: An Overview and Related Controversial Issues. Dent Clin North Am 2024; 68:167-202. [PMID: 37951632 DOI: 10.1016/j.cden.2023.08.001] [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] [Indexed: 11/14/2023]
Abstract
Periimplant mucositis and periimplantitis are common complications of dental implant. This article provides a comprehensive overview of the 2017 World Workshop's new definition, clinical and radiographic presentation, pathogenesis, risk factors, and classification of periimplant diseases. Also, the authors discuss various types of instruments, materials, and techniques commonly used for treatment of nonsurgical and surgical periimplantitis. Lastly, the authors include some controversial topics surrounding this subject.
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Affiliation(s)
- Michael H Chan
- Oral & Maxillofacial Surgery, Department of Veterans Affairs, New York Harbor Healthcare System (Brooklyn Campus), 800 Poly Place (Bk-160), Brooklyn, NY 11209, USA; Oral & Maxillofacial Surgery, Department of Oral and Maxillofacial Surgery, The Brooklyn Hospital Center, 121 DeKalb Avenue (Box-187), Brooklyn, NY 11201, USA.
| | - Joseph Kang
- Oral & Maxillofacial Surgery, Department of Oral and Maxillofacial Surgery, The Brooklyn Hospital Center, 121 DeKalb Avenue (Box-187), Brooklyn, NY 11201, USA
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11
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Satpathy A, Grover V, Kumar A, Jain A, Gopalakrishnan D, Grover HS, Kolte A, Melath A, Khatri M, Dani N, Thakur R, Tiwari V, Yadav VS, Thomas B, Chahal GS, Bhasin MT, Pandit N, Lawande SA, Manjunath RGS, Sachdeva S, Bhardwaj A, Pradeep AR, Nichani AS, Singh B, Ganesh PR, Deshpande NC, Reddy SSP, Raj SC. Indian Society of Periodontology Good Clinical Practice Recommendations for Peri-implant Care. J Indian Soc Periodontol 2024; 28:6-31. [PMID: 38988964 PMCID: PMC11232813 DOI: 10.4103/jisp.jisp_124_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 04/10/2024] [Accepted: 04/18/2024] [Indexed: 07/12/2024] Open
Abstract
Current implant therapy is a frequently employed treatment for individuals who have lost teeth, as it offers functional and biological advantages over old prostheses. Concurrently, active exploration of intervention strategies aims to prevent the progression of peri-implant diseases and manage the existing peri-implant tissue damage. Indian Society of Periodontology has recognized the need for systematic documents to update the everyday clinical practice of general dental practitioners and has provided evidence-based consensus documents, namely good clinical practice recommendations from time to time to raise the oral health-related awareness and standards of oral health-care delivery across the country. The current clinical practice recommendations focused on peri-implant care to bridge the gap between academic theory and clinical practice by compiling evidence-based suggestions for preventing and treating peri-implant diseases. Twenty-eight subject experts across the country prepared these recommendations after a thorough literature review and group discussions. The document has been prepared in three sections covering peri-implant health and maintenance, peri-implant mucositis, and peri-implantitis. It will be a quick and concise reference for oral implant practitioners in patient management. The guidelines provide distinct definitions, signs, and symptoms, treatment required; recall visit specifications for plausible clinical case situations, and home-care recommendations regarding maintaining peri-implant health. The document advocates combined efforts of oral implant practitioners and the population at large with evidence-based, integrated, and comprehensive peri-implant care. By providing accessible, applicable guidance, these guidelines would empower dental professionals to uphold the well-being of implant patients and ensure the long-term success of implant therapy.
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Affiliation(s)
- Anurag Satpathy
- Department of Periodontics and Oral Implantology, Institute of Dental Sciences, Siksha 'O' Anusandhan (Deemed to be University), Bhubaneswar, Odisha, India
| | - Vishakha Grover
- Department of Periodontology, Dr. HSJ Institute of Dental Sciences and Hospital, Panjab University, Chandigarh, Manipur, India
| | - Ashish Kumar
- Department of Periodontology, Dental College, Regional Institute of Medical Sciences, Imphal, Manipur, India
| | - Ashish Jain
- Department of Periodontology, Dr. HSJ Institute of Dental Sciences and Hospital, Panjab University, Chandigarh, Manipur, India
| | - Dharmarajan Gopalakrishnan
- Department of Periodontology, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Pune, Maharashtra, India
| | | | - Abhay Kolte
- Department of Periodontology and Implantology, Ranjeet Deshmukh Dental College and Research Centre, Nagpur, Maharashtra, India
| | - Anil Melath
- Department of Periodontics, Mahe Institute of Dental Sciences and Hospital, Chalakkara, Puducherry, India
| | - Manish Khatri
- Department of Periodontology, Institute of Dental Studies and Technologies, Modinagar, Uttar Pradesh, India
| | - Nitin Dani
- Private Practitioner, Nashik, Maharashtra, India
| | - Roshani Thakur
- Department of Periodontics, Saraswati Dhanvantari Dental College and Hospital, Parbhani, Maharashtra, India
| | - Vaibhav Tiwari
- Department of Periodontology, Government Dental College, Raipur, Chhattisgarh, India
| | - Vikender Singh Yadav
- Division of Periodontics, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Biju Thomas
- Department of Periodontology, AB Shetty Memorial Institute of Dental Sciences, NITTE (Deemed to be university), Mangalore, Karnataka, India
| | - Gurparkash Singh Chahal
- Department of Periodontology, Dr. HSJ Institute of Dental Sciences and Hospital, Panjab University, Chandigarh, Manipur, India
| | - Meenu Taneja Bhasin
- Department of Periodontics, Sudha Rustagi Dental College, Faridabad, Uttar Pradesh, India
| | - Nymphea Pandit
- Department of Periodontology, D.A.V Dental College and Hospital, Yamunanagar, Haryana, India
| | | | - R G Shiva Manjunath
- Department of Periodontology, Dental Institute, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Surinder Sachdeva
- Department of Periodontology, M.M. College of Dental Sciences and Research, MM Deemed to be University, Mullana, Punjab, India
| | - Amit Bhardwaj
- Department of Periodontology, Faculty of Dental Sciences, SGT University, Gurugram, Haryana, India
| | - Avni Raju Pradeep
- Department of Periodontology, Government Dental College, Bengaluru, Karnataka, India
| | - Ashish Sham Nichani
- Department of Periodontology, The Oxford Dental College, Bengaluru, Karnataka, India
| | - Baljeet Singh
- Department of Periodontology and Implantology, Himachal Dental College, Sunder Nagar, Himachal Pradesh, India
| | - P R Ganesh
- Department of Periodontology, Tamil Nadu Government Dental College and Hospital, Chennai, Tamil Nadu, India
| | - Neeraj Chandrahas Deshpande
- Department of Periodontology, K. M. Shah Dental College, Sumandeep Vidyapeeth (Deemed to be University), Vadodara, Gujarat, India
| | | | - Subash Chandra Raj
- Department of Periodontology, S.C.B Dental College and Hospital, Cuttack, Odisha, India
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12
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Risolo M, Cevik-Aras H, Sayardoust S. The effect of reconstructive techniques as treatment modality for peri-implant osseous defects - a systematic review and meta-analysis. Acta Odontol Scand 2023; 81:569-577. [PMID: 37551914 DOI: 10.1080/00016357.2023.2243325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 07/27/2023] [Indexed: 08/09/2023]
Abstract
OBJECTIVES The aim of this systematic review is to compare conventional peri-implant flap surgery and reconstructive surgical techniques regarding evidence of remission from peri-implantitis. MATERIAL AND METHODS Searches were made among randomized controlled trials evaluating clinical aspects and the changes in marginal bone level before and after surgical treatment of peri-implantitis, with and without bone substitute. RESULTS Nine published articles and 442 patients were eligible for inclusion in the study. Reconstructive techniques exhibited a greater extent of defect fill than conventional surgical techniques alone. No significant differences could be found for clinical measures of peri-implant disease (bleeding on probing and reduction of probing depth) from baseline to the 12-month follow-up. CONCLUSIONS With regards to the clinical measures of disease, our review shows that there are no differences between open flap debridement and regenerative surgery. From an esthetic standpoint, it may however be that regenerative measures may lead to improvement but further publications with this focus will be necessary to verify this.
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Affiliation(s)
- Massimo Risolo
- Department of Periodontology, Institute for Postgraduate Dental Education, Jönköping, Sweden
| | - Hülya Cevik-Aras
- Department of Oral Pathology and Medicine, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- NÄL Hospital, Trollhättan, Sweden
| | - Shariel Sayardoust
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Center for Oral Rehabilitation, Linköping, Sweden
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13
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Ichioka Y, Virto L, Nuevo P, Gamonal JD, Derks J, Larsson L, Sanz M, Berglundh T. Decontamination of biofilm-contaminated implant surfaces: An in vitro evaluation. Clin Oral Implants Res 2023; 34:1058-1072. [PMID: 37469250 DOI: 10.1111/clr.14136] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 06/17/2023] [Accepted: 07/04/2023] [Indexed: 07/21/2023]
Abstract
OBJECTIVES The aim of the present study was to evaluate the cleaning efficacy of two mechanical and two chemical protocols in the decontamination of implant surfaces. METHODS In total, 123 commercially available implants were mounted in plastic models mimicking peri-implant circumferential intra-bony defects. A multispecies biofilm was grown on implant surfaces. Mechanical (air-polishing (AP), rotating titanium brush (TiB)) and chemical decontamination (alkaline electrolyzed water, N-acetyl-L-cysteine) protocols were used. Cleaning efficacy in terms of residual biofilm area, chemical surface properties, and bacterial counts were analyzed by scanning electron microscopy, energy-dispersive X-ray spectroscopy, and quantitative polymerase chain reaction. RESULTS Surface decontamination protocols including use of an AP device or a rotating TiB were superior in terms of biofilm removal and in reducing atomic% of Carbon on implant surfaces when compared to methods restricted to wiping with gauze. The use of chemical agents as adjuncts to the mechanical cleaning protocols provided no relevant overall benefit over saline. No treatment modality, however, resulted in complete biofilm removal. CONCLUSION Air-polishing and rotating TiB were more effective implant surface decontamination protocols than wiping with gauzes. Use of chemical agents did not improve cleaning efficacy.
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Affiliation(s)
- Yuki Ichioka
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Leire Virto
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, Faculty of Dentistry, Complutense University, Madrid, Spain
- Department of Anatomy and Embryology, Faculty of Optics, Complutense University, Madrid, Spain
| | - Paula Nuevo
- Research Laboratory, Faculty of Odontology, Complutense University, Madrid, Spain
| | - Juan Daniel Gamonal
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, Faculty of Dentistry, Complutense University, Madrid, Spain
| | - Jan Derks
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Lena Larsson
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Mariano Sanz
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, Faculty of Dentistry, Complutense University, Madrid, Spain
| | - Tord Berglundh
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
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14
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D’Addazio G, Manciocchi E, Tafuri G, Schiavone R, Murmura G, Mavriqi L, Sinjari B, Caputi S. Long-Term Efficacy of Chlorhexidine Gel in Single-Crown Implant Rehabilitation: A Five-Year Follow-Up Study. Dent J (Basel) 2023; 11:228. [PMID: 37886913 PMCID: PMC10605130 DOI: 10.3390/dj11100228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/07/2023] [Accepted: 09/21/2023] [Indexed: 10/28/2023] Open
Abstract
Chlorhexidine digluconate (CHX) has shown the ability to significantly reduce inflammation and marginal bone loss (MBL) at the 1-year follow-up but limited data exist regarding its long-term efficacy in peri-implant stability. The objective was to compare the long-term effects (5 years of follow-up) of a placebo gel (16 patients in Group A) or a 0.20% CHX gel (15 patients in Group B) used at each previous surgical and prosthetic stage. Control visits were conducted in 2022, investigating the long-term effects by biological, radiological, and clinical evaluation. The data were statistically analyzed. The research achieved a 96.7% implant success rate over five years, but 41.9% of patients did not attend annual oral hygiene check-ups. The average MBL was 1.04 ± 0.39 mm, with no significant differences between the two groups. Notably, patients who attended regular periodontal check-ups experienced significantly less MBL than those who did not (p < 0.05). At five years, direct effects of CHX were absent, with both groups showing moderate bone loss. However, the results suggest that early disinfection could enhance both short- and long-term outcomes. In fact, patients with initial minor MBL due to use of CHX, preserve this advantage also after 5 years of follow-up. Additionally, the data underscore the importance of annual check-ups in early detection and management of biological complications.
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Affiliation(s)
- Gianmaria D’Addazio
- Unit of Prosthodontics, Department of Innovative Technologies in Medicine and Dentistry, University “G. d’Annunzio” of Chieti-Pescara, 66100 Chieti, Italy; (G.D.); (E.M.); (G.T.); (R.S.); (G.M.); (S.C.)
- Electron Microscopy Laboratory, University “G. d’Annunzio” of Chieti-Pescara, 66100 Chieti, Italy
| | - Eugenio Manciocchi
- Unit of Prosthodontics, Department of Innovative Technologies in Medicine and Dentistry, University “G. d’Annunzio” of Chieti-Pescara, 66100 Chieti, Italy; (G.D.); (E.M.); (G.T.); (R.S.); (G.M.); (S.C.)
- Electron Microscopy Laboratory, University “G. d’Annunzio” of Chieti-Pescara, 66100 Chieti, Italy
| | - Giuseppe Tafuri
- Unit of Prosthodontics, Department of Innovative Technologies in Medicine and Dentistry, University “G. d’Annunzio” of Chieti-Pescara, 66100 Chieti, Italy; (G.D.); (E.M.); (G.T.); (R.S.); (G.M.); (S.C.)
- Electron Microscopy Laboratory, University “G. d’Annunzio” of Chieti-Pescara, 66100 Chieti, Italy
| | - Ruggero Schiavone
- Unit of Prosthodontics, Department of Innovative Technologies in Medicine and Dentistry, University “G. d’Annunzio” of Chieti-Pescara, 66100 Chieti, Italy; (G.D.); (E.M.); (G.T.); (R.S.); (G.M.); (S.C.)
| | - Giovanna Murmura
- Unit of Prosthodontics, Department of Innovative Technologies in Medicine and Dentistry, University “G. d’Annunzio” of Chieti-Pescara, 66100 Chieti, Italy; (G.D.); (E.M.); (G.T.); (R.S.); (G.M.); (S.C.)
- Electron Microscopy Laboratory, University “G. d’Annunzio” of Chieti-Pescara, 66100 Chieti, Italy
| | - Luan Mavriqi
- Department of Dentistry, Albanian University, 1001 Tirana, Albania;
| | - Bruna Sinjari
- Unit of Prosthodontics, Department of Innovative Technologies in Medicine and Dentistry, University “G. d’Annunzio” of Chieti-Pescara, 66100 Chieti, Italy; (G.D.); (E.M.); (G.T.); (R.S.); (G.M.); (S.C.)
- Electron Microscopy Laboratory, University “G. d’Annunzio” of Chieti-Pescara, 66100 Chieti, Italy
| | - Sergio Caputi
- Unit of Prosthodontics, Department of Innovative Technologies in Medicine and Dentistry, University “G. d’Annunzio” of Chieti-Pescara, 66100 Chieti, Italy; (G.D.); (E.M.); (G.T.); (R.S.); (G.M.); (S.C.)
- Electron Microscopy Laboratory, University “G. d’Annunzio” of Chieti-Pescara, 66100 Chieti, Italy
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15
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Chiang YC, Sirinirund B, Rodriguez A, Velasquez D, Chan HL. Operating microscope-assisted reconstructive strategy for peri-implantitis: A case series report. Clin Adv Periodontics 2023. [PMID: 37724638 DOI: 10.1002/cap.10265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 08/25/2023] [Accepted: 08/26/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND Treating peri-implantitis with reconstructive means has been largely unpredictable due to access limitations for surface decontamination, unfavorable bony topography, difficulty in achieving wound stability, and inferior soft tissue qualities. A microsurgical approach with the use of the operating microscope (OM) that provides adjustable higher magnification (∼5-30 times) and coaxial illumination, coupled with the use of microsurgical instruments, may overcome, or alleviate some of the abovementioned obstacles, resulting in more predictable outcomes. METHODS Three patients received reconstructive therapy for correcting peri-implant defects under OM in private practice settings. After precise incisions to preserve soft tissue volume, the flaps were dissected prudently from underlying granulomatous tissues, which were subsequently removed, followed by controlled flap releasing under ∼10-15x magnification. Surface decontamination was performed using a piezoelectric ultrasonic device, air polishing, and hand instruments at ∼30x magnification. The biomaterial selections were dehydrated human de-epithelialized amnion-chorion membrane with mineralized allograft particulates in two cases and xenografts in one case, based on the surgeons' preference. Wound closure followed the non-submerged approach. RESULTS These cases demonstrated uneventful soft tissue healing, favorable radiographic bone fill, and disease resolution with follow-ups ranging from 2 to 4 years. CONCLUSIONS Preliminary data suggest encouraging outcomes after the microsurgical approach following biological as well as biomechanical principles for peri-implant defect reconstruction.
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Affiliation(s)
- Yi-Chen Chiang
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Benyapha Sirinirund
- Department of Restorative Dentistry and Periodontology, Faculty of Dentistry, Chiang Mai University, Chiang Mai, Thailand
| | - Amanda Rodriguez
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Diego Velasquez
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
- Private Practice, Fenton, Michigan, USA
| | - Hsun-Liang Chan
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
- Division of Periodontology, The Ohio State University College of Dentistry, Columbus, Ohio, USA
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16
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Heitz-Mayfield LJA, Heitz F, Koong B, Huang T, Chivers P. Surgical peri-implantitis treatment with and without guided bone regeneration. A randomized controlled trial. Clin Oral Implants Res 2023; 34:892-910. [PMID: 37382408 DOI: 10.1111/clr.14116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/20/2023] [Accepted: 06/07/2023] [Indexed: 06/30/2023]
Abstract
OBJECTIVE To evaluate the efficacy of reconstructive peri-implantitis treatment. MATERIALS AND METHODS Forty participants, with peri-implantitis and a contained intraosseous defect, were randomized to access flap (control) or access flap with xenograft and collagen membrane (test). All received systemic antimicrobials. Blinded examiners recorded probing depths (PD), bleeding and suppuration on probing (BOP & SOP), soft tissue levels, and marginal bone levels (MBL) at baseline and 12 months. Patient reported outcomes were recorded. The primary outcome was PD change. RESULTS All 40 participants (40 implants) completed the 12-month study. The mean (standard deviation) PD reduction (deepest site) was 4.2 (1.8) mm in the control and 3.7 (1.9) mm in the test group. MBL gain (deepest site) was 1.7 (1.6) mm in the control and 2.4 (1.4) mm in the test group. Absence of BOP & SOP was observed at 60% of both control and test implants. Buccal recession was 0.9 (1.6) mm in the control and 0.4 (1.1) mm in the test group. A successful outcome (absence of PD ≥ 5 mm with BOP, absence of SOP and absence of progressive bone loss) was achieved for 90% of the control and 85% of test group implants. No statistically significant differences in clinical or radiographic parameters were found between treatment groups. 30% of participants experienced mild gastro-intestinal disturbances. Reporting followed CONSORT guidelines. CONCLUSION Similar clinical and radiographic improvements at 12 months were observed with high levels of patient satisfaction for both the access flap and xenograft covered by collagen membrane groups. Registered clinical trials.gov. ID:NCT03163602 (23/05/2017).
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Affiliation(s)
- Lisa J A Heitz-Mayfield
- International Research Collaborative, Oral Health and Equity, School of Human Anatomy and Biology, The University of Western Australia, Crawley, Western Australia, Australia
- Faculty of Medicine and Health, School of Dentistry, The University of Sydney, Sydney, New South Wales, Australia
- Perth Periodontal Specialists, West Leederville, Western Australia, Australia
| | - Fritz Heitz
- Perth Periodontal Specialists, West Leederville, Western Australia, Australia
| | - Bernard Koong
- Envision Medical Imaging, Wembley, Western Australia, Australia
| | - Tom Huang
- Envision Medical Imaging, Wembley, Western Australia, Australia
| | - Paola Chivers
- Institute for Health Research, The University of Notre Dame, Fremantle, Western Australia, Australia
- School of Medical and Health Sciences, ECU, Joondalup, Western Australia, Australia
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17
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Baus-Domínguez M, Bakkali S, Hermida-Cabrera P, Serrera-Figallo MA, Gutiérrez-Pérez JL, Torres-Lagares D. A Systematic Review and Meta-Analysis of Systemic and Local Antibiotic Therapy in the Surgical Treatment of Peri-Implantitis. Antibiotics (Basel) 2023; 12:1223. [PMID: 37508319 PMCID: PMC10376060 DOI: 10.3390/antibiotics12071223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 07/12/2023] [Accepted: 07/20/2023] [Indexed: 07/30/2023] Open
Abstract
(1) Background: Given the existing controversy regarding the use of antibiotics in the treatment of peri-implantitis, this systematic review and meta-analysis aim to ascertain how beneficial the role of systemic and local antibiotics is in peri-implant surgical therapy, considering the harmful effects that they represent and the abuse of antibiotics in terms of global health. (2) Methods: To determine the therapeutic efficacy of the administration of antibiotics in the surgical treatment of peri-implantitis in terms of probing pocket depth (PPD) and bleeding on probing (BoP), electronic and manual bibliographic searches were carried out in the Embase and PubMed databases, collecting data that related to before and after treatment. (3) Results: The adjunctive use of local antibiotics provides significant improvements in PPD (MD = 1.29; 95% CI: 0.56 to 2.02; p ≤ 0.0006; I2 = 0%) when compared with surgical treatment alone. No significant differences were found in the other subgroup; that is, the use of systemic antibiotics did not significantly improve PPD changes in the surgical treatment of peri-implantitis (MD = 0.40; 95% CI: -0.15 to 0.95; p = 0.15; I2 = 0). (4) Conclusions: The use of local antibiotics in the surgical treatment of peri-implantitis seems to offer treatment improvements in terms of PPD and BoP, unlike that observed with the use of systemic antibiotics. However, these results should be taken with caution as they also depend on the type of surgical technique used, whether regenerative or resective. More research is needed on this topic to understand the role of local and systemic antibiotics in the treatment of peri-implantitis.
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Affiliation(s)
- María Baus-Domínguez
- Departamento de Estomatología, Facultad de Odontología, Universidad de Sevilla, 41009 Sevilla, Spain
| | - Sara Bakkali
- Departamento de Estomatología, Facultad de Odontología, Universidad de Sevilla, 41009 Sevilla, Spain
| | - Paula Hermida-Cabrera
- Departamento de Estomatología, Facultad de Odontología, Universidad de Sevilla, 41009 Sevilla, Spain
| | | | - José-Luis Gutiérrez-Pérez
- Departamento de Estomatología, Facultad de Odontología, Universidad de Sevilla, 41009 Sevilla, Spain
- Hospital Universitario Virgen del Rocío, Universidad de Sevilla, 41013 Sevilla, Spain
| | - Daniel Torres-Lagares
- Departamento de Estomatología, Facultad de Odontología, Universidad de Sevilla, 41009 Sevilla, Spain
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18
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Stiesch M, Grischke J, Schaefer P, Heitz-Mayfield LJA. Supportive care for the prevention of disease recurrence/progression following peri-implantitis treatment: A systematic review. J Clin Periodontol 2023. [PMID: 37339881 DOI: 10.1111/jcpe.13822] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 04/05/2023] [Accepted: 04/11/2023] [Indexed: 06/22/2023]
Abstract
OBJECTIVES This systematic review aimed to evaluate the efficacy of supportive care provision, frequency and protocol in patients treated for peri-implantitis, as reported in prospective and retrospective studies of at least 3-years duration. MATERIALS AND METHODS A systematic search of three electronic databases was undertaken up to 21 July 2022 and supplemented by hand-search to identify studies that included participants treated for peri-implantitis and followed for at least 3 years. Owing to high heterogeneity, a meta-analysis was not appropriate, and therefore, data and risk of bias were explored qualitatively. PRISMA guidelines for reporting were followed. RESULTS The search identified 2596 studies. Of 270 records selected during screening, 255 were excluded through independent review and 15 studies (10 prospective and 5 retrospective, with at least 20 patients) were retained for qualitative assessments. Study designs, population characteristics, supportive care protocols and reported outcomes varied markedly. Thirteen of the 15 studies had low risk of bias. Supportive peri-implant care (SPIC) following different surgical peri-implantitis treatment protocols and with recall intervals varying between 2 months and annually resulted in peri-implant tissue stability (no disease recurrence or progression) ranging from 24.4% to 100% at patient level and from 28.3% to 100% at implant level. Sevenhundred and eighty-five patients with 790 implants were included in this review. CONCLUSIONS Provision of SPIC following peri-implantitis therapy may prevent disease recurrence or progression. Insufficient evidence is available to identify (i) a specific supportive care protocol for secondary prevention of peri-implantitis, (ii) the effect of adjunctive local antiseptic agents in the secondary prevention of peri-implantitis and (iii) the impact of frequency of supportive care measures. Prospective, randomised, controlled studies designed to evaluate supportive care protocols are needed in future.
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Affiliation(s)
- Meike Stiesch
- Clinic of Prosthetic Dentistry and Biomedical Materials Science, Hanover Medical School, Hanover, Germany
| | - Jasmin Grischke
- Clinic of Prosthetic Dentistry and Biomedical Materials Science, Hanover Medical School, Hanover, Germany
| | - Paula Schaefer
- Clinic of Prosthetic Dentistry and Biomedical Materials Science, Hanover Medical School, Hanover, Germany
| | - Lisa J A Heitz-Mayfield
- International Research Collaborative Oral Health and Equity, School of Anatomy and Biology, The University of Western Australia, Crawley, Western Australia, Australia
- Discipline of Periodontics, School of Dentistry, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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Wilensky A, Shapira L, Limones A, Martin C. The efficacy of implant surface decontamination using chemicals during surgical treatment of peri-implantitis: A systematic review and meta-analysis. J Clin Periodontol 2023; 50 Suppl 26:336-358. [PMID: 36792071 DOI: 10.1111/jcpe.13794] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 01/03/2023] [Accepted: 02/12/2023] [Indexed: 02/17/2023]
Abstract
AIM To answer the following PICOS question: "In adult patients with peri-implantitis, what is the efficacy of surgical therapy with chemical surface decontamination of implant surfaces in comparison with surgical therapy alone or surgery with placebo decontamination, on probing pocket depth (PD) reduction and bleeding on probing (BoP)/suppuration on probing (SoP), in randomized controlled clinical trials (RCTs) and non-RCTs with at least 6 months of follow-up?" MATERIALS AND METHODS Six databases were searched from their inception up to 20 May 2022. Data on clinical outcome variables were pooled and analysed using mean differences (MDs), risk ratios (RRs), or risk differences (RDs) as appropriate, 95% confidence intervals (CIs), and prediction intervals (PIs) in the case of significant heterogeneity. Primary outcomes were determined as changes in PD and BoP/SoP. Secondary outcomes were radiographic marginal bone loss (MBL), implant loss, and disease resolution. PROSPERO registration number: CRD42022325603. RESULTS Six RCTs-two with moderate, three with high, and one with low risk of bias (RoB)-were included. These studies test the adjunctive effect of photodynamic therapy (PDT), chlorhexidine (CHX), and administration of local antibiotics (LAbs) during surgery on the clinical outcome. In a single 12-month study, the adjunctive use of local antibiotics showed a clinically relevant reduction of PD [MD = 1.44; 95%CI (0.40 to -2.48)] and MBL [MD = 1.21; 95%CI (0.44-1.98); one trial, 32 participants]. PDT showed a small but significant reduction in BoP [MD = 7.41%; 95%CI (0.81-14.00); p = 0.028; two trials; 42 participants]. Treatment with CHX resulted in no significant changes in PD, BoP, or MBL compared to placebo (saline solution). None of the interventions affected disease resolution and implant loss. Certainty of the evidence was very low for all outcome measures assessed. CONCLUSIONS Within the limitations of this systematic review and the meta-analysis, adjunctive use of chemicals such as PDT, CHX, and LAbs for surface decontamination during surgery of peri-implantitis cannot be recommended as superior to standard debridement procedures (mechanical debridement with or without saline).
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Affiliation(s)
- Asaf Wilensky
- Department of Periodontology, Hadassah Medical Center, Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Lior Shapira
- Department of Periodontology, Hadassah Medical Center, Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Alvaro Limones
- Department of Conservative and Prosthetic Dentistry, Faculty of Dentistry, Complutense University of Madrid (UCM), Madrid, Spain
| | - Conchita Martin
- Department of Dental Clinical Specialties, Faculty of Dentistry, Complutense University of Madrid (UCM), Madrid, Spain
- BIOCRAN Research group, Complutense University of Madrid (UCM), Madrid, Spain
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20
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Karlsson K, Trullenque-Eriksson A, Tomasi C, Derks J. Efficacy of access flap and pocket elimination procedures in the management of peri-implantitis: A systematic review and meta-analysis. J Clin Periodontol 2023; 50 Suppl 26:244-284. [PMID: 36217689 DOI: 10.1111/jcpe.13732] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/16/2022] [Accepted: 10/04/2022] [Indexed: 11/28/2022]
Abstract
AIM To evaluate the efficacy of access flap and pocket elimination procedures in the surgical treatment of peri-implantitis. MATERIALS AND METHODS Systematic electronic searches (Central/MEDLINE/EMBASE) up to March 2022 were conducted to identify prospective clinical studies evaluating surgical therapy (access flap or pocket elimination procedures) of peri-implantitis. Primary outcome measures were reduction of probing depth (PD) and bleeding on probing (BOP). Risk of bias was evaluated according to study design. Meta-analysis and meta-regression were performed. Results were expressed as standardized mean effect with 95% confidence interval (CI). RESULTS Evidence from studies directly comparing surgical with non-surgical therapy is lacking. Based on pre-post data originating from 13 prospective patient cohorts, pronounced reductions of PD (standardized mean effect: 2.2 mm; 95% CI 1.8-2.7) and BOP% (27.0; 95% CI 19.8-34.2) as well as marginal bone level gain (0.2 mm; 95% CI -0.0 to 0.5) were observed at evaluation time points ranging from 1 to 5 years. Wide prediction intervals suggested a high degree of heterogeneity. Reduction of mean PD increased by 0.7 mm (95% CI 0.5-0.9) for every millimetre in increase of mean PD at baseline. During the follow-up period ranging from 1 to 5 years, disease recurrence occurred frequently and implant loss was not uncommon. CONCLUSIONS Access flap and pocket elimination surgery are effective procedures in the management of peri-implantitis, although rates of disease recurrence during 5 years were high. Treatment outcomes were affected by baseline conditions.
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Affiliation(s)
- Karolina Karlsson
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Anna Trullenque-Eriksson
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Cristiano Tomasi
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Jan Derks
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
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Malheiros SS, Nagay BE, Bertolini MM, de Avila ED, Shibli JA, Souza JGS, Barão VAR. Biomaterial engineering surface to control polymicrobial dental implant-related infections: focusing on disease modulating factors and coatings development. Expert Rev Med Devices 2023:1-17. [PMID: 37228179 DOI: 10.1080/17434440.2023.2218547] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 04/29/2023] [Accepted: 05/23/2023] [Indexed: 05/27/2023]
Abstract
INTRODUCTION Peri-implantitis is the leading cause of dental implant loss and is initiated by a polymicrobial dysbiotic biofilm formation on the implant surface. The destruction of peri-implant tissue by the host immune response and the low effectiveness of surgical or non-surgical treatments highlight the need for new strategies to prevent, modulate and/or eliminate biofilm formation on the implant surface. Currently, several surface modifications have been proposed using biomolecules, ions, antimicrobial agents, and topography alterations. AREAS COVERED Initially, this review provides an overview of the etiopathogenesis and host- and material-dependent modulating factors of peri-implant disease. In addition, a critical discussion about the antimicrobial surface modification mechanisms and techniques employed to modify the titanium implant material is provided. Finally, we also considered the future perspectives on the development of antimicrobial surfaces to narrow the bridge between idea and product and favor the clinical application possibility. EXPERT OPINION Antimicrobial surface modifications have demonstrated effective results; however, there is no consensus about the best modification strategy and in-depth information on the safety and longevity of the antimicrobial effect. Modified surfaces display recurring challenges such as short-term effectiveness, the burst release of drugs, cytotoxicity, and lack of reusability. Stimulus-responsive surfaces seem to be a promising strategy for a controlled and precise antimicrobial effect, and future research should focus on this technology and study it from models that better mimic clinical conditions.
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Affiliation(s)
- Samuel S Malheiros
- Department of Prosthodontics and Periodontology, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo 13414-903, Brazil
| | - Bruna E Nagay
- Department of Prosthodontics and Periodontology, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo 13414-903, Brazil
| | - Martinna M Bertolini
- Department of Periodontics and Preventive Dentistry, School of Dental Medicine, University of Pittsburgh, Pittsburgh, PA 15106, USA
| | - Erica D de Avila
- Department of Dental Materials and Prosthodontics, School of Dentistry at Araçatuba, São Paulo State University (UNESP), Araçatuba, Sao Paulo 16015-050, Brazil
| | - Jamil A Shibli
- Dental Research Division, Guarulhos University, Guarulhos, São Paulo 07023-070, Brazil
| | - João Gabriel S Souza
- Dental Research Division, Guarulhos University, Guarulhos, São Paulo 07023-070, Brazil
- Dental Science School (Faculdade de Ciências Odontológicas - FCO), Montes Claros, Minas Gerais39401-303, Brazil
| | - Valentim A R Barão
- Department of Prosthodontics and Periodontology, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo 13414-903, Brazil
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Zakir M, Thomas D, Adams R, Farnell D, Claydon N. A Systematic Review and Meta-Analysis of the Clinical Outcomes for Adjunctive Physical, Chemical, and Biological Treatment of Dental Implants With Peri-Implantitis. J ORAL IMPLANTOL 2023; 49:168-178. [PMID: 37071563 DOI: 10.1563/aaid-joi-d-21-00204] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
The present systematic review evaluated the efficacy of adjunctive therapies in the treatment of peri-implantitis. Studies comparing the outcome of conventional surgical- or nonsurgical mechanical debridement with the addition of an adjunctive therapeutic modality were identified through an electronic and hand search of available literature. Following data extraction, meta-analyses were performed on the primary outcome measures. The effects of the adjunctive therapies on bleeding on probing (13 studies), probing pocket depth (9 studies), and radiographic bone level changes (7 studies) were analyzed to evaluate potential clinical benefit. Heterogeneity was expressed as the I2 index. Fixed and random effect models were demonstrated. The potential benefit of adjunctive therapies over control procedures was evaluated in 18 studies, representing a total of 773 implants. Quality assessment of the studies found only 3 studies to be at a low risk of bias. Meta-analysis among the different additional modalities revealed chemical therapy demonstrating significant effects in probing pocket depth reduction (0.58 mm; 0.44-0.72) and radiographic bone level gain (0.54 mm; 0.16-0.92). No significant improvements in bleeding on probing reduction were found using any adjunctive therapy. Available evidence on the benefits of adjunctive therapy to nonsurgical or surgical mechanical debridement in the treatment of peri-implantitis is limited by low numbers of standardized, controlled studies for individual therapies, heterogeneity between studies, and a variety of outcome measures. The lack of effect of any adjunctive therapy in reducing bleeding on probing questions the overall effectiveness over conventional treatment. The long-term clinical benefit potential of these therapies is not demonstrated.
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Affiliation(s)
- Mehreen Zakir
- School of Dentistry, Cardiff University, Heath Park, Cardiff, CF14 4XY, United Kingdom
| | - David Thomas
- School of Dentistry, Cardiff University, Heath Park, Cardiff, CF14 4XY, United Kingdom
| | - Robert Adams
- School of Dentistry, Cardiff University, Heath Park, Cardiff, CF14 4XY, United Kingdom
| | - Damian Farnell
- School of Dentistry, Cardiff University, Heath Park, Cardiff, CF14 4XY, United Kingdom
| | - Nicholas Claydon
- School of Dentistry, Cardiff University, Heath Park, Cardiff, CF14 4XY, United Kingdom
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Vilarrasa J, Soldini MC, Pons R, Valles C, Blasi G, Monje A, Nart J. Outcome indicators of non-surgical therapy of peri-implantitis: a prospective case series analysis. Clin Oral Investig 2023:10.1007/s00784-023-04918-2. [PMID: 36786958 DOI: 10.1007/s00784-023-04918-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 02/05/2023] [Indexed: 02/15/2023]
Abstract
OBJECTIVES This study aims to identify patient and implant indicators influencing the non-surgical therapeutic outcomes of peri-implantitis at 6 months of follow-up. METHODS This case series involved patients with at least one implant diagnosed with peri-implantitis according to the 2017 World Workshop criteria. Non-surgical therapy consisted of mechanical debridement of the peri-implant pockets combined with metronidazole 500 mg 3 times a day for 7 days. At baseline and at 6 months, clinical and radiographic variables were collected to calculate treatment success (probing pocket depth reduction to 5 mm without bleeding on probing or < 5 mm irrespective of bleeding on probing at all implant sites, and lack of bone loss progression). The primary outcome was treatment success (%) at 6 months. The influence of the patient and implant/prosthetic variables upon disease resolution was assessed through simple and multiple logistic regression analyses at patient and implant level, using generalized estimation equations models. RESULTS A total of 74 patients and 107 implants were analyzed at 6 months. Disease resolution was established in 25.7% of the patients and 24.1% of the implants. Patients with stage IV and grade C periodontitis, inadequate oral hygiene at baseline, and wide diameter (≥ 4.5 mm) presented significantly greater treatment failure, whereas smokers and former smokers demonstrated a tendency toward failure. At 6 months, there was a significant decrease in probing pocket depth and bleeding on probing of 1.08 ± 1.06 mm and 14%, respectively. Radiographically, a significant gain in marginal bone level of 0.43 ± 0.56 mm was observed. CONCLUSION Disease resolution after non-surgical treatment of peri-implantitis is negatively influenced by the loss of support of the adjacent periodontium, poor baseline oral hygiene, and wide diameter implants (≥ 4.5 mm). CLINICAL RELEVANCE This study helps to discriminate the clinical situations in which non-surgical treatment is less likely to achieve treatment success at short term.
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Affiliation(s)
- Javi Vilarrasa
- Department of Periodontology, Universitat Internacional de Catalunya, C/ Josep Trueta s/n, Sant Cugat del Vallés, 08195, Barcelona, Spain
| | - Maria Costanza Soldini
- Department of Periodontology, Universitat Internacional de Catalunya, C/ Josep Trueta s/n, Sant Cugat del Vallés, 08195, Barcelona, Spain
| | - Ramón Pons
- Department of Periodontology, Universitat Internacional de Catalunya, C/ Josep Trueta s/n, Sant Cugat del Vallés, 08195, Barcelona, Spain.
| | - Cristina Valles
- Department of Periodontology, Universitat Internacional de Catalunya, C/ Josep Trueta s/n, Sant Cugat del Vallés, 08195, Barcelona, Spain
| | - Gonzalo Blasi
- Department of Periodontology, Universitat Internacional de Catalunya, C/ Josep Trueta s/n, Sant Cugat del Vallés, 08195, Barcelona, Spain
| | - Alberto Monje
- Department of Periodontology, Universitat Internacional de Catalunya, C/ Josep Trueta s/n, Sant Cugat del Vallés, 08195, Barcelona, Spain.,Department of Periodontology and Oral Medicine, University of Michigan, Ann Arbor, MI, USA.,Department of Periodontology, University of Bern, Bern, Switzerland
| | - José Nart
- Department of Periodontology, Universitat Internacional de Catalunya, C/ Josep Trueta s/n, Sant Cugat del Vallés, 08195, Barcelona, Spain
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Abrahamsson I, Almohandes A, Dionigi C, Berglundh T. Early bone healing to implants with different surface characteristics. A pre-clinical in vivo study. Clin Oral Implants Res 2023; 34:312-319. [PMID: 36702795 DOI: 10.1111/clr.14041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 12/15/2022] [Accepted: 01/12/2023] [Indexed: 01/28/2023]
Abstract
AIM To examine early bone healing around implants with non-modified and modified surfaces. MATERIAL & METHODS Four implants with 4 different surface characteristics were installed in one side of the mandible following tooth extraction in 6 dogs. Implants in group A had a non-modified, turned surface, while implants in group B had a surface modification consisting of TiO-blasting and sequential acid-etching in oxalic and hydrofluoric acid. The surface modification of implants in group C was confined to sequential acid-etching in oxalic and hydrofluoric acid and Group D implants had a surface modification of TiO-blasting and acid-etching in hydrofluoric acid. The implant installation procedures were repeated in the opposite side of the mandible 4 weeks later. Biopsies were obtained and prepared for histological analysis 2 weeks later. RESULTS B and C implants had a higher degree of bone-to-implant contact (BIC%) than A and D implants at 2 weeks of healing. At 6 weeks of healing, the BIC% was higher at B than at A, C and D implants, and higher at C implants than at A implants. The amount of newly formed bone in contact with the implant within the defect area at 2 weeks was higher at implants with modified surfaces (groups B, C and D) than at implants with a non-modified surface (group A). Corresponding results at 6 weeks were superior at B implants. CONCLUSION It is suggested that an implant surface modification with acid-etching in oxalic and hydrofluoric acid promotes early formation of bone-to-implant contact.
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Affiliation(s)
- Ingemar Abrahamsson
- Department of Periodontology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ahmed Almohandes
- Department of Periodontology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Carlotta Dionigi
- Department of Periodontology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Tord Berglundh
- Department of Periodontology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Chloro-aluminum phthalocyanine-mediated photodynamic therapy improves peri-implant parameters and crevicular fluid cytokine levels in cigarette smokers with chronic hyperglycemia. Photodiagnosis Photodyn Ther 2023; 41:103309. [PMID: 36709015 DOI: 10.1016/j.pdpdt.2023.103309] [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: 09/10/2022] [Revised: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 01/26/2023]
Abstract
PURPOSE This clinical trial aimed to evaluate the effectiveness of chloroaluminum phthalocyanine-mediated photodynamic therapy (CAPC-PDT) as an adjunct to peri-implant mechanical debridement (PID) in the treatment of peri-implantitis in patients with chronic hyperglycemia and cigarette smoking. METHODS The selected participants with peri-implantitis were divided into two groups: Group I (n=15) included hyperglycemic patients with no history of smoking and Group II (n=15) included hyperglycemic patients with a history of smoking cigarettes. Both groups were further divided into two subgroups based on the type of therapy provided: PDT+PID and PID alone. Peri-implant bleeding on probing (PiBOP), peri-implant pocket depth (PiPD), peri-implant plaque scores (PiPS), and crestal bone loss (CBL) were assessed. Peri-implant crevicular fluid (PICF) was sampled for quantification of interleukin (IL)-1β and tumor necrosis factor-alpha (TNF-α) using an enzyme-linked immunosorbent assay. All assessments were performed at baseline and at three and six months. RESULTS PDT+PID showed a higher reduction in PiBOP than PID alone in hyperglycemic/non-smoking participants (p<0.01). PDT+PID and PID show a significant reduction in PiBOP in smokers only at 6 months (p<0.05), with comparable differences between PDT+PID and PID (p>0.05). PDT+PID significantly reduced PiPD hyperglycemic/smoking patients at 3 and 6 months (p<0.05), whereas PID only produced a significant reduction in PiPD at 6 months in smoking patients (p<0.05). CBL alone with PDT+PID in both smokers and non-smokers showed a statistically significant reduction at 6 months follow-up (p<0.05). IL-1β was significantly reduced in hyperglycemic/non-smoking participants at 6 months follow-up with both PDT+PID and PID alone (p<0.01). This trend was also observed in cigarette smokers, with an additional short-term reduction in IL-1β at 3 months with PDT+PID (p<0.05). Only the PDT+PID group showed a significant reduction in TNF-a among cigarette smoking patients with chronic hyperglycemia at 6 months follow-up (p<0.05) CONCLUSION: Chloroaluminum phthalocyanine-mediated PDT proved effective in improving peri-implant clinical outcomes and reducing cytokine levels in smoking patients with chronic hyperglycemia.
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Teughels W, Seyssens L, Christiaens V, Temmerman A, Castro AB, Cosyn J. Adjunctive locally and systemically delivered antimicrobials during surgical treatment of peri-implantitis: A systematic review. J Clin Periodontol 2023. [PMID: 36644805 DOI: 10.1111/jcpe.13773] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 12/23/2022] [Accepted: 01/09/2023] [Indexed: 01/17/2023]
Abstract
AIM To answer the following PICOS question: "In patients with peri-implantitis, what is the efficacy of surgical therapy with adjunctive systemic or local antimicrobials, in comparison with surgical therapy alone, in terms of pocket probing depth reduction, as assessed in randomized controlled trials (RCTs) with at least 6 months of follow-up?" MATERIALS AND METHODS A systematic literature search was conducted. Reduction in mean probing pocket depth (PPD) was the primary outcome. Secondary clinical outcomes were changes in suppuration (%), changes in bleeding on probing (BOP) (%), marginal bone level changes (mm), disease resolution (%), and implant/prosthesis loss (%). Patient-reported outcome measures, possible adverse effects, and oral-health-related quality of life were also extracted if such data were available. RESULTS Four RCTs assessing the use of locally (two RCTs) and systemically (two RCTs) administered antimicrobial adjuncts to surgical treatment of peri-implantitis, with 6-36-month follow-up, were included. Because of the substantial heterogeneity of interventions between the studies, meta-analysis could not be performed. A reduction in the mean PPD was observed following all the involved surgical treatments, irrespective of the addition of antimicrobials. Except for the effect of systemic antimicrobials on marginal bone level changes and local antimicrobials on BOP, the effect of systemic and local antimicrobials was equivocal for all secondary outcome measures. CONCLUSIONS Based on the limited available evidence, the adjunctive use of the currently tested systemic or local antimicrobials during surgical therapy, in comparison with surgical therapy alone, in patients with peri-implantitis does not seem to improve the clinical efficacy. With regard the use of systemic antimicrobials, only 50% of the cases showed disease resolution after 1 year. There is a lack of studies that consider the sole use of local antimicrobials. Therefore, their true effect remains unclear.
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Affiliation(s)
- Wim Teughels
- Department of Oral Health Sciences, Periodontology and Oral Microbiology, KU Leuven and Dentistry, University Hospitals Leuven, Leuven, Belgium
| | - Lorenz Seyssens
- Faculty of Medicine and Health Sciences, Oral Health Sciences, Department of Periodontology and Oral Implantology, Ghent University, Ghent, Belgium
| | - Véronique Christiaens
- Faculty of Medicine and Health Sciences, Oral Health Sciences, Department of Periodontology and Oral Implantology, Ghent University, Ghent, Belgium
| | - Andy Temmerman
- Department of Oral Health Sciences, Periodontology and Oral Microbiology, KU Leuven and Dentistry, University Hospitals Leuven, Leuven, Belgium
| | - Ana B Castro
- Department of Oral Health Sciences, Periodontology and Oral Microbiology, KU Leuven and Dentistry, University Hospitals Leuven, Leuven, Belgium
| | - Jan Cosyn
- Faculty of Medicine and Health Sciences, Oral Health Sciences, Department of Periodontology and Oral Implantology, Ghent University, Ghent, Belgium
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In-Vitro Biofilm Removal Efficacy Using Water Jet in Combination with Cold Plasma Technology on Dental Titanium Implants. Int J Mol Sci 2023; 24:ijms24021606. [PMID: 36675120 PMCID: PMC9867126 DOI: 10.3390/ijms24021606] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 12/22/2022] [Accepted: 12/29/2022] [Indexed: 01/15/2023] Open
Abstract
Peri-implantitis-associated inflammation can lead to bone loss and implant failure. Current decontamination measures are ineffective due to the implants' complex geometry and rough surfaces providing niches for microbial biofilms. A modified water jet system (WaterJet) was combined with cold plasma technology (CAP) to achieve superior antimicrobial efficacy compared to cotton gauze treatment. Seven-day-old multi-species-contaminated titanium discs and implants were investigated as model systems. The efficacy of decontamination on implants was determined by rolling the implants over agar and determining colony-forming units supported by scanning electron microscopy image quantification of implant surface features. The inflammatory consequences of mono and combination treatments were investigated with peripheral blood mononuclear cell surface marker expression and chemokine and cytokine release profiles on titanium discs. In addition, titanium discs were assayed using fluorescence microscopy. Cotton gauze was inferior to WaterJet treatment according to all types of analysis. In combination with the antimicrobial effect of CAP, decontamination was improved accordingly. Mono and CAP-combined treatment on titanium surfaces alone did not unleash inflammation. Simultaneously, chemokine and cytokine release was dramatically reduced in samples that had benefited from additional antimicrobial effects through CAP. The combined treatment with WaterJet and CAP potently removed biofilm and disinfected rough titanium implant surfaces. At the same time, non-favorable rendering of the surface structure or its pro-inflammatory potential through CAP was not observed.
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Gholami L, Shahabi S, Jazaeri M, Hadilou M, Fekrazad R. Clinical applications of antimicrobial photodynamic therapy in dentistry. Front Microbiol 2023; 13:1020995. [PMID: 36687594 PMCID: PMC9850114 DOI: 10.3389/fmicb.2022.1020995] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 11/30/2022] [Indexed: 01/07/2023] Open
Abstract
Given the emergence of resistant bacterial strains and novel microorganisms that globally threaten human life, moving toward new treatment modalities for microbial infections has become a priority more than ever. Antimicrobial photodynamic therapy (aPDT) has been introduced as a promising and non-invasive local and adjuvant treatment in several oral infectious diseases. Its efficacy for elimination of bacterial, fungal, and viral infections and key pathogens such as Streptococcus mutans, Porphyromonas gingivalis, Candida albicans, and Enterococcus faecalis have been investigated by many invitro and clinical studies. Researchers have also investigated methods of increasing the efficacy of such treatment modalities by amazing developments in the production of natural, nano based, and targeted photosensitizers. As clinical studies have an important role in paving the way towards evidence-based applications in oral infection treatment by this method, the current review aimed to provide an overall view of potential clinical applications in this field and summarize the data of available randomized controlled clinical studies conducted on the applications of aPDT in dentistry and investigate its future horizons in the dental practice. Four databases including PubMed (Medline), Web of Science, Scopus and Embase were searched up to September 2022 to retrieve related clinical studies. There are several clinical studies reporting aPDT as an effective adjunctive treatment modality capable of reducing pathogenic bacterial loads in periodontal and peri-implant, and persistent endodontic infections. Clinical evidence also reveals a therapeutic potential for aPDT in prevention and reduction of cariogenic organisms and treatment of infections with fungal or viral origins, however, the number of randomized clinical studies in these groups are much less. Altogether, various photosensitizers have been used and it is still not possible to recommend specific irradiation parameters due to heterogenicity among studies. Reaching effective clinical protocols and parameters of this treatment is difficult and requires further high quality randomized controlled trials focusing on specific PS and irradiation parameters that have shown to have clinical efficacy and are able to reduce pathogenic bacterial loads with sufficient follow-up periods.
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Affiliation(s)
- Leila Gholami
- Department of Oral Biological and Medical Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, BC, Canada
| | - Shiva Shahabi
- Dental Implants Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Marzieh Jazaeri
- Dental Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mahdi Hadilou
- Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Reza Fekrazad
- Radiation Sciences Research Center, Laser Research Center in Medical Sciences, AJA University of Medical Sciences, Tehran, Iran,International Network for Photo Medicine and Photo Dynamic Therapy (INPMPDT), Universal Scientific Education and Research Network (USERN), Tehran, Iran,*Correspondence: Reza Fekrazad,
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Romandini M, Laforí A, Pedrinaci I, Baima G, Ferrarotti F, Lima C, Paternó Holtzman L, Aimetti M, Cordaro L, Sanz M. Effect of sub-marginal instrumentation before surgical treatment of peri-implantitis: A multi-centre randomized clinical trial. J Clin Periodontol 2022; 49:1334-1345. [PMID: 36085409 PMCID: PMC9826024 DOI: 10.1111/jcpe.13713] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 07/28/2022] [Accepted: 08/01/2022] [Indexed: 01/11/2023]
Abstract
AIM The present multi-centre randomized clinical trial with 12 months of follow-up aimed at studying the added effect of sub-marginal instrumentation before surgical treatment of peri-implantitis. MATERIALS AND METHODS Forty-two patients diagnosed with peri-implantitis were recruited. After a behavioural intervention phase including oral hygiene instructions, patients were randomized to either receiving supra- and sub-marginal instrumentation on their affected implants (control group: 21 patients and 29 implants) or only supra-marginal instrumentation (test group: 21 patients and 24 implants), before undergoing surgery. Changes in the deepest probing pocket depth (PPD) with respect to baseline and a composite outcome of treatment success (no implant loss, no bone loss > 0.5 mm, no bleeding or suppuration on probing [BoP/SoP], and PPD ≤ 5 mm) at the 12-month examination were regarded as the primary outcomes of the trial. RESULTS At the 12-month examination, changes in the deepest PPD with respect to baseline amounted to -2.96 mm in the control group and to -3.11 mm in the test one (MD = -0.16; SE = 0.56; p = .769), while 21.4% of the implants in the control group and 33.3% in the test group presented treatment success (OR = 1.83; SE = 1.15; p = .338). With the exception of a longer non-surgical treatment duration in the control group (differences in = -14.29 min; SE = 2.91; p < .001), no other secondary (e.g., soft-tissue recession, keratinized mucosa height, and bone level changes, as well as BoP, SoP, profuse bleeding and implant loss rates) or exploratory (i.e., early wound healing, aesthetics, surgical and total treatment duration, surgery difficulty, intra-operative bleeding, and adverse events) outcome demonstrated statistically significant differences between groups. CONCLUSIONS The present multi-centre randomized clinical trial did not demonstrate an added effect of performing sub-marginal instrumentation 6 weeks before the surgical treatment of peri-implantitis. Larger clinical trials are however needed to confirm the present findings (Clinicaltrials.gov: NCT03620331).
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Affiliation(s)
- Mario Romandini
- Section of Post‐graduate Periodontology, Faculty of OdontologyUniversity ComplutenseMadridSpain,ETEP (Etiology and Therapy of Periodontal and Peri‐implant Diseases) Research GroupUniversity ComplutenseMadridSpain
| | - Andreina Laforí
- Department of Periodontology and Prosthodontics, “George Eastman” Dental HospitalUniversity Policlinic “Umberto I”RomeItaly,Division of Fixed Prosthodontics and Biomaterials, Clinic of Dental MedicineUniversity of GenevaGenevaSwitzerland
| | - Ignacio Pedrinaci
- Section of Post‐graduate Periodontology, Faculty of OdontologyUniversity ComplutenseMadridSpain,Department of Restorative Dentistry and Biomaterials Science, Harvard School of Dental MedicineHarvard UniversityBostonMassachusettsUSA
| | - Giacomo Baima
- Department of Surgical Sciences, C.I.R. Dental SchoolUniversity of TurinTurinItaly
| | - Francesco Ferrarotti
- Department of Surgical Sciences, C.I.R. Dental SchoolUniversity of TurinTurinItaly
| | - Cristina Lima
- Section of Post‐graduate Periodontology, Faculty of OdontologyUniversity ComplutenseMadridSpain
| | - Lucrezia Paternó Holtzman
- Department of Periodontology and Prosthodontics, “George Eastman” Dental HospitalUniversity Policlinic “Umberto I”RomeItaly
| | - Mario Aimetti
- Department of Surgical Sciences, C.I.R. Dental SchoolUniversity of TurinTurinItaly
| | - Luca Cordaro
- Department of Periodontology and Prosthodontics, “George Eastman” Dental HospitalUniversity Policlinic “Umberto I”RomeItaly
| | - Mariano Sanz
- Section of Post‐graduate Periodontology, Faculty of OdontologyUniversity ComplutenseMadridSpain,ETEP (Etiology and Therapy of Periodontal and Peri‐implant Diseases) Research GroupUniversity ComplutenseMadridSpain
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Galarraga‐Vinueza ME, Tavelli L. Soft tissue features of peri‐implant diseases and related treatment. Clin Implant Dent Relat Res 2022. [PMID: 36444772 DOI: 10.1111/cid.13156] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 11/01/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND The need for soft tissue grafting at implant sites for preventing and treating peri-implant diseases is a currently investigated and debated topic. PURPOSE The aim of this manuscript is to explore the inflammatory mechanisms at the peri-implant soft tissue compartment, to distinguish the structural components of the peri-implant soft tissue phenotype and their role on peri-implant health, and to appraise the clinical indications and expected outcomes of soft tissue augmentation procedures at peri-implant diseased sites. MATERIALS AND METHODS This narrative review depicts the inflammatory biomarkers and mediators in the peri-implant crevicular fluid utilized to diagnose peri-implant disease and that have been shown to be associated with peri-implant soft tissue phenotype modification and disease resolution. The impact of the peri-implant soft tissue phenotype, involving keratinized mucosa (KM) width, attached mucosa (AM), mucosal thickness (MT), and supracrestal tissue height (STH), on peri-implant health, esthetic, patient's comfort and disease prevention are discussed. The manuscript also illustrates the use of ultrasonography for the detection of peri-implant health/disease and the evaluation of the treatment outcomes following surgical therapies. RESULTS Current evidence indicates that soft tissue phenotype modification at implant sites with inadequate KM width, AM and MT can be beneficial for promoting peri-implant health and improving patient's comfort and hygiene procedures. Treatment approaches and outcomes from the available literature on soft tissue phenotype modification in combination with conventional techniques at sites with peri-implant mucositis or peri-implantitis are presented and discussed in detail. CONCLUSIONS Soft tissue grafting can be beneficial in preventing and treating peri-implant diseases. Clinical recommendations based on the disease, soft tissue phenotype characteristics and bone defect morphology are provided for a comprehensive hard- and soft-tissue-oriented treatment of peri-implant disease.
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Affiliation(s)
- Maria Elisa Galarraga‐Vinueza
- Department of Prosthodontics Tufts University School of Dental Medicine Boston Massachusetts USA
- School of Dentistry Universidad de las Américas (UDLA) Quito Ecuador
| | - Lorenzo Tavelli
- Department of Oral Medicine, Infection, and Immunity, Division of Periodontology Harvard School of Dental Medicine Boston Massachusetts USA
- Center for Clinical Research and Evidence Synthesis in Oral TissuE RegeneratION (CRITERION) Boston Massachusetts USA
- Department of Periodontics and Oral Medicine University of Michigan School of Dentistry Ann Arbor Michigan USA
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Ramanauskaite A, Cafferata EA, Begic A, Schwarz F. Surgical interventions for the treatment of peri-implantitis. Clin Implant Dent Relat Res 2022. [PMID: 36419243 DOI: 10.1111/cid.13162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 11/01/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Peri-implantitis constitutes one of the most frequent late dental implant complications. The disease is initiated by bacterial infection; therefore, anti-infective peri-implantitis treatment strategies are required to arrest the progressive marginal bone loss and maintain the affected implant in function. Although nonsurgical treatment strategies appear to be of limited predictability, treatment outcomes have been frequently improved following surgical interventions. PURPOSE The present narrative review describes various surgical peri-implantitis treatment modalities, with respect to their indications, performance, and effectiveness. MATERIALS AND METHODS The present narrative review considered the most relevant studies in the field published in the English language. RESULTS Surgical peri-implantitis treatment approaches can be categorized as nonreconstrucive therapy, reconstructive therapy, and combined therapy (ie, reconstructive and resective therapy). In addition to disease resolution, reconstructive approaches also seek to regenerate the bone defect and achieve reosseointegration. CONCLUSIONS The severity of the disease, the regenerative potential of the defetc and esthetic demands of the patient are the factors determining the surgical peri-implantitis treatment modality.
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Affiliation(s)
- Ausra Ramanauskaite
- Department of Oral Surgery and Implantology, Johann Wolfgang Goethe-University, Carolinum, Frankfurt, Germany
| | - Emilio A Cafferata
- Department of Oral Surgery and Implantology, Johann Wolfgang Goethe-University, Carolinum, Frankfurt, Germany
| | - Amira Begic
- Department of Oral Surgery and Implantology, Johann Wolfgang Goethe-University, Carolinum, Frankfurt, Germany
| | - Frank Schwarz
- Department of Oral Surgery and Implantology, Johann Wolfgang Goethe-University, Carolinum, Frankfurt, Germany
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Baima G, Citterio F, Romandini M, Romano F, Mariani GM, Buduneli N, Aimetti M. Surface decontamination protocols for surgical treatment of peri-implantitis: A systematic review with meta-analysis. Clin Oral Implants Res 2022; 33:1069-1086. [PMID: 36017594 PMCID: PMC9825968 DOI: 10.1111/clr.13992] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 07/14/2022] [Accepted: 08/20/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To answer the following PICO question: "In patients requiring surgical treatment of peri-implantitis (P), is any implant surface decontamination protocol (I) superior to others (C) in terms of clinical and radiographic parameters (O)?" METHODS Randomized clinical trials (RCTs) comparing two or more decontamination protocols as part of the surgical treatment of peri-implantitis were included. Two authors independently searched for eligible studies, screened titles and abstracts, did full-text analysis, extracted data, and performed the risk-of-bias assessment. Whenever possible, results were summarized through random effects meta-analyses. RESULTS Twenty-two manuscripts reporting on 16 RCTs were included, testing mechanical, chemical and physical decontamination protocols. All of them resulted in an improvement in clinical parameters; however, the superiority of specific protocols over others is mainly based on single RCTs. The use of titanium brushes and implantoplasty showed favorable results as single decontamination methods. Meta-analyses indicated a lack of added effect of Er:Yag laser on probing pocket depth (PPD) reduction (n = 2, WMD = -0.24 mm, 95% confidence interval [CI] [-1.10; 0.63], p = .59); while systemic antimicrobials (amoxicillin or azithromycin) showed an added effect on treatment success ([PPD ≤5 mm, no bleeding or suppuration, no progressive bone loss]; n = 2, RR = 1.84, 95% CI [1.17;2.91], p = .008), but not in terms of PPD reduction (n = 2, WMD = 0.93 mm, 95% CI [-0.69; 2.55], p = .26), even if with substantial heterogeneity. CONCLUSIONS No single decontamination method demonstrated clear evidence of superiority compared to the others. Systemic antibiotics, but not Er:Yag laser, may provide short-term clinical benefits in terms of treatment success (CRD42020182303).
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Affiliation(s)
- Giacomo Baima
- Department of Surgical Sciences, C.I.R. Dental SchoolUniversity of TurinTurinItaly
| | - Filippo Citterio
- Department of Surgical Sciences, C.I.R. Dental SchoolUniversity of TurinTurinItaly
| | - Mario Romandini
- Section of Graduate Periodontology, Faculty of OdontologyUniversity ComplutenseMadridSpain
| | - Federica Romano
- Department of Surgical Sciences, C.I.R. Dental SchoolUniversity of TurinTurinItaly
| | - Giulia Maria Mariani
- Department of Surgical Sciences, C.I.R. Dental SchoolUniversity of TurinTurinItaly
| | - Nurcan Buduneli
- Department of Periodontology, School of DentistryEge UniversityİzmirTurkey
| | - Mario Aimetti
- Department of Surgical Sciences, C.I.R. Dental SchoolUniversity of TurinTurinItaly
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Moaven H, Giacaman A, Beltrán V, Sam YH, Betancur D, Mainas G, Tarjomani SA, Donos N, Sousa V. Biomarker Expression of Peri-Implantitis Lesions before and after Treatment: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14085. [PMID: 36360962 PMCID: PMC9659150 DOI: 10.3390/ijerph192114085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 09/05/2022] [Accepted: 09/15/2022] [Indexed: 06/16/2023]
Abstract
The need to predict, diagnose and treat peri-implant diseases has never been greater. We present a systematic review of the literature on the changes in the expression of biomarkers in peri-implant crevicular fluid (PICF) before and after treatment of peri-implantitis. Bacterial composition, clinical and radiographic parameters, and systemic biomarkers before and after treatment are reported as secondary outcomes. A total of 17 studies were included. Treatment groups were non-surgical treatment or surgical treatment, either alone or with adjunctive therapy. Our findings show that non-surgical treatment alone does not influence biomarker levels or clinical outcomes. Both adjunctive photodynamic therapy and local minocycline application resulted in a reduction of interleukin (IL)-1β and IL-10 twelve months after treatment. Non-surgical treatments with adjunctive use of lasers or antimicrobials were more effective at improving the clinical outcomes in the short-term only. Access flap debridement led to matrix metalloproteinase (MMP)-8 and tumour necrosis factor-α reduction twelve months post-surgery. Surgical debridement with adjunctive antimicrobials achieved a decrease in MMP-8 at three months. Adjunctive use of Emdogain™ (EMD) was associated with a reduction in 40 PICF proteins compared to access flap surgery alone. Surgical interventions were more effective at reducing probing pocket depth and bleeding on probing both in the short- and long-term. Surgical treatment in combination with EMD was found to be more effective in resolving inflammation up to twelve months.
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Affiliation(s)
- Haniyeh Moaven
- Centre for Oral Clinical Research, Centre for Oral Immunobiology & Regenerative Medicine, Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University London, London E1 2AD, UK
| | - Annesi Giacaman
- Center of Excellence in Translational Medicine, Faculty of Medicine, Universidad de la Frontera, Temuco 4780000, Chile
| | - Víctor Beltrán
- Clinical Investigation and Dental Innovation Center, Dental School & Center for Translational Medicine, Universidad de La Frontera, Temuco 4780000, Chile
| | - Ye Han Sam
- Periodontology and Periodontal Medicine, Centre for Host-Microbiome Interactions, Faculty of Dentistry, Oral & Craniofacial Sciences, King’s College London, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 9RT, UK
| | - Daniel Betancur
- Discipline of Periodontology, Department of Surgical Stomatology, Faculty of Dentistry, Universidad de Concepción, Concepción 4030000, Chile
| | - Giuseppe Mainas
- Periodontology and Periodontal Medicine, Centre for Host-Microbiome Interactions, Faculty of Dentistry, Oral & Craniofacial Sciences, King’s College London, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 9RT, UK
| | - Seyed Ali Tarjomani
- Periodontology and Periodontal Medicine, Centre for Host-Microbiome Interactions, Faculty of Dentistry, Oral & Craniofacial Sciences, King’s College London, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 9RT, UK
| | - Nikolaos Donos
- Centre for Oral Clinical Research, Centre for Oral Immunobiology & Regenerative Medicine, Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University London, London E1 2AD, UK
| | - Vanessa Sousa
- Periodontology and Periodontal Medicine, Centre for Host-Microbiome Interactions, Faculty of Dentistry, Oral & Craniofacial Sciences, King’s College London, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 9RT, UK
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Derks J, Ortiz‐Vigón A, Guerrero A, Donati M, Bressan E, Ghensi P, Schaller D, Tomasi C, Karlsson K, Abrahamsson I, Ichioka Y, Dionigi C, Regidor E, Berglundh T. Reconstructive surgical therapy of peri-implantitis: A multicenter randomized controlled clinical trial. Clin Oral Implants Res 2022; 33:921-944. [PMID: 35804491 PMCID: PMC9544523 DOI: 10.1111/clr.13972] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/29/2022] [Accepted: 07/04/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To evaluate the potential benefit of the use of a bone substitute material in the reconstructive surgical therapy of peri-implantitis. METHODS In this multicenter randomized clinical trial, 138 patients (147 implants) with peri-implantitis were treated surgically, randomized by coin toss to either a control (access flap surgery) or a test group (reconstructive surgery using bone substitute material). Clinical assessments, including probing pocket depth (PPD), bleeding and suppuration on probing (BOP & SOP) as well as soft tissue recession (REC), were recorded at baseline, 6 and 12 months. Marginal bone levels (MBL), measured on intra-oral radiographs, and patient-reported outcomes (PROs) were recorded at baseline and 12 months. No blinding to group allocation was performed. The primary outcome at 12 months was a composite measure including (i) implant not lost, (ii) absence of BOP/SOP at all aspects, (iii) PPD ≤5 mm at all aspects and (iv) ≤1 mm recession of mucosal margin on the buccal aspect of the implant. Secondary outcomes included (i) changes of MBL, (ii) changes of PPD, BOP%, and buccal KM, (iii) buccal REC and (iv) patient-reported outcomes. RESULTS During follow-up, four implants (one in the test group, three in the control group) in four patients were removed due to disease progression. At 12 months, a total of 69 implants in the test and 68 implants in the control group were examined. Thus, 16.4% and 13.5% of implants in the test and control group, respectively, met all predefined criteria of the composite outcome. PPD reduction and MBL gain were 3.7 mm and about 1.0 mm in both groups. Reduction in mean BOP% varied between 45% (test) and 50% (control), without significant differences between groups. Buccal REC was less pronounced in the test group (M = 0.7, SD = 0.9 mm) when compared to controls (M = 1.1, SD = 1.5 mm). PROs were favorable in both groups without significant differences. One case of allergic reaction to the antibiotic therapy was recorded. No other adverse events were noted. CONCLUSIONS Surgical therapy of peri-implantitis effectively improved the clinical and radiographic status at 12 months. While the use of a bone substitute material did not improve reductions of PPD and BOP, buccal REC was less pronounced in the test group. Patient satisfaction was high in both groups.
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Affiliation(s)
- Jan Derks
- Department of Periodontology, Institute of OdontologyThe Sahlgrenska Academy at University of GothenburgGothenburgSweden,Clinic of Periodontics, Public Dental ServiceRegion Västra GötalandGothenburgSweden
| | - Alberto Ortiz‐Vigón
- Clínica Ortiz‐VigónPerioCentrumBilbaoSpain,ETEP Research Group, Faculty of OdontologyUniversity Complutense of MadridMadridSpain
| | | | - Mauro Donati
- Department of Periodontology, Institute of OdontologyThe Sahlgrenska Academy at University of GothenburgGothenburgSweden
| | - Eriberto Bressan
- Department of Neuroscience, Faculty of OdontologyUniversity of PaduaPaduaItaly
| | | | | | - Cristiano Tomasi
- Department of Periodontology, Institute of OdontologyThe Sahlgrenska Academy at University of GothenburgGothenburgSweden
| | - Karolina Karlsson
- Department of Periodontology, Institute of OdontologyThe Sahlgrenska Academy at University of GothenburgGothenburgSweden,Clinic of Periodontics, Public Dental ServiceRegion Västra GötalandGothenburgSweden
| | - Ingemar Abrahamsson
- Department of Periodontology, Institute of OdontologyThe Sahlgrenska Academy at University of GothenburgGothenburgSweden,Clinic of Periodontics, Public Dental ServiceRegion Västra GötalandGothenburgSweden
| | - Yuki Ichioka
- Department of Periodontology, Institute of OdontologyThe Sahlgrenska Academy at University of GothenburgGothenburgSweden
| | - Carlotta Dionigi
- Department of Periodontology, Institute of OdontologyThe Sahlgrenska Academy at University of GothenburgGothenburgSweden
| | | | - Tord Berglundh
- Department of Periodontology, Institute of OdontologyThe Sahlgrenska Academy at University of GothenburgGothenburgSweden,Clinic of Periodontics, Public Dental ServiceRegion Västra GötalandGothenburgSweden
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Mijiritsky E, Assaf HD, Kolerman R, Mangani L, Ivanova V, Zlatev S. Autologous Platelet Concentrates (APCs) for Hard Tissue Regeneration in Oral Implantology, Sinus Floor Elevation, Peri-Implantitis, Socket Preservation, and Medication-Related Osteonecrosis of the Jaw (MRONJ): A Literature Review. BIOLOGY 2022; 11:biology11091254. [PMID: 36138733 PMCID: PMC9495871 DOI: 10.3390/biology11091254] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/11/2022] [Accepted: 08/16/2022] [Indexed: 12/02/2022]
Abstract
Simple Summary Autologous platelet concentrates with high growth factor levels are used in many fields of dentistry. In recent years, the critical role of blood-derived materials in bone and soft tissue engineering has become apparent. After tooth extraction, the alveolar bone is exposed to progressive bone resorption, which can lead to difficulties in implant placement. Hence, many studies have demonstrated that APCs have the potential for soft tissue and bone regeneration. Furthermore, no inflammatory reactions occur, and they may be used alone or in combination with bone grafts, promoting bone growth and maturation. Moreover, the released growth factors and the presence of fibrin structures can induce osteogenesis. This review aims to provide information regarding the applications, indications, advantages, and disadvantages of three APC techniques in hard tissue regeneration. Abstract Over recent years, the usage of autologous platelet concentrates (APCs) has risen in hard tissue regeneration and oral implantology. The purpose of the present review is to offer an overview of the use of three APC techniques in dentistry: platelet-rich plasma (PRP), platelet-rich fibrin (PRF), and concentrated growth factor (CGF). A narrative summary of articles published between January 2011 and April 2022 is provided. The PubMed, Cochrane Library, Scopus, and Embase databases were used to conduct the search. The following keywords were used in the preliminary: “VEGF”, “TGF-b1”, “PRP”, “PRF”, “CGF”, AND “sinus augmentation” OR “implants” OR “peri-implantitis” OR “socket preservation” OR “MRONJ”. A total of 82 articles was finally included. The review then takes into account the application of the three techniques in different areas of treatment—including oral implantology, sinus floor elevation, peri-implantitis, socket preservation, and medication-related osteonecrosis of the jaw (MRONJ)—as well as their advantages and disadvantages.
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Affiliation(s)
- Eitan Mijiritsky
- Head and Neck Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Department of Otolaryngology, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 699350, Israel
| | - Haya Drora Assaf
- Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem 9190401, Israel
| | - Roni Kolerman
- Department of Periodontology and Oral Implantology, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel
| | - Luca Mangani
- Department of Translational Medicine and Clinical Science, University of Tor Vegata, 00133 Rome, Italy
| | - Vasilena Ivanova
- Oral Surgery Department, Faculty of Dental Medicine, Medical University of Plovdiv, 4000 Plovdiv, Bulgaria
- Correspondence:
| | - Stefan Zlatev
- CAD/CAM Center of Dental Medicine at the Research Institute, Medical University-Plovdiv, 4000 Plovdiv, Bulgaria
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Luengo F, Solonko M, Sanz-Esporrín J, Sanz-Sánchez I, Herrera D, Sanz M. Clinical, Microbiological, and Biochemical Impact of the Surgical Treatment of Peri-Implantitis-A Prospective Case Series. J Clin Med 2022; 11:jcm11164699. [PMID: 36012939 PMCID: PMC9410201 DOI: 10.3390/jcm11164699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/01/2022] [Accepted: 08/09/2022] [Indexed: 11/24/2022] Open
Abstract
Background: The aim of this study, a prospective case series, was to evaluate the clinical, microbiological, and biochemical impact of the surgical treatment of peri-implantitis. Methods: Thirty subjects with diagnosis of peri-implantitis were treated following a surgical protocol including access flaps, surface decontamination with ultrasonics and glycine powder air-polishing, and systemic antibiotics. Disease resolution was defined by the composite outcome including presence of probing depths (PD) ≤5 mm, absence of bleeding on probing (BoP)/suppuration, and no additional radiographic bone loss (>1 mm). Regression analysis was used to evaluate the patient-, implant-, and prosthetic-related factors possibly influencing treatment outcomes. Results: Patients were evaluated at 6 months post treatment, demonstrating statistically significant reductions in PD (2.14 ± 1.07 mm) and increase in mucosal recession (1.0 ± 0.77 mm). Plaque, BoP, and suppuration were also reduced by 40.56%, 62.22%, and 7.78%, respectively. Disease resolution was achieved in 56.67% of patients. No significant changes were detected in microbiological parameters except for a significant reduction in proportions of Parvimonas micra. Similarly, the levels of the biomarker interleukin-8 in crevicular fluid were significantly lower at 6 months. Conclusions: The proposed surgical treatment of peri-implantitis demonstrated statistically significant clinical improvements although the impact on microbiological and biochemical parameters was scarce.
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Affiliation(s)
- Fernando Luengo
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, University Complutense, 28040 Madrid, Spain
| | - Myroslav Solonko
- Section of Periodontology, Faculty of Odontology, University Complutense, 28040 Madrid, Spain
| | - Javier Sanz-Esporrín
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, University Complutense, 28040 Madrid, Spain
| | - Ignacio Sanz-Sánchez
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, University Complutense, 28040 Madrid, Spain
- Correspondence:
| | - David Herrera
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, University Complutense, 28040 Madrid, Spain
| | - Mariano Sanz
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, University Complutense, 28040 Madrid, Spain
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Montero E, Roccuzzo A, Molina A, Monje A, Herrera D, Roccuzzo M. Minimal invasiveness in the reconstructive treatment of peri-implantitis defects. Periodontol 2000 2022; 91:199-216. [PMID: 35899987 DOI: 10.1111/prd.12460] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 05/30/2022] [Accepted: 06/05/2022] [Indexed: 11/30/2022]
Abstract
Peri-implantitis is a plaque-associated pathologic condition occurring in tissues around dental implants, clinically characterized by increased peri-implant probing pocket depth and progressive loss of supporting bone. Consequently, to arrest further disease progression and to increase the chance to obtain re-osseointegration, surgical reconstructive procedures have been adopted. In particular, following a paradigm gathered from periodontal therapy, recent protocols have underlined the importance of a minimally invasive approach to optimize the outcomes of therapy while minimizing the risks of postoperative complications. The present review summarizes the level of evidence on the surgical reconstructive protocols focusing on the new approaches aiming to minimize surgical trauma and patients' postoperative discomfort, underlining the pros and cons of each treatment modality.
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Affiliation(s)
- Eduardo Montero
- ETEP (Etiology and Therapy of Periodontal and Peri-Implant Diseases) Research Group, University Complutense, Madrid, Spain
| | - Andrea Roccuzzo
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland.,Department of Oral and Maxillofacial Surgery, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - Ana Molina
- ETEP (Etiology and Therapy of Periodontal and Peri-Implant Diseases) Research Group, University Complutense, Madrid, Spain
| | - Alberto Monje
- Department of Periodontology, Universitat Internacional de Catalunya, Barcelona, Spain.,Department of Periodontics and Oral Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - David Herrera
- ETEP (Etiology and Therapy of Periodontal and Peri-Implant Diseases) Research Group, University Complutense, Madrid, Spain
| | - Mario Roccuzzo
- Department of Periodontics and Oral Medicine, University of Michigan, Ann Arbor, Michigan, USA.,Division of Maxillofacial Surgery, University of Torino, Torino, Italy
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Rahman B, Acharya AB, Siddiqui R, Verron E, Badran Z. Photodynamic Therapy for Peri-Implant Diseases. Antibiotics (Basel) 2022; 11:antibiotics11070918. [PMID: 35884171 PMCID: PMC9311944 DOI: 10.3390/antibiotics11070918] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 06/28/2022] [Accepted: 07/05/2022] [Indexed: 11/16/2022] Open
Abstract
Peri-implant diseases are frequently presented in patients with dental implants. This category of inflammatory infections includes peri-implant mucositis and peri-implantitis that are primarily caused by the oral bacteria that colonize the implant and the supporting soft and hard tissues. Other factors also contribute to the pathogenesis of peri-implant diseases. Based on established microbial etiology, mechanical debridement has been the standard management approach for peri-implant diseases. To enhance the improvement of therapeutic outcomes, adjunctive treatment in the form of antibiotics, probiotics, lasers, etc. have been reported in the literature. Recently, the use of photodynamic therapy (PDT)/antimicrobial photodynamic therapy (aPDT) centered on the premise that a photoactive substance offers benefits in the resolution of peri-implant diseases has gained attention. Herein, the reported role of PDT in peri-implant diseases, as well as existing observations and opinions regarding PDT, are discussed.
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Affiliation(s)
- Betul Rahman
- Periodontology Unit, Department of Preventive and Restorative Dentistry, College of Dental Medicine, University of Sharjah, Sharjah P.O. Box 27272, United Arab Emirates; (B.R.); (A.B.A.)
| | - Anirudh Balakrishna Acharya
- Periodontology Unit, Department of Preventive and Restorative Dentistry, College of Dental Medicine, University of Sharjah, Sharjah P.O. Box 27272, United Arab Emirates; (B.R.); (A.B.A.)
| | - Ruqaiyyah Siddiqui
- College of Arts and Sciences, University City, American University of Sharjah, Sharjah P.O. Box 26666, United Arab Emirates;
| | - Elise Verron
- CNRS, UMR 6230, CEISAM, UFR Sciences et Techniques, Université de Nantes, 2, rue de la Houssinière, BP 92208, CEDEX 3, 44322 Nantes, France;
| | - Zahi Badran
- Periodontology Unit, Department of Preventive and Restorative Dentistry, College of Dental Medicine, University of Sharjah, Sharjah P.O. Box 27272, United Arab Emirates; (B.R.); (A.B.A.)
- Correspondence:
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Roccuzzo A, Klossner S, Stähli A, Imber JC, Eick S, Sculean A, Salvi GE. Non-surgical mechanical therapy of peri-implantitis with or without repeated adjunctive diode laser application. A 6-month double-blinded randomized clinical trial. Clin Oral Implants Res 2022; 33:900-912. [PMID: 35775311 PMCID: PMC9546299 DOI: 10.1111/clr.13969] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 06/14/2022] [Accepted: 06/24/2022] [Indexed: 11/27/2022]
Abstract
Objectives The objective of this study is to investigate the outcomes following non‐surgical therapy of peri‐implantitis (PI) with or without adjunctive diode laser application. Materials and methods A double‐blinded randomized controlled clinical trial was carried out in 25 subjects with 25 implants diagnosed with PI. Following curettage of granulation tissue, test implants (T) were treated with adjunctive application of a diode laser for 90 s (settings: 810 nm, 2.5 W, 50 Hz, 10 ms), while at control implants (C) non‐activated adjunctive diode laser was applied. The entire treatment procedure was performed at days 0 (i.e., baseline), 7 and 14. The primary outcome measure was change in mean pocket probing depth (PPD). Clinical and microbiological outcomes, as well as host‐derived inflammatory markers were evaluated at baseline, 3 and 6 months, while radiographic outcomes were assessed at baseline and at the 6‐month follow‐up. Results No statistically significant differences with respect to baseline patient characteristic were observed. After 6 months, both test and control implants yielded statistically significant PPD changes compared with baseline (T: 1.28 and C: 1.47 mm) but without statistically significant difference between groups (p = .381). No statistically significant changes in peri‐implant marginal bone levels were detected (p = .936). No statistically significant differences between test and control implants were observed with respect to microbiological and host‐derived parameters (p > .05). At the 6‐month follow‐up, treatment success was observed in 41.7% (n = 5) of test and 46.2% (n = 6) of control patients, respectively (p = .821). Conclusion Repeated adjunctive application of diode laser in the non‐surgical management of PI failed to provide significant benefits compared with mechanical instrumentation alone.
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Affiliation(s)
- Andrea Roccuzzo
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Sabrina Klossner
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Alexandra Stähli
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Jean-Claude Imber
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Sigrun Eick
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Anton Sculean
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Giovanni E Salvi
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
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The Main Bacterial Communities Identified in the Sites Affected by Periimplantitis: A Systematic Review. Microorganisms 2022; 10:microorganisms10061232. [PMID: 35744750 PMCID: PMC9228476 DOI: 10.3390/microorganisms10061232] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 06/12/2022] [Accepted: 06/13/2022] [Indexed: 11/24/2022] Open
Abstract
(1) Background: Periimplantitis is an infectious condition that affects the periimplant tissue and is of bacterial etiology. However, to date, the exact bacterial flora involved in its occurrence is not known. The aim of this literature review was to summarize the articles published on this topic and to identify the main bacterial species isolated in periimplantitis. (2) Methods: The articles published in three databases were researched: Pubmed, Embase and Web of Science using Prisma guides and combinations of MeSH terms. We selected 25 items from the 980 found by applying the inclusion and exclusion criteria. (3) Results: We quantified the results of the 25 studies included in this review. In general, the most commonly identified bacterial species were Gram-negative anaerobic species, as Prevotella, Streptococcus, Fusobacterium and Treponema. (4) Conclusion: The most frequent bacteria in the periimplantitis sites identified in this review are Gram-negative anaerobic species, also involved in the pathogenesis of the periodontal disease.
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Abdullatif FA, Al-Askar M. Does Ultraviolet Radiation Exhibit Antimicrobial Effect against Oral Pathogens Attached on Various Dental Implant Surfaces? A Systematic Review. Dent J (Basel) 2022; 10:dj10060093. [PMID: 35735635 PMCID: PMC9221630 DOI: 10.3390/dj10060093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 05/09/2022] [Accepted: 05/12/2022] [Indexed: 12/10/2022] Open
Abstract
Background: Dental implant therapy is currently identified as the most effective treatment for edentulous patient. However, peri-implant inflammations were found to be one of the most common complications that leads to the loss and failure of dental implantation. Ultraviolet (UV) radiation has been proposed to enhance bone integration and reduce bacterial attachment. In this study, we aimed to systematically review the current evidence regarding the antimicrobial effect of UV on different dental implant surfaces. Methods: Five databases including PubMed, Scopus, Web of science, VHL, and Cochran Library were searched to retrieve relevant articles. All original reports that examined the effect of the application of UV radiation on dental implants were included in our study. Results: A total of 16 in vitro studies were included in this systematic review. Polymethyl methacrylate UV radiation has induced a significant decrease in bacterial survival in PMMA materials, with an increased effect by modification with 2.5% and 5% TiO2 nanotubes. UV-C showed a superior effect to UV-A in reducing bacterial attachment and accumulation. UV wavelength of 265 and 285 nm showed powerful bactericidal effects. UV of 365 nm for 24 h had the highest inhibition of bacterial growth in ZnO coated magnesium alloys. In UV-irradiated commercially pure titanium surfaces treated with plasma electrolytic oxidation, silver ion application, heat or alkali had shown significant higher bactericidal effect vs non-irradiated treated surfaces than the treatment with any of them alone. UVC and gamma-ray irradiation increased the hydrophilicity of zirconia surface, compared to the dry heat. Conclusion: UV radiation on Ti surfaces exhibited significant antibacterial effects demonstrated through the reduction in bacterial attachment and biofilm formation with suppression of bacterial cells growth. Combination of UV and treated surfaces with alkali, plasma electrolytic oxidation, silver ion application or heat enhance the overall photocatalytic antimicrobial effect.
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Toledano-Osorio M, Vallecillo C, Toledano R, Aguilera FS, Osorio MT, Muñoz-Soto E, García-Godoy F, Vallecillo-Rivas M. A Systematic Review and Meta-Analysis of Systemic Antibiotic Therapy in the Treatment of Peri-Implantitis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116502. [PMID: 35682086 PMCID: PMC9180155 DOI: 10.3390/ijerph19116502] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 05/23/2022] [Accepted: 05/24/2022] [Indexed: 02/07/2023]
Abstract
Research has been conducted into the advantages of the systemic administration of antibiotics. The aim of this systematic review and meta-analysis was to assess the efficacy of systemic antibiotic administration in the treatment of peri-implantitis in terms of bleeding on probing (BoP) and probing pocket depth (PPD). Literature searches were performed across PubMed, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) to identify randomized controlled trials and observational clinical studies. After peri-implantitis treatment, PPD was reduced by 0.1 mm (p = 0.58; IC 95% [-0.24, 0.47]), indicating a non-significant effect of antibiotic administration on PPD. The BoP odds ratio value was 1.15 (p = 0.5; IC 95% [0.75, 1.75]), indicating that the likelihood of bleeding is almost similar between the test and control groups. Secondary outcomes were found, such as reduced clinical attachment level, lower suppuration and recession, less bone loss, and a reduction in total bacterial counts. In the treatment of peri-implantitis, the systemic antibiotic application reduces neither PPD nor BoP. Therefore, the systemic administration of antibiotics, in the case of peri-implantitis, should be rethought in light of the present results, contributing to address the problem of increasing antibiotic resistance.
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Affiliation(s)
- Manuel Toledano-Osorio
- Department of Stomatology, Faculty of Dentistry, University of Granada, Colegio Máximo de Cartuja s/n, 18071 Granada, Spain; (M.T.-O.); (F.S.A.); (E.M.-S.); (M.V.-R.)
| | - Cristina Vallecillo
- Department of Stomatology, Faculty of Dentistry, University of Granada, Colegio Máximo de Cartuja s/n, 18071 Granada, Spain; (M.T.-O.); (F.S.A.); (E.M.-S.); (M.V.-R.)
- Correspondence: ; Tel.: +34-958-243-789
| | - Raquel Toledano
- Independent Researcher, 18071 Granada, Spain; (R.T.); (M.T.O.)
| | - Fátima S. Aguilera
- Department of Stomatology, Faculty of Dentistry, University of Granada, Colegio Máximo de Cartuja s/n, 18071 Granada, Spain; (M.T.-O.); (F.S.A.); (E.M.-S.); (M.V.-R.)
| | - María T. Osorio
- Independent Researcher, 18071 Granada, Spain; (R.T.); (M.T.O.)
| | - Esther Muñoz-Soto
- Department of Stomatology, Faculty of Dentistry, University of Granada, Colegio Máximo de Cartuja s/n, 18071 Granada, Spain; (M.T.-O.); (F.S.A.); (E.M.-S.); (M.V.-R.)
| | - Franklin García-Godoy
- Health Science Center, College of Dentistry, University of Tennessee, 875 Union Avenue, Memphis, TN 38103, USA;
| | - Marta Vallecillo-Rivas
- Department of Stomatology, Faculty of Dentistry, University of Granada, Colegio Máximo de Cartuja s/n, 18071 Granada, Spain; (M.T.-O.); (F.S.A.); (E.M.-S.); (M.V.-R.)
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Matthes R, Jablonowski L, Pitchika V, Holtfreter B, Eberhard C, Seifert L, Gerling T, Vilardell Scholten L, Schlüter R, Kocher T. Efficiency of biofilm removal by combination of water jet and cold plasma: an in-vitro study. BMC Oral Health 2022; 22:157. [PMID: 35524324 PMCID: PMC9074283 DOI: 10.1186/s12903-022-02195-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 04/25/2022] [Indexed: 11/10/2022] Open
Abstract
Background Peri-implantitis therapy is a major problem in implantology. Because of challenging rough implant surface and implant geometry, microorganisms can hide and survive in implant microstructures and impede debridement. We developed a new water jet (WJ) device and a new cold atmospheric pressure plasma (CAP) device to overcome these problems and investigated aspects of efficacy in vitro and safety with the aim to create the prerequisites for a clinical pilot study with these medical devices. Methods We compared the efficiency of a single treatment with a WJ or curette and cotton swab (CC) without or with adjunctive use of CAP (WJ + CAP, CC + CAP) to remove biofilm in vitro from rough titanium discs. Treatment efficacy was evaluated by measuring turbidity up to 72 h for bacterial re-growth or spreading of osteoblast-like cells (MG-63) after 5 days with scanning electron microscopy. With respect to application safety, the WJ and CAP instruments were examined according to basic regulations for medical devices. Results After 96 h of incubation all WJ and CC treated disks were turbid but 67% of WJ + CAP and 46% CC + CAP treated specimens were still clear. The increase in turbidity after WJ treatment was delayed by about 20 h compared to CC treatment. In combination with CAP the cell coverage significantly increased to 82% (WJ + CAP) or 72% (CC + CAP), compared to single treatment 11% (WJ) or 10% (CC). Conclusion The newly developed water jet device effectively removes biofilm from rough titanium surfaces in vitro and, in combination with the new CAP device, biologically acceptable surfaces allow osteoblasts to grow. WJ in combination with CAP leads to cleaner surfaces than the usage of curette and cotton swabs with or without subsequent plasma treatment. Our next step will be a clinical pilot study with these new devices to assess the clinical healing process. Supplementary Information The online version contains supplementary material available at 10.1186/s12903-022-02195-1.
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Affiliation(s)
- Rutger Matthes
- Department of Restorative Dentistry, Periodontology, Endodontology, Preventive Dentistry and Pedodontics, Dental School, University Medicine Greifswald, Fleischmannstr. 42, 17475, Greifswald, Germany
| | - Lukasz Jablonowski
- Department of Restorative Dentistry, Periodontology, Endodontology, Preventive Dentistry and Pedodontics, Dental School, University Medicine Greifswald, Fleischmannstr. 42, 17475, Greifswald, Germany
| | - Vinay Pitchika
- Department of Restorative Dentistry, Periodontology, Endodontology, Preventive Dentistry and Pedodontics, Dental School, University Medicine Greifswald, Fleischmannstr. 42, 17475, Greifswald, Germany
| | - Birte Holtfreter
- Department of Restorative Dentistry, Periodontology, Endodontology, Preventive Dentistry and Pedodontics, Dental School, University Medicine Greifswald, Fleischmannstr. 42, 17475, Greifswald, Germany
| | | | - Leo Seifert
- Sirona Dental Systems GmbH, Bensheim, Germany
| | - Torsten Gerling
- ZIK Plasmatis, Leibniz-Institute for Plasma Science and Technology e.V. (INP), Greifswald, Germany
| | - Laura Vilardell Scholten
- ZIK Plasmatis, Leibniz-Institute for Plasma Science and Technology e.V. (INP), Greifswald, Germany
| | - Rabea Schlüter
- Imaging Center of the Department of Biology, University of Greifswald, Greifswald, Germany
| | - Thomas Kocher
- Department of Restorative Dentistry, Periodontology, Endodontology, Preventive Dentistry and Pedodontics, Dental School, University Medicine Greifswald, Fleischmannstr. 42, 17475, Greifswald, Germany.
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Almohandes A, Abrahamsson I, Dionigi C, Berglundh T. Surgical treatment of experimental peri-implantitis using mechanical and chemical decontamination procedures: A pre-clinical in vivo study. J Clin Periodontol 2022; 49:518-525. [PMID: 35191056 DOI: 10.1111/jcpe.13607] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 02/07/2022] [Accepted: 02/10/2022] [Indexed: 11/26/2022]
Abstract
AIM To evaluate the effect of surgical treatment of experimental peri-implantitis at implants with different surface characteristics using mechanical and chemical decontamination methods. MATERIALS AND METHODS Following extraction of mandibular premolars, four implants with two different surface characteristics (A, moderately rough and B, smooth) were placed in each side of the mandible of six dogs. Experimental peri-implantitis was induced. Surgical treatment of the peri-implantitis sites was carried out using four implant surface decontamination protocols: (i) deposition of a citric acid gel, (ii) mechanical cleaning using a rotating titanium brush, (iii) a combination of the mechanical and chemical procedures, and (iv) saline (control). Clinical and radiographic examinations were performed. Block biopsies were obtained 6 months after therapy and prepared for histological analysis. RESULTS Irrespective of the treatment group, treatment resulted in 0.63 ± 0.92 and 0.65 ± 0.67 mm radiographic bone gain around implants A and B, respectively. Histological analyses revealed that persisting soft tissue inflammation as assessed using an infiltrated connective tissue (ICT) score was significantly lower at implant type B than at implant type A for all treatment groups. The test decontamination procedures did not demonstrate better results regarding resolution of peri-implantitis lesions, as indicated by the ICT scores, than the control procedure. The control treatment resulted in significantly superior outcomes of resolution of peri-implantitis lesions than the citric acid regimen. CONCLUSIONS It is concluded that decontamination procedures including citric acid gel or rotating titanium brush did not improve outcomes following surgical treatment of experimental peri-implantitis. Results were, however, influenced by the implant surface characteristics.
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Affiliation(s)
- Ahmed Almohandes
- Department of Periodontology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ingemar Abrahamsson
- Department of Periodontology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Carlotta Dionigi
- Department of Periodontology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Tord Berglundh
- Department of Periodontology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Wei YW, Sayed SM, Zhu WW, Xu KF, Wu FG, Xu J, Nie HP, Wang YL, Lu XL, Ma Q. Antibacterial and Fluorescence Staining Properties of an Innovative GTR Membrane Containing 45S5BGs and AIE Molecules In Vitro. NANOMATERIALS 2022; 12:nano12040641. [PMID: 35214970 PMCID: PMC8874606 DOI: 10.3390/nano12040641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/06/2022] [Accepted: 02/07/2022] [Indexed: 12/04/2022]
Abstract
This study aimed to add two functional components-antibacterial 45S5BGs particles and AIE nanoparticles (TPE-NIM+) with bioprobe characteristics-to the guided tissue regeneration (GTR) membrane, to optimize the performance. The PLGA/BG/TPE-NIM+ membrane was synthesized. The static water contact angle, morphologies, and surface element analysis of the membrane were then characterized. In vitro biocompatibility was tested with MC3T3-E1 cells using CCK-8 assay, and antibacterial property was evaluated with Streptococcus mutans and Porphyromonas gingivalis by the LIVE/DEAD bacterial staining and dilution plating procedure. The fluorescence staining of bacteria was observed by Laser Scanning Confocal Microscope. The results showed that the average water contact angle was 46°. In the cytotoxicity test, except for the positive control group, there was no significant difference among the groups (p > 0.05). The antibacterial effect in the PLGA/BG/TPE-NIM+ group was significantly (p < 0.01), while the sterilization rate was 99.99%, better than that in the PLGA/BG group (98.62%) (p < 0.01). Confocal images showed that the membrane efficiently distinguished G+ bacteria from G- bacteria. This study demonstrated that the PLGA/BG/TPE-NIM+ membrane showed good biocompatibility, efficient sterilization performance, and surface mineralization ability and could be used to detect pathogens in a simple, fast, and wash-free protocol.
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Affiliation(s)
- Yu-Wen Wei
- Jiangsu Province Key Laboratory of Oral Diseases, Department of General Dentistry, The Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing 210029, China; (Y.-W.W.); (W.-W.Z.); (J.X.); (H.-P.N.); (Y.-L.W.)
| | - Sayed Mir Sayed
- State Key Laboratory of Bioelectronics, School of Biological Science and Medical Engineering, Southeast University, 2 Sipailou Road, Nanjing 210096, China; (S.M.S.); (K.-F.X.); (F.-G.W.)
| | - Wei-Wen Zhu
- Jiangsu Province Key Laboratory of Oral Diseases, Department of General Dentistry, The Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing 210029, China; (Y.-W.W.); (W.-W.Z.); (J.X.); (H.-P.N.); (Y.-L.W.)
| | - Ke-Fei Xu
- State Key Laboratory of Bioelectronics, School of Biological Science and Medical Engineering, Southeast University, 2 Sipailou Road, Nanjing 210096, China; (S.M.S.); (K.-F.X.); (F.-G.W.)
| | - Fu-Gen Wu
- State Key Laboratory of Bioelectronics, School of Biological Science and Medical Engineering, Southeast University, 2 Sipailou Road, Nanjing 210096, China; (S.M.S.); (K.-F.X.); (F.-G.W.)
| | - Jing Xu
- Jiangsu Province Key Laboratory of Oral Diseases, Department of General Dentistry, The Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing 210029, China; (Y.-W.W.); (W.-W.Z.); (J.X.); (H.-P.N.); (Y.-L.W.)
| | - He-Peng Nie
- Jiangsu Province Key Laboratory of Oral Diseases, Department of General Dentistry, The Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing 210029, China; (Y.-W.W.); (W.-W.Z.); (J.X.); (H.-P.N.); (Y.-L.W.)
| | - Yu-Li Wang
- Jiangsu Province Key Laboratory of Oral Diseases, Department of General Dentistry, The Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing 210029, China; (Y.-W.W.); (W.-W.Z.); (J.X.); (H.-P.N.); (Y.-L.W.)
| | - Xiao-Lin Lu
- State Key Laboratory of Bioelectronics, School of Biological Science and Medical Engineering, Southeast University, 2 Sipailou Road, Nanjing 210096, China; (S.M.S.); (K.-F.X.); (F.-G.W.)
- Correspondence: (Q.M.); (X.-L.L.); Tel.: +86-13770963117 (Q.M.)
| | - Qian Ma
- Jiangsu Province Key Laboratory of Oral Diseases, Department of General Dentistry, The Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing 210029, China; (Y.-W.W.); (W.-W.Z.); (J.X.); (H.-P.N.); (Y.-L.W.)
- Correspondence: (Q.M.); (X.-L.L.); Tel.: +86-13770963117 (Q.M.)
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Schwarz F, Jepsen S, Obreja K, Galarraga-Vinueza ME, Ramanauskaite A. Surgical therapy of peri-implantitis. Periodontol 2000 2022; 88:145-181. [PMID: 35103328 DOI: 10.1111/prd.12417] [Citation(s) in RCA: 47] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Peri-implantitis is caused by a bacterial challenge; therefore, anti-infective treatment strategies should be employed to manage the disease. As nonsurgical approaches demonstrate limited efficacy in most cases of peri-implantitis, surgical interventions are often required. Treatment outcomes improve following access flap surgery, with or without adjunctive resective and/or augmentation measures. Whereas nonaugmentative therapies (ie, access flap surgery and resective techniques) primarily aim to resolve inflammation and arrest further disease progression, augmentation approaches also seek to regenerate the bony defect and achieve reosseointegration. Currently, limited evidence supports the superiority of augmentative surgical techniques for peri-implantitis treatment over nonaugmentation methods, and human histologic evidence for reosseointegration is sparse. For patients involved in regular postoperative maintenance programs, success of peri-implantitis surgical treatment based on various definitions of success was obtained in over half of the cases after 5-7 years. Despite surgical treatment, cases of further disease progression that required retreatment or led to implant loss were reported.
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Affiliation(s)
- Frank Schwarz
- Department of Oral Surgery and Implantology, Johann Wolfgang Goethe-University, Carolinum, Frankfurt an Main, Germany
| | - Søren Jepsen
- Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, Bonn, Germany
| | - Karina Obreja
- Department of Oral Surgery and Implantology, Johann Wolfgang Goethe-University, Carolinum, Frankfurt an Main, Germany
| | - Maria Elisa Galarraga-Vinueza
- Post-Graduate Program in Implant Dentistry (PPGO), Federal University of Santa Catarina (UFSC), Florianópolis, Brazil
| | - Ausra Ramanauskaite
- Department of Oral Surgery and Implantology, Johann Wolfgang Goethe-University, Carolinum, Frankfurt an Main, Germany
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47
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Øen M, Leknes KN, Lund B, Bunæs DF. The efficacy of systemic antibiotics as an adjunct to surgical treatment of peri-implantitis: a systematic review. BMC Oral Health 2021; 21:666. [PMID: 34961495 PMCID: PMC8711198 DOI: 10.1186/s12903-021-02020-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 12/08/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Microbial biofilm accumulation is the main cause of peri-implantitis. The majority of surgical peri-implantitis treatment protocols suggests adjunctive use of systemic antibiotics to target specific putative bacteria. The aim of this systematic review was to critically evaluate the adjunctive use of systemically administered antibiotics in surgical treatment of peri-implantitis by reviewing previously published systematic reviews and primary studies. METHODS A systematic literature search was conducted in four electronic databases (MEDLINE, The Cochrane Library, EMBASE, and Web of Science) for randomised controlled trials, cohort studies, case-control studies, and systematic reviews reporting surgical treatment of peri-implantitis with and without adjunctive systemically administered antibiotic therapy. The included systematic reviews and primary studies were qualitatively assessed using AMSTAR and GRADE, respectively. No restrictions were set for date of publication, journal, or language. RESULTS The literature search identified 681 papers. Only seven systematic reviews and two primary studies met the inclusion criteria. Four out of seven included systematic reviews concluded that no evidence exists for use of systemic antibiotics to improve the clinical outcomes in surgical treatment of peri-implantitis. One review did not estimate the level of evidence, one did not clearly state any beneficial effect, whereas one reported a limited adjunctive effect. Further, the two included primary studies did not show a long-term significant benefit of adjunctive use of systemically administrated antibiotics. However, one study reported a short-term adjunctive effect in patients with modified surface implants. Due to heterogeneity in study design, low number of included primary studies, and grade of bias, no meta-analysis was performed. CONCLUSION The use of systemically administered antibiotics as an adjunct to surgical interventions of peri-implantitis cannot be justified as a part of a standard treatment protocol. A pervasive problem is the lack of uniform diagnosis criteria for peri-implantitis, deficient information about patient characteristics, absence of high quality long-term randomised controlled trials, and authors' declaration on conflict of interest.
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Affiliation(s)
- Malene Øen
- Department of Clinical Dentistry - Periodontics, Faculty of Medicine, University of Bergen, Aarstadveien 19, 5009, Bergen, Norway
| | - Knut N Leknes
- Department of Clinical Dentistry - Periodontics, Faculty of Medicine, University of Bergen, Aarstadveien 19, 5009, Bergen, Norway.
| | - Bodil Lund
- Division of Oral Diagnostics and Oral Rehabilitation, Department of Dental Medicine, Karolinska Institutet and Medical Unit for Reconstructive Plastic- and Craniofacial Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Dagmar F Bunæs
- Department of Clinical Dentistry - Periodontics, Faculty of Medicine, University of Bergen, Aarstadveien 19, 5009, Bergen, Norway
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48
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Vanmunster L, D'Haeyer C, Coucke P, Braem A, Van Hooreweder B. Mechanical behavior of Ti6Al4V produced by laser powder bed fusion with engineered open porosity for dental applications. J Mech Behav Biomed Mater 2021; 126:104974. [PMID: 34883458 DOI: 10.1016/j.jmbbm.2021.104974] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 11/09/2021] [Accepted: 11/10/2021] [Indexed: 01/14/2023]
Abstract
Implant failure due to biofilm formation is a substantial problem in the field of dental prosthetics. A solution has been proposed in the form of implants with a built-in drug reservoir, but combining sufficient strength and longevity with controlled release capability has proven difficult. This work investigates the feasibility of using laser powder bed fusion to create Ti6Al4V structures with open pore channels while maintaining their mechanical stability. These interconnected pore channels are generated by increasing the distance between consecutive melt pools, denominated as oversized hatch spacing. The impact of varying hatch spacing, laser power and scan speed on the degree of porosity was examined, with both an increase in hatch spacing and a decrease in energy density leading to higher porosity. The pore channels were found to be fully interconnected at total porosity values of 14% or more. The compressive modulus, yield strength and ultimate compressive strength are shown to be strongly related to the density of the structure. Based on the minimal strength and full interconnectivity requirements, the optimal additive manufacturing building conditions were determined. The fatigue properties of the resulting samples were investigated under uniaxial and under inclined compression-compression testing according to ISO 14801, which indicated an endurance limit of 217 MPa in the heat treated state. The results indicate that the use of an oversized hatch spacing is suitable for engineering open porous networks.
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Affiliation(s)
- Lars Vanmunster
- KU Leuven, Department of Mechanical Engineering - Celestijnenlaan 300, 3001 Leuven, Belgium.
| | - Camille D'Haeyer
- KU Leuven, Department of Materials Engineering - Kasteelpark Arenberg 44, 3001 Leuven, Belgium
| | - Pauline Coucke
- KU Leuven, Department of Materials Engineering - Kasteelpark Arenberg 44, 3001 Leuven, Belgium
| | - Annabel Braem
- KU Leuven, Department of Materials Engineering - Kasteelpark Arenberg 44, 3001 Leuven, Belgium
| | - Brecht Van Hooreweder
- KU Leuven, Department of Mechanical Engineering - Celestijnenlaan 300, 3001 Leuven, Belgium
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49
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Ramanauskaite A, Fretwurst T, Schwarz F. Efficacy of alternative or adjunctive measures to conventional non-surgical and surgical treatment of peri-implant mucositis and peri-implantitis: a systematic review and meta-analysis. Int J Implant Dent 2021; 7:112. [PMID: 34779939 PMCID: PMC8593130 DOI: 10.1186/s40729-021-00388-x] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 10/06/2021] [Indexed: 12/26/2022] Open
Abstract
Purpose To evaluate the efficacy of alternative or adjunctive measures to conventional non-surgical or surgical treatment of peri-implant mucositis and peri-implantitis. Material and methods Prospective randomized and nonrandomized controlled studies comparing alternative or adjunctive measures, and reporting on changes in bleeding scores (i.e., bleed0ing index (BI) or bleeding on probing (BOP)), probing depth (PD) values or suppuration (SUPP) were searched. Results Peri-implant mucositis: adjunctive use of local antiseptics lead to greater PD reduction (weighted mean difference (WMD) = − 0.23 mm; p = 0.03, respectively), whereas changes in BOP were comparable (WMD = − 5.30%; p = 0.29). Non-surgical treatment of peri-implantitis: alternative measures for biofilm removal and systemic antibiotics yielded higher BOP reduction (WMD = − 28.09%; p = 0.01 and WMD = − 17.35%; p = 0.01, respectively). Surgical non-reconstructive peri-implantitis treatment: WMD in PD amounted to − 1.11 mm favoring adjunctive implantoplasty (p = 0.02). Adjunctive reconstructive measures lead to significantly higher radiographic bone defect fill/reduction (WMD = 56.46%; p = 0.01 and WMD = − 1.47 mm; p = 0.01), PD (− 0.51 mm; p = 0.01) and lower soft-tissue recession (WMD = − 0.63 mm; p = 0.01), while changes in BOP were not significant (WMD = − 11.11%; p = 0.11). Conclusions Alternative and adjunctive measures provided no beneficial effect in resolving peri-implant mucositis, while alternative measures were superior in reducing BOP values following non-surgical treatment of peri-implantitis. Adjunctive reconstructive measures were beneficial regarding radiographic bone-defect fill/reduction, PD reduction and lower soft-tissue recession, although they did not improve the resolution of mucosal inflammation. Supplementary Information The online version contains supplementary material available at 10.1186/s40729-021-00388-x.
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Affiliation(s)
- Ausra Ramanauskaite
- Department of Oral Surgery and Implantology, Johann Wolfgang Goethe-University Frankfurt, Carolinum, 60596, Frankfurt am Main, Germany
| | - Tobias Fretwurst
- Department of Oral- and Maxillofacial Surgery, Medical Center, Faculty of Medicine, University of Freiburg, University of Freiburg, Frankfurt, Germany
| | - Frank Schwarz
- Department of Oral Surgery and Implantology, Goethe University, Carolinum, Frankfurt, Germany.
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50
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Blanco C, Pico A, Dopico J, Gándara P, Blanco J, Liñares A. Adjunctive benefits of systemic metronidazole on non-surgical treatment of peri-implantitis. A randomized placebo-controlled clinical trial. J Clin Periodontol 2021; 49:15-27. [PMID: 34713471 DOI: 10.1111/jcpe.13564] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/21/2021] [Accepted: 10/01/2021] [Indexed: 11/29/2022]
Abstract
AIM To study clinical, radiographic, and microbiological outcomes after non-surgical therapy of peri-implantitis with or without adjunctive systemic metronidazole. MATERIALS AND METHODS A randomized placebo-controlled clinical trial was carried out in 32 subjects (62 implants) diagnosed with peri-implantitis. Implants received a mechanical non-surgical debridement session and systemic metronidazole or placebo. Clinical, radiographic, and microbiological outcomes were evaluated at baseline, 3, 6, and 12 months. RESULTS After 12 months, the test treatment resulted in significantly greater PPD reduction (2.53 vs. 1.02 mm) and CAL gain (2.14 vs. 0.53 mm) (p value <.05) in comparison with placebo. The test treatment also resulted in additional radiographic bone gain (2.33 vs. 1.13 mm) compared with placebo (p value <.05). There was a significantly greater decrease in Porphyromonas gingivalis, Tannerella forsythia, and Campylobacter rectus counts compared with the control group (p value <.05). At the end of follow-up, 56.3% of patients met the success criteria in the test group and 25% in the control group. CONCLUSIONS The use of systemic metronidazole as an adjunct to non-surgical treatment of peri-implantitis resulted in significant additional improvements in clinical, radiographic, and microbiological parameters after 12 months of follow-up. This study is registered in ClinicalTrials.gov (NCT03564301).
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Affiliation(s)
- Carlota Blanco
- Periodontology Unit, Faculty of Odontology, University of Santiago de Compostela, Santiago de Compostela, Spain.,Medical-Surgical Dentistry Research Group, Health Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
| | - Alex Pico
- Periodontology Unit, Faculty of Odontology, University of Santiago de Compostela, Santiago de Compostela, Spain.,Medical-Surgical Dentistry Research Group, Health Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
| | - Jose Dopico
- Periodontology Unit, Faculty of Odontology, University of Santiago de Compostela, Santiago de Compostela, Spain.,Medical-Surgical Dentistry Research Group, Health Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
| | - Pilar Gándara
- Medical-Surgical Dentistry Research Group, Health Research Institute of Santiago de Compostela, Santiago de Compostela, Spain.,Oral Surgery Unit, Faculty of Odontology, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Juan Blanco
- Periodontology Unit, Faculty of Odontology, University of Santiago de Compostela, Santiago de Compostela, Spain.,Medical-Surgical Dentistry Research Group, Health Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
| | - Antonio Liñares
- Periodontology Unit, Faculty of Odontology, University of Santiago de Compostela, Santiago de Compostela, Spain.,Medical-Surgical Dentistry Research Group, Health Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
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