Management of Peri-Implant Diseases: A Survey of Australian Periodontists

Management of adverse effects following additively manufactured subperiosteal jaw implantation in the maxilla

OBJECTIVE

This expert opinion presents provisional guidelines for addressing complications associated with Additively Manufactured Subperiosteal Jaw Implants (AMSJI®) in patients with severe maxillary atrophy. AMSJI®'s custom design, supported by finite element analysis (FEA), allows precise placement that avoids critical anatomical structures and minimizes complications relative to alternative solutions.

MATERIALS AND METHODS

Data were gathered through firsthand experiences, direct communications, two structured surveys and insights from international workgroup meetings.

RESULTS

Minor complications, such as soft tissue recession with inflammation, can be managed through thorough patient selection and early intervention. Severe complications, such as ascending infections and mechanical issues (e.g., fractures of implant components), have been rare. Compared to zygomatic implants and bone grafting, AMSJI® demonstrates a favorable safety profile. Zygomatic implants may lead to severe issues like orbital cellulitis and diplopia, while bone grafting risks include graft resorption, loss, and donor site complications. To mitigate risks, selecting patients carefully and ensuring diligent follow-up are critical, especially in those with risk factors like smoking or bruxism. Improved imaging, planning, and FEA have further contributed to minimizing complications, reinforcing AMSJI®'s role in complex maxillary reconstructions and implant-supported prosthetics.

CONCLUSIONS

AMSJI® demonstrates high success rates but requires meticulous risk management. Key strategies involve carefully candidates by excluding those who are smokers, immunocompromised, or non-compliant, or diabetics with a history of infectious complications. Additionally, strict adherence to oral hygiene protocols is essential to optimize outcomes and minimize risks.Proactive management in these areas is crucial to optimize outcomes, ensure implant longevity, and support successful prosthetic rehabilitation.

Dental Practitioners' Knowledge and Attitudes Toward the Etiology, Diagnosis, and Treatment of Peri-Implantitis

Objectives: The objective of this study was to assess the level of knowledge and attitude about the etiology, diagnosis, and management of peri-implantitis among dental practitioners. Methods: An online cross-sectional study on 303 dentists in Saudi Arabia was conducted. A closed-ended survey consisting of 28 questions was designed. Three sections were created, i.e., (1) participants' characteristics; (2) knowledge of peri-implantitis etiology, risk factors, diagnosis, and complications; and (3) the use of antibiotics to manage peri-implantitis and methods used for diagnosis and treatment. The data were analyzed using mean and percentages. Results: A total of 303 dentists participated in this study with a 78.8% response rate, comprising 80% general dentists and 20% specialists. The majority of dentists demonstrated knowledge about peri-implantitis, with 85.5% identifying bacterial plaque as an etiologic factor and 83.8% recognizing it as an inflammatory reaction. Regarding risk factors, 88.1% identified smoking and 86.1% recognized periodontitis as contributors to peri-implant disease development. In terms of clinical decision making, 63% of participants considered implant mobility as a definitive indication for implant removal, and more than half reported using crater-like bone defects surrounding implants as a diagnostic criterion for peri-implantitis. For antimicrobial therapy, amoxicillin alone (30%) was the most commonly prescribed antibiotic, followed by the combination of amoxicillin with metronidazole (29%). Despite these treatment approaches, it is important to note that currently there are no established, predictable protocols for treating any phase of peri-implant disease. Conclusion: While participating dentists demonstrated a strong understanding of peri-implantitis etiology and risk factors, particularly regarding bacterial plaque and smoking as major contributors, there was considerable variation in antibiotic selection and usage patterns. These findings suggest the need for standardized guidelines and further research to establish evidence-based protocols for managing peri-implant diseases.

Knowledge and attitude of dental students regarding etiology, diagnosis, and treatment of peri-implantitis

OBJECTIVE

The objective of this study was to assess the level of knowledge and attitude of dental students about the etiology, diagnosis, and management of peri-implantitis.

METHODS

An online cross-sectional study that targeted senior undergraduate dental students at the College of Dentistry was conducted. A closed-ended survey consisting of 28 questions was designed. Three sections were created: 1) participants' characteristics; 2) Knowledge of peri-implantitis etiology, risk factors, diagnosis, and complications; 3) The use of antibiotics in peri-implantitis, diagnosis, and treatment methods. SPSS version 22 (IBM Corp.) was used for data analysis. Counts and percentages were calculated for correct answers in each section.

RESULTS

A total of 267 dental students responded to the questionnaire. The majority of the participants (81.6%) were knowledgeable about peri-implantitis being an inflammatory reaction, and a lesser percentage (77.9%) knew that bacterial plaque is an etiologic factor for peri-implant diseases. 82.0% of the participants identified smoking as a risk factor, followed by periodontitis (80.5%). Regarding implant complications, 57.3% of the participants considered implant mobility as a definitive indication for implant removal. More than half of the participants reported using crater-like bone defects surrounding implants to diagnose peri-implantitis. The most commonly used antibiotic was amoxicillin (34.1%), followed by amoxicillin combined with metronidazole (26.9%).

CONCLUSION

Most participants had a basic understanding of the etiology and risk factors of peri-implantitis. On the other hand, more courses addressing peri-implantitis diagnosis are needed.

Peri-Implantitis: Application of a Protocol for the Regeneration of Deep Osseous Defects. A Retrospective Case Series

Background and aims: Peri-implantitis is a complex pathology, both in its diagnosis and in the identification of etiological causes. Although we have been studying more and more over the years to try to answer the many questions that remain regarding everything that circulates around this disease which affects implants, nothing has yet been taken as an official consensus regarding its surgical treatment. There are still many proposed protocols, each of which has been shown to have comforting results and promising prospects, but no total predictability. The aim of this case series is to assess the clinical outcomes of a mixed protocol for the regeneration of deep osseous defects. Materials and methods: The data and clinical records of 23 patients, with 29 implants affected by peri-implantitis treated surgically in private practice, were analyzed retrospectively. The method used for the surgical treatment was a mixed protocol of mechanical–chemical decontamination and bone regeneration with bovine xenograft. Results: All patients were followed for at least 2 years, averaging 28.9 months (a range of 24–38 months) with a reduction in the probing depth (PD) at one year from the initial 8.14 ± 1.156 mm to 3.72 ± 0.649 mm, and to 4.14 ± 1.093 mm at the final assessment. The differences between assessment time points were always statistically significant. The data regarding bleeding on probing (BoP) and suppuration also showed a statistically significant reduction at the final time point compared to the baseline. Only one patient, at 24 months, still showed BoP, suppuration, and a PD deeper than 5 mm, indicating a recurrence of the disease compared to the initial improvement of the PD (5 mm) at one year. Conclusions: In conclusion, within the limits of this retrospective analysis, it can be affirmed that this combined mechanical–chemical and regenerative decontamination therapy is effective in the treatment of peri-implantitis.

Peri-Implant Health and the Knowing-Doing Gap—A Digital Survey on Procedures and Therapies

Objectives: Peri-implant tissue maintenance and treatment is becoming a serious challenge in implantology. With increasing numbers of implants being placed, more cases of peri-implant mucositis and peri-implantitis is seen. A digital survey on peri-implant disease management was issued to experts in periodontology and implantology to identify the tools and procedures most commonly used today to treat peri-implant diseases and successfully manage peri-implant health. The primary aim was to assess whether there is consensus in the choice of treatment to manage peri-implant diseases and to prevent their recurrence once treated. The secondary aim was to obtain insight into future protocols and /or devices, and the research and development needed.

Materials and Methods: Participants in this digital survey were professionals specialising in periodontology, oral surgery, and implant dentistry. The questionnaire included both a series of closed- and open-ended questions. A total of 16 countries participated. The survey was sent by e-mail to 70 individuals, 66 received the survey and 37 of receivers responded, two of the participants were excluded due to insufficient filling of the survey. In the end 35 respondents completed the survey.

Results: Respondents agree that the efficacy of mechanical and chemical decontamination of implant surfaces needs to be improved and better documented. It is a common opinion that the current remedies, mostly adapted from periodontal practises, do not provide effective and reliable clinical outcomes when treating peri-implant ailments. There is a general agreement amongst experts that regularly scheduled (3–6-month intervals) maintenance treatments are essential for maintaining peri-implant health in patients experiencing implant complications. Respondents are also concerned about unnecessary use of systemic antibiotics for managing peri-implant health.

Conclusion: Regardless of agreements in parts, there was no observed consensus on the most effective treatment options for treating peri-implantitis. The experts all agree it is an urgent need for well-designed, long-term follow-up randomised and controlled clinical trials comparing interventions to provide an evidence-based strategy for peri-implant health management.

Impact of physical decontamination methods on zirconia implant surface and subsequent bacterial adhesion: An in-vitro study

Objective

To evaluate the effect of routinely used physical decontamination methods on the surface characteristics of zirconia implants and subsequent ability of bacteria to adhere in vitro.

Background

Physical decontamination methods commonly used in peri‐implantitis therapy and routine implant maintenance can potentially alter zirconia implant surfaces.

Methods

Acid‐etched zirconia discs were instrumented with titanium curette (TC), plastic curette, air abrasive device, ultrasonic scaler (US) with stainless steel tip. Following instrumentation, surface topography, and surface elemental composition was analyzed using 3D‐laser scanning microscopy and energy‐dispersive X‐ray spectroscopy, respectively. Subsequently, plaque biofilm was cultured on zirconia discs for 48 h and bacterial adhesion assessed using a turbidity test and scanning electron microscopy.

Results

A significant difference in surface roughness was observed between the US and control group (p < 0.05). The US and TC caused gray surface discolouration on zirconia discs due to deposition of metallic residue as confirmed by X‐ray spectroscopy. No significant difference in bacterial adhesion was noted among all treatment groups (p > 0.05).

Conclusion

TC and US with stainless steel tips should be used with caution due to deposition of metallic residue on the surface. Air abrasive devices and plastic curettes caused minimal surface alterations and are, therefore, safer for zirconia implant decontamination.

A Mini Review on Non-augmentative Surgical Therapy of Peri-Implantitis—What Is Known and What Are the Future Challenges?

Non-augmentative surgical therapy of peri-implantitis is indicated for cases with primarily horizontal bone loss or wide defects with limited potential for bone regeneration and/or re-osseointegration. This treatment approach includes a variety of different techniques (e.g., open flap debridement, resection of peri-implant mucosa, apically positioned flaps, bone re-contouring, implantoplasty, etc.) and various relevant aspects should be considered during treatment planning. The present mini review provides an overview on what is known for the following components of non-augmentative surgical treatment of peri-implantitis and on potential future research challenges: (1) decontamination of the implant surface, (2) need of implantoplasty, (3) prescription of antibiotics, and (4) extent of resective measures.