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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. [PMID: 38690660 DOI: 10.1111/jcpe.13993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [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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Sanz-Sánchez I, Molina A, Martin C, Bollain J, Calatrava J, Sanz M. The effect of one-time abutment placement on clinical and radiographic outcomes: A 5-year randomized clinical trial. Clin Oral Implants Res 2024. [PMID: 38506392 DOI: 10.1111/clr.14256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 02/22/2024] [Accepted: 03/07/2024] [Indexed: 03/21/2024]
Abstract
OBJECTIVE The aim of this study was to evaluate the long-term (5 years) clinical efficacy of the one-abutment one-time protocol (test) versus the standard of care by placing the definitive abutment on the day of the prosthetic delivery (control). MATERIALS AND METHODS In this study, 39 subjects with 60 implants were randomly allocated to either the test or the control group. Changes in the radiographic interproximal bone levels (DIB), modified sulcus bleeding index, probing depth, modified plaque index, papilla fill (Jemt score), incidence of peri-implantitis and peri-implant mucositis as well as patient-reported outcomes measures (PROMs) were collected and compared at 1, 3 and 5 years. RESULTS At 5 years, the control group showed a greater, although not statistically significant, change in mean DIB values (0.97 mm vs. 0.53 mm). Regarding the other clinical parameters evaluated, no statistically significant differences were observed between groups at any time point. At 5 years, 51% of the implants presented peri-implant mucositis (25.5% in the control and 23.5% in the test), and only one implant in the test group developed peri-implantitis. CONCLUSIONS The connection and disconnection of healing abutments during the healing period was not associated with higher long-term bone loss. Clinical outcomes and PROMs were similar between groups.
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Affiliation(s)
- Ignacio Sanz-Sánchez
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, Faculty of Dentistry, University Complutense of Madrid, Madrid, Spain
| | - Ana Molina
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, Faculty of Dentistry, University Complutense of Madrid, Madrid, Spain
| | - Conchita Martin
- BIOCRAN (Craniofacial Biology: Orthodontics and Dentofacial Orthopedics) Research Group, Faculty of Dentistry, University Complutense of Madrid, Madrid, Spain
| | - Juan Bollain
- Section of Graduate Periodontology, University Complutense, Madrid, Spain
| | - Javier Calatrava
- Section of Graduate Periodontology, University Complutense, Madrid, Spain
| | - Mariano Sanz
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, Faculty of Dentistry, University Complutense of Madrid, Madrid, Spain
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Jepsen K, Tietmann C, Martin C, Kutschera E, Jäger A, Wüllenweber P, Gaveglio L, Cardaropoli D, Sanz-Sánchez I, Fimmers R, Jepsen S. Synergy of Regenerative Periodontal Surgery and Orthodontics Improves Quality of Life of Patients with Stage IV Periodontitis: 24-Month Outcomes of a Multicenter RCT. Bioengineering (Basel) 2023; 10:695. [PMID: 37370626 PMCID: PMC10295428 DOI: 10.3390/bioengineering10060695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 05/15/2023] [Accepted: 06/01/2023] [Indexed: 06/29/2023] Open
Abstract
In stage IV periodontitis patients with pathologic tooth migration (PTM), interdisciplinary treatment includes regenerative periodontal surgery (RPS) with an application of biomaterials and orthodontic therapy (OT) to restore function, esthetics and thereby quality of life (QoL). In a 24-month randomized trial we explored the synergy between regenerative medicine and biomechanical force application. The following methods were used: Forty-three patients had been randomized to a combined treatment comprising RPS and subsequent OT starting either 4 weeks (early OT) or 6 months (late OT) post-operatively. Clinical periodontal parameters and oral health-related QoL (GOHAI) were recorded up to 24 months. We obtained the following results: Mean clinical attachment gain (∆CAL ± SD) was significantly higher with early OT (5.96 ± 2.1 mm) versus late OT (4.65 ± 1.76 mm) (p = 0.034). Pocket closure (PPD ≤ 4 mm) was obtained in 91% of defects with early OT compared to 90% with late OT. GOHAI-scores decreased significantly from 26.1 ± 7.5 to 9.6 ± 4.7 (early OT) and 25.1 ± 7.1 to 12.7 ± 5.6 (late OT). Inconclusion, teeth severely compromised by intrabony defects and PTM can be treated successfully by RPS followed by early OT with the advantage of an overall reduced treatment time. As a result of the combined periodontal-orthodontic therapy, the oral health-related QoL of patients was significantly improved. Early stimulation of wound healing with orthodontic forces had a favorable impact on the outcomes of regenerative periodontal surgery.
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Affiliation(s)
- Karin Jepsen
- Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, Welschnonnenstrasse 17, 53111 Bonn, Germany; (C.T.)
| | - Christina Tietmann
- Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, Welschnonnenstrasse 17, 53111 Bonn, Germany; (C.T.)
- Private Practice for Periodontology, Krefelder Strasse 73, 52070 Aachen, Germany
| | - Conchita Martin
- BIOCRAN Research Group, University Complutense of Madrid, 28040 Madrid, Spain
| | - Eric Kutschera
- Department of Orthodontics, University of Bonn, Welschnonnenstrasse 17, 53111 Bonn, Germany
| | - Andreas Jäger
- Department of Orthodontics, University of Bonn, Welschnonnenstrasse 17, 53111 Bonn, Germany
| | - Peter Wüllenweber
- Private Practice for Orthodontics, Theaterstraße 98-102, 52062 Aachen, Germany
| | - Lorena Gaveglio
- Private Practice, Corso Galileo Ferraris 148, 10129 Turino, Italy
| | | | | | - Rolf Fimmers
- Institute for Medical Biometry, Informatics and Epidemiology, University of Bonn, 53127 Bonn, Germany
| | - Søren Jepsen
- Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, Welschnonnenstrasse 17, 53111 Bonn, Germany; (C.T.)
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Morón-Conejo B, Sanz-Sánchez I, Salido MP, Martínez-Rus F, Pradíes G. The effect of a convergent transmucosal neck on soft tissues and radiographic outcomes: a 1-year follow-up randomized controlled trial. Clin Oral Investig 2023; 27:2923-2933. [PMID: 36749412 PMCID: PMC10264266 DOI: 10.1007/s00784-023-04892-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 02/01/2023] [Indexed: 02/08/2023]
Abstract
PURPOSE The aim of this randomized controlled clinical trial was to evaluate peri-implant marginal bone levels (MBLs) and soft tissue dimension changes 1 year after loading. Patients in the control group received bone-level implants, whereas in the test group, tissue-level implants with a convergent transmucosal neck were used. MATERIAL AND METHODS MBLs were calculated by measuring the distance from the implant shoulder to the first visible bone-to-implant contact using standardized periapical digital radiographs. Baseline (day of loading) and follow-up digital models obtained with an intraoral scanner were used to quantify the changes in the peri-implant soft tissue dimensions with a best-fit algorithm. RESULTS The difference between final and baseline MBLs showed a mean bone loss of 0.16 ± 0.01 mm in the test group (n = 15) and 0.45 ± 0.09 mm in the control group (n = 14) (p > 0.05). Soft tissue contour at the level of the gingival margin (GM) increased by 1.96 ± 2.69 mm in the test group and 0.65 ± 0.42 mm in the control group (p = 0.167). Both groups showed a coronal displacement of the gingival margin with no significant differences among them. CONCLUSIONS The present study demonstrated peri-implant hard and soft tissues stability at both implant designs with no significant differences 12 months after loading. CLINICAL RELEVANCE There is still insufficient scientific evidence to demonstrate the role and advantages of the convergent transmucosal neck on the behavior of the peri-implant soft and hard tissues stability compared to a straight neck in bone-level implants 12 months after loading.
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Affiliation(s)
- Belén Morón-Conejo
- Analysis of Techniques, Material and Instruments Applied to Digital Dentistry and CAD/CAM Procedures Research Group, University Complutense, Madrid, Spain
| | - Ignacio Sanz-Sánchez
- ETEP (Etiology and Therapy of Periodontal and Peri-Implant Diseases) Research Group, University Complutense, Madrid, Spain
| | - Maria Paz Salido
- Analysis of Techniques, Material and Instruments Applied to Digital Dentistry and CAD/CAM Procedures Research Group, University Complutense, Madrid, Spain.
- Department of Conservative and Prosthetic Dentistry, Faculty of Dentistry, University Complutense of Madrid, Plaza Ramón Y Cajal S/N. 28040, Madrid, Spain.
| | - Francisco Martínez-Rus
- Analysis of Techniques, Material and Instruments Applied to Digital Dentistry and CAD/CAM Procedures Research Group, University Complutense, Madrid, Spain
| | - Guillermo Pradíes
- Analysis of Techniques, Material and Instruments Applied to Digital Dentistry and CAD/CAM Procedures Research Group, University Complutense, Madrid, Spain
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Urban I, Sanz-Sánchez I, Monje A, Montero E. Complications and treatment errors in peri-implant hard tissue management. Periodontol 2000 2023; 92:278-298. [PMID: 37016554 DOI: 10.1111/prd.12472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 08/14/2022] [Accepted: 08/21/2022] [Indexed: 04/06/2023]
Abstract
Bone augmentation procedures aim to regenerate the deficient alveolar ridge to properly place dental implants that are completely surrounded by bone. However, these are invasive and technically demanding surgeries that are not free of either complications or treatment errors. Careful patient selection and preparation is a mandatory process to reduce the rate of complications in bone regeneration procedures, irrespective of the technique used. It is important to assess the cost benefit of the intervention and to evaluate the potential impact on the patient's quality of life, especially in the elderly and medically compromised patients. Most common postoperative complications are wound dehiscences, which may be reduced, at least partially, by proper knowledge of the surgical technique and the craniofacial anatomy. Other complications that may appear are postoperative infections or nerve injuries. The aim of this narrative review is to summarize the best available scientific evidence on the incidence of complications, as well as the ideal strategies for their prevention and management. Depending on the severity of the complication, treatment approaches may vary and can include drug prescription or even surgical re-entries to remove exposed barrier membranes or contaminated bone grafts. Adequate prevention and proper management of complications associated with bone augmentation interventions are a requirement for clinicians carrying out these demanding procedures. A series of cases illustrating proper management of complications in different clinical scenarios is presented.
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Affiliation(s)
- Istvan Urban
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
- Department of Periodontology and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Ignacio Sanz-Sánchez
- ETEP (Etiology and Therapy of Periodontal and Peri-Implant Diseases) Research Group, University Complutense, Madrid, Spain
| | - Alberto Monje
- Department of Periodontology, School of Dentistry, International University of Catalonia, Barcelona, Spain
- Department of Periodontology and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Eduardo Montero
- ETEP (Etiology and Therapy of Periodontal and Peri-Implant Diseases) Research Group, University Complutense, Madrid, Spain
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Liñares A, Sanz-Sánchez I, Dopico J, Molina A, Blanco J, Montero E. Efficacy of adjunctive measures in the non-surgical treatment of peri-implantitis: A systematic review. J Clin Periodontol 2023. [PMID: 37143407 DOI: 10.1111/jcpe.13821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 03/08/2023] [Accepted: 04/10/2023] [Indexed: 05/06/2023]
Abstract
AIM The aim of this systematic review was to evaluate the efficacy of patient-performed or administered adjunctive measures to non-surgical peri-implantitis therapy in terms of probing depth (PD) and/or bleeding on probing (BoP) reductions. MATERIALS AND METHODS Randomized and controlled clinical trials with at least 6 months of follow-up were searched in three databases. Secondary outcomes included implant loss, disease resolution, recurrence of peri-implantitis, need of re-treatment, changes in marginal bone levels, patient-reported outcomes and adverse effects. RESULTS Of 567 titles, 10 publications, reporting 9 investigations, were included. Three types of adjunctive measures were found (local/systemic antimicrobials and probiotics). Four studies evaluated the effects of local antimicrobials (i.e., minocycline microspheres, chlorhexidine chips or a metronidazole + amoxicillin gel), three studies evaluated systemic antimicrobials (either amoxicillin + metronidazole or metronidazole alone) and two studies evaluated probiotics (Lactobacillus reuteri strains). The addition of local antimicrobials led to modest improvements in PD reduction. Systemic antimicrobials showed significantly greater reductions in PD and BoP, especially at initially deep sites (PD > 6 mm). Due to the large heterogeneity among included studies, no meta-analyses were performed. CONCLUSIONS Different adjunctive measures in the non-surgical treatment of peri-implantitis have different impact in terms of PD and BoP reductions. Improved PD reductions result after the use of systemic antimicrobials, and to a lesser extent, after the use of local antimicrobials.
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Affiliation(s)
- 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
| | - Ignacio Sanz-Sánchez
- Section of Graduate Periodontology, University Complutense of Madrid, Madrid, Spain
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, University Complutense of Madrid, Madrid, Spain
| | - José 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
| | - Ana Molina
- Section of Graduate Periodontology, University Complutense of Madrid, Madrid, Spain
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, University Complutense of Madrid, Madrid, 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
| | - Eduardo Montero
- Section of Graduate Periodontology, University Complutense of Madrid, Madrid, Spain
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, University Complutense of Madrid, Madrid, Spain
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Annunziata M, Donnarumma G, Guida A, Nastri L, Persico G, Fusco A, Sanz-Sánchez I, Guida L. Clinical and microbiological efficacy of indocyanine green-based antimicrobial photodynamic therapy as an adjunct to non-surgical treatment of periodontitis: a randomized controlled clinical trial. Clin Oral Investig 2023; 27:2385-2394. [PMID: 36719506 PMCID: PMC10159973 DOI: 10.1007/s00784-023-04875-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 01/22/2023] [Indexed: 02/01/2023]
Abstract
OBJECTIVES The aim of the present randomized clinical trial (RCT) with a parallel arm design was to evaluate the clinical and microbiological efficacy of repeated ICG-aPDT as an adjunct to full-mouth subgingival debridement in the treatment of periodontitis. MATERIALS AND METHODS Twenty-four periodontitis patients were treated with full-mouth ultrasonic subgingival debridement (FMUD). Initial sites with probing depth (PD) > 4 mm were randomly assigned to receive the test (ICG-aPDT with an 810 nm diode laser) or the control treatment (off-mode aPDT) one and four weeks after FMUD. Clinical parameters were registered after 3 and 6 months. The presence of the main periodontal pathogens in subgingival samples was assessed with real-time PCR. RESULTS Both treatment modalities resulted in significant clinical improvements at 3 and 6 months. The only significant differences in favour of the test group were found at 6 months for a higher PD reduction in initial deep pockets (PD ≥ 6 mm) and a higher percentage of closed pockets (PD ≤ 4 mm/no bleeding on probing). Limited microbiological changes were observed in both groups after treatment with no inter-group difference, except for a more significant reduction in Aggregatibacter actinomycetemcomitans and Parvimonas micra levels in the test group at 3 months. CONCLUSION The combination of repeated ICG-aPDT and FMUD provided no benefits except for selective clinical and microbiological improvements compared to FMUD alone. CLINICAL RELEVANCE Based on the obtained results, only limited adjunctive effects could be found for the combined use of ICG-aPDT and FMUD. Further, well-designed RCT with larger sample sizes are required to confirm these findings. TRIAL REGISTRATION ClinicalTrials.gov NCT04671394.
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Affiliation(s)
- Marco Annunziata
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Giovanna Donnarumma
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Agostino Guida
- U.O.C. Odontostomatologia, A.O.R.N. "A. Cardarelli", Naples, Italy
| | - Livia Nastri
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Gerardo Persico
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Alessandra Fusco
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Ignacio Sanz-Sánchez
- Etiology and Therapy of Periodontal and Peri-Implant Diseases (ETEP) Research Group, University Complutense, Madrid, Spain.
| | - Luigi Guida
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania "Luigi Vanvitelli", Naples, Italy
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Luengo F, Sanz-Esporrín J, Sanz-Sánchez I, Solonko M, Herrera D, Sanz M. Clinical, microbiological and biochemical impact of a supportive care protocol with an air-polishing device, after surgical treatment of peri-implantitis: Randomized clinical trial. Clin Oral Implants Res 2023; 34:378-392. [PMID: 36789504 DOI: 10.1111/clr.14049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 01/07/2023] [Accepted: 02/03/2023] [Indexed: 02/16/2023]
Abstract
OBJECTIVES The aim of the present study was to evaluate the efficacy of a supportive peri-implant care (SPIC) protocol after surgical therapy of peri-implantitis, combining ultrasonic mechanical debridement and glycine powder air polishing. MATERIALS AND METHODS Thirty subjects diagnosed with peri-implantitis and treated by means of access flap were randomized 6 months later into two different SPIC groups: the test group combined a piezoelectric ultrasonic instrumentation with a specific implant PEEK tip and glycine powder air polishing, while control group received the same ultrasonic instrumentation together with a rubber cup and a polishing paste. Patients were followed for 12 months, with intermediate SPIC visits every 3 months. Clinical, radiological, microbiological and biochemical outcome variables were registered and calculated. RESULTS After 12 months of SPIC, probing depths (PD) showed a mean reduction of 0.33 ± 0.11 mm, with significant differences (p < .001) between the test (-0.84 ± 0.43 mm) and the control group (+0.18 ± 0.73 mm). Healthy peri-implant tissues defined by PD <5 mm, absence of BoP (or in only one site around the implant), and no additional bone loss (<0.5 mm), were observed at the final visit in 83% of the implants (87% in the test group and 80% in the control group, p = .255). No adverse events were reported by the subjects participating in the study. CONCLUSIONS The SPIC protocol including mechanical ultrasonic debridement and glycine powder air-polishing demonstrated significantly better efficacy in terms of PD reductions. A strict SPIC protocol can maintain for 1 year, or even improve, the results obtained after surgical treatment of peri-implantitis.
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Affiliation(s)
- Fernando Luengo
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, University Complutense, Madrid, Spain
| | - Javier Sanz-Esporrín
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, University Complutense, Madrid, Spain
| | - Ignacio Sanz-Sánchez
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, University Complutense, Madrid, Spain
| | - Myroslav Solonko
- Section of Periodontology, Faculty of Odontology, University Complutense, Madrid, Spain
| | - David Herrera
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, University Complutense, Madrid, Spain
| | - Mariano Sanz
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, University Complutense, Madrid, Spain
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Urban I, Montero E, Sanz-Sánchez I, Palombo D, Monje A, Tommasato G, Chiapasco M. Minimal invasiveness in vertical ridge augmentation. Periodontol 2000 2023; 91:126-144. [PMID: 36700299 DOI: 10.1111/prd.12479] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/11/2022] [Accepted: 05/15/2022] [Indexed: 01/27/2023]
Abstract
Vertical ridge augmentation is one of the most challenging procedures in implant dentistry because of the advanced skills required by the operator and the fact that bone augmentation is aimed outside the bony contour, in an environment of reduced blood supply. What is more, the flap management required to ensure soft tissue closure frequently leads to associated comorbidities in terms of swelling and hematomas. For these reasons, and even if autologous onlay block grafts are still the gold standard, new techniques and biomaterials have favored the development of potentially less invasive approaches. The present work evaluates the most recent strategies in vertical ridge augmentation to reduce invasiveness and complications, including diagnostic/treatment planning considerations, surgical techniques, digital tools (eg, customized titanium meshes/membranes or bone blocks), and future trends in the field of tissue engineering and cell therapy.
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Affiliation(s)
- Istvan Urban
- Department of Periodontics and Oral Medicine, University of Michigan, Ann Arbor, Michigan, USA.,Private Practice, Budapest, Hungary
| | - Eduardo Montero
- ETEP (Etiology and Therapy of Periodontal and Peri-Implant Diseases) Research Group, University Complutense, Madrid, Spain.,Section of Postgraduate Periodontology, University Complutense, Madrid, Spain
| | - Ignacio Sanz-Sánchez
- ETEP (Etiology and Therapy of Periodontal and Peri-Implant Diseases) Research Group, University Complutense, Madrid, Spain.,Section of Postgraduate Periodontology, University Complutense, Madrid, Spain
| | - David Palombo
- Section of Postgraduate Periodontology, University Complutense, Madrid, Spain
| | - Alberto Monje
- Department of Periodontics and Oral Medicine, University of Michigan, Ann Arbor, Michigan, USA.,Department of Periodontology, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Grazia Tommasato
- Unit of Oral Surgery, Department of Biomedical, Surgical, and Dental Sciences, A.O. Santi Paolo & Carlo, Dental Clinic, University of Milan, Milan, Italy
| | - Matteo Chiapasco
- Unit of Oral Surgery, Department of Biomedical, Surgical, and Dental Sciences, A.O. Santi Paolo & Carlo, Dental Clinic, University of Milan, Milan, Italy
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10
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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11
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Shi JY, Montero E, Wu XY, Palombo D, Wei SM, Sanz-Sánchez I. Bone preservation or augmentation simultaneous with or prior to dental implant placement: A systematic review of outcomes and outcome measures used in clinical trials in the last 10 years. Clin Oral Implants Res 2022; 34 Suppl 25:68-83. [PMID: 35817421 DOI: 10.1111/clr.13953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 03/07/2022] [Accepted: 04/03/2022] [Indexed: 11/28/2022]
Abstract
AIM To evaluate outcome measures and methods of assessment in clinical studies on bone augmentation/preservation procedures for the placement of dental implants. MATERIALS AND METHODS A systematic search was performed on three databases from January 2011 to April 2021 to identify clinical studies reporting on any type of bone augmentation/preservation procedure. The outcomes that have been used to assess efficacy or performance in each study were registered and assigned to different domains (group of outcomes). The review followed the Preferred Reporting Items for Systematic Review and Meta-Analyses statement. RESULTS Seven-hundred and eighty-three publications were included. Only 81.8% of the papers had a clear definition of their primary outcome. The rate of complications (59.3%), implant survival (58.2%), 3D radiographic bone gain/change (30%), marginal bone level (MBL; 29%), and histological outcomes (25.5%) were the most frequently reported outcome domains. The most commonly used primary outcome was 3D radiographic bone gain/change (25.8%), followed by implant survival (13.0%). Patient-reported outcome measures (PROMs) were reported in 15.7% of studies. Differences in the reported outcomes were observed among different types of bone preservation/augmentation interventions (i.e., alveolar ridge preservation, immediate implants, horizontal and/or vertical ridge augmentation, and sinus floor augmentation). CONCLUSION Within the past decade, great heterogeneity was observed among the outcomes considered in studies evaluating bone preservation/augmentation procedures. Three-dimensional radiographic bone gain/change was the most routinely reported main outcome variable, while PROMs were rarely reported.
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Affiliation(s)
- Jun-Yu Shi
- Shanghai PerioImplant Innovation Center, Department Oral and Maxillofacial Implantology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,College of Stomatology, Shanghai Jiao Tong University, Shanghai, China.,National Center for Stomatology, Shanghai, China.,National Clinical Research Center for Oral Diseases, Shanghai, China.,Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Eduardo Montero
- Section of Post-Graduate Periodontology-Faculty of Odontology, University Complutense, Madrid, Spain.,Etiology and Therapy of Periodontal and Peri-Implant Diseases (ETEP) Research Group, University Complutense, Madrid, Spain
| | - Xin-Yu Wu
- Shanghai PerioImplant Innovation Center, Department Oral and Maxillofacial Implantology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - David Palombo
- Section of Post-Graduate Periodontology-Faculty of Odontology, University Complutense, Madrid, Spain
| | - Shi-Min Wei
- Shanghai PerioImplant Innovation Center, Department Oral and Maxillofacial Implantology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ignacio Sanz-Sánchez
- Section of Post-Graduate Periodontology-Faculty of Odontology, University Complutense, Madrid, Spain.,Etiology and Therapy of Periodontal and Peri-Implant Diseases (ETEP) Research Group, University Complutense, Madrid, Spain
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12
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Shi JY, Montero E, Wu XY, Palombo D, Wei SM, Sanz-Sánchez I. Bone preservation or augmentation simultaneous with or prior to dental implant placement: A systematic review of outcomes and outcome measures used in clinical trials in the last 10 years. J Clin Periodontol 2022; 50 Suppl 25:67-82. [PMID: 35815430 DOI: 10.1111/jcpe.13626] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 03/07/2022] [Accepted: 04/03/2022] [Indexed: 11/27/2022]
Abstract
AIM To evaluate outcome measures and methods of assessment in clinical studies on bone augmentation/preservation procedures for the placement of dental implants. MATERIALS AND METHODS A systematic search was performed on three databases from January 2011 to April 2021 to identify clinical studies reporting on any type of bone augmentation/preservation procedure. The outcomes that have been used to assess efficacy or performance in each study were registered and assigned to different domains (group of outcomes). The review followed the Preferred Reporting Items for Systematic Review and Meta-Analyses statement. RESULTS Seven-hundred and eighty-three publications were included. Only 81.8% of the papers had a clear definition of their primary outcome. The rate of complications (59.3%), implant survival (58.2%), 3D radiographic bone gain/change (30%), marginal bone level (MBL; 29%), and histological outcomes (25.5%) were the most frequently reported outcome domains. The most commonly used primary outcome was 3D radiographic bone gain/change (25.8%), followed by implant survival (13.0%). Patient-reported outcome measures (PROMs) were reported in 15.7% of studies. Differences in the reported outcomes were observed among different types of bone preservation/augmentation interventions (i.e., alveolar ridge preservation, immediate implants, horizontal and/or vertical ridge augmentation, and sinus floor augmentation). CONCLUSION Within the past decade, great heterogeneity was observed among the outcomes considered in studies evaluating bone preservation/augmentation procedures. Three-dimensional radiographic bone gain/change was the most routinely reported main outcome variable, while PROMs were rarely reported.
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Affiliation(s)
- Jun-Yu Shi
- Shanghai PerioImplant Innovation Center, Department Oral and Maxillofacial Implantology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,College of Stomatology, Shanghai Jiao Tong University, Shanghai, China.,National Center for Stomatology, Shanghai, China.,National Clinical Research Center for Oral Diseases, Shanghai, China.,Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Eduardo Montero
- Section of Post-Graduate Periodontology-Faculty of Odontology, University Complutense, Madrid, Spain.,Etiology and Therapy of Periodontal and Peri-Implant Diseases (ETEP) Research Group, University Complutense, Madrid, Spain
| | - Xin-Yu Wu
- Shanghai PerioImplant Innovation Center, Department Oral and Maxillofacial Implantology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - David Palombo
- Section of Post-Graduate Periodontology-Faculty of Odontology, University Complutense, Madrid, Spain
| | - Shi-Min Wei
- Shanghai PerioImplant Innovation Center, Department Oral and Maxillofacial Implantology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ignacio Sanz-Sánchez
- Section of Post-Graduate Periodontology-Faculty of Odontology, University Complutense, Madrid, Spain.,Etiology and Therapy of Periodontal and Peri-Implant Diseases (ETEP) Research Group, University Complutense, Madrid, Spain
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13
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Montero E, Molina A, Matesanz P, Monje A, Sanz-Sánchez I, Herrera D. Efficacy of soft tissue substitutes, in comparison with autogenous grafts, in surgical procedures aiming to increase the peri-implant keratinized mucosa: A systematic review. Clin Oral Implants Res 2022; 33 Suppl 23:32-46. [PMID: 35763018 DOI: 10.1111/clr.13751] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/22/2021] [Accepted: 03/01/2021] [Indexed: 12/30/2022]
Abstract
OBJECTIVES The aim of this systematic review was to evaluate the efficacy of soft tissue substitutes compared to autogenous gingival grafts in surgical procedures aimed at increasing the width of keratinized mucosa (KM) around dental implants. MATERIALS AND METHODS Two focused questions were developed: PICOS #1) "What is the efficacy of surgical procedures using soft tissue substitutes, as compared to autogenous grafts, to increase the amount of peri-implant keratinized mucosa, in randomized clinical trials (RCTs) and controlled clinical trials (CCTs)?"; and PICOS #2) "What is the effectiveness of soft tissue substitutes to increase the amount of peri-implant keratinized mucosa, in RCTs, CCTs, cohort studies or case series?". Besides KM augmentation, other relevant outcomes such as clinical and radiographic peri-implant outcomes, incidence of biological complications, surgical time, or patient-reported outcome measures (PROMs) were collected. Meta-analyses were performed whenever possible. RESULTS Ten publications and an unpublished study were included. KM augmentation was significantly greater for autogenous grafts (n = 6; weighted mean difference (WMD) = -0.9 mm; 95% confidence interval (CI) [-1.4; -0.3]; p = .001). However, no significant differences between autogenous grafts and soft tissue substitutes were observed when exclusively xenografts were considered (n = 5; WMD=-0.8 mm; 95% CI [-1.6; 0.0]; p = .062). Surgical time and postsurgical pain seemed to be reduced by the use of soft tissue substitutes. CONCLUSIONS Free gingival grafts (FGG) are more effective in the augmentation of KM mucosa around dental implants than soft tissue substitutes. However, substitutes of xenogeneic origin may be an alternative to autogenous tissues.
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Affiliation(s)
- Eduardo Montero
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases), Research Group, University Complutense of Madrid, Madrid, Spain
| | - Ana Molina
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases), Research Group, University Complutense of Madrid, Madrid, Spain
| | - Paula Matesanz
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases), Research Group, University Complutense of Madrid, Madrid, Spain
| | - Alberto Monje
- Department of Periodontology, Universidad Internacional de Catalunya, Barcelona, Spain.,Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - Ignacio Sanz-Sánchez
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases), Research Group, University Complutense of Madrid, Madrid, Spain
| | - David Herrera
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases), Research Group, University Complutense of Madrid, Madrid, Spain
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14
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Jung RE, Becker K, Bienz SP, Dahlin C, Donos N, Hammächer C, Iglhaut G, Liñares A, Ortiz-Vigón A, Sanchez N, Sanz-Sánchez I, Thoma DS, Valles C, Weng D, Nart J. Effect of peri-implant mucosal thickness on esthetic outcomes and the efficacy of soft tissue augmentation procedures: Consensus report of group 2 of the SEPA/DGI/OF workshop. Clin Oral Implants Res 2022; 33 Suppl 23:100-108. [PMID: 35763020 PMCID: PMC9543632 DOI: 10.1111/clr.13955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 05/06/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The aim of this study was to comprehensively assess the literature in terms of the effect of peri-implant mucosal thickness on esthetic outcomes and the efficacy of soft tissue augmentation procedures to increase the mucosal thickness with autogenous grafts or soft tissue substitutes. MATERIAL AND METHODS Two systematic reviews (SR) were performed prior to the consensus meeting to assess the following questions. Review 1, focused question: In systemically healthy patients with an implant-supported fixed prosthesis, what is the influence of thin as compared to thick peri-implant mucosa on esthetic outcomes? Review 2, focused question 1: In systemically healthy humans with at least one dental implant (immediate or staged implant), what is the efficacy of connective tissue graft (CTG), as compared to absence of a soft tissue grafting procedure, in terms of gain in peri-implant soft tissue thickness (STT) reported by randomized controlled clinical trials (RCTs) or controlled clinical trials (CCTs)? Review 2, focused question 2: In systemically healthy humans with at least one dental implant (immediate or staged implant), what is the efficacy of CTG, as compared to soft tissue substitutes, in terms of gain in peri-implant STT reported by RCTs or CCTs? The outcomes of the two SRs, the consensus statements, the clinical implications, and the research recommendations were discussed and subsequently approved at the consensus meeting during the group and plenary sessions. CONCLUSIONS There was a tendency of superior esthetic outcomes in the presence of a thick mucosa. The connective tissue graft remains the standard of care in terms of increasing mucosa thickness.
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Affiliation(s)
- Ronald E Jung
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Kathrin Becker
- Department of Orthodontics, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Stefan P Bienz
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Christer Dahlin
- Department of Biomaterials, Institute for Surgical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Nikos Donos
- Centre for Oral Clinical Research, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | | | - Gerhard Iglhaut
- Department of Oral and Craniomaxillofacial Surgery, Translational Implantology, Center for Dental Medicine, University Medical Center of Freiburg, Freiburg, Germany.,Private Center of Oral Surgery, Memmingen, Germany
| | - Antonio Liñares
- Periodontology Unit, Faculty of Odontology, University of Santiago de Compostela & Medical-Surgical Dentistry Research Group, Health Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
| | | | - Nerea Sanchez
- Section of Graduate Periodontology, University Complutense, Madrid, Spain.,ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, School of Dentistry, University Complutense, Madrid, Spain
| | - Ignacio Sanz-Sánchez
- Section of Graduate Periodontology, University Complutense, Madrid, Spain.,ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, School of Dentistry, University Complutense, Madrid, Spain
| | - Daniel S Thoma
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Cristina Valles
- Department of Periodontology, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Dietmar Weng
- Department of Prosthodontics, Propaedeutics and Dental Materials, School of Dentistry, Christian-Albrechts University, Kiel, Germany
| | - José Nart
- Department of Periodontology, Universitat Internacional de Catalunya, Barcelona, Spain
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15
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Molina A, Sanz-Sánchez I, Sanz-Martín I, Ortiz-Vigón A, Sanz M. Complications in sinus lifting procedures: Classification and management. Periodontol 2000 2022; 88:103-115. [PMID: 35103321 DOI: 10.1111/prd.12414] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Open and closed sinus lifting procedures are predictable methods to augment the bone needed for appropriate implant placement in the posterior maxilla in cases where available bone is limited. However, these techniques may give rise to complications and associated comorbidities. In the case of open sinus lifting, perforation of the Schneiderian membrane during osteotomy is the most common complication, with an incidence rate of around 20%-25%. Apart from those complications associated with oral surgery in general (such as swelling or hematoma), there are specific complications of open sinus lifting procedures that may arise less frequently (chronic rhinosinusitis, hemorrhage, or ostium blockage by overfilling) but which may nevertheless compromise the viability of the graft and/or the implants and cause substantial discomfort to the patient. Closed sinus lifting is a less invasive approach that allows transcrestal placement of the implants in cases where there is sufficient residual bone height. However, it may also be associated with specific complications, including membrane perforation, benign paroxysmal positional vertigo, and implant displacement to the sinus cavity. New technologies have been proposed to reduce these complications and comorbidities associated with conventional sinus lifting procedures, such as the use of piezoelectric devices and hydraulic sinus lift or reamer burs. The evidence supporting their effectiveness and safety, however, is still lacking. A detailed medical history together with a thorough radiographic and clinical examination are essential prior to any kind of bone regenerative augmentation involving the maxillary sinus. Moreover, it is recommended to employ the most appropriate surgical technique for the specific characteristics of the case and, at the same time, accommodating the experience and skills of the surgeon.
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Affiliation(s)
- Ana Molina
- Section of Graduate Periodontology, School of Dentistry, University Complutense, Madrid, Spain.,ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, University Complutense, Madrid, Spain
| | - Ignacio Sanz-Sánchez
- Section of Graduate Periodontology, School of Dentistry, University Complutense, Madrid, Spain.,ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, University Complutense, Madrid, Spain
| | - Ignacio Sanz-Martín
- Section of Graduate Periodontology, School of Dentistry, University Complutense, Madrid, Spain
| | - Alberto Ortiz-Vigón
- Section of Graduate Periodontology, School of Dentistry, University Complutense, Madrid, Spain
| | - Mariano Sanz
- Section of Graduate Periodontology, School of Dentistry, University Complutense, Madrid, Spain.,ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, University Complutense, Madrid, Spain
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16
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Sanz-Sánchez I, Sanz-Martín I, Ortiz-Vigón A, Molina A, Sanz M. Complications in bone-grafting procedures: Classification and management. Periodontol 2000 2022; 88:86-102. [PMID: 35103322 DOI: 10.1111/prd.12413] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Bone-regenerative interventions aiming to restore deficient alveolar ridges, such as the use of block grafts or through the application of guided bone-regeneration principles, have reported positive outcomes in the published scientific literature. These interventions, however, are invasive, and hence, intraoperative and/or postoperative complications may occur. The types of complications and their severity may vary from the exposure of the biomaterial (membrane or graft) to postsurgical infections, neurosensorial disturbances, occurrence of hemorrhage, and pain, etc. The aim of the present narrative review was to search the available scientific evidence concerning the incidence of these complications, their effect on treatment outcomes, their clinical management and, finally, strategies aimed at prevention. Exposure of the barrier membrane or the block graft is the most common complication associated with oral regenerative interventions. To manage these complications, depending on the extent of the exposure and the presence or absence of concomitant infections, therapeutic measures may vary, from the topical application of antiseptics to the removal of the barrier membrane or the block graft. Regardless of their treatment, the occurrence of these complications has been associated with patient selection, with compliant patients (eg, nonsmokers) having a lower reported incidence of complications. Similarly, surgical factors such as correct flap elevation and a tensionless closure are of obvious importance. Finally, to prevent the incidence of complications, it appears prudent to utilize whenever possible less invasive surgical interventions.
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Affiliation(s)
- Ignacio Sanz-Sánchez
- Section of Graduate Periodontology, University Complutense, Madrid, Spain.,Etiology and Therapy of Periodontal and Peri-Implant Diseases (ETEP) Research Group, University Complutense, Madrid, Spain
| | | | | | - Ana Molina
- Section of Graduate Periodontology, University Complutense, Madrid, Spain.,Etiology and Therapy of Periodontal and Peri-Implant Diseases (ETEP) Research Group, University Complutense, Madrid, Spain
| | - Mariano Sanz
- Section of Graduate Periodontology, University Complutense, Madrid, Spain.,Etiology and Therapy of Periodontal and Peri-Implant Diseases (ETEP) Research Group, University Complutense, Madrid, Spain
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17
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Serrano B, Sanz-Sánchez I, Serrano K, Montero E, Sanz M. One-year outcomes of dental implants with a hybrid surface macro-design placed in patients with history of periodontitis: A randomized clinical trial. J Clin Periodontol 2021; 49:90-100. [PMID: 34881442 DOI: 10.1111/jcpe.13575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 11/07/2021] [Accepted: 11/12/2021] [Indexed: 11/28/2022]
Abstract
AIM To evaluate the radiological, clinical, and microbiological outcomes of implants with a hybrid surface macro-design in patients with a history of periodontitis. MATERIAL AND METHODS The study was designed as a 12-month, parallel-arm, randomized controlled trial where patients with a history of treated periodontitis in need of dental implants for single-unit or short-span prosthesis were randomly allocated to a test [implants with a machined titanium surface in the coronal collar (hybrid; HS)] or a control group [conventional implants with moderately rough surface up to the implant shoulder (RS)]. Patients were followed at 3, 6, and 12 months after loading with assessment of radiological, clinical, and microbiological outcomes, as well as patient-related outcome measures (PROMs). RESULTS Forty patients were randomly assigned to either the RS group (n = 20) or the HS (n = 20) group. At 1 year, the mean marginal bone level changes were 0.22 [standard deviation (SD) 0.36] mm for the HS group and 0.22 (SD 0.29) mm for the RS group, with no significant differences between them (p = .961). Similarly, no significant differences in clinical, microbiological, or PROMs were observed between groups. CONCLUSIONS HS implants demonstrated radiographic, clinical, and microbiological characteristics equal to RS implants in patients with a history of periodontitis. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov (identifier NCT05010382).
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Affiliation(s)
- Benjamín Serrano
- Section of Post-Graduate Periodontology-Faculty of Odontology, University Complutense, Madrid, Spain
| | - Ignacio Sanz-Sánchez
- Section of Post-Graduate Periodontology-Faculty of Odontology, University Complutense, Madrid, Spain.,Etiology and Therapy of Periodontal and Peri-Implant Diseases (ETEP) Research Group, University Complutense, Madrid, Spain
| | - Katherine Serrano
- Section of Post-Graduate Periodontology-Faculty of Odontology, University Complutense, Madrid, Spain
| | - Eduardo Montero
- Section of Post-Graduate Periodontology-Faculty of Odontology, University Complutense, Madrid, Spain.,Etiology and Therapy of Periodontal and Peri-Implant Diseases (ETEP) Research Group, University Complutense, Madrid, Spain
| | - Mariano Sanz
- Section of Post-Graduate Periodontology-Faculty of Odontology, University Complutense, Madrid, Spain.,Etiology and Therapy of Periodontal and Peri-Implant Diseases (ETEP) Research Group, University Complutense, Madrid, Spain
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18
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Montero E, Molina A, Palombo D, Morón B, Pradíes G, Sanz-Sánchez I. Efficacy and risks of tooth-supported prostheses in the treatment of partially edentulous patients with stage IV periodontitis. A systematic review and meta-analysis. J Clin Periodontol 2021; 49 Suppl 24:182-207. [PMID: 34786742 DOI: 10.1111/jcpe.13482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 02/26/2021] [Accepted: 03/31/2021] [Indexed: 01/08/2023]
Abstract
AIM The aim was to evaluate the efficacy and effectiveness of tooth-supported fixed prostheses in partially edentulous patients with stage IV periodontitis. MATERIAL AND METHODS Randomized and controlled clinical trials (RCTs and CCTs) and prospective/retrospective cohort studies or case series were searched in three databases. Survival rate of abutment teeth was considered the primary outcome. Meta-analyses were performed whenever possible. RESULTS Twenty-four publications were included. No RCTs or CCTs compared the efficacy of tooth-supported fixed prostheses between patients with severe periodontitis or non-periodontitis patients. Most of the data retrieved were derived from case series. The incidence of abutment-tooth loss after a follow-up period from 2 to 35.4 years was low (n = 17 studies; weighted mean incidence (WMI) = 4.8%; confidence interval (CI) [3.2, 6.5]). The corresponding figure for prostheses failure was WMI = 6.9% (n = 18; 95% CI [4.1, 9.7]). Technical complications seemed to be more frequent than biological complications (caries, endodontic failure, root fracture, etc.). Periodontal outcomes tended to remain stable over time. CONCLUSION Tooth-supported fixed prostheses seemed to be a valid treatment approach to restore masticatory function in patients with stage IV periodontitis once periodontal therapy has been accomplished. However, the comparative efficacy of this treatment among periodontitis and non-periodontitis patients is unclear due to the absence of clinical trials.
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Affiliation(s)
| | - Ana Molina
- Universidad Complutense de Madrid, Madrid, Spain
| | | | - Belén Morón
- Universidad Complutense de Madrid, Madrid, Spain
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19
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González Regueiro I, Martínez Rodriguez N, Barona Dorado C, Sanz-Sánchez I, Montero E, Ata-Ali J, Duarte F, Martínez-González JM. Surgical approach combining implantoplasty and reconstructive therapy with locally delivered antibiotic in the treatment of peri-implantitis: A prospective clinical case series. Clin Implant Dent Relat Res 2021; 23:864-873. [PMID: 34651432 DOI: 10.1111/cid.13049] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 09/12/2021] [Accepted: 09/13/2021] [Indexed: 01/20/2023]
Abstract
BACKGROUND Nonsurgical treatment, resective surgery, reconstructive surgery, or combined approaches have been proposed for the treatment of peri-implantitis, with variable results. PURPOSE To evaluate the 1-year clinical and radiographic outcomes following combined resective and reconstructive surgical treatment with topical piperacillin/tazobactam antibiotic in the management of peri-implantitis. MATERIAL AND METHODS Forty-three patients diagnosed with peri-implantitis were included. Surgical treatment consisted of implantoplasty of the supra-crestal component of the defect, the application of a topical antibiotic solution over the implant surface, and subsequent reconstruction of the intra-osseous component of the peri-implant defect. The primary outcome was disease resolution, defined as the absence of bleeding on probing (BoP) and/or suppuration on probing (SoP), a peri-implant pocket probing depth (PPD) ≤5 mm, and no bone loss >0.5 mm 1 year after surgery. Secondary outcomes included changes in BoP, PPD, SoP, and peri-implant marginal bone levels. One implant per patient was included in the analysis. RESULTS The treatment success rate of the 43 dental implants included in the study was 86% at 1 year after surgery. Mean PPD and BoP decreased from 6.41 ± 2.11 mm and 100% at baseline to 3.19 ± 0.99 mm (p < 0.001) and 14% (p < 0.001) at 1 year, respectively. SoP was significantly reduced from 48.8% at baseline to 0% 1 year after surgery (p < 0.001). Radiographically, a mean defect fill of 2.64 ± 1.59 mm was recorded (p < 0.001). CONCLUSIONS The combination of a resective and reconstructive surgical approach together with locally delivered antibiotic achieved a high disease resolution rate after 1 year of follow-up and constitutes a viable option for the management of peri-implantitis.
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Affiliation(s)
| | | | | | - Ignacio Sanz-Sánchez
- Etiology and Therapy of Periodontal and Peri-Implant Diseases (ETEP) Research Group, University Complutense, Madrid, Spain
| | - Eduardo Montero
- Etiology and Therapy of Periodontal and Peri-Implant Diseases (ETEP) Research Group, University Complutense, Madrid, Spain
| | - Javier Ata-Ali
- Faculty of Health Sciences, Department of Dentistry, Universidad Europea de Valencia, Valencia, Spain.,Public Dental Health Service, Conselleria de Sanitat Universal i Salut Pública, Generalitat Valenciana, Valencia, Spain.,Department of Surgery and Medical-Surgical Specialities, Area of Orthodontics, University Medical and Dental School, University of Oviedo (Spain), Instituto Asturiano de Odontologia, Oviedo, Spain
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20
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Sanz-Martín I, Cha JK, Sanz-Sánchez I, Figuero E, Herrera D, Sanz M. Changes in peri-implant soft tissue levels following surgical treatment of peri-implantitis: A systematic review and meta-analysis. Clin Oral Implants Res 2021; 32 Suppl 21:230-244. [PMID: 34642993 DOI: 10.1111/clr.13840] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 07/29/2021] [Accepted: 08/02/2021] [Indexed: 11/27/2022]
Abstract
AIM To assess the changes in peri-implant soft tissue levels after the surgical treatment of peri-implantitis. METHODS Randomized controlled trials, controlled clinical trials, cohort studies and case series, evaluating the changes in the position of the mucosal margin before and after surgical treatment of peri-implantitis, were searched. Secondary outcomes were changes in keratinized mucosa (KM), radiographic bone levels, probing depths (PD), plaque indices, bleeding on probing and patient perception. Meta-analyses were performed to determine weighted mean differences (WMD) or effects (WME). RESULTS Twenty-six articles, reporting 20 investigations, were included. Reconstructive approaches yielded significantly less increase in mucosal recession, when compared to access flaps (n = 3, WMD = -1.35 mm, 95% confidence interval [CI] [-2.62; -0.07], p = .038). When comparing among reconstructive surgical interventions similar outcomes were observed irrespective of the use of a barrier membrane (n = 3, WMD = -0.01 mm, 95% CI [-0.15; 0.13], p = .917). When considering the effects over time, limited mucosal recession was observed after reconstructive procedures (n = 23, WME = 0.389 mm, 95% CI [0.204; 0.574]), p = .001), while increased recession was reported with either resective or access flap surgery (n = 6, WME = 1.21 mm, 95% CI [0.70; 1.72], p = <.001; and n = 3, WME = 0.95 mm, 95% CI [0.20; 2.10], p = .106; respectively). When resective and reconstructive approaches were combined the highest values on peri-implant recession were reported (n = 2, WME = 1.97 mm, 95% CI [0.81; 3.14], p < .001). Reconstructive surgical interventions were associated with greater radiographic bone level gains, while similar values were reported for PD reduction when comparing reconstructive, access and resective procedures. CONCLUSIONS Resective surgical procedures were associated with significant post-surgical recession while minimal recession was observed in regenerative interventions.
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Affiliation(s)
- Ignacio Sanz-Martín
- Private Practice, Lausanne, Switzerland.,Department of Periodontology, Research Institute for Periodontal Regeneration, Yonsei University College of Dentistry, Seoul, South Korea
| | - Jae-Kook Cha
- Department of Periodontology, Research Institute for Periodontal Regeneration, Yonsei University College of Dentistry, Seoul, South Korea
| | - Ignacio Sanz-Sánchez
- Department of Dental Clinical Specialties, University Complutense of Madrid, Madrid, Spain.,ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, University Complutense of Madrid, Madrid, Spain
| | - Elena Figuero
- Department of Dental Clinical Specialties, University Complutense of Madrid, Madrid, Spain.,ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, University Complutense of Madrid, Madrid, Spain
| | - David Herrera
- Department of Dental Clinical Specialties, University Complutense of Madrid, Madrid, Spain.,ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, University Complutense of Madrid, Madrid, Spain
| | - Mariano Sanz
- Department of Dental Clinical Specialties, University Complutense of Madrid, Madrid, Spain.,ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, University Complutense of Madrid, Madrid, Spain
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21
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Thoma DS, Cosyn J, Fickl S, Jensen SS, Jung RE, Raghoebar GM, Rocchietta I, Roccuzzo M, Sanz M, Sanz-Sánchez I, Scarlat P, Schou S, Stefanini M, Strasding M, Bertl K. WITHDRAWN: Consensus Report of Working Group 2: Soft Tissue Management. Clin Oral Implants Res 2021; 32 Suppl 21:174-180. [PMID: 34145925 PMCID: PMC8596754 DOI: 10.1111/clr.13798] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 06/10/2021] [Indexed: 11/28/2022]
Abstract
Objectives The task of working Group 2 at the 6th Consensus Meeting of the European Association for Osseointegration was to comprehensively assess the effects of soft tissue augmentation procedures at dental implant sites on clinical, radiographic and patient‐reported outcome measures (PROMs) including an overview on available outcome measures and methods of assessment. Materials and methods Three systematic reviews and one critical review were performed in advance on (i) the effects of soft tissue augmentation procedures on clinical, radiographic and aesthetic outcomes, (ii) reliability and validity of outcome measures and methods of assessment and (iii) PROMs applied in clinical studies for soft tissue augmentation procedures at dental implant sites. Major findings, consensus statements, clinical recommendations and implications for future research were discussed in the group and approved during the plenary sessions. Results The four reviews predominantly revealed: Soft tissue augmentation procedures in conjunction with immediate and delayed implant placement result in superior aesthetic outcomes compared to no soft tissue augmentation in the zone of aesthetic priority. Soft tissue augmentation procedures have a limited effect on marginal bone level changes compared to implant sites without soft tissue augmentation. Clinically relevant parameters (gingival index, mucosal recession) and plaque control improve at implant sites when the width of keratinised mucosa is increased. A variety of aesthetic indices have been described with good reliability. Pink Esthetic Score and Complex Esthetic Index are the most validated aesthetic indices for single implants, though. Superimposed digital surface scans are most accurate to assess profilometric tissue changes. PROMs following soft tissue augmentation procedures have been assessed using various forms of questionnaires. Soft tissue augmentation had a limited effect on PROMs.
Conclusions Soft tissue augmentation procedures are widely applied in conjunction with implant therapy. Depending on the indication of these interventions, clinical, radiographic and aesthetic outcomes may improve, whereas the effect on PROMs is limited.
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Affiliation(s)
- Daniel S Thoma
- Clinic of Reconstructive Dentistry, University of Zurich, Zurich, Switzerland
| | - Jan Cosyn
- Faculty of Medicine and Health Sciences, Oral Health Sciences, Department of Periodontology and Oral Implantology, Ghent University, Ghent, Belgium.,Faculty of Medicine and Pharmacy, Oral Health Research Group (ORHE), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Stefan Fickl
- Private Practice, Fürth, Germany.,Division of Periodontology, University of Würzburg, Würzburg, Germany
| | - Simon S Jensen
- Department of Oral and Maxillofacial Surgery, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark.,Department of Oral and Maxillofacial Surgery, School of Dentistry, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ronald E Jung
- Clinic of Reconstructive Dentistry, University of Zurich, Zurich, Switzerland
| | - Gerry M Raghoebar
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Isabella Rocchietta
- Department of Periodontology, UCL Eastman Dental Institute, University College London, London, England
| | - Mario Roccuzzo
- Private Practice, Torino, Italy.,Division of Maxillofacial Surgery, University of Torino, Torino, Italy
| | - Mariano Sanz
- Department of Dental Clinical Specialities, School of Dentistry, Complutense University of Madrid, Madrid, Spain
| | - Ignacio Sanz-Sánchez
- ETEP (Etiology and Therapy of Periodontal and Peri-Implant Diseases) Research Group, University Complutense of Madrid, Madrid, Spain
| | | | - Soren Schou
- Department of Periodontology, School of Dentistry, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Martina Stefanini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Malin Strasding
- Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Kristina Bertl
- Department of Periodontology, Faculty of Odontology, University of Malmö, Malmö, Sweden.,Division of Oral Surgery, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
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22
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Alarcón MA, Sanz-Sánchez I, López-Pacheco A, Tavelli L, Galarraga-Vinueza ME, Schwarz F, Romanelli H, Peredo L, Pannuti CM, Javer E, Vieira AF, Montealegre M, Galindo R, Umanzor V, Treviño A, Fretes-Wood P, Cisneros M, Collins JR, Bueno L, Gimenéz X, Málaga-Figueroa L, Sanz M. Ibero-Panamerican Federation of Periodontics Delphi study on the trends in diagnosis and treatment of peri-implant diseases and conditions: A Latin American consensus. J Periodontol 2021; 92:1697-1718. [PMID: 33851728 DOI: 10.1002/jper.21-0086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/26/2021] [Accepted: 04/05/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND The social diversity, heterogeneous culture, and inherent economic inequality factors in Latin America (LA) justify conducting a comprehensive analysis on the current status and future trends of peri-implant diseases and conditions. Thus, the aim of this Delphi study was to predict the future trends in the diagnosis and treatment of peri-implant diseases and conditions in LA countries for the year 2030. METHODS A Latin American steering committee and group of experts in implant dentistry validated a questionnaire including 64 questions divided into eight sections. The questionnaire was run twice with an interval of 45 days, with the results from the first round made available to all the participants in the second round. The results were expressed in percentages and data was analyzed describing the consensus level reached in each question. RESULTS A total of 221 experts were invited to participate in the study and a total 214 (96.8%) completed the two rounds. Moderate (65%-85%) to high consensus (≥ 85%) was reached in 51 questions (79.69%), except in the questions dealing with "prevalence", where no consensus was reached. High and moderate consensus was attained for all the questions in three fields (risk factors and indicators, diagnosis and treatment of peri-implant conditions and deficiencies, and prevention and maintenance). CONCLUSIONS The present study has provided relevant and useful information on the predictions in the diagnosis and treatment of peri-implant diseases with a high level of consensus among experts. Nevertheless, there is still a lack of agreement in certain domains.
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Affiliation(s)
- Marco Antonio Alarcón
- Academic Department of Clinical Stomatology, PerioImplant Research Group UPCH, Cayetano Heredia Peruvian University, Lima, Perú
| | - Ignacio Sanz-Sánchez
- ETEP (Etiology and Therapy of Periodontal and Peri-Implant Diseases) Research Group, University Complutense, Madrid, Spain
| | - Andrea López-Pacheco
- Academic Department of Clinical Stomatology, PerioImplant Research Group UPCH, Cayetano Heredia Peruvian University, Lima, Perú
| | - Lorenzo Tavelli
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | | | - Frank Schwarz
- Department of Oral Surgery and Implantology, Carolinum, Johann Wolfgang Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Hugo Romanelli
- Department of Periodontics, Faculty of Health Sciences, Maimónides University, Buenos Aires, Argentina
| | | | - Claudio Mendes Pannuti
- Department of Periodontology, School of Dentistry, University of São Paulo, São Paulo, SP, Brazil
| | - Enrique Javer
- Conservative Dentistry Department, Chair of Periodontology, Faculty of Dentistry, University of Chile, Santiago, Chile
| | - Andrés Felipe Vieira
- Assistant Professor of Periodontology Posgraduate Program, Pontificia Universidad Javeriana, Bogota, Colombia
| | | | - Roberto Galindo
- Posgraduate Periodontology and Oral Implantology, Universidad Francisco Marroquín, Ciudad de Guatemala, Guatemala
| | - Vilma Umanzor
- Private Practice, Periodontics and Implant Dentistry, Department of Social/Prevention, School of Dentistry, Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras
| | - Alejandro Treviño
- Postgraduate Studies and Research Division, Faculty of Dentistry, National Autonomous University of Mexico, UNAM, Mexico City, Mexico
| | | | - Marissa Cisneros
- Department of Periodontology, School of Dentistry, Universidad Interamericana de Panama, Panama City, Panama
| | - James R Collins
- Department of Periodontology, School of Dentistry, Pontificia Universidad Católica Madre y Maestra (PUCMM), Santo Domingo, Dominican Republic
| | - Luis Bueno
- Periodontics Department, School of Dentistry, Universidad de la República, Montevideo, Uruguay
| | - Xiomara Gimenéz
- PerioImplant Research Group UCV, University Central of Venezuelan, Caracas, Venezuela
| | - Lilian Málaga-Figueroa
- Academic Department of Clinical Stomatology, PerioImplant Research Group UPCH, Cayetano Heredia Peruvian University, Lima, Perú
| | - Mariano Sanz
- ETEP (Etiology and Therapy of Periodontal and Peri-Implant Diseases) Research Group, University Complutense, Madrid, Spain
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23
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Alarcón MA, Sanz-Sánchez I, Shibli JA, Treviño Santos A, Caram S, Lanis A, Jiménez P, Dueñas R, Torres R, Alvarado J, Avendaño A, Galindo R, Umanzor V, Shedden M, Invernizzi C, Yibrin C, Collins J, León R, Contreras L, Bueno L, López-Pacheco A, Málaga-Figueroa L, Sanz M. Delphi Project on the trends in Implant Dentistry in the COVID-19 era: Perspectives from Latin America. Clin Oral Implants Res 2021; 32:521-537. [PMID: 33595844 PMCID: PMC8014337 DOI: 10.1111/clr.13723] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 01/13/2021] [Accepted: 02/08/2021] [Indexed: 02/07/2023]
Abstract
AIM To establish trends in Implant Dentistry in Latin America in the COVID-19 pandemic. MATERIAL AND METHODS A steering committee and an advisory group of experts in Implant Dentistry were selected among eighteen countries. An open-ended questionnaire by Delphi methodology was validated including 64 questions, divided in 7 topics, concerning the various trends in dental implantology. The survey was conducted in two rounds, which provided the participants in the second round with the results of the first. The questionnaires were completed on August 2020, and the online meeting conference was held on September 2020. The final prediction was developed through consensus by a selected group of experts. RESULTS A total of 197 experts from Latin America answered the first and second questionnaire. In the first round, the established threshold for consensus (65%) was achieved in 30 questions (46.87%). In the second round, performed on average 45 days later, this level was achieved in 47 questions (73.43%). Consensus was completely reached on the item "Diagnostic" (100%), the field with the lowest consensus was "Demand for treatment with dental implants" (37.5%). CONCLUSIONS The present study in Latin America has provided relevant and useful information on the predictions in the education and practice of Implant Dentistry in the COVID-19 era. The consensus points toward a great confidence of clinicians in the biosecurity protocols used to minimize the risk of SARS-CoV-2 transmission. It is foreseen as an important change in education, with introduction of virtual reality and other simulation technologies in implant training.
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Affiliation(s)
- Marco Antonio Alarcón
- PerioImplant Research Group UPCH, Academic Department of Clinical Stomatology, Cayetano Heredia Peruvian University, Lima, Perú
| | - Ignacio Sanz-Sánchez
- ETEP (Etiology and Therapy of Periodontal and Peri-Implant Diseases) Research Group, University Complutense, Madrid, Spain
| | - Jamil Awad Shibli
- Department of Periodontology and Oral Implantology, Dental Research Division, Guaruhos University, Guarulhos, SP, Brazil
| | - Alejandro Treviño Santos
- Postgraduate Studies and Research Division, Faculty of Dentistry, National Autonomous University of Mexico, UNAM, Mexico City, Mexico
| | | | - Alejandro Lanis
- Private Practice, Santiago, Chile.,Department of Prosthodontics, Indiana University School of Dentistry, Indianapolis, IN, USA
| | | | - Ricardo Dueñas
- Centro de Investigaciones Odontológicas, School of Dentistry, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Ronald Torres
- Department of Diagnostic and Surgical Sciences, Faculty of Dentistry, University of Costa Rica, San José, Costa Rica
| | - Jacinto Alvarado
- Research Group GIRO, Department of Periodontology, University of Cuenca, Cuenca, Ecuador
| | | | - Roberto Galindo
- Posgraduate Periodontology and Oral Implantology, Universidad Francisco Marroquín, Ciudad de Guatemala, Guatemala
| | - Vilma Umanzor
- Periodontics and Implant Dentistry, Department of Social/Prevention, School of Dentistry, Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras
| | | | - Carlos Invernizzi
- Department of Research in Dentistry, Autonomous University of Asunción, Asunción, Paraguay
| | - Caroll Yibrin
- Universidad Central de Venezuela, Caracas, Venezuela
| | - James Collins
- Department of Periodontology, School of Dentistry, Pontificia Universidad Católica Madre y Maestra, Santo Domingo, Dominican Republic
| | - Roberto León
- Public Health and Dentistry Services Management Research Unit, Cayetano Heredia Peruvian University, Lima, Perú
| | | | - Luis Bueno
- Periodontics Department, School of Dentistry, Universidad de la República, Montevideo, Uruguay
| | - Andrea López-Pacheco
- PerioImplant Research Group UPCH, Academic Department of Clinical Stomatology, Section of Oral Implantology, Cayetano Heredia Peruvian University, Lima, Perú
| | - Lilian Málaga-Figueroa
- PerioImplant Research Group UPCH, Academic Department of Clinical Stomatology, Cayetano Heredia Peruvian University, Lima, Perú
| | - Mariano Sanz
- ETEP (Etiology and Therapy of Periodontal and Peri-Implant Diseases) Research Group, University Complutense, Madrid, Spain
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24
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Carral C, Flores-Guillén J, Figuero E, Rodrigo D, Sanz-Sánchez I, Llodra JC, Bravo M, Caffesse RG, Vallcorba N, Guerrero A, Bujaldón A, Herrera D. Peri-implant radiographic bone level and associated factors in Spain. J Clin Periodontol 2021; 48:805-815. [PMID: 33527462 DOI: 10.1111/jcpe.13437] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 01/04/2021] [Accepted: 01/22/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To evaluate radiographic bone level (RxBL) at dental implants and its associated factors in Spain. MATERIAL AND METHODS This cross-sectional study was performed by a network of sentinel dentists from regions of Spain. RxBL was defined as the distance from the implant shoulder to the first clearly visible contact between the implant surface and the bone. Radiographic measurements were performed by two trained and experienced periodontists. Implant and patient data were also collected. Descriptive, bivariate, discriminative and multivariate analyses were done. RESULTS A total of 49 sentinel dentists provided data 275 patients. Mean RxBL from 474 implants (5-13 years) was 1.87 mm (range: 0.00-13.17 mm). Statistically significant associations between RxBL and clinical output variables (bleeding on probing, oedema, plaque, probing depth, suppuration, keratinized tissue) were found. In the multiple regression analysis, statistically significant associations for RxBL were found for smoking habit, implant diameter, years of follow-up and type of prosthesis (p < 0.01). CONCLUSIONS Peri-implant RxBL ranged from 0 to 13.17 mm. It was significantly associated with clinical output variables and with some potentially predictor variables, at patient- (smoking >10 cigarettes/day) and implant- (diameter, years of follow-up, Toronto bridge) levels.
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Affiliation(s)
- Cristina Carral
- Unit of Periodontology, Department of Estomatology, Santiago de Compostela University, Santiago de Compostela, Spain
| | - Juan Flores-Guillén
- Master in Periodontology, Faculty of Odontology, University Complutense of Madrid, Madrid, Spain
| | - Elena Figuero
- Expert Group for Peri-Implant Diseases, Sociedad Española de Periodoncia y Osteointegración (SEPA) Spanish Society of Periodontology and Osseointegration, Madrid, Spain.,ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, University Complutense, Madrid, Spain
| | - Daniel Rodrigo
- Expert Group for Peri-Implant Diseases, Sociedad Española de Periodoncia y Osteointegración (SEPA) Spanish Society of Periodontology and Osseointegration, Madrid, Spain
| | - Ignacio Sanz-Sánchez
- Expert Group for Peri-Implant Diseases, Sociedad Española de Periodoncia y Osteointegración (SEPA) Spanish Society of Periodontology and Osseointegration, Madrid, Spain.,ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, University Complutense, Madrid, Spain.,SEPA Foundation (Fundación SEPA de Periodoncia e Implantes Dentales), Madrid, Spain
| | - Juan Carlos Llodra
- Preventive and Community Dentistry, University of Granada, Granada, Spain
| | - Manuel Bravo
- Preventive and Community Dentistry, University of Granada, Granada, Spain
| | - Raul G Caffesse
- Expert Group for Peri-Implant Diseases, Sociedad Española de Periodoncia y Osteointegración (SEPA) Spanish Society of Periodontology and Osseointegration, Madrid, Spain
| | - Nuria Vallcorba
- SEPA Foundation (Fundación SEPA de Periodoncia e Implantes Dentales), Madrid, Spain
| | - Adrián Guerrero
- SEPA Foundation (Fundación SEPA de Periodoncia e Implantes Dentales), Madrid, Spain
| | - Antonio Bujaldón
- SEPA Foundation (Fundación SEPA de Periodoncia e Implantes Dentales), Madrid, Spain
| | - David Herrera
- Expert Group for Peri-Implant Diseases, Sociedad Española de Periodoncia y Osteointegración (SEPA) Spanish Society of Periodontology and Osseointegration, Madrid, Spain.,ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, University Complutense, Madrid, Spain.,SEPA Foundation (Fundación SEPA de Periodoncia e Implantes Dentales), Madrid, Spain
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Sanz-Martín I, Regidor E, Navarro J, Sanz-Sánchez I, Sanz M, Ortiz-Vigón A. Factors associated with the presence of peri-implant buccal soft tissue dehiscences: A case-control study. J Periodontol 2020; 91:1003-1010. [PMID: 31977079 DOI: 10.1002/jper.19-0490] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 10/12/2019] [Accepted: 12/21/2019] [Indexed: 11/08/2022]
Abstract
BACKGROUND To identify factors associated with the presence of buccal soft tissue dehiscences (BSTD). METHODS This cross-sectional observational study assessed 52 cases (CAS) with a minimum of 24 months of loading, with the presence of a BSTD, defined as an exposure of the prosthetic abutment, the implant neck or the implant surface in the anterior maxillae or mandible (premolar-premolar) and 52 carefully selected controls (CON) matched for age and years in function, being the only difference between groups the BSTD. Clinical parameters and radiographic findings from periapical radiographs and Cone Beam Computed Tomographies (CBCT) were analyzed to assess their association with the occurrence of BSTD using a multivariate regression model. RESULTS The CAS had a mean keratinzed mucosa (KM) of 1.65 ± 1.31 mm, whereas in the CON KM was 3.27 ± 1.28 mm (P = 0.001). Probing depths were similar in both groups, whereas bleeding on probing and plaque scores were higher in the CAS (P = 0.001). Mean bone level scores in the CAS were 1.71 ± 1.04 mm, and 1.27 ± 1.01 mm in CON (P = 0.143). The first bone to implant contact at the buccal aspect was 4.85 ± 3.12 mm in CAS and 2.15 ± 3.44 mm in CON (P = 0.001). CAS were 1.48 ± 0.93 mm outside the alveolar envelope, whereas the CON were 0.46 ± 0.77 mm. Implants buccally positioned in the CBCT's were 34 times more likely to belong to the case group. The presence of >2 mm of KM at the time of evaluation, presence of adjacent natural teeth, cemented restorations and two-piece implants were protective factors. CONCLUSION The bucco-palatal implant position was the most relevant factor related to the presence of BSTD.
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Affiliation(s)
- Ignacio Sanz-Martín
- Section of graduate Periodontology, Faculty of Odontology, University Complutense of Madrid, Madrid, Spain
| | - Erik Regidor
- ThinkingPerio Research, Periocentrum Bilbao, private practice, Bilbao, Spain
| | - Jordi Navarro
- ThinkingPerio Research, Periocentrum Bilbao, private practice, Bilbao, Spain
| | - Ignacio Sanz-Sánchez
- Section of graduate Periodontology, Faculty of Odontology, University Complutense of Madrid, Madrid, Spain
- ETEP (Etiology and Therapy of Periodontal diseases) Research Group, University Complutense of Madrid, Madrid, Spain
| | - Mariano Sanz
- Section of graduate Periodontology, Faculty of Odontology, University Complutense of Madrid, Madrid, Spain
- ETEP (Etiology and Therapy of Periodontal diseases) Research Group, University Complutense of Madrid, Madrid, Spain
| | - Alberto Ortiz-Vigón
- Section of graduate Periodontology, Faculty of Odontology, University Complutense of Madrid, Madrid, Spain
- ThinkingPerio Research, Periocentrum Bilbao, private practice, Bilbao, Spain
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Bollain J, Pulcini A, Sanz-Sánchez I, Figuero E, Alonso B, Sanz M, Herrera D. Efficacy of a 0.03% chlorhexidine and 0.05% cetylpyridinium chloride mouth rinse in reducing inflammation around the teeth and implants: a randomized clinical trial. Clin Oral Investig 2020; 25:1729-1741. [PMID: 32737664 DOI: 10.1007/s00784-020-03474-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 07/24/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To evaluate the efficacy of a 0.03% chlorhexidine (CHX) and 0.05% cetylpyridinium chloride (CPC) mouth rinse, as an adjunct to professional plaque removal (PPR) and mechanical hygiene, in the treatment of peri-implant mucositis (PiM) and gingivitis. MATERIAL AND METHODS Patients displaying PiM in, at least, one implant were included in this randomized, double-blinded, clinical trial. Subjects received PPR (at baseline and 6-month visits) and were instructed to rinse, twice daily, during 1 year with the tested mouth rinse or a placebo. Clinical and patient-reported outcomes were recorded at baseline and 6 and 12 months. RESULTS Fifty-four patients were included in the study and 46 attended the final visit. In the teeth and implants with inflammation, a higher reduction in BOP was observed in the test group. Statistically significant differences between groups were only observed in the lingual sites of the teeth with gingivitis (mean difference = 11.96%; 95% confidence interval [1.09; 22.83]; p = 0.03). Overall, compliance and satisfaction were good, even though staining were higher for the test group (p < 0.05). CONCLUSIONS The combined use of mechanical debridement with a 0.03% CHX and 0.05% CPC mouth rinse may have adjunctive benefits in the management of gingivitis, and it is associated with a higher degree of staining. CLINICAL RELEVANCE The control of gingivitis can be improved, after professional mechanical debridement, with toothbrushing and the supplementary use of a 0.03% CHX and 0.05% CPC mouth rinse at home. CLINICAL TRIAL REGISTRATION NUMBER NCT03533166.
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Affiliation(s)
- Juan Bollain
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, Faculty of Dentistry, University Complutense of Madrid, Madrid, Spain
| | - Alberto Pulcini
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, Faculty of Dentistry, University Complutense of Madrid, Madrid, Spain
| | - Ignacio Sanz-Sánchez
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, Faculty of Dentistry, University Complutense of Madrid, Madrid, Spain
| | - Elena Figuero
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, Faculty of Dentistry, University Complutense of Madrid, Madrid, Spain. .,Department of Dental Clinical Specialties, Faculty of Dentistry, Complutense University of Madrid, Plaza de Ramón y Cajal, s/n, 28040, Madrid, Spain.
| | - Bettina Alonso
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, Faculty of Dentistry, University Complutense of Madrid, Madrid, Spain
| | - Mariano Sanz
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, Faculty of Dentistry, University Complutense of Madrid, Madrid, Spain
| | - David Herrera
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, Faculty of Dentistry, University Complutense of Madrid, Madrid, Spain
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Jepsen S, Schwarz F, Cordaro L, Derks J, Hämmerle CHF, Heitz-Mayfield LJ, Hernández-Alfaro F, Meijer HJA, Naenni N, Ortiz-Vigón A, Pjetursson B, Raghoebar GM, Renvert S, Rocchietta I, Roccuzzo M, Sanz-Sánchez I, Simion M, Tomasi C, Trombelli L, Urban I. Regeneration of alveolar ridge defects. Consensus report of group 4 of the 15th European Workshop on Periodontology on Bone Regeneration. J Clin Periodontol 2019; 46 Suppl 21:277-286. [PMID: 31038223 DOI: 10.1111/jcpe.13121] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 04/19/2018] [Accepted: 04/22/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS Bone augmentation procedures to enable dental implant placement are frequently performed. The remit of this working group was to evaluate the current evidence on the efficacy of regenerative measures for the reconstruction of alveolar ridge defects. MATERIAL AND METHODS The discussions were based on four systematic reviews focusing on lateral bone augmentation with implant placement at a later stage, vertical bone augmentation, reconstructive treatment of peri-implantitis associated defects, and long-term results of lateral window sinus augmentation procedures. RESULTS A substantial body of evidence supports lateral bone augmentation prior to implant placement as a predictable procedure in order to gain sufficient ridge width for implant placement. Also, vertical ridge augmentation procedures were in many studies shown to be effective in treating deficient alveolar ridges to allow for dental implant placement. However, for both procedures the rate of associated complications was high. The adjunctive benefit of reconstructive measures for the treatment of peri-implantitis-related bone defects has only been assessed in a few RCTs. Meta-analyses demonstrated a benefit with regard to radiographic bone gain but not for clinical outcomes. Lateral window sinus floor augmentation was shown to be a reliable procedure in the long term for the partially and fully edentulous maxilla. CONCLUSIONS The evaluated bone augmentation procedures were proven to be effective for the reconstruction of alveolar ridge defects. However, some procedures are demanding and bear a higher risk for post-operative complications.
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Affiliation(s)
- Søren Jepsen
- Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, Bonn, Germany
| | - Frank Schwarz
- Department of Oral Surgery and Implantology, Carolinum, Johann Wolfgang Goethe-University, Frankfurt, Germany
| | - Luca Cordaro
- Department of Periodontics and Prosthodontics, Policlinico Umberto I, Eastman Dental Hospital, Rome, Italy
| | - Jan Derks
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Christoph H F Hämmerle
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, University of Zürich, Zurich, Switzerland
| | - Lisa J Heitz-Mayfield
- International Research Collaborative - Oral Health and Equity, School of Anatomy, Physiology and Human Biology, University of Western Australia, Perth, Western Australia, Australia
| | - Federico Hernández-Alfaro
- Department of Oral and Maxillofacial Surgery, International University of Catalonia, Barcelona, Spain
| | - Henny J A Meijer
- Department of Oral and Maxillofacial Surgery and Department of Implant Dentistry, University Medical Center Groningen, Groningen, The Netherlands
| | - Nadja Naenni
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, University of Zürich, Zurich, Switzerland
| | - Alberto Ortiz-Vigón
- ETEP (Etiology and Therapy of Periodontal Diseases) Research Group, University Complutense, Madrid, Spain
| | - Bjarni Pjetursson
- Department of Reconstructive Dentistry, University of Iceland, Reykjavik, Iceland
| | - Gerry M Raghoebar
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Stefan Renvert
- Oral Health Sciences, Kristianstad University, Kristianstad, Sweden
| | | | - Mario Roccuzzo
- Division of Maxillofacial Surgery, University of Torino, Torino, Italy
| | - Ignacio Sanz-Sánchez
- ETEP (Etiology and Therapy of Periodontal Diseases) Research Group, University Complutense, Madrid, Spain
| | - Massimo Simion
- Department of Periodontology, University of Milan, Milan, Italy
| | - Cristiano Tomasi
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Leonardo Trombelli
- Research Centre for the Study of Periodontal and Peri-implant Diseases University of Ferrara, Ferrara, Italy
| | - Istvan Urban
- Graduate Implant Dentistry, Loma Linda University, Loma Linda, California
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Pulcini A, Bollaín J, Sanz-Sánchez I, Figuero E, Alonso B, Sanz M, Herrera D. Clinical effects of the adjunctive use of a 0.03% chlorhexidine and 0.05% cetylpyridinium chloride mouth rinse in the management of peri-implant diseases: A randomized clinical trial. J Clin Periodontol 2019; 46:342-353. [PMID: 30779246 DOI: 10.1111/jcpe.13088] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 02/01/2019] [Accepted: 02/13/2019] [Indexed: 12/17/2022]
Abstract
AIM To evaluate the efficacy of a 0.03% chlorhexidine and 0.05% cetylpyridinium chloride mouth rinse, as an adjunct to professionally and patient-administered mechanical plaque removal, in the treatment of peri-implant mucositis (PiM). MATERIAL AND METHODS Patients displaying PiM in, at least, one implant were included in this randomized, double-blinded, clinical trial. Subjects received professional prophylaxis (baseline and 6 months) and were instructed to regular oral hygiene practices and to rinse, twice daily, with the test or placebo mouth rinses, during one year. Clinical, radiographic and microbiological outcomes were evaluated at baseline, 6 and 12 months. Disease resolution was defined as absence of bleeding on probing (BOP). Data were analysed by repeated measures ANOVA, Student's t and chi-square tests. RESULTS Fifty-four patients were included and 46 attended the final visit (22 in control and 24 in test group). In the test group, there was a 24.49% greater reduction in BOP at the buccal sites (95% confidence interval [3.65-45.34%]; p = 0.002) than in controls. About 58.3% of test implants and 50% controls showed healthy peri-implant tissues at final visit (p > 0.05). CONCLUSIONS The use of the test mouth rinse demonstrated some adjunctive benefits in the treatment of PiM. Complete disease resolution could not be achieved in every case.
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Affiliation(s)
- Alberto Pulcini
- ETEP (Etiology and Therapy of Periodontal Diseases) Research Group, University Complutense, Madrid, Spain
| | - Juan Bollaín
- ETEP (Etiology and Therapy of Periodontal Diseases) Research Group, University Complutense, Madrid, Spain
| | - Ignacio Sanz-Sánchez
- ETEP (Etiology and Therapy of Periodontal Diseases) Research Group, University Complutense, Madrid, Spain
| | - Elena Figuero
- ETEP (Etiology and Therapy of Periodontal Diseases) Research Group, University Complutense, Madrid, Spain
| | - Bettina Alonso
- ETEP (Etiology and Therapy of Periodontal Diseases) Research Group, University Complutense, Madrid, Spain
| | - Mariano Sanz
- ETEP (Etiology and Therapy of Periodontal Diseases) Research Group, University Complutense, Madrid, Spain
| | - David Herrera
- ETEP (Etiology and Therapy of Periodontal Diseases) Research Group, University Complutense, Madrid, Spain
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Urban IA, Montero E, Monje A, Sanz-Sánchez I. Effectiveness of vertical ridge augmentation interventions: A systematic review and meta-analysis. J Clin Periodontol 2019; 46 Suppl 21:319-339. [DOI: 10.1111/jcpe.13061] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 12/15/2018] [Accepted: 01/06/2019] [Indexed: 01/02/2023]
Affiliation(s)
- Istvan A. Urban
- Department of Implant Dentistry; University of Loma Linda; Loma Linda California
| | - Eduardo Montero
- ETEP (Etiology and Therapy of Periodontal Diseases) Research Group; University Complutense; Madrid Spain
| | - Alberto Monje
- Department of Periodontology; School of Dentistry; International University of Catalonia; Barcelona Spain
- Department of Oral Surgery and Stomatology; ZMK School of Dentistry; University of Bern; Bern Switzerland
| | - Ignacio Sanz-Sánchez
- ETEP (Etiology and Therapy of Periodontal Diseases) Research Group; University Complutense; Madrid Spain
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Schwarz F, Messias A, Sanz-Sánchez I, Carrillo de Albornoz A, Nicolau P, Taylor T, Beuer F, Schär A, Sader R, Guerra F, Sanz M. Influence of implant neck and abutment characteristics on peri-implant tissue health and stability. Oral reconstruction foundation consensus report. Clin Oral Implants Res 2019; 30:588-593. [PMID: 31006157 DOI: 10.1111/clr.13439] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 04/11/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of this consensus meeting was to assess the influence of implant neck and abutment characteristics on peri-implant tissue health and stability. MATERIAL AND METHODS Group and plenary discussions were based on two systematic reviews focusing on the effect of titanium implants with different collar designs/surface modifications and the abutment material on the stability of marginal bone levels (MBLs), peri-implant health, and survival rates. RESULTS The changes in MBLs were not influenced by the abutment material and were also similar at one- and two-piece implants after one year of loading. Rough collar implants improved MBLs in comparison to machined collar implants. Additional modifications of the collar had no beneficial clinical effect on MBLs. Titanium abutments were associated with significantly higher increases in bleeding on probing when compared with zirconia abutments. CONCLUSION MBLs are mainly influenced by the microstructure (i.e., rough surfaced) of the implant neck. Consensus statements and specific recommendations for future research were elaborated during the consensus meeting.
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Affiliation(s)
- Frank Schwarz
- Department of Oral Surgery and Implantology, Carolinum, Johann Wolfgang Goethe-University, Frankfurt, Germany
| | - Ana Messias
- Department of Dentistry, Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal
| | | | | | - Pedro Nicolau
- Department of Dentistry, Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal
| | - Tom Taylor
- Department of Reconstructive Sciences, University of Connecticut School of Dental Medicine, Farmington, Connecticut
| | - Florian Beuer
- Department of Prosthodontics, Charité University Medicine, Berlin, Germany
| | - Alex Schär
- Oral Reconstruction Foundation, Basel, Switzerland
| | - Robert Sader
- Department for Oral, Cranio-Maxillofacial and Facial Plastic Surgery, Medical Center of the Goethe University, Frankfurt, Germany
| | - Fernando Guerra
- Department of Dentistry, Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal
| | - Mariano Sanz
- Section of Graduate Periodontology, University Complutense, Madrid, Spain
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Sanz-Martín I, Cha JK, Yoon SW, Sanz-Sánchez I, Jung UW. Long-term assessment of periodontal disease progression after surgical or non-surgical treatment: a systematic review. J Periodontal Implant Sci 2019; 49:60-75. [PMID: 31098328 PMCID: PMC6494769 DOI: 10.5051/jpis.2019.49.2.60] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 03/18/2019] [Accepted: 04/14/2019] [Indexed: 12/14/2022] Open
Abstract
The primary aim of this systematic review was to assess the evidence on periodontal disease progression after treatment in patients receiving supportive periodontal therapy (SPT) and to identify predictors of clinical attachment level (CAL) loss. A protocol was developed to answer the following focused question: In adult patients treated for periodontitis, what is the disease progression in terms of CAL loss after surgical or non-surgical treatment? Randomized controlled clinical trials, prospective cohort studies, and longitudinal observational human studies with a minimum of 5 years of follow-up after surgical or non-surgical treatment that reported CAL and probing depth changes were selected. Seventeen publications reporting data from 14 investigations were included. Data from 964 patients with a follow-up range of 5-15 years was evaluated. When the CAL at the latest follow-up was compared to the CAL after active periodontal therapy, 10 of the included studies reported an overall mean CAL loss of ≤0.5 mm, 3 studies reported a mean CAL loss of 0.5-1 mm, and 4 studies reported a mean CAL loss of >1 mm. Based on 7 publications, the percentage of sites showing a CAL loss of ≥2 mm varied from 3% to 20%, and a high percentage of sites with CAL loss was associated with poor oral hygiene, smoking, and poor compliance with SPT. The outcomes after periodontal therapy remained stable over time. Disease progression occurred in a reduced number of sites and patients, mostly associated with poor oral hygiene, poor compliance with SPT, and smoking.
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Affiliation(s)
- Ignacio Sanz-Martín
- Section of Graduate Periodontology, Faculty of Odontology, University Complutense of Madrid, Madrid, Spain
| | - Jae-Kook Cha
- Department of Periodontology, Research Institute for Periodontal Regeneration, Yonsei University College of Dentistry, Seoul, Korea
| | - Sung-Wook Yoon
- Department of Periodontology, Research Institute for Periodontal Regeneration, Yonsei University College of Dentistry, Seoul, Korea
| | - Ignacio Sanz-Sánchez
- Section of Graduate Periodontology, Faculty of Odontology, University Complutense of Madrid, Madrid, Spain.,Etiology and Therapy of Periodontal Diseases (ETEP) Research Group, University Complutense of Madrid, Madrid, Spain
| | - Ui-Won Jung
- Department of Periodontology, Research Institute for Periodontal Regeneration, Yonsei University College of Dentistry, Seoul, Korea
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Sanz-Sánchez I, Oteo-Calatayud J, Serrano J, Martín C, Herrera D. Changes in plaque and gingivitis levels after tooth bleaching: A systematic review. Int J Dent Hyg 2019; 17:117-129. [PMID: 30609262 DOI: 10.1111/idh.12382] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 11/27/2018] [Accepted: 01/02/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The primary aim of this systematic review was to evaluate the effect of external tooth-bleaching products on plaque indices and to compare it to a placebo or a negative control. METHODS A protocol was developed aimed to answer the next focused question: What is the effect of tooth bleaching compared to no treatment or a placebo, in subjects without periodontitis aged ≥18 years in the levels of plaque and gingivitis? Two electronic databases were used as sources in the search for studies satisfying the inclusion criteria: (a) The National Library of Medicine (MEDLINE via PubMed); (b) Cochrane Central Register of Controlled Trials. RESULTS Only randomized controlled trials were included. The initial search found 382 potential publications. Seven of them were finally included, and six were used in the meta-analyses. The use of bleaching products showed higher reductions in plaque (n = 6; standardized mean difference [SMD] = 0.47; 95% confidence interval [CI] = 0.06, 0.88; P < 0.001) and gingivitis indices (n = 4; SMD = 0.47; 95% CI = 0.22, 0.73; P < 0.001), when compared to a control group (no treatment or placebo). CONCLUSIONS External tooth bleaching is associated with statistically significant short-term reductions in plaque and gingivitis indices. However, no data were available to evaluate long-term effects.
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Affiliation(s)
- Ignacio Sanz-Sánchez
- ETEP (Etiology and Therapy of Periodontal Diseases) Research Group, University Complutense, Madrid, Spain
| | - Jesús Oteo-Calatayud
- Department of Conservative Dentistry and Prosthesis, University Complutense, Madrid, Spain
| | - Jorge Serrano
- ETEP (Etiology and Therapy of Periodontal Diseases) Research Group, University Complutense, Madrid, Spain
| | - Conchita Martín
- Department of Dental Clinical Specialties, University Complutense, Madrid, Spain
| | - David Herrera
- ETEP (Etiology and Therapy of Periodontal Diseases) Research Group, University Complutense, Madrid, Spain
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Sanz-Martín I, Encalada C, Sanz-Sánchez I, Aracil J, Sanz M. Soft tissue augmentation at immediate implants using a novel xenogeneic collagen matrix in conjunction with immediate provisional restorations: A prospective case series. Clin Implant Dent Relat Res 2018; 21:145-153. [DOI: 10.1111/cid.12696] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Revised: 09/20/2018] [Accepted: 10/10/2018] [Indexed: 11/28/2022]
Affiliation(s)
| | - Carolina Encalada
- Section of Graduate Periodontology; University Complutense; Madrid Spain
| | - Ignacio Sanz-Sánchez
- Section of Graduate Periodontology; University Complutense; Madrid Spain
- ETEP (Etiology and Therapy of Periodontal Diseases) Research Group; University Complutense; Madrid Spain
| | - Javier Aracil
- Section of Graduate Periodontology; University Complutense; Madrid Spain
| | - Mariano Sanz
- Section of Graduate Periodontology; University Complutense; Madrid Spain
- ETEP (Etiology and Therapy of Periodontal Diseases) Research Group; University Complutense; Madrid Spain
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Thoma DS, Naenni N, Figuero E, Hämmerle CHF, Schwarz F, Jung RE, Sanz-Sánchez I. Effects of soft tissue augmentation procedures on peri-implant health or disease: A systematic review and meta-analysis. Clin Oral Implants Res 2018; 29 Suppl 15:32-49. [PMID: 29498129 DOI: 10.1111/clr.13114] [Citation(s) in RCA: 184] [Impact Index Per Article: 30.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2017] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To review the dental literature in terms of soft tissue augmentation procedures and their influence on peri-implant health or disease in partially and fully edentulous patients. METHODS A MEDLINE search from 1966 to 2016 was performed to identify controlled clinical studies comparing soft tissue grafting versus no soft tissue grafting (maintenance) or two types of soft tissue grafting procedures at implant sites. The soft tissue grafting procedures included either an increase of keratinized tissue or an increase of the thickness of the peri-implant mucosa. Studies reporting on the peri-implant tissue health, as assessed by bleeding or gingival indices, were included in the review. The search was complemented by an additional hand search of all selected full-text articles and reviews published between 2011 and 2016. The initial search yielded a total number of 2,823 studies. Eligible studies were selected based on the inclusion criteria (finally included: four studies on gain of keratinized tissue; six studies on gain of mucosal thickness) and quality assessments conducted. Meta-analyses were applied whenever possible. RESULTS Soft tissue grafting procedures for gain of keratinized tissue resulted in a significantly greater improvement of gingival index values compared to maintenance groups (with or without keratinized tissue) [n = 2; WMD = 0.863; 95% CI (0.658; 1.067); p < .001]. For final marginal bone levels, statistically significant differences were calculated in favor of an apically positioned flap (APF) plus autogenous grafts versus all control treatments (APF alone; APF plus a collagen matrix; maintenance without intervention [with or without residual keratinized tissue]) [n = 4; WMD = -0.175 mm; 95% CI: (-0.313; -0.037); p = .013]. Soft tissue grafting procedures for gain of mucosal thickness did not result in significant improvements in bleeding indices over time, but in significantly less marginal bone loss over time [WMD = 0.110; 95% CI: 0.067; 0.154; p < .001] and a borderline significance for marginal bone levels at the study endpoints compared to sites without grafting. CONCLUSIONS Within the limitations of this review, it was concluded that soft tissue grafting procedures result in more favorable peri-implant health: (i) for gain of keratinized mucosa using autogenous grafts with a greater improvement of bleeding indices and higher marginal bone levels; (ii) for gain of mucosal thickness using autogenous grafts with significantly less marginal bone loss.
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Affiliation(s)
- Daniel S Thoma
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, University of Zurich, Zurich, Switzerland
| | - Nadja Naenni
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, University of Zurich, Zurich, Switzerland
| | - Elena Figuero
- Section of Graduate Periodontology, University Complutense, Madrid, Spain.,ETEP (Etiology and Therapy of Periodontal Diseases) Research Group, University Complutense, Madrid, Spain
| | - Christoph H F Hämmerle
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, University of Zurich, Zurich, Switzerland
| | - Frank Schwarz
- Department of Oral Surgery, Universitätsklinikum Düsseldorf, Düsseldorf, Germany.,Department of Oral Surgery and Implantology, Carolinum, Johann Wolfgang Goethe-University Frankfurt, Frankfurt, Germany
| | - Ronald E Jung
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, University of Zurich, Zurich, Switzerland
| | - Ignacio Sanz-Sánchez
- Section of Graduate Periodontology, University Complutense, Madrid, Spain.,ETEP (Etiology and Therapy of Periodontal Diseases) Research Group, University Complutense, Madrid, Spain
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Sanz-Sánchez I, Carrillo de Albornoz A, Figuero E, Schwarz F, Jung R, Sanz M, Thoma D. Effects of lateral bone augmentation procedures on peri-implant health or disease: A systematic review and meta-analysis. Clin Oral Implants Res 2018; 29 Suppl 15:18-31. [PMID: 29498126 DOI: 10.1111/clr.13126] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2017] [Indexed: 12/24/2022]
Abstract
OBJECTIVES This systematic review evaluated the evidence on the effect of the interventions aimed for lateral ridge augmentation (both simultaneously with implant placement or as a staged procedure) on peri-implant health or disease. METHODS A protocol was developed to answer the following PICO question: "In patients with horizontal alveolar ridge deficiencies (population), what is the effect of lateral bone augmentation procedures (intervention and comparison) on peri-implant health (outcome)?" Included studies were randomised controlled trials or controlled clinical trials with a follow-up of at least 12 months after implant loading. Meta-analyses were performed whenever possible, including subgroup analysis based on follow-up. RESULTS Twelve final publications from eight investigations were included. The results from the meta-analysis indicated that irrespective of the type of intervention, the inflammatory changes, based on bleeding on probing (%) were minimal, both at short- (n = 1; weighted mean difference [WMD] = -1.00; 95% CI [-14.04; 12.04]; p = .881) and long-term (n = 5; WMD = -5.63; 95% CI [-18.42; 7.16]; p = .881). When comparing different treatment modalities, no significant differences were observed (n = 6; WMD = -3.36; 95% CI [-12.49; 5.77]; p < .471). Similarly, changes in probing pocket depth and marginal bone levels were not significantly different among groups. The incidence of peri-implantitis was evaluated in three investigations and varied from 16% to 26% after a follow-up period of 6-8 years. CONCLUSIONS The results from this systematic review and meta-analysis have shown that lateral ridge augmentation procedures can maintain peri-implant health over time with low mucosal inflammatory changes and a relatively small incidence of peri-implant bone loss.
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Affiliation(s)
- Ignacio Sanz-Sánchez
- Section of Graduate Periodontology, University Complutense, Madrid, Spain.,ETEP (Etiology and Therapy of Periodontal Diseases) Research Group, University Complutense, Madrid, Spain
| | | | - Elena Figuero
- Section of Graduate Periodontology, University Complutense, Madrid, Spain.,ETEP (Etiology and Therapy of Periodontal Diseases) Research Group, University Complutense, Madrid, Spain
| | - Frank Schwarz
- Department of Oral Surgery, Universitätsklinikum Düsseldorf, Düsseldorf, Germany.,Department of Oral Surgery and Implantology, Carolinum, Johann Wolfgang Goethe-University Frankfurt, Frankfurt, Germany
| | - Ronald Jung
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, University of Zurich, Zurich, Switzerland
| | - Mariano Sanz
- Section of Graduate Periodontology, University Complutense, Madrid, Spain.,ETEP (Etiology and Therapy of Periodontal Diseases) Research Group, University Complutense, Madrid, Spain
| | - Daniel Thoma
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, University of Zurich, Zurich, Switzerland
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Sanz-Sánchez I, Sanz-Martín I, Carrillo de Albornoz A, Figuero E, Sanz M. Biological effect of the abutment material on the stability of peri-implant marginal bone levels: A systematic review and meta-analysis. Clin Oral Implants Res 2018; 29 Suppl 18:124-144. [DOI: 10.1111/clr.13293] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 05/05/2018] [Accepted: 05/08/2018] [Indexed: 12/25/2022]
Affiliation(s)
- Ignacio Sanz-Sánchez
- Section of Graduate Periodontology; University Complutense; Madrid Spain
- ETEP (Etiology and Therapy of Periodontal Diseases) Research Group; University Complutense; Madrid Spain
| | | | | | - Elena Figuero
- Section of Graduate Periodontology; University Complutense; Madrid Spain
- ETEP (Etiology and Therapy of Periodontal Diseases) Research Group; University Complutense; Madrid Spain
| | - Mariano Sanz
- Section of Graduate Periodontology; University Complutense; Madrid Spain
- ETEP (Etiology and Therapy of Periodontal Diseases) Research Group; University Complutense; Madrid Spain
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Sanz-Martín I, Sanz-Sánchez I, Carrillo de Albornoz A, Figuero E, Sanz M. Effects of modified abutment characteristics on peri-implant soft tissue health: A systematic review and meta-analysis. Clin Oral Implants Res 2017; 29:118-129. [PMID: 29072346 PMCID: PMC6084371 DOI: 10.1111/clr.13097] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2017] [Indexed: 12/24/2022]
Abstract
Objectives The purpose of this systematic review was to evaluate the impact of the abutment characteristics on peri‐implant tissue health and to identify the most suitable material and surface characteristics. Methods A protocol was developed aimed to answer the following focused question: “Which is the effect of the modification of the abutment design in regard to the maintenance of the peri‐implant soft tissue health?” Further subanalysis aimed to investigate the impact of the abutment material, macroscopic design, surface topography and surface manipulation. Randomised controlled trials (RCTs) with a follow‐up of at least 6 months after implant loading were considered as inclusion criteria. Meta‐analyses were performed whenever possible. Results Nineteen final publications from thirteen investigations were included. The results from the meta‐analysis indicated that zirconia abutments (Zi) experienced less increase in BOP values over time [n = 3; WMD = −26.96; 95% CI (−45.00; −8.92); p = .003] and less plaque accumulation [n = 1; MD = −20.00; 95% CI (−41.47; 1.47); p = .068] when compared with titanium abutments (Ti). Bone loss was influenced by the method of abutment decontamination [n = 1; MD = −0.44; 95% CI (−0.65; −0.23); p < .001]. The rest of the studied outcomes did not show statistically significant differences. Conclusions The macroscopic design, the surface topography and the manipulation of the implant abutment did not have a significant influence on peri‐implant inflammation. In contrast, the abutment material demonstrated increased BOP values over time for Ti when compared to Zi abutments.
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Affiliation(s)
| | - Ignacio Sanz-Sánchez
- Section of Graduate Periodontology, University Complutense, Madrid, Spain.,ETEP (Etiology and Therapy of Periodontal Diseases) Research Group, University Complutense, Madrid, Spain
| | | | - Elena Figuero
- Section of Graduate Periodontology, University Complutense, Madrid, Spain.,ETEP (Etiology and Therapy of Periodontal Diseases) Research Group, University Complutense, Madrid, Spain
| | - Mariano Sanz
- Section of Graduate Periodontology, University Complutense, Madrid, Spain.,ETEP (Etiology and Therapy of Periodontal Diseases) Research Group, University Complutense, Madrid, Spain
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González-Serrano J, López-Pintor R, Sanz-Sánchez I, Paredes V, Elisabeth E, de Arriba L, Vallejo G. Surgical Treatment of a Peripheral Ossifying Fibroma and Reconstruction with a Porcine Collagen Matrix: A Case Report. INT J PERIODONT REST 2017; 37:443-449. [DOI: 10.11607/prd.2697] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Sanz-Martín I, Sanz-Sánchez I, Noguerol F, Cok S, Ortiz-Vigón A, Sanz M. Randomized controlled clinical trial comparing two dental implants with different neck configurations. Clin Implant Dent Relat Res 2017; 19:512-522. [DOI: 10.1111/cid.12482] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 12/26/2016] [Accepted: 02/04/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Ignacio Sanz-Martín
- Section of Post-graduate Periodontology, Faculty of Odontology; University Complutense of Madrid; Spain
| | - Ignacio Sanz-Sánchez
- Section of Post-graduate Periodontology, Faculty of Odontology; University Complutense of Madrid; Spain
| | - Fernando Noguerol
- Section of Post-graduate Periodontology, Faculty of Odontology; University Complutense of Madrid; Spain
| | - Susy Cok
- Section of Post-graduate Periodontology, Faculty of Odontology; University Complutense of Madrid; Spain
| | - Alberto Ortiz-Vigón
- Section of Post-graduate Periodontology, Faculty of Odontology; University Complutense of Madrid; Spain
| | - Mariano Sanz
- Section of Post-graduate Periodontology, Faculty of Odontology; University Complutense of Madrid; Spain
- ETEP (Etiology and Therapy of Periodontal Diseases) Research Group; University Complutense; Madrid Spain
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Molina A, Sanz-Sánchez I, Martín C, Blanco J, Sanz M. The effect of one-time abutment placement on interproximal bone levels and peri-implant soft tissues: a prospective randomized clinical trial. Clin Oral Implants Res 2016; 28:443-452. [PMID: 27016157 DOI: 10.1111/clr.12818] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To compare the effect of placing the definitive abutment at the time of implant placement versus at a later stage, on the soft and hard tissue changes around dental implants. MATERIAL AND METHODS Platform-switched implants were placed in the posterior maxilla or mandible of partial edentulous patients and they were randomized to receive the definitive abutment at the moment of implant placement, or 6-12 weeks later. Final prostheses were delivered 2-4 weeks later. Radiographic assessment of vertical bone level changes (primary outcome), clinical status of peri-implant tissues, changes in soft tissues margin, papilla filling, patient-related outcomes and adverse events were assessed 6 and 12 months after loading. RESULTS 60 implants were placed in 40 patients, replacing single or multiple absent teeth. One implant was lost 1 week after insertion (overall survival rate: 98.3%). A statistically significant greater bone resorption from surgery to 6 months post-loading was observed for those implants subjected to abutment change (control group: -1.24 ± 0.79 mm; test group: -0.61 ± 0.40 mm; P = 0.028). Periodontal clinical parameters and patient-related outcomes, however, did not demonstrate significant differences between groups at any time point. A significant increase in papilla height was observed from loading to 12 months in all implants (control group: 1.17 ± 1.47 mm; test group: 0.98 ± 0.89 mm) and a slight but not significant coronal migration of the gingival margin. CONCLUSIONS The connection and disconnection of healing abutments is associated with significantly increased bone loss during the healing period between implant placement and 6 months post-loading, when compared to one-time abutment placement.
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Affiliation(s)
- Ana Molina
- Section of Graduate Periodontology, University Complutense, Madrid, Spain
| | | | - Conchita Martín
- Section of Graduate Orthodontics, University Complutense, Madrid, Spain
| | - Juan Blanco
- Section of Graduate Periodontology, University of Santiago de Compostela, A Coruña, Spain
| | - Mariano Sanz
- Section of Graduate Periodontology, University Complutense, Madrid, Spain.,ETEP (Etiology and Therapy of Periodontal Diseases) Research Group, University Complutense, Madrid, Spain
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Sanz-Sánchez I, Ortiz-Vigón A, Herrera D, Sanz M. Microbiological effects and recolonization patterns after adjunctive subgingival debridement with Er:YAG laser. Clin Oral Investig 2015; 20:1253-61. [PMID: 26419675 DOI: 10.1007/s00784-015-1617-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 09/21/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The objective of this study was to assess the microbiological effects and recolonization patterns after non-surgical periodontal treatment protocol based on the adjunctive use of erbium-doped yttrium aluminium garnet (Er:YAG) laser. MATERIAL AND METHODS Patients diagnosed with chronic periodontitis were randomly assigned to two different treatment protocols: test, full-mouth subgingival ultrasonic instrumentation followed by Er-YAG laser application 1 week later to sites with initial probing pocket depth ≥4.5 mm; and control, full-mouth ultrasonic subgingival instrumentation within 1 week. Clinical (at sampled sites) and microbiological (culture-based) parameters were recorded at baseline and 3 and 12 months. Microbiological variables included total counts, frequency of detection, proportions and counts of target species. RESULTS Results from 19 test and 21 control patients were compared. Minor changes were observed for total colony-forming units, with no differences between groups. For the frequency of detection, a limited and similar impact in both groups was observed for the most prevalent (over 80 %) periodontal pathogens (Porphyromonas gingivalis, Prevotella intermedia, Fusobacterium nucleatum). For proportions, reductions in P. gingivalis occurred at 3 months, both in the test and control groups (from 16.3 to 10 % and 16 to 14.8 %, respectively), although these differences were not statistically significant. At 12 months, the test group showed a statistically significant greater reduction in probing depth for the sampled sites. CONCLUSIONS The adjunctive use of Er:YAG laser when compared with conventional ultrasonic debridement did not provide a microbiological added benefit. CLINICAL RELEVANCE Even though some clinical benefits with the adjunctive laser application were identified when comparing both treatment protocols, there were no differences in microbiological outcomes or in the bacterial recolonization patterns.
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Affiliation(s)
- Ignacio Sanz-Sánchez
- Postgraduate Clinic in Periodontology, Faculty of Odontology, Universidad Complutense de Madrid, Plaza Ramón y Cajal S/N., 28040, Madrid, Spain.
| | - Alberto Ortiz-Vigón
- Postgraduate Clinic in Periodontology, Faculty of Odontology, Universidad Complutense de Madrid, Plaza Ramón y Cajal S/N., 28040, Madrid, Spain
| | - David Herrera
- Postgraduate Clinic in Periodontology, Faculty of Odontology, Universidad Complutense de Madrid, Plaza Ramón y Cajal S/N., 28040, Madrid, Spain
- ETEP (Etiology and Therapy of Periodontal Diseases) Research Group, University Complutense, Madrid, Spain
| | - Mariano Sanz
- Postgraduate Clinic in Periodontology, Faculty of Odontology, Universidad Complutense de Madrid, Plaza Ramón y Cajal S/N., 28040, Madrid, Spain
- ETEP (Etiology and Therapy of Periodontal Diseases) Research Group, University Complutense, Madrid, Spain
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Sanz-Sánchez I, Sanz-Martín I, Figuero E, Sanz M. Clinical efficacy of immediate implant loading protocols compared to conventional loading depending on the type of the restoration: a systematic review. Clin Oral Implants Res 2015; 26:964-982. [PMID: 24917174 DOI: 10.1111/clr.12428] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2014] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVES Immediate loading has become a predictable option to restore all clinical situations. The aim of this systematic review was to assess whether immediate loading protocols achieve comparable clinical outcomes when compared to conventional loading protocols depending on the type of prosthetic restoration. METHODS A protocol was developed aimed to answer the following focused question: "What are the effects of immediate implant loading protocols compared to conventional implant loading, in terms of implant failure, marginal bone levels, and biological and mechanical complications based on the type of restoration?" The next subanalysis were performed as follows: the extent, type, and material of the restoration and the type of occlusal contact in function. This systematic review only included randomized controlled trials (RCTs) with a follow-up of at least 6 months after implant loading. RESULTS Thirty-seven final papers were included. The results from the meta-analyses have shown that the immediately loading implants demonstrated a statistically significant higher risk of implant failure [RR = 1.92; 95% CI (1.04; 3.54); P = 0.036], a statistically significant lower bone loss [WMD = 0.046; 95% CI (0.043; 0.049); P = 0.000] and a smaller increase in ISQ values [WMD = -1.096; 95% CI (-1.615; -0.577); P < 0.001, although both groups attained high survival rates (98.2% in the test and 99.6% in the control). Single teeth implants were greater risk of failure, when compared to immediately loaded full arch restorations (RR = 2 vs. 0.9), so as the occlusal pattern when compared to non-occlusal (RR = 1.9 vs. 1.4). CONCLUSIONS Immediate loading may impose a greater risk for implant failure when compared to conventional loading, although the survival rates were high for both groups.
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Affiliation(s)
| | | | - Elena Figuero
- Section of Graduate Periodontology, University Complutense, Madrid, Spain
- ETEP (Etiology and Therapy of Periodontal Diseases) Research Group, University Complutense, Madrid, Spain
| | - Mariano Sanz
- Section of Graduate Periodontology, University Complutense, Madrid, Spain
- ETEP (Etiology and Therapy of Periodontal Diseases) Research Group, University Complutense, Madrid, Spain
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Abstract
Lateral ridge augmentation procedures are aimed to reconstruct deficient alveolar ridges or to build up peri-implant dehiscence and fenestrations. The objective of this systematic review was to assess the efficacy of these interventions by analyzing data from 40 clinical studies evaluating bone augmentation through either the staged or the simultaneous approach. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guideline for systematic reviews was used. The primary outcomes were the changes at reentry, in the ridge width, and in the vertical and horizontal dimensions of the peri-implant defect, measured in millimeters, in the staged and simultaneous approaches, respectively. The results of the meta-analysis showed, for the simultaneous approach, a statistically significant defect height reduction when all treatments were analyzed together (weighted mean difference [WMD] = −4.28 mm; 95% confidence interval: [CI] –4.88, –3.69; P < 0.01). The intervention combining bone replacement grafts with barrier membranes was associated with superior outcomes The most frequently used intervention was the combination of xenograft and bioabsorbable membrane. Similarly, for the staged approach, there was a statistically significant horizontal gain when all treatment groups were combined (WMD = 3.90 mm; 95% CI: 3.52, 4.28; P < 0.001). The most frequently used intervention was the use of autogenous bone blocks. Both treatment strategies led to high survival and success rates (>95%) for the implants placed on the regenerated sites. Nonexposed sites gained significantly more in the simultaneous and staged approaches (WMD = 1.1 and 3.1 mm).
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Affiliation(s)
- I. Sanz-Sánchez
- Section of Graduate Periodontology, University Complutense, Madrid, Spain
| | - A. Ortiz-Vigón
- Section of Graduate Periodontology, University Complutense, Madrid, Spain
| | - I. Sanz-Martín
- Section of Graduate Periodontology, University Complutense, Madrid, Spain
| | - E. Figuero
- Section of Graduate Periodontology, University Complutense, Madrid, Spain
- ETEP (Etiology and Therapy of Periodontal Diseases) Research Group, University Complutense, Madrid, Spain
| | - M. Sanz
- Section of Graduate Periodontology, University Complutense, Madrid, Spain
- ETEP (Etiology and Therapy of Periodontal Diseases) Research Group, University Complutense, Madrid, Spain
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Sanz-Sánchez I, Ortiz-Vigón A, Matos R, Herrera D, Sanz M. Clinical Efficacy of Subgingival Debridement With Adjunctive Erbium:Yttrium-Aluminum-Garnet Laser Treatment in Patients With Chronic Periodontitis: A Randomized Clinical Trial. J Periodontol 2015; 86:527-35. [DOI: 10.1902/jop.2014.140258] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Polak D, Martin C, Sanz-Sánchez I, Beyth N, Shapira L. Are anti-inflammatory agents effective in treating gingivitis as solo or adjunct therapies? A systematic review. J Clin Periodontol 2015; 42 Suppl 16:S139-51. [DOI: 10.1111/jcpe.12340] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2014] [Indexed: 02/02/2023]
Affiliation(s)
- David Polak
- Department of Periodontology; Hebrew University-Hadassah Faculty of Dental Medicine; Jerusalem Israel
| | - Conchita Martin
- Department of Stomatology IV; Area of Orthodontics; Complutense University of Madrid; Madrid Spain
| | - Ignacio Sanz-Sánchez
- Department of Stomatology; Area of Periodontics; Complutense University of Madrid; Madrid Spain
| | - Nurit Beyth
- Department of Prosthodontics; Hebrew University-Hadassah Faculty of Dental Medicine; Jerusalem Isreal
| | - Lior Shapira
- Department of Periodontology; Hebrew University-Hadassah Faculty of Dental Medicine; Jerusalem Israel
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