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Impact of defect configuration on the clinical outcome following surgical regenerative therapy of peri-implantitis
Abstract
The present study aimed at investigating the impact of defect configuration on the clinical outcome of surgical regenerative therapy of peri-implantitis lesions using a natural bone mineral in combination with a collagen membrane (NBM+CM).
Twenty-seven patients (n=27 defects) exhibited three different types of peri-implantitis lesions including either Class Ib (buccal dehiscence+semicircumferential), Class Ic (buccal dehiscence+circumferential), or Class Ie (circumferential) intra-bony defects (n=9 defects per group). All defects were treated with access flap surgery and the application of NBM+CM.
At 6 and 12 months, Class Ie defects tended to reveal higher changes in the mean probing depth (PD) and clinical attachment level (CAL) values when compared with Class Ib and Class Ic groups. However, significant differences were only observed at 6 months (PD: 2.9 +/- 0.3 versus 1.4 +/- 0.5 versus 1.3 +/- 0.7 mm; CAL: 2.5 +/- 0.5 versus 0.9 +/- 0.8 versus 0.9 +/- 0.7 mm). Site-level analysis has pointed to lowest PD and CAL changes at the midbuccal aspect of Class Ib and Class Ic groups.
Defect configuration may have an impact on the clinical outcome following surgical regenerative therapy of peri-implantitis lesions. While Class Ie defects seem to be promising in conjunction with NBM+CM, Class Ib and Class Ic may be considered as unfavourable.
... 24,29,32,34,42,52,55,56 Up to 72% of the included patients were smokers. Studies were performed either in a university setting [15][16][17][18][19][20][21][22][23][24][25]30,[34][35][36][37][41][42][43][44]46,52,[54][55][56][57][58][59]61,64 and/or a hospital 23,[27][28][29]33 or a private practice 31,32,40,45,47,49,60,63 , but three did not specify the setting. 39,51,62 ...
... The surgical interventions described in the in cluded studies were subdivided into reconstructive 24,[32][33][34][38][39][40][41]45,47,49,[54][55][56][57]60,63,64 and non-reconstructive modalities. [15][16][17]19,21,22,25,28,30,36,42,43,52,59,61,62 The reconstructive group included all types of surgical procedures that sought to rebuild the lost marginal bone using biomaterials. ...
... Among the reconstructive modalities that were described, bone grafts included autogenous (n = 5) 24 23,34,41,54 In one study, titanium granules were used. 30 In some studies, a resorbable (n = 11) 35,38,41,45,46,[54][55][56][57][58]60,63 or nonresorbable (n = 2) membrane 24,32 was also employed. ...
Purpose: To assess the implant failure rate and clinical and radiographic outcomes of implants affected by peri-implantitis that received surgical treatment. Materials and methods: A systematic search was conducted of three databases (PubMed, Embase and Cochrane Library) to identify studies that examined implant failure and biological outcomes after surgical peri-implantitis treatment, including ≥ 10 patients and reporting on a follow-up period of at least 12 months. Data and risk of bias were assessed qualitatively and quantitively. Surgical modalities were subdivided into reconstructive, non-reconstructive and combined. Meta-analyses were performed for implant failure, marginal bone level and probing pocket depth at 12 and 36 months with the respective subset of available data for each time and endpoint. Results: A total of 45 studies with 3,463 treated implants were included in the quantitative evaluation. Meta-analyses revealed low implant failure rates of 1.2% (95% confidence interval 0.4%, −2.1%) and 4.2% (95% confidence interval 1.0%, −8.8%) at 12 and 36 months, respectively. No significant difference between the subgroups was observed at 12 months. At 36 months, reconstruct-ive modalities showed a significantly lower implant failure rate (1.0%; 95% confidence interval 0.0%, 5.0%; P = 0.04, χ 2 (1) = 4.1) compared to non-reconstructive modalities (8.0%; 95% confidence interval 2.0%, 18.0%). The mean probing pocket depth was 3.71 mm (95% confidence interval 3.48, 3.94 mm) at 12 months and 3.63 mm (95% confidence interval 3.02, 4.24 mm) at 36 months. The mean marginal bone loss was 3.31 mm (95% confidence interval 2.89, 3.74 mm) at 12 months and 2.38 mm (95% confidence interval 1.01, 3.74 mm) at 36 months. No significant differences between the modalities were observed for bleeding on probing after either of these time points. Cumulative interventions during supportive therapy were reported in 9% of the studies. Conclusion: Surgical treatment of peri-implantitis results in a low implant failure rate in the short and medium term. No differences were noted between the different interventions with regard to failure rate. Surrogate therapeutic endpoints were improved after treatment, without significant differences between the different modalities. Therapeutic success and/or disease resolution and cumulative interventions during supportive therapy are seldom reported in the literature, but limited long-term outcomes are documented consistently.
... In general, peri-implantitis bone defects exhibiting contained defects are prone to show favorable reconstructive/regenerative outcomes together with a consistent reduction in the pocket depth. 8,9 On the other hand, noncontained defects are discouraged from applying the principles of bone regeneration by means of using bone substitutes and/or barrier membranes. Despite these indications, the benefit provided by biomaterials in the reconstructive management of peri-implantitis bone defects remains unclear. ...
... In general, contained defects are prone to show favorable reconstructive outcomes when managed by means of regeneration. 8 Schwarz et al. 8 tested the effectiveness of reconstructive therapy by means of anorganic bovine bone and collagen membrane in three different scenarios, including buccal dehiscence + semicircumferential defects, buccal dehiscence + circumferential defects, or pure circumferential intrabony defects. At the 6-month follow-up, significant differences were noted in the PPD (mean difference approximately 1 mm) and clinical attachment level (mean difference approximately 1 mm), favoring the defects exhibiting a pure circumferential configuration. ...
... In general, contained defects are prone to show favorable reconstructive outcomes when managed by means of regeneration. 8 Schwarz et al. 8 tested the effectiveness of reconstructive therapy by means of anorganic bovine bone and collagen membrane in three different scenarios, including buccal dehiscence + semicircumferential defects, buccal dehiscence + circumferential defects, or pure circumferential intrabony defects. At the 6-month follow-up, significant differences were noted in the PPD (mean difference approximately 1 mm) and clinical attachment level (mean difference approximately 1 mm), favoring the defects exhibiting a pure circumferential configuration. ...
Peri‐implantitis is a pathogenic inflammatory condition characterized by progressive bone loss and clinical inflammation that may compromise the stability of dental implants. Therapeutic modalities have been advocated to arrest the disorder and to establish peri‐implant health. Reconstructive therapy is indicated for bone defects exhibiting contained/angular components. This therapeutic modality is based upon the application of the biological and technical principles of periodontal regeneration. Nonetheless, the comparative efficacy of reconstructive therapy and nonreconstructive modalities remains unclear. Therefore, the aim of this narrative review is to address major clinical concerns regarding the efficacy, effectiveness, and feasibility of using biomaterials in peri‐implantitis therapy. In particular, the use of bone grafting materials, barrier membranes, and biologics is comprehensively explored.
... Peri-implant osseous defects were estimated during the surgical procedure, following granulation tissue removal and implant surface mechanical decontamination. The defect morphology was classified into categories previously described by Schwarz et al. [18]; 7. ...
... The reconstructive peri-implantitis approach has been suggested as a feasible concept in the presence of PI-B defects [18], aiming to achieve bone regeneration, re-osseointegration, and, respectively, limit peri-implant mucosa recession occurrence [40]. Considering various PI-B defect types as one of the determining factors influencing treatment outcomes [18], an MB gain of 2 mm with 2.8 mm of PD reduction was obtained by performing this approach [41], which is in accordance with our gained results. ...
... The reconstructive peri-implantitis approach has been suggested as a feasible concept in the presence of PI-B defects [18], aiming to achieve bone regeneration, re-osseointegration, and, respectively, limit peri-implant mucosa recession occurrence [40]. Considering various PI-B defect types as one of the determining factors influencing treatment outcomes [18], an MB gain of 2 mm with 2.8 mm of PD reduction was obtained by performing this approach [41], which is in accordance with our gained results. However, according to the study of Schwarz et al. [18], as opposed to our results, Class Ib and Ic defects could make a less favorable biological environment for the BBS, resulting in a lower clinical outcome success after six months of treatment. ...
Background:
The present pilot study aimed to assess clinical and radiographic efficiencies of bovine bone substitute (BBS) merged with hyaluronic acid (HA) in peri-implantits reconstructive surgery.
Methods:
Peri-implantitis (diagnosed 6.03 ± 1.61 years of implant loading) bone defects were randomly treated either with BBS plus HA (test group) or BBS alone (control group). Clinical parameters including peri-implant probing depth (PPD), bleeding on probing (BOP), implant stability (ISQ), and radiographic changes in vertical and horizontal marginal bone (MB) levels were assessed at six months postoperatively. New temporary and permanent screw-retained crowns were made at two weeks and three months postoperatively. Data were analyzed using parametric and non-parametric tests.
Results:
In both groups, 75% of patients and 83% of implants achieved treatment success after six months (no BOP, PPD <5 mm, and no further MB loss). Clinical outcomes improved over time within groups; however, without significant difference between them. ISQ value obtained significant increases in the test compared to the control group at six months postoperatively (p < 0.05). The vertical MB gain was significantly greater in the test group compared to the control (p < 0.05).
Conclusions:
Short-term outcomes suggested that BBS merged with HA could improve clinical and radiographic outcomes in peri-implantitis reconstructive therapy.
... Two other studies used natural bone minerals with collagen membrane. 61,62 The detoxification methods used were 3% hydrogen peroxide and saline solution, 59,60 24% EDTA gel and saline solution, 63 implantoplasty and Er:YAG laser, 67 and saline solution only. 61 The Wohlfahrt et al study 63 used the submerged implant treatment, while the other four used a nonsubmerged technique. ...
... 61,62 The detoxification methods used were 3% hydrogen peroxide and saline solution, 59,60 24% EDTA gel and saline solution, 63 implantoplasty and Er:YAG laser, 67 and saline solution only. 61 The Wohlfahrt et al study 63 used the submerged implant treatment, while the other four used a nonsubmerged technique. The patients received ABs (azithromycin, amoxicillin, or metronidazole) and CHX mouthwash postsurgically in all studies. ...
... The effect of the intervention on BOP was reported by four out of five studies, which verified a significant reduction compared to before treatment. [59][60][61][62] Wohlfahrt et al 63 reported no difference between the two groups (intergroup) nor compared to the baseline (intragroup). None of the studies noted a statistical reduction between tested groups, except Schwarz et al. 61 The highest percentage reduction occurred in patients treated only with implantoplasty and saline solution (85.2% of reduction). ...
The goal of this overview was to systematically verify the best available literature on surgical and nonsurgical treatments of peri-implantitis to determine evidence-based treatment protocols for peri-implantitis. Three databases (MEDLINE/PubMed, Web of Science, and Cochrane Library/Evidence) were searched by two independent reviewers, including systematic reviews (SRs) that involved randomized controlled trials (RCTs). The search was limited to articles between January 2014 to January 2021 with an English language restriction. In total, 437 articles were initially found, of which only 34 were selected for full-text reading. Nine SRs were included in this study, enrolling 59 different RCTs. Some studies investigated both surgical and nonsurgical techniques, while others focused on only one approach or the other. In total, six of the studies included nonsurgical techniques, and eight included surgical techniques (ie, augmentative, regenerative, and corrective/resective techniques). Nonsurgical interventions appeared to offer some degree of clinical improvements, especially in bleeding on probing levels, but they were not enough to fully treat peri-implantitis. Whereas surgical techniques seemed to be more effective in improving overall clinical parameters, especially probing depth, bleeding on probing, and to some extent, marginal bone level, no specific surgical technique or material (graft or membrane) had a clear advantage over others. Therefore, resective surgical and implantoplasty techniques demonstrated significant improvements in clinical parameters. Although surgical interventions are more indicated to treat peri-implantitis than nonsurgical procedures, the predictability is still a concern due to titanium particles scattered within the local tissue.
... The hard tissue morphology of the bone defect and other local factors impact the clinical outcome of decontamination treatment (Monje, Pons, et al., 2019;Schwarz et al., 2010). Chronic inflammation may cause anatomical changes resulting in soft tissue recession, bone configuration changes, and intraorally exposed implant surface. ...
... Since peri-implant bone defects vary in configuration and severity (Schwarz et al., 2010), it is uncertain whether the tools for mechanical decontamination can access all areas of the implant surface for effective biofilm removal. ...
Objectives
Access to the implant surface plays a significant role in effective mechanical biofilm removal in peri‐implantitis treatment. Mechanical decontamination may also alter the surface topography of the implant, potentially increasing susceptibility to bacterial recolonization. This in vitro study aimed to evaluate a newly developed, anatomically realistic, and adaptable three‐dimensional (3D)printed model with a peri‐implant bone defect to evaluate the accessibility and changes of dental implant surfaces after mechanical decontamination treatment.
Material and Methods
A split model of an advanced peri‐implant bone defect was prepared using 3D printing. The function of the model was tested by mechanical decontamination of the exposed surface of dental implants (Standard Implant Straumann AG) coated with a thin layer of colored occlusion spray. Two different instruments for mechanical decontamination were used. Following decontamination, the implants were removed from the split model and photographed. Image analysis and fluorescence spectroscopy were used to quantify the remaining occlusion spray both in terms of area and total amount, while scanning electron microscopy and optical profilometry were used to analyze alteration in the implant surface morphology.
Results
The 3D model allowed easy placement and removal of the dental implants without disturbing the implant surfaces. Qualitative and quantitative assessment of removal of the occlusion spray revealed differences in the mechanism of action and access to the implant surface between tested instruments. The model permitted surface topography analysis following the decontamination procedure.
Conclusion
The developed 3D model allowed a realistic simulation of decontamination of implant surfaces with colored occlusion spray in an advanced peri‐implant defect. 3D printing allows easy adaptation of the model in terms of the shape and location of the defect. The model presents a valuable tool for in vitro investigation of the accessibility and changes of the implant surface after mechanical and chemical decontamination.
... Serino et al. reported that the measurement of peri-implant bone loss based on periapical radiographs differed from that of clinical bone loss during surgery [83]. Accurate assessment of the extent [84] and configuration of the bone defect around the implant is important during decision making, such as whether regenerative therapy could be possible, in the treatment for peri-implantitis [85]. The recent advances in three-dimensional (3D) imaging using conebeam computed tomography (CBCT) are remarkable, and the size and types of periodontal bone defects can be easily predicted using this technique [86,87]. ...
... Resective therapy has been proposed for Class II bone resorption because improving deficient bone conditions is challenging even with the application of regenerative therapy. In contrast, in Class I defects, circular bone resorption, such as Class Ie, has great potential for regeneration [85]. A systematic review by Daugela et al. assessed the efficacy of regeneration therapy for peri-implantitis and reported that the average radiographic marginal bone level fill was 1.97 mm, and the PD and BOP were reduced by 2.78 mm and 52.5%, respectively [108]; therefore, regenerative therapy can be recommended in cases of Class I bone resorption. ...
Peri-implant diseases, such as peri-implant mucositis and peri-implantitis, are induced by dysbiotic microbiota resulting in the inflammatory destruction of peri-implant tissue. Nonetheless, there has yet to be an established protocol for the treatment of these diseases in a predictable manner, although many clinicians and researchers have proposed various treatment modalities for their management. With the increase in the number of reports evaluating the efficacy of various treatment modalities and new materials, the use of multiple decontamination methods to clean infected implant surfaces is recommended; moreover, the use of hard tissue laser and/or air abrasion techniques may prove advantageous in the future. Limited evidence supports additional effects on clinical improvement in antimicrobial administration for treating peri-implantitis. Implantoplasty may be justified for decontaminating the implant surfaces in the supracrestal area. Surgical treatment is employed for advanced peri-implantitis, and appropriate surgical methods, such as resection therapy or combination therapy, should be selected based on bone defect configuration. This review presents recent clinical advances in debridement methods for contaminated implant surfaces and regenerative materials for treating peri-implant bone defects. It also proposes a new flowchart to guide the treatment decisions for peri-implant disease.
... This is in line with the outcomes of the recent FDI consensus report . Rather than the biomaterials employed, the history of periodontitis, morphology of the defect (vertical depth, number of intrabony defect walls) and adherence to supportive care may be factors playing a more significant role on treatment success (Schwarz et al., 2010, Isler et al., 2022. It is however important to note that the outcomes of our network metaanalysis resulted from the combination of only 4 RCTs, which had intrinsic limitations and did not consider the whole plethora of biomaterials and bioactive factors that have been documented in the literature. ...
... The configuration of peri-implant defects, as well as implant surface characteristics differed between studies, with a potential influence on healing outcomes. Several studies have suggested that defect morphology can influence the healing potential following reconstructive therapy, with defect fill more likely at circumferential and 4-wall defects (Aghazadeh et al., 2012, Schwarz et al., 2010. While the limited clinical studies do not allow to make assumptions regarding the possible impact of implant material on peri-implantitis progression (Schwarz et al., 2021, two recent reviews based on pre-clinical studies indicated that peri-implantitis occurs independently from implant surface, but implant surface characteristics play a critical role on the progression and treatment outcomes. ...
Aim:
To evaluate the efficacy of bone reconstructive procedures for the reduction of probing pocket depth (PPD), bleeding on probing (BOP) and suppuration (SOP) in peri-implantitis-related bone defects at ≥ 12-month follow-up.
Materials and methods:
Three databases were searched for RCTs and CCTs that compared bone reconstructive therapies to access flap surgery (Focused Question - FQ 1) and RCTs, CCTs and prospective case series that assessed the efficacy of reconstructive therapies (FQ 2). Meta-analysis was performed for FQ1 when ≥3 studies were identified, while for FQ2 a network was drawn based on RCTs with common treatment arms.
Results:
Seven RCTs were identified for FQ1, while 5 RCTs and 6 prospective case series for FQ2. There was no significant difference in PPD change between access flap surgery and reconstructive surgery (-0.387; p=0.325) at 12 months. Furthermore, no clear differences in terms of PPD and BOP changes resulted from the different reconstructive therapies included in the network. Only a small percentage of treated cases with any modality achieved peri-implantitis resolution, as defined by different composite outcomes.
Conclusions:
Reconstructive surgery does not offer significant improvements in peri-implant clinical parameters as compared to access flap surgery at 12-months. It was not possible to establish a hierarchy of efficacy amongst the different biomaterials employed for reconstructive surgery. This article is protected by copyright. All rights reserved.
... The specific objective examination showed a generalized change in gingival shape and contour. Absence of teeth 18,17,12,27,28,38,37,45 and 48, presence of satisfactory restorations, absence of caries and presence of implants in the regions of elements 24 and 25 were observed in the dental examination. ...
... However, as mentioned above, in the present clinical case the morphology of the bone defect in the implant area was not favorable to regeneration. The configuration of the bone defect can be considered a clinical parameter that potentially influences the outcome after regenerative therapy of periimplantitis lesions [27], which justifies the option to treat the case with implantoplasty only. It is worth emphasizing that regenerative techniques alone do not treat the disease, however they can favorably alter the morphology of the bone defect [14]. ...
Periimplantitis is a destructive inflammatory disease that affects peri-implant tissues after osseointegration. It is a prevalent condition and does not present an established and consensual therapeutic protocolyet. The objective of this study was to report a case of advanced periimplantitis treated with the implantoplasty technique. The patient presented the diagnosis of generalized periodontitis stage 3 and peri-implantitis in the implants installed in the region of teeth 24 and 25. After periodontal therapy, the implantoplasty procedure was performed, aiming to obtain a smooth and decontaminated surface and favor the insertion of periimplant tissues in the implant body after healing. Photodynamic therapy was also performed. The results showed improvement in the periimplant condition, characterized by significant reduction in the probing depth and bleeding.
... On the other hand, infra-osseous defect configurations are prone to exhibit favorable outcomes whenever reconstructive measures are applied. 24 In fact, Schwarz et al 92 Another site-specific feature speculated to influence the reconstructive outcome in the management of peri-implantitis is soft tissue characteristics. It seems reasonable that, given that implants lacking keratinized and attached mucosa are more exposed to periimplantitis, soft tissues may play a role in disease resolution. ...
... explored the impact of infra-osseous defect configuration upon the reconstructive outcomes of peri-implantitis lesions using deproteinized bovine bone mineral in combination with a collagen membrane. Interestingly, it was demonstrated that circumferential-like defects (class Ie) yielded more favorable outcomes when compared with dehiscence or crater-like defects.92 Later on, Aghazadeh et al 93 tested the association of defect configuration and depth upon the clinical and radiographic outcomes of reconstructive therapy using either autogenous bone or deproteinized bovine bone mineral combined with a resorbable barrier membrane. ...
Peri‐implantitis is a plaque‐associated pathologic condition occurring in tissues around dental implants, clinically characterized by increased peri‐implant probing pocket depth and progressive loss of supporting bone. Consequently, to arrest further disease progression and to increase the chance to obtain re‐osseointegration, surgical reconstructive procedures have been adopted. In particular, following a paradigm gathered from periodontal therapy, recent protocols have underlined the importance of a minimally invasive approach to optimize the outcomes of therapy while minimizing the risks of postoperative complications. The present review summarizes the level of evidence on the surgical reconstructive protocols focusing on the new approaches aiming to minimize surgical trauma and patients’ postoperative discomfort, underlining the pros and cons of each treatment modality.
... The morphology of peri-implant lesions influences both the choice of the surgical approach and the implant prognosis. It was demonstrated that the clinical success of surgical regenerative therapy of peri-implantitis also depends on the morphological features of the peri-implant lesions: in particular, contained circumferential peri-implant defects (also referred to as Class Ie) [1] registered better results in terms of probing depth (PD) reduction and clinical attachment level gain as compared to other types of defects [2]. ...
Objectives
The aims of this study were to assess the morphologic features of peri-implant defects, as measured on 2D intraoral radiographs, and to investigate the possible correlation between such morphology and other parameters related to the position and characteristics of the implant or the implant-supported prosthesis.
Materials and Methods
Implants with peri-implantitis were included in this retrospective study. Data collected were related both to the patients and to the position/characteristics of the implants and the implant-supported prosthesis. Measurements of the morphologic defects were performed by two operators on digitalized intraoral periapical radiographs. Results and Conclusion. In total, 73 implants in 27 patients were included. The measurements of the periapical radiograph suggested that the most common defect conformation was crateriform, with both intraosseous and horizontal components. An inverse correlation was found between the extension of the peri-implant lesion and the time between the radiographic assessment and the implant placement. The total lesion area was strongly correlated to oral hygiene levels. No correlations between lesion extension and smoking, diabetes, history of periodontal were found. In conclusion, the results from this 2D radiographic study showed the prevalence of crateriform peri-implant defects, with a hygiene-correlated extension, perceptible on the mesial and distal aspects; 3D imaging could be used when available for further research and clinical investigation.
... Guided bone regeneration can be used to manage the intraosseous aspect of peri-implant defects, although regenerative treatments are typically more effective for circumferential defects than buccal dehiscence. 43 A systematic review by Khoshkam et al found that regenerative treatments resulted in a mean radiographic bone fill of 2.17 mm, a 2.97-mm reduction in probing depth, a 1.65-mm improvement in clinical attachment level, and a 45% reduction in bleeding on probing. 44 However, the results of regenerative treatments for peri-implant defects have been inconsistent, with reported bone fill ranging from 1.5 to 3.3 mm, making it difficult to predict treatment outcomes. ...
... In advanced peri-implant bone loss, deep V-shaped defects 10 and buccal dehiscence 11 around the implant are key factors that influence the choice of treatment -such as resection or regeneration -and the treatment outcome. [10][11][12] Therefore, objectively evaluating the morphology of the bone defect is crucial. Clinically, bone defects resulting from peri-implantitis vary, but they can generally be classified into suprabony and intrabony defect configurations. ...
... It was thought that the presence of peri-implant defects like dehiscence and fenestration would affect the survival and success rate of the dental implant and could cause total loss of the implant. The extent of peri-implant bone loss and the configuration of the defect have a major impact on the treatment outcomes of peri-implantitis [5,6]. As a result, early accurate radiographic assessment of bone defects surrounding dental implants is crucial [7]. ...
... The authors did, however, observe more pronounced radiographic bone fill at sites with narrower defect angles (<40°). Somewhat contradicting findings were presented by Schwarz et al., 182 who reported more favorable 6-month clinical improvements (reductions of probing depth and clinical attachment level) at fully contained defects. ...
Peri‐implantitis is a plaque‐associated pathological condition occurring in tissues around dental implants. It is characterized by inflammation in the peri‐implant mucosa and progressive loss of supporting bone. Over the last 30 years, peri‐implantitis has become a major disease burden in dentistry. An understanding of the diagnosis, etiology and pathogenesis, epidemiology, and treatment of peri‐implantitis must be a central component in undergraduate and postgraduate training programs in dentistry. In view of the strong role of European research in periodontology and implant dentistry, the focus of this review was to address peri‐implantitis from a European perspective. One component of the work was to summarize new and reliable data on patients with dental implants to underpin the relevance of peri‐implantitis from a population perspective. The nature of the peri‐implantitis lesion was evaluated through results presented in preclinical models and evaluations of human biopsy material together with an appraisal of the microbiological characteristics. An overview of strategies and outcomes presented in clinical studies on nonsurgical and surgical treatment of peri‐implantitis is discussed with a particular focus on end points of therapy and recommendations presented in the S3 level Clinical Practice Guideline for the prevention and treatment of peri‐implant diseases.
... 2,8 In general lines, periimplantitis bone defects exhibiting contained defects are prone to show favorable reconstructive outcomes together with a consistent pocket depth reduction. 9,10 On the other side, non-contained defects are discouraged to apply the principles of bone regeneration. In this sense, defect configuration has been shown to play a critical role in the reconstructive outcomes. ...
Objective:
To analyze the influence of the characteristics of bone defects caused by peri-implantitis on the clinical resolution and radiographic bone gain following reconstructive surgery.
Methods:
This is a secondary analysis of a randomized clinical trial. Periapical x-rays of bone defects, caused by peri-implantitis exhibiting intrabony component, were analyzed at baseline and 12-month follow-up after reconstructive surgery. Therapy consisted of anti-infective therapy along with a mixture of allografts with or without a collagen barrier membrane. The association of defect configuration, defect angle (DA), defect width (DW), and baseline marginal bone level (MBL) with clinical resolution (based on a prior defined composite criteria) and radiographic bone gain was correlated by means of generalized estimating equations.
Results:
Overall, 33 patients with a total of 48 implants exhibiting peri-implantitis were included. None of the evaluated variables yielded statistical significance with disease resolution. Defect configuration demonstrated statistical significance when compared to class 1B and 3B, favoring radiographic bone gain for the former (p = 0.005). DW and MBL did not demonstrate statistical significance with radiographic bone gain. On the contrary, DA exhibited strong statistical significance with bone gain (p < 0.001) in the simple and multiple logistic regression analyses. Mean DA reported in this study was 40°, and this resulted in 1.85 mm radiographic bone gain. To achieve ≥1 mm of bone gain, DA must be <57°, while to attain ≥2 mm of bone gain, DA must be <30°.
Conclusion:
Baseline DA of peri-implantitis intrabony components predicts radiographic bone gain in reconstructive therapy (NCT05282667-this clinical trial was not registered prior to participant recruitment and randomization).
... It should be emphasized that the composite bone graft was applied in the absence of a membrane. Membranes are currently applied on top of reconstructive material to comply with the principle of "compartmentalization" [67][68][69][70], based on the concept that it prevents soft tissue ingrowth into a defect region, allows the angiogenic and osteogenic cells to migrate into the blood clot, and as a stabilizer for the material in case of "non-contenitive" defects [71]. However, their use was recently discussed because of reports of post-surgical exposure, resulting in increased morbidity and a higher prevalence of residual soft tissue inflammation. ...
Peri-implant infections, in the absence of adequate treatment, can finally lead to premature loss of the implant. Among targeted protocols recently proposed for the treatment of peri-implant bone defects, and in the case of short implants, reconstructive surgery represents a recommended option. The purpose of this study was to evaluate the outcomes, in terms of maintenance, of a reconstructive treatment for peri-implantitis in locking-taper plateau-design single-crown implants, followed for 5 years after surgery. A retrospective evaluation was conducted in 20 patients treated with access flap surgery, concomitant chemical and mechanical surface decontamination, and bone grafting (using a self-hardening mixture of bone substitutes and biphasic calcium sulfate without the use of membranes). Of the 21 implants assessed, 9 were 8 mm-length, and 12 were 6 mm-length. Implant loss and treatment success were, respectively, 0% and 80.95% after 5 years from surgery. All parameters related to bone levels and soft tissue conditions significantly improved after 3 years and remained stable at the 5-year follow-up. The proposed protocol, followed by an effective supporting periodontal therapy, demonstrated the maintenance of the function of all implants, providing adequate stability during the healing process after surgery and limiting the onset of disease recurrence.
... Specifically, greater PD reduction and radiographic defect fill following reconstructive peri-implantitis therapy using particulated bone filler in conjunction with a barrier membrane was obtained in peri-implantitis cases featuring circumferential-type defects (ie, four-wall defects) compared to those lacking buccal or lingual walls (ie, three-wall defects). 97,98 Likewise, four-wall defects showed 6.0 to 7.0 times greater odds ratios of a successful treatment outcome (ie, absence of additional bone loss and PD ≤ 5 mm) compared to three-and two-wall defects, respectively. 95 Moreover, deeper intrabody defects resulted in greater radiographic defect fill. ...
Peri-implant diseases define bacterial-plaque-induced inflammatory conditions affecting implant-surrounding tissues, classified as peri-implant mucositis and peri-implantitis. Peri-implant mucositis characterizes an inflammatory lesion that resides in the soft-tissue compartment, whereas at peri-implantitis sites, the lesions also feature progressive loss of implant-supporting bone. Inflammation resolution of and disease progression arrestment are the main therapeutic endpoints of peri-implant diseases treatment. The present position paper presents the current evidence and clinical recommendations of the European Association for Osseointegration for the treatment of peri-implant diseases. Mechanical biofilm removal along with the reinforcement of patient-administered oral hygiene is considered the standard treatment for managing peri-implant mucositis. It is recommended to assess the outcomes of peri-implant mucositis treatment 2 to 3 months after therapy, and in the absence of treatment success, a repeated intervention should be considered. Peri-implantitis treatment should follow a stepwise treatment approach, starting with a non-surgical treatment, and if not sufficient, followed by the surgical intervention. Surgical peri-implantitis therapies encompass non-reconstructive, reconstructive, and combined treatment modalities. Implantoplasty may be advocated for the treatment of supracrestal peri-implant defects, whereas reconstructive therapy is indicated at peri-implantitis sites featuring intra-osseous defects with a depth of ≥ 3 mm. Adjunctive reconstructive measures may be beneficial in enhancing radiographic defect fill and maintaining postoperative soft-tissue levels, which may have a great impact in aesthetic cases. The adjunctive use of systemic antibiotics during surgical therapy does not seem to improve the clinical outcomes. Regular supportive peri-implant therapy with biofilm removal should be an integral part of the treatment protocol of peri-implant diseases. In the presence of advanced bone loss at implants that do not play a strategic role in masticatory function, implant removal may be immediately considered.
... Bony topography surrounding infected implants is a basic factor, which determines the intrinsic conducive potential leading to defect regeneration (Schwarz et al., 2010). Such defects typically comprise suprabony and infrabony components ( Figure 2). ...
Objectives
The current strategies to reconstruct lost peri‐implant tissues due to the disease have been largely unpredictable. The aim of this conceptual review is to discuss relevant biological and biomechanical challenges of applying reconstructive means to treat peri‐implantitis. Additionally, opportunities to improve treatment predictability are presented.
Material and Methods
A narrative review was conducted to fulfill the aim.
Results
The four interrelated negative conditions hampering effective reconstruction are: inferior tissue perfusion, unfavorable bone topography, ineffective surface treatment, and unstable wound. First, peri‐implant tissues resemble scars with reduced cellularity and vascularity, coupled with the absence of the periodontal ligament plexuses and the avascular implant and biomaterials, maintaining primary closure is a challenge, which is critical for regeneration. Second, defect morphology and bone topography surrounding implants determine the reconstructive potential. Unfortunately, noncontained defects are frequently encountered, with a combination of suprabony (horizontal bone loss) and infrabony (vertical usually involving circumferential bone loss) defects. Third, current attempts for implant surface decontamination are insufficient due to inaccessible macrostructure and rough surfaces in the micro‐scale. Histologic evaluation has shown bacteria aggregation and calcified deposits around implants. Lastly, wound stability is difficult to achieve due to inherent soft tissue biomechanical quality and quantity deficiencies and mobile bone particulates. Opportunities to tackle the abovementioned challenges include the use of novel imaging technologies, such as high‐frequency dental ultrasound and laser speckle imaging to evaluate tissue perfusion, soft tissue quality/quantity, and bone topography pre‐surgically. The use of the operating microscope could allow better visualization and removal of etiologic factors. Strategies to improve soft tissue quality may include preoperative control of soft tissue inflammation and the potential use of biologics. Methods such as fixation to stabilize the biomaterials could be beneficial.
Conclusions
A more nuanced understanding of the current challenges and opportunities can lead to more effective preoperative and postoperative care protocols, ultimately improving the success rate of reconstructive procedures.
... Despite a lack of consensus on peri-implantitis treatment, several classifications and treatment decision trees have been proposed based on the configuration of the bony defects. [1][2][3] Regenerative procedures should be considered for a crater-like defect to regain bony support and reduce the risk of mucosal recession. In contrast, resective surgery provides access for better debridement and implant surface decontamination, resulting in better postoperative home care. ...
Peri-implantitis is an inflammatory condition that involves the loss of attachment and support around dental implants. In this case report, a middle-aged woman presented with two implants in the mandibular right quadrant that were diagnosed with peri-implantitis. The patient also had tenderness around the implants and reported sensitivity when performing oral hygiene procedures. Surgical treatment comprised a free gingival graft to augment the keratinized tissue width around the implants, followed by a second procedure of implantoplasty and surface decontamination. The outcome showed radiographic resolution of the peri-implant defect around the premolar implant with a marked increase of keratinized tissue (> 4 mm) around both implants after 1 year of follow up. On a patient level, significantly reduced sensitivity around the implants and better home care were reported. This case report showed that the increase of keratinized tissue may benefit the clinical and patient outcomes of peri-implantitis treatment in terms of decreased probing depths, absence of inflammation, and improved radiographic crestal stability. The combined correction of both hard and soft tissue defects around peri-implantitis lesions may facilitate treatment success and help maintain peri-implant stability.
... 20 In line are the results of previous clinical studies that pointed to greater PD reduction and RDF following the use of a GBR-supported reconstruction protocol in peri-implantitis cases featuring circumferential-type defects compared to those lacking buccal and/or lingual walls. 29,30 In this context, for instance, when interpreting the findings of the aforementioned RCT comparing the GBR and non-GBR therapeutic approaches, the defect configurations were unequally distributed between the test (GBR) and the control (non-GBR) groups, with more favorable contained defect configurations (i.e., four-wall defects) being treated with the non-GBR approach (Xeno + M: 45.5%, Xeno: 19.0%), which may be the reason for the lack of observed differences between the test and the control groups. Subsequently, it might be speculated that the barrier membrane effect may be dependent on the defect configuration, with greater benefits provided at non-contained defects (i.e., 2-3 wall defects). ...
Guided bone regeneration (GBR) at peri‐implantitis‐related bone defects involves the placement of bone‐filler particles in the intrabony defects and the application of a barrier membrane. The efficacy of different GBR‐supported reconstructive measures as well as their potential superiority compared to non‐GBR‐supported treatment strategies for bone defects at peri‐implantitis sites, however, remains unclear. Therefore, this analysis was designed to evaluate the long‐term (≥12 months) clinical efficacy of GBR‐supported reconstructive surgical therapy for peri‐implantitis‐related bone defects. In terms of resolving inflammation, the implementation of GBR protocols applying xenogenic bone substitutes yielded a higher reduction of bleeding on probing and probing depth value compared to the GBR protocol applying autogenous bone. Furthermore, for the changes in bleeding on probing and probing depths, GBR approaches using xenogenic bone showed superiority over the non‐GBR treatments. Xenogenic bone with or without a barrier membrane was associated with improved radiographic bone levels and less soft tissue recession compared to the use of a GBR protocol implementing autogenous bone. Nonetheless, when interpreting this findings, the limited number of available studies with low to serious risk of bias and the short follow‐up periods limited to 12 months should be considered.
... At 12 months after reconstructive therapy, the authors could not observe differences in outcomes across five defect categories. This stands in contrast with data reported by Schwarz et al. (2010) Schwarz et al., 2007). ...
Aim:
To identify predictors of treatment outcomes following surgical therapy of peri-implantitis.
Materials and methods:
We performed a secondary analysis of data from a randomized controlled trial (RCT) comparing access flap with or without bone replacement graft. Outcomes at 12 months were probing pocket depth (PPD), bleeding on probing (BOP), soft-tissue recession (REC) and marginal bone level (MBL) change. Multilevel regression analyses were used to identify predictors. We also built an explanatory model for residual signs of inflammation.
Results:
Baseline PPD was the most relevant predictor, showing positive associations with final PPD, REC and MBL gain, and negative association with probability of pocket closure. Smokers presented higher residual PPD. Absence of keratinized mucosa at baseline increased the probability of BOP but was otherwise not indicative of outcomes. Plaque at 6 weeks was detrimental in terms of residual PPD and BOP. Treatment allocation had an effect on REC. Final BOP was explained by residual PPD ≥6 mm and plaque at more than two sites.
Conclusions:
Baseline PPD was the most relevant predictor of the outcomes of surgical therapy of peri-implantitis. Pocket closure should be a primary goal of treatment. Bone replacement grafts may be indicated in aesthetically demanding cases to reduce soft-tissue recession. The importance of smoking cessation and patient-performed plaque control is also underlined.
... Les techniques régénératives visent le comblement des défauts infraosseux autour de l'implant et le rétablissement du soutien des tissus mous [68] . La possibilité de régénération est influencée par le nombre de parois résiduelles, avec un meilleur résultat pour les défauts circonférentiels [69] . ...
La péri-implantite est une maladie inflammatoire des tissus de soutien des implants den-taires avec un modèle d'évolution rapide. Cette maladie peut aboutir à la perte de l'implant avec des conséquences biologiques, fonctionnelles, prothétiques et émotionnelles pour le patient. Compte tenu de l'augmentation constante du nombre d'implants posés, les maladies péri-implantaires sont devenues très répandues dans la pratique clinique, avec une prévalence de 20 % des patients avec restauration sur implant. La gestion de cette pathologie est complexe et elle peut représenter un défi pour le praticien au quotidien. L'objectif de cet article est de synthétiser les données scientifiques actuelles afin de proposer un diagnostic précoce et une prise en charge adaptée aux besoins individuels. © 2023 Elsevier Masson SAS. Tous droits réservés.
... The importance of including patient reported outcome measures in studies evaluating implant treatment has been highlighted (Abrahamsson et al., 2017). Hence, in the present study a novel composite success outcome was constructed which included a patient reported outcome, as follows (i) The peri-implant defect configuration has been suggested to be an important factor in the outcome of reconstructive/regenerative treatment for management of periodontal and peri-implant intraosseous defects (Schwarz et al., 2010). An analysis evaluating the defect geometry and its effect on the treatment outcome failed to identify this as a contributing factor to a successful outcome. ...
Objective:
To evaluate the efficacy of reconstructive peri-implantitis treatment.
Materials and methods:
Forty participants, with peri-implantitis and a contained intraosseous defect, were randomized to access flap (control) or access flap with xenograft and collagen membrane (test). All received systemic antimicrobials. Blinded examiners recorded probing depths (PD), bleeding and suppuration on probing (BOP & SOP), soft tissue levels, and marginal bone levels (MBL) at baseline and 12 months. Patient reported outcomes were recorded. The primary outcome was PD change.
Results:
All 40 participants (40 implants) completed the 12-month study. The mean (standard deviation) PD reduction (deepest site) was 4.2 (1.8) mm in the control and 3.7 (1.9) mm in the test group. MBL gain (deepest site) was 1.7 (1.6) mm in the control and 2.4 (1.4) mm in the test group. Absence of BOP & SOP was observed at 60% of both control and test implants. Buccal recession was 0.9 (1.6) mm in the control and 0.4 (1.1) mm in the test group. A successful outcome (absence of PD ≥ 5 mm with BOP, absence of SOP and absence of progressive bone loss) was achieved for 90% of the control and 85% of test group implants. No statistically significant differences in clinical or radiographic parameters were found between treatment groups. 30% of participants experienced mild gastro-intestinal disturbances. Reporting followed CONSORT guidelines.
Conclusion:
Similar clinical and radiographic improvements at 12 months were observed with high levels of patient satisfaction for both the access flap and xenograft covered by collagen membrane groups. Registered clinical trials.gov. ID:NCT03163602 (23/05/2017).
... Knochendefekte ließen sich besser behandeln als solche mit bukkalen Dehiszenzen45 .Zur Verbesserung augmentativer Therapien sind darüber hinaus weitere Behandlungsstrategien und Materialien untersucht worden, so beispielsweise poröse Titangranulate (PTG). Der einfache Zugangslappen mit Dekontamination der Implantatoberflächen wurde mit der zusätzlichen Augmentation mit PTG verglichen48,63 . ...
ZUSAMMENFASSUNG Ungefähr ein Fünftel aller Implantatpatienten leiden unter einer Periimplantitis. Im Rahmen einer systematischen Behandlung ist die nichtchirurgische Therapie nur eingeschränkt wirksam. In den meisten Fällen ist daher eine chirurgische Periimplantitistherapie erforderlich. Auf diese Weise ist ein direkter Zugang zur Dekontamination infizierter Implantatoberflächen gewähr-leistet. Das Entzündungsgewebe kann besser beseitigt werden und möglicherweise kann eine Reosseointegration erreicht werden. Mithilfe der neuen Klassifikation werden Behandlungsziele definiert, damit verschiedene Therapieverfahren besser miteinander verglichen werden können. Die effektivste chirurgische Behandlungsmethode lässt sich derzeit aus der Literatur noch nicht ableiten. Je nach knöcherner Defektkonfiguration und Position des Implantats kommen entweder nichtaugmentative/resektive Verfahren oder knochen-und weichgewebeaugmentative Verfah-ren sowie Kombinationen infrage. Ein Entscheidungsdiagramm mit Empfehlungen zur Auswahl der adäquaten chirurgischen Therapie wird vorgestellt. Insgesamt ist zu empfehlen, die Behand-lungsmethode von der Schwere der Erkrankung, dem Regenerationspotential des periimplantären Defekts sowie den ästhetischen Erwartungen des Patienten abhängig zu machen. Darüber hinaus sollte der Patient aufgeklärt sein, dass es nicht immer möglich ist, erkrankte Implantate durch eine chirurgische Therapie zu erhalten. Generell sollten Implantatpatienten, insbesondere nach einer Periimplantitistherapie, unbedingt in ein individuelles unterstützendes Erhaltungsprogramm aufgenommen werden.
... The outcome of peri-implant bone regeneration seems to be dependent on the defect morphology. 42 Regenerative therapy of peri-implantitis lesions using DBBM and a CM in sites with a circumferential bone loss was more predictable than in situations with a buccal dehiscence. A recent study evaluated the periimplant defect morphology and the severity of peri-implantitis lesions as this might have an impact on the decision-making process in reconstructive peri-implantitis therapy. ...
Introduction:
Analysis of the 3-dimensional implant position, the bone defect morphology, and the soft tissue situation guides the decision to preserve or to remove an implant with a severe peri-implantitis lesion. The aim of this narrative review was to analyze and to comprehensively illustrate the treatment options focusing on peri-implant bone regeneration in presence of severe peri-implant bone loss.
Methods:
A database search was performed independently by the two reviewers to identify case reports, case series, cohort, retrospective, and prospective studies about peri-implant bone regeneration with a follow-up of at least 6 months. Of the 344 studies issued during the database analysis, 96 publications were selected by the authors for this review.
Results:
Deproteinized bovine bone mineral remains the best documented material for defect regeneration in peri-implantitis in combination with or without a barrier membrane. While studies using autogenous bone in peri-implantitis therapy are rarely found, they do report favorable potential of vertical bone regeneration. Moreover, while membranes are an inherent part of the guided bone regeneration, a 5-year follow-up study demonstrated clinical and radiographic improvements with and without a membrane. The administration of systemic antibiotics is frequently performed in clinical studies observing regenerative surgical peri-implantitis therapy, but the analysis of the literature does not support a positive effect of this medication. Most studies for regenerative peri-implantitis surgery recommend the removal of the prosthetic rehabilitation and the use a marginal incision with a full-thickness access flap elevation. This allows for a good overview for regenerative procedures with a certain risk of wound dehiscences and incomplete regeneration. An alternative approach referring to the poncho technique may reduce the risk of dehiscence. The effectiveness of implant surface decontamination might have an impact on peri-implant bone regeneration without any clinical superiority of a certain technique.
Conclusion:
The available literature reveals that the success of peri-implantitis therapy is limited to the reduction of bleeding on probing, the improvement of the peri-implant probing depth and a small amount of vertical defect fill. On this basis, no specific recommendations for bone regeneration in surgical peri-implantitis therapy can be made. Innovative approaches for flap design, surface decontamination, bone defect grafting material, and soft tissue augmentation should be followed closely to find advanced techniques for favorable peri-implant bone augmentation.
... Peri-implantitis lesions at rough implant surfaces are more aggressive and extend more apically to the bone than in machined surfaces(Carcuac et al., 2013), which could explain why the adjunctive use of systemic antibiotics may have an impact when treating rough implant surfaces. Indeed, the radiographic bone gain observed after the addition of systemic metronidazole to the non-surgical therapy protocol was similar to the one reported in a recent systematic review (≈1.9 mm) comparing the reconstructive surgical therapy of peri-implantitis to access flaps(Tomasi et al., 2019).Still, further investigations are needed to test other systemic antimicrobials, shorter intake periods and the role of peri-implant defect configuration, as it has shown to play an important role in clinical and radiographic outcomes of peri-implantitis therapy(Schwarz et al., 2010). ...
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.
... Anatomía de los defectos óseos periimplantarios [10][11][12] Históricamente, en el campo de la regeneración periodontal de defectos alrededor de dientes la toma de decisiones siempre ha ido guiada por la anatomía del defecto. Es decir, la existencia de defectos angulares, verticales o tipo cráter, son aquellos en los que el clínico puede plantearse la posibilidad de enfocarlos de manera regenerativa. ...
... After 1 year, as indicated by another RCT, significantly higher RBL was measured in the test group (i.e., treated with adjunctive titanium brushes; 2.51 [SD 1.21] mm vs. 0.73 [SD 1.26] mm; p = .003) (de Tapia et al., 2019).One RCT reported insignificant changes in PI values throughout the 2-year period in both the test group (i.e., Er:YAG laser) and control group, with no difference between the two groups(Schwarz et al., 2010). Likewise, significant reduction of PI values compared to the baseline was observed in another RCT after 6 months, with similar reductions in the test (Er:YAG laser) and control groups(Wang et al., 2021). ...
Aim:
To evaluate the efficacy of adjunctive/alternative photo-/mechanical and physical implant-surface decontamination approaches compared to a standard instrumentation in conjunction with surgical peri-implantitis treatment.
Materials and methods:
Randomized controlled clinical trials (RCTs) and controlled clinical trials (CCTs) investigating the efficacy of adjunctive or alternative photo-/mechanical/physical measures for implant surface decontamination in conjunction with surgical peri-implantitis treatment without (PICOS 1) or with (PICOS 2) additional decontamination methods performed in test and control groups with changing inflammation parameters. Changes in bleeding scores (i.e., bleeding index (BI), or bleeding on probing (BOP)), suppuration (SUP) and PD values were considered as primary outcomes.
Results:
Six articles describing five original RCTs were eligible for analysis. Based on two RCTs, the adjunctive/alternative use of an air polishing with glycine or erythritol powders did not improve BOP reduction compared to a standard instrumentation (PICOS 1). Based on one RCT, alternative use of titanium brushes resulted in significantly higher BOP reduction compared to either air polishing or a standard instrumentation (PICOS 1). During reconstructive therapy and as an adjunct to implantoplasty, use of a titanium brush did not have a benefit on the BOP and mean PD reductions compared to the control group (i.e., implantoplasty + mechanical and chemical implant surface decontamination; 1 RCT; PICOS 2). An Er:YAG laser resulted in significantly higher PD reduction after 6 months (1 RCT), whereas no difference between the test and respective controls could be detected after 1 and 2 years (1 RCT). Additionally, the use of the Er:YAG laser was not associated with improved BOP reductions over respective controls (2 RCTs; PICOS 2).
Conclusions:
Due to the limited available data, clinical efficacy of photo-/mechanical and physical implant surface decontamination in conjunction with surgical peri-implantitis therapy is inconclusive. However, titanium brushes may be beneficial in reducing signs of inflammation.
... 53 Bu tedavi yöntemi, suprakrestal olarak uygulanan implantoplastiyi ve ogmentasyon prosedürlerini içerir. 66 Tapia ve arkadaşlarının 67 iki farklı dekontaminasyon yöntemi ile implant yüzey temizliğinin ardından aynı tür greft ve membranlarla ogmente edilen peri-implantitis vakalarını değerlendirdikleri çalışmanın sonuçlarına göre, titanyum fırçalarla dekontamine edilen peri-implant bölgelerde sondlama derinliklerinde ve sondlamada kanamada azalma olduğu ve başlangıç değerlerine göre kemik kaybında ilerleme olmadığı bildirilmiştir. Bir diğer araştırmada, kemik içi defektlerde ksenojenik kemik materyalleri ile birlikte kollajen matriksin kullanıldığı implant çevresi bölgelerde 8 ay ila 6.5 yıllık iyileşme periyotları sonrası kontrollerde kemik dolumunun %85 civarında olduğu ortaya konulmuştur. ...
Dental implantlar, dişsiz bölgelerde diş kökü gibi fonksiyon görmek üzere tasarlanmış biyouyumlu materyallerdir. Dental implant uygulamalarının son yıllarda artmasıyla birlikte implant çevresi hastalıkların görülme olasılığı da artmıştır. Peri-implant hastalık yalnızca mukoza enflamasyonu ile sınırlı kaldığında peri-implant mukozitis olarak adlandırılırken bu duruma peri-implant kemik kaybı da eklendiğinde hastalık peri-implantitis adını alır. Hastalığın etiyolojisinde temelde mikrobiyal biyofilm rol oynar. Bununla birlikte, implantın yüzey özellikleri, pozisyonu, üst yapısı, yetersiz oral hijyen, sigara ve/veya alkol tüketimi, sistemik hastalıklar ve stres gibi risk faktörleri de peri-implant hastalıklarla ilişkilendirilmiştir. Bu derlemede amaç, peri-implantitis tedavisine yönelik cerrahi olan ve olmayan yaklaşımlar ile yapılan tedavilerin etkinliklerini değerlendirmektir.
... It was thought that the presence of peri-implant defects like dehiscence and fenestration would affect the survival and success rate of the dental implant and could cause total loss of the implant. The extent of peri-implant bone loss and the configuration of the defect have a major impact on the treatment outcomes of peri-implantitis [5,6]. As a result, early accurate radiographic assessment of bone defects surrounding dental implants is crucial [7]. ...
Background
Early accurate radiographic assessment of peri-implant bone condition is highly important to avoid excessive loss of supporting bone and implant failure. Cone beam computed tomography (CBCT) is the radiographic technique of choice if peri-implant dehiscence and fenestration defects are suspected. The higher radiation dose and the presence of beam hardening artifacts are the main drawbacks of CBCT imaging techniques. This study aims to evaluate the influence of low-dose cone beam computed tomography (LD-CBCT) and metal artifact reduction (MAR) tool on the assessment of peri-implant dehiscence and fenestration.
Methodology
Thirty titanium implants were inserted into bovine rib blocks. Twenty had standardized bone defects (10 with dehiscence and 10 with fenestration), while the remaining 10 were used as control group with no defects. Radiographic examinations held with high‐definition CBCT (HD-CBCT) and LD-CBCT with and without application of MAR tool. Images were assessed by four examiners for the presence or absence of peri-implant defects. The area under the area under the receiver operating characteristic (ROC) curve (AUC), sensitivity, specificity, and accuracy were calculated for all radiographic protocols.
Results
In the absence of MAR tool, there was no difference in AUC and diagnostic values between LD-CBCT and HD-CBCT for detection of both defects. When the MAR tool was applied, the AUC values, sensitivity, and accuracy were higher in HD-CBCT than in LD-CBCT for the detection of both defects, especially for the dehiscence, while specificity remained the same.
Conclusion
LD-CBCT can be used in the evaluation of peri-implant dehiscence and fenestration without any decrease in diagnostic accuracy. The application of MAR tool decrease the diagnostic ability of both defects, especially for the detection of dehiscence defects.
... In particular, two studies have indicated greater PD reduction and radiographic defect fill following the use of particulate bone filler particles along with a barrier membrane in cases featuring contained circumferential-type defects compared to those lacking buccal and/or lingual walls. 61,62 On the other hand, in one 5-year prospective clinical study, the resolution of peri-implantitis lesions treated with particulate bone filler particles embedded in a collagen matrix was not associated with the defect's morphology. 28 The aforementioned contradictions might be explained at least to some extent by the nature of the bone filler, as particulate bone substitutes may be less prone to obtaining stability within the defect compared to bone filler particles stabilized in a collagen matrix. ...
Background:
Peri-implantitis constitutes one of the most frequent late dental implant complications. The disease is initiated by bacterial infection; therefore, anti-infective peri-implantitis treatment strategies are required to arrest the progressive marginal bone loss and maintain the affected implant in function. Although nonsurgical treatment strategies appear to be of limited predictability, treatment outcomes have been frequently improved following surgical interventions.
Purpose:
The present narrative review describes various surgical peri-implantitis treatment modalities, with respect to their indications, performance, and effectiveness.
Materials and methods:
The present narrative review considered the most relevant studies in the field published in the English language.
Results:
Surgical peri-implantitis treatment approaches can be categorized as nonreconstrucive therapy, reconstructive therapy, and combined therapy (ie, reconstructive and resective therapy). In addition to disease resolution, reconstructive approaches also seek to regenerate the bone defect and achieve reosseointegration.
Conclusions:
The severity of the disease, the regenerative potential of the defetc and esthetic demands of the patient are the factors determining the surgical peri-implantitis treatment modality.
... 9 In general lines, peri-implantitis bone defects exhibiting contained defects are prone to show favorable reconstructive outcomes together with a consistent reduction in pocket depth. 10,11 Multiple clinical trials have validated this approach alone [12][13][14] or in combination with other measures such as implantoplasty 15,16 in combined defects exhibiting supracrestal components. It is worth noting that no consensus or solid evidence exists regarding the use and type of biomaterials and barrier membranes. ...
Objective:
To investigate the clinical and radiographic significance of using a mixture of mineralized and demineralized allografts in combination (M) or not (NM) with a resorbable cross-linked barrier membrane in the reconstructive therapy of peri-implantitis defects.
Methods:
A two-arm randomized clinical trial was performed in patients diagnosed with peri-implantitis that exhibited contained defects. Clinical parameters were recorded at baseline (T<sub>0</sub> ), 6 months (T<sub>1</sub> ) and 12 months (T<sub>2</sub> ). Radiographic parameters were recorded at T<sub>0</sub> and T<sub>2</sub> . A composite criteria for disease resolution was defined a priori. A generalized linear model (GLM) of repeated measures with generalized estimation equations (GEE) statistical methods were used.
Results:
Overall, 33 patients (n<sub>implants</sub> = 48) completed the study. At T<sub>2</sub> , mean disease resolution was 77.1%. The use of a barrier membrane did not enhance the probability of disease resolution at T<sub>2</sub> (OR = 1.55, p = 0.737). Conversely, the odds of disease resolution were statistically associated with modified plaque index (mPI) recorded at T<sub>0</sub> (OR = 0.13, p = 0.006) and keratinized mucosa (KM) width (OR = 2.10, p = 0.035). Moreover, women exhibited greater odds to show disease resolution (OR = 5.56, p = 0.02).
Conclusion:
Reconstructive therapy by means of a mixture of mineralized and demineralized allografts is effective in clinically resolving peri-implantitis and in gaining radiographic marginal bone level. The addition of a barrier membrane to reconstructive therapy of peri-implantitis does not seem to enhance the outcomes of contained bone defects (NCT05282667). This article is protected by copyright. All rights reserved.
... In more complicated peri-implantitis cases, complicated bony defects may exist, including supracrestal and intrabony defect components. For the management of supracrestal aspects, surgical elimination of pathological peri-implant pockets in combination with implantoplasty (IP) has been introduced [22,23]. Resective therapy with implantoplasty seems to positively impact the survival of oral implants affected by inflammatory processes [24]. ...
Although laser irradiation and implantoplasty (IP) are both treatment options for peri-implantitis, no studies have yet combined these two treatment solutions. The aim of this study was to identify the effect of an Er, Cr: YSGG laser on the IP surface. In experiment 1, TiUnite anodized surface implants were treated with an Er, Cr: YSGG laser at 0.5 to 2 W on the panel energy setting and 20 Hz under water irrigation. In experiment 2, all implant surfaces were treated with the IP procedure first, then irradiated with the Er, Cr: YSGG laser. All samples were analyzed by stereomicroscopy, scanning electron microscopy (SEM), energy dispersive X-ray spectroscopy (EDS), and surface topography. Stereomicroscopy and SEM revealed no obvious surface change at any energy setting once the surface was polished with the IP procedure, whereas damage was caused to the TiUnite original implant surface when the Er, Cr: YSGG laser panel energy was set at 1 W or higher. EDS showed no significant difference in element composition once the surface was polished with the IP procedure, while a compositional change was detected when the Er, Cr: YSGG laser panel energy was set to 0.5 W or higher to irradiate the original TiUnite surface. Surface roughness may be related to laser irradiation energy, but no significant changes occurred following IP. These results indicated that the Er, Cr: YSGG laser may have little effect on the post-IP surface compared with the virgin TiUnite surface.
... Limitations worth mentioning are mainly related to the available trials, since most of the evidence on decontamination protocols is based on single RCTs, and that half of the included trials were not considered at low risk of bias. Moreover, several factors such as implant surface characteristics (Berglundh, Wennström, & Lindhe, 2018) configurations of peri-implant defect (Schwarz et al., 2010) frequency and quality of supportive therapy Roccuzzo et al., 2018) can affect the results of surgical treatment of periimplantitis, but their impact could not be analyzed due to the high heterogeneity among the included trials. ...
Objective:
To answer the following PICO question: "In patients requiring surgical treatment of peri-implantitis (P), is any implant surface decontamination protocol (I) superior to others (C) in terms of clinical and radiographic parameters (O)?".
Methods:
Randomized clinical trials (RCTs) comparing two or more decontamination protocols as part of the surgical treatment of peri-implantitis were included. Two authors independently searched for eligible studies, screened titles and abstracts, did full-text analysis, extracted data, and performed the risk-of-bias assessment. Whenever possible, results were summarized through random effects meta-analyses.
Results:
Sixteen RCTs were included, testing mechanical, chemical and physical decontamination protocols. All of them resulted in an improvement in clinical parameters; however, the superiority of some protocols over the others is mainly based on single RCTs. The use of titanium brushes and implantoplasty showed favorable results as single decontamination methods. Meta-analyses indicated a lack of added effect of Er:Yag laser on probing pocket depth (PPD) reduction (n = 2, WMD = -0.24 mm, 95% confidence interval [CI] [-1.10; 0.63], p =.59); while systemic antimicrobials (amoxicillin or azithromycin) showed an added effect on treatment success ([PPD ≤5 mm, no bleeding or suppuration, no progressive bone loss]; n = 2, RR = 1.84, 95% CI [1.17;2.91], p =.008), but not in terms of PPD reduction (n = 2, WMD = 0.93 mm, 95% CI [-0.69; 2.55]), p =.26), even if with substantial heterogeneity.
Conclusions:
No single decontamination method demonstrated clear evidence of superiority compared to the others. Systemic antibiotics, but not Er:Yag laser, may provide short-term clinical benefits in terms of treatment success (CRD42020182303).
... Tapia et al., 2019;Schwarz et al., 2010), 12 experimental subjects and 12 control subjects were needed to reject the null hypothesis with an alpha error of 0.05 and a beta error of 0.2 and a statistical power of 80%. In order to compensate for attrition over the 6-month follow-up, 15 patients/group were allocated to intervention. ...
Objectives:
To investigate the outcomes following non-surgical therapy of peri-implantitis (PI) with or without adjunctive diode laser application.
Materials and methods:
A double-blinded randomized controlled clinical trial was carried out in 25 subjects with 25 implants diagnosed with PI. Following curettage of granulation tissue, test implants (T) were treated with adjunctive application of a diode laser for 90 s (settings: 810 nm, 2.5 W, 50 Hz, 10 ms), while at control implants (C) non-activated adjunctive diode laser was applied. The entire treatment procedure was performed at day 0 (i.e., baseline), 7 and 14. The primary outcome measure was change in mean pocket probing depth (PPD). Clinical and microbiological outcomes, as well as host-derived inflammatory markers were evaluated at baseline, 3 and 6 months, while radiographic outcomes were assessed at baseline and at the 6-month follow-up.
Results:
No statistically significant differences with respect to baseline patient characteristic were observed. After 6 months, both test and control implants yielded statistically significant PPD changes compared with baseline (T: 1.28 and C: 1.47 mm) but without statistically significant difference between groups (p=0.381). No statistically significant changes in peri-implant marginal bone levels were detected (p=0.936). No statistically significant differences between test and control implants were observed with respect to microbiological and host-derived parameters (p>0.05). At the 6-month follow-up, treatment success was observed in 41.7% (n=5) of test and 46.2% (n=6) of control patients, respectively (p=0.821).
Conclusion:
Repeated adjunctive application of diode laser in the non-surgical management of PI failed to provide significant benefits compared with mechanical instrumentation alone.
... In the current study, it was shown that the amounts of VDD values at baseline were negatively associated with the treatment outcome in agreement with the findings of previous studies that observed peri-implant bone loss at baseline as a negative predictive factor for the success of treatment outcome [50][51][52]. Besides, studies have also exhibited that peri-implant bone defect configuration has a potential impact on the outcome of reconstructive therapy of peri-implantitis [49,51,53]. It has also been highlighted in a recent review by that augmentative treatment outcomes were affected by the morphology of the peri-implant bone defects [8]. ...
Objectives
To compare the 3-year clinical and radiographic outcomes of two different reconstructive surgical management of peri-implantitis using a bone substitute in combination with either concentrated growth factor (CGF) or collagen membrane (CM).
Material and methods
Fifty-one patients who had at least one implant presenting peri-implantitis with an intrabony defect were filled with a xenogenic bone grafting material and covered either CGF or CM. Clinical and radiographic assessments were carried out at baseline and postoperative years 1 and 3. Three different composite outcomes were defined to evaluate treatment success at a 3-year follow-up. The effects of possible prognostic indicators on treatment success were identified by using multilevel regression analysis.
Results
The changes in probing depth (PD) and radiographic vertical defect depth (VDD) between baseline and year 1 and baseline and year 3 presented significantly greater decreases for the CM group in comparison with the CGF group ( p < 0.05). No significant differences between the two treatment modalities were demonstrated regarding treatment success outcomes. History of periodontitis, VDD at baseline, and the number of intrabony defect walls revealed significant impacts on treatment success ( p = 0.033; OR = 3.50, p = 0.039; OR = 0.975, and p = 0.024; OR = 7.0 and p = 0.019;OR = 6.0, respectively).
Conclusions
CM in combination with a bone substitute seems to have slightly better outcomes compared to the CGF membranes in reconstructive surgical therapy of peri-implantitis. The history of periodontitis, baseline VDD, and peri-implant bone defect configuration could be possible predictors influencing treatment success.
Trial registration
ClinicalTrials.gov NCT04769609.
Clinical relevance
For the reconstruction of peri-implant bone defects, using a bone substitute in combination with a collagen membrane may show more favorable outcomes.
... 31 It has been suggested that for less than two-wall defect configurations, regenerative procedures are not indicated in peri-implantitis, since the defect may not hold the grafting biomaterial. 17,32 Case 1 showed a twowall configuration apically, which extended coronally with the loss of the buccal bone, and distally with the absence of the interproximal bone peak, while case 2 showed a supraalveolar-type defect. The combined use of an apical approach, biomaterials, and a CTG appears to be a desirable strategy. ...
Objective:
Advanced peri-implantitis treatment is a clinical challenge. Reconstructive surgery is not suggested in defects with limited bony walls and/or in those with a suprabony defect. All studies of peri-implantitis reconstructive surgery have considered a marginal surgical approach. However, in the present case report, a new apical approach is presented for the reconstruction of an advanced peri-implantitis lesion.
Materials and method:
First, a non-surgical phase combines prosthetic, mechanical, and chemical strategies. Second, a surgical phase combines the apical nonincised papillae surgical approach (NIPSA) with biomaterials and a connective tissue graft.
Conclusion:
Successful results have been obtained when using a NIPSA for the treatment of peri-implantitis, despite the unfavorable characteristics of the peri-implant defect.
Aim
Supportive therapy is key to prevent disease recurrence after peri‐implantitis treatment. The primary objective was to quantify disease recurrence during supportive peri‐implant therapy (SPIT) after peri‐implantitis treatment. A secondary objective was to assess the success/failure of cumulative interceptive supportive therapy (CIST) after peri‐implantitis treatment.
Methods
Compliers (whether regular or erratic) with SPIT after peri‐implantitis treatment during ≥12 months were retrospectively evaluated. CIST was prescribed whenever residual pockets ≥6 mm concomitant with profuse bleeding on probing (disease recurrence) were identified. Patient‐ and implant‐related factors were analyzed to explore their associations with disease recurrence and the need for CIST.
Results
Disease recurrence was considered in 28 patients (40 implants). Of these, 14 patients (23 implants) further demonstrated radiographic evidence of progressive bone loss (≥1 mm). This represented an overall disease recurrence following peri‐implantitis treatment of ~20% and ~ 10% at patient and implant levels, respectively. Smokers, patients diagnosed at baseline with periodontitis grade C, and males were significantly more prone to exhibit recurrence. Patients undergoing CIST due to instability were not likely to respond favorably (~70% continued to exhibit residual pockets).
Conclusion
Disease recurrence during SPIT following peri‐implantitis treatment on selected cases is ~20%. Patients undergoing CIST due to instability are not likely to respond favorably.
Healing of peri-implant diseases is still difficult, and there is no consensus on the best approach. In recent years, dental laser irradiation has attracted attention as an effective method for eliminating implant surface contaminants brought by peri-implant diseases. In this article, the effect of dental laser irradiation on the treatment of peri-implant diseases is revisited by reviewing literature on the effect of laser use.
Objectives:
To compare the clinical effectiveness of a control and two modified protocols for surgical therapy of combined peri-implantitis related defects.
Materials and methods:
A total of n=36 patients (n=40 implants) diagnosed with combined supra- and intrabony defects were identified for this retrospective analysis. All protocols considered access flap surgery, granulation tissue removal and implant surface decontamination using a titanium brush. The control combined protocol included implantoplasty at supracrestal/ buccal- and reconstructive therapy at intrabony components using a particulate natural bone mineral + a native collagen membrane (CM) (n=11 patients, n=11 implants, CP). The modified protocols included the augmentation at both supra- and intrabony defect components using either a collagen-stabilized natural bone mineral (BOC) (n=15 patients, n=15 implants, MP1), or BOC mixed with autogenous bone chips + CM (n=10 patients, n=14 implants, MP2). Linear mixed effects analyses were used to assess the changes in clinical parameters (i.e. bleeding on probing - BOP, probing pocket depth - PD, and mucosal recession - MR) over time (i.e. 6 and 12 months) and the impact of the treatment groups (CP, MP1, MP2).
Results:
At 12 months, median BOP and PD reductions amounted to -58.33 % and -1.16 mm in the MP1, to -62.50 % and -1.95 mm in the MP2, and to -66.67% and -0.83 mm in the CP groups, respectively. The associated MR changes ranged between 0.00 and 0.08 mm. The survival rates were 100% in all groups.
Conclusions:
All treatment protocols were associated with short-term improvements of the clinical parameters investigated.
Oral health is vital for the general well-being, overall body health and the quality of life throughout our lifetime. Most of the oral diseases and conditions are largely related to the maintenance of oral hygiene, lacking that people suffer from diverse oral diseases at different times in their life. With greater life expectancy, the individuals have teeth involved with periodontal diseases that would not only require professional care but also home gum care for them to last a lifetime. Indian Society of Periodontology (ISP) has recognized the need for systematic documents to update everyday clinical practice of general dental practitioners and have provided evidence-based consensus documents, namely good clinical practice recommendations from time to time to raise the oral health-related awareness and standards of oral healthcare delivery across the country. The current set of clinical practice recommendations focused to "Gum Care for All", is aimed at emphasizing and enhancing the awareness regarding oral health promotion, maintenance, and disease prevention. Twenty-five subject matter experts from across the nation, prepared these recommendations after a thorough literature review and group discussions. The document has been prepared in three distinct sections, namely pretherapeutic, therapeutic, and post therapeutic, to provide guidance during the respective phases of patient management and may serve as a quick and concise reference to the readers. The guidelines shall provide the distinct definitions, signs and symptoms, treatment required; recall visit specifications for plausible clinical case situations, home care advice regarding maintenance of oral hygiene including information on brushing technique, care and change of brush, use of interdental aids, and mouthwashes, etc. The document should advocate and guide the combined efforts of general dentists, and the population at large toward an empowered, evidence based, integrated, and comprehensive oral health care, which shall enhance the healthful functioning and longevity of the dentition and general health of the individual.
Objectives:
To determine the reliability and accuracy of intraoral radiography (IR), cone-beam-computed tomography (CBCT), and dental magnetic resonance imaging (dMRI) in measuring peri-implant bone defects around single zirconia implants.
Methods:
Twenty-four zirconia implants were inserted in bovine ribs with various peri-implant defect sizes and morphologies. True defect extent was measured without implant in CBCT. Defects were measured twice in IR, CBCT, and dMRI with the inserted implant by three experienced readers. Reliability was assessed by ICC, accuracy by the Friedman test, and post-hoc-Tukey's test.
Results:
A comparable good to excellent intra- and inter-reader reliability was observed for all modalities (Intra-/inter-rater-CC range for IR; CBCT; dMRI: 0.81-0.91/0.79;0.87-0.97/0.96;0.87-0.95/0.94). Accuracy was generally high, with mean errors below 1 mm in all directions. However, measuring defect depth in the mesiodistal direction was significantly more accurate in dMRI (0.65 ± 0.38 mm) compared to IR (2.71 ± 1.91 mm), and CBCT (1.98 ± 1.97 mm), p-values ≤ 0.0001 respectively ≤ 0.01.
Conclusions:
Osseous defects around zirconia implants can be reliably measured in IR/CBCT/dMRI in the mesiodistal directions. In addition, CBCT and dMRI allow assessment of the buccolingual directions. dMRI provides a comparable accuracy in all directions, except for the mesiodistal defect depth, where it outperforms IR and CBCT.
https://journals.lww.com/jisp/Fulltext/2023/27010/ISP_good_clinical_practice_recommendations_for_gum.4.aspx
Objectives
The aim of this in vitro study was to compare the efficacy of chemical and mechanical methods for decontamination of titanium dental implant surfaces previously infected with polymicrobial biofilms in a model simulating a peri-implant defect. Furthermore, the effect of each decontamination protocol on MG-63 osteoblast-like cells morphology and adhesion to the treated implants was assessed.
Background
Peri-implantitis is a growing issue in dentistry, and evidence about implant surface decontamination procedures is lacking and inconclusive.
Methods
A total of 40 previously biofilm-contaminated implants were placed into a custom-made model simulating a peri-implant defect and randomly assigned to five treatment groups: (C) control (no treatment); (AW) air abrasion without any powder; (ESC) air abrasion with powder of erythritol, amorphous silica, and 0.3% chlorhexidine; (HBX) decontamination with a sulfonic/sulfuric acid solution in gel; and (HBX + ESC) a combination of HBX and ESC. Microbiological analysis was performed on five implants per treatment group, and the residual viable bacterial load measured in log 10 CFU/mL was counted for each bacterial strain and for the total number of colonies. The remaining three implants per group and three noncontaminated (NC) implants were used to assess surface biocompatibility using a scanning electron microscope and a backscattered electron microscope after seeding with MG-63 cells.
Results
A significant decontaminant effect was achieved using HBX or HBX + ESC, while no differences were observed among other groups. The percentage of implant surface covered by adherent MG-63 cells was influenced by the treatment method. Progressive increases in covered surfaces were observed in groups C, AW, ESC, HBX, HBX + ESC, and NC.
Conclusions
A combination of mechanical and chemical decontamination may provide more predictable results than mechanical cleaning alone.
Objectives: to evaluate the influence of low-dose cone beam computed tomography (LD-CBCT) and metal artifact reduction (MAR) tool on the assessment of peri-implant dehiscence and fenestration.
Methodology: Thirty titanium implants were inserted into bovine rib blocks. Twenty had standardized bone defects (10 with dehiscence and 10 with fenestration), while the remaining 10 were used as control group with no defects. Radiographic examinations held with high‐definition CBCT(HD-CBCT) and LD-CBCT with and without application of MAR tool. Images were assessed by four examiners for the presence or absence of peri-implant defects. The area under the area under the receiver operating characteristic (ROC) curve (AUC), sensitivity, specificity, and accuracy were calculated for all radiographic protocols.
Results: Results: In the absence of MAR tool, there was no difference in AUC and diagnostic values between LD-CBCT and HD-CBCT for detection of both defects. When the MAR tool was applied, the AUC values, sensitivity, and accuracy were higher in HD-CBCT than in LD-CBCT for the detection of both defects, especially for the dehiscence, while specificity remained the same.
Conclusion: LD-CBCT can be used in the evaluation of peri-implant dehiscence and fenestration without any decrease in diagnostic accuracy. The application of MAR tool decrease the diagnostic ability of both defects, especially for the detection of dehiscence defects.
Clinical relevance: low-dose protocols of CBCT devices can be performed to assess the peri-implant defects with a significant decrease in patient radiation dose. MAR algorithm is not recommended for use in the evaluation of peri-implant defects.
Background and aim
Peri‐implantitis is a biological complication characterised by inflammation and progressive bone loss around a dental implant. The definitions of peri‐implantitis show inconsistency, making diagnosis and treatment regimen incomparable. The 2017 World Workshop on the Classification of Periodontal and Peri‐implant diseases rationalised the definition of peri‐implantitis. This narrative review aims to provide an overview of the surgical management of peri‐implantitis and critically evaluate current evidence published after the 2017 World Workshop.
Method
An electronic literature search of MEDLINE, EMBASE and The Cochrane Library was performed, limited to prospective cohort studies and randomised controlled trials. Outcome measures were: bleeding on probing, suppuration on probing, pocket probing depth and radiographic marginal bone level.
Results
Nine randomised controlled trials met the inclusion criteria. None of the studies used the 2017 World Workshop definition for peri‐implantitis. Seven studies were regenerative in nature (four xenografts, two alloplasts and one enamel matrix derivative). Two studies were non‐regenerative. Aggregation of outcome data was not possible due to significant heterogeneities for treatment protocols and volunteer inclusion criteria. All interventions led to a reduction in bleeding on probing and pocket probing depths. Gain in radiographic bone height was greater for regenerative studies.
Conclusion
Surgical interventions for peri‐implantitis appear effective at reducing clinical signs of inflammation in the short term. There is no reliable evidence to determine which methods are most effective. Universal adoption of the 2017 World Workshop definition of peri‐implantitis by future studies is a prerequisite for the development of standardised evidence‐based protocols for the treatment of peri‐implantitis.
Across years, potential strategies to fight peri-implantitis have been notoriously explored through the antimicrobial coating implant surfaces capable of interfering with the bacterial adhesion process. However, although experimental studies have significantly advanced, no product has been marketed so far. For science to reach the society, the commercialization of research outcomes is necessary to provide real advancement in the biomedical field. Therefore, the aim of this study was to investigate the challenges involved in the development of antimicrobial dental implant surfaces to fight peri-implantitis, through a systematic search. Research articles reporting antimicrobial dental implant surfaces were identified by searching PubMed, Scopus, Web of Science, The Cochrane Library, Embase, and System of Information on Grey Literature in Europe, between 2008 and 2020. A total of 1778 studies were included for quality assessment and the review. An impressive number of 1655 articles (93,1%) comprised in vitro studies, whereas 123 articles refer to in vivo investigations. From those 123, 102 refer to animal studies and only 21 articles were published on the clinical performance of antibacterial dental implant surfaces. The purpose of animal studies is to test how safe and effective new treatments are before they are tested in people. Therefore, the discrepancy between the number of published studies clearly reveals that preclinical investigations still come up against several challenges to overcome before moving forward to a clinical setting. Additionally, researchers need to recognize that the complex journey from lab to market requires more than a great idea and resources to develop a commercial invention; research teams must possess the skills necessary to commercialize an invention.
Peri-implantitis is an inflammatory process caused by microorganisms affecting the tissues around an osseointegrated implant in function, resulting in a loss of supporting bone. Limited data exist regarding the treatment of peri-implantitis. The aim of this study was to assess the clinical and microbiologic outcome of repeated local administration of minocycline microspheres, 1 mg, in cases of peri-implantitis.
Thirty-two subjects with at least one implant with a probing depth > or =4 mm combined with bleeding and/or exudate on probing and the presence of putative pathogenic bacteria were included in the study. At baseline, subjects were randomly assigned to receive local minocycline microspheres (17 subjects and 57 implants) or chlorhexidine gel (15 subjects and 38 implants) following debridement. Treatments were performed on three occasions: baseline and days 30 and 90. Follow-up examinations were conducted at 10 days and at 1, 3, 6, 9, and 12 months.
The use of minocycline resulted in significant improvements in probing depths compared to chlorhexidine at days 30, 90, and 180 (P = 0.5, P = 0.01, and P = 0.04, respectively). For the deepest sites of the minocycline-treated implants, the mean probing depth reduction was 0.6 mm at 12 months. Regarding bleeding on probing, significant differences between groups, based on all four sites at the implants, were found at days 30, 90, 180, 270, and 360. Both treatments resulted in a marked reduction in the indicator bacteria.
The use of a repeated local antibiotic as an adjunct to the mechanical treatment of peri-implantitis lesions demonstrated improvements in probing depths that were significantly different from controls and were sustained for 6 months. The adjunctive use of minocycline microspheres is beneficial in the treatment of peri-implant lesions, but the treatment may have to be repeated.
The aim of this review was to search the literature for the existing evidence of re-osseointegration after treatment of peri-implantitis at contaminated implant surfaces.
A search of PubMed as well as additional hand search of articles were conducted. Publications and articles accepted for publication up to November 2008 were included.
A total of 25 animal studies fulfilled the inclusion criteria for this review. Access surgery with closed healing has been observed to positively influence the rate of re-osseointegration when compared with non-surgical decontamination of the implant surface with open healing. Open debridement including surface decontamination may result in re-osseointegration and this integration was more pronounced on rougher than on smooth implant surfaces. The adjunctive use of regenerative procedures resulted in varying amounts of re-osseointegration.
Re-osseointegration is possible to obtain on a previously contaminated implant surface and can occur in experimentally induced peri-implantitis defects following therapy. The amount of re-osseointegration, varied considerably within and between studies. Implant surface characteristics may influence the degree of re-osseointegration. Surface decontamination alone can not achieve substantial re-osseointegration on a previously contaminated implant surface. No method predictably accomplished complete resolution of the peri-implant defect.
The present case series aimed at investigating the 4-year clinical outcomes following surgical regenerative therapy of peri-implantitis lesions using either a nanocrystalline hydroxyapatite (NHA) or a natural bone mineral in combination with a collagen membrane (NBM+CM).
Twenty patients suffering from moderate peri-implantitis (n=20 intrabony defects) were randomly treated with (1) access flap surgery (AFS) and the application of NHA (n=9), or with AFS and the application of NBM+CM (n=11). Clinical and radiographic (R) parameters were recorded at baseline (R) and after 36 and 48 (R) months of non-submerged healing.
One patient from the NBM+CM group was discontinued from the study due to severe pus formation at 36 months. Compared with NHA, the application of NBM+CM resulted in higher mean PD reductions (NBM+CM: 2.5 +/- 0.9 mm versus NHA: 1.1 +/- 0.3 mm) and clinical attachment-level gains (NBM+CM: 2.0 +/- 1.0 mm versus NHA: 0.6 +/- 0.5 mm) at 48 months. A radiographic bone fill was observed for five sites in the NHA group, and eight sites in the NBM+CM group.
While the application of NBM+CM resulted in clinical improvements over a period of 4 years, the long-term outcome obtained with NHA without barrier membrane must be considered as poor.
Peri-implantitis is a frequent finding in patients with dental implants. The present study compared two non-surgical mechanical debridement methods of peri-implantitis.
Thirty-seven subjects (mean age 61.5; S.D+/-12.4), with one implant each, demonstrating peri-implantitis were randomized, and those treated either with titanium hand-instruments or with an ultrasonic device were enrolled. Data were obtained before treatment, and at 1, 3, and 6 months. Parametric and non-parametric statistics were used.
Thirty-one subjects completed the study. The mean bone loss at implants in both groups was 1.5 mm (SD +/-1.2 mm). No group differences for plaque or gingival indices were found at any time point. Baseline and 6-month mean probing pocket depths (PPD) at implants were 5.1 and 4.9 mm (p=0.30) in both groups. Plaque scores at treated implants decreased from 73% to 53% (p<0.01). Bleeding scores also decreased (p<0.01), with no group differences. No differences in the total bacterial counts were found over time. Higher total bacterial counts were found immediately after treatment (p<0.01) and at 1 week for ultrasonic-treated implants (p<0.05).
No group differences were found in the treatment outcomes. While plaque and bleeding scores improved, no effects on PPD were identified.
To review the literature on surgical treatment of peri-implantitis.
A search of PubMed and as well as a hand search of articles were conducted. Publications and articles accepted for publication up to November 2007 were included.
A total of 43 studies were selected for the review. Only 13 of these were studies in humans and only one study directly addressed disease resolution. Thus the available evidence for surgical treatment of peri-implantitis is extremely limited. ANIMAL STUDIES: Re-osseointegration can occur on previously contaminated surfaces. The surface characteristics are decisive for regeneration and re-osseointegration. No single surface decontamination method appears to be distinctly superior. Open debridement with surface decontamination can achieve resolution. HUMAN STUDIES: Access surgery has been investigated in one study demonstrating that resolution occurred in 58% of the lesions. No single method of surface decontamination (chemical agents, air abrasives and lasers) was found to be superior. The use of regenerative procedures such as bone graft techniques with or without the use of barrier membranes has been reported with various degrees of success. However, it must be stressed that such techniques do not address disease resolution but rather merely attempt to fill the osseous defect.
The purpose of this study was to clinically evaluate an absorbable collagen membrane (Bio-Gide®) and a nonabsorbable polytetrafluoroethylene membrane (PTFE), associated or not with bone grafts, for the treatment of ligature-induced peri-implantitis defects in dogs. The bilateral mandibular premolars were removed from 5 2-year-old mongrel dogs. After 3 months of healing, 3 titanium implants were placed on each side of the mandible. Experimental peri-implantitis was induced after abutment connection. Ligatures and abutments were removed after 1 month and the bone defects were randomly assigned to one of the following treatments: DB: debridement alone; GBR+BG-I: debridement plus PTFE membrane associated with mineralized bone graft (Bio-Oss®); GBR+BG-II: debridement plus collagen membrane (Bio-Gide®) associated with mineralized bone graft; GBR-I: debridement plus PTFE membrane; GBR-II: debridement plus collagen membrane; BG: debridement plus mineralized bone graft. The peri-implant bone defects were measured before and 5 months after treatment. Results showed the greatest percentage of vertical bone fill for GBR+BG-II (27.77±14.07) followed by GBR-II (21.78±16.19), BG (21.26±6.87), GBR+BG-I (19.57±13.36), GBR-I (18.86±10.63) and DB (14.03±5.6). However, the values were not statistically significant (ANOVA, contrast F test, P=0.612). Within the limits of the present investigation, it can be concluded that no difference was detected among treatments.
The purpose of this study was to histometrically evaluate an absorbable collagen membrane (Bio-Gide) and a nonabsorbable polytetrafluoroethylene membrane (PTFE), associated with or without bone grafts, regarding "re-osseointegration" after treating ligature-induced peri-implantitis defects in dogs. All mandibular premolars were removed from five 2-year-old mongrel dogs. After 3 months of healing, 3 titanium implants were placed on each side of the mandible. Experimental peri-implantitis was induced with ligatures after abutment connection. Ligatures and abutments were removed after 1 month and the bone defects were randomly assigned to one of the following treatments; debridement alone (DB), debridement plus PTFE membrane associated with mineralized bone graft (Bio-Oss) (GBR+BG-I), debridement plus collagen membrane (Bio-Gide) associated with mineralized bone graft (GBR+BG-II), debridement plus PTFE membrane (GBR-I), debridement plus collagen membrane (GBR-II), or debridement plus mineralized-bone graft (BG). The dogs were sacrificed after 5 months. Data analysis did not reveal significant differences among the treatments regarding the percentage of bone-to-implant contact ("re-osseointegration") within the limits of the threads of the implant (P = .997). Thus, in the treatment of peri-implantitis, debridement alone as well as grafting alone had the same effect as did either membrane.
Advanced peri-implant intrabony defects require comprehensive surgical treatment regimens different from periodontal therapy strategies. The purpose of this longitudinal trial was to evaluate the peri-implant outcomes following guided bone regeneration with 3 treatment protocols.
In 25 patients, 41 peri-implant defects with supporting bone loss >50% of the implant length were treated with flap surgery plus autogenous bone grafts alone (FG) (controls, n = 12) plus non-resorbable (FGM) (test 1, n = 20) or bioabsorbable barriers (FGRM) (test 2, n = 9) and supportive antimicrobial therapy. Following submerged healing, the membranes were removed (FGM), and the peri-implant probing depths (PD), probing bone levels (BL), mobility scores (PT), and intrabony defect height (DH) were radiographically evaluated at baseline, 6 months, and 1 and 3 years post-therapy.
Non-surgical/anti-infective therapy resulted in a limited improvement of PD scores after 6 months. At the 3-year visit, surgical treatment revealed significant changes from baseline for the controls and both of the test groups for PD: 5.1 +/- 2.7 mm (FG), 5.4 +/- 3.0 mm (FGM), and 2.6 +/- 1.6 mm (FGRM), and for BL: 3.2 +/- 2.4 mm (FG), 3.4 +/- 2.4 mm (FGM), and 2.3 +/- 1.6 mm (FGRM), Mann-Whitney test, P < or = 0.05. The changes for DH and PT were significant only for FG- and FGM-treated subjects. The overall improvement for FGRM-treated patients during the 3-year observation was less marked. However, the differences between the 3 surgical treatment protocols did not affect the treatment outcomes after 3 years.
Autogenous bone grafting is an appropriate treatment regimen to augment open crater-formed peri-implant defects. Although certain clinical situations require an additional fixation of barrier membranes, their routine application should be approached with caution.
The goal of this study was to evaluate, morphometrically, hard-tissue healing following the treatment of ligature-induced peri-implantitis defects in dogs and guided bone regeneration and/or bone grafts. Five dogs were used, and the mandibular premolars were removed. Three months later, two titanium implants were installed on each side of the mandible, and after another 3 months, abutment connection was performed. Following abutment connection, experimental periimplantitis was induced by placing cotton ligatures in a submarginal position. Ligatures and abutments were removed after 1 month and the bony defects were randomly assigned to one of the following treatments: debridement (DE), debridement plus guided bone regeneration (GBR), debridement plus mineralized bone graft (BG), and debridement plus guided bone regeneration associated with mineralized bone graft (GBR/BG). The dogs were euthanatized after 5 months. Morphometric analysis did not reveal significant differences among the treatments neither with respect to the percentage of bone to implant contact (p = 0.996) nor to the bone area (p = 0.946) within the limits of the threads of the implant. Within the limits of this investigation, there is insufficient evidence to indicate that any of the treatments presented an improved response in dealing with bony defects resulting from peri-implantitis.
The aim of this controlled, parallel design clinical study was to compare the effectiveness of an Er:YAG laser (ERL) to that of mechanical debridement using plastic curettes and antiseptic therapy for nonsurgical treatment of peri-implantitis. Twenty patients with moderate to advanced peri-implantitis lesions were randomly treated with either (1) an ERL using a cone-shaped glass fiber tip at an energy setting of 100 mJ/pulse and 10 pps (ERL), or (2) mechanical debridement using plastic curettes and antiseptic therapy with chlorhexidine digluconate (0.2%) (C). The following clinical parameters were measured at baseline, 3 and 6 months after treatment by one blinded and calibrated examiner: Plaque index (PI), bleeding on probing (BOP), probing depth (PD), gingival recession (GR) and clinical attachment level (CAL). At the baseline examination, there were no statistically significant differences in any of the investigated parameters. Mean value of BOP decreased in the ERL group from 83% at baseline to 31% after 6 months (P < 0.001) and in the C group from 80% at baseline to 58% after 6 months (P < 0.001). The difference between the two groups was statistically significant (P < 0.001, respectively). The sites treated with ERL demonstrated a mean CAL change from 5.8 +/- 1 mm at baseline to 5.1 +/- 1.1 mm (P < 0.01) after 6 months. The C sites demonstrated a mean CAL change from 6.2 +/- 1.5 mm at baseline to 5.6 +/- 1.6 mm (P < 0.001) after 6 months. After 6 months, the difference between the two groups was statistically not significant (P > 0.05). Within the limits of the present study, it was concluded that (i) at 6 months following treatment both therapies led to significant improvements of the investigated clinical parameters, and (ii) ERL resulted in a statistically significant higher reduction of BOP than C.
The aim of the present study was to assess clinical and histo-pathological healing pattern of peri-implantitis lesions following non-surgical treatment with an Er:YAG laser (ERL).
Twelve patients suffering from peri-implantitis (n = 12 implants) received a single episode of non-surgical instrumentation using ERL (12.7 J/cm2). Assessment of clinical parameters (plaque index (PI), bleeding on probing (BOP), probing pocket depth, gingival recession (GR), and clinical attachment level (CAL)), surgical defect examination, and histo-pathological examination of peri-implant tissue biopsies was performed after 1, 3, 6, 9, 12, and 24 months.
All patients exhibited improvements of all clinical parameters investigated. However, histo-pathological examination of tissue biopsies revealed a mixed chronic inflammatory cell infiltrate (macrophages, lymphocytes, and plasma cells) which seemed to be encapsulated by deposition of irregular bundles of fibrous connective tissue showing increased proliferation of vascular structures.
It was concluded that a single course of non-surgical treatment of peri-implantitis using ERL may not be sufficient for the maintenance of failing implants.
This randomized clinical trial presents a 12-month follow-up of the clinical and microbiological results after application of minocycline microspheres as an adjunct to mechanical treatment of incipient peri-implant infections compared with an adjunctive treatment using 1% chlorhexidine gel application.
Thirty-two subjects with probing depth > or =4 mm, combined with bleeding and/or exudate on probing and presence of putative pathogenic bacteria were given oral hygiene instructions and mechanical treatment of infected areas adjacent to implants. The subjects were then randomly assigned adjunctive subgingival antimicrobial treatment using either chlorhexidine gel or minocycline microspheres. Sixteen patients in the minocycline group and 14 in the chlorhexidine group completed the study. Follow-up examinations were carried out after 10 days, 1, 2, 3, 6, 9 and 12 months.
The adjunctive use of minocycline microspheres resulted in improvements of probing depths and bleeding scores, whereas the adjunctive use of chlorhexidine only resulted in limited reduction of bleeding scores. For the deepest sites of the treated implants in the minocycline group, the mean probing depth was reduced from 5.0 to 4.4 mm at 12 months. This study could not show any significant difference in the levels of bacterial species or groups at any time point between the two antimicrobial agents tested. The present findings encourage further studies on adjunctive use of minocycline microspheres in the treatment of peri-implant lesions.
The use of a local antibiotic as an adjunct to mechanical treatment of incipient peri-implantitis lesions demonstrated improvements in probing depths that were sustained over 12 months.
The aim of the present case series was to evaluate the healing of intrabony peri-implantitis defects following application of a nanocrystalline hydroxyapatite (NHA) or a bovine-derived xenograft in combination with a collagen membrane (BDX+BG).
Twenty-two patients having moderate peri-implantitis (n=22 intrabony defects) were randomly treated with (i) access flap surgery (AFS) and the application of NHA, or with AFS and the application of BDX+BG. Clinical parameters were recorded at baseline and after 6 months of non-submerged healing.
Post-operative wound healing revealed that NHA compromized initial adhesion of the mucoperiosteal flaps in all patients. At 6 months after therapy, NHA showed a reduction in the mean PD from 7.0+/-0.6 to 4.9+/-0.6 mm and a change in the mean clinical attachment loss (CAL) from 7.5+/-0.8 to 5.7+/-1.0 mm. In the BDX+BC group, the mean PD was reduced from 7.1+/-0.8 to 4.5+/-0.7 mm and the mean CAL changed from 7.5+/-1.0 to 5.2+/-0.8 mm.
Within the limits of the present case series, it can be concluded that at 6 months after surgery both therapies resulted in clinically important PD reductions and CAL gains.
[corrected] The aim of the present study was to evaluate non-submerged and submerged healing of ligature induced peri-implantitis in dogs.
Peri-implantitis was induced by ligature placement in five beagle dogs (n = 30 implants). The defects were randomly and equally allocated in a split-mouth design to either closed treatment + non-submerged healing (CNS), or open treatment + submerged healing (OS) using an Er:YAG laser (ERL), an ultrasonic device (VUS), or plastic curettes + local application of metronidazole gel (PCM), respectively. The animals were sacrificed after 3 months. Clinical, radiological and histological (e.g. new bone-to-implant contact (BIC)) parameters were assessed.
All treatment procedures resulted in statistically significant improvements of all clinical parameters at both CNS and OS implants. Radiological improvements were merely observed at OS implants. Histomorphometrical analysis revealed that all CNS implants exhibited comparable low amounts of new BIC (1.0-1.2%), while mean BIC was statistically significant higher in the respective OS groups [ERL (44.8%), PCM (14.8%), VUS (8.7%)].
Within the limits of the present study, it was concluded that (i) OS improved the outcome of treatment in comparison with CNS and (ii) ERL seemed to be more suitable to promote re-osseointegration than PCM and VUS.
The aim of this controlled, parallel design clinical study was to evaluate the effectiveness of an Er:YAG (erbium-doped:yttrium, aluminum, and garnet) laser for nonsurgical treatment of periimplantitis lesions. Twenty patients, each of whom displayed at least one implant with (a) moderate and (b) advanced periimplantitis (n=40 implants; IMZ, ITI, Spline Twist, ZL-Duraplant, Camlog), were randomly instrumented nonsurgically using either (1) an Er:YAG laser (100 mJ/pulse, 10 Hz) device (LAS) or (2) mechanical debridement using plastic curettes and antiseptic therapy with chlorhexidine digluconate (0.2%) (C). The following clinical parameters were measured at baseline, 3, 6, and 12 months after treatment: plaque index, bleeding on probing (BOP), probing depth, gingival recession, and clinical attachment level (CAL). Mean BOP improved significantly in both groups at 3, 6, and 12 months (a- lesions: P<0.001 and b- lesions: P<0.01, respectively). After 3 and 6 months, the mean reduction of BOP was significantly higher in the LAS group when compared to the C group (a- and b- lesions: P<0.01 and P<0.05, respectively). At 3 and 6 months, both groups revealed significant CAL gains at a- and b- lesions (P<0.01, respectively). In both groups, however, the mean CAL at a- and b- lesions was not significantly different from the respective baseline values at 12 months (P>0.05, respectively). Although treatment of periimplantitis lesions with LAS resulted in a significantly higher BOP reduction than C, its effectiveness seemed to be limited to a period of 6 months, particularly at b- lesions.
The aim of the present study was to evaluate and compare naturally occuring and ligature-induced peri-implantitis bone defects in humans and dogs.
Twenty-four partially and fully edentulous patients undergoing peri-implant bone augmentation procedures due to advanced peri-implant infections were included in this study (n=40 implants). Furthermore, peri-implantitis was induced by ligature placement and plaque accumulation in five beagle dogs for three months following implant insertion (n=15 implants). The ligatures were removed when about 30% of the initial bone was lost. During open flap surgery, configuration and defect characteristics of the peri-implant bone loss were recorded in both humans and dogs.
Open flap surgery generally revealed two different classes of peri-implant bone defects. While Class I defects featured well-defined intrabony components, Class II defects were characterized by consistent horizontal bone loss. The allocation of intrabony components of Class I defects regarding the implant body allowed a subdivision of five different configurations (Classes Ia-e). In particular, human defects were most frequently Class Ie (55.3%), followed by Ib (15.8%), Ic (13.3%), Id (10.2%), and Ia (5.4%). Similarly, bone defects in dogs were also most frequently Class Ie (86.6%), while merely two out of 15 defects were Classes Ia and Ic (6.7%, respectively).
Within the limits of the present study, it might be concluded that configurations and sizes of ligature-induced peri-implantitis bone defects in dogs seemed to resemble naturally occurring lesions in humans.
The aim was to study a regenerative surgical treatment modality for peri-implantitis employing submerged healing.
Twelve patients, having a minimum of one osseointegrated implant with peri-implantitis, with a progressive loss of >or=3 threads (1.8 mm) following the first year of healing were involved in the study. After surgical exposure of the defect, granulomatous tissue was removed and the implant surface was treated using 3% hydrogen peroxide. The bone defects were filled with a bone substitute (Algipore), a resorbable membrane (Osseoquest) was placed over the grafted defect and a cover screw was connected to the fixture. The implant was then covered by flaps and submerged healing was allowed for 6 months. After 6 months the abutment was re-connected to the supra-structure.
A 1-year follow-up demonstrated clinical and radiographic improvements. Probing depth was reduced by 4.2 mm and a mean defect fill of 2.3 mm was obtained.
Treatment of peri-implant defects using a bone graft substitute combined with a resorbable membrane and submerged healing results in defect fill and clinical healthier situations.
The aim of this prospective cohort study was to compare two regenerative surgical treatment modalities for peri-implantitis.
Thirty-six patients having a minimum of one osseointegrated implant, with a progressive loss of bone amounting to > or =3 threads (1.8 mm) following the first year of healing, combined with bleeding and/or pus on probing, were involved in this study. The patients were assigned to two different treatment strategies. After surgical exposure of the defect, granulomatous tissue was removed and the infected implant surface was treated using 3% hydrogen peroxide. The bone defects were filled with a bone substitute (Algipore). In 17 patients (Group 1), a resorbable membrane (Osseoquest) was placed over the grafted defect before suturing. In 19 patients (Group 2), the graft was used alone.
One-year follow-up demonstrated clinical and radiographic improvements. Probing depths were reduced by 2.9 mm in Group 1 and by 3.4 mm in Group 2. Defect fill amounted to 1.5 and 1.4 mm, respectively. There was no significant difference between the groups.
It is possible to treat peri-implant defects with a bone substitute, with or without a resorbable membrane.
The aim of the present case series was to evaluate the 2-year results obtained following treatment of peri-implantitis lesions using either a nanocrystalline hydroxyapatite (NHA) or a natural bone mineral in combination with a collagen membrane (NBM+CM).
Twenty-two patients suffering from moderate peri-implantitis (n=22 intra-bony defects) were randomly treated with (i) access flap surgery (AFS) and the application of NHA, or with AFS and the application of NBM+CM. Clinical parameters were recorded at baseline and after 12, 18, and 24 months of non-submerged healing.
Two patients from the NHA group were excluded from the study due to severe pus formation at 12 months. At 24 months, both groups revealed clinically important probing depth (PD) reductions (NHA: 1.5+/-0.6 mm; NBM+CM: 2.4+/-0.8 mm) and clinical attachment level (CAL) gains (NHA: 1.0+/-0.4 mm; NBM+CM: 2.0+/-0.8 mm). However, these clinical improvements seemed to be better in the NBM+CM group (difference between groups: PD reduction: 0.9+/-0.2 mm; CAL gain: 1.0+/-0.3 mm).
Both treatment procedures have shown efficacy over a period of 24 months, however, the application of NBM+CM may result in an improved outcome of healing.
The aim of the present study was to investigate the effects of an Er:YAG laser (ERL) and the Vector ultrasonic system (VS) on the biocompatibility of titanium implants in cultures of human osteoblast-like cells (SAOS-2). One hundred and sixty-eight titanium discs with four different surfaces (sand-blasted and acid-etched, titanium plasma-sprayed, machine-polished, and hydroxyapatite-coated) were used to evaluate cell attachment. The samples were equally and randomly assigned to the following groups: (1) an ERL at an energy level of 100 mJ/pulse and 10 Hz using a special application tip, (2) the VS using carbon fibre tips, or (3) untreated control (C). The discs were placed in culture plates, covered with a solution of SAOS-2 cells, and incubated for 7 days. The specimens were then washed with phosphate buffer to remove cells not attached to the surface, and the adherent cells were stained with hematoxilin-eosin. Cells were counted using a reflected light microscope and the cell density per mm2 was calculated. Additionally, cell morphology and surface alterations of the titanium discs after treatment were investigated using scanning electron microscopy (SEM). All titanium discs treated with ERL demonstrated nearly the same cell density per mm2 as the untreated C surfaces. There was a significant decrease in the number of cells that attached to the implant surfaces treated with VS. The SEM examination showed no visible differences between lased and C titanium surfaces. All surfaces treated with VS showed conspicuous surface damage and debris of the used carbon fibres. The results of the present study indicate that (i) ERL does not damage titanium surfaces and subsequently does not influence the attachment rate of SAOS-2 cells, and (ii) VS, used with this type of carbon fibre tip, does not seem to be suitable for the instrumentation of titanium surfaces.
Treatment of peri-implantitis defects with autogenous bone grafts
- A. Behneke
- N. Behneke
- B. D'Hoedt
Mechanical non-surgical treatment of peri-implantitis
- Renvert
Surgical therapy of peri-implant disease
- Khoury
Re-osseointegration on previously contaminated surfaces
- Renvert
Treatment of peri‐implantitis defects with autogenous bone grafts
- Behneke A.