International Journal of Oral Implantology, 3/2022
PubMed-ID: 36082658Seiten: 213-248, Sprache: Englisch
Peri-implantitis is an infectious disease that leads to progressive bone loss. Surgical therapy has been advocated as a way of halting its progression and re-establishing peri-implant health. One of the most challenging but crucial tasks in the management of peri-implantitis is biofilm removal to achieve reosseointegration and promote the reduction of peri-implant pockets. A wide variety of strategies have been used for implant surface decontamination. Mechanical means have been demonstrated to be effective in eliminating calculus deposits and residual debris; however, the presence of undercuts and the grooves and porosities along the roughened implant surface make it difficult to achieve an aseptic surface. In conjunction with mechanical measures, use of chemical adjuncts has been advocated to dilute bacterial concentrations, destroy the bacteria’s organic components and eliminate endotoxins. Pharmacological adjuncts have also been recommended to diminish the bacterial load. Other strategies, such as use of lasers, implantoplasty and electrolysis, have been suggested for implant surface decontamination to promote predictable clinical and radiographic outcomes.
Schlagwörter: dental implant, dental implantation, peri-implant endosseous healing, peri-implantitis
Conflict-of-interest statement: The authors declare that they have no direct conflicts of interest. Dr Monje owns royalties to a peri-implantitis kit that includes burs for mechanical detoxi
International Journal of Oral Implantology, 3/2022
PubMed-ID: 36082657Seiten: 203-204, Sprache: Englisch
The International Journal of Oral & Maxillofacial Implants, 2/2022
DOI: 10.11607/ jomi.9374Seiten: 329-338, Sprache: Englisch
Purpose: The scarce standard therapeutic protocols for the management of peri-implant diseases results in the empirical application of therapeutic modalities. The objective of this study was to carry out a survey to analyze the therapeutic trends of professionals with different academic backgrounds and levels of expertise.
Materials and methods: An exploratory cross-sectional internet-based study survey of board-certified members of the American Academy of Periodontology (AAP) and the European Federation of Periodontology (EFP) was conducted. To assess the therapeutic trends, four clinical vignettes representing different scenarios of peri-implant biologic complications were provided to the participants. Differences in practice patterns were determined using chi-square test and Student t test or analysis of variance (ANOVA) test for qualitative variables.
Results: A total of 268 members of the AAP and EFP completed the survey. A significant difference in preferred treatment plan was found between EFP and AAP periodontists, resective therapy being the treatment of choice by the majority of the former (41.2%) and regenerative therapy by the latter (48.9%; P < .001). Overall, 48.1% of experts did not consider any intervention for the management of mucositis. Antibiotic prescriptions differed among groups, with statistical significance in each clinical case, and the explantation criteria were inconsistent and differed significantly among groups.
Conclusion: Substantial variations exist concerning the decision-making to manage peri-implant diseases and conditions.
Schlagwörter: diagnostic procedure, peri-implantitis, periodontist, periodontology, surgical procedure
International Journal of Periodontics & Restorative Dentistry, 6/2021
Online OnlyDOI: 10.11607/prd.5201Seiten: e223-e231, Sprache: Englisch
This pilot study aimed to assess the diagnostic accuracy of CBCT in identifying peri-implantitis-like bone defects in cadavers. Three cadaver dental arches treated with the Thiel embalming method were used. Three different types of peri-implant bone defects (buccal dehiscence, two- to three-wall defects, and circumferential defects) were prepared on 15 implants. Defect depths and lengths were identified clinically using a periodontal probe, radiologically by means of CBCT images, and histologically with a micrometer using an optic microscope. Peri-implant bone defect morphology evaluated using CBCT images matched the clinical defect configuration (100% accuracy). CBCT assessment demonstrated lower values in defect depth and defect length when compared with the clinical evaluation. A statistically significant difference in defect depth (0.35 ± 0.45 mm; P = .037) was recorded between the clinical and CBCT data. Regarding defect length, a statistically significant mean difference of 0.81 ± 0.83 mm (P = .003) was noted between the clinical and CBCT data. Similarly, a mean difference of 1.09 ± 1.52 mm was recorded between the defect length assessed histologically and the CBCT data (P = .031). No statistically significant differences were observed between the other evaluated variables. CBCT is a reliable tool for peri-implantitis diagnosis and treatment planning, though the underestimation of defect severity may affect the prognosis and clinical decision-making. Clinicians need to be flexible in establishing prognoses and treatment based on CBCT assessment.
International Journal of Oral Implantology, 4/2021
PubMed-ID: 34726848Seiten: 385-399, Sprache: Englisch
Peri-implant diseases at implant sites represent the most considerable concern for many dental clinicians nowadays due to their detrimental effect on implant longevity. Preventive measures include patient education and motivation, supportive peri-implant therapy and routine assessment of the hard and soft tissues. Nevertheless, the reliability of clinical parameters to monitor peri-implant conditions is subject to debate. As such, the primary purpose of the present review was to gain further insight into the diagnostic accuracy of probing as a clinical tool to monitor dental implants and assist clinicians in preventing peri-implant diseases. Studies have recommended periodic probing to monitor the condition of the peri-implant tissues. Increased probing pocket depth, profuse bleeding on probing and suppuration at implants are clinical signs that have been associated with peri-implantitis; thus, if these clinical parameters are present, radiographic assessment is encouraged to make a definitive diagnosis considering potential inaccuracies related to local and/or systemic factors identified in the present review.
Schlagwörter: complications, diagnostic procedure, peri-implantitis, surgical
Conflict-of-interest statement: The authors declare there are no conflicts of interest relating to this study.
International Journal of Periodontics & Restorative Dentistry, 2/2021
Seiten: 295-301, Sprache: Englisch
Keratinized mucosa (KM) is regarded as a key factor in peri-implant health. A lack of KM has been associated with discomfort, higher plaque accumulation, and mucosal inflammation. Persistent inflammation might lead to progressive peri-implant bone loss. Several approaches to manage peri-implantitis have been advocated. Despite the effectiveness shown by surgical therapeutic modalities, soft tissue conditioning seems pivotal for long-term peri-implant health and stability. Free epithelial grafts have been demonstrated to efficiently augment the band of KM. Nevertheless, morbidity, dynamic soft tissue changes, and longer healing periods are shortcomings to be considered. The purpose of this technical note is to provide an alternative therapeutic modality for the surgical management of peri-implantitis combined with simultaneous soft tissue conditioning by means of pedicle flaps. Three main clinical scenarios are provided to conceive pedicle epithelial or connective tissue flaps, combined or not with collagen matrices, as predictable approaches to augment KM in the surgical therapy of peri-implantitis.
International Journal of Periodontics & Restorative Dentistry, 6/2020
DOI: 10.11607/prd.4554, PubMed-ID: 33151197Seiten: 899-e909, Sprache: Englisch
The significance of keratinized mucosa around dental implants for the prevention of biologic complications has been a subject of controversy. Agreement, however, exists on the benefits provided to achieve more satisfactory oral hygiene measures and reduced clinical inflammation. A prospective interventional case series of 14 patients (31 implants) were examined every 3 months for up to 12 months. The effect of soft tissue conditioning by means of free autologous epithelial graft on the management of peri-implantitis with supracrestal and/or dehiscence-type defect morphology was evaluated. All clinical parameters were significantly reduced (P < .001), with complete disease resolution in 78.6% of the patients and 87.1% of the peri-implantitis implants. Unsuccessful cases were associated with less gain of keratinized mucosa, deep probing pocket depths, bleeding on probing, and less satisfaction during brushing at 12 months. Dimensional changes following soft tissue grafting were more significant during the first 3 months and led to a 42.4% shrinkage at 12 months. Soft tissue conditioning by means of free autologous epithelial graft in combination with apically positioned flap is a viable and effective therapy to manage peri-implantitis associated with deficient keratinized mucosa.
Forum Implantologicum, 1/2020
Seiten: 22-31, Sprache: Englisch
Peri-implantitis is a biofilm-mediated inflammatory process that leads to soft- and hard-tissue breakdown. Periimplant diseases are the most frequent biologic implant complication in daily practice. Certain systemic conditions as well as detrimental habits have been demonstrated to negatively impact peri-implant tissue health and stability. In addition, several local predisposing factors were also identified to be associated with the development of periimplantitis, such as the lack of keratinized mucosa, residual cement or a micro-rough implant surface exposed to the oral cavity or the peri-implant sulcus. This clinical review paper will focus on the latter risk factor, which is often caused by poor surgical performance by the clinician during implant surgery.
Schlagwörter: Peri-implantitis, peri-implant disease, dental implant, implant infection, risk factor, surgical risk factors
The International Journal of Oral & Maxillofacial Implants, 7/2019
SupplementSeiten: s7-s23b, Sprache: Englisch
Purpose: This systematic review was prepared as part of the Academy of Osseointegration (AO) 2018 Summit, held August 8-10 in Oak Brook Hills, Illinois, to assess the relationship between the primary (mechanical) and secondary (biological) implant stability.
Materials and Methods: Electronic and manual searches were conducted by two independent examiners in order to address the following issues. Meta-regression analyses explored the relationship between primary stability, as measured by insertion torque (IT) and implant stability quotient (ISQ), and secondary stability, by means of survival and peri-implant marginal bone loss (MBL).
Results: Overall, 37 articles were included for quantitative assessment. Of these, 17 reported on implant stability using only resonance frequncy analysis (RFA), 11 used only IT data, 7 used a combination of RFA and IT, and 2 used only the Periotest. The following findings were reached:
• Relationship between primary and secondary implant stability: Strong positive statistically significant relationship (P < .001).
• Relationship between primary stability by means of ISQ and implant survival: No statistically significant relationship (P = .4).
• Relationship between IT and implant survival: No statistically significant relationship (P = .2).
• Relationship between primary stability by means of ISQ unit and MBL: No statistically significant relationship (P = .9).
• Relationship between IT and MBL: Positive statistically significant relationship (P = .02).
• Accuracy of methods and devices to assess implant stability: Insufficient data to address this issue.
Conclusion: Data suggest that primary/mechanical stability leads to more efficient achievement of secondary/biological stability, but the achievement of high primary stability might be detrimental for bone level stability. While current methods/devices for tracking implant stability over time can be clinically useful, a robust connection between existing stability metrics with implant survival remains inconclusive.
Schlagwörter: alveolar bone, bone homeostasis, dental implants, diagnostic, implant stability, mechanical, resonance frequency analysis
The International Journal of Oral & Maxillofacial Implants, 6/2019
DOI: 10.11607/jomi.7657, PubMed-ID: 31532826Seiten: 1328-1336a, Sprache: Englisch
Purpose: There is a lack of knowledge concerning the critical buccal bone thickness required for securing favorable functional and esthetic outcomes, conditioned to the dimensional changes after implant placement. A preclinical study was therefore carried out to identify the critical buccal bone wall thickness for minimizing bone resorption during physiologic and pathologic bone remodeling.
Materials and Methods: A randomized, two-arm in vivo study in healthy beagle dogs was carried out. The first group of dogs was sacrificed 8 weeks after implant placement for histomorphometric examination of postsurgical resorption of the buccal bone wall. The second group of dogs was monitored during three ligature-induced peri-implantitis episodes and a spontaneous progression episode. Morphometric and clinical variables were defined for the study of physiologic and pathologic buccal and lingual bone loss.
Results: Seventy-two implants were placed in healed mandibular ridges of 12 beagle dogs. Two groups were defined: 36 implants were placed in sites with a thin buccal bone wall (< 1.5 mm), and 36 were placed in sites with a thick buccal bone wall (≥ 1.5 mm). No implants failed during the study period. For the great majority of the histomorphometric parameters, a critical buccal bone wall thickness of at least 1.5 mm seemed to be essential for maintaining the buccal bone wall during physiologic and pathologic bone resorption. Suppuration (+) and mucosal recession (-) were more often associated with implants placed in sites with a thin buccal bone wall.
Conclusion: A critical buccal bone wall thickness of 1.5 mm at implant placement is advised, since a thicker peri-implant buccal bone wall (≥ 1.5 mm) is exposed to significantly less physiologic and pathologic bone loss compared with a thinner buccal bone wall (< 1.5 mm).
Schlagwörter: alveolar bone, dental implants, diagnostic, implant stability, peri-implant mucositis, peri-implantitis