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The aim of this PRISMA-compliant systematic review was to analyze the evidence pertaining to disease resolution after treatment of peri-implant diseases (PROSPERO: CRD42022306999) with the following PICO question: what is the rate of disease resolution following non-surgical and surgical therapy for peri-implant diseases in adult human subjects? A literature search to identify studies that fulfilled a pre-established eligibility criteria was conducted. Data on primary therapeutic outcomes, including treatment success, rate of disease resolution and/or recurrence, as well as a variety of secondary outcomes was extracted and categorized. Fifty-five articles were included. Few studies investigated the efficacy of different non-surgical and surgical therapies to treat peri-implant diseases using a set of pre-defined criteria and with follow-up periods of at least one year. The definition of treatment success and outcomes of disease resolution differed considerably among the included studies. Treatment of peri-implant mucositis was most commonly reported to be successful in arresting disease progression for ≤60% of the cases, whereas most studies on peri-implantitis treatment reported disease resolution occurring in <50% of the fixtures. In conclusion, disease resolution is generally unpredictable and infrequently achieved after the treatment of peri-implant diseases. A great variety of definitions have been used to define treatment success. Notably, percentages of treatment success and disease resolution were generally underreported. The use of standardized parameters to evaluate disease resolution should be considered an integral component in future clinical studies. Keywords: Peri-implantitis, dental implant, diagnosis, peri-implant endosseous healing, tooth loss, outcome assessment.

A clinical observation usually encountered after vestibuloplasty or interventions aiming at deepening the vestibule with or without simultaneous free epithelialized grafts in the posterior ridges is that they are subjected to major dimensional changes attributed to the buccinator fibers attachment. Hence, this study aimed at assessing the attachment of the buccinator muscles in relation to other anatomical landmarks. An ex-vivo study was performed in cadaver heads to explore the association of fibers attachment in relation to the distance from the crestal aspect of edentulous alveolar process (CAP) and the vestibular depth (VD), crestal band of keratinized mucosa (KM), and ridge height (RH). Interestingly, VD and KM were found to be strongly correlated. Likewise, VD/KM and CAP-BUC were further noted being correlated. CAP-BUC was negatively correlated with RH. Accordingly, the more atrophic the alveolar ridge (being more noticeable in the mandible) is, the shallower the vestibule, the lesser the crestal band of KM and the more crestal attachment of the buccinator muscular fibers. That might be the reason why whenever performing free epithelized graft in the posterior ridges to enhance the peri-implant soft tissue phenotype and deepening the vestibule, the graft is subjected to major dimensional changes. 

Purpose: To assess site-related features of peri-implantitis occurring adjacent to teeth and its association with the proximal periodontal bone level. Materials and Methods: Periapical radiographs were collected from partially edentulous patients exhibiting peri-implantitis adjacent to teeth. The following variables were quantified: intrabony defect width (DW), implant marginal bone loss (MBLi), tooth marginal bone loss (MBLt), implant-tooth distance (ITd), intrabony defect angulation (DA), adjacent periodontal bone peak height (ABPh), and implant-tooth angulation (ITa). A correlation matrix using the Spearman correlation coefficient was created to explore the dependence of these variables. Univariate linear regression analysis was carried out by means of generalized estimating equations (GEE), using MBLt as dependent variable. Results: Overall, 61 patients and 84 implants were included in this study, consisting of a total of 105 implant sites facing adjacent teeth. This resulted in 515 linear and 194 angular measurements. A total of 11 different statistically significant associations were demonstrated between the different variables analyzed. Moreover, the univariate regression analysis revealed significant positive associations between MBLt and MBLi (P = .013) and between MBLt and periodontitis (PD) (P = .014). These associations were confirmed in the multivariate model. Conclusions: Teeth adjacent to untreated peri-implantitis lesions are associated with proximal loss of periodontal support. This finding is more remarkable in scenarios that display short implant-tooth distance. Keywords: peri-implantitis, peri-implant diseases, dental implant, periodontal disease, periodontitis

The goal of this section ist o bring our readers eye-catching and high quality images related to novel techniques, clinical challenges and emerging trends relevant to esthetic dentistry. The section portrays the clinical image, the photographer, the camera and a short caption of the story behind the photograph.

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. Keywords: 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

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. Keywords: diagnostic procedure, peri-implantitis, periodontist, periodontology, surgical procedure

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.

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. Keywords: complications, diagnostic procedure, peri-implantitis, surgical Conflict-of-interest statement: The authors declare there are no conflicts of interest relating to this study.