Periodontists and oral surgeons' peri-implantitis-related education, knowledge, attitudes, and professional behavior: A national survey.

OBJECTIVES: Each year, approximately 5 million dental implants are placed in the United States and one out of three patients is likely to experience peri-implantitis (PI). The objectives were to compare the PI-related education, knowledge, attitudes, and professional behavior of periodontists and oral maxillofacial surgeons (OMS), and to explore relationships between these constructs of interest. METHODS: A total of 389 periodontists and 161 OMS responded to a web-based survey. Descriptive and inferential statistical analyses (independent sample t-tests, chi-square tests, and correlational analyses) were conducted. RESULTS: On average, periodontists reported a higher percentage of time spent in residency on implant surgery (21.02% vs. 7.27%; p < 0.001), better education about PI (5-point scale with 1 = not at all well: means: 2.86 vs. 2.59; p < 0.001), and better knowledge of risk factors (4.07 vs. 3.86; p < 0.001) than OMS. Periodontists argued that oral hygiene-related treatment (4.45 vs. 4.22; p = 0.001) and regeneration-focused treatments such as guided tissue regeneration (3.62 vs. 3.20; p < 0.001) contributed more to successfully treating PI and used these treatments more in their practices (4.86 vs. 4.56; p < 0.001/3.06 vs. 2.68; p < 0.001) than OMS. They also considered PI as a more serious problem than OMS (4.55 vs. 3.80; p < 0.001). The better the respondents' PI-related knowledge was, the more they considered PI as a serious problem (r = 0.19; p < 0.001). The more cases they treated per month, the more they considered PI as a serious problem (r = 0.19; p < 0.001). CONCLUSIONS: The results of the present study highlight the lack of standardization in the specialty training of periodontists and OMS. Best practice guidelines for the diagnosis and treatment of PI are needed to optimize graduate education about this important topic.

Non-surgical peri-implantitis treatment with or without systemic antibiotics: a randomized controlled clinical trial.

OBJECTIVES: To assess the adjunctive effect of systemic amoxicillin (AMX) and metronidazole (MTZ) in patients receiving non-surgical treatment (NST) for peri-implantitis (PI). MATERIALS AND METHODS: Thirty-seven patients were randomized into an experimental group treated with NST plus AMX + MTZ (N = 18) and a control group treated with NST alone (N = 19). Clinical parameters were evaluated at 12 weeks post-treatment. The primary outcome was the change in peri-implant pocket depth (PIPD) from baseline to 12 weeks, while secondary outcomes included bleeding on probing (BoP), suppuration on probing (SoP), and plaque. Data analysis was performed at patient level (one target site per patient). RESULTS: All 37 patients completed the study. Both groups showed a significant PIPD reduction after NST. The antibiotics group showed a higher mean reduction in PIPD at 12 weeks, compared with the control group (2.28 ± 1.49 mm vs. 1.47 ± 1.95 mm), however, this difference did not reach statistical significance. There was no significant effect of various potential confounders on PIPD reduction. Neither treatment resulted in significant improvements in BoP at follow-up; 30 of 37 (81%) target sites still had BoP after treatment. Only two implants, one in each group, exhibited a successful outcome defined as PIPD < 5 mm, and absence of BoP and SoP. CONCLUSIONS: Non-surgical treatment was able to reduce PIPD at implants with PI. The adjunctive use of systemic AMX and MTZ did not show statistically significant better results compared to NST alone. NST with or without antibiotics was ineffective to completely resolve inflammation around dental implants.

Risk factors, diagnosis, and treatment of peri-implantitis: A cross-cultural comparison of U.S. and European periodontists' considerations.

BACKGROUND: Peri-implantitis (PI) is a growing concern in the dental community worldwide. The study aimed to compare U.S. versus European periodontists' considerations of risk factors, diagnostic criteria, and management of PI. METHODS: A total of 393 periodontists from the United States and 100 periodontists from Europe (Germany, Greece, Netherlands) responded to anonymous surveys electronically or by mail. RESULTS: Compared to U.S. periodontists, European respondents were younger, more likely to be female and placed fewer implants per month (9.12 vs 13.90; P = 0.003). Poor oral hygiene, history of periodontitis, and smoking were considered as very important risk factors by both groups (rated > 4 on 5-point scale). European periodontists rated poor oral hygiene (4.64 vs 4.45; P = 0.005) and history of periodontitis (4.36 vs 4.10; P = 0.006) as more important and implant surface (2.91 vs 3.18; P = 0.023), occlusion (2.80 vs 3.75; P < 0.001) and presence of keratinized tissue (3.27 vs 3.77; P < 0.001) as less important than did U.S. periodontists. Both groups rated clinical probing, radiographic bone loss, and presence of bleeding and suppuration as rather important diagnostic criteria. They rated implant exposure/mucosal recession as relatively less important with U.S. periodontists giving higher importance ratings than European periodontists (3.99 vs 3.54; P = 0.001). Both groups nearly always used patient education, plaque control and mechanical debridement when treating PI. U.S. periodontists were more likely to use antibiotics (3.88 vs 3.07; P < 0.001), lasers (2.11 vs 1.68; P = 0.005), allograft (3.39 vs 2.14; P < 0.001) and regenerative approaches (3.57 vs 2.56; P < 0.001), but less likely to use resective surgery (3.09 vs 3.53; P < 0.001) than European periodontists. CONCLUSIONS: U.S. and European periodontists' considerations concerning risk factors, diagnosis and management of PI were evidence-based. Identified differences between the two groups can inform future educational efforts.

Submucosal microbiome of peri-implant sites: A cross-sectional study.

AIM: To study the peri-implant submucosal microbiome in relation to implant disease status, dentition status, smoking habit, gender, implant location, implant system, time of functional loading, probing pocket depth (PPD), and presence of bleeding on probing. MATERIALS AND METHODS: Biofilm samples were collected from the deepest peri-implant site of 41 patients with paper points, and analysed using 16S rRNA gene pyrosequencing. RESULTS: We observed differences in microbial profiles by PPD, implant disease status, and dentition status. Microbiota in deep pockets included higher proportions of the genera Fusobacterium, Prevotella, and Anaeroglobus compared with shallow pockets that harboured more Rothia, Neisseria, Haemophilus, and Streptococcus. Peri-implantitis (PI) sites were dominated by Fusobacterium and Treponema compared with healthy implants and peri-implant mucositis, which were mostly colonized by Rothia and Streptococcus. Partially edentulous (PE) individuals presented more Fusobacterium, Prevotella, and Rothia, whereas fully edentulous individuals presented more Veillonella and Streptococcus. CONCLUSIONS: PPD, implant disease status, and dentition status may affect the submucosal ecology leading to variation in composition of the microbiome. Deep pockets, PI, and PE individuals were dominated by Gram-negative anaerobic taxa.

Surgical treatment of peri-implantitis defects with two different xenograft granules: A randomized clinical pilot study.

OBJECTIVES: To investigate whether xenograft EB (EndoBon) is non-inferior to xenograft BO (Bio-Oss) when used in reconstructive surgery of peri-implant osseous defects. MATERIALS AND METHODS: Dental patients with one implant each demonstrating peri-implantitis were randomized to receive surgical debridement and defect fill with either BO or EB. Changes in bone level (BL) and intrabony defect depth (IDD) evaluated radiographically were the primary outcomes. The secondary outcomes included changes in probing pocket depth (PPD), bleeding on probing (BoP), and suppuration on probing (SoP). All outcomes were recorded before treatment and at 6 and 12 months post-treatment. RESULTS: Twenty-four patients (n = 11 BO, n = 13 EB) completed the study. Both groups demonstrated significant within-group improvements in all clinical and radiographic parameters at 6 and 12 months (p ≤ .001). At 12 months, both groups presented with IDD reductions of 2.5-3.0 mm on average. The inter-group differences were not statistically significant at all time points and for all the examined parameters (p > .05). While the radiographic defect fill in both groups exceeded > 1 mm and can be considered treatment success, successful treatment outcomes as defined by Consensus Reporting (no further bone loss, PPD ≤ 5 mm, no BOP, and no SoP) were identified in 2/11 (18%) BO and 0/13 (0%) EB individuals (Fisher's exact test, p = .199). CONCLUSIONS: Within the limitations of this pilot study, the application of xenograft EB showed to be non-inferior to xenograft BO when used in reconstructive surgery of peri-implant osseous defects.

Occlusal Migration of Teeth Adjacent to Implant Prostheses in Adults: A Long-Term Study.

PURPOSE: To evaluate the effect of continuous tooth eruption on the outcomes of single-implant-supported restorations in the anterior maxilla of adults. MATERIALS AND METHODS: Seventy-six patients (age: 21 to 78 years) treated with single-implant-supported restorations in the esthetic zone were included. Radiographs obtained at crown placement and follow-up examinations from 1 to 15 years postloading were analyzed with regard to vertical incisal plane changes of the implant-supported crown relative to adjacent teeth. RESULTS: Infraocclusion increased over time by 0.08 ± 0.02 mm/year. Infraocclusion was more pronounced (P = .04) for delayed (0.09 mm/year) versus immediate implant placement (0.06 mm/year) and for younger versus older adults (0.0013 mm/year per additional year of age; P = .014). No statistically significant association between infraocclusion and sex, ethnicity, implant site, timing of implant temporization, surgical protocol, and type of restoration was found. CONCLUSION: Infraocclusion of single-implant-supported maxillary anterior restorations may result in esthetic concerns over time. Greater infraocclusion occurs in delayed implant placement and in younger individuals.

Stem cell therapy for reconstruction of alveolar cleft and trauma defects in adults: A randomized controlled, clinical trial.

BACKGROUND: Stem cell therapy with bone marrow-derived mesenchymal stem cells is a promising tissue engineering strategy to promote regeneration of craniofacial bone. PURPOSE: To determine whether cell therapy with ex vivo expanded stem cell populations would be safe and efficacious in the regeneration of large alveolar defects in patients with a history of cleft palate or craniofacial trauma. MATERIALS AND METHODS: Eighteen patients (10 patients with traumatic injury and 8 patients with cleft palate) presenting with missing teeth associated with horizontal alveolar bone deficiencies were included in this randomized controlled clinical trial. Patients were randomized to receive either conventional autogenous block grafts or stem cell therapy. After a healing period of 4 months the treated sites were re-entered and the bone width re-assessed prior to implant placement. Implant stability was evaluated through torque testing of the implant upon insertion and at 6 months postloading. RESULTS: The mean gain in bone width was 1.5 ± 1.5 mm in the stem cell therapy group and 3.3 ± 1.4 mm in the control group. Overall, bone gain was higher in trauma patients as compared to patients with cleft palate, for both the control and the stem cell therapy groups. Most postoperative complications were wound dehiscences and incision line openings. Implants were placed successfully in 5 out of 10 patients in the stem cell therapy group and in all 8 patients in the control group. One implant from the control/cleft palate group failed before loading, while the rest of the implants were loaded successfully and remained stable at 6 months. The patients who did not receive implants were re-treated with autogenous block bone graft. CONCLUSION: The ability of stem cells to treat large alveolar defects is safe, yet, their ability to completely reconstitute large alveolar defects is limited. This approach requires further optimization to meet the outcomes seen using current methods to treat large defects, particularly those resultant of cleft palate.

Bisphosphonates: Clinical Applications and Adverse Events in Dentistry.

PURPOSE: To review the mechanisms of action and clinical applications of bisphosphonate drugs, which are widely used in the management of metastatic bone cancer and systemic metabolic bone diseases, as well as the complications related to bisphosphonate treatment, emphasising the occurrence and management of bisphosphonate-related osteonecrosis of the jaws (BRONJ). MATERIALS AND METHODS: A search of the medical and dental literature was conducted in Medline and Embase using a combination of the key words bisphosphonates, jaw, complications, osteonecrosis, osteoporosis and periodontal disease. A manual search of the references of the retrieved articles was also performed. RESULTS: BRONJ predominantly affects cancer patients being treated with high-dose intravenous bisphosphonates and is characterised by the appearance of necrotic bone in the oral cavity either spontaneously or following an invasive surgical procedure such as dental extraction. The severity of this condition warrants a thorough medical and dental history in every patient in order to identify high risk patients. CONCLUSION: It is important that dental practitioners be aware of the association between bisphosphonate treatment and osteonecrosis of the jaws. Clinicians should perform a thorough oral examination in cancer patients before they begin intravenous bisphosphonate treatment. Optimal oral hygiene and regular dental care can lower BRONJ risk. Further clinical research is necessary to unveil the full therapeutic potential of bisphosphonates, their mechanisms of action and the factors that induce unwanted side-effects.

The effect of blue light on periodontal biofilm growth in vitro.

We have previously shown that blue light eliminates the black-pigmented oral bacteria Porphyromonas gingivalis, Prevotella intermedia, Prevotella nigrescens, and Prevotella melaninogenica. In the present study, the in vitro photosensitivity of the above black-pigmented microorganisms and four Fusobacteria species (Fusobacterium nucleatum ss. nucleatum, F. nucleatum ss. vincentii, F. nucleatum ss. polymorphum, Fusobacterium periodonticum) was investigated in pure cultures and human dental plaque suspensions. We also tested the hypothesis that phototargeting the above eight key periodontopathogens in plaque-derived biofilms in vitro would control growth within the dental biofilm environment. Cultures of the eight bacteria were exposed to blue light at 455 nm with power density of 80 mW/cm2 and energy fluence of 4.8 J/cm2. High-performance liquid chromatography (HPLC) analysis of bacteria was performed to demonstrate the presence and amounts of porphyrin molecules within microorganisms. Suspensions of human dental plaque bacteria were also exposed once to blue light at 455 nm with power density of 50 mW/cm2 and energy fluence of 12 J/cm2. Microbial biofilms developed from the same plaque were exposed to 455 nm blue light at 50 mW/cm2 once daily for 4 min (12 J/cm2) over a period of 3 days (4 exposures) in order to investigate the cumulative action of phototherapy on the eight photosensitive pathogens as well as on biofilm growth. Bacterial growth was evaluated using the colony-forming unit (CFU) assay. The selective phototargeting of pathogens was studied using whole genomic probes in the checkerboard DNA-DNA format. In cultures, all eight species showed significant growth reduction (p < 0.05). HPLC demonstrated various porphyrin patterns and amounts of porphyrins in bacteria. Following phototherapy, the mean survival fractions were reduced by 28.5 and 48.2% in plaque suspensions and biofilms, respectively, (p < 0.05). DNA probe analysis showed significant reduction in relative abundances of the eight bacteria as a group in plaque suspensions and biofilms. The cumulative blue light treatment suppressed biofilm growth in vitro. This may introduce a new avenue of prophylactic treatment for periodontal diseases.

Metastatic papillary thyroid carcinoma to the maxilla: case report and literature review.

Metastatic tumors to the oral cavity are uncommon and a thyroid origin is considered exceedingly rare. A case of metastatic papillary thyroid carcinoma (PTC) presenting as a painful swelling in the right posterior maxilla of a 63-year-old male is reported here. The patient had been diagnosed with PTC 2 years ago and treated with thyroidectomy and radioactive iodine treatment. Radiographically, the metastatic lesion presented as a poorly-defined radiolucent lesion around an impacted maxillary third molar in the right maxilla. Histopathologic examination revealed features of PTC which was immunohistochemically positive for pancytokeratin, keratin 19 and thyroglobulin. Imaging studies revealed the presence of residual maxillary and neck disease as well as additional metastatic lesions in the sternum, ribs, and left tibia. A thorough review of the English language literature revealed only 36 previously published cases of thyroid cancer metastases to the oral cavity, the demographic and clinicopathologic features of which are summarized.