Tooth discoloration induced by the different phases of a calcium aluminate cement: One-year assessment.

OBJECTIVES: To assess the discoloration of teeth treated with the different phases of calcium aluminate cement (CAC), in comparison with the conventional CAC and mineral trioxide aggregate (MTA). MATERIALS AND METHODS: Fifty bovine incisors were prepared and filled. Two millimeters of the filling was removed to fabricate a cervical plug with the following cements (n=10): CA(CaO.Al2 O3 ); CA2 (CaO.2Al2 O3 ); C12 A7 (12CaO.7Al2 O3 ); CAC and MTA. The initial color measurement was performed and after 7, 15, 30, 45, 90, 180, and 365 days new color measurements were performed to determine the color (ΔE00 ), lightness (ΔL'), chroma (ΔC'), hue differences (ΔH'), and the whiteness index (WID ). RESULTS: ΔE00 was significant for groups (p = 0.036) and periods (p < 0.05). The greater ΔE00 was observed after 365 days for CAC (12.8). C12 A7 (7.2) had the smallest ΔE00 . ΔL' and ΔC' were significant for groups and periods (p < 0.05). ΔH' was significant for periods (p < 0.05). After 365 days, significant reduction in lightness was observed for all groups. For CA, CA2 , CAC, and MTA groups, the WID values decreased over time (p < 0.05). CONCLUSIONS: The tested cements changed the color behavior of the samples, resulting in greater teeth darkening over time. CLINICAL SIGNIFICANCE: There is no long-term study assessing the discoloration induced by the different phases of CAC.

Tooth Discoloration Induced by Different Calcium Silicate-Based Cements: A Two-Year Spectrophotometric and Photographic Evaluation in Vitro.

OBJECTIVE: Calcium silicate-based cements (CSCs) may lead to coronal staining in young permanent teeth over the time. The purpose of this study was to evaluate and compare the long-term tooth discoloration induced by different CSCs. STUDY DESIGN: Ninety freshly-extracted human molars were assigned randomly into 6 groups (n=15/group) according to the CSC used as a pulpotomy material: ProRoot MTA, MTA Angelus, NeoMTA, EndoSequence Putty, Biodentine and Negative control (No cement). The color was assessed at baseline, and thereafter at 3, 6, 12 and 24 months by using both a spectrophotometer and digital images taken with and without a cross-polarizing filter. The time-dependent changes in color (ΔE) were compared within and among groups using Analysis of Variance. RESULTS: Angelus MTA and ProRooT MTA showed severe coronal discoloration (p>0.05) starting at 3 months. ΔE values of NeoMTA, EndoSequence Bioceramic Putty and Biodentine were below the perceptibility threshold, with Biodentine showing greater ΔE values than NeoMTA and EndoSequence Putty in the absence of statistical significance (p>0.05). CONCLUSIONS: Discoloration elicited by CSCs may develop soon after placement, and continue to increase for up to two years. Angelus MTA and ProRooT MTA cannot be recommended for vital pulp therapies in the esthetic zone of young individuals.

Effects of modifying implant screw access channels on the amount of extruded excess cement and retention of cement-retained implant-supported dental prostheses: A systematic review.

STATEMENT OF PROBLEM: Cement-retained implant-supported prostheses eliminate screw loosening and enhance esthetics. However, retrievability and the possibility of removing extruded excess cement (EEC) have been problematic. PURPOSE: The purpose of this systematic review was to analyze the effects of modifying the screw access channel (SAC) on the amount of EEC and the retention of cement-retained implant-supported prostheses. MATERIAL AND METHODS: PubMed, Web of Science, Scopus, and Google Scholar databases were searched with appropriate key words. Related titles and abstracts published up to June 2017 were screened and selected on the basis of defined inclusion criteria. Full texts of all studies were read and subjected to quality assessments. After the initial search, 1521 articles were included in the study. Of these, 11 studies were subjected to critical appraisal, and 10 of them were reliable enough in methodology to be systemically reviewed. RESULTS: All the studies were in vitro and described a total of 260 specimens. According to the interpreted results, closed SACs caused lower retention with a higher amount of EEC, whereas open SACs caused the reverse. Also, as the abutment height decreased, retention decreased. CONCLUSIONS: Extending the crown's margin into the SAC, leaving the SAC open, and using internal vents in the SAC space are possible methods of modifying the SAC to gain higher retentive values. Also, the use of internal vents in the SAC system and open or partially filled SAC space reduce the amount of EEC.

Comparison of clinical bond failure rates and bonding times between two adhesive precoated bracket systems.

OBJECTIVE: To compare the clinical bracket failure rate and bonding time differences between Adhesive Precoated Flash-Free (APCF) and Adhesive Precoated Plus (APCP) bracket systems. METHODS: Thirty-three patients (7 male and 26 female) with a mean age of 17.2 ± 3.6 years and permanent dentition were included in the study. Total of 660 brackets were bonded by 1 operator with the use of a split-mouth design, and bracket failure rates were observed over 6 months. Bracket bonding time of each group was also evaluated. Bracket failure rates were evaluated by means of chi-square test. One-way analysis of variance (ANOVA) and Tukey honestly significant difference tests were used to evaluate the bonding time differences between groups. RESULTS: The overall, APCF, and APCP bracket failure rates were 1.21%, 1.81%, and 1.51%, respectively. Chi-square test revealed significant differences (P <0.01) between groups in bracket failure rates. The upper left APCP group showed significantly (P <0.05) more failure than the other groups. One-way ANOVA test (P <0.001) showed statistically significant bonding time differences between groups. Bonding time of APCF brackets was significantly shorter than the bonding time of APCP brackets for the same quadrants. Chi-square test did not reveal significant differences (P >0.05) between groups according to adhesive remnant index scores. CONCLUSIONS: Compared with APCP brackets, APCF brackets can reduce the bonding time without increasing bracket failure rate.

Resin Cement: Correspondence with Try-In Paste and Influence on the Immediate Final Color of Veneers.

PURPOSE: To assess the correspondence of shades between try-in pastes and resin cements and their influence on the final color of veneers. MATERIALS AND METHODS: Bovine teeth (n = 140) were prepared and divided into 2 groups (a or b) according to ceramic veneer thickness (0.35 or 0.70 mm). Seventy teeth (n = 70) were distributed in 7 groups (groups 1 to 7a and groups 1 to 7b; n = 10). Try-in pastes and their corresponding resin cements were used according to the value: groups 1a and 1b (value -3); groups 2a and 2b (-2); groups 3a and 3b (-1); groups 4a and 4b (0); groups 5a and 5b (+1); groups 6a and 6b (+2); groups 7a and 7b (+3). Color measurements were performed with spectrophotometer, and the coordinates L* , a* , and b* were obtained. The final color change (ΔE) was calculated from these coordinates: ΔE0 (trial - substrate), ΔE1 (cementation - substrate), and ΔE2 (cementation - trial). The data were analyzed using the Kolmogorov-Smirnov test, the Wilcoxon test, or t-test for paired samples and repeated-measures ANOVA, post hoc Bonferroni, or the Friedman test (p < 0.05). RESULTS: The results indicated no statistically significant difference between the groups comparing ΔE0 and ΔE1 for 0.35 mm thickness laminate veneers, except for groups 2a and 5a. For 0.70 mm thickness laminate veneers, no statistically significant differences were observed between the groups comparing ΔE0 and ΔE1. ΔE2 values for 0.35 mm and 0.70 mm thickness laminate veneers ranged from 1.77 ± 0.81 to 4.99 ± 3.80 and from 1.01 ± 0.73 to 4.66 ± 2.96, respectively. CONCLUSIONS: Try-in pastes correspond with their respective resin cements for most colors investigated. The color of the resin cement may influence the final color of laminate veneers. Thickness of the ceramic was the most relevant variable for color change.

Mineral trioxide aggregate and other bioactive endodontic cements: an updated overview - part II: other clinical applications and complications.

Mineral trioxide aggregate (MTA) is a dental material used extensively for vital pulp therapies (VPT), protecting scaffolds during regenerative endodontic procedures, apical barriers in teeth with necrotic pulps and open apices, perforation repairs as well as root canal filling and root-end filling during surgical endodontics. A number of bioactive endodontic cements (BECs) have recently been introduced to the market. Most of these materials have calcium and silicate in their compositions; however, bioactivity is a common property of these cements. These materials include the following: BioAggregate, Biodentine, BioRoot RCS, calcium-enriched mixture cement, Endo-CPM, Endocem, EndoSequence, EndoBinder, EndoSeal MTA, iRoot, MicroMega MTA, MTA Bio, MTA Fillapex, MTA Plus, Neo MTA Plus, Ortho MTA, Quick-Set, Retro MTA, Tech Biosealer, and TheraCal LC. It has been claimed that these materials have properties similar to those of MTA but without the drawbacks. In Part I of this review, the available information on the chemical composition of the materials listed above was reviewed and their applications for VPT was discussed. In this article, the clinical applications of MTA and other BECs will be reviewed for apexification, regenerative endodontics, perforation repair, root canal filling, root-end filling, restorative procedures, periodontal defects and treatment of vertical and horizontal root fractures. In addition, the literature regarding the possible drawbacks of these materials following their clinical applications is reviewed. These drawbacks include their discolouration potential, systemic effects and retreatability following use as a root filling material. Based on selected keywords, all publications were searched regarding the use of MTA as well as BECs for the relevant clinical applications. Numerous publications were found regarding the use of BECs for various endodontic applications. The majority of these investigations compared BECs with MTA. Despite promising results for some materials, the number of publications using BECs for various clinical applications was limited. Furthermore, most studies had several methodological shortcomings and low levels of evidence.

Monomer release from orthodontic retentions: An in vitro study.

INTRODUCTION: The adhesives used to bond orthodontic retentions are low-loaded composite resins with a resinous matrix containing bisphenol A diglycidyl ether dimethacrylate synthesized from bisphenol A (BPA), fluidizers such as triethylene glycol dimethacrylate (TEGDMA) and hydrophilic polymers such as hydroxyethylmethacrylate. BPA disrupts the endocrine balance, and TEGDMA has high risks for human health: eg, allergies and cytotoxicity. The aim of this study was to evaluate in vitro the release of monomers from orthodontic bonded retentions. METHODS: A reproducible model of bonded retentions was carried out using calibrated molds. We analyzed the release of monomers by gas phase chromatography coupled with mass spectrometry. RESULTS: This model allowed us to qualitatively and quantitatively evaluate the in-vitro release of monomers from orthodontic adhesives. The quantitative and qualitative analyses showed no BPA release above the 0.02 ppm detection limit. A greater release of TEGDMA was observed with Transbond LR (31.7 µg/mL) than with Transbond XT (13.12 µg/mL) (both, 3M Unitek, Monrovia, Calif). Other toxic components (iodobenzene, iodobiphenyl, triphenyl stibine, and so on) were also identified. CONCLUSIONS: Toxic and carcinogenic molecules not mentioned in the material safety data sheets were identified.

Evaluation of Radiopacity of Luting Cements Submitted to Different Aging Procedures.

PURPOSE: To evaluate the radiopacity of luting cements submitted to different aging procedures. MATERIALS AND METHODS: Twenty discs (1 × 4 mm) of each of the following cements were prepared: zinc phosphate, RelyX Luting 2, Variolink 2, AllCem, RelyX U200, Multilink, Panavia F2.0, and RelyX ARC. Then, they were randomly divided into two groups (n = 10/group), according to the aging procedure: thermal cycling group and water storage group. Before and after aging procedures, specimens were x-rayed with an aluminum step-wedge (11 steps, 1 mm thick each) and three dental slices (1 mm thick). The radiopacity was evaluated by means of optical density, which was measured using ImageJ software. The values were converted into millimeters of aluminum with a logistic regression calibration curve. The data were analyzed by one-way ANOVA and Tukey post-hoc test (α = 0.05). RESULTS: In the thermal cycling group, RelyX Luting 2, RelyX U200, and Panavia F2.0 showed a statistically significant reduction in radiopacity (p < 0.05). In the water storage group, all cements showed a significant reduction in radiopacity (p < 0.05), and RelyX Luting 2 and Panavia F2.0 performed below the desired ISO 4049 standard. CONCLUSIONS: The radiopacity of luting cements can decrease after aging, especially after 1-year water storage.

The Impact of Residual Subgingival Cement on Biological Complications Around Dental Implants: A Systematic Review.

OBJECTIVES: To perform a systematic review on the impact of residual subgingival cement on peri-implant diseases and crestal bone loss. MATERIAL AND METHODS: MEDLINE, SCOPUS, ISI Web of Knowledge and Cochrane Central Register of Controlled Trials (CENTRAL) databases were used to identify articles published without time limits. RESULTS: A total of 6 articles were selected for a total of 389 patients (687 implants). The studies were heterogeneous and had a moderate-to-high risk of bias, but met the inclusion criteria. Four of 6 studies were published by the same research group and assessed similar populations over time. A positive relationship between residual cement and peri-implant inflammation was observed. Data on peri-implant probing depths and crestal bone loss were reported in 1 study. CONCLUSION: Residual subgingival cement seems to be strongly associated with peri-implant mucositis which is a risk factor for increased probing depths crestal bone loss and peri-implantitis. Zinc oxide eugenol cements should be preferred to resin cements especially in patients with a history of periodontitis.

In vitro effects of dental cements on hard and soft tissues associated with dental implants.

STATEMENT OF PROBLEM: Dental cements for cement-retained restorations are often chosen based on clinician preference for the product's material properties, mixing process, delivery mechanism, or viscosity. The composition of dental cement may play a significant role in the proliferation or inhibition of different bacterial strains associated with peri-implant disease, and the effect of dental cements on host cellular proliferation may provide further insight into appropriate cement material selection. PURPOSE: The purpose of this in vitro study was to investigate the cellular host response of bone cells (osteoblasts) and soft tissue cells (gingival fibroblasts) to dental cements. MATERIAL AND METHODS: Zinc oxide (eugenol and noneugenol), zinc phosphate, and acrylic resin cements were molded into pellets and directly applied to confluent preosteoblast (cell line MC3T3 E1) or gingival fibroblast cell cultures (cell line HGF) to determine cellular viability after exposure. Controls were defined as confluent cell cultures with no cement exposure. Direct contact cell culture testing was conducted following International Organization for Standardization 10993 methods, and all experiments were performed in triplicate. To compare either the MC3T3 E1 cell line, or the HGF cell line alone, a 1-way ANOVA test with multiple comparisons was used (α=.05). To compare the MC3T3 E1 cell line results and the HGF cell line results, a 2-way ANOVA test with multiple comparisons was used (α=.05). RESULTS: The results of this study illustrated that while both bone and soft tissue cell lines were vulnerable to the dental cement test materials, the soft tissue cell line (human gingival fibroblasts) was more susceptible to reduced cellular viability after exposure. The HGF cell line was much more sensitive to cement exposure. Here, the acrylic resin, zinc oxide (eugenol), and zinc phosphate cements significantly reduced cellular viability after exposure with respect to HGF cells only. CONCLUSIONS: Within the limitation of this in vitro cellular study, the results indicated that cell response to various implant cements varied significantly, with osteoblast proliferation much less affected than gingival fibroblast cells. Furthermore, the zinc oxide noneugenol dental cement appeared to affect the cell lines significantly less than the other test cements.

Comparison of Hypersensitivity in Metal Ceramic Crowns cemented with Zinc Phosphate and Self-adhesive Resin: A Prospective Study.

BACKGROUND: Luting agents used to fix artificial prostheses, such as fixed partial denture (FPD) to tooth are basically viscous in nature and show chemical reaction for fixation. Postcementation hypersensitivity is a frequent complaint of patients. The present study was conducted to compare postcementation hypersensitivity with zinc phosphate and self-adhesive resin in complete coverage crown. MATERIALS AND METHODS: This study included 30 patients in which 60 porcelein fused to metal crowns was placed. Two metal crowns were placed in each patient in nonantagonis-tic contralateral quadrants. First crown was cemented with zinc phosphate cement, while the other was cemented with self-adhesive resin. Hypersensitivity was evaluated by visual analog scale (VAS) score and by clinical test. For clinical evaluation of sensitivity, hot and cold water was applied to the cervical margin of restoration for 5 seconds and response was recorded. RESULTS: This study consisted of 30 patients in which 60 crowns were given. There was no statistical difference in VAS score of mastication in zinc phosphate cement recorded at baseline, 1 week, 4 weeks, 6 months, 1 year, and 2 years (p > 0.05). Cold response also did not show a significant difference at six time points. Warm response showed slight decrease in subsequent time points but was nonsignificant (p > 0.05). Similarly, with self-adhesive resin cement, VAS score during mastication, hot and cold response was statistically nonsignificant (p > 0.05). CONCLUSION: Postcementation hypersensitivity is a frequent complaint that patient may experience. However, we found no statistically significant difference in both cements tested. CLINICAL SIGNIFICANCE: Postcementation hypersensitivity is an unpleasant sensation experienced by patients. This may affect the success of any prosthesis. Thus, selection of luting agent for cementation plays an important role to eliminate this symptom.

Cytocompatibility of HEMA-free resin-based luting cements according to application protocols on dentine surfaces.

AIM: To evaluate the transdentinal cytotoxicity of resin-based luting cements (RBLCs), with no HEMA in their composition, to odontoblast-like cells. METHODOLOGY: Human dentine discs 0.3 mm thick were adapted to artificial pulp chambers (APCs) and placed in wells of 24-well plates containing 1 mL of culture medium (DMEM). Two categories of HEMA-free RBLCs were evaluated: group 1, self-adhesive Rely X Unicem (RU; 3M ESPE), applied directly to the dentine substrate; and group 2, Rely X ARC (RARC; 3M ESPE), applied to dentine previously acid-etched and treated with a bonding agent. In group 3 (control), considered as representing 100% cell metabolic activity, no treatment was performed on dentine. The APC/disc sets were incubated for 24 h or 7 days at 37 °C and 5% CO2 . Then, the extracts (DMEM + dental materials components that diffused through dentine) were applied to cultured odontoblast-like MDPC-23 cells for 24 h. After that, the cell viability (MTT assay), cell morphology (SEM), total protein production (TP) and alkaline phosphatase (ALP) activity were assessed. Data from MTT assay and TP production were analysed by Kruskal-Wallis and Mann-Whitney tests (α = 5%). Data from ALP activity were analysed by one-way anova and Tukey's test (α = 5%). RESULTS: In group 1, a slight reduction in cell viability (11.6% and 16.8% for 24-h and 7-day periods, respectively) and ALP activity (13.5% and 17.9% for 24-h and 7-day periods, respectively) was observed, with no significant difference from group 3 (control) (P > 0.05). In group 2, a significant reduction in cell viability, TP production and ALP activity compared with group 3 (control) occurred (P < 0.05), regardless of incubation time. Alteration in MDPC-23 cell morphology was observed only in group 2. CONCLUSIONS: HEMA-free Rely X ARC cement caused greater toxicity to odontoblast-like MDPC-23 cells than did Rely X Unicem cement when both resin-based luting materials were applied to dentine as recommended by the manufacturer.

Comparative in vitro study of cementing techniques for implant-supported restorations.

STATEMENT OF PROBLEM: Various techniques are used to cement implant-supported restorations. Excess residual cement is a concern. PURPOSE: The purpose of this in vitro study was to evaluate 3 techniques for cementing implant-supported restorations. MATERIAL AND METHODS: Twelve crowns and implant-abutment complexes (IAC) were cemented with 3 techniques: technique 1, a certain amount of cement evenly placed and excess cement removed with an explorer; technique 2, a smaller amount of cement without removal of excess cement; technique 3, a resin abutment replica used for excess cement removal after using a large amount of cement. Each specimen was treated with each technique 3 times. Precementing discrepancies (predis) and postcementing discrepancies (postdis) between IACs and crowns and the postcementing linear roughness (Ra and Rz) on designated junction areas of each specimen were measured. Tensile strength of the specimens was recorded with a universal testing machine at a crosshead speed of 0.5 mm/min. Repeated measures analysis with mixed models was used for differences among the 3 cementing techniques (α=.05). RESULTS: Compared with techniques 1 and 2, the specimens with technique 3 showed significantly lower mean differences between postdis and predis and Ra and Rz and higher mean tensile strength (P<.05). CONCLUSIONS: The application of a resin abutment replica for the cementation of implant-supported restorations decreased the discrepancy between the restoration and abutment, reduced cement residue, and increased restoration retention.

Release of monomers from orthodontic adhesives.

INTRODUCTION: Most composite resins release both bisphenol A (BPA), which disrupts the endocrine balance, and triethylene glycol dimethacrylate (TEGDMA), which has high risks for human health: eg, allergies and cytotoxicity. The aim of this study was to characterize monomers released from orthodontic adhesives. METHODS: We studied samples of orthodontic adhesives by associating 2 techniques: gas phase chromatography and mass spectrometry. RESULTS: The in-vitro analysis detected significant quantities of BPA, TEGDMA, and other monomers in orthodontic adhesives used in daily practice: Transbond XT, Transbond Supreme LV (both, 3M Unitek, Monrovia, Calif), Blugloo (Ormco, Orange, Calif), and MonoLok 2 (Rocky Mountain Orthodontics, Denver, Colo). CONCLUSIONS: Clinicians should consider that orthodontic adhesives contain BPA, an endocrine disruptor; TEGDMA, an allergic and a cytotoxic compound; and carcinogenic genotoxic compounds. These molecules are not mentioned in the material safety data sheets. Manufacturers should declare all components of dental composites to identify these substances that may result in allergic or undesirable side effects for patients and dental staff.

Effect of 3 cements on white spot lesion formation after full-coverage rapid maxillary expander: A comparative in-vivo study.

INTRODUCTION: The aim of this study was to assess the effects of 3 luting agents (glass ionomer cement, compomer, and polycarboxylate cement) on white spot lesion formation in patients with full-coverage bonded acrylic splint expanders. White spot lesion formation was assessed with quantitative light-induced fluorescence. METHODS: Full-coverage rapid maxillary expanders were cemented with glass ionomer cement, compomer, and polycarboxylate cement in groups 1, 2, and 3, respectively. A control group comprised patients who never had orthodontic treatment. Quantitative light-induced fluorescence images taken before and after rapid maxillary expansion treatment were analyzed for these parameters: the percentages of fluorescence loss with respect to the fluorescence of sound tooth tissue (ΔF) and maximum loss of fluorescence intensity in the whole lesion; lesion area with ΔF equal to less than a -5% threshold; and the percentage of fluorescence loss with respect to the fluorescence of sound tissue times the area that indicated lesion volume. RESULTS: All 3 groups showed statistically significantly greater demineralization than the control group. The 3 experimental groups differed from each other in half of the parameters calculated. Teeth in the polycarboxylate group developed the most white spot lesions. CONCLUSIONS: With the highest rate of white spot lesion formation, polycarboxylate cements should not be used for full-coverage bonded acrylic splint expanders. Compomers may be preferred over glass ionomer cements, based on the findings of this study.

Risk indicators for peri-implant mucositis: a systematic literature review.

OBJECTIVES: To examine the existing evidence in identifying risk indicators in the aetiology of peri-implant mucositis. MATERIAL AND METHODS: A search was performed in PubMed, Web of Science (WOS) and The Cochrane Library databases for articles published until June 2014. RESULTS: This search gave 3135 results of which 15 studies fulfilled the inclusion criteria. The current review revealed that only a few studies provided data on risk indicators for the development of peri-implant mucositis. Based on the data available, there is evidence that plaque is a risk indicator for peri-implant mucositis. Smoking has also been identified as an independent risk indicator whereas the overall evidence for surface roughness, residual cement, the dimension of the keratinized tissue and time of implant in function is weak. There are limited data available to support systemic conditions as risk indicators for peri-implant mucositis. CONCLUSIONS: Plaque accumulation at implants will result in development of peri-implant mucositis. Smoking should also be considered as a risk indicator for the development of peri-implant mucositis.

Primary prevention of peri-implantitis: managing peri-implant mucositis.

AIMS: Over the past decades, the placement of dental implants has become a routine procedure in the oral rehabilitation of fully and partially edentulous patients. However, the number of patients/implants affected by peri-implant diseases is increasing. As there are--in contrast to periodontitis--at present no established and predictable concepts for the treatment of peri-implantitis, primary prevention is of key importance. The management of peri-implant mucositis is considered as a preventive measure for the onset of peri-implantitis. Therefore, the remit of this working group was to assess the prevalence of peri-implant diseases, as well as risks for peri-implant mucositis and to evaluate measures for the management of peri-implant mucositis. METHODS: Discussions were informed by four systematic reviews on the current epidemiology of peri-implant diseases, on potential risks contributing to the development of peri-implant mucositis, and on the effect of patient and of professionally administered measures to manage peri-implant mucositis. This consensus report is based on the outcomes of these systematic reviews and on the expert opinion of the participants. RESULTS: Key findings included: (i) meta-analysis estimated a weighted mean prevalence for peri-implant mucositis of 43% (CI: 32-54%) and for peri-implantitis of 22% (CI: 14-30%); (ii) bleeding on probing is considered as key clinical measure to distinguish between peri-implant health and disease; (iii) lack of regular supportive therapy in patients with peri-implant mucositis was associated with increased risk for onset of peri-implantitis; (iv) whereas plaque accumulation has been established as aetiological factor, smoking was identified as modifiable patient-related and excess cement as local risk indicator for the development of peri-implant mucositis; (v) patient-administered mechanical plaque control (with manual or powered toothbrushes) has been shown to be an effective preventive measure; (vi) professional intervention comprising oral hygiene instructions and mechanical debridement revealed a reduction in clinical signs of inflammation; (vii) adjunctive measures (antiseptics, local and systemic antibiotics, air-abrasive devices) were not found to improve the efficacy of professionally administered plaque removal in reducing clinical signs of inflammation. CONCLUSIONS: Consensus was reached on recommendations for patients with dental implants and oral health care professionals with regard to the efficacy of measures to manage peri-implant mucositis. It was particularly emphasized that implant placement and prosthetic reconstructions need to allow proper personal cleaning, diagnosis by probing and professional plaque removal.

Risk indicators for peri-implantitis. A narrative review.

AIM: To examine the existing evidence in identifying risk indicators in the etiology of peri-implantitis. MATERIAL AND METHODS: A literature search was performed in MEDLINE via PubMed database of the US National Library of Medicine, for articles published until October 2014 using Medical Subject Heading search terms + free text terms and in different combinations. RESULTS: The microbiota associated with peri-implantitis is complex, demonstrating differences and similarities to the one seen at periodontitis sites. Plaque accumulation at dental implants triggers the inflammatory response leading to peri-implant mucositis/peri-implantitis. Individuals with a history of periodontal disease and smokers have an increased risk of developing peri-implantitis. There is some evidence to support the role of genetic polymorphism, diabetes, and excess cement as risk indicators for the development of peri-implantitis. There is also evidence to support that individuals on regular maintenance are less likely to develop peri-implantitis and that successful treatment of periodontitis prior to implant placement lowers the risk of peri-implantitis. CONCLUSIONS: Plaque accumulation at implants will result in the development of an inflammation at implants. A history of periodontal disease, smoking, excess cement, and lack of supportive therapy should be considered as risk indicators for the development of peri-implantitis.

Systematic review of some prosthetic risk factors for periimplantitis.

STATEMENT OF PROBLEM: The recent literature underlines a correlation between plaque and the development of periimplantitis but neglects the importance of the prosthetic factors. PURPOSE: The purpose of this systematic review was to appraise the available literature to evaluate the role played by cement excess and misfitting components on the development of periimplantitis. MATERIAL AND METHODS: An electronic search restricted to the English language was performed in PubMed, Embase, and the Cochrane Register up to September 1, 2014, based on a selected search algorithm. Only cohort studies and case-control studies were included without additional restrictions. The presence of periimplantitis and implant failure were considered primary and secondary outcome variables. RESULTS: The search produced 275 potentially relevant titles, of which only 2 were found eligible. They showed a correlation in cemented implant prostheses between cement excess and the presence of periimplant disease, especially in patients with a history of periodontal disease. After cement excess removal by means of debridement, disease symptoms disappeared around most of the implants. CONCLUSIONS: Scientific articles on prosthetic risk factors for periimplantitis are scarce. Although the studies found on cement remnants have a high risk for bias, cement excess seems to be associated with mucositis and possibly with periimplantitis, especially in patients with a history of periodontal disease.

Cement-associated peri-implantitis: a retrospective clinical observational study of fixed implant-supported restorations using a methacrylate cement.

BACKGROUND: Cement-retained fixed implant-supported restorations involve the risk of excess cement, which can associate peri-implantitis. In connection with routine therapy using a methacrylate cement (Premier Implant Cement, Premier(®) Dental Products Company, Plymouth Meeting, PA, USA) to retain fixed implant-supported restorations, complications, that is, inflammations, were developed in some cases. After removing the suprastructure and the abutment, residual excessive cement was found. For this reason, all implant-supported restorations that had been fixed with this type of methacrylate cement were reevaluated and retreated. METHODS: In a retrospective clinical observational study including 71 patients with 126 implants, the findings made during retreatment were documented. In all cases, the suprastructure and the abutment were removed. For recementation, Temp Bond (Kerr Sybron Dental Specialities, Washington, D.C., USA) was used. If an inflammation had developed, a follow-up appointment was scheduled 3-4 weeks later. RESULTS: In 59.5% of the implants, cement residues were identified. Bleeding on probing was diagnosed at 80% of the implants with excess cement and suppuration at 21.3% of the implants. After removal of the excess cement and recementation with Temp Bond, a 76.9% reduction in bleeding on probing was found at follow-up. Suppuration was not found around any of the implants at follow-up. CONCLUSION: Excess cement left in the implant-mucosal interface caused bleeding on probing in most cases and suppuration in some. The removal of excess cement after cementation should be given high priority. In this retrospective observational study, an unusually high number of implants with excess cement after cementation was found with the methacrylate cement applied in the study.