Peri-implant diseases and systemic inflammation: A preliminary analysis from a cross-sectional survey of patients with hypertension.

BACKGROUND: The aim of this study was to investigate the association between peri-implant diseases and systemic inflammation assessed by serum C-reactive protein (CRP) levels in a sample of patients with hypertension. METHODS: A total of 151 participants with hypertension were included in a cross-sectional study. The population was divided into six groups according to their peri-implant and periodontal status (healthy controls, mucositis, peri-implantitis, periodontitis, periodontitis and mucositis, periodontitis, and peri-implantitis). Linear, logistic regression, and correlation analyses were performed. RESULTS: CRP levels were statistically significantly higher in participants with periodontitis alone (median 3.2 mg/L, interquartile range [IQR] 1.8, p = 0.012), combined with mucositis (3.10 mg/L, IQR 2.35, p < 0.001) or peri-implantitis (2.7 mg/L, IQR 2.53, p = 0.002) when compared to the healthy controls (1 mg/L, IQR 1.2). This association was independent of age, sex, smoking status, and adiposity differences. Participants with periodontitis with and without peri-implant diseases had the greatest odds of exhibiting CRP > 3 mg/L (odds ratio = 7.3, 95% confidence interval 1.6-33.9). CONCLUSIONS: Peri-implant diseases are associated with systemic inflammation, but the nature of the association should be further investigated.

Association between subclinical atherosclerosis and oral inflammation: A cross-sectional study.

BACKGROUND: The aim of this cross-sectional study was to investigate the association between carotid intima-media thickness (c-IMT) values and periodontal and peri-implant diseases in a sample of patients with hypertension. METHODS: A total of 151 participants with presence of at least one dental implant in function for >5 years were recruited. Anthropometric measurements, 24-h ambulatory blood pressure monitoring, ultrasound assessment of carotid arteries (c-IMT and presence of plaque) were recorded and venous blood samples obtained. An oral examination was performed by calibrated examiners to ascertain prevalence and severity of periodontal and peri-implant diseases. Binomial logistic regression was performed to investigate the potential association between various measures of exposure of dental diseases and predictors of cardiovascular risk (c-IMT > 0.9 mm and presence of plaque or their combination). RESULTS: Diagnosis of periodontitis (OR 6.71, 95% CI: 2.68-16.76, P < 0.001), cumulative mucosal/gingival inflammation (Periodontal Screening and Recording score) (OR 1.25, 95% CI:1.12-1.41, P < 0.001), and mucositis (OR 3.34, 95% CI:1.13-9.85, P < 0.05) were associated with c-IMT > 0.9 mm and/or plaque presence independent of age, sex, smoking, 24 h systolic blood pressure and body mass index differences. No statistically significant results were noted for peri-implantitis. Linear regression models confirmed a positive association of cumulative mucosal/gingival inflammation (ß = 0.011, SE 0.002, P < 0.001), diagnosis of periodontitis (ß = 0.114, SE 0.020, P < 0.001), and peri-implant diseases (ß = 0.011, SE 0.002, P < 0.001) with increased c-IMT values. CONCLUSIONS: This study confirms a positive association between mucosal/gingival inflammation and subclinical atherosclerosis assessed by c-IMT values and the presence of carotid plaque in patients with hypertension, independent of traditional cardiovascular risk factors. Future studies are needed to further characterize this relationship.

Microbiological Profiles of Dental Implants in Metabolic Syndrome Patients: A Case-Control Study.

There is a lack of knowledge on the possible influence of systemic conditions on peri-implantitis. The aim of this case-control study is to evaluate the difference in terms of oral pathogens' concentrations in the peri-implant sulcus of a group of patients affected by metabolic syndrome (Mets) compared to healthy subjects. For each patient, peri-implant sulcular biofilm samples were obtained by inserting two sterile endodontic paper points in the deepest aspect of the peri-implant sulcus for 30 s. The quantitative real-time polymerase chain reaction was performed to evaluate total bacterial counts of six pathogens. Patients were screened for peri-implant diseases and clinical and radiographic parameters were recorded. A total of 50 patients was enrolled in the study, 25 affected by Mets and 25 healthy. Significantly higher bacterial counts were discovered for Aggregatibacter actinomycetemcomitans (p = 0.0008), Prevotella intermedia (p = 0.0477) and Staphylococcus aureus (p = 0.034) in MetS patients compared to healthy subjects. Performing a sub-group analysis, considering peri-implant status and dividing patients by MetS diagnosis, no statistically significant (p < 0.05) differences were found. For the first time, a correlation between MetS presence and a greater prevalence of some bacterial species in the peri-implant sulcus was reported, irrespectively from peri-implant status (health vs. disease).

Prevalence and treatment of retrograde peri-implantitis: a retrospective cohort study covering a 20-year period.

OBJECTIVES: The aims of this retrospective study were to report data on the prevalence of retrograde peri-implantitis (RPI) in a single-center in a 20-year observation period and to evaluate implant survival after surgical treatment. MATERIALS AND METHODS: A retrospective cohort study was conducted screening all patients who underwent implant treatment in a private practice. Patients were enrolled if they had one or more implants showing a radiolucency around the implant apex, without implant mobility. Furthermore, clinical symptoms of RPI and days from symptoms' appearance after implant placement were also collected, as well as periodontal and endodontic status of nearby teeth. All patients were treated with the same surgical approach: antibiotic therapy, mechanical curettage, chemical decontamination and xenograft application. RESULTS: Out of the 1749 implants placed, only 6 implants were classified as affected by RPI, with a prevalence of 0.34%. Clinical symptoms of RPI (pain, swelling, dull percussion or fistula presence) varied among patients and were reported after a mean period of 51.83 ± 52.43 days. CONCLUSIONS: RPI was successfully treated with surgical curettage and bone substitute application and all implants are still in place after a mean follow-up of 8.83 ± 5.34 years. CLINICAL RELEVANCE: Bacteria from teeth with failed endodontic treatment or residual lesions might be reactivated by drilling for implant osteotomy, with subsequent colonization of the implant apex and possible failure before prosthetic loading. Therefore, it might be recommended to take a periapical x-ray at implant placement and after 6-8 weeks in order to intercept RPI before prostheses delivery.

Correlation between endodontic pulpal/periapical disease and retrograde peri-implantitis: A case series.

Retrograde peri-implantitis is a symptomatic complication, characterised by radiographic detection of bone loss at the periapex of the implant. The aim of this study was to investigate the possible endodontic aetiology, evaluating the effectiveness of surgical treatment without endodontic therapy of adjacent teeth. In the 10-year interval, three patients reported symptoms of retrograde peri-implantitis after a mean period of 30.6 days from implant placement. Mean follow-up after surgical procedures was 8.66 years, with an implant survival of 100%. Retrograde peri-implantitis was probably caused by colonisation of the apical surface of the implant by bacteria persisting in the area after endodontic failure/apical periodontitis, reactivated by drilling in the site. In all cases, the adjacent teeth remained vital during the years, showing that a direct cause-and-effect relationship between pulpal/periapical disease of adjacent teeth and retrograde peri-implantitis was never present.

Clinical and volumetric analysis of peri-implant soft tissue augmentation using an acellular dermal matrix: A prospective cohort study.

BACKGROUND: The role of keratinized mucosa in promoting peri-implant health is controversial, however recent evidence support the use of soft tissue augmentation procedures around dental implants. Soft tissue substitutes have been proposed to replace autogenous connective tissue grafts, therefore the aims of this study are to report clinical and volumetric three-dimensional changes in mucosal thickness (MT) 1 year after treatment with an acellular dermal matrix (ADM). METHODS: Soft tissue augmentation was performed at second-stage surgery in the premolar maxillary area with an ADM. MT was assessed prior to implant placement and 1, 6, and 12 months after treatment. Digital linear and volumetric measurements were recorded at baseline and after 1 and 12 months. Furthermore, clinical parameters (Probing Pocket Depths, Bleeding On Probing, Plaque Index) and marginal bone loss were also recorded. Esthetic outcomes of treatment were evaluated objectively using the Pink Esthetic Score and through patient reported outcomes. RESULTS: Twelve patients were enrolled in this prospective study. Post-hoc analysis of the assessments with Tukey's honestly significant difference adjustment revealed that the MT had increased significantly from baseline to 1 month (P < 0.001), 6 months (P < 0.001) and 12 months (P < 0.001), and remained stable between 6 months and 12 months (P > 0.05). Based on the volumetric evaluation, a shrinkage of 23.31% occurred from 1 month to 12 months (P > 0.05). CONCLUSIONS: A significant increase in MT was reported after 1 year, with a mean gain of 1.25 mm. Soft tissues were stable, with no statistically significant differences between 6 months and 1 year.

Knowledge and Attitude towards Retrograde Peri-Implantitis among Italian Implantologists: A Cross-Sectional Survey.

BACKGROUND: Retrograde peri-implantitis (RPI) is a pathological entity with an unclear etiology (e.g., overheating during implant insertion, residual infection of the tooth replaced by the implant or the endodontic lesion of neighboring teeth) and an extremely low prevalence and has been scarcely investigated. Therefore, the aim of this cross-sectional survey was to evaluate the knowledge and attitude of Italian implantologists regarding RPI. METHODS: An anonymous questionnaire was sent via email to implantologists randomly selected, including a section about demographic information and questions related to RPI origin, radiographic representation, symptoms and treatment options. All questions were multiple answer and close-ended. Binomial logistic regression was performed to investigate the relationship between correct answers and the following independent variables: age, years of experience and number of dental implants placed per year. RESULTS: In total, 475 implantologists completed the questionnaire, with a response rate of 46.3%. Based on the results of the study, incorrect answers were associated with less experienced participants (<80 implants/year) for all questions evaluated, with the exception of treatment strategies. Furthermore, 26.7% of the survey takers did not recognize radiographic representation of RPI and 35.5% picked "implant removal" when asked about treatment modality. CONCLUSIONS: The majority of participants were able to recognize symptoms and indicated the probable causes of RPI; however, around 30% of them showed very limited knowledge of available management strategies.

Attitude in Radiographic Post-Operative Assessment of Dental Implants among Italian Dentists: A Cross-Sectional Survey.

There is a lack of evidence in the attitude and prescribing practice of implantologists in dental implant post-operative assessment; therefore, the aims of this cross-sectional study were to investigate these habits and the knowledge about radiographic aspect of retrograde peri-implantitis (RPI) among Italian implantologists. A questionnaire was sent via email to dentists randomly selected from the register of implantology and oral surgery societies. It included three questions: the preferred X-ray after implant placement, the timing of post-operative assessment and the knowledge of the RPI radiographic representation. A final sample of 434 implantologists was included in the study. The majority of them (84.3%) perform a periapical X-ray as control radiograph and picked the correct radiographic representation of RPI (74.3%), without statistically significant differences (p > 0.05) for sex, age, years of working practice and number of implants placed per year. Just 47.7% of dentists perform a control radiograph at prostheses delivery, to establish a proper baseline. A statistically significant difference (p < 0.05) was detectable only for the number of implants placed per year, with dentists placing > 80 implants selecting the correct choice. To the best of authors' knowledge, this is the first study to report data on attitude of implantologists in radiographic imaging after implant placement.

Salivary Levels of Titanium, Nickel, Vanadium, and Arsenic in Patients Treated with Dental Implants: A Case-Control Study.

BACKGROUND: Recent articles have hypothesized a possible correlation between dental implants dissolution products and peri-implantitis. The null hypothesis tested in this case-control study was that there would be no differences in salivary concentrations of titanium (Ti), vanadium (V), nickel (Ni) and arsenic (As) ions among patients with dental implants, healthy (Group A) or affected by peri-implantitis (Group B), compared to subjects without implants and/or metallic prosthetic restorations (Group C). METHODS: Inductively coupled plasma mass spectrometry was used to analyze saliva samples. One-way repeated-measure analysis of variance (ANOVA) was used to identify statistically significant differences in the salivary level of Ti, V, Ni and As between the three groups. RESULTS: A total of 100 patients were enrolled in the study (42 males and 58 females), distributed in three groups: 50 patients in Group C, 26 patients in Group B and 24 patients Group B. In our study, concentrations of metallic ions were higher in Group A and B, compared to the control group, with the exception of vanadium. However, there were no statistically significant differences (p > 0.05) for metallic ions concentrations between Group A and Group B. CONCLUSIONS: Based on our results, there are no differences in titanium or other metals concentrations in saliva of patients with healthy or diseased implants.

The Use of a Non-Absorbable Membrane as an Occlusive Barrier for Alveolar Ridge Preservation: A One Year Follow-Up Prospective Cohort Study.

：The aims of this study were to obtain preliminary data and test the clinical efficacy of a novel nonporous dense-polytetrafluoroethylene (d-PTFE) membrane (permamem®, botiss) in alveolar ridge preservation (ARP) procedures with a flapless approach. A traumatic extraction was performed in the premolar maxillary area, and a d-PTFE membrane was used to seal the alveolar cavity: no biomaterial was used to graft the socket and the membrane was left intentionally exposed and stabilized with sutures. The membrane was removed after four weeks and dental implants were placed four months after the procedure. The primary outcome variables were defined as the dimensional changes in the ridge width and height after four months. A total of 15 patients were enrolled in this study. The mean width of the alveolar cavity was 8.9 ± 1.1 mm immediately after tooth extraction, while four months later a mean reduction of 1.75 mm was experienced. A mean vertical reduction of 0.9 ± 0.42 mm on the buccal aspect and 0.6 ± 0.23 mm on the palatal aspect were recorded at implant placement. Within the limitations of this study, the d-PTFE membrane proved to be effective in alveolar ridge preservation, with the outcomes of the regeneration not affected by the complete exposure of this biomaterial.

The relationship of tooth shade and skin tone and its influence on the smile attractiveness.

OBJECTIVE: The purpose of this clinical study was to determine if skin tone and tooth color had the same influence on smile attractiveness. MATERIALS AND METHODS: A woman's smile photograph was digitally manipulated to create a range of images with varying colors. The skin shade was modified to create four tones (p1: light, p2: light medium, p3: medium dark, p4: dark) using the L'Oreal True Illusion shade as a guide. The tooth shade was modified in four different tones: A1, A2, A3, A4 using the VITAPAN Classical shade guide to produce 16 images. A sample of 328 participants rated each image for attractiveness by means of a visual analog scale (VAS). Comparison among groups was performed with a 2-way ANOVA adjusted for multiple comparisons with the Bonferroni test (α = .05). RESULTS: Image (p3-a1) showed the highest VAS values, while image (p1-a4) obtained the lowest, (Bonferroni Test: a1 vs a2, a3, a4 P < .001; p3 vs p1, p2, p4 P < .001). Analysis performed for age, sex, level of education, and laypeople/dentists were not statistically significant (P > .05). CONCLUSIONS: Variations in tooth and skin tone can significantly influence the perception of smile attractiveness. In the tested conditions, a brighter tooth shade significantly affected the attractiveness of the smile independently from skin tone. CLINICAL SIGNIFICANCE: Understanding patient and dentist perception of the attractiveness of a smile with the important role-played by skin tone, may help clinicians to better identify teeth shade, helping delivery of tailored prostheses and esthetic restorations.

Prevalence of peri-implant diseases among an Italian population of patients with metabolic syndrome: A cross-sectional study.

BACKGROUND: Over the years, only few authors have studied the association of systemic conditions with peri-implantitis. The aim of this study is to detect frequency and severity of peri-implant diseases among an Italian population of patients affected by metabolic syndrome (MetS). METHODS: In this cross-sectional study, patients with at least one dental implant with >5 years of functional loading were screened to evaluate metabolic, periodontal, and peri-implant status. MetS diagnosis was established in accordance with the National Cholesterol Education Program (NCEP) ATP III criteria, while case definitions of the 2017 World Workshop were adopted for peri-implant diseases. For each implant, probing depths, mucosal redness, bleeding on probing, suppuration, plaque index, and marginal bone loss were recorded. Multinomial logistic regression analyzed the relationship between sex, diagnosis of MetS, presence of periodontitis, smoking, type of prosthesis, and location of implants and peri-implant mucositis and peri-implantitis. RESULTS: A total of 183 patients were enrolled: in MetS subjects, peri-implantitis was detected in 36.9% (n = 31) of implants, and mucositis in 60.7% (n = 51), with an OR of 10.01(P = 0.005) for mucositis and OR 15.26 (P = 0.001) for peri-implantitis, compared with subjects without MetS, where 26.3% of implants showed peri-implantitis and 55.5% mucositis. No differences were found for smoking, implant location, sex, and type of prosthetic rehabilitation. Patients with periodontitis showed a higher association with peri-implant mucositis (OR = 4.33) and peri-implantitis (OR = 9.00). CONCLUSION: Based on the results of this study, patients affected by MetS showed a greater prevalence of peri-implant diseases, but further studies are needed to confirm the possibility of this new possible risk indicator.

The prevalence of peri-implant diseases in patients with metabolic syndrome: a case-control study on an Italian population sample.

BACKGROUND: The correlation of peri-implantitis with systemic diseases is still highly debated and controversial in literature. The objective of this work was to evaluate the possible association between peri-implant diseases and metabolic syndrome. METHODS: In this case-control study, subjects healthy or affected by metabolic syndrome, with at least one dental implant with >5 years of functional loading were screened to detect peri-implant health or diseases. A complete full mouth periodontal and peri-implant examination at six sites was performed for each implant and standardized periapical X-ray were taken to evaluate marginal bone loss. Diagnostic Criteria of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions were applied. The analysis of variance (ANOVA) was used to compare means of recorded variables between the two groups, with a P<0.05 value considered statistically significant. Sub-group analysis was performed for smoking (smokers vs. non-smokers), sex (males vs. females), implant site (maxillary vs. mandible) and type of prostheses (single crown vs. bridge). RESULTS: Forty-one patients were enrolled, divided into two groups, for a total of 132 dental implants: 71 in the metabolic syndrome group and 61 in the control group. The overall prevalence of peri-implant diseases (peri-implantitis + mucositis) in the two groups was, respectively, 93% vs. 63%, with an odds ratio (OR) of 7.4462 (95% CI: 2.6092; 21.2496) for the metabolic syndrome group (P<0.001). CONCLUSIONS: Despite the limited sample, our results showed a statistically significant higher prevalence of peri-implant diseases in patients with metabolic syndrome compared to healthy patients. Further longitudinal studies are needed to verify this relationship.