Surgical Alternatives for Treating Peri-implantitis.

The objective of this case series was to describe surgical approaches that can be used to efficiently and effectively treat peri-implantitis as measured by positive changes in clinical parameters. A total of 32 patients with 45 implants were treated surgically to eliminate peri-implantitis. Baseline clinical parameters measured prior to surgery were compared to those made 6 months postsurgery to evaluate the efficacy of each procedure. Implants demonstrating signs of peri-implantitis were treated by one of three approaches: (1) regenerative surgery, (2) osseous resective surgery, or (3) apically repositioned flap surgery. In all instances, the exposed implant surfaces were debrided and decontaminated. Relative to baseline values, regenerative surgery yielded statistically significant changes in probing depth (PD) (7.21 ± 0.27 mm to 4.09 ± 0.14 mm) and percentage of sites exhibiting bleeding on probing (BoP) (100.0% ± 0.0% to 10.6% ± 3.3%) as measured at the 6-month recall visit (P ≤ .05). The decrease in probing depth was not dependent on the type of graft material used (P ≤ .05). Resective surgery yielded statistically significant changes in PD (5.86 ± 0.23 mm to 3.63 ± 0.14 mm) and the percentage of sites exhibiting BoP (100.0% ± 0.0% to none) (P ≤ .05). Finally, the implants treated via apically repositioned flap surgery demonstrated statistically significant decreases (P ≤ .05) in both PD (6.79 ± 0.27 mm to 4.32 ± 0.16 mm) and BOP (100.0% ± 0.0% to 14.3% ± 6.7%) (P ≤ .05). Regenerative, resective, and apically positioned flap surgery can be utilized to successfully treat peri-implantitis.

The Effect of Osteopontin and an Osteopontin-Derived Synthetic Peptide Coating on Osseointegration of Implants in a Canine Model.

Osteopontin (OPN) and an OPN-derived synthetic peptide, OC-1016, have demonstrated their potential to enhance osseointegration in vitro. The purpose of this study was to evaluate bone-to-implant contact (BIC) and surrounding bone density (BD) of implants coated with either recombinant human OPN (rhOPN) or OC-1016 as compared with noncoated titanium plasma sprayed (TPS) surface in a canine model. Histomorphometric analysis revealed that at 4 weeks, %BIC and %BD of coated implants were significantly higher than those of noncoated TPS implants. At 12 weeks, %BIC of coated implants was also significantly higher than that of noncoated implants; however, there was no statistically significant difference in %BD. The rhOPN and OC-1016 were concluded to be capable of significantly accelerating the early stage of osseointegration and bone healing around implants.

A Classification System for Peri-implant Diseases and Conditions.

Peri-implant bone levels are influenced by pathologic and nonpathologic conditions. The understanding of peri-implant disease has evolved over the past several decades, and the classification of peri-implantitis has been limited to descriptions of disease progression or those involving soft and/or hard tissues (peri-implant mucositis or peri-implantitis). However, no classification system has been established based on etiology. The objective of this study was to identify various etiologies for peri-implantitis and to establish a classification system based on the pathogenesis. The results indicate that the majority of bone loss was related to biofilm, followed by iatrogenic factors, exogenous irritants, absence of keratinized tissue, and extrinsic pathology. The proposed classification system will allow the clinician to properly diagnose peri-implant diseases in relation to etiology. These conditions may respond differently to applied therapies.

Prevalence of torus mandibularis in Rochester, New York, region.

The purpose of this study was to investigate the prevalence of torus mandibularis within a population residing in the Rochester, New York, region. During a comprehensive initial exam, utilizing clinical inspection and palpation, 1,323 subjects were examined for any tori in the mandibular area. Of the 1,323 subjects studied, 37.8% had tori mandibularis, with a higher frequency occurring in male patients (overall mean age: 40 years). In the Rochester, New York, area the observations noted a high prevalence of torus mandibularis (37.8%), with a mean population age of 40 years; 52% of the tori were observed in men.