Use of wide-field optical fluorescence for visualization of oral biofilm in a patient with peri-implant mucositis: a new approach / Uso da fluorescência óptica de campo amplo para visualização de biofilme oral em paciente com mucosite peri-implantar: uma nova abordagem

ABSTRACT Peri-implant diseases, caused by bacteria from biofilm related to dental implants, are one of the main causes of late loss of implants. In this sense, peri-implant diseases are divided into peri-implant mucositis, when it affects only the soft tissues, and peri-implantitis, when there is a bone involvement, which can lead to the failure of dental implant therapy. Thus, biofilm removal is essential for peri-implant health, allowing long-term success in implant therapy. To improve the visualization of oral biofilm, which is usually transparent or colorless, disclosing agents have been routinely used. However, disclosing agents have allergenic potential and can cause staining extrinsically in restorative and prosthetic materials, leading to aesthetic impairment. Thus, the use of fluorescence has been studied as an alternative for visualization of oral biofilm. Therefore, this report describes the use of wide-field optical fluorescence for visualization of oral biofilm associated with implants and teeth, in a routine appointment and follow-up of a partially edentulous patient with peri-implant mucositis. In addition, this report showed wide-field optical fluorescence can be used in a clinical routine of care of patients with dental implants. In this sense, wide-field optical fluorescence allowed easy and immediate visualization of the mature oral biofilm for its adequate removal, evaluation of the quality of restoration to sealing of screw access-hole of implant and identification of cariogenic lesions, without risk of allergic reactions or staining of prostheses and restorations.

RESUMO Doenças peri-implantares, causadas por bactérias de biofilme relacionadas a implantes dentários, são uma das principais causas de perda tardia de implantes. Nesse sentido, as doenças peri-implantares são divididas em mucosite peri-implantar, quando afeta apenas tecidos moles, e peri-implantite, quando há comprometimento ósseo, o que pode levar ao fracasso da terapia com implantes dentários. Assim, a remoção do biofilme é essencial para a saúde peri-implantar, permitindo sucesso a longo prazo na terapia com implantes. A fim de melhorar a visualização do biofilme oral, que geralmente é transparente ou incolor, agentes reveladores têm sido rotineiramente utilizados. No entanto, esses agentes têm potencial alergênico e podem causar manchas extrinsecamente em materiais restauradores e protéticos, levando a prejuízo estético. Assim, o uso da fluorescência tem sido estudado como alternativa para visualização do biofilme oral. Este relato descreve o uso da fluorescência óptica de campo amplo para visualização do biofilme oral associado a implantes e dentes em uma consulta de acompanhamento de rotina de uma paciente parcialmente edêntula com mucosite peri-implantar. Além disso, este relato evidenciou que a fluorescência óptica de campo amplo pode ser utilizada dentro da rotina clínica de atendimento de pacientes com implantes dentários. Nesse sentido, a fluorescência óptica de campo amplo permitiu a visualização fácil e imediata do biofilme oral maduro para sua remoção adequada, a avaliação da qualidade da restauração do selamento do orifício de acesso do parafuso do implante e a identificação de lesões cariogênicas, sem risco de reações alérgicas ou manchamento de próteses e restaurações.

Implant-based factor as possible risk for peri-implantitis

Abstract Peri-implantitis is currently a topic of major interest in implantology. Considered one of the main reasons of late implant failure, there is an emerged concern whether implant characteristics could trigger inflammatory lesion and loss of supporting bone. The purpose of this narrative review is to provide an evidence based overview on the influence of implant-based factors in the occurrence of peri-implantitis. A literature review was conducted addressing the following topics: implant surface topography; implant location; occlusal overload; time in function; prosthesis-associated factors (rehabilitation extension, excess of cement and implant-abutment connection); and metal particle release. Although existing data suggests that some implant-based factors may increase the risk of peri-implantitis, the evidence is still limited to consider them a true risk factor for peri-implantitis. In conclusion, further evidences are required to a better understanding of the influence of implant-based factors in the occurrence of peri-implantitis. Large population-based studies including concomitant analyses of implant- and patient-based factors are required to provide strong evidence of a possible association with peri-implantitis in a higher probability. The identification of these factors is essential for the establishment of strategies to prevent peri-implantitis.

The impact of maintenance on peri-implant health

Abstract Most of the literature evaluating dental implants focuses on implant survival, which is a limited proxy for the successful rehabilitation of patients with missing teeth. Success should include not only survival but also lack of mechanical, biological, and esthetics problems. A comprehensive review of local and systemic risk factors prior to implant placement will allow the tailoring of treatment planning and maintenance protocols to the patient's profile in order to achieve longitudinal success of the therapy. This review discusses the role of controlling different risk factors and prevention/treatment of peri-implant mucositis in order to avoid peri-implantitis. Although the literature addressing the topic is still scarce, the existing evidence shows that performing optimal plaque control and regular visits to the dentist seem to be adequate to prevent peri-implant lesions. Due to impossibility of defining a probing depth associate with peri-implant health, radiographic evaluations may be considered in the daily practice. So far, there is a strong evidence linking a past history of periodontal disease to peri-implant lesions, but this is not so evident for other factors including smoking and diabetes. The prevention of biological complications starts even before implant placement and include a broader analysis of the patient risk profile and tailoring the rehabilitation and maintenance protocols accordingly. It should be highlighted that the installation of implants does not modify the patient profile, since it does not modify genetics, microbiology or behavioral habits of any individual.

Does traumatic occlusal forces lead to peri-implant bone loss? A systematic review

Abstract Observational studies have indicated that crestal bone level changes at implants are typically associated with clinical signs of inflammation, but still mechanical overload has been described as possible factor leading to hard-tissue deficiencies at implant sites without mucosal inflammation. The aim of this paper was systematically review the literature regarding the possible effect of traumatic occlusal forces on the peri-implant bone levels. Literature search was conducted using PubMed, Scielo and Lilacs, including the following terms: oral OR dental AND implant$ AND (load OR overload OR excessive load OR force$ OR bruxism) AND (bone loss OR bone resorption OR implant failure$). Databases were searched for the past 10 years of publications, including: clinical human studies, either randomized or not, cohort studies, case control studies, case series and animal research. Exclusion criteria were review articles, guidelines and in vitro and in silico (finite element analysis) research, as well as retrospective studies. The PICO questions formulated was: "does traumatic occlusal forces lead to peri-implant bone loss?" The database searches as well as additional hand searching, resulted in 807 potentially relevant titles. After inclusion/exclusion criteria assessment 2 clinical and 4 animal studies were considered relevant to the topic. The included animal studies did not reveal an association between overload and peri-implant bone loss when lower overloads were applied, whereas in the presence of excessive overload it seemed to generate peri-implant bone loss, even in the absence of inflammation. The effect of traumatic occlusal forces in peri-implant bone loss is poorly reported and provides little evidence to support a cause-and-effect relationship in humans, considering the strength of a clinically relevant traumatic occlusal force.

Prevalence of peri-implant diseases - a critical review on the current evidence

Abstract The objective of this paper was to evaluate the current evidence reporting on the prevalence of peri-implantitis and to determine the influencing factors. An electronic search for articles published until February 2019 reporting on the prevalence of peri-implantitis was performed in MEDLINE. Included criteria were published in international peer-reviewed journals, written in English language, reported on the prevalence of peri-implantitis, included implants with a minimum follow-up of one year after functional loading and used a clear definition for peri-implantitis and/or peri-implant mucositis with a clear cutoff for bone level changes according to the case definitions of Sanz and Chapple and Berglundh et al. 2018. Included papers were anaylized for factors affecting the reported prevalences for peri-implantitis. Twenty-five papers were included in the present review and a wide range for the reported prevalence of peri-implantitis was seen. Case definitions for peri-implantitis with various thresholds for bone loss together with the type of reporting on patient- or implant-level were the most significant factors that lead to a large variety of the occurrence of the disease. Additionally, follow-up time and the evaluation in a certain "convenience" population may have influenced the prevalence values. In conclusion, it can be stated that a wide range for reporting the prevalence of peri-implantitis can be found and no real estimation of the global burden of the disease can be made. Applying accurate case definitions for peri-implantitis is the most important factor for reporting the prevalence and should be strictly followed in future reports.

An umbrella review on the effects of diabetes on implant failure and peri-implant diseases

Abstract The aim of this review is to summarize the evidence on associations between diabetes mellitus (DM) and complications around dental implants. Electronic database searches of MEDLINE, EMBASE, JBI Database of Systematic Reviews and Implementation Reports, Cochrane Database of Systematic Reviews and the PROSPERO register were performed from 1990 up to and including May 2018, using MeSH terms and other keywords. Systematic reviews and meta-analyses investigating the associations of DM and implant complications (failure, survival, bone loss, peri-implant diseases, and post-surgery infection) were eligible. The quality of the included reviews was determined using the Assessment of Multiple Systematic Reviews Tool 2 (AMSTAR 2). Twelve systematic reviews were included. Implant survival rates ranged from 83.5% to 100%, while implant failure rates varied from 0% to 14.3% for subjects with DM. The three meta-analyses performed for event "implant failure" reported no statistically significant differences between diabetic and non-diabetic subjects. An apparently increased risk of peri-implantitis is reported in patients with DM. According to the AMSTAR 2 classification, 50% of the reviews were classified as being of "critically low", 25% as of "low" and 25% as of "moderate" quality. Evidence indicates high levels of survival and low levels of failure of implants inserted in patients with DM. However, DM was assessed as a whole in the majority of studies and, the actual influence of hyperglycemia on implant survival/failure is still uncertain. DM/hyperglycemia seems to be associated with a high risk of peri-implantitis. However, this conclusion is based on a limited number of systematic reviews.

Diagnóstico, etiologia e tratamento das doenças peri-implantares / Diagnosis, etiology, and treatment of peri-implant diseases

Sendo a mucosite e a peri-implantite as lesões mais recorrentes ao redor de implantes, e cada vez mais frequentes no consultório odontológico, faz-se necessária uma compreensão abrangente sobre seus principais fatores etiológicos, métodos de prevenção e modalidades de tratamento para uma correta conduta clínica. A presente revisão da literatura visa, de forma clara e sintetizada, identificar e ressaltar as principais causas de mucosite e peri-implantite descritas na literatura, orientar o cirurgião-dentista na obtenção do diagnóstico, informar o leitor sobre as principais modalidades de tratamento e destacar a importância da terapia de suporte para a manutenção da saúde peri-implantar. A busca eletrônica nas bases de dados Scopus, PubMed e Web of Science foi orientada pelos seguintes tópicos: definição de mucosite e peri-implantite, prevalência, obtenção do diagnóstico, fatores de risco, modalidades de tratamento e terapia de suporte. Os resultados da busca indicaram: 1) a mucosite peri-implantar pode ocorrer em 80% dos indivíduos, e a peri-implantite em até 56%; 2) não há uma única ferramenta para o diagnóstico das doenças peri-implantares, mas sim uma associação destas; 3) a etiologia da peri-implantite parece ser multifatorial, e alguns indivíduos parecem ser mais propensos ao seu desenvolvimento do que outros; 4) a mucosite pode se resolver apenas com a remoção e desinfecção não cirúrgica dos fatores locais, enquanto que na peri-implantite a terapia cirúrgica é adotada quando os sítios afetados não respondem à terapia básica; e 5) a terapia de suporte é imprescindível na determinação do sucesso a longo prazo no tratamento das doenças peri-implantares.

As the mucositis and peri-implantitis are the most recurrent lesions around implants and these increasingly frequent in the dental office, a comprehensive understanding of its main etiological factors, prevention methods and treatment modalities is necessary for proper clinic conduct. This literature review aims, in a clearly and synthesized form, identify and highlight the main causes of mucositis and peri-implantitis described in the literature, guide the dentist in getting the diagnosis, inform the reader about the main types of treatment and highlight the importance of supportive therapy for maintenance of the peri-implant health. The electronic search in Scopus databases, PubMed and Web of Science was guided by the following topics: definition of mucositis and peri-implantitis, prevalence, diagnosis, risk factors, treatment modalities and supportive therapy. The search results indicated that: 1) peri-implant mucositis can occur in 80% of individuals, peri-implantitis up to 56%; 2) there isn't a unique tool for the diagnosis of peri-implant disease, but a association of tools; 3) etiology of peri-implantitis appears to be multifactorial, and some individuals appear to be more prone to their development than others; 4) mucositis can be solved only with the non-surgical removal and disinfection of factors, while in peri-implantitis surgical therapy is used where the affected sites do not respond to primary therapy; and 5) supportive therapy is essential in determining the long-term success in the treatment of peri-implant diseases.

Periimplantitis: revisión de la literatura / Peri-Implantitis: literature review

El uso de implantes ha tomado un gran auge en los últimos años, sin embargo así como se ha visto un aumento en la demanda también se ha visto un incremento en el fracaso de los mismos, existen múltiples razones que intervienen para esto como son; deficiencias en la cantidad y calidad de hueso, patologías óseas preexistentes, mala técnica quirúrgica, implante inadecuado, hábito tabáquico, entre otras. La mucositis periimplantaria y la periimplantitis son las primeras causas de complicaciones en los implantes, los pacientes con enfermedades crónico degenerativas, fumadores y con mala higiene son considerados pacientes de riesgo para presentar periimplantitis. La literatura ofrece tratamientos quirúrgicos y no quirúrgicos los cuales van enfocados a la eliminación de microorganismos y a la desinfección de la superficie del implante, el tratamiento quirúrgico como la debridación y curetaje tienen la finalidad de eliminar la placa bacteriana, desinfectar la superficie del implante así como retirar el tejido dañado por el proceso inflamatorio, el realizar una adecuada historia clínica y valoración previa, permitirá identificar a los pacientes con mayor o menor riesgo de desarrollar periimplantitis, las citas de mantenimiento ayudan a detectar oportunamente posibles complicaciones.

The use of implants has taken a giant leap in recent years, however, greater demand has also resulted in an increase in the failure of these procedures. There are multiple reasons involved such as; deficiencies in the amount and quality of bone, preexisting bone disease, poor surgical technique, improper implant, tobacco habit, among others. The peri-implant mucositis and peri-implantitis are the main causes of complications in implants, patients with chronic degenerative diseases, smokers and patients with poor oral hygiene are considered risk patients to present peri-implantitis. The literature provides surgical and nonsurgical treatments which are focused on the elimination of microorganisms and the disinfection of the implant surface; surgical treatment as debridement and curettage are designed to remove plaque, disinfect the implant surface and remove damaged tissue caused by the inflammatory process, the performance of an adequate medical history and prior assessment will identify patients with greater or lesser risk of developing peri-implantitis, maintenance appointments help in the early detection of possible complications.

Peri-implantite: etiologia e tratamento / Peri-implantitis: etiology and treatment

Objetivo: analisar a etiologia e os possíveis meios de tratamento da peri-implantite, por meio de pesquisas de trabalhos recentemente publicados acerca do tema e estudos realizados em humanos. Material e métodos: foram selecionados 50 artigos relacionados à etiologia e ao tratamento das doenças peri-implantares. Destes, foram analisados seus títulos e resumos, seguindo os critérios de exclusão e inclusão, e escolhidos nove artigos para a realização desta revisão da literatura. Esta tinha como critérios de inclusão artigos publicados na língua inglesa, que abordavam os tipos de bactérias presentes em volta dos implantes e induzem o estabelecimento e a progressão das doenças peri-implantares. Trabalhos com o objetivo de descrever as possíveis formas de tratamento, desde as mais simples, como uma terapia mecânica de raspagem na mucosite, até uma terapia mais complexa, como a regeneração óssea na peri-implantite. Resultados: as principais bactérias presentes em volta dos implantes são: Aggregatibacter actinomycetemcomitans, Fusobacterium, Prevotela intermedia e Phorphyromonas gingivalis, além de ocorrer diminuição dos Streptococcus e aumento das espiroquetas. Em relação ao tratamento da peri-implantite, este consiste em uma intervenção cirúrgica com a elevação do retalho, remoção do tecido de granulação, limpeza e desinfecção da superfície dos implantes. Em alguns casos, este tratamento é complementado com uma cirurgia regenerativa, utilizando enxerto ósseo. Conclusão: a peri-implantite uma doença imunoinflamatória, sendo a placa bacteriana o principal agente etiológico. O seu tratamento tem como objetivo reduzir a colonização bacteriana em volta do implante, eliminar a microbiota bacteriana e promover a formação de um tecido peri-implantar saudável.

Objective: to analyze the etiology and possible treatments for periimplantitis through recently published papers and human studies. Material and methods: 50 related references were selected in this review. From these, after title and abstract analyses following the inclusion/exclusion criteria, 9 articles were selected. The inclusion criteria were papers published in the English language involving bacterial species at the peri-implant region which lead to establishment and progression of peri-implant diseases. Also, papers with the aim to describe treatment therapies, even from mechanical debridement to mucositis until a more complex approach such as bone regeneration were included. Results: the most prevalent species around the peri-implant region were Aggregatibacter actinomycetemcomitans, Fusobacterium, Prevotela intermedia and Phorphyromonas gingivalis, along with a reduction on Streptococcus and an increase on the spirochaete levels. The treatment basically consists on flap elevation, granulation tissue removal, cleaning and disinfection of peri-implant surfaces. Conclusion: peri-implantitis is a immunoinfl ammatory disease, being the bacterial build-up the main etiological agent. The proposed treatments aim to reduce the bacterial colonization around the dental implant, to eliminate the microfl ora, and to promote the formation of a healthy peri-implant tissue.

Prevalence of peri-implant disease on platform switching implants: a cross-sectional pilot study

The objective of this study was to assess the prevalence of mucositis and peri-implantitis associated with the use of two types of implants—conventional versus platform switching after one year of loading. A longitudinal study of 64 implants in 25 patients was performed. Clinical variables, such as clinical pocket depth and bleeding upon probing, plaque, mobility, gingival recession, clinical attachment loss, and radiographic bone loss, were analyzed. The case definition for peri-implantitis was established as pockets of ≥ 5 mm with bleeding and bone loss ≥ 2 mm. One year after implant loading, the prevalence of mucositis and peri-implantitis with conventional implants (CIs) was 81.2% and 15.6%, respectively. For platform switching implants (PSIs) the prevalence was 90% and 6.6%, respectively. These differences were not statistically significant (p = 0.5375). However, there was a trend towards a lower prevalence of peri-implantitis with platform switching Implants.

Peri-implantite (Parte I): etiologia, características e diagnóstico / Peri-implantitis: causes, characteristics and diagnosis

A peri-implantite é uma infecção dos tecidos ao redor do implante que resulta na perda do osso de suporte. Alguns fatores locais e sistêmicos influenciam na evolução desta doença e seu tratamento pode ser cirúrgico ou não. O objetivo desta revisão bibliográfica foi orientar os profissionais a diagnosticar as doenças peri-implantares, conhecer suas características e avaliar os fatores de risco. O estudo bibliográfico foi realizado utilizando os bancos de dados Medline e Ebsco, no qual o período de referência foi entre 1992 e 2013. A pesquisa foi limitada a artigos completos publicados no idioma inglês. Todos os níveis de evidência foram incluídos, tais como relato de caso, experimentos em animais, revisões bibliográficas e estudos estatísticos com humanos. De acordo com a revisão bibliográfica o principal agente etiológico das doenças peri- implantares ainda é a placa bacteriana, no entanto, fatores de risco sistêmicos e locais influenciam no seu desenvolvimento. Os principais microrganismos presentes nas infecções peri-implantares são os mesmos encontrados na periodontite, ou seja, bactérias gram e anaeróbios. Contudo, nenhuma definição evidente da microbiota associada com a peri-implantite foi estabelecida até o momento, dificultando um diagnóstico mais preciso e a determinação do protocolo de tratamento. O tratamento não cirúrgico isoladamente não apresentou resultados satisfatórios, no entanto, quando combinado com antibiótico oral ou antisséptico reduziu a infecção peri-implantar. O tratamento cirúrgico permite o debridamento exato da área contaminada peri-implantar do implante, o que resulta em ganho de inserção clínica e reconstrução óssea. Até a presente data, nenhum protocolo de tratamento padrão foi definido para peri-implantite.

Peri-implantitis is an infection of the tissues around the dental implant resulting in loss of supporting bone. Many local and systemic factors influence the development of the disease and its treatment can be surgical or non-surgical. The purpose of this literature review is to guide professionals to diagnose peri-implant diseases, knowing their characteristics, assess to risk factors and choosing appropriate treatments for each situation. The literature search was performed using Medline and Ebsco database and the period between 1992 and 2013. The search was limited to full-text articles published in English. All levels of evidence were included such as case report, animal experiments, literature reviews and statistical studies with humans. According to literature review the main etiological agent of peri-implant diseases still is the plaque, however, systemic and local risk factors influence its development. The main present microorganisms in the periimplant infection are the same found in periodontitis such as Gram- and anaerobic bacteria. However, no clear definition of the microbiota associated with the peri-implantitis has been established yet, making a more accurate diagnosis and determination of the treatment protocol. The non-surgical treatment alone did not show satisfactory results, however, when combined with oral antibiotic or antiseptic reduces peri-implant infection. Surgical treatment allows accurate debridement of the peri-implant area, decontamination of the implant surface and results in gain of clinical attachment and bone reconstruction. To date, no standard treatment protocol of peri-implantitis.

Peri-implantite: etiologia e tratamento / Periimplantitis: etiology and treatment

A peri-implantite tem sido descrita como uma alteração patológica dos tecidos ao redor dos implantes osseointegrados, sendo a microbiota e o trauma oclusal considerados seus principais fatores etiológicos. A profundidade de sondagem, o sangramento, a mucosa queratinizada, o fluxo do fluido sulcular e o infiltrado inflamatório servem como parâmetros para avaliar a saúde peri-implantar. O tratamento da peri-implantite inclui debridamento mecânico, instrução de higiene oral, destoxificação da superfície implantar, uso de antimicrobianos e terapias ressectivas e regenerativas. Uma correta intervenção parece ser necessária para a resolução da lesão peri-implantar.

The peri-implantitis has been described as a pathological alteration of tissues around dental implants, and the microbiota and occlusal trauma considered its main etiological factors. The probing depth, bleeding, keratinized tissue, the flow of sulcular fluid and inflammatory infiltrate serve as parameters to evaluate the peri-implant health. Treatment of peri-implant includes mechanical debridement, oral hygiene instruction, surface detoxification deploy, use of antibiotics and resective and regenerative therapies. A correct intervention seems necessary for the resolution of the peri-implant injury.

Does the number of implants have any relation with peri-implant disease?

Objective: The aim of this study was to evaluate the relationship between the number of pillar implants of implant-supported fixed prostheses and the prevalence of periimplant disease. Material and Methods: Clinical and radiographic data were obtained for the evaluation. The sample consisted of 32 patients with implant-supported fixed prostheses in function for at least one year. A total of 161 implants were evaluated. Two groups were formed according to the number of implants: G1) ≤5 implants and G2) >5 implants. Data collection included modified plaque index (MPi), bleeding on probing (BOP), probing depth (PD), width of keratinized mucosa (KM) and radiographic bone loss (BL). Clinical and radiographic data were grouped for each implant in order to conduct the diagnosis of mucositis or peri-implantitis. Results: Clinical parameters were compared between groups using Student’s t test for numeric variables (KM, PD and BL) and Mann-Whitney test for categorical variables (MPi and BOP). KM and BL showed statistically significant differences between both groups (p<0.001). Implants from G1 – 19 (20.43%) – compared with G2 – 26 (38.24%) – showed statistically significant differences regarding the prevalence of peri-implantitis (p=0.0210). Conclusion: It seems that more than 5 implants in total fixed rehabilitations increase bone loss and consequently the prevalence of implants with periimplantitis. Notwithstanding, the number of implants does not have any influence on the prevalence of mucositis. .

Peri-implantite: visão crítica e atual sobre fatores etiológicos, diagnóstico clínico/radiográfico e prognóstico: revisão de literatura / Peri-implantitis: critical and current overview of etiological factors, clinical/radiographic diagnosis and prognosis: a literature review

A peri-implantite tem sido diagnosticada mais frequentemente, porém, a melhor forma de tratamento ainda não foi estabelecida. É necessário o conhecimento da etiologia, diagnósticos clínico e radiográfico para a prevenção, tratamento e controle das infecções peri-implantares, visando o sucesso no tratamento com implantes. Objetivo: essa revisão de literatura tem como objetivo realizar uma abordagem crítica e atual da etiologia, diagnóstico e prognóstico nos casos deperi-implantite, baseando-se em artigos nas bases de dados PubMed e Science Direct. Resultados: a peri-implantite é um processo infeccioso/inflamatório que afeta os tecidos duros e moles ao redor dos implantes, com etiologia multifatorial. Alguns métodos de diagnóstico clínico/radiográfico são essenciais para avaliar sua ocorrência e progressão. Apesar de crescentes, os trabalhos científicos são divergentes e inconclusivos quanto ao tratamento ideal e prognóstico. Conclusão: a peri-implantite é um comprometimento que deve ser diagnosticado de forma precoce, sendo necessário o acompanhamento periódico dos pacientes para o sucesso do tratamento com implantes.

Peri-implantitis has been more frequently diagnosed; however, the best treatment method has not yet been established. It is paramount to understand its etiology, as well as clinical and radiographic diagnosis to prevent, treat and control peri-implant infections and, asa result, achieve implant success. Objective: This literature review aims to address the etiology, diagnosis and prognosis of peri-implantitis in a critical and up-to-date manner. It is based on articles retrieved from PubMed and Science Direct databases. Results: Peri-implantitis is an infectious/inflammatory process affecting the peri-implant tissues around dental implants and of multifactorial etiology. Some clinical/radiographic, diagnostic methods are essential to assess the occurrence and progression of peri-implantitis. Despite existing in high numbers, scientific studies are divergent and inconclusive with regard to ideal treatment and prognosis. Conclusion: peri-implantitis is a disease that must be diagnosed at an early stage. Regular monitoring of patients is important for treatmentand implant success.

Nível de conhecimento dos cirurgiões-dentistas quanto ao diagnóstico e tratamento da peri-implantite / Level of knowledge of dentists about the diagnosis and treatment of peri-implantitis

Introdução: a peri-implantite é definida como um processo inflamatório que afeta o tecido ósseo ao redor dos implantes osseointegrados; assim, pode ser considerada um dos fatores que levam ao fracasso do tratamento com implantes. Objetivo: esse estudo teve como objetivo verificar o conhecimento dos cirurgiões-dentistas quanto ao diagnóstico e tratamento da peri-implantite, com base em um questionário aplicado aos profissionais das cidades de Cascavel e Maringá, no estado do Paraná. Métodos: especialistas em Implantodontia compuseram a amostra desse estudo. O questionário foi detalhadamente apresentado e realizado por um único pesquisador. Quanto às características clínicas da peri-implantite, 33% dos profissionais entrevistados a relacionaram com a inflamação; 28%, com a perda óssea radiográfica ao redor do implante; 26%, com o sangramento; 24%, com a presença de placa e cálculo; 5%, com mobilidade e aproximadamente 16% dos entrevistados não souberam responder às questões relacionadas à peri-implantite. Resultados: geralmente, o procedimento não cirúrgico para a peri-implantite foi manutenção com raspagem peri-implantar, seguida de antibioticoterapia. Para mais da metade dos profissionais, o tratamento cirúrgico da peri-implantite poderia ser realizado por meio de regeneração óssea guiada associada ao enxerto ósseo. Oitenta por cento dos profissionais entrevistados consideraram que a taxa de fracasso da osseointegração pode estar relacionada com a superfície, forma e material do implante. Conclusão: podemos concluir que os meios diagnósticos e formas de tratamento da peri-implantite devem ser, ainda, esclarecidos pela literatura científica, pois se observou a falta de conhecimento, por parte dos implantodontistas entrevistados, quanto aos aspectos específicos relacionados à peri-implantite...

Peri-implantitis is defined as an inflammatory process that affects the bone tissue around osseointegrated implants and may therefore be a cause of dental implant failure. Objective: The objective of this study was to evaluate dentists' knowledge of the diagnosis and treatment of peri-implantitis using a questionnaire applied to dentists from the towns of Cascavel and Maringá, State of Paraná, Brazil. Methods: The sample consisted of specialists in Implantology. The same researcher explained and applied the questionnaire. With respect to the clinical characteristics of peri-implantitis, 33% of the respondents associated the condition with inflammation, 28% with radiographic bone loss around the implant, 26% with bleeding, 24% with the presence of plaque and calculus, and 5% with implant mobility. Approximately 16% of the respondents were unable to answer the questions related to peri-implantitis. Results: In the presence of a diagnosis of peri-implantitis, the most frequently used treatment was maintenance by peri-implant curettage, followed by antibiotic therapy. More than half the dentists suggested surgical treatment of peri-implantitis by guided bone regeneration combined with bone grafting. Eighty percent of the respondents considered the failure rate of osseointegration to be related to the surface, shape and material of the implant. Conclusion: We conclude that diagnostic methods and treatment modalities of peri-implantitis should be further clarified by scientific literature, since this study showed a lack of knowledge of dentists regarding specific aspects related to peri-implantitis...

Factores de riesgo y periimplantitis en la terapia implantológica: revisión narrativa / Risk factors and periimplantitis in implant therapy: narrative review

Las enfermedades que involucran a los tejidos que rodean a los dientes y a los implantes osteointegrados son el resultado de una interacción entre algún tipo de agente patológico (bacteriano, viral, etc.) y la respuesta inmunitaria del huésped. Estas interacciones se pueden dar tanto en los tejidos dentarios como en aquellos biomateriales que se introducen para tratar de corregir algún tipo de patología periodontal; los implantes al ser sustitutos biocompatibles de las piezas dentarias no están exentas de este tipo de interacciones que muchas veces cursan con patologías periodontales y periimplantarias. La periimplantitis es un tipo de patología que resulta de dicha interacción; los factores de riesgo e indicadores de riesgo de la periimplantitis son amplios y complejos. El presente artículo resume las múltiples fuentes de información de la literatura científica para abordar al detalle los aspectos de los principales factores de riesgo y la periimplantitis en la terapia implantológica.

Diseases involving tissue around the teeth and osseo integrated implants are the result of an interaction between some type of pathological agent (bacterial, viral, etc.) and host immune response. These interactions can occur both in the dental tissues as those biomaterials which are introduced to attempt to correct some type of periodontal disease, the implant being a biocompatible substitute of the teeth is not free from this type of interaction often enrolled periodontal and peri-implant pathology. The peri-implantitisis a type of disease that results from this interaction, the risk factors and risk indicators of peri-implantitis are broad and complex. This article summarizes the multiple sources of information in the scientific literature to address in detail the aspects of the main risk factors and the peri-implantitis in the peri implant therapy.

History of Chronic Periodontitis Is a High Risk Indicator for Peri-Implant Disease

The success rates in implant dentistry vary significantly among patients presenting previous history of periodontitis. The aim of this study was to evaluate if patients with history of chronic periodontitis (CP) are more susceptible to peri-implant disease (PID) than those without history of CP. Two hundred and fifteen individuals, under periodontal maintenance, presenting 754 osseointegrated implants, were selected for this study. The patients were divided into two groups according to the peri-implant status: Control group (patients without PID; n=129) and PID group (patients with PID; n=86). All peri-implant regions were clinically evaluated, including analyses of mucosa inflammation, edema and implant mobility. Periapical radiography assessed the presence of peri-implant bone loss. According to the clinical/radiographic characteristics, patients in Control and PID groups were diagnosed as having CP or not. Nominal variables were evaluated by the chi-square test. The distribution of numeric variables was analyzed by Shapiro-Wilk test. Student's t-test and Mann-Whitney test were used to analyze significant differences for parametric and non-parametric data. A p-value <0.05 was considered significant. There was a highly significant correlation between CP history and PID (p<0.0001). Patients with CP had 4 times more chance of developing PID than patients with healthy periodontal tissues. Also, CP patients showed higher bleeding on probing (p=0.002) and bone loss around implant (p=0.004) when compared with patients without CP. In conclusion, history of CP is a high risk factor for the development of PID, irrespective of gender or region of implant placement.

Resumo O índice de sucesso em implantodontia varia significantemente entre indivíduos apresentando história prévia de periodontite. O objetivo deste estudo foi avaliar se pacientes com história de periodontite crônica (CP) são mais susceptíveis ao desenvolvimento de doença peri-implantar (PID) do que pacientes sem história de CP. Duzentos e quinze indivíduos, sob manutenção periodontal, apresentando 754 implantes osseointegrados, foram selecionados para este estudo. Os pacientes foram divididos em 2 grupos de acordo com o estado peri-implantar: Grupo Controle (pacientes sem PID, n=129) e Grupo PID (pacientes com PID, n=86). Todas as regiões peri-implantares foram clinicamente avaliadas, incluindo análise da inflamação na mucosa, edema e mobilidade do implante. Radiografias periapicais avaliaram a presença de perda óssea peri-implantar. De acordo com as características clínico/radiográficas, pacientes nos Grupos Controle e PID foram diagnosticados como tendo CP ou não. As variáveis nominais foram avaliadas pelo teste do qui-quadrado. A distribuição das variáveis numéricas foi avaliada pelo teste de Shapiro-Wilk. O Teste t e o teste de Mann-Whitney foram utilizados para analisar a significância dos dados, em caso de distribuição normal e não-normal, respectivamente. Valor de p<0,05 foi considerado significante. Os resultados mostraram que há correlação altamente significativa entre história de CP e presença PID (p<0,0001), com risco 4 vezes maior de desenvolver PID para pacientes com CP. Pacientes com CP também mostraram maior sangramento à sondagem (p=0,002) e perda óssea peri-implantar (p=0,004) quando comparados a pacientes sem CP. Concluímos que história de periodontite crônica é um fator de alto risco ao desenvolvimento ...

Freqüência e fatores associados às doenças peri-implantares / Frequency and associated factors of Peri-Implant diseases

As doenças peri-implantares são decorrentes da inflamação dos tecidos Peri-implantares e podem ser divididas em mucosite peri-implantar e peri-implantite. O objetivo do presente estudo foi avaliar a possível a influência da utilização de diferentes critérios de diagnóstico na freqüência das doenças peri-implantares, e por fim, avaliar possíveis fatores associados às doenças peri-implantares. Pacientes que receberam implantes SIN® e posterior reabilitação protética em função por no mínimo dois anos foram inclusos na pesquisa. Estes pacientes foram chamados para consultas de reavaliação e compuseram a amostra. Os dados foram obtidos por meio de entrevistas, análises radiográficas e exames clínicos periodontais dos pacientes, além de consulta à ficha clínica. As variáveis analisadas foram mucosite Peri-implantar e peri-implantite, em diferentes critérios (variáveis principais) e história médica, gênero, idade no momento da instalação do implante, período de acompanhamento, uso de tabaco, história de doença periodontal, número de implantes por paciente, tipo de prótese e região do implante (variáveis secundárias). Análise descritiva foi realizada para verificar diferenças na freqüência de doenças peri-implantares quando diferentes critérios de diagnóstico foram utilizados e modelos de regressão logística e teste exato de Fisher foram utilizados para aferir associação entre as variáveis secundárias e as doenças peri-implantares. Trinta e um indivíduos receberam 67 implantes e participaram do estudo. A freqüência de mucosite peri-implantar variou de 93,5% (n=29) a 12,9% (n=4) e de peri-implantite de 51,6% (n= 16) a 0% (n=0%) de acordo com diferentes critérios utilizados. Nenhuma das variáveis estudadas apresentou associação com a freqüência tanto de mucosite peri-implantar, quanto de peri-implantite. Dentro dos limites deste estudo pode-se concluir que a utilização de critérios diferentes relacionados à doença peri-implantar resulta em uma variação substancial...