Effects of a toothpaste containing 0.3% triclosan in the maintenance phase of peri-implantitis treatment: 2-Year randomized clinical trial.

OBJECTIVE: To evaluate the effects of a toothpaste containing 0.3% triclosan in volunteers that have been treated for peri-implantitis and were enrolled in a maintenance program. MATERIAL AND METHODS: Subjects presenting at least one implant with peri-implantitis were selected. They received anti-infective surgical therapy, and sixty days post-surgery (baseline) were randomized into two groups, brushing twice/day for 2 years (a) with a toothpaste containing 0.3% triclosan+2.0% PVM/MA copolymer (GantrezTM )+1,450 ppm fluoride (test) or (b) with a toothpaste containing 1,450 ppm fluoride (control). They received clinical and microbiological monitoring at baseline, 3, 6, 12, 18, and 24 months, and professional maintenance every 3 months. RESULTS: A total of 102 subjects were enrolled (test: 48; control: 54). The control group showed loss of clinical attachment (CA) around treated implants over the course of the study (p < 0.05), while the test group was stable for this parameter. The difference between groups (0.55 mm) for CA change between baseline and 24 months (primary outcome variable) was statistically significant (p < 0.05). Red complex pathogens were only reduced in the test group at 24 months. The implants with no history of peri-implantitis in the test group had a significant reduction in the percentage of sites with bleeding on probing and in mean probing depth, throughout the study (p < 0.05). This improvement was not observed in the control group. CONCLUSION: A toothpaste containing 0.3% triclosan was more effective than a toothpaste without triclosan in maintaining a healthy peri-implant environment around treated implants and implants with no history of peri-implantitis during a 2-year maintenance program (ClinicalTrials.govNCT03191721).

Peri-implant crevicular fluid biomarkers as discriminants of peri-implant health and disease.

AIM: The objective of this cross-sectional study was to examine the potential of peri-implant crevicular fluid (PICF) analytes to discriminate between peri-implant health and disease using a multi-biomarker approach. METHODS: We collected PICF samples from the mesio-buccal site of every implant (n = 145) from 52 subjects with peri-implantitis and measured the levels of 20 biomarkers using Luminex. We grouped implants and subjects based on the clinical characteristic of the sampled sites and implants into: healthy sites from healthy implants (HH), diseased sites from diseased implants (DD) and healthy sites from diseased implants (HD). The significance of the differences between the HH and DD groups was determined using general linear models controlling for false discovery rate. We used logistic regression to determine the best multi-biomarker models that could distinguish HH from DD subjects and HH from HD subjects. RESULTS: There were statistically significant differences between HH and DD groups for 12/20 biomarkers. Logistic regression resulted in a 6-biomarker model (Flt-3L, GM-CSF, IL-10, sCD40L, IL-17 and TNFα) that discriminated HH from DD subjects (AUC = 0.93) and a 3-biomarker model (IL-17, IL-1ra and vascular endothelial growth factor) that distinguished HH from DD subjects (AUC = 0.90). CONCLUSION: PICF biomarkers might help discriminate peri-implant health from disease.

Immunohistochemical analysis of inflammatory infiltrate in aggressive and chronic periodontitis: a comparative study.

This immunohistochemical study evaluated the inflammatory infiltrate with its cluster differentiation markers (CD 4, CD 8, CD 20, and CD 68) in aggressive and chronic periodontitis gingival tissues in order to identify the specific cell distribution. Twenty-seven human gingival biopsies were obtained and analyzed. Fourteen patients were suffering from chronic periodontitis and six from aggressive periodontitis; seven patients with healthy gingiva were included as the control group. The specimens were immunohistochemically stained for anti-CD 4 (T helper cells), anti-CD 8 (T cytotoxic/suppressor), anti CD-20 (B plasma cells) and anti CD-68 (macrophages). Chronic periodontitis samples were mainly dominated by CD 4 and CD 8+ cells. On the contrary, in aggressive periodontitis patients all four cell types (CD 4, CD 8, CD 20 and CD 68 + cells, respectively) were remarkably increased. CD 20+ cells were significantly (p < 0.05) more prevalent in aggressive versus chronic periodontitis. The control samples expressed lower CD 4, CD 8, CD 20 and CD 68+ cells confirming a none inflammatory state. The present study demonstrates prevalence for CD 20+ cells in aggressive periodontitis lesions. However, further studies need to be performed to confirm and identify a clear pattern of inflammatory cells and hereafter the mechanisms sustaining the disease.

Early human bone response to laser metal sintering surface topography: a histologic report.

This histologic report evaluated the early human bone response to a direct laser metal sintering implant surface retrieved after a short period of healing. A selective laser sintering procedure using a Ti-6Al-4V alloy powder with a particle size of 25-45 microm prepared this surface topography. One experimental microimplant was inserted into the anterior mandible of a patient during conventional implant surgery of the jaw. The microimplant and surrounding tissues were removed after 2 months of unloaded healing and were prepared for histomorphometric analysis. Histologically, the peri-implant bone appeared in close contact with the implant surface, whereas marrow spaces could be detected in other areas along with prominently stained cement lines. The mean of bone-to-implant contact was 69.51%. The results of this histologic report suggest that the laser metal sintering surface could be a promising alternative to conventional implant surface topographies.

Effects of a toothpaste containing 0.3% triclosan on periodontal parameters of subjects enrolled in a regular maintenance program: A secondary analysis of a 2-year randomized clinical trial.

BACKGROUND: The triclosan-containing dentifrices are effective in controlling biofilm formation and maintaining gingival health; however, there is limited information on their effects during the periodontal maintenance phase. Therefore, the aim of this study was to evaluate the clinical effects of a toothpaste containing 0.3% triclosan on the periodontal parameters of subjects that have been treated for peri-implantitis and were enrolled in a regular maintenance program. METHODS: Subjects presenting at least one implant with peri-implantitis and received surgical anti-infective therapy were selected. Sixty days post-surgery (baseline), subjects were randomized into two groups: (1) toothpaste containing 0.3% triclosan + 2.0% PVM/MA copolymer + 1450 ppm fluoride (test) or (2) toothpaste containing 1450 ppm fluoride (control), and were instructed to brush with the assigned toothpaste twice/day for 2 years. They received clinical monitoring at baseline, 3, 6, 12, 18, and 24 months, and professional maintenance every 3 months. RESULTS: Eighty-eight subjects with natural teeth were enrolled in the study (Test, n = 39; Control, n = 49). The test group showed a greater reduction in the percentage of sites exhibiting bleeding on probing (primary outcome) and lower levels of plaque in comparison with the control group after 24 months (P < 0.05). The mean percentage of sites with probing depth ≥5 mm was reduced over the course of the study only in the test group (P < 0.05). CONCLUSION: A toothpaste containing 0.3% triclosan was more effective than a regular fluoride toothpaste in improving the periodontal clinical condition around natural teeth of periodontally healthy subjects enrolled in a regular maintenance program for 2 years.

Effect of systemic intermittent administration of human parathyroid hormone (rhPTH[1-34]) on the resistance to reverse torque in rabbit tibiae.

The aim of this study was to evaluate the effect of intermittent administration of human parathyroid hormone [rhPTH (1-34)] on the removal torque of implants placed in rabbit tibiae. Twenty male New Zealand rabbits were submitted to implant surgery. Each animal received one machined screw-type implant (3.75 mm diameter x 8 mm length) in the proximal metaphysis of the right tibia. The rabbits were then divided into 2 groups: the test group (n = 10) received 6 microg/kg of rhPTH (1-34) subcutaneously in the dorsal region 3 days a week, and the control group (n = 10) received placebo. Removal torque was performed at 28 and 56 days after implant placement for both groups. The mean removal torque values at 28 days were 37.0 +/- 4.36 Ncm and 47.4 +/- 6.77 Ncm for control and test groups respectively (P < .05). At 56 days the reverse torque was 45.8 +/- 3.96 Ncm for the control group and 55.8 +/- 2.86 Ncm for the test group, indicating that the removal torque was significantly higher in the test groups (P < .05). These results demonstrated that intermittent treatment with rhPTH (1-34) enhanced the removal torque of implants in rabbit tibiae.

Levels of osteoclastogenesis-related factors in the peri-implant crevicular fluid and clinical parameters of immediately loaded implants in patients with osteopenia: a short-term report.

PURPOSE: The aim of this prospective controlled study was to evaluate the influence of osteopenia on the levels of osteoclastogenesis-related factors in the peri-implant crevicular fluid (PICF) and on the clinical parameters of immediately loaded implants. MATERIALS AND METHODS: This study included 24 patients who received at least two implants in the mandible, with restorations delivered 48 hours after implant placement. Patients were divided into control (n = 11) and osteopenia (n = 13) groups. Seven days after implant placement (baseline) and 4 months after implant placement, PICF samples were obtained, and clinical parameters (Plaque Index, Gingival Index, bleeding on probing, suppuration, probing depths, clinical attachment levels) were measured. A commercially available enzyme-linked immunosorbent assay was used to analyze PICF samples for levels of soluble receptor activator of nuclear factor of κB ligand (sRANKL) and osteoprotegerin (OPG). At the 4-month follow-up visit, the implant-supported restorations were removed and periapical radiographs were acquired to evaluate bone loss around the implants. RESULTS: Eighty-eight immediately loaded implants were included in this study (38 in the control group, 50 in the osteopenia group). The RANKL and OPG levels, the RANKL/OPG ratio, and the clinical parameters were similar between the groups at both time points. However, the levels of these factors in PICF differed significantly between baseline and 4 months after surgery. CONCLUSION: Within the limitations of this short-term study, it can be concluded that osteopenia does not influence the PICF levels of osteoclastogenesis-related factors in immediately loaded implants after 4 months of loading.

Simultaneous sinus membrane elevation and dental implant placement without bone graft: a 6-month follow-up study.

BACKGROUND: Previous studies have shown that simultaneous elevation of the sinus mucosal lining and placement of dental implants without graft materials can be a predictable procedure. Nevertheless, few prospective, controlled, and randomized studies have evaluated this technique. The aim of this prospective, controlled, and randomized clinical study is to evaluate whether sinus membrane elevation and simultaneous placement of dental implants without autogenous bone graft can create sufficient bone support to allow implant success 6 months post-surgically. METHODS: Sinus membrane elevation and simultaneous placement of dental implants were performed bilaterally in 15 patients in a split-mouth design. The sinuses were assigned to two groups: the test group, with simultaneous sinus mucosal lining elevation and placement of dental implants without graft materials; and the control group, with simultaneous sinus mucosal lining elevation and placement of dental implants with intraoral autogenous bone graft. After 6 months of healing, abutments were connected. For each implant, length of implant protrusion into the sinus, resonance frequency analysis, and bone gain were recorded at baseline and 6 months follow-up. RESULTS: Clinical complications were not observed, except for two postoperative fistulas and suppuration in both groups. Only one implant of the test group was lost, reaching a success rate of 96.4% and 100% for the test and control groups, respectively. After healing, radiographic new peri-implant bone was observed in both groups ranging between 8.3 ± 2.6 and 7.9 ± 3.6 mm for the control and test groups, respectively (P >0.05). Resonance frequency analysis values were lower for the control group compared to baseline (P <0.05). However, these values were similar at 6 months (P >0.05). A significant positive correlation was found between the protruded implant length/bone gain and implant survival/sinusitis (P <0.0001). CONCLUSION: Implants placed simultaneously to sinus membrane elevation without graft material resulted in bone formation over a period of 6 months.

Histomorphometric evaluation of bioceramic molecular impregnated and dual acid-etched implant surfaces in the human posterior maxilla.

BACKGROUND: Physical and bioceramic incorporation surface treatments at the nanometer scale showed higher means of bone-to-implant contact (BIC) and torque values compared with surface topography at the micrometer scale; however, the literature concerning the effect of nanometer scale parameters is sparse. PURPOSE: The aim of this study was to evaluate the influence of two different implant surfaces on the percentage bone-to-implant contact (BIC%) and bone osteocyte density in the human posterior maxilla after 2 months of unloaded healing. MATERIALS AND METHODS: The implants utilized presented dual acid-etched (DAE) surface and a bioceramic molecular impregnated treatment (Ossean®, Intra-Lock International, Boca Raton, FL, USA) serving as control and test, respectively. Ten subjects (59 ± 9 years of age) received two implants (one of each surface) during conventional implant surgery in the posterior maxilla. After the non-loaded period of 2 months, the implants and the surrounding tissue were removed by means of a trephine and were non-decalcified processed for ground sectioning and analysis of BIC%, bone density in threaded area (BA%), and osteocyte index (Oi). RESULTS: Two DAE implants were found to be clinically unstable at time of retrieval. Histometric evaluation showed significantly higher BIC% and Oi for the test compared to the control surface (p < .05), and that BA% was not significantly different between groups. Wilcoxon matched pairs test was used to compare the differences of histomorphometric variables between implant surfaces. The significance test was conducted at a 5% level of significance. CONCLUSION: The histological data suggest that the bioceramic molecular impregnated surface-treated implants positively modulated bone healing at early implantation times compared to the DAE surface.

Immunoexpression of angiogenesis, nitric oxide synthase, and proliferation markers in gingival samples of patients with aggressive and chronic periodontitis.

BACKGROUND: In periodontal tissues, angiogenesis seems to be important for the maintenance of healthy tissues and in periodontal diseases. Angiogenesis is regulated through a complex interplay of molecular signals mediated by growth factors involving extracellular matrix remodeling, endothelial cell migration and proliferation, capillary differentiation and anastomosis. However, the influence of angiogenesis in the development, progression, and healing of periodontal lesions is currently under investigation. This immunohistochemical study evaluates the expression of vascular endothelial growth factor (VEGF), microvessel density (MVD), nitric oxide synthase (NOS) 1 and 3, and Ki-67 in gingival tissues of patients with aggressive and chronic periodontitis. METHODS: Twenty-seven human gingival biopsies were taken from patients with chronic periodontitis (n = 14 patients), generalized aggressive periodontitis (n = 6 patients), and healthy periodontia (n = 7 patients). The specimens were immunohistochemically stained for VEGF, MVD, NOS 1 and 3, and Ki-67. RESULTS: The levels of VEGF, MVD, NOS 1 and 3, and Ki-67 were found to be significantly different among groups (P >0.001). Patients with aggressive periodontitis had higher levels of these markers compared to those in patients with chronic periodontitis and healthy patients. CONCLUSIONS: The analysis demonstrates a higher expression of all immunologic markers particularly in subjects with aggressive periodontitis. In summary, the data from this pilot investigation suggests that VEGF is an important factor in the pathogenesis of the aggressive and chronic forms of periodontitis.

Influence of direct laser fabrication implant topography on type IV bone: a histomorphometric study in humans.

The aim of this histologic study was to evaluate the influence of the direct laser fabrication (DFL) surface topography on bone-to-implant contact (BIC%), on bone density in the threaded area (BA%) as well as bone density outside the threaded area (BD%) in type IV bone after 8 weeks of unloaded healing. Thirty patients (mean age 51.34 +/- 3.06 years) received 1 micro-implant (2.5-mm diameter and 6-mm length) each during conventional implant surgery in the posterior maxilla. Thirty micro-implants with three topographies were evaluated: 10 machined (cpTi); 10 sandblasted and acid etched surface (SAE) and 10 DFL micro-implants. After 8 weeks, the micro-implants and the surrounding tissue were removed and prepared for histomorphometric analysis. Four micro-implants (2 cpTi, 1 SAE and 1DLF) showed no osseointegration after the healing period. Histometric evaluation indicated that the mean BIC% was higher for the DFL and SAE surfaces (p = 0.0002). The BA% was higher for the DFL surface, although there was no difference with the SAE surface. The BD% was similar for all topographies (p > 0.05). Data suggest that the DFL and SAE surfaces presented a higher bone-to-implant contact rate compared with cpTi surfaces under unloaded conditions, after a healing period of 8 weeks.

Effect of smoking on early bone healing around oxidized surfaces: a prospective, controlled study in human jaws.

BACKGROUND: This prospective and controlled histologic study evaluates the impact of smoking on bone-to-implant contact, the bone density in the threaded area, and the bone density outside the threaded area around microimplants with anodized surface retrieved from human jaws. METHODS: A total of 24 subjects (mean age 51.32 + or - 7.5 years) were divided in two groups: smokers (n = 13 subjects) and non-smokers (n = 11 subjects). Each subject received one microimplant with oxidized surface during conventional mandible or maxilla implant surgery. After 8 weeks, the microimplants and the surrounding tissue were removed and prepared for histomorphometric analysis. RESULTS: Three microimplants placed in smokers showed no osseointegration. The newly formed bone showed early stages of maturation, mainly in the non-smokers. Marginal bone loss, gap, and fibrous tissue were present around implants retrieved from smokers. Histometric evaluation indicated that the mean bone-to-implant contact ranged between 25.97% + or - 9.02% and 40.01% + or - 12.98% for smokers and non-smokers, respectively (P <0.001). Smokers presented 28.17% + or - 10.32% of bone density in the threaded area, whereas non-smokers showed 46.34% + or - 19.12%. The mean of bone density outside the threaded area ranged between 18.76% and 25.11% for smokers and non-smokers, respectively (P >0.05). CONCLUSION: The present data obtained in human subjects confirm that smoking has a detrimental effect on early bone tissue response around oxidized implant surfaces.

Influência de diferentes topografias de implantes sobre o tecido ósseo peri-implantar humano / Influence of different implant tomographies on human peri-implant bone tissue

O principal parâmetro para avaliação do sucesso dos implantes osseointegrados é baseado no percentual do contato do tecido ósseo à superfície do implante. Este processo depende de vários fatores que vão desde a inserção do implante no leito cirúrgico e a formação do coágulo sanguíneo a todos os eventos celulares relacionados à biologia óssea peri-implantar. Logo, o objetivo deste estudo foi avaliar, de maneira sistemática, a sequência de eventos celulares assim como os fatores que influenciam a qualidade e a quantidade de contato do tecido ósseo humano a superfície do implante e suas consequências clínicas.