Impact of peri-implant keratinized mucosa width on the long-term reconstructive outcomes of peri-implantitis: A retrospective analysis with a follow-up up to 10 years.

PURPOSE: To investigate the effect of mid-buccal peri-implant keratinized mucosa width (KMW) ≥2 mm or peri-implant KMW >0 mm and <2 mm on the long-term outcomes of peri-implantitis reconstructive treatment. MATERIALS AND METHODS: Twenty-nine patients (40 implants; mean follow-up: 9.2 ± 1.4 years) with at least one implant affected by peri-implantitis and surgically treated through a reconstructive procedure followed by a submerged healing were included. Patients were categorized according to their initial KMW: Group 1 (KMW ≥2 mm) and Group 2 (KMW >0 mm and <2 mm). Peri-implant clinical and radiographic parameters and a dedicated composite outcome were assessed at different follow-up visits during supportive peri-implant therapy for up to 10 years. Regression analyses were utilized to identify possible risk/predictive indicators for probing pocket depth (PPD) change and treatment success at the latest follow-up. RESULTS: The mean PPD did not exhibit any statistical difference from the baseline to the latest follow-up between the groups at both patient and implant levels. Long-term treatment success was 46.6% (Group 1) and 42.6% (Group 2) at patient level, it was 42.8% (Group 1) and 33.3% (Group 2), respectively, at implant level (p > 0.05). Group 1 demonstrated significantly higher vertical defect depth reduction than Group 2 (p = 0.018). Presence of buccal bony wall and mean PPD at the baseline were found to be associated with mean PPD change, while KMW at 6 months following surgery was identified as the only significant indicator for treatment success (p < 0.05). CONCLUSION: Implants with KMW ≥2 mm did not present significantly better long-term clinical outcomes following reconstructive therapy than those exhibiting KMW >0 mm and <2 mm. However, KMW values at the end of healing phase following a submerged approach had a significant impact on long-term treatment success.

Evaluation of salivary stress markers and inflammatory cytokine levels in peri-implantitis patients.

BACKGROUND AND OBJECTIVE: Psychological stress has been identified in some observational studies as a potential factor that may modify and affect periodontal diseases, but there are no similar data for peri-implantitis. The aim of this study was to determine the relationship between interleukin (IL)-1ß, IL-6, IL-10, interferon (IFN)α inflammatory cytokines and the psychological stress-related markers, glucocorticoid receptor-α (GRα), and salivary α-amylase (sAA) gene expression levels in saliva samples obtained from healthy implants and peri-implantitis patients. MATERIALS AND METHODS: The study included a total of 50 systemically healthy subjects. Peri-implant clinical parameters were recorded and psychological stress level was evaluated with the hospital anxiety and depression scale (HAD) and state-trait anxiety inventory (STAI) questionnaire forms. Following the evaluations, the patients were divided into 4 groups according their stress and clinical status (Ia, Ib, IIa, IIb). IL-1ß, IL-6, IL-10, IFNα, GRα, sAA gene expression levels in the saliva samples were quantified by quantitative polymerase chain reaction (qPCR). RESULTS: In the group of peri-implantitis who had a high score in stress level assessment scales, significantly higher IL-1ß, IL-6, sAA expression levels were observed (p < 0.001). The IL-10 gene expression levels were lower in the groups with a high score in the stress level assessment scales (p < 0.001). GRα gene was expressed at lower levels in the group of peri-implantitis who had a high score in stress level assessment scales but the difference was not statistically significant (p = 0.065). CONCLUSION: The study findings suggest that psychological stress may increase the inflammation associated with peri-implantitis by affecting cytokine expression levels. CLINICAL RELEVANCE: To prevent peri-implantitis or reduce its prevalence, it could be beneficial to evaluate stress levels and identify individuals experiencing stress.

Efficacy of concentrated growth factor versus collagen membrane in reconstructive surgical therapy of peri-implantitis: 3-year results of a randomized clinical trial.

OBJECTIVES: To compare the 3-year clinical and radiographic outcomes of two different reconstructive surgical management of peri-implantitis using a bone substitute in combination with either concentrated growth factor (CGF) or collagen membrane (CM). MATERIAL AND METHODS: Fifty-one patients who had at least one implant presenting peri-implantitis with an intrabony defect were filled with a xenogenic bone grafting material and covered either CGF or CM. Clinical and radiographic assessments were carried out at baseline and postoperative years 1 and 3. Three different composite outcomes were defined to evaluate treatment success at a 3-year follow-up. The effects of possible prognostic indicators on treatment success were identified by using multilevel regression analysis. RESULTS: The changes in probing depth (PD) and radiographic vertical defect depth (VDD) between baseline and year 1 and baseline and year 3 presented significantly greater decreases for the CM group in comparison with the CGF group (p < 0.05). No significant differences between the two treatment modalities were demonstrated regarding treatment success outcomes. History of periodontitis, VDD at baseline, and the number of intrabony defect walls revealed significant impacts on treatment success (p = 0.033; OR = 3.50, p = 0.039; OR = 0.975, and p = 0.024; OR = 7.0 and p = 0.019;OR = 6.0, respectively). CONCLUSIONS: CM in combination with a bone substitute seems to have slightly better outcomes compared to the CGF membranes in reconstructive surgical therapy of peri-implantitis. The history of periodontitis, baseline VDD, and peri-implant bone defect configuration could be possible predictors influencing treatment success. TRIAL REGISTRATION: ClinicalTrials.gov NCT04769609. CLINICAL RELEVANCE: For the reconstruction of peri-implant bone defects, using a bone substitute in combination with a collagen membrane may show more favorable outcomes.

The effects of decontamination methods of dental implant surface on cytokine expression analysis in the reconstructive surgical treatment of peri-implantitis.

The aim of this trial was to analyze the effect of implant surface decontamination procedures combined with reconstructive surgical treatment (RST) of peri-implantitis on gene expression levels of selected biomarkers in peri-implant crevicular fluid (PICF). Forty patients diagnosed with peri-implantitis were treated with RST + decontamination of the implant surface using sterile saline and ozone therapy (ozone group) or sterile saline alone (control group). The gene expression levels of interleukin (IL)-6, IL-8, IL-17, vascular endothelial growth factor (VEGF), sclerostin (SOST) and osteoprotegerin (OPG) were evaluated by qPCR analysis at baseline and 6-month follow-up. Changes in cytokine mRNA expression levels were analyzed and compared with clinical/radiographic parameters. Both decontamination methods lead to the downregulations of the selected gene expressions. Ozone group showed significantly higher clinical attachment level (CAL) and radiographic defect fill (DF) values at 6 months compared to the control group (p = 0.026 and p = 0.011). The downregulation of SOST levels was significantly associated with probing depth reduction and radiographic DF (p < 0.05). Implant surface decontamination procedures applied with the RST contribute to a notable reduction in immuno-inflammatory response. The additional use of ozone therapy could have favorable effects in anti-infective regimens of peri-implantitis therapy. SOST, which was found to have significant relationship with both clinical and radiographic outcomes, could be a valuable indicator for the progression of peri-implantitis and may aid the development of new therapeutic strategies for bone gain in the RST of peri-implantitis.

Evaluation of adipokines and inflammatory mediator expression levels in patients with periodontitis and peri-implantitis: a cross-sectional study.

OBJECTIVES: The aim of this study was to analyze the mRNA and protein expression of adiponectin, leptin, visfatin, tumor necrosis factor (TNF)-α, and interleukin (IL)-6 levels in periodontitis and peri-implantitis sites in systemically healthy individuals and to investigate the influence of the presence of current periodontitis on their expression levels in peri-implantitis sites. MATERIALS AND METHODS: Soft tissue biopsy samples were collected from 60 systemically healthy patients [15 periodontally healthy patients (group I), 16 patients with periodontitis (group II), 15 patients with peri-implantitis (group III), and 14 patients with peri-implantitis and periodontitis (group IV)]; mRNA expression levels of adiponectin, leptin, visfatin, TNF-α, and IL-6 were measured by quantitative real-time PCR; and their protein levels were assessed by immunohistochemistry. RESULTS: The mRNA expression levels of all biomarkers were significantly higher for group II compared to group I, while significantly higher levels of leptin, TNF-α, and IL-6 were observed in group III in comparison with group I. Group II exhibited significantly higher mRNA expression of adiponectin and TNF-α than group III. Group IV showed significantly higher expression levels of adiponectin, leptin, TNF-α, and IL-6 compared to group III. Regarding the expression of protein levels, which was estimated through quantification of the histoscore, both groups II and III presented higher H-scores than group I for all biomarkers except leptin. CONCLUSIONS: The presence of current periodontitis may enhance expression levels of adiponectin, leptin, TNF-α, and IL-6 in peri-implant soft tissue. CLINICAL RELEVANCE: The presence of periodontitis is an important risk factor for the severity of peri-implant inflammation as well as the onset of peri-implantitis.

Could drug burden be associated with severe periodontitis in patients receiving haemodialysis?

BACKGROUND: Periodontitis increases the risk of cardiovascular disease in the general population by triggering systemic inflammation. AIM: To investigate the relationship between systemic inflammation and periodontitis, and clarify any association between severe periodontitis and the medications used by patients receiving haemodialysis. DESIGN: A cross-sectional study. PARTICIPANTS: The study was undertaken with 56 patients receiving haemodialysis. MEASUREMENTS: Demographic and laboratory data and prescribed drugs regularly used by patients were recorded from hospital records. During the dialysis session, a validated Xerostomia Inventory score was completed. A complete dental/periodontal examination was also undertaken on all patients by the same periodontist. RESULTS: In the study population, stage I periodontitis was determined in 41%, stage II periodontitis in 17%, stage III periodontitis in 21%, and stage IV periodontitis in 21%. Male gender, hypertension, coronary artery disease, ß antagonists, calcium channel blockers, sodium polystyrene sulphonate, teeth brushing less than twice a day and high sensitive C-reactive protein > 8 mg/l were significantly associated with severe periodontitis. CONCLUSION: Drugs, including ß antagonists, calcium channel blockers, polystyrene sulphonate, co-morbid conditions and poor or insufficient oral care could facilitate an increase in the severity of periodontitis in patients receiving haemodialysis. Severe periodontitis also seems to be associated with cardiovascular disease and inflammation in patients with chronic renal disease.

Regenerative surgical treatment of peri-implantitis using either a collagen membrane or concentrated growth factor: A 12-month randomized clinical trial.

BACKGROUND: Platelet concentration based membranes, as well as collagen membranes in combination with bone substitutes, have demonstrated successful outcomes in regeneration of peri-implant bone defects (PBD). PURPOSE: The aim of this study was to evaluate the clinical and radiographic outcomes of regenerative surgical treatment (RST) of peri-implantitis using a bone substitute combined with two different bioresorbable barrier membranes, either collagen membrane (CM) or concentrated growth factor (CGF), during 12-month follow-up. MATERIALS AND METHODS: Fifty two patients, who had at least one peri-implantitis lesion was treated by using a bone substitute in combination with CGF or CM. After surgical procedures, implants were allowed for submerged healing. Clinical assessments were conducted at baseline, 6 and 12 months postoperatively, while radiographic evaluation was performed at baseline and 12 months. RESULTS: Significant reductions were obtained in the mean gingival index (GI), bleeding on probing (BOP), probing depth (PD), clinical attachment level (CAL) and mucosal recession (MR) values at both 6 and 12 months postoperatively compared to baseline for both treatment procedures (P < 0.05). At 6 months, no statistically significant difference was observed for all clinical parameters between the groups, whereas the mean PD, CAL and vertical defect depth (VDD) values were statistically significant in favor of the CM group at 12 months (P < 0.05). The mean defect fill (DF) in the CM group (1.99 ±0.76) was not statistically significantly different from that observed in the CCF group (1.63 ±1.00) (P = 0.154). CONCLUSIONS: The outcomes of the present study suggest that both regenerative approaches yielded significant improvements in both clinical and radiographic assessments. The procedure using a collagen membrane in combination with a bone substitute showed better results at 12 months in RST of peri-implantitis.

The effects of ozone therapy as an adjunct to the surgical treatment of peri-implantitis.

PURPOSE: The decontamination procedure is a challenging aspect of surgical regenerative therapy (SRT) of peri-implantitis that affects its success. The purpose of the present study was to determine the impact of additional topical gaseous ozone therapy on the decontamination of implant surfaces in SRT of peri-implantitis. METHODS: A total of 41 patients (22 males, 19 females; mean age, 53.55±8.98 years) with moderate or advanced peri-implantitis were randomly allocated to the test group (ozone group) with the use of sterile saline with additional ozone therapy or the control group with sterile saline alone for decontamination of the implant surfaces in SRT of peri-implantitis. Clinical and radiographic outcomes were evaluated over a period of 12 months. RESULTS: At the 12-month follow-up, the plaque and gingival index values were significantly better in the ozone group (P<0.05). Probing depth decreased from 6.27±1.42 mm and 5.73±1.11 mm at baseline to 2.75±0.7 mm and 3.34±0.85 mm at the end of the 12-month observation period in the ozone and control groups, respectively. Similarly, the clinical attachment level values changed from 6.39±1.23 mm and 5.89±1.23 mm at baseline to 3.23±1.24 mm and 3.91±1.36 mm at the 12-month follow-up in the ozone and control groups, respectively. According to the radiographic evidence, the defect fill between baseline and 12 months postoperatively was 2.32±1.28 mm in the ozone group and 1.17±0.77 mm in the control group, which was a statistically significant between-group difference (P<0.05). CONCLUSIONS: Implant surface decontamination with the additional use of ozone therapy in SRT of peri-implantitis showed clinically and radiographically significant. Trial registry at ClinicalTrials.gov, NCT03018795.