Long-term impact of patients' compliance to peri-implant maintenance therapy on the incidence of peri-implant diseases: An 11-year prospective follow-up clinical study.

OBJECTIVE: To prospectively evaluate the incidence of peri-implant diseases and the associated risk factors during 11 years of peri-implant maintenance therapy (PIMT). MATERIAL AND METHODS: A sample of 80 partially edentulous individuals rehabilitated with dental implants was invited to participate in a PIMT program (T1-prior to entering the PIMT program). After 11 years, 51 individuals remained regularly or irregularly adherent to PIMT (T2-last recall after 11 years) and were classified as regular (RC; n = 27) or irregular (IC; n = 24) compliers. Data of interest were analyzed using univariate and multivariate logistic regression analyses. RESULTS: The incidence of peri-implant mucositis and peri-implantitis observed at T2 in the IC group (70.8% and 37.5%, respectively) were significantly higher than those observed in the RC group (37.0% and 11.1%, respectively). The incidence of peri-implant diseases was mostly attributable to potentially modifiable risk factors, as such: RC group-PM (p = 0.013); IC group-high plaque index (p < 0.001), irregular compliance (p < 0.001), the presence of PM (p = 0.015) and periodontitis (p < 0.039). CONCLUSION: Regular compliance during PIMT had a strong effect in minimizing the incidence of peri-implant diseases. Increasing regular dental visits and improving oral hygiene would provide benefits for preventing peri-implant diseases.

Periodontal disease, peri-implant disease and levels of salivary biomarkers IL-1ß, IL-10, RANK, OPG, MMP-2, TGF-ß and TNF-α: follow-up over 5 years.

OBJECTIVE: The aim of this study was to evaluate the levels of salivary biomarkers IL-1ß, IL-10, RANK, OPG, MMP-2, TG-ß and TNF-α in individuals with diagnosis of peri-implant mucositis in the absence or presence of periodontal and peri-implant maintenance therapy (TMPP) over 5 years. MATERIAL AND METHODS: Eighty individuals diagnosed with peri-implant mucositis were divided into two groups: one group that underwent periodontal and peri-implant regularly maintenance therapy, called GTP (n=39), and a second group that received no regular maintenance GNTP (n=41). Each participant underwent a complete periodontal and peri-implant clinical examination. Collection of saliva samples and radiographic examination to evaluate peri-implant bone levels were conducted at two times: initial examination (T1) and after 5 years (T2). The salivary samples were evaluated through ELISA for the following markers: IL-1ß, IL-10, RANK, OPG, MMP-2, TGF and TNF-α. RESULTS: A higher incidence of peri-implantitis was observed in the GNTP group (43.9%) than in the GTP group (18%) (p=0.000). All individuals (n=12) who presented peri-implant mucositis and had resolution at T2 were in the GTP group. After 5 years, there was an increase in the incidence of periodontitis in the GNTP group compared to the GTP group (p=0.001). The results of the study revealed an increase in the salivary concentration of TNF-α in the GNTP group compared to the GTP group. The other salivary biomarkers that were evaluated did not show statistically significant differences between the two groups. CONCLUSIONS: The salivary concentration of TNF-α was increased in individuals with worse periodontal and peri-implant clinical condition and in those with a higher incidence of peri-implantitis, especially in the GNTP group. Longitudinal studies in larger populations are needed to confirm these findings and elucidate the role of this biomarker in peri-implant disease.

Microbiological profile associated with peri-implant diseases in individuals with and without preventive maintenance therapy: a 5-year follow-up.

OBJECTIVES: Clinical and microbiological longitudinal changes in individuals with peri-implant mucositis (PM) with or without preventive maintenance therapy (PMT) have not been reported, especially in long periods of monitoring. This 5-year follow-up study aimed to assess the clinical and microbiological changes along time in individuals initially diagnosed with PM. MATERIALS AND METHODS: Eighty individuals diagnosed with PM (T1) and followed during 5 years (T2) were divided into one group with PMT during the study period (GTP; n = 39) and another group without PMT (GNTP; n = 41). Full-mouth periodontal/peri-implant examinations were performed. Peri-implant microbiological samples were collected and analyzed through qPCR for Tannerella forsythia, Treponema denticola, Porphyromonas gingivalis, Prevotella intermedia, Fusobacterium nucleatum, and Actinomyces naeslundii at T1 and T2. RESULTS: GNTP presented higher incidence of peri-implantitis than GTP. Moreover, GNTP showed significantly higher total bacterial load and higher frequency of the evaluated orange complex bacteria than GTP. Individuals who progressed to peri-implantitis presented significantly higher total bacterial load and higher frequencies of P. gingivalis, T. denticola, and F. nucleatum. CONCLUSIONS: The absence of regular appointments for PMT was associated with a higher incidence of peri-implantitis and a significant increase in total bacterial load. CLINICAL RELEVANCE: Regular visits during PMT positively influenced subgingival microbiota and contributed to peri-implant homeostasis and clinical status stability during a 5-year monitoring period. Compliance with PMT programs should be reinforced among individuals rehabilitated with dental implants.

Periodontal disease, peri-implant disease and levels of salivary biomarkers IL-1ß, IL-10, RANK, OPG, MMP-2, TGF-ß and TNF-α: follow-up over 5 years

Abstract Objective The aim of this study was to evaluate the levels of salivary biomarkers IL-1β, IL-10, RANK, OPG, MMP-2, TG-β and TNF-α in individuals with diagnosis of peri-implant mucositis in the absence or presence of periodontal and peri-implant maintenance therapy (TMPP) over 5 years. Material and Methods Eighty individuals diagnosed with peri-implant mucositis were divided into two groups: one group that underwent periodontal and peri-implant regularly maintenance therapy, called GTP (n=39), and a second group that received no regular maintenance GNTP (n=41). Each participant underwent a complete periodontal and peri-implant clinical examination. Collection of saliva samples and radiographic examination to evaluate peri-implant bone levels were conducted at two times: initial examination (T1) and after 5 years (T2). The salivary samples were evaluated through ELISA for the following markers: IL-1β, IL-10, RANK, OPG, MMP-2, TGF and TNF-α. Results A higher incidence of peri-implantitis was observed in the GNTP group (43.9%) than in the GTP group (18%) (p=0.000). All individuals (n=12) who presented peri-implant mucositis and had resolution at T2 were in the GTP group. After 5 years, there was an increase in the incidence of periodontitis in the GNTP group compared to the GTP group (p=0.001). The results of the study revealed an increase in the salivary concentration of TNF-α in the GNTP group compared to the GTP group. The other salivary biomarkers that were evaluated did not show statistically significant differences between the two groups. Conclusions The salivary concentration of TNF-α was increased in individuals with worse periodontal and peri-implant clinical condition and in those with a higher incidence of peri-implantitis, especially in the GNTP group. Longitudinal studies in larger populations are needed to confirm these findings and elucidate the role of this biomarker in peri-implant disease.

Periodontitis as a risk factor for peri-implantitis: Systematic review and meta-analysis of observational studies.

OBJECTIVES: To evaluate the scientific evidence from observational studies concerning the risk of peri-implantitis development in periodontally-compromised patients. SOURCE: The search was carried out in Medline, via PubMed, and the Cochrane Library up to March 2018. STUDY SELECTION: Clinical studies reporting data on periodontitis and peri-implantitis, with confirmed diagnosis of peri-implantitis based on specific parameters (peri-implant probing depth and peri-implant bleeding on probing) and with evaluations of implants with at least 1 year of function were selected. DATA: Nineteen articles were included; only two did not show any association between periodontitis and peri-implantitis. Quality analysis of the articles revealed a low risk of bias in most of the studies. Meta-analyses by study design on patient data showed that patients with periodontitis had a 2.29 higher risk of peri-implantitis than patients without periodontitis (95%CI: 1.34-3.24). However, the effect estimate was OR 5.15 (95%CI: -3.35; 13.65; I2: 0%, p = 0.887) for cohort studies. A subgroup analysis showed a significant association between peri-implantitis and chronic periodontitis (patient based data: OR = 2.89, 95% CI: 1.79-4.00). Meta-analysis by study design on implant data showed that implants in individuals with periodontitis had 2.15 higher chances of having peri-implantitis (95%CI: 1.10; 3.21). However, the effect estimate was OR 3.24 (95%CI: -0.05; 6.53) for cohort studies. CONCLUSIONS: This systematic review showed that diagnosis or history of periodontitis was associated with the occurrence of peri-implantitis. However, this association was not observed when only the cohort studies were analyzed. Results should be evaluated with caution due to heterogeneity among the included primary studies. Registration number CRD42015009518. CLINICAL SIGNIFICANCE: Peri-implantitis is a prevalent condition and and present an uncertain prognosis. Determining the potential factors associated with peri-implantitis is fundamental for preventive strategies.

Disfunção endotelial e periodontite ­ predição de risco para eventos cardiovasculares / Periodontitis and endothelial dysfunction ­ risk prediction for cardiovascular events

O objetivo deste estudo foi realizar uma revisão da literatura sobre a associação entre a disfunção endotelial, diagnosticada no exame de dilatação mediada por fluxo (DMF) da artéria braquial, e a periodontite crônica. Algumas evidências demonstraram uma associação entre as infecções periodontais e a disfunção endotelial. Alterações na função endotelial estão intimamente relacionadas com a aterosclerose, bem como seus fatores de risco, e constituem uma etapa intermediária na progressão de eventos adversos ao longo da história natural da doença cardiovascular, sendo esta uma das maiores causas de morte no mundo. A busca por artigos foi realizada no site Pubmed com as palavras-chave: periodontite, periodontite crônica, endotélio vascular, enfartos, derrames e doenças cardiovasculares. Após a busca, nove artigos foram selecionados para entrar nesta revisão. Os resultados dos estudos mostraram que indivíduos com periodontite apresentam a função endotelial prejudicada, quando comparados a indivíduos sem periodontite, e o tratamento da doença periodontal melhora a disfunção endotelial. Concluiu-se que a periodontite (DP) parece influenciar na função endotelial, e o seu tratamento pode melhorar a disfunção endotelial, um preditor de eventos cardiovasculares.

The aim of this study is to conduct a literature review on the association between endothelial dysfunction diagnosed on examination of flow-mediated dilatation (DMF) and chronic periodontitis. Some evidence shows an association between periodontal infections and endothelial dysfunction. Changes in endothelial function are closely related to atherosclerosis and its risk factors and is an intermediary step in the progression of adverse events throughout the natural history of cardiovascular disease, which is one of the largest causes of death worldwide. The electronic search was performed on Pubmed with the following key words: periodontitis, chronic periodontitis, vascular endothelium, heart attacks, strokes, cardiovascular diseases; overall, 9 articles were selected. The results of the studies showed that individuals with periodontitis have impaired endothelial function when compared to patients without periodontitis and the treatment of periodontal disease improves endothelial dysfunction. It was concluded that periodontal disease (PD) appears to influence on endothelial function and the treatment of periodontitis could improve endothelial dysfunction is a predictor of cardiovascular events.

O papel das citocinas na peri-implantite ­ revisão narrativa da literatura / The role of cytokines on peri-implantitis ­ a narrative literature review

O objetivo desta revisão da literatura narrativa foi tentar fornecer um melhor entendimento sobre o papel das citocinas encontradas no fluido peri-crevicular (FCPI) e associadas à peri-implantite (PI). As citocinas são mediadores inespecíficos da resposta inflamatória, com atividades quimiotáticas, efeito direto antiviral, ou ação citotóxica, detectadas por exames como o ELISA e o multiplex. Na comparação entre sítios peri-implantares sadios e doentes, citocinas como a IL4, IL-6, IL-8, IL-10, IL-12, IL-17, IL-1ß, TNF-α e a tríade RANKL/RANK/OPG podem ser vistas, entretanto, algumas vezes não associadas significativamente (com correlações positivas ou negativas) aos valores de sangramento a sondagem, nível de inserção clínica ou profundidade de bolsa. A evidência científica atual com número reduzido de estudos prospectivos não sustenta se as citocinas do FCPI podem ser utilizadas como um método diagnóstico eficaz no monitoramento longitudinal dos tecidos peri-implantares. Ainda, não existem testes disponíveis na clínica diária, tampouco uma citocina específica é usada como biomarcador no diagnóstico precoce da PI.

This narrative literature review attempts to provide a better understanding on the role of cytokines at the peri-implant crevicular fl uid (PICF) and associated to peri-implantitis (PI). Cytokines are unspecific mediators of the inflammatory response, with chemotaxis, antiviral, and cytotoxic actions, detected by ELISA or multiplex methods. Regarding healthy and affected peri-implant sites, factors such as IL4, IL-6, IL-8, IL-10, IL-12, IL-17, IL-1ß, TNF-α, and the RANKL/RANK/OPG triad can be seen, but sometimes not statistically associated (positive or negative relationships) to bleeding on probing, clinical attachment level, or pocket depth values. The contemporary scientific evidence with its reduced number of prospective studies does not support that the cytokines found at the PICF can be used as an efficient diagnostic method for long-term peri-implant tissue monitoring. In addition, no tests are available for routine clinical use and no single cytokine is used as a biomarker for early PI diagnosis.

Doença peri-implantar follow-up microbiológico de 5 anos e revisão sistemática com meta-análise / Peri-implant disease: Microbiological 5-year follow-up and systematic review with meta-analysis

Objetivos: Avaliar, em um estudo longitudinal de 5 anos, a associação entre o diagnóstico da doença peri-implantar (DPi) e a contagem de patógenos na presença e ausência de terapia de manutenção periodontal/peri-implantar (TMPP). Realizar uma revisão sistemática de estudos observacionais para avaliar se dados presentes na literatura indicam uma maior prevalência de peri-implantite (PI) em indivíduos com diagnóstico ou histórico de periodontite (PE). Métodos: O estudo longitudinal microbiológico foi realizado avaliando-se, através da técnica da reação em cadeia da polimerase em tempo real, as seguintes espécies bacterianas: T. forsythia, T. denticola, P. gingivalis, P. intermedia, F. nucleatum e A. naeslundii em 80 indivíduos com mucosite peri-implantar (MP) que realizavam consultas para manutenção periodontal/peri-implantar regular (GTP, n = 39) comparados aos que não realizavam (GNTP, n = 41). Para a revisão sistemática uma busca eletrônica foi conduzida até março de 2016. Foram encontrados 1330 estudos, 17 artigos foram incluídos na análise final (PROSPERO CRD42015009518). A meta-análise foi realizada para presença ou ausência de PI. Medidas de efeito sumário e taxas de razão de chances (OR) com 95% IC foram calculadas. Resultados: Os resultados do estudo longitudinal mostraram que, após 5 anos, houve uma diminuição da carga bacteriana total (CBT), na frequência das bactérias analisadas do complexo laranja (p = 0.013) e nas frequências isoladas de T. forsythia (p = 0.000), P. gingivalis (p = 0.003) e P. intermedia (p = 0.013) no GTP. Indivíduos com PI apresentaram maiores frequências de P. gingivalis (GNTP: p = 0,030; GTP: p = 0,000), T. denticola (GNTP: p = 0,017) e F. nucleatum (GTP e GNTP; p = 0.002) comparados aos com MP. Indivíduos que desenvolveram PI apresentaram um aumento na CBT (GTP: p = 0.047; GNTP: p = 0,055) e na frequência isolada de P. gingivalis (GNTP: p = 0,002) e F. nucleatum (GTP e GNTP; p = 0.000). Não houve diferenças estatisticamente significativas intergrupos em relação aos patógenos do complexo vermelho (p > 0,05). Tanto nos indivíduos com MP (T1 e T2: p = 0,000), quanto nos indivíduos com PI (T2: p = 0,000), a frequência do complexo laranja foi significativamente menor no GTP. A meta-análise dos estudos coorte mostrou que indivíduos (OR = 7.22), e implantes (OR = 5.63) apresentaram maior risco de desenvolver PI. Nos estudos transversais, em análises não ajustadas, indivíduos com PE apresentaram maior chance de ter PI (OR = 3.18). Quando a análise foi ajustada para tabagismo e diabetes não houve aumento estatisticamente significativo no risco para PI (OR = 1.73; IC 95% 0.86- 3.45). Conclusões: Pôde-se concluir que a ausência de consultas regulares para manutenção periodontal/peri-implantar foi associada com pior condição clínica periimplantar, maior incidência de PI e um aumento significativo na CBT. Adicionalmente, indivíduos com diagnóstico de PI apresentaram maiores frequências de P. gingivalis, T. denticola e F. nucleatum e maior CBT. A revisão sistemática permitiu concluir que indivíduos com diagnóstico ou histórico de PE podem apresentar um risco aumentado para PI. Mais estudos prospectivos são necessários para confirmar a evidência, principalmente os ensaios clínicos controlados randomizados

Aims: Evaluate, in a 5-year longitudinal study, the association between peri-implant disease's (DPi) diagnosis and the count of pathogens in the presence and absence of periodontal/peri-implant maintenance therapy. Conduct a systematic review of observational studies to evaluate whether data in the literature indicates a higher prevalence of peri-implantitis (PI) in subjects with diagnosis or history of periodontitis (PE). Methods: the microbiologic study was performed evaluating, through polymerase chain reaction in real time technique, the following bacterial species: T. forsythia, T. denticola, P. gingivalis, P. intermedia, F. nucleatum and A. naeslundii in 80 patients with peri-implant mucositis (PM) that were queries for periodontal/periimplant regular maintenance (GTP, n = 39) compared to those who were not (GNTP, n = 41). For the systematic review an electronic search was conducted until March 2016. It was found 1330 studies, 19 articles were included in the final analysis (PROSPERO CRD42015009518). The meta-analysis was performed for presence or absence of PI. Summary measures and odds ratio (OR) with 95% IC were calculated. Results: the results of the longitudinal study showed that, after 5 years, there was a decrease in the total bacterial load (TBL), the frequency of bacteria analyzed in the orange complex (p = 0.013) and in the frequencies of T. forsythia (p = 0.000), P. gingivalis (p = 0.003) and P. intermedia (p = 0.013) in the GTP. Individuals with PI had higher frequencies of P. gingivalis (GNTP: p = 0.030; GTP: p = 0.000), T. denticola (GNTP: p = 0.017) and T. nucleatum (GTP and GNTP; p = 0.002) compared to those with PM diagnosis. Individuals who have developed PI showed an increase in TBL (GTP: p = 0047; GNTP: p = 0.055) and in the isolated frequencies of P. gingivalis (GNTP: p = 0.002) and F. nucleatum (GTP and GNTP; p = 0.000). There were no statistically significant differences intergroups in relation to red complex pathogens (p > 0.05). Both in individuals with PM (T1 and T2: p = 0.000), as in individuals with PI (T2: p = 0.000), the frequency of orange complex was significantly lower in the GTP. The meta-analysis of cohort studies showed that individuals (OR = 7.22), and implants (OR = 5.63) presented a higher risk of developing PI. In the cross-sectional studies, in unadjusted analyses, individuals with PE presented a higher chance of having PI (OR = 3.18). When the analysis was adjusted for smoking and diabetes, there was no statistically significant increase in risk for PI (OR = 1.73; 95% CI 0.86-3.45). Conclusions: it might be concluded that the absence of regular periodontal/peri-implant maintenance was associated with worse peri-implant clinical condition, higher incidence of PI and a significant increase in TBL. Additionally, individuals diagnosed with PI showed greater frequencies of P. gingivalis, T. denticola and F. nucleatum and largest TBL. The systematic review showed that individuals diagnosed or with PE's history may have an increased risk for PI. More prospective studies are needed to confirm this evidence, especially the randomized controlled clinical trials

Peri-implant disease in subjects with and without preventive maintenance: a 5-year follow-up.

AIM: To determine the incidence of peri-implantitis in individuals with mucositis in a 5-year follow-up study. MATERIAL AND METHODS: A sample of 212 partially edentulous individuals, rehabilitated with dental implants, underwent periodontal and peri-implant clinical examinations in 2005 (baseline). Five years later, 80 individuals who had been diagnosed with mucositis in the baseline examination were re-examined. These individuals were divided into two groups: one group with preventive maintenance during the study period (GTP; n = 39), and another group without preventive maintenance (GNTP; n = 41). The following parameters were clinically evaluated: plaque index, bleeding on periodontal and peri-implant probing, periodontal and peri-implant probing depth, suppuration and peri-implant bone loss. The influence of biological and behavioural risk variables associated with the occurrence of peri-implantitis was analysed using univariate and multivariate logistic regression analyses. RESULTS: The incidence of peri-implantitis in the global sample was 31.2% (GNTP = 43.9% and GTP = 18.0%). CONCLUSION: The absence of preventive maintenance in individuals with pre-existing peri-implant mucositis was associated with a high incidence of peri-implantitis. Clinical parameters, such as bleeding on peri-implant probing, periodontal probing depth and the presence of periodontitis were associated with a higher risk of developing peri-implantitis.

Mucosite periimplantar e periimplantite: prevalência e indicadores de risco em individuos parcialmente edêntulos / Peri-implant mucositis and peri-implantitis: prevalence and risk indicators in partially edentulous

Um estudo transversal foi conduzido para investigar a prevalência de complicações biológicas em implantes e potenciais indicadores de risco em 125 indivíduos parcialmente desdentados. Análises uni e multivariada por regressão logística foram realizadas para identificar possíveis indicadores de risco associados com a ocorrência das complicações biológicas em implantes. As prevalências de mucosite periimplantar e de periimplantite foram, respectivamente, de 72,8% e 8%. O tempo de função dos implantes foi associado com uma profundidade de sondagem periimplantar aumentada (p=0,003) e com perda óssea periimplantar (p=0,018). Apesar de indivíduos com periodontite apresentarem maior profundidade de sondagem periimplantar (p=0,002), e supuração (p< 0.05) sua presença não foi associada significativamente com a ocorrência das doençasperiimplantares. (p=0,284). O modelo multivariado de regressão logística revelou que indivíduos que perderam seus dentes devido doença periodontal (OR=11,0) e com um altoíndice de placa bacteriana (OR=14,0) apresentaram maior risco para a presença de periimplantite. Os resultados deste estudo demonstraram a importância da utilização dos parâmetros clínicos no monitoramento dos implantes osseointegrados, assim como a influência das condições periodontais na manutenção da saúde periimplantar.

Demographic, pharmacologic, and periodontal variables for gingival overgrowth in subjects medicated with cyclosporin in the absence of calcium channel blockers.

BACKGROUND: The role of cyclosporin in the absence of calcium channel blockers and the associated risk variables of development and severity of gingival overgrowth have not yet been properly established. The present study was conducted to determine the effect of potential risk variables for gingival overgrowth severity in Brazilian renal transplant subjects medicated with cyclosporin in the absence of any calcium channel blockers. METHODS: A cross-sectional study was conducted in a public hospital in Belo Horizonte, Brazil. Demographic, pharmacologic, and periodontal data, recorded from 194 subjects taking cyclosporin in the absence of calcium channel blockers, were analyzed using independent sample t, chi2 statistic, or Mann-Whitney U tests. The effects of potential risk variables of gingival overgrowth severity were determined using backward stepwise regression analysis. RESULTS: The prevalence of clinically significant gingival overgrowth was 34.5% (N = 67). These subjects presented a significantly higher papillary bleeding index and a higher plaque index compared to those without clinically significant gingival overgrowth. When all demographic, pharmacologic, and periodontal data were evaluated in relation to gingival overgrowth severity, time since transplant, papillary bleeding index, serum cyclosporin concentration, and prednisolone and azathioprine dosages were significant in the univariate modeling (P <0.05) and remained significant when evaluated in the multivariate modeling (P <0.0001; adjusted R2 = 39.4%). CONCLUSIONS: In the absence of calcium channel blockers, this study showed that pharmacologic variables, such as cyclosporin serum concentration, prednisolone and azathioprine dosages, and time since transplant, are strongly related to gingival overgrowth. In addition, the periodontal variable papillary bleeding index highlighted the primary role of inflammation on the pathogenesis and severity of gingival overgrowth.