Abordaje reconstructivo para un defecto de periimplantitis / Reconstructive approach for a peri-implantitis defect

Si bien el conocimiento científico para el tratamiento de la periimplantitis ha avanzado significativamente en los últimos años, sigue en discusión qué tipo de abordaje quirúrgico genera los mejores resultados clínicos y si el uso de biomateriales da mejoras significativas en dicho tratamiento. Este reporte de caso describe un abordaje quirúrgico reconstructivo de un defecto intraóseo por periimplantitis en una paciente que refería dolor y un intenso sangrado en sus implantes dentales, empleando un sustituto óseo anorgánico mineral bovino, sin el uso de una membrana o barrera, y con un protocolo de descontaminación de la superficie del implante mecánico y químico. Posteriormente, a las 20 semanas de realizado el procedimiento, se hizo la evaluación del defecto, obteniendo profundidades al sondeo menores a 5 mm, ausencia de sangrado al sondeo en todos los sitios y un llenado óseo radiográfico de aproximadamente 90%; cumpliendo con los criterios de éxito de la terapia periimplantaria. Lo anterior muestra que la terapia reconstructiva para los defectos por periimplantitis puede ser posible mediante el uso de un sustituto óseo xenogénico únicamente y con una correcta descontaminación de la superficie del implante (AU)

Although scientific knowledge for the treatment of peri-implantitis have advanced significantly in recent years, the type of surgical approach that generates the best clinical results is still under discussion and whether the use of biomaterials gives significant improvements in said treatment. This case report describes a reconstructive surgical approach for a periimplantitis intrabony defect using an anorganic bovine bone substitute, without the use of a membrane or barrier, and with a mechanical and chemical implant surface decontamination protocol. Twenty weeks after the procedure, the defect was reassessed, obtaining probing depths of less than 5 mm, no bleeding on probing in all sites, and radiographic bone filling of approximately 90%; meeting the success criteria for the peri-implant therapy. This shows that reconstructive therapy for periimplantitis defects may be possible using a xenogeneic bone substitute only and proper decontamination of the implant surface (AU)

Peri-Implant Surgical Treatment Downregulates the Expression of sTREM-1 and MMP-8 in Patients with Peri-Implantitis: A Prospective Study.

sTREM-1 and its ligand PGLYRP1 play an essential role in the inflammatory process around teeth and implants. In this study, we aimed to evaluate the impact of peri-implant treatment on the salivary levels of the sTREM-1/PGLYRP-1/MMP-8 axis after 3 months. A total of 42 participants (with a mean age of 61 years old ± 7.3) were enrolled in this longitudinal study, 24 having peri-implant mucositis (MU) and 18 having peri-implantitis (PI). Clinical peri-implant parameters, such as probing pocket depth (PPD), % of plaque, and bleeding on probing (BOP), and the whole unstimulated saliva samples were evaluated at baseline and 3 months after treatment. The MU group received nonsurgical peri-implant treatment, while the PI group received open-flap procedures. The levels of sTREM-1, PGLYRP-1, MMP-8, and TIMP-1 were analyzed using enzyme-linked immunosorbent assays. BOP, plaque levels, and PPD significantly reduced after treatment in both groups. A significant decrease in the salivary levels of sTREM-1, MMP-8, and TIMP-1 in the PI group and PGLYRP1 and TIMP-1 in the MU group were observed. Salivary levels of sTREM-1 were significantly reduced in patients with PI but not with MU. Additionally, peri-implant treatment had a significantly higher impact on MMP-8 reduction in patients with PI than in those with MU.

Eficácia da implantoplastia adjuvante no tratamento cirúrgico da peri-implantite / Efficacy of adjuvant implantoplasty in the surgical treatment of peri-implantitis

A terapia cirúrgica tem sido apontada como a estratégia mais apropriada para o tratamento da peri-implantite. Uma dessas técnicas é a implantoplastia, cuja proposta é a modificação da superfície do implante através da remoção de roscas expostas, tornando-a menos aderente ao biofilme. O estudo objetivou avaliar o efeito da implantoplastia no tratamento da peri-implantite, através da comparação entre dois grupos de intervenção: um com e outro sem implantoplastia. Assim, trata-se de um ensaio clínico prospectivo, controlado, randomizado e cego. 13 participantes com 33 implantes foram alocados aleatoriamente em dois grupos: acesso cirúrgico + debridamento mecânico (grupo controle-I) e acesso cirúrgico + debridamento mecânico + implantoplastia (grupo teste- II). Os desfechos primários foram avaliados no baseline e aos 3 meses: Índice de Placa Visível -IPV, Índice de Sangramento Gengival -ISG, Profundidade de Sondagem -PS, Sangramento à Sondagem -SS e Faixa de Mucosa Ceratinizada -MC. Avaliou- se a qualidade de vida pelo Oral Health Impact Profile -OHIP14 e também os marcadores de estresse oxidativo pelas amostras salivares. Os resultados apontaram que 69,2% eram mulheres, com idade média de 60,6 anos. Dos 32 implantes, 16 receberam a terapia I e 16 a terapia II. De todas as reabilitações, 53,8% foram totais e 30,8% foram parciais, sendo as demais unitárias. O teste de Mann-Whitney apontou que os valores de IPV e do ISG no grupo II foram maiores do que no grupo I aos 3 meses, mas não foram significativos (p=0,193; p=0,419). O SS foi maior no grupo I (50%) do que no grupo II (41,6%) aos 3 meses, porém, sem significância (p=0,759). Aos 3 meses, todos os parâmetros - exceto SS no grupo II - diminuíram de valor, sendo significativos para o IPV no grupo I (p=0,038), ISG nos grupos I e II (p=0,011 e p=0,015) e PS no grupo II (p=0,041). O ANOVA Split-Plot não mostrou interação entre tempo e tratamento. O OHIP14 mostrou que no baseline houve predomínio da "Dor física", "Desconforto psicilógico" e "Incapacidade física", enquanto que aos 3 meses houve melhora dos itens avaliados. A análise salivar mostrou que houve uma redução dos níveis de marcadores de estresse oxidativo após o tratamento, sendo significativo para o superóxido dismutase (Z=-2,701; p=0,007). Conclusão: não há evidências suficientes de que a adição da implantoplastia melhore os parâmetros clínicos no tratamento cirúrgico da peri-implantite aos 3 meses, em relação ao debridamento mecânico realizado de forma isolada (AU).

Surgical therapy has been identified as the most appropriate strategy for the treatment of peri-implantitis. One of these techniques is implantoplasty, whose proposal is to modify the surface of the implant by removing exposed threads, making it less adherent to the biofilm. The study aimed to evaluate the effect of implantoplasty in the treatment of peri-implantitis, by comparing two intervention groups: one with and the other without implantoplasty. Thus, it is a prospective, controlled, randomized and blinded clinical trial. 13 participants with 33 implants were randomly allocated into two groups: surgical access + mechanical debridement (control-I group) and surgical access + mechanical debridement + implantoplasty (test-II group). The primary outcomes were assessed at baseline and at 3 months: Plaque Index -PI, Gingival Bleeding Index -GBI, Probing Depth -PD, Bleeding on Probing -BoP, and Keratinized Mucosal Band -MK. Quality of life was evaluated by the Oral Health Impact Profile -OHIP14 and oxidative stress markers by salivary samples. The results showed that 69.2% were women, with an average age of 60.6 years. Of the 32 implants, 16 received therapy I and 16 received therapy II. Of all rehabilitations, 53.8% were total and 30.8% were partial, with the rest being single. The Mann-Whitney test showed that the values of PI and GBI in group II were higher than in group I at 3 months, but they were not significant (p=0,193; p=0,419). The BoP was higher in I group (50%) than in II group (41.6%) at 3 months, however, without significance (p=0,759). At 3 months, all parameters - except BoP in II group - decreased in value, being significant for PI in I group (p=0,038), GBI in I and II groups (p=0,011 and p=0,015) and PD in II group (p=0,041). Split-Plot ANOVA showed no interaction between time and treatment. The OHIP14 showed that at baseline there was a predominance of "Physical pain", "Psychological discomfort" and "Physical disability", while at 3 months there was an improvement in the evaluated items. Salivary analysis showed that there was a reduction in the levels of oxidative stress markers after treatment, being significant for superoxide dismutase (Z=-2,701; p=0,007). Conclusion: there is insufficient evidence that the addition of implantoplasty improves clinical parameters in the surgical treatment of peri-implantitis at 3 months, in relation to mechanical debridement alone (AU).

Is Implantoplasty Efficacious at Treating Peri-Implantitis? A Systematic Review and Meta-Analysis.

PURPOSE: Peri-implantitis is an inflammatory disease, characterized by the progressive loss of the peri-implant support bone tissue. The objective of this study was to assess whether implantoplasty is efficacious in promoting peri-implant health. METHODS: In this systematic review and meta-analysis, a search without restrictions regarding language or date of publication was conducted across different databases. Grey literature search, Google Scholar search and manual searches were also carried out. Studies evaluating periimplant clinical parameters of individuals with peri-implantitis who had been submitted to implantoplasty were included. Study selection, data extraction, and risk of bias assessment were conducted. The outcome variables were implant probing depth, the percentage of implants with bleeding on probing or suppuration on probing, and the success rate of implants after implantoplasty. The predictor variable was implantoplasty and the follow-up time after implantoplasty. Data on sample size, implant location, implant diameter, and diagnostic criteria for peri-implantitis were also collected during data extraction. Meta-analysis, sensitivity analysis, and analysis of the probability of implant success after implantoplasty with the Kalan-Meier method were performed. RESULTS: Ninety-four studies were assessed. Eight articles were included and 7 were incorporated into quantitative analyses. Subjects' mean age ranged between 50 to 70.7 years. The studies demonstrated that implantoplasty contributed to a significant improvement in the peri-implant condition, reducing the probing depth, bleeding and suppuration on probing. Overall, the included studies exhibited low risk of bias. Meta-analysis demonstrated that probing depth before implantoplasty was significantly higher than after implantoplasty (mean difference = -3.37 mm, confidence interval = -4.74; -2.00). This result was confirmed in the sensitivity analysis. The probability of success of implants at 6 months of follow-up after implantoplasty was 97.5% and at 24 months of follow-up was 94.7%. CONCLUSIONS: There is some evidence in the literature to recommend implantoplasty as a potential treatment for periimplantitis.

Surgical and non-surgical debridement for the treatment of peri-implantitis: a two-center 12-month randomized trial.

OBJECTIVES: To compare surgical (ST) and non-surgical (NST) debridement for the treatment of peri-implantitis in a two-center randomized trial. MATERIALS AND METHODS: Forty-five individuals with 63 implants with probing depth (PPD) ≥5mm, bleeding on probing (BOP), and radiographic bone loss ≥2mm were included. In the NST (30 implants), submucosal debridement was performed. In the ST (33 implants), a mucoperiosteal flap was raised and surfaces were decontaminated only by debridement as performed in NST. Clinical parameters and radiographs were compared at baseline and after 12 months. Means and standard errors were reported. RESULTS: PPD considering all implant sites reduced significantly in NST from 4.14±0.25 to 3.25±0.18mm. In ST, PPD also significantly changed (3.74±0.22 to 3.00±0.29mm). No significant differences were observed between the two groups. For deep sites (≥7mm), PPD was 7.82±0.20mm at baseline and reduced to 5.10±0.30mm in NST, while in ST group, it was 7.11±0.11mm and changed to 5.22±0.91mm (between-groups p value=0.51). BOP significantly reduced from ~60 to 35% of all sites in both groups, without significant differences between them. When sites with radiographic bone level ≥3mm at baseline were analyzed, there was a significant difference between groups in bone gain after 12 months in favor of ST (ST=0.78±0.30mm compared to NST=0.25mm±0.13; p=0.03). CONCLUSIONS: Surgical and non-surgical debridement for the treatment of peri-implantitis present similar clinical outcomes. Bone levels were better improved in ST than NST for sites with higher initial bone loss. CLINICAL RELEVANCE: The treatment of peri-implantitis is still a challenge in clinical practice, since less than half of affected implants achieve health after surgical or non-surgical debridement. Considering the lack of clinically relevant differences between these two treatments, non-surgical debridement should be considered the first therapeutic choice for peri-implantitis, mainly mild to moderate cases.

Efeito clínico, radiográfico e imunológico do tratamento cirúrgico associado à terapia fotodinâmica com azul de toluidina 0,2% em peri-implantite: estudo clínico randomizado longitudinal de 1 ano / Clinical, radiographic and immunological effects of surgical treatment associated with photodynamic therapy with 0.2% toluidine blue in peri-implantitis: randomized 1-year longitudinal clinical study

O objetivo do presente estudo foi comparar os efeitos clínicos, radiográficos e imunológicos do tratamento cirúrgico para peri-implantite com ou sem terapia fotodinâmica após 1 ano. Participaram deste estudo 21 pacientes com peri-implantite (idade média 56,0 ± DP 9,6 anos). Divididos os grupos em teste e controle de forma randomizada. Foram utilizados os seguintes parâmetros clínicos: profundidade de bolsa à sondagem (PBS); índice de placa visível (IPV)e índice de sangramento à sondagem (ISS). A radiografia periapical foi utilizada como parâmetro radiográfico em baseline e 1 ano. A coleta do fluido periimplantar foi realizada com periopaper e congelada à -70°C para posterior análise. Os biomarcadores do metabolismo ósseo utilizados no fluido periimplantar foram TNF-α, SOST, PTH, OPG, OPN, OC, Leptina, IL-6, IL-1ß FGF-23. Os pacientes de ambos os grupos receberam tratamento periimplantar cirúrgico de acesso para raspagem e no grupo teste foi utilizada a terapia fotodinâmica com azul de toluidida 0,12%, na qual emite uma radiação infravermelha pulsada no comprimento de onda de 2,94 mm. Os parametros do laser foram fixados em 100 mJ / pulso (12,7 J/cm2) e 10 pps (energia de pulso na ponta: cerca de 85 mJ/pulso). Os dados clínicos foram coletados em quatro visitas em ambos os grupos (baseline, 03 meses, 6 meses e 1 ano). Os dados radiográficos e imunológicos foram coletados (baseline e 1 ano). Os biomarcadores foram mensurados por meio de um imunoensaio multiplex. Os resultados mostraram uma redução significativa dos parâmetros clínicos 3 meses após o tratamento, em ambos grupos. No baseline, os valores de PBS 8,5mm ± 0,9, ISS 100%, ISG 100% IPV 100% no grupo controle. Os valores correspondentes do grupo teste foram 8,6mm ± 0,7,100%,100% e 100%). Aos 3 meses as médias de PBS, ISS, ISG e IPV foram 5,7mm ± 0,5, 11%, 100% e 0% no grupo controle e 5,7mm, 8%, 100% e 0% no grupo teste (p<0,05). Esses valores mantiveram-se constantes até os 12 meses de acompanhamento. Aos 12 meses, foi observado uma melhora nos parâmetros ósseo estatisticamente significante no grupo controle (baseline 6,2±1 mm x 12 meses5,7± 0,6 mm) (p = 0,008). No grupo teste houve um ganho ósseo (baseline 6 ±0,8 mm x12 meses 5,9 ± 0,6 mm) (p>0,5). A análise imunológica mostrou uma redução significativa nos níveis de IL6 e OC em ambos os grupos, após 1 ano de tratamento. No entanto, no grupo teste houve uma redução significativa de Leptina (p= 0,05) e uma tendência a uma redução dos níveis de OPN (p= 0,08). Concluindo, a terapia peri-implantar cirúrgica levou a uma melhora significativa dos parâmetros clínicos periimplantares após 1 ano, um ganho ósseo no grupo controle e uma redução de biomarcadores em ambos grupos. O uso adicional da terapia fotodinânima ao acesso cirúrgico não ofereceu resultados superioresaos observados no grupo somente com acesso cirúrgico(AU)

The aim of the present study was to evaluate the clinical, radiographic and immunological effects of surgical treatment for peri-implantitis after 1 year. Twenty-one patients with peri-implantitis participated in this study (mean age 56.0 ± SD 9.6 years). Patients were divided into a test and control group at random. The following clinical parameters were used: probing depth (PS); plaque index (PI)and probing bleeding index (BOP). Periapical radiography was used as a baseline and 1-year radiographic parameter. Peri-implant fluid samples were collected with periopaper and frozen at -70° C for further analysis. Bone metabolism biomarkers included TNF-α, SOST, PTH, OPG, OPN, OC, Leptin, IL-6, IL-1ß FGF-23. Patients in both groups received peri-implant surgical treatment for scaling. The test group underwent a photodynamic therapy with 0.2% toluidide blue, in which pulsed infrared radiation is emitted at a wave length of 2.94 mm. The laser parameters were set at 100 mJ/pulse (12.7 J/cm2) and 10 pps (pulse energy at the tip: about 85 mJ/pulse). Clinical data were collected in four visits in both groups (baseline, 3 months, 6 months and 1 year). Radiographic and immunological data were collected (baseline and 1 year). Biomarkers were measured using a multiplex immunoassay. The results showed a significant reduction in clinical parameters 3 months after treatment, in both groups. In the baseline, the control group presented the values of PBS 8.5 mm ± 0.9, ISS 100%, ISG 100% VPI 100%, while the test group presented PBS 8.6 mm ± 0.700%, ISS 100% and ISG 100% After 3 months, the average values of PBS, ISS, ISG and VPI were 5.7 mm ± 0.5, 11%, 100% and 0% in the control group and 5.7 mm, 8%, 100% and 0% in the test group ( p <0.05). These values remained constant until the 12-month follow-up, at which point a statistically significant bone gain was observed in the control group (baseline 6.2 ± 1 mm x 12 months 5.7 ± 0.6 mm) (p = 0.008). In the test group there was a bone gain (baseline 6 ± 0.8 mm x 12 months 5.9 ± 0.6 mm) (p> 0.5). The immunological analysis showed a significant reduction in the levels of IL6 and OC in both groups, after 1 year of treatment. However, in the test group there was a significant reduction in Leptin (p = 0.05) and a tendency towards a reduction in OPN levels (p = 0.08). In conclusion, peri-implant surgical therapy led to a significant improvement in peri-implant clinical parameters after 1 year, a bone gain in the control group, and a reduction in biomarkers in both groups. The additional use of photodynamic therapy for surgical treatment in the test group did not present superior results to those observed in the control group(AU)

A prospective case series on surgical treatment of circumferential and semi-circumferential defects due to peri-implantitis.

Different surgical treatment strategies for peri-implantitis with the use of graft material and membranes have been suggested without any longitudinal remarkable success rate. The present preliminary study was aimed to analyze a new clinical approach based on the disinfection of the implant connection, the disinfection of the implant surface and GBR approach in the treatment of circumferential and semi-circumferential bony defect resulting from peri-implantitis. Six consecutive patients were selected for the present study. After removal of factors that could potentially influence peri-implant pathology, the prosthetic rehabilitation was always removed and a full thickness flap was elevated to allow access to the peri-implant defect and the exposed implant surface. Once the defect was degranulated and the implant surface cleaned, a mixture (50:50) of autogenous bone and allograft was used. Guided bone regeneration technique using membranes was adopted and the flaps were closed for a submerged healing. Six months thereafter, a new re-opening procedure was performed and cleaned superstructures and crowns were repositioned. Patients were followed for one year thereafter and recalled for a customized oral hygiene every three months. Radiological and periodontal analysis was performed before surgery and every six months. The studied procedure was associated with a pronounced increase in REC and CAL with stable peri-implant conditions at 6 and 12 months. PI, BOP and PD values were significantly reduced both at 6 and 12 months. At 12 months, a mean PD gain of 4.5 mm and a bone loss reduction of 5.1 mm was obtained. Within the limitation of the present preliminary study, the proposed technique might represent a promising result for treatment of circumferential and semi-circumferential bone defects around implants affected by peri-implantitis.

Prospective longitudinal comparison study of surgical therapies for peri-implantitis: 3-year follow-up.

BACKGROUND: The aim of this study was to compare different surgical therapies to treat peri-implantitis. METHODS: Twenty-three patients presenting one implant affected by peri-implantitis were divided into three groups: (i) open flap debridement (OFD) and citric acid decontamination (CAD); (ii) OFD, CAD and subepithelial connective tissue graft (SCTG); (iii) OFD, CAD and implantoplasty. Modified plaque index (MPI), gingival bleeding index (GBI), keratinized mucosa (KM) width, probing depth (PD), bleeding or suppuration on probing (B/SOP), and radiographic crestal bone level were registered 1(T1), 2(T2) and 3(T3) years after treatment. RESULTS: In Group 1 there was a significant improvement in MPI from baseline to T1, and a significant reduction in PD over time. In Group 2, none of the assessed clinical parameters showed any statistically significant variation over time. In Group 3, there was a significant decrease in PD and B/SOP over time. When comparing the 3 Groups, KM was significanlty greater in Group 2 vs. Group 1 and Group 3 at T1 and T2, and in Group 2 vs. Group 3 at T3. CONCLUSION: All therapies were successful in the management of peri-implantitis; however, SCTG maintained the greatest KM width. Surgical therapies combined with mechanical and chemical decontamination contributed to peri-implant tissue health.

A prospective case series on surgical treatment of circumferential and semi-circumferential defects due to peri-implantitis

Abstract Different surgical treatment strategies for peri-implantitis with the use of graft material and membranes have been suggested without any longitudinal remarkable success rate. The present preliminary study was aimed to analyze a new clinical approach based on the disinfection of the implant connection, the disinfection of the implant surface and GBR approach in the treatment of circumferential and semi-circumferential bony defect resulting from peri-implantitis. Six consecutive patients were selected for the present study. After removal of factors that could potentially influence peri-implant pathology, the prosthetic rehabilitation was always removed and a full thickness flap was elevated to allow access to the peri-implant defect and the exposed implant surface. Once the defect was degranulated and the implant surface cleaned, a mixture (50:50) of autogenous bone and allograft was used. Guided bone regeneration technique using membranes was adopted and the flaps were closed for a submerged healing. Six months thereafter, a new re-opening procedure was performed and cleaned superstructures and crowns were repositioned. Patients were followed for one year thereafter and recalled for a customized oral hygiene every three months. Radiological and periodontal analysis was performed before surgery and every six months. The studied procedure was associated with a pronounced increase in REC and CAL with stable peri-implant conditions at 6 and 12 months. PI, BOP and PD values were significantly reduced both at 6 and 12 months. At 12 months, a mean PD gain of 4.5 mm and a bone loss reduction of 5.1 mm was obtained. Within the limitation of the present preliminary study, the proposed technique might represent a promising result for treatment of circumferential and semi-circumferential bone defects around implants affected by peri-implantitis.

Comparison between two antimicrobial protocols with or without guided bone regeneration in the treatment of peri-implantitis. A histomorphometric study in dogs.

OBJECTIVES: This study used a dog model to evaluate two antimicrobial protocols with or without guided bone regeneration (GBR) in the surgical reconstruction of peri-implantitis defects. MATERIAL AND METHODS: Eight beagle dogs subject to ligature-induced peri-implantitis were used. The animals either received antimicrobial photodynamic therapy or topical tetracycline hydrochloride combined with GBR or as stand-alone surgical interventions. Block biopsies of the defect sites for histological analysis were obtained at euthanasia, 12 weeks postsurgery. The primary outcome of the study was re-osseointegration; secondary outcomes included alveolar bone gain and remaining defect characteristics. The effects of the implant site, early exposure, and type of antimicrobial protocol on bone regeneration were also evaluated. RESULTS: No significant differences were observed between the two antimicrobial protocols, and the adjunctive use of GBR failed to significantly improve re-osseointegration or bone gain using either protocol. Buccal sites and implant early exposure negatively affected bone regeneration. CONCLUSION: Both antimicrobial therapies stand-alone or combined with GBR allowed similar and limited bone gain.

Tratamento cirúrgico de peri-implantite û relato de caso com 3 anos de acompanhamento / Surgical treatment for peri-implantitis û case report with 3-years follow-up

A peri-implantite (PI), doença peri-implantar causada pelo desequilíbrio entre a colonização bacteriana ao redor dos implantes e a resposta do hospedeiro, é caracterizada pela perda óssea e profundidade de sondagem aumentada com sangramento e/ou supuração. Este artigo relata um caso clínico de tratamento cirúrgico de peri-implantite em área estética da maxila e descreve o acompanhamento longitudinal da paciente, num período de 3 anos após cirurgia. A paciente compareceu ao Centro de Ensino e Pesquisa em Implantes Dentários (CEPID), no Departamento de Odontologia da Universidade Federal de Santa Catarina (UFSC) (Florianópolis/Brasil) para tratamento de doença peri-implantar na região do dente 11. Após diagnóstico de PI e tratamento não cirúrgico local, a terapia cirúrgica foi indicada. A coroa parafusada foi removida e o osso foi exposto através de uma incisão de espessura total. O tecido de granulação foi removido através de raspagem manual e a osteoplastia foi realizada ao redor do implante com cinzéis, de forma manual, buscando preservar ao máximo o osso próximo aos dentes vizinhos à região. Ácido cítrico a 3% foi aplicado com o intuito de promover a descontaminação química e, também, o condicionamento do osso para reinserção dos tecidos. O manejo da PI permanece sem um protocolo de tratamento definido, porém, as opções terapêuticas adotadas foram suficientes para limitar os danos da doença e restabelecer a saúde dos tecidos peri-implantares no caso apresentado...

Peri-implantitis (PI), a peri-implant disease caused by an imbalance between bacterial colonization around the implant and host response, is characterized by bone loss and increased probing depths with bleeding and/or suppuration. This paper reports a clinical case of surgical treatment of PI in aesthetic area of the maxilla and describes the longitudinal follow-up of the patient over a period of 3 years after surgery. The patient searched the Center of Education and Research on Dental Implants (CEPID), Department of Dentistry of the Federal University of Santa Catarina (UFSC) (Florianopolis/Brazil), for peri-implant disease treatment in the 11 tooth region. After diagnosis of PI and local non-surgical treatment, surgical therapy was indicated. The screwed crown was removed and the bone exposed through a full thickness incision. Granulation tissue was removed by manual curettage and osteoplasty was performed manually around the implant with chisels, as an attempt to preserve bone near the adjacent teeth. In order to promote chemical decontamination and bone conditioning for tissue reinsertion, citric acid at 3% was applied. PI management remains without a defined treatment protocol, however in the present case the adopted therapeutic options were sufficient to limit the damage of the disease and restore health of peri-implant tissues...

Peri-implantite: Tratamento com acesso cirúrgico, descontaminação com solução de iodo e enxerto ósseo / Iodine decontamination of implant surface associated with bone graft for the treatment of peri-implantitis. Case report

O uso de implantes osseointegrados é uma terapia já difundida e consolidada, com excelentes resultados demonstrados. Porém, assim como os dentes naturais, os implantes podem acumular biofilme e apresentar doenças inflamatórias. A peri-implantite foi definida como um processo inflamatório destrutivo ao redor de implantes osseointegrados, com a formação de bolsas peri-implantares e perda de suporte ósseo. Vários fatores foram apontados como fatores de risco. Entretanto, evidências demonstram que os principais fatores são a higiene oral insatisfatória, o fumo e o histórico de doenças periodontais. Diversos sinais e sintomas podem ser encontrados nos casos com peri-implantite, sendo sangramento e/ou supuração a sondagem peri-implantar, margem tecidual edemaciada e avermelhada os mais encontrados. Defeito ósseo tipicamente em forma de cratera ao redor de todo o implante é frequentemente encontrado em casos de peri-implantite. Existem diversas modalidades de tratamento para os casos de peri-implantite, sendo basicamente divididas em terapias cirúrgicas e não cirúrgicas. Existem limitadas evidências a partir de estudos de casos indicando efeitos benéficos da terapia não cirúrgica, deixando imprevisíveis os resultados desta. As técnicas cirúrgicas utilizadas no tratamento da peri-implantite descritas na literatura são versões modificadas de técnicas primárias usadas por diversos anos para o tratamento de defeitos ósseos ao redor dos dentes naturais. O objetivo deste trabalho foi apresentar um relato de caso clínico no qual se realizou o acesso cirúrgico, a descontaminação da superfície do implante com solução de iodo e o preenchimento do defeito ósseo com enxerto ósseo xenógeno.

Influence of etiologic factors in peri-implantitis: literature review and case report.

Peri-implantitis is a pathology that has been described in many clinical studies and case reports. However, it is still not clear how the roles of its etiologic agents work. This article is based on a review of the literature and a case report. It aims to offer data related to the factors that cause this pathology, and to analyze how these factors interact, leading to the contamination of the peri-implant tissue.

Moldagem de transferência com moldeira aberta para próteses implantossuportadas - relato de caso clínico / Open tray impression technique for an implant-supported prosthesis – case report

O sucesso das próteses sobre implantes está relacionado à adaptação passiva na interface implante/intermediário. Alguns critérios são fundamentais para atingir esta passividade, dentre eles a obtenção de modelos com correta transferência dos implantes. O objetivo da moldagem de transferência é reproduzir com precisão o posicionamento dos implantes e seu relacionamento com estruturas adjacentes: tecidos peri-implantares e dentes vizinhos. Existem duas técnicas de moldagem de transferência: moldeira aberta (com arrasto do transferente na moldagem) e outra com moldeira fechada (com reposicionamento do transferente no molde). Este estudo se propôs a descrever e demonstrar sequencia clínica da transferência com moldeira aberta. Esta técnica foi descrita, utilizando transferentes quadrados fixados com resina acrílica, moldeira de estoque individualizada e silicone de condensação. Foi possível obter um modelo adequado de gesso especial, com análogos em posicionamento semelhante à cavidade oral e ainda utilização de gengiva artificial ao redor dos análogos. A escolha da técnica de moldagem de transferência é dependente de cada situação clínica e da habilidade do profissional de selecionar componentes e materiais de impressão adequados

Success on implantsupported prosthesis is related to passive fit of abutment-implant interface. Some criteria are fundamental to achieve this passivity, among them, proper implant transfer. The purpose of impression is to reproduce accurately the implant position and its relationship to adjacent structures: peri-implant tissues and adjacent teeth. Two impression techniques are described in the literature: open tray (pick-up impression copings) and closed tray (repositioning impression copings). The aim of this work is to describe and demonstrate a clinical sequence of the open tray technique. The open tray technique was described using square impression copings secured with acrylic resin, customized tray, and condensation silicone. This technique obtained good casts with analogs in the same position as in the oral cavity and also with an application of artificial gingiva around them. The choice of the impression technique depends on the clinical situation and professional ability to select the technique, components and adequate impression materials

Unusual presentation of active implant periapical lesions: a report of two cases.

Active implant periapical lesion (IPL) is a rare lesion which has been reported as one of the causes of dental implant failures. Usually, an affected implant shows radiolucency in the apical area, while remaining clinically stable. IPL is often accompanied by symptoms of pain, swelling, tenderness, and fistulation. In this paper, we describe two cases of IPL with very unusual findings which led to implant failure. A large IPL associated with an inflammatory cyst in the anterior maxilla, and a mandibular IPL resulting in an extra-oral fistula are presented. The etiology and treatment approaches for IPL are discussed.

Surgical anti-infective mechanical therapy for peri-implantitis: a clinical report with a 12-month follow-up.

According to previous studies, bacterial infection plays the most important role in the late failures of dental implants. Peri-implantitis has been described as a site-specific infection that causes soft tissue inflammation and bone loss around osseointegrated implants that have performed masticatory functions. To reduce the number of pathogenic species and improve the clinical parameters (that is, probing depth, bleeding on probing, and suppuration) around dental implants, several anti-infective therapies have been developed for peri-implantitis. However, recent reviews have not identified sufficient evidence to support an ideal anti-infective protocol for this disease. This article presents a case of advanced peri-implantitis that was treated with a single surgical anti-infective mechanical therapy. A follow-up visit 12 months post-treatment showed improved clinical features.