Non-surgical treatment of peri-implant mucositis and peri-implantitis at two-piece zirconium implants: A clinical follow-up observation after up to 3 years.

OBJECTIVES: To assess the long-term clinical outcomes following non-surgical therapy of peri-implant diseases at two-piece zirconium implants. MATERIAL AND METHODS: A total of 27 patients suffering from either (i) peri-implant mucositis (n = 24 implants), or (ii) peri-implantitis (n = 16 implants) completed a mean follow-up period of 32.8 ± 2.85 months (median: 34 months). The initial treatment procedures included (i) mechanical debridement + local antiseptic therapy using chlorhexidine digluconate (MD + CXH), or (ii) Er:YAG laser monotherapy (ERL). The primary outcome was disease resolution (i.e. absence of bleeding on probing (BOP) at mucositis sites/absence of BOP and probing pocket depths (PD) ≥6 mm at peri-implantitis sites). RESULTS: Resolution of peri-implant mucositis and peri-implantitis was obtained in 7/14 (50.0%; p = .003) and 5/13 (38.5%; p = .001) of the patients investigated. This corresponded to 54.2% (13/24) and 50.0% (8/16) at the implant level respectively. CONCLUSION: Both MD + CHX and ERL were effective on the long-term, but failed to achieve a complete disease resolution.

Combined surgical therapy of advanced peri-implantitis evaluating two methods of surface decontamination: a 7-year follow-up observation.

OBJECTIVES: To assess the long-term outcomes (>4 years) following combined surgical resective/regenerative therapy of advanced peri-implantitis lesions using two surface decontamination methods. MATERIAL & METHODS: Fifteen patients (n = 15 combined supra- and intrabony defects) completed a follow-up observation period of 7 years. The treatment procedure included access flap surgery, granulation tissue removal and implantoplasty at buccally and supracrestally exposed implant parts, and a randomly assigned decontamination of the unmodified intrabony implant surface areas using either (i) an Er:YAG laser (ERL) or (ii) plastic curettes + cotton pellets + sterile saline (CPS). Intrabony defects were filled using a natural bone mineral and covered by a native collagen membrane. RESULTS: At 7 years, both ERL and CPS were associated with similar mean bleeding on probing reductions (CPS: 89.99 ± 11.65% versus ERL: 86.66 ± 18.26%) and clinical attachment level gains (CPS: 2.76 ± 1.92 mm versus ERL: 2.06 ± 2.52 mm). CONCLUSION: Combined surgical resective/regenerative therapy of advanced peri-implantitis was effective on the long-term, but not influenced by the initial method of surface decontamination.

Long-term outcomes of simultaneous guided bone regeneration using native and cross-linked collagen membranes after 8 years.

OBJECTIVES: To assess the clinical outcomes of simultaneous guided bone regeneration using native (CM) and cross-linked (VN) collagen membranes at 8 years. MATERIALS AND METHODS: A total of n = 19 patients (19 implants) were available for the analysis. Each subject had received a simultaneous grafting of dehiscence-type defects using a natural bone mineral (NBM) and a random allocation to either CM and VN membranes (submerged healing of 4 months). Clinical parameters (e.g., bleeding on probing - BOP, probing pocket depth - PD, mucosal recession - MR, clinical attachment level - CAL) were recorded at 8 years after prosthesis installation. RESULTS: At 8 years, CM and VN groups revealed comparable median BOP, PD, MR and CAL values at both vestibular and oral aspects. From 4 to 8 years (n = 14 patients), median CAL at the vestibular aspect improved in both groups; however, these changes were significantly higher at CM-treated sites (CM: 0.7 mm vs. VN: 0.5 mm). CONCLUSION: The clinical long-term outcomes at 8 years were comparable in both VN and CM groups.

Initial case report of an extracted tooth root used for lateral alveolar ridge augmentation.

OBJECTIVES: Recent animal studies have indicated, that tooth roots reveal a structural and biological potential to serve as alternative autografts for localized ridge augmentation. This proof-of-concept initial report aimed at investigating, whether this new surgical concept may be applied to humans. MATERIAL & METHODS: In one patient, who was in need for horizontal ridge augmentation, the roots of a retained upper wisdom tooth were separated and rigidly fixed at the defect site. After 24 weeks of submerged healing, the primary endpoint was defined as gain in ridge width (mm) being sufficient to place an adequately dimensioned titanium implant at the respective site. Secondary outcomes included safety assessments. RESULTS: Soft tissue healing was uneventful during the entire observation period. Clinical re-entry at 24 weeks revealed, that the transplanted root was homogeneously incorporated at the former defect site and mainly replaced by a newly formed hard tissue. The gain in ridge width amounted to 4.5 mm and allowed for a successful implant placement with good primary stability. The procedure was not associated with any wound infection or adverse events. CONCLUSIONS: This novel approach may be further investigated in implant site development procedures.

Efficacy of alternative or adjunctive measures to conventional treatment of peri-implant mucositis and peri-implantitis: a systematic review and meta-analysis.

In patients with peri-implant mucositis and peri-implantitis, what is the efficacy of nonsurgical (i.e. referring to peri-implant mucositis and peri-implantitis) and surgical (i.e. referring to peri-implantitis) treatments with alternative or adjunctive measures on changing signs of inflammation compared with conventional nonsurgical (i.e. mechanical/ultrasonic debridement) and surgical (i.e. open flap debridement) treatments alone? After electronic database and hand search, a total of 40 publications (reporting on 32 studies) were finally considered for the qualitative and quantitative assessment. The weighted mean changes (WM)/ and WM differences (WMD) were estimated for bleeding on probing scores (BOP) and probing pocket depths (PD) (random effect model). Peri-implant mucositis: WMD in BOP and PD reductions amounted to -8.16 % [SE = 4.61] and -0.15 mm [SE = 0.13], not favouring adjunctive antiseptics/antibiotics (local and systemic) over control measures (p > 0.05). Peri-implantitis (nonsurgical): WMD in BOP scores amounted to -23.12 % [SE = 4.81] and -16.53 % [SE = 4.41], favouring alternative measures (glycine powder air polishing, Er:YAG laser) for plaque removal and adjunctive local antibiotics over control measures (p < 0.001), respectively. Peri-implantitis (surgical): WMD in BOP and PD reductions did not favour alternative over control measures for surface decontamination. WM reductions following open flap surgery (±resective therapy) and adjunctive augmentative therapy amounted to 34.81 and 50.73 % for BOP and 1.75 and 2.20 mm for PD, respectively. While mechanical debridement alone was found to be effective for the management of peri-implant mucositis, alternative/adjunctive measures may improve the efficacy over/of conventional nonsurgical treatments at peri-implantitis sites. Adjunctive resective and/or augmentative measures are promising; however, their beneficial effect on the clinical outcome of surgical treatments needs to be further investigated.