Influence of antiresorptive/antiangiogenic therapy on changes in periodontal and oral tissue structures: a histomorphometrical analysis in rats.

OBJECTIVE: The objective of this study was to investigate the influence of various antiresorptive and antiangiogenic medications on morphological changes in periodontal and oral tissue structures. MATERIALS AND METHODS: Fifty-five Wistar rats randomly received dual application (i.e., at baseline and after 12-weeks) one of the following medications: (1) amino-bisphosphonate [zoledronate (Zo)], (2) RANKL inhibitor [denosumab (De)], (3) antiangiogenic [bevacizumab (Be)], (4) Zo + Be, (5) De + Be or (6) no medication [Control (Co)]. Periodontal and oral tissue biopsies were obtained at 17 (n = 21 animals, Phase 1, (De = 3, De + Be = 3, Zo = 5, Be = 3, Zo + Be = 2, Co = 5) and 29 (n = 34 animals, (De = 8, De + Be = 6, Zo = 2, Be = 7, Zo + Be = 4, Co = 7, Phase 2) weeks after the second drug application. The following outcomes were histomorphometrically assessed: periodontal space width in the coronal (PLS-C, mm) and apical sections (PLS- A), number of empty alveolar bone lacunae in the coronal, apical sections and at the apex at respective tooth sites (EL - C, EL- A, EL- Ap), mucosal thickness at edentulous alveolar ridge areas (MT, mm), and, when present, associated areas of inflammatory cell infiltrates (ICI, mm2). RESULTS: Comparable mean PLS-C, PLS-A, ET-A, ET-C, ET-Ap, and MT values were observed in all experimental groups after Phases 1 and 2. The presence of ICI was identified in 3 animals in the Co group (Phase 1: 1, Phase 2: 2), and 17 animals in the test groups (Phase 1: 4; Phase 2: 14). The estimated ICI surface area was significantly higher in the Zo + Be group, followed by the Zo and Be groups compared to that measured in the Co group. The time (i.e., Phases 1 and 2) was not found to be a predictor for the extent of the ICI area. In all groups, the EL-C, EL-A, and EL-Ap values were significantly higher after Phase 2 compared to those assessed after Phase 1. The MT values were significantly reduced in all groups after Phase 2 compared to those measured after Phase 1. CONCLUSIONS: The present evaluation was not able to find any morphological effects of different antiresorptive and antiangiogenic medications on periodontal and oral tissue structures. The presence of inflammatory cell infiltrates was more frequently observed in the animals administered with antiresorptive and antiangiogenic medications as well as combinations thereof. CLINICAL RELEVANCE: Administration of antiresorptive and antiangiogenic medications may be capable of inducing inflammatory reactions in periodontal tissues.

Current concepts for the treatment of peri-implant disease.

Peri-implant diseases define bacterial-plaque-induced inflammatory conditions affecting implant-surrounding tissues, classified as peri-implant mucositis and peri-implantitis. Peri-implant mucositis characterizes an inflammatory lesion that resides in the soft-tissue compartment, whereas at peri-implantitis sites, the lesions also feature progressive loss of implant-supporting bone. Inflammation resolution of and disease progression arrestment are the main therapeutic endpoints of peri-implant diseases treatment. The present position paper presents the current evidence and clinical recommendations of the European Association for Osseointegration for the treatment of peri-implant diseases. Mechanical biofilm removal along with the reinforcement of patient-administered oral hygiene is considered the standard treatment for managing peri-implant mucositis. It is recommended to assess the outcomes of peri-implant mucositis treatment 2 to 3 months after therapy, and in the absence of treatment success, a repeated intervention should be considered. Peri-implantitis treatment should follow a stepwise treatment approach, starting with a non-surgical treatment, and if not sufficient, followed by the surgical intervention. Surgical peri-implantitis therapies encompass non-reconstructive, reconstructive, and combined treatment modalities. Implantoplasty may be advocated for the treatment of supracrestal peri-implant defects, whereas reconstructive therapy is indicated at peri-implantitis sites featuring intra-osseous defects with a depth of ≥ 3 mm. Adjunctive reconstructive measures may be beneficial in enhancing radiographic defect fill and maintaining postoperative soft-tissue levels, which may have a great impact in aesthetic cases. The adjunctive use of systemic antibiotics during surgical therapy does not seem to improve the clinical outcomes. Regular supportive peri-implant therapy with biofilm removal should be an integral part of the treatment protocol of peri-implant diseases. In the presence of advanced bone loss at implants that do not play a strategic role in masticatory function, implant removal may be immediately considered.

Influence of antiresorptive/antiangiogenic therapy on the surgical treatment outcomes of experimentally induced peri-implantitis lesions.

OBJECTIVE: To investigate the influence of various antiresorptive and antiangiogenic medications on the resolution of experimentally induced peri-implantitis lesions after different surgical treatment approaches. MATERIALS AND METHODS: Forty-eight albino rats randomly received a dual application of the following medications: (1) amino-bisphosphonate (zoledronate (Zo)) (n = 8), (2) RANKL inhibitor (denosumab (De)) (n = 8), (3) antiangiogenic (bevacizumab (Be)) (n = 8), (4) Zo + Be (n = 8), (5) De + Be (n = 8), or (6) no medication (control (Co)) (n = 8). Ligature-induced peri-implantitis lesions were established at 2 maxillary implants over 16 weeks. Afterward, animals were randomly treated either with open flap debridement (OFD) or reconstructive therapy (RT). Treatment procedures were followed by a 12-week healing period. The histological outcomes included residual defect length (DL); defect width (DW) at the bone crest (BC-DW); 25%, 50%, and 75% of the DL; and areas of inflammatory cell infiltrate (ICT). When present, areas of bone sequester (BS) were assessed considering the animal as a statistical unit. RESULTS: A total of 21 animals were analyzed (Zo: RT = 3, OFD = 1; De: RT = 3, OFD = 2; Be: OFD = 1; Zo + Be: RT = 2, OFD = 2; Co: RT = 3, OFD = 2). Implant loss rates were comparable among the experimental groups. Except for the 25% and 75% DW values that were significantly higher in the Zo + Be group compared to the Co group (p = 0.04 and p = 0.03, respectively), no significant differences were found among the experimental groups for the DL (lowest-Be: 0.56 mm; highest-Co: 1.05 mm), BC-DW (lowest-De: 0.86 mm, highest-Co: 1.07 mm), 50% DW (lowest-De: 0.86 mm; highest-Be + Zo: 1.29 mm), and ICT (lowest-Be: 0.56 mm2; highest-Be + Zo: 1.65 mm2). All groups, except for the Zo and Be following RT, showed presence of BS. CONCLUSIONS: The present findings did not reveal a marked effect of various antiresorptive/antiangiogenic medications on the resolution of experimentally induced peri-implantitis lesions, regardless of the surgical approach employed (OFD and RT). CLINICAL RELEVANCE: Resolution of peri-implantitis lesions may not be affected by the investigated antiresorptive/antiangiogenic medications.

Clinical efficacy of guided bone regeneration in peri-implantitis defects. A network meta-analysis.

Guided bone regeneration (GBR) at peri-implantitis-related bone defects involves the placement of bone-filler particles in the intrabony defects and the application of a barrier membrane. The efficacy of different GBR-supported reconstructive measures as well as their potential superiority compared to non-GBR-supported treatment strategies for bone defects at peri-implantitis sites, however, remains unclear. Therefore, this analysis was designed to evaluate the long-term (≥12 months) clinical efficacy of GBR-supported reconstructive surgical therapy for peri-implantitis-related bone defects. In terms of resolving inflammation, the implementation of GBR protocols applying xenogenic bone substitutes yielded a higher reduction of bleeding on probing and probing depth value compared to the GBR protocol applying autogenous bone. Furthermore, for the changes in bleeding on probing and probing depths, GBR approaches using xenogenic bone showed superiority over the non-GBR treatments. Xenogenic bone with or without a barrier membrane was associated with improved radiographic bone levels and less soft tissue recession compared to the use of a GBR protocol implementing autogenous bone. Nonetheless, when interpreting this findings, the limited number of available studies with low to serious risk of bias and the short follow-up periods limited to 12 months should be considered.

Three-dimensional changes of a porcine collagen matrix and free gingival grafts for soft tissue augmentation to increase the width of keratinized tissue around dental implants: a randomized controlled clinical study.

BACKGROUND: Emerging clinical data points to the relevance of the presence of keratinized tissue (KT). Although apically positioned flap/vestibuloplasty along with free gingival graft (FGG) is considered as a standard intervention for augmenting KT, substitute materials appear to be a viable treatment alternative. So far, there is a lack of data investigating the dimensional changes at implant sites treated with soft-tissue substitutes or FGG. AIM: The present study aimed at comparing three-dimensional changes of a porcine derived collagen matrix (CM) and FGG for increasing KT at dental implants over a 6-month follow-up period. MATERIALS AND METHODS: The study enrolled 32 patients exhibiting deficient KT width (i.e., < 2 mm) at the vestibular aspect who underwent soft tissue augmentation using either CM (15 patients/23 implants) or FGG (17 patients/31 implants). The primary outcome was defined as tissue thickness change (mm) at treated implant sites between 1- (S0), 3- (S1), and 6-months (S2). Secondary outcomes considered changes of KT width over a 6-month follow-up period, surgical treatment time, and patient-reported outcomes. RESULTS: Dimensional analyses from S0 to S1 and from S0 to S2 revealed a mean decrease in tissue thickness of - 0.14 ± 0.27 mm and - 0.04 ± 0.40 mm in the CM group, and - 0.08 ± 0.29 mm and - 0.13 ± 0.23 mm in the FGG group, with no significant differences noted between the groups (3 months: p = 0.542, 6 months: p = 0.659). Likewise, a comparable tissue thickness decrease was observed from S1 to S2 in both groups (CM: - 0.03 ± 0.22 mm, FGG: - 0.06 ± 0.14 mm; p = 0.467). The FGG group exhibited a significantly greater KT gain after 1, 3 and 6 months compared to the CM group (1 month: CM: 3.66 ± 1.67 mm, FGG: 5.90 ± 1.58 mm; p = 0.002; 3 months: CM: 2.22 ± 1.44; FGG: 4.91 ± 1.55; p = 0.0457; 6 months: CM: 1.45 ± 1.13 mm, FGG: 4.52 ± 1.40 mm; p < 0.1). Surgery time (CM: 23.33 ± 7.04 min.; FGG: 39.25 ± 10.64 min.; p = 0.001) and postoperative intake of analgesics were significantly lower in the CM group (CM: 1.2 ± 1.08 tablets; FGG: 5.64 ± 6.39 tablets; p = 0.001). CONCLUSIONS: CM and FGG were associated with comparable three-dimensional thickness changes between 1 and 6 months. While a wider KT band could be established with FGG, the use of CM significantly reduced surgical time and patients´ intake of analgesics.

Influence of antiresorptive/antiangiogenic therapy on the extension of experimentally induced peri-implantitis lesions.

OBJECTIVES: To investigate the extension of experimentally induced peri-implantitis lesions under various antiresorptive and antiangiogenic medications. MATERIAL AND METHODS: Fourty-eight albino rats had randomly received the following medications (dual application, n = 8 each): (1) amino-bisphosphonate (zoledronate) (Zo), (2) RANKL inhibitor (denosumab) (De), (3) antiangiogenic (bevacizumab) (Be), (4) Zo+Be, (5) De+Be, or (6) no medication (Co). Ligature- and lipopolysaccharide-induced peri-implantitis lesions were established at 2 maxillary implants over a period of 16 weeks. Histological (e.g., apical extension and surface area of the inflammatory cell infiltrate-aICT, ICT; defect length; defect width; CD68 positive cells) and bone micromorphometric (µCT) outcomes were assessed. The animal was defined as a statistical unit. RESULTS: A total of n = 38 animals (Zo = 6, De = 6, Be = 8, Zo + Be = 6, De + Be = 5, Co = 7) were analyzed. ICT's were commonly marked by a positive CD68 antigen reactivity. Comparable median aICT (lowest-Zo: 0.53 mm; highest-Be: 1.22 mm), ICT (lowest-De + Be: 0.00 mm2; highest-Co: 0.49 mm2), defect length (lowest-Zo: 0.90 mm; highest-Co: 1.93 mm) and defect width (lowest-De+Be: 1.27 mm; highest-Be: 1.80 mm) values were noted in all test and control groups. Within an inner (diameter: 0.8 mm) cylindric volume of interest, the bone microstructure did not significantly differ between groups. CONCLUSIONS: The present analysis did not reveal any marked effects of various antiresorptive/ antiangiogenic medications on the extension of experimentally induced peri-implantitis lesions. CLINICAL RELEVANCE: The extension of peri-implantitis lesions may not be facilitated by the antiresorptive and antiangiogenic medications investigated.

Effectiveness of modified and control protocols for the surgical therapy of combined peri-implantitis-related defects. A retrospective analysis.

OBJECTIVES: To compare the clinical effectiveness of control and two modified protocols for surgical therapy of combined peri-implantitis-related defects. MATERIALS AND METHODS: A total of n = 36 patients (n = 40 implants) diagnosed with combined supra- and intrabony defects were identified for this retrospective analysis. All protocols considered access flap surgery, granulation tissue removal and implant surface decontamination using a titanium brush. The control combined protocol included implantoplasty at supracrestal/ buccal- and reconstructive therapy at intrabony components using a particulate natural bone mineral + a native collagen membrane (CM) (n = 11 patients, n = 11 implants, CP). The modified protocols included the augmentation at both supra- and intrabony defect components using either a collagen-stabilized natural bone mineral (BOC) (n = 15 patients, n = 15 implants, MP1), or BOC mixed with autogenous bone chips + CM (n = 10 patients, n = 14 implants, MP2). Linear mixed effects analyses were used to assess the changes in clinical parameters (i.e., bleeding on probing - BOP, probing pocket depth - PD, and mucosal recession - MR) over time (i.e., 6 and 12 months) and the impact of the treatment groups (CP, MP1, MP2). RESULTS: At 12 months, median BOP and PD reductions amounted to -58.33% and - 1.16 mm in the MP1, to -62.50% and -1.95 mm in the MP2, and to -66.67% and -0.83 mm in the CP groups, respectively. The associated MR changes ranged between 0.00 and 0.08 mm. The survival rates were 100% in all groups. CONCLUSIONS: All treatment protocols were associated with short-term improvements in the clinical parameters investigated.

Photo/mechanical and physical implant surface decontamination approaches in conjunction with surgical peri-implantitis treatment: A systematic review.

AIM: To evaluate the efficacy of adjunctive/alternative photo/mechanical and physical implant-surface decontamination approaches compared to standard instrumentation in conjunction with surgical peri-implantitis treatment. MATERIALS AND METHODS: Randomized controlled clinical trials (RCTs) and controlled clinical trials investigating the efficacy of adjunctive or alternative photo/mechanical/physical measures for implant surface decontamination in conjunction with surgical peri-implantitis treatment without (PICOS 1) or with (PICOS 2) additional decontamination methods performed in test and control groups with changing inflammation parameters were covered. Changes in bleeding scores (i.e., bleeding index, or bleeding on probing [BOP]), suppuration, and probing depth (PD) were considered the primary outcomes. RESULTS: Six articles describing five original RCTs were eligible for analysis. Based on two RCTs, the adjunctive/alternative use of air polishing with glycine or erythritol powder did not improve BOP reduction compared to standard instrumentation (PICOS 1). Based on one RCT, alternative use of titanium brushes resulted in significantly higher BOP reduction compared to either air polishing or standard instrumentation (PICOS 1). During reconstructive therapy and as an adjunct to implantoplasty, use of a titanium brush did not have any benefit on the BOP and mean PD reductions compared to the control group (i.e., implantoplasty + mechanical and chemical implant surface decontamination; one RCT; PICOS 2). Use of the Er:YAG laser resulted in significantly higher PD reduction after 6 months (one RCT), whereas no difference between the test and respective controls could be detected after 1 and 2 years (one RCT). Additionally, the use of the Er:YAG laser was not associated with improved BOP reductions over respective controls (two RCTs; PICOS 2). CONCLUSIONS: Owing to the limited available data, clinical efficacy of photo/mechanical and physical implant surface decontamination in conjunction with surgical peri-implantitis therapy is inconclusive. However, titanium brushes may be beneficial in reducing signs of inflammation.

Reliability of probing depth assessments at healthy implant sites and natural teeth.

AIM: To evaluate the intra- and inter-examiner reliability in the assessment of probing depth (PD) measurements at healthy dental implant sites and periodontally healthy natural teeth. MATERIALS AND METHODS: Five patients exhibiting 21 dental implants were enrolled in the study. Eight experienced examiners performed duplicate PD measurements at six sites of all implants and of preselected natural teeth. Intra-examiner accuracy was estimated using intra-examiner correlation coefficients (ICCs) with 95% confidence intervals (CI). A gold standard (GS) examiner was set. Inter-examiner accuracy compared to the GS examiner was assessed using pairwise inter-examiner ICCs. RESULTS: The intra-examiner ICC ranged from 0.759 (95% CI, 0.692-0.812) to 0.863 (95% CI, 0.826-0.892) for the measurements at teeth and from 0.712 (95% CI, 0.580-0.800) to 0.841 (95% CI, 0.774-0.888) for the PDs assessed at implants. The inter-examiner ICCs for tooth measurements varied from 0.197 (95% CI, - 0.280 to 0.511) to 0.791 (95% CI, 0.560-0.892). The corresponding values for the assessments at implants varied from 0.576 (95% CI, 0.286-0.734) to 0.794 (95% CI, 0.708-0.855). CONCLUSIONS: The intra- and inter-examiner reproducibility of repeated PD measurements assessed by experienced examiners tended to be higher for the measurements at periodontally healthy teeth compared to healthy dental implant sites. CLINICAL RELEVANCE: Experienced examiners demonstrated a higher degree of reliability of probing measurements around teeth compared to dental implants.

Surgical interventions for the treatment of peri-implantitis.

BACKGROUND: Peri-implantitis constitutes one of the most frequent late dental implant complications. The disease is initiated by bacterial infection; therefore, anti-infective peri-implantitis treatment strategies are required to arrest the progressive marginal bone loss and maintain the affected implant in function. Although nonsurgical treatment strategies appear to be of limited predictability, treatment outcomes have been frequently improved following surgical interventions. PURPOSE: The present narrative review describes various surgical peri-implantitis treatment modalities, with respect to their indications, performance, and effectiveness. MATERIALS AND METHODS: The present narrative review considered the most relevant studies in the field published in the English language. RESULTS: Surgical peri-implantitis treatment approaches can be categorized as nonreconstrucive therapy, reconstructive therapy, and combined therapy (ie, reconstructive and resective therapy). In addition to disease resolution, reconstructive approaches also seek to regenerate the bone defect and achieve reosseointegration. CONCLUSIONS: The severity of the disease, the regenerative potential of the defetc and esthetic demands of the patient are the factors determining the surgical peri-implantitis treatment modality.

Importance of keratinized mucosa around dental implants: Consensus report of group 1 of the DGI/SEPA/Osteology Workshop.

OBJECTIVES: To assess the literature on (i) the relevance of the presence of a minimum dimension of keratinized peri-implant mucosa (KPIM) to maintain the health and stability of peri-implant tissues, and; (ii) the surgical interventions and grafting materials used for augmenting the dimensions of the KPIM when there is a minimal amount or absence of it. MATERIAL & METHODS: Two systematic reviews complemented by expert opinion from workshop group participants served as the basis of the consensus statements, implications for clinical practice and future research, and were approved in plenary session by all workshop participants. RESULTS: Thirty-four consensus statements, eight implications for clinical practice, and 13 implications for future research were discussed and agreed upon. There is no consistent data on the incidence of peri-implant mucositis relative to the presence or absence of KPIM. However, reduced KPIM width is associated with increased biofilm accumulation, soft-tissue inflammation, greater patient discomfort, mucosal recession, marginal bone loss and an increased prevalence of peri-implantitis. Free gingival autogenous grafts were considered the standard of care surgical intervention to effectively increase the width of KPIM. However, substitutes of xenogeneic origin may be an alternative to autogenous tissues, since similar results when compared to connective tissue grafts were reported. CONCLUSION: Presence of a minimum width of KPIM should be assessed routinely in patients with implant supported restorations, and when associated with pathological changes in the peri-implant mucosa, its dimensions may be surgically increased using autogenous grafts or soft-tissue substitutes with evidence of proven efficacy.

Influence of width of keratinized tissue on the prevalence of peri-implant diseases: A systematic review and meta-analysis.

AIM: To evaluate the influence of the width of keratinized tissue (KT) on the prevalence of peri-implant diseases, and soft- and hard-tissue stability. MATERIALS AND METHODS: Clinical studies reporting on the prevalence of peri-implant diseases (primary outcome), plaque index (PI), modified plaque index (mPI), bleeding index (mBI), bleeding on probing (BOP), probing pocket depths (PD), mucosal recession (MR), and marginal bone loss (MBL) and/or patient-reported outcomes (PROMs; secondary outcomes) were searched. The weighted mean differences (WMD) were estimated for the assessed clinical and radiographic parameters by employing a random-effect model that considered different KT widths (i.e., <2 and ≥2 mm). RESULTS: Twenty-two articles describing 21 studies (15 cross-sectional, five longitudinal comparative studies, and one case series with pre-post design) with an overall high to low risk of bias were included. Peri-implant mucositis and peri-implantitis affected 20.8% to 42% and at 10.5% to 44% of the implants with reduced or absent KT (i.e., <2 mm or 0 mm). The corresponding values at the implant sites with KT width of ≥2 mm or >0 mm were 20.5% to 53% and 5.1% to 8%, respectively. Significant differences between implants with KT < 2 mm and those with KT ≥ 2 mm were revealed for WMD for BOP, mPI, PI, MBL, and MR all favoring implants with KT ≥ 2 mm. CONCLUSION: Reduced KT width is associated with an increased prevalence of peri-implantitis, plaque accumulation, soft-tissue inflammation, mucosal recession, marginal bone loss, and greater patient discomfort.

Efficacy of autogenous tooth roots for a combined vertical and horizontal alveolar ridge augmentation and staged implant placement. A prospective controlled clinical study.

OBJECTIVES: To assess and compare the efficacy and safety of autogenous tooth roots (TRs) and autogenous bone blocks (ABs) for combined vertical and horizontal alveolar ridge augmentation and two-stage implant placement. MATERIALS AND METHODS: A total of 28 patients in need of implant therapy and vertical ridge augmentation were allocated to parallel groups receiving either healthy autogenous tooth roots (e.g., retained wisdom teeth) (n = 14, n = 15 defects) or cortical autogenous bone blocks harvested from the retromolar area (n = 14, n = 17 defects). After 26 weeks of submerged healing, the clinical reduction in ridge height (RH) deficiency was defined as the primary outcome. RESULTS: Both surgical procedures were associated with a similar mean reduction in RH deficiency values, amounting to 4.48 ± 2.42 mm (median: 4.25; 95% CI: 3.08-5.88) in the TR group and 4.46 ± 3.31 mm (median: 3.00; 95% CI: 2.54-6.38) in the AB group (p = .60, Mann-Whitney U-test). In all patients investigated, the reduction in RH deficiency values allowed for an adequate implant placement at the respective sites. The frequency of complications (e.g., soft tissue dehiscences) was low (TR: n = 4; AB: n = 0). CONCLUSIONS: Up to staged-implant placement, both TR and AB grafts appeared to be associated with comparable efficacy and safety for combined vertical and horizontal alveolar ridge augmentation.

Volumetric tissue changes following combined surgical therapy of peri-implantitis: A 2-year follow-up analysis. A prospective case series.

AIM: To assess volumetric tissue changes following combined surgical therapy of peri-implantitis over a follow-up period of 24 months. MATERIALS AND METHODS: A total of 20 patients (n = 28 implants) were diagnosed with peri-implantitis and underwent access flap surgery, implantoplasty, and augmentative therapy at intrabony components (ie, combined therapy) using a natural bone mineral and a native collagen membrane. The peri-implant region of interest (ROI) was intraorally scanned pre-operatively (S0), and after 12 (S3) and 24 (S4) months. Digital files were superimposed for the assessment of volumetric changes between the referred time points. The change in thickness was assessed at a standardized ROI, segmented into two equidistant sections (ie, marginal and apical). RESULTS: Peri-implant tissues exhibited a nonsignificant mean thickness loss of 0.16 (95% CI: -4 to 0.06) and 0.17 mm (95% CI: -0.05 to 0.4) at S3 and S4, respectively. S0-S3 dimensional thickness changes at marginal and apical areas were -0.24 (95% CI: -0.48 to 0.002) and -0.19 mm (95% CI: -0.36 to -0.2), respectively. Dimensional changes from S0 to S4 amounted to -0.22 mm (95% CI: -0.46 to 0.02) and -0.07 mm (95% CI: -0.09 to 0.2), respectively. The thickness changes at marginal and apical ROIs were significant from S0 to S3. Clinical parameters (ie, plaque index, bleeding on probing, and probing depth) significantly improved over the 24-month follow-up period. Linear regression analyses revealed no significant association between baseline bone loss (%), width of keratinized mucosa, and mucosal recession scores and thickness changes. CONCLUSIONS: Peri-implant tissues revealed minor volumetric changes at 12 and 24 months after combined surgical therapy.

Esthetic complications in implant dentistry.

Esthetic complications in implant dentistry have become a significant consideration for patients and practitioners. This review presents an appraisal on the current knowledge of the physiological peri-implant soft-tissue dimensions and factors that may compromise peri-implant tissue esthetics. Factors such as papilla fill adjacent to the implant and midfacial mucosal height are critical parameters that determine the esthetic success of implant-supported restorations. Papilla fill adjacent to a single dental implant appears to depend upon the clinical attachment level of the neighboring tooth. A horizontal inter-implant distance of at least 3 mm is necessary to ensure optimal interproximal mucosal embrasure between two adjacent implants in the anterior maxilla. In cases where implants cannot be placed at least 3 mm apart, a single implant with a cantilever bridge should be considered. Buccolingual implant positioning plays a major role in midfacial mucosal height. Soft-tissue volume grafting following immediate implant placement in the presence of a thin soft-tissue phenotype or simultaneous to surgical peri-implantitis therapy might help to overcome facial mucosa recession.

It is all about peri-implant tissue health.

Healthy peri-implant tissues have become synonymous with implant success and a major challenge in contemporary implant dentistry. Numerous local and systemic factors, as well as iatrogenic and other hitherto underappreciated factors of potential clinical relevance may influence the outcome of implant therapy. In this volume of Periodontology 2000, a group of outstanding experts has elaborated on the latest insights on the prevention and management of major surgical, biological and technical complications, to facilitate the establishment and maintenance of peri-implant health. This volume focusses on factors affecting early and late implant loss and the potential role of systemic diseases and local conditions. It comprehensively discusses the implementation of guided implant surgery to facilitate the cleansibility of implant-supported restorations, as well as iatrogenic factors related to bone augmentation/sinus grafting procedures. The challenges associated with soft-tissue grafting and the prevention of esthetic complications are also reviewed as the paradigm of success in implant dentistry shifts from implant survival towards a greater focus on patient-reported outcomes. Prosthetic failures remain a significant challenge and are discussed in light of new evidence, as is the relevance of the structural dimensions of the peri-implant mucosa. The volume closes with detailed and well-illustrated appraisals of the surgical management of peri-implantitis, the management and sequelae of dental implant removal, and the latest evidence for the oral health related quality of life in patients treated with dental implants.

Surgical therapy of peri-implantitis.

Peri-implantitis is caused by a bacterial challenge; therefore, anti-infective treatment strategies should be employed to manage the disease. As nonsurgical approaches demonstrate limited efficacy in most cases of peri-implantitis, surgical interventions are often required. Treatment outcomes improve following access flap surgery, with or without adjunctive resective and/or augmentation measures. Whereas nonaugmentative therapies (ie, access flap surgery and resective techniques) primarily aim to resolve inflammation and arrest further disease progression, augmentation approaches also seek to regenerate the bony defect and achieve reosseointegration. Currently, limited evidence supports the superiority of augmentative surgical techniques for peri-implantitis treatment over nonaugmentation methods, and human histologic evidence for reosseointegration is sparse. For patients involved in regular postoperative maintenance programs, success of peri-implantitis surgical treatment based on various definitions of success was obtained in over half of the cases after 5-7 years. Despite surgical treatment, cases of further disease progression that required retreatment or led to implant loss were reported.

Efficacy of rehabilitation with different approaches of implant-supported full-arch prosthetic designs: A systematic review.

AIM: To evaluate the efficacy of different types of rehabilitation with fixed or removable full-arch implant-supported prosthesis designs in terms of implant loss and success in patients with at least one edentulous jaw, with tooth loss mainly due to periodontitis. MATERIALS AND METHODS: Clinical studies with at least 12 months reporting on implant loss and implant success were searched. Meta-analysis was conducted to estimate cumulative implant loss considering different prostheses designs. RESULTS: A total of 11 studies with unclear to low risk of bias were included in the analysis. Estimated cumulative implant loss for fixed prostheses within 1 year and 5 years was 0.64% (95% confidence interval [CI]: 0.31%-1.31%) and 1.85% (95% CI: 0.85%-3.95%), respectively. The corresponding values for removable prostheses amounted to 0.71% (95% CI: 0.22%-2.28%) and 4.45% (95% CI: 2.48%-7.85%). Peri-implantitis affected 10%-50% of the patients restored with implant-supported fixed prostheses. CONCLUSIONS: Based on the limited low-quality data, the present analysis points to a low and similar cumulative implant loss within 1 year for patients with tooth loss mainly due to stage IV periodontitis restored with either removable or fixed implant-supported full-arch prosthesis. At 5 years of functioning, there was a tendency for better outcomes using fixed designs.

Significance of probing for monitoring peri-implant diseases.

Peri-implant diseases at implant sites represent the most considerable concern for many dental clinicians nowadays due to their detrimental effect on implant longevity. Preventive measures include patient education and motivation, supportive peri-implant therapy and routine assessment of the hard and soft tissues. Nevertheless, the reliability of clinical parameters to monitor peri-implant conditions is subject to debate. As such, the primary purpose of the present review was to gain further insight into the diagnostic accuracy of probing as a clinical tool to monitor dental implants and assist clinicians in preventing peri-implant diseases. Studies have recommended periodic probing to monitor the condition of the peri-implant tissues. Increased probing pocket depth, profuse bleeding on probing and suppuration at implants are clinical signs that have been associated with peri-implantitis; thus, if these clinical parameters are present, radiographic assessment is encouraged to make a definitive diagnosis considering potential inaccuracies related to local and/or systemic factors identified in the present review.