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1.
Artigo em Inglês | MEDLINE | ID: mdl-33819321

RESUMO

This paper reports on a study undertaken to ascertain the efficacy of the erbium:YAG laser (EYL) for peri-implantitis treatment. A total of 12 patients with bone loss resulting from peri-implantitis were involved in this study. The treatment protocol consisted of using the EYL for implant surface debridement and deproteinized bovine bone mineral (DBBM) for bone grafting. The following parameters were analyzed: probing pocket depth (PPD), clinical attachment level (CAL), bleeding on probing (BOP), bone levels (BLs), and the lipopolysaccharide levels before and after debridement with the EYL. This study found a statistically significant improvement in PPD, CAL, BOP, and BL at 3 and 12 months postoperative. Furthermore, a statistically significant decrease in implant-surface LPS levels was observed following debridement with the EYL. These findings show that using the EYL for debridement in peri-implantitis cases is effective in decreasing LPS levels. Moreover, after partial reconstruction with DBBM grafting, BLs were restored for at least 12 months. It was shown in one case that BLs had remained stable over 6 years, which also attests to the efficacy of this treatment. The combined use of EYL and DBBM could be effective for regenerative surgical peri-implantitis treatment.


Assuntos
Implantes Dentários , Lasers de Estado Sólido , Peri-Implantite , Animais , Biomarcadores , Bovinos , Érbio , Humanos , Lasers de Estado Sólido/uso terapêutico , Peri-Implantite/cirurgia
2.
Artigo em Inglês | MEDLINE | ID: mdl-33819337

RESUMO

Keratinized mucosa (KM) is regarded as a key factor in peri-implant health. A lack of KM has been associated with discomfort, higher plaque accumulation, and mucosal inflammation. Persistent inflammation might lead to progressive peri-implant bone loss. Several approaches to manage peri-implantitis have been advocated. Despite the effectiveness shown by surgical therapeutic modalities, soft tissue conditioning seems pivotal for long-term peri-implant health and stability. Free epithelial grafts have been demonstrated to efficiently augment the band of KM. Nevertheless, morbidity, dynamic soft tissue changes, and longer healing periods are shortcomings to be considered. The purpose of this technical note is to provide an alternative therapeutic modality for the surgical management of peri-implantitis combined with simultaneous soft tissue conditioning by means of pedicle flaps. Three main clinical scenarios are provided to conceive pedicle epithelial or connective tissue flaps, combined or not with collagen matrices, as predictable approaches to augment KM in the surgical therapy of peri-implantitis.


Assuntos
Implantes Dentários , Placa Dentária , Peri-Implantite , Tecido Conjuntivo , Implantes Dentários/efeitos adversos , Humanos , Peri-Implantite/cirurgia , Retalhos Cirúrgicos
3.
Lasers Med Sci ; 36(3): 619-629, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33590365

RESUMO

The aim of this study was comparing different lasers with conventional non-surgical treatment (CNT) for the management of peri-implantitis, regarding probing depth (PD), plaque index (PLI), clinical attachment level (CAL), and sulcus bleeding index (SBI). Randomized controlled trials (RCTs) on different lasers and CNT for peri-implantitis were searched. Pairwise and network meta-analyses were performed to analyze the PD, PLI, CAL, and SBI outcomes. The risk of bias, evidence quality, statistical heterogeneity, and ranking probability were also evaluated. Eleven studies were included in this study, involving three types of lasers. Diode + CNT had significantly superior efficacy to CNT alone, regarding PD reduction, while Er:YAG + CNT had significantly superior efficacy than CNT in terms of the PLI, CAL, and SBI. The highest probability of being most effective for PD was diode + CNT (49%), while Er:YAG + CNT had the highest probability of improving the PLI, CAL, and SBI (66%, 53%, and 79%, respectively). Diode + CNT was significantly superior for PD management in peri-implantitis compared with CNT alone, while Er:YAG + CNT significantly improved the PLI, CAL, and SBI. Therefore, Er:YAG + CNT might be recommended methods considered for management of peri-implantitis.


Assuntos
Lasers , Peri-Implantite/cirurgia , Adulto , Índice de Placa Dentária , Hemorragia/etiologia , Humanos , Metanálise em Rede , Probabilidade , Viés de Publicação , Ensaios Clínicos Controlados Aleatórios como Assunto , Risco , Resultado do Tratamento
4.
Clin Oral Investig ; 25(4): 1627-1640, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33616805

RESUMO

OBJECTIVE: This integrative review aimed to report the toxic effect of submicron and nano-scale commercially pure titanium (cp Ti) debris on cells of peri-implant tissues. MATERIALS AND METHODS: A systematic search was carried out on the PubMed electronic platform using the following key terms: Ti "OR" titanium "AND" dental implants "AND" nanoparticles "OR" nano-scale debris "OR" nanometric debris "AND" osteoblasts "OR "cytotoxicity" OR "macrophage" OR "mutagenic" OR "peri-implantitis". The inclusion criteria involved articles published in the English language, until December 26, 2020, reporting the effect of nano-scale titanium particles as released from dental implants on the toxicity and damage of osteoblasts. RESULTS: Of 258 articles identified, 14 articles were selected for this integrative review. Submicron and nano-scale cp Ti particles altered the behavior of cells in culture medium. An inflammatory response was triggered by macrophages, fibroblasts, osteoblasts, mesenchymal cells, and odontoblasts as indicated by the detection of several inflammatory mediators such as IL-6, IL-1ß, TNF-α, and PGE2. The formation of a bioactive complex composed of calcium and phosphorus on titanium nanoparticles allowed their binding to proteins leading to the cell internalization phenomenon. The nanoparticles induced mutagenic and carcinogenic effects into the cells. CONCLUSIONS: The cytotoxic effect of debris released from dental implants depends on the size, concentration, and chemical composition of the particles. A high concentration of particles on nanometric scale intensifies the inflammatory responses with mutagenic potential of the surrounding cells. CLINICAL RELEVANCE: Titanium ions and debris have been detected in peri-implant tissues with different size, concentration, and forms. The presence of metallic debris at peri-implant tissues also stimulates the migration of immune cells and inflammatory reactions. Cp Ti and TiO2 micro- and nano-scale particles can reach the bloodstream, accumulating in lungs, liver, spleen, and bone marrow.


Assuntos
Implantes Dentários , Peri-Implantite , Humanos , Macrófagos , Osteoblastos , Titânio/toxicidade
5.
J Am Dent Assoc ; 152(3): 189-201.e1, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33632408

RESUMO

BACKGROUND: The impact of hyperglycemia on dental implant therapy remains unclear. In this systematic review and meta-analysis, the authors compared the rates of implant failure and peri-implant bleeding on probing (BOP), probing depth (PD), and peri-implant bone loss (PIBL) among patients with type 2 diabetes mellitus and nondiabetic patients. The authors performed subgroup analyses based on glycemic level to evaluate whether patients with higher glycemic levels were more prone to peri-implant inflammation. TYPE OF STUDIES REVIEWED: The authors searched 4 databases for original clinical studies. Studies in which the researchers provided information on the rate of implant failure or peri-implant parameters were included. RESULTS: Nine clinical studies were identified on the basis of the inclusion criteria. No significant differences were found in rates of implant failure (P = .46) and PD (P = .1) between diabetic and nondiabetic patients. Significant differences in BOP (P < .00001) and PIBL (P = .02), favoring nondiabetic patients, were observed. Results of subgroup analyses indicated that the increase in glycemic level did not significantly influence BOP, PD, and PIBL values among diabetic patients. CONCLUSIONS AND PRACTICAL IMPLICATIONS: Patients with type 2 diabetes mellitus seem to be able to achieve a rate of implant survival similar to that of healthy patients. Regarding peri-implant parameters, BOP and PIBL were higher in patients with type 2 diabetes mellitus, indicating that hyperglycemia is an important risk factor for peri-implant inflammation. No association was found between peri-implant parameters and glycemic level among patients with type 2 diabetes mellitus, providing oral hygiene was strictly maintained.


Assuntos
Perda do Osso Alveolar , Implantes Dentários , Diabetes Mellitus Tipo 2 , Hiperglicemia , Peri-Implantite , Índice de Placa Dentária , Diabetes Mellitus Tipo 2/complicações , Humanos , Hiperglicemia/etiologia , Índice Periodontal
6.
Int J Prosthodont ; 34: s21-s26, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33571324

RESUMO

PURPOSE: To provide an overview of the influence of medical and geriatric factors on implant survival in order to form clinical recommendations for the practitioner. MATERIALS AND METHODS: This narrative literature review was performed to address the following questions: (1) Is age (> 75 years) a risk factor for implant survival?; (2) Is diabetes mellitus a risk factor for implant survival?; and (3) Is antiresorptive therapy a risk factor for implant survival? The PubMed, Web of Knowledge (Thomson Reuters), and Google Scholar databases were searched for systematic reviews and research papers of evidence level II and above that were published up to February 2019 for each topic. RESULTS: (1) Age > 75 years does not affect implant survival according to short-term follow up (1 to 5 years). However, polypharmacy should be considered in this patient group. (2) Diabetes mellitus is not a risk factor for implant survival in the short term, but there is no information on appropriate perioperative treatment and wound closure. There is little evidence in the literature on the success of bone grafting and progressive loading protocols in diabetic patients. (3) Implant therapy cannot be recommended in patients under high-dose bisphosphonate and antibody therapy. Bone grafting should be avoided under antiresorptive therapy. There are no treatment regimens available for patients with peri-implantitis receiving antiresorptive medication. CONCLUSION: This review suggests that the risk assessment for an implant patient should not be based on age, but rather on the patient's specific risk factors, such as former and current diseases and medication.


Assuntos
Conservadores da Densidade Óssea , Implantes Dentários , Peri-Implantite , Idoso , Implantação Dentária Endo-Óssea , Falha de Restauração Dentária , Humanos , Fatores de Risco
7.
Int J Prosthodont ; 34: s27-s45, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33571325

RESUMO

PURPOSE: To assess the prevalence of peri-implant diseases (ie, peri-implant mucositis and peri-implantitis) in patients rehabilitated with full-arch, implant-supported restorations. MATERIALS AND METHODS: A search protocol was developed to answer the following focus question: What is the prevalence of peri-implant diseases in edentulous patients rehabilitated with implant-supported fixed or removable restorations? RCTs, controlled clinical trials, and prospective studies with at least 12 months of follow-up and a minimum of 10 patients having at least one edentulous arch were searched. RESULTS: A total of 18 studies (3 RCTs, 1 nonrandomized controlled trial, and 14 prospective studies) were included. According to a single study, the prevalence of peri-implant mucositis in fully edentulous patients was 57%, corresponding to 47% at the implant level. The prevalence of peri-implant mucositis among patients having at least one edentulous arch ranged between 0% and 13.7% of patients, and from 0% to 20% of implants. In fully edentulous patients, the prevalence of peri-implantitis was found to range between 1.5% and 29.7% of patients and between 2.1% and 20.3% of the implants, while the corresponding values among the patients with at least one edentulous arch were 0% to 25% and 0% to 7.2%, respectively. CONCLUSION: Edentulous patients (fully edentulous or at least one edentulous arch) restored with either fixed or removable restorations were frequently affected by peri-implant disease.


Assuntos
Implantes Dentários , Peri-Implantite , Prótese Dentária Fixada por Implante , Falha de Restauração Dentária , Seguimentos , Humanos , Peri-Implantite/epidemiologia , Prevalência , Estudos Prospectivos
8.
Int J Oral Maxillofac Implants ; 36(1): 86-93, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33600527

RESUMO

PURPOSE: Gingiva-resident memory B cells found recently in healthy periodontal tissue may play important roles in maintaining homeostasis against bacterial plaque. Whether resident memory B cells exist in healthy peri-implant tissue and how they respond in peri-implantitis lesions are of interest. The aim of this study was to preliminarily investigate whether memory B cell activities are related to inflamed or healthy peri-implant status. MATERIALS AND METHODS: Patients with peri-implantitis or healed implants were recruited. The gingiva samples were collected and divided into inflamed (n = 4), treated (n = 4), and healed (n = 3) groups, followed by a flow cytometry analysis staining with CD3, CD19, CD27, CD38, and RANKL. The biopsy samples were also cryo-embedded for immunofluorescent double staining of CD19 and CD27. RESULTS: CD27+ CD38+ ASC comprised 83.3% ± 3.3% of the total B cells in the inflamed group, and this proportion in the treated group was reduced to 44.5% ± 13.4%. The proportion of CD27+ CD3+ T cells was found to be unchanged between the inflamed and treated groups. Immunofluorescent staining indicated that CD19+ CD27+ population infiltrated peri-implant connective tissue. RANKL was expressed by almost all B cells and a portion of T cells in the inflamed group, while the proportions of RANKL+ B and T cells were significantly reduced in the treated group. Barely any memory B cells were detected in the healed group. CONCLUSION: Memory B cells were markedly activated in peri-implantitis and responded to the suprastructure removal treatment. The lack of gingiva-resident memory B cells in the clinically healed implants serves as a hint for the weakness of peri-implant tissue against bacterial plaque.


Assuntos
Implantes Dentários , Peri-Implantite , Linfócitos B , Gengiva , Humanos , Projetos Piloto
9.
Int J Oral Maxillofac Implants ; 36(1): 115-121, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33600531

RESUMO

PURPOSE: Peri-implantitis, a potentially progressive disease that occurs in patients with dental implants, is more aggressive than periodontal lesions, which makes the prevention of peri-implantitis an important priority. Due to problems in the early detection of peri-implantitis, there is an urgent need for discovering novel biologic molecules with the ability of early diagnosis. The goal of this study was to profile the microRNA content of saliva samples collected from patients with titanium-aluminum-vanadium alloy dental implants who experienced peri-implantitis and to find potential diagnostic markers for detection of this disease. MATERIALS AND METHODS: The microRNA expression profiles of eight saliva samples (four collected from patients with peri-implantitis, four collected from patients who have successful implants) were investigated, and the deregulation of select microRNAs was further confirmed using quantitative polymerase chain reaction. RESULTS: The expressions of 179 microRNAs were found as deregulated in the saliva of peri-implantitis patients in comparison to controls. Then, downregulation of miR-4484 was confirmed in the saliva of peri-implantitis patients in a larger validation cohort. Also, 40% of non-peri-implantitis patients and 78% of peri-implantitis patients had significantly decreased miR-4484 expression in saliva samples collected after 4 to 6 months subsequent to implant placement compared with samples collected before implant placement. CONCLUSION: Considering these findings, microRNA content of saliva might be proposed as a plausible source for the early diagnosis of peri-implantitis, where miR-4484 might serve as an encouraging early diagnostic biomarker.


Assuntos
Implantes Dentários , MicroRNAs , Peri-Implantite , Biomarcadores , Implantes Dentários/efeitos adversos , Diagnóstico Precoce , Humanos , MicroRNAs/genética , Peri-Implantite/diagnóstico , Saliva
10.
J Oral Sci ; 63(2): 152-156, 2021 Mar 31.
Artigo em Inglês | MEDLINE | ID: mdl-33597334

RESUMO

PURPOSE: To determine the impact of experimentally preformed peri-implant crater-shaped bone defects on the evolution of in situ microbiota and development of bone defects compared to those induced over time by ligature placement only. METHODS: Implants were installed in the mandibles of eight dogs. Standardized bone defects were preformed in four test animals but not in the other four control animals, prior to implant (3.3 mm × 8 mm) installation. After 2 months of healing, peri-implantitis was induced with silk ligatures in both groups for 2 months. Microbial samples were obtained from implants and teeth for analysis at three time points (qPCR), and the average depths of the bone defects were measured. RESULTS: At the baseline, the total marker load of periodontal-pathogenic bacteria (TML) for teeth accounted for 5.2% (0-17.4%). After implant healing, TMLs for implants and teeth were comparable (7.1% [0.3-17.4%]). The TML of both groups was 3.5%, 2 months after ligature placement. Bone defects had a mean depth of 1.84 mm at preformed defects and 1.64 mm at control sites (P > 0.05). CONCLUSION: Preformed defects in the test group showed comparable results to the control group in terms of TML, the incidence of periodontal-pathogenic bacteria, and bone defect depth.


Assuntos
Perda do Osso Alveolar , Implantes Dentários , Peri-Implantite , Perda do Osso Alveolar/etiologia , Animais , Implantes Dentários/efeitos adversos , Ligadura , Mandíbula
11.
Monogr Oral Sci ; 29: 133-143, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33427227

RESUMO

During the last decade, photodynamic therapy (PDT) has been extensively investigated for the treatment of periodontal and peri-implant infections. Nonetheless, contradicting clinical and microbiological outcomes and only results on a short-term basis have been reported so far, thus making it difficult to conclude on clinically relevant recommendations for the use of PDT. Therefore, the aim of this narrative review is to provide an overview of the current evidence from randomized controlled clinical trials (RCTs) evaluating the potential clinical and/or microbiological benefit for the use of PDT in non-surgical periodontal and peri-implant therapy, and to draw clinically relevant conclusions on the use of PDT in periodontal practice. Based on the available evidence from RCTs and recent meta-analyses, we can conclude the following: in patients with mild to moderate periodontitis, the combination of scaling and root planing (SRP) and PDT may result in significantly higher clinical improvements (bleeding on probing and probing depth reduction, clinical attachment gain) compared to SRP alone in the non-surgical treatment of periodontitis; in patients with stage III and IV grade C periodontitis (previously known as AgP) the use of PDT provides clinical improvements, although PDT cannot so far be recommended as a replacement for systemic antibiotics (i.e., amoxicillin and metronidazole); PDT may be indicated as a valuable tool for treating moderate residual periodontal pockets during maintenance therapy; limited evidence on the use of PDT in medically compromised patients (i.e., diabetes mellitus, oral lichen planus) indicates that PDT may represent a possible alternative to other more invasive medication/treatment procedures; limited evidence suggests that PDT may represent a valuable tool in attaining inflammation reduction on a short-term basis in peri-implant diseases (i.e., peri-implantitis, peri-implant mucositis).


Assuntos
Implantes Dentários , Peri-Implantite , Fotoquimioterapia , Raspagem Dentária , Humanos , Peri-Implantite/tratamento farmacológico , Aplainamento Radicular
12.
Monogr Oral Sci ; 29: 98-104, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33427228

RESUMO

The present narrative review provides a summary of the temporal and spatial reactions of the oral microbiome to the placement of a dental implant into the oral cavity, depicting the most important interactions between the oral microbiota and the host response involved in the development of peri-implant infections in humans (i.e., peri-implant mucositis and peri-implantitis). Starting with the formation of a pellicle to acute and rampant peri-implant inflammation, a number of steps, including biofilm formation, aggressive bacterial invasion, and host defense mechanisms, are involved. Better understanding of the factors related to the host response and changes in the composition of microbiota has led to the development of novel treatment modalities. Finally, a short outlook into the future is provided.


Assuntos
Implantes Dentários , Microbiota , Peri-Implantite , Estomatite , Bactérias , Implantes Dentários/efeitos adversos , Humanos , Peri-Implantite/etiologia , Estomatite/etiologia
13.
ACS Appl Mater Interfaces ; 13(4): 5782-5794, 2021 Feb 03.
Artigo em Inglês | MEDLINE | ID: mdl-33464812

RESUMO

Peri-implantitis is a typical pathological condition characterized by the destructive inflammation in the soft tissue and the progressive loss of supporting bones. As the current effective treatments and preventive measures are inconsistent and unpredictable, the use of biomaterials as carriers of bioactive ion coatings is a promising approach. However, the translation from lab to large-scale production and clinical applications is difficult due to a technology barrier. Determining the effective dosage of each ion to achieve an in vivo application of the in vitro screening is challenging. Here, we selected zinc and strontium ions to provide multiple effects on antibacterial activity and osteogenesis. The optimal coating with effective release concentrations of the two ions was obtained after the two-step screening from in vitro testing. The results showed that this type of in vivo bioactive ion usage leads to an enhanced osseointegration during the immediate implantation in a periodontitis-affected environment and prevents soft tissue inflammation and bone resorption in an inflammatory environment. The new biologically active ion screening method could verify the effectiveness of this clinical translation and its potential for large-scale production and could determine the effective dosage of each ion for a specific application.


Assuntos
Antibacterianos/uso terapêutico , Implantes Dentários , Peri-Implantite/prevenção & controle , Estrôncio/uso terapêutico , Zinco/uso terapêutico , Animais , Células Cultivadas , Materiais Revestidos Biocompatíveis/uso terapêutico , Implantes Dentários/microbiologia , Cães , Humanos , Osseointegração/efeitos dos fármacos , Osteogênese/efeitos dos fármacos , Peri-Implantite/microbiologia , Ratos Sprague-Dawley , Estomatite/microbiologia , Estomatite/prevenção & controle
14.
Quintessence Int ; 52(2): 112-121, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33433077

RESUMO

OBJECTIVE: Retrograde peri-implantitis (RPI) is defined as bone loss around an osseointegrated implant apex that usually appears within the first few months of its placement. This retrospective study aimed to evaluate the relationships between RPI and demographic factors, local bone and intraoral factors, and implant and surgery-related factors. METHOD AND MATERIALS: A retrospective study was conducted in 116 patients with a total of 369 implants placed between January and June 2019. The associations between RPI and the following data were evaluated: location of the recipient site, bone quality, reason for previous tooth loss, condition of adjacent teeth, marginal bone loss, immediate or late placement of implants, implant brand and size, activation of lesions, and treatment modality.
Results: Among the 14 (3.8%) implants that showed RPI, 10 (5.8%) were in the maxilla and four (?2.0%) were in the mandible, which were detected before prosthetic loading. There was no significant difference in terms of RPI between the arches. Of the 14 RPI implants, four (28.?6%) were placed into a previously periapical lesion site, three (21.4%) had endodontically treated adjacent teeth, two (14.3%) were immediately placed following extraction, three (?21.4%) revealed marginal bone loss, and one (7.1%) was lost at the abutment connection. Eight RPI implants healed spontaneously, while the remaining six were subjected to treatment (P = .05).
Conclusion: Local bone and intraoral factors, particularly the reason for tooth loss at the recipient site and the condition of the adjacent teeth, had stronger effects on RPI than other factors. (Quintessence Int 2021;52:112-121; doi: 10.3290/j.qi.a45264).


Assuntos
Perda do Osso Alveolar , Implantes Dentários , Peri-Implantite , Perda do Osso Alveolar/diagnóstico por imagem , Perda do Osso Alveolar/cirurgia , Protocolos Clínicos , Implantação Dentária Endo-Óssea/efeitos adversos , Implantes Dentários/efeitos adversos , Humanos , Mandíbula , Peri-Implantite/diagnóstico por imagem , Peri-Implantite/terapia , Estudos Retrospectivos
15.
Quintessence Int ; 52(2): 122-131, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33433078

RESUMO

Objective: The aim of this systematic review and meta-analysis was to evaluate the impact of supportive peri-implant therapy (SPIT) on the rates of peri-implant diseases and peri-implant marginal bone loss. ?Data sources: The guidelines of PRISMA statement were followed in searching for randomized controlled trials, controlled clinical trials, and retrospective studies in several electronic databases and reference lists. The Cochrane Collaboration's Risk of Bias tools for nonrandomized studies were used to assess the risk of bias. Data were analyzed using statistical software. ?A total of 159 studies were identified. Five trials, with 1,570 implants in 617 patients, met the inclusion criteria. Overall meta-analysis showed significantly reduced rates of peri-implantitis with SPIT compared with non-SPIT at implant and patient levels. Peri-implant mucositis was significantly reduced with SPIT at implant level only. Peri-implant marginal bone loss was significantly reduced in patients with SPIT compared to those who did not attend SPIT.
Conclusion: SPIT can significantly reduce the rate of peri-implantitis and marginal bone loss. The evidence on the role of SPIT in reducing the rate of peri-implant mucositis, on the other hand, remains limited. Further well-designed studies on the impact of SPIT on implant treatment outcome are still needed. Clinical significance: There is a need to adopt a SPIT regimen for patients receiving implant therapy to reduce the rate of peri-implant diseases and marginal bone loss. This need should be stipulated in the patient information and consent forms prior to implant therapy. (Quintessence Int 2021;52:122-131; doi: 10.3290/j.qi.a45428)

.


Assuntos
Perda do Osso Alveolar , Implantes Dentários , Peri-Implantite , Estomatite , Humanos , Estudos Retrospectivos , Estomatite/prevenção & controle
16.
J Biol Regul Homeost Agents ; 35(1 Suppl. 1): 11-18, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33463139

RESUMO

Implant dentistry has emerged as a first line of treatment to replace missing teeth for both the edentulous and partially dentate patients. Implant dentistry is accompanied by the onset of peri-implantitis (PIM). PIM is characterized by the inflammatory destruction of the implant-supporting tissues, because of biofilm formation on the implant surface. A history of periodontitis, poor oral hygiene, and smoking are considered as risk factors for PIM. Occasionally PIM is associated with iatrogenic factors, that, only recently, have been acknowledged as direct cause of PIM, i.e.: non-parallel adjacent implants or the presence of a gap, between fixture and prosthetic components. The use both of traditional protocols of nonsurgical periodontal therapy and the laser seems to be an effective alternative treatment modality for PMI. By the application of laser-assisted non-surgical peri-implant therapy the periodontal pocket depth was reduced. The present article illustrates the nonsurgical management of one case, where failure to remove residual cement, from an implant-supported dental prosthesis, seemed to cause PMI.


Assuntos
Implantes Dentários , Peri-Implantite , Implantes Dentários/efeitos adversos , Odontologia , Humanos , Lasers , Peri-Implantite/etiologia , Peri-Implantite/terapia , Bolsa Periodontal , Periodontite/etiologia , Periodontite/terapia
17.
J Biol Regul Homeost Agents ; 35(1 Suppl. 1): 63-72, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33463144

RESUMO

Implant dentistry has become a popular restorative option in clinical practice. Titanium and titanium alloys (TTA) are the gold standard for endo-osseus dental implants production, thanks to their biocompatibility, resistance to corrosion and mechanical properties. The characteristics of the TTA implant surface seem to be particularly relevant in the early phase of osseointegration. Furthermore, the microstructure of implant surface can largely influence the bone remodelling at the level of the bone-implant surface. Recently, research has stated on the long-term of both survival and success rates of osseointegrated implants and mainly on biomechanical aspects, such as load distribution and biochemical and histological processes at the bone-implant interface. This short review reports recent knowledge on chemical and mechanical properties, biological aspects, innovations in preventing peri-implantitis, describing clinical applications and recent improvements of TTA dental implants. In addition, it highlights current knowledge about a new implant coating that has been demonstrated to reduce the number of initially adhering bacteria and peri-implantitis.


Assuntos
Implantes Dentários , Ligas , Odontologia , Humanos , Osseointegração , Peri-Implantite , Propriedades de Superfície , Titânio
18.
Clin Oral Implants Res ; 32(3): 297-313, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33340418

RESUMO

OBJECTIVES: The aim of the present study was to evaluate the diagnostic accuracy of clinical and radiographic evaluations made at a single time point during follow-up in identifying (a) a history of peri-implant bone loss and (b) the presence of peri-implantitis. MATERIAL & METHODS: 427 patients provided with implant-supported reconstructions 9 years earlier were evaluated clinically by Probing Pocket Depth, Bleeding or Suppuration on Probing (PPD, BoP & SoP) and radiographically. Bone levels were assessed relative to the most coronal point of the intra-osseous part of the implant. A history of bone loss and diagnosis of peri-implantitis was confirmed through baseline documentation (direct evidence). Diagnostic accuracy of radiographic bone levels at 9 years and clinical findings (indirect evidence/secondary case definition) in identifying a history of bone loss and peri-implantitis were evaluated through correlation and multilevel regression analyses as well as receiver operating characteristic curves. Results were expressed as sensitivity/specificity and area under the curve (AUC). RESULTS: Bone levels observed at 9 years were highly accurate in identifying pronounced bone loss (>2 mm; AUC = 0.96; 95% CI 0.95-0.98). In the absence of baseline documentation, a secondary case definition based on the presence of BoP/SoP & bone level ≥ 1 mm (indirect evidence) provided the overall best diagnostic accuracy (AUC = 0.80; 95% CI 0.77-0.82) in identifying peri-implantitis cases (direct evidence: BoP/SoP & bone loss > 0.5 mm). Moderate/severe peri-implantitis (BoP/SoP & bone loss > 2 mm) was most accurately identified by the combination of BoP/SoP & bone level ≥ 2 mm (AUC = 0.93; 95% CI 0.91-0.96). Sensitivity of the secondary case definition suggested by the 2017 World Workshop of Periodontology (WWP) (BoP/SoP ≥ 1 site & bone level ≥ 3 mm & PPD ≥ 6 mm) was low. CONCLUSIONS: The present results underline the importance of baseline documentation for the correct diagnosis of peri-implantitis, especially in its early/incipient forms. The secondary case definition of peri-implantitis suggested at the 2017 WWP demonstrated a high level of specificity but low sensitivity. Moderate/severe peri-implantitis was most accurately identified by the combination of BoP/SoP & bone level ≥ 2 mm.


Assuntos
Implantes Dentários , Peri-Implantite , Implantes Dentários/efeitos adversos , Humanos , Peri-Implantite/diagnóstico por imagem , Índice Periodontal , Periodontia , Supuração
19.
Int. j. med. surg. sci. (Print) ; 7(4): 1-12, dic. 2020. ilus
Artigo em Espanhol | LILACS | ID: biblio-1151807

RESUMO

Los implantes dentales son ampliamente usados para el reemplazo de piezas dentarias y se han convertido en el "gold standard" de las terapias protésicas en odontología. Dado el mayor uso de éstos, las investigaciones epidemiológicas recientes han demostrado elevadas tasas de prevalencia de enfermedad periimplantaria. En el presente estudio se presentan tres casos clínicos diagnosticados con periimplantitis. Todos los casos presentaron aumento de la profundidad al sondaje periimplantario en relación a controles anteriores, supuración, sangramiento al sondaje y pérdida ósea confirmada a través de tomografía computada cone beam. El tratamiento indicado para todos los casos fue una terapia conjunta entre un tratamiento mecánico mediante ultrasonido con la utilización de puntas plásticas (P.I EMS®, Suiza) y la terapia con láser. Para la laserterapia se utilizó un equipo de láser diodo de 940 nm (Biolase®, USA) con una potencia de 2 W en modo CW, utilizando una punta de 300 µm. El láser de diodo no daña la superficie de titanio y es capaz de descontaminar las superficies rugosas de los implantes. En este reporte, el uso de una terapia combinada mecánica y láser fue efectiva en todos los casos. En los controles clínicos, la mucosa periimplantaria no presentó signos de supuración ni sangramiento, y la profundidad al sondaje también se vió disminuída. El nivel óseo se controló a través de una tomografía computada cone beam y no se evidenciaron cambios significativos. En la actualidad, la evidencia clínica para el tratamiento periimplantario mediante la fototerapia todavía es limitada. Sin embargo, el láser ofrece un enfoque técnico novedoso que es completamente diferente de los instrumentos mecánicos y tiene varios efectos beneficiosos, por lo que puede desempeñar un papel importante, en la resolución de la peri-implantitis.


Dental implants are widely used for the replacement of teeth and have become the "gold standard" of prosthetic therapies in dentistry. Given the increased use of these, recent epidemiological investigations have shown high prevalence rates of peri-implant disease. In the present study, three clinical cases diagnosed with peri-implantitis are presented. All cases presented increased depth to peri-implant probing in relation to previous controls, suppuration, bleeding and bone loss confirmed by cone beam computed tomography. The treatment indicated for all cases was a joint therapy between a mechanical ultrasound treatment with the use of plastic tips (P.I EMS®, Switzerland) and laser therapy. For laser therapy, a 940 nm diode laser equipment was used (Biolase®, USA) with a power of 2W in continuous laser beam mode, using a 300 µm tip. The diode laser does not damage the titanium surface and is capable of decontaminating the rough surfaces of the implants. In this report, the use of a combined mechanical and laser therapy was effective in all cases. In clinical controls, the peri-implant mucosa did not show signs of suppuration or bleeding, and the depth on probing was decreased. The bone level was controlled through a cone beam computed tomography and no significant changes were evidenced. At present, the clinical evidence for peri-implant treatment using phototherapy is still limited. However, the laser offers a novel technical approach that is completely different from mechanical instruments and has several beneficial effects, so it can play an important role in the resolution of peri-implantitis.


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Lasers Semicondutores/uso terapêutico , Peri-Implantite/radioterapia , Implantes Dentários
20.
Rev. ADM ; 77(6): 321-328, nov.-dic. 2020. ilus
Artigo em Espanhol | LILACS | ID: biblio-1151475

RESUMO

La periimplantitis se define como la patología inflamatoria e irreversible que afecta al hueso periimplantario y le hace perder soporte y función al implante según la definición del European Workshop on Periodontology (EWOP). La prevalencia estimada de la periimplantitis es de 28 a 77%. Los diferentes protocolos de abordaje de la periimplantitis nos ofrecen diversas posibilidades: destoxificación de la superficie y regeneración, limpieza mecánica y resección del tejido inflamado, extracción del implante, entre otros. El principal problema de los tratamientos regenerativos es limpiar y desintoxicar correctamente la superficie del implante expuesto, ya que al tratarse de superficies generalmente muy rugosas, las bacterias del medio bucal las colonizan con mucha facilidad y es prácticamente imposible eliminar por completo el biofilm. El protocolo de tratamiento para la periimplantitis se basa en un algoritmo de tratamiento, en el que se retiran los implantes gravemente afectados por periimplantitis de forma atraumática, lo cual garantiza la conservación del lecho al 100% al no retirarse volumen óseo, y cuándo deben utilizarse las trefinas, pues las que se utilizan en el protocolo únicamente rompen la unión ósea de los primeros milímetros sin retirarlo. En el siguiente caso clínico mostramos el retratamiento de un caso de periimplantitis en el que se ha realizado una nueva rehabilitación implantosoportada (AU)


Periimplantitis is defined as the inflammatory and irreversible pathology that affects the peri-implantary bone and causes it to lose support and function to the implant as defined by the European Workshop on Periodontology (EWOP). The estimated prevalence of periimplantitis figures ranging from 28 to 77%. The different protocols for approaching periimplantitis offer different possibilities: detoxification of the surface and re-generation, mechanical cleaning and resection of inflamed tissue and extraction of the implant mainly. The main problem with regenerative treatments is to correctly clean and detoxify the surface of the exposed implant, since as these are generally highly rough surfaces, bacteria in the oral environment colonise them very easily and it is practically impossible to completely eliminate the biofilm. This treatment algorithm, in which implants severely affected by periimplantitis are removed atraumatically, guarantees the conservation of the bed at 100% since no bone volume is removed and trephines must be used, since those used in the protocol only break the bone union of the first few millimetres, without removing it. In the following clinical case, we show the re-treatment of a case of peri-implantitis where a new implant-supported rehabilitation has been performed (AU)


Assuntos
Humanos , Masculino , Idoso , Osseointegração , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Implantação Dentária Endo-Óssea , Peri-Implantite/terapia , Regeneração Óssea , Algoritmos , Protocolos Clínicos , Prótese Dentária Fixada por Implante , Retratamento , Reabilitação Bucal/métodos
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