The Addition of Hydroxyapatite Nanoparticles on Implant Surfaces Modified by Zirconia Blasting and Acid Etching to Enhance Peri-Implant Bone Healing.

This study investigated the impact of adding hydroxyapatite nanoparticles to implant surfaces treated with zirconia blasting and acid etching (ZiHa), focusing on structural changes and bone healing parameters in low-density bone sites. The topographical characterization of titanium discs with a ZiHa surface and a commercially modified zirconia-blasted and acid-etched surface (Zi) was performed using scanning electron microscopy, profilometry, and surface-free energy. For the in vivo assessment, 22 female rats were ovariectomized and kept for 90 days, after which one implant from each group was randomly placed in each tibial metaphysis of the animals. Histological and immunohistochemical analyses were performed at 14 and 28 days postoperatively (decalcified lab processing), reverse torque testing was performed at 28 days, and histometry from calcified lab processing was performed at 60 days The group ZiHa promoted changes in surface morphology, forming evenly distributed pores. For bone healing, ZiHa showed a greater reverse torque, newly formed bone area, and bone/implant contact values compared to group Zi (p < 0.05; t-test). Qualitative histological and immunohistochemical analyses showed higher features of bone maturation for ZiHa on days 14 and 28. This preclinical study demonstrated that adding hydroxyapatite to zirconia-blasted and acid-etched surfaces enhanced peri-implant bone healing in ovariectomized rats. These findings support the potential for improving osseointegration of dental implants, especially in patients with compromised bone metabolism.

Antimicrobial effect of platelet-rich fibrin: A systematic review of in vitro evidence-based studies.

This systematic review (SR) aimed to evaluate the antimicrobial potential of different types of platelet-rich fibrin (PRF) often used in regenerative treatments. An electronic search was performed in four databases and in Gray literature for articles published until January, 2023. The eligibility criteria comprised in vitro studies that evaluated the antimicrobial effect of different types of PRF. For the analysis of the risk of bias within studies, the modified OHAT (Office of Health Assessment and Translation) tool was used. For the evaluation of the results, a qualitative critical analysis was carried out in the synthesis of the results of the primary studies. Sixteen studies published between 2013 and 2021 were included in this SR. The antimicrobial effects of PRF variations (PRF, injectable PRF [I-PRF], PRF with silver nanoparticles [agNP-PRF], and horizontal PRF [H-PRF]), were analyzed against 16 types of bacteria from the oral, periodontal, and endodontic environments. All types of PRF showed significant antimicrobial action, with the antibacterial efficacy being more expressive than the fungal one. The I-PRF, H-PRF, and agNP-PRF subtypes improve antimicrobial activity. According to the OHAT analysis, no study was classified as having a high risk of bias. Evidence suggests that PRF variations have significant antimicrobial activity, with bacterial action being greater than fungal. Evolutions such as I-PRF, H-PRF, and agNP-PRF improve antimicrobial activity. Future studies analyzing the clinical effect of these platelets are fundamental. This SR was registered in INPLASY under number INPLASY202340016.

In-vitro polymicrobial oral biofilm model represents clinical microbial profile and disease progression during implant-related infections.

AIM: Clinically relevant in-vitro biofilm models are essential and valuable tools for mechanistically dissecting the etiopathogenesis of infectious diseases and test new antimicrobial therapies. Thus, the aim of this study was to develop and test a clinically relevant in-vitro oral polymicrobial biofilm model that mimics implant-related infections in terms of microbial profile. METHODS AND RESULTS: For this purpose, 24-well plate system was used to model oral biofilms, using three different microbial inoculums to grow in-vitro biofilms: (1) human saliva from periodontally healthy patients; (2) saliva as in inoculum 1 + Porphyromonas gingivalis strain; and (3) supra and subgingival biofilm collected from peri-implant sites of patients diagnosed with peri-implantitis. Biofilms were grown to represent the dynamic transition from an aerobic to anaerobic community profile. Subsequently, biofilms were collected after each phase and evaluated for microbiological composition, microbial counts, biofilm biomass, structure, and susceptibility to chlorhexidine (CHX). Results showed higher live cell count (P < .05) for biofilms developed from patients' biofilm inoculum, but biomass volume, dry weight, and microbiological composition were similar among groups (P > .05). Interestingly, according to the checkerboard DNA-DNA hybridization results, the biofilm developed from stimulated human saliva exhibited a microbial composition more similar to the clinical subgingival biofilm of patients with peri-implantitis, with proportions of the main pathogens closer to those found in the disease. In addition, biofilm developed using saliva as inoculum was shown to be susceptible to CHX with significant reduction in bacteria compared with biofilms without exposure to CHX (P < .05). CONCLUSION: The findings suggested that the in-vitro polymicrobial biofilm developed from human saliva as inoculum is a suitable model and clinically relevant tool for mimicking the microbial composition of implant-related infections.

A multifunctional guided surgery to assist in the 3-dimensional positioning of dental implants and in obtaining a palatal gingival graft.

Parameters such as the correct 3-dimensional positioning and the quality of peri-implant soft tissues are fundamental to the success of implant-supported restorations. Digital planning and guided surgery techniques can make the implant placement more accurate, and modifying the periodontal phenotype is often fundamental to increasing esthetics and peri-implant health, mainly in esthetic areas. This article describes a guided surgery technique that assists in the 3-dimensional positioning of implants and identifies the best anatomic area (volume and safety) for obtaining a palatal gingival graft.

Oral microbial colonization on titanium and polyetheretherketone dental implant healing abutments: An in vitro and in vivo study.

STATEMENT OF PROBLEM: Although polyetheretherketone (PEEK) implant healing abutments have become popular because of their esthetic, mechanical, and chemical properties, studies analyzing oral polymicrobial adhesion to PEEK abutments are lacking. PURPOSE: The purpose of this in vitro and in vivo study was to evaluate oral microbial adhesion and colonization on titanium (Ti) and PEEK healing abutments. MATERIAL AND METHODS: Ti (N=35) and PEEK substrates (N=35) were evaluated in vitro in terms of the initial adhesion (1 hour) or biofilm accumulation (48 hours) of Candida albicans and a polymicrobial inoculum using stimulated human saliva to mimic a diverse oral microbiome. Surface decontamination ability was evaluated after 24 hours of in vitro biofilm formation after exposure to an erbium-doped yttrium aluminum garnet (Er:YAG) laser. Conventional and flowable composite resin veneering on PEEK was also tested for microbial adhesion. In addition, an in vivo model with 3 healthy volunteers was conducted by using a palatal appliance containing the tested materials (3 or 4 specimens of each material per appliance) for 2 days to evaluate the effect of substrate on the microbial profile. Biofilms were evaluated by live cell counts and scanning electron microscopy images, and the microbial profile by Checkerboard deoxyribonucleic acid (DNA)-DNA hybridization. The t test and Mann-Whitney test were used to compare the groups (α=.05). RESULTS: PEEK and Ti materials showed similar fungal adhesion (P>.05). Although the PEEK surface limited the initial in vitro polymicrobial adhesion (approximately 2 times less) compared with Ti (P=.040), after 48 hours of biofilm accumulation, the microbial load was statistically similar (P=.209). Er:YAG laser decontamination was more effective on PEEK than on Ti surfaces, reducing approximately 11 times more microbial accumulation (P=.019). Both composite resins tested showed similar microbial adhesion (1 hour). In vivo, the PEEK material showed reduced levels of 6 bacterial species (P<.05), including the putative pathogen Treponema denticola. CONCLUSIONS: Although PEEK and Ti had similar bacterial and fungus biofilm attachment and accumulation, PEEK promoted a host-compatible microbial profile with a significantly reduced T. denticola load.

Does implant location influence the risk of peri-implantitis?

Peri-implantitis is characterized by nonreversible and progressive loss of supporting bone and is associated with bleeding and/or suppuration on probing. Peri-implant disease is considered as the main etiologic factor related to implant failure. Peri-implant disease has a pathogenesis similar to that of periodontal disease, both being triggered by an inflammatory response to the biofilm accumulation. Although the prevalence of peri-implantitis has been evaluated by several clinical studies with different follow-ups, there are currently little data on the impact of implant location and the prevalence of peri-implantitis. The aim of this review, therefore, was to summarize the evidence concerning the prevalence of peri-implantitis in relation to implant location and associated risk predictors. Even though most studies evaluating the prevalence of peri-implantitis in relation to implant location are cross-sectional or retrospective, they suggest that the occurrence of peri-implantitis is most prevalent in the anterior regions of the maxilla and mandible. Moreover, it seems that there is a higher prevalence of peri-implantitis in the maxilla than in the mandible.

Do the progression of experimentally induced gingivitis and peri-implant mucositis present common features? A systematic review of clinical human studies.

This systematic review evaluated the features of the progression of experimentally induced gingivitis and peri-implant mucositis in humans. Included were studies that evaluated clinical, immunological, or microbiological responses between experimentally induced gingivitis and peri-implant mucositis in periodontally healthy patients. A total of 887 articles were initially identified, but only 12 were included in the final analysis. Implants accumulate less biofilm and suffer the most heterogeneous alterations in the microbiota, in the abstinence of oral hygiene, compared with the tooth. Interestingly, although dental implants presented less biofilm accumulation, the peri-implant mucosa showed a more exacerbated clinical response than the gingival tissue. The risk of bias of the selected studies was moderate to low, with one study presenting serious risk. The progression events of peri-implant mucositis were similar to those of experimental gingivitis but led to a different host response. This review was registered in the PROSPERO database CRD420201 123360.

Delphi Project on the trends in Implant Dentistry in the COVID-19 era: Perspectives from Latin America.

AIM: To establish trends in Implant Dentistry in Latin America in the COVID-19 pandemic. MATERIAL AND METHODS: A steering committee and an advisory group of experts in Implant Dentistry were selected among eighteen countries. An open-ended questionnaire by Delphi methodology was validated including 64 questions, divided in 7 topics, concerning the various trends in dental implantology. The survey was conducted in two rounds, which provided the participants in the second round with the results of the first. The questionnaires were completed on August 2020, and the online meeting conference was held on September 2020. The final prediction was developed through consensus by a selected group of experts. RESULTS: A total of 197 experts from Latin America answered the first and second questionnaire. In the first round, the established threshold for consensus (65%) was achieved in 30 questions (46.87%). In the second round, performed on average 45 days later, this level was achieved in 47 questions (73.43%). Consensus was completely reached on the item "Diagnostic" (100%), the field with the lowest consensus was "Demand for treatment with dental implants" (37.5%). CONCLUSIONS: The present study in Latin America has provided relevant and useful information on the predictions in the education and practice of Implant Dentistry in the COVID-19 era. The consensus points toward a great confidence of clinicians in the biosecurity protocols used to minimize the risk of SARS-CoV-2 transmission. It is foreseen as an important change in education, with introduction of virtual reality and other simulation technologies in implant training.

Treg and TH17 link to immune response in individuals with peri-implantitis: a preliminary report.

BACKGROUND AND OBJECTIVES: Treg and TH17 cells influence the inflammatory process in periodontal diseases and could also play in a similar pattern, an essential role in immune-inflammatory mechanisms involved in the destruction of the peri-implant tissues, peri-implantitis. Therefore, this study evaluated the levels of RORγT and FOXP3 gene expression in subjects with peri-implantitis and healthy peri-implant tissues. METHODS: A total of 35 subjects with implant-supported restorations in both diseased and healthy clinical conditions (n = 15 healthy; n = 20 peri-implantitis) were included in this study. Peri-implantitis was defined as probing depth > 5 mm, bleeding on probing and/or suppuration, and peri-implant bone loss >4 mm. Peri-implant tissue biopsies were collected for analysis of the mRNA, RORγT, and FOXP3 expression levels. The samples were submitted to total RNA extraction, treatment with DNAse, and cDNA synthesis. Subsequently, real-time PCR reaction was performed to evaluate the levels of RORγT and FOXP3 gene expression to the reference gene. These were analyzed by the non-parametric Mann-Whitney method with a level of significance of 5%. RESULTS: Higher gene expression levels of the transcription factors RORγT and FOXP3 were detected in the tissues affected by peri-implantitis when compared with healthy tissues (p < 0.05). CONCLUSIONS: The present study demonstrated the possible existence of a hybrid TH17-Treg profile, based on the gene expression of transcription factors inducing differentiation of these cells. Further studies must be designed to gain a better understanding of the immunological mechanisms involved in the pathogenesis of peri-implantitis. CLINICAL RELEVANCE: The levels of RORγT and FOXP3 transcription factors that were linked to cells with the FOXP3+RORγT+ phenotype could be used as a predictor of peri-implantitis progression.

Metabolic activity of hydro-carbon-oxo-borate on a multispecies subgingival periodontal biofilm: a short communication.

OBJECTIVE: This study evaluated the metabolic activity of hydro-carbon-oxo-borate complex (HCOBc) on a multispecies subgingival biofilm as well as its effects on cytotoxicity. MATERIALS AND METHODS: The subgingival biofilm with 32 species related to periodontitis was formed in the Calgary Biofilm Device (CBD) for 7 days. Two different therapeutic schemes were adopted: (1) treatment with HCOBc, 0.12% chlorhexidine (CHX), and negative control group (without treatment) from day 3 until day 6, two times a day for 1 min each time, totaling 8 treatments and (2) a 24-h treatment on a biofilm grown for 6 days. After 7 days of formation, biofilm metabolic activity was determined by colorimetry assay, and bacterial counts and proportions of complexes were determined by DNA-DNA hybridization. Both substances' cytotoxicity was evaluated by cell viability (XTT assay) and clonogenic survival assay on ovary epithelial CHO-K1 cells and an osteoblast precursor from calvaria MC3T3-E1 cells. RESULTS: The first treatment scheme resulted in a significant reduction in biofilm's metabolic activity by means of 77% by HCOBc and CHX treatments versus negative control. The total count of 11 and 25 species were decreased by treatment with hydro-carbon-oxo-borate complex and CHX, respectively, compared with the group without treatment (p < 0.05), highlighting a reduction in the levels of Porphyromonas gingivalis, Tannerella forsythia, Prevotella intermedia, and Fusobacterium periodontium. CHX significantly reduced the count of 10 microorganisms compared to the group treated with HCOBc (p < 0.05). HCOBc and CHX significantly decreased the pathogenic red-complex proportion compared with control-treated biofilm, and HCOBc had even a more significant effect on the red complex than CHX had (p ≤ 0.05). For the second treatment scheme, HCOBc complex and CHX significantly decreased 61 and 72% of control biofilms' metabolic activity and the counts of 27 and 26 species, respectively. HCOBc complex did not significantly affect the proportions of formed biofilms, while CHX significantly reduced red, orange, and yellow complexes. Both substances exhibited similar cytotoxicity results. CONCLUSIONS: This short communication suggested that the HCOBc complex reduced a smaller number of bacterial species when compared to chlorhexidine during subgingival biofilm formation, but it was better than chlorhexidine in reducing red-complex bacterial proportions. Although HCOBc reduced the mature 6-day-old subgingival multispecies biofilms, it did not modify bacterial complexes' ratios as chlorhexidine did on the biofilms mentioned above. Future in vivo studies are needed to validate these results. CLINICAL RELEVANCE: HCOBc complex could be used to reduce red-complex periodontal bacterial proportions.

Assessment of the reproducibility and precision of milling and 3D printing surgical guides.

BACKGROUND: Technology advancement has rising in the past decade and brought several innovations and improvements. In dentistry, this advances provided more comfortable and quick procedures to both the patient and the dental surgeon, generating less predictability in the final result. Several techniques has been developed for the preparation of surgical guides aiming at the optimization of surgical procedures. The present study aimed to evaluate the reproducibility and precision of two types of surgical guides obtained using 3D printing and milling methods. METHODS: A virtual model was developed that allowed the virtual design of milled (n = 10) or 3D printed (n = 10) surgical guides. The surgical guides were digitally oriented and overlapped on the virtual model. For the milling guides, the Sirona Dentsply system was used, while the 3D printing guides were produced using EnvisionTEC's Perfactory P4K Life Series 3D printer and E-Guide Tint, a biocompatible Class I certified material. The precision and trueness of each group during overlap were assessed. The data were analyzed with GraphPad software using the Kolmogorov-Smirnov test for normality and Student's t test for the variables. RESULTS: The Kolmogorov-Smirnov test showed a normal distribution of the data. Comparisons between groups showed no statistically significant differences for trueness (p = 0.529) or precision (p = 0.3021). However, a significant difference was observed in the standard deviation of mismatches regarding accuracy from the master model (p < 0.0001). CONCLUSIONS: Within the limits of this study, surgical guides fabricated by milling or prototyped processes achieved similar results.

Antimicrobial effects of a pulsed electromagnetic field: an in vitro polymicrobial periodontal subgingival biofilm model.

The objective was to test the influence of a pulsed electromagnetic field (PEMF) on bacterial biofilm colonization around implants incorporated with healing abutments. Healing abutments with (test group) and without (control group) active PEMF devices were placed in a multispecies biofilm consisting of 31 different bacterial species. The biofilm composition and total bacterial counts (x105) were analyzed by checkerboard DNA-DNA hybridization. After 96 h, the mean level of 7 out of the 31 bacterial species differed significantly between groups, namely Eubacterium nodatum, Fusobacterium nucleatum ssp. nucleatum, Streptococcus intermedius, Streptococcus anginosus, Streptococcus mutans, Fusobacterium nucleatum ssp. Vicentii and Capnocytophaga ochracea were elevated in the control group (p < 0.05). The mean total bacterial counts were lower in the Test group vs the control group (p < 0.05). An electromagnetic healing cap had antimicrobial effects on the bacterial species and can be used to control bacterial colonization around dental implants. Further clinical studies should be conducted to confirm these findings.

Clinical efficacy of xenogeneic and allogeneic 3D matrix in the management of gingival recession: a systematic review and meta-analysis.

OBJECTIVE: A systematic review and meta-analysis was thus conducted to answer the following focused question based on PICO strategy: Is there any 3D matrix biomaterial used for root coverage of human Miller class I and II defects equivalent with the connective tissue graft in localized defects of at least 2 mm and 3 mm? MATERIAL AND METHODS: The search on electronic database included MEDLINE, Cochrane Central Register of Controlled Trials, Clinical Trials.gov, Web of Science, and New Zealand/Australian Clinical Trials. Only randomized clinical trials (RCTs) that compared connective tissue graft (CTG) with at least one 3D matrix alone for root coverage in Class I and II Miller localized defects of at least 2 mm, with at least 6 months follow-up, were included in this systematic review. RESULTS: A total of 14 studies were included for meta-analysis (12 compared CTG with acellular dermal matrix allograft and 2 compared CTG with Xenogenic Collagen Matrix). Relative root coverage showed no significant difference among the materials, for either 2 or 3 mm minimal recessions. For keratinized tissue width, on 2 mm recessions, CTG showed superiority above other biomaterials, but on 3 mm recessions, it seemed to have the same results. The percentage of recessions with complete root coverage for both 2 and 3 mm recessions showed similar results for all biomaterials. CONCLUSIONS: With their limits, the present data concluded that CTG, acellular dermal matrix allograft, and xenogenic collagen matrix provided similar results for root coverage. CLINICAL RELEVANCE: To know if there is a 3D matrix with equivalent predictable results for root coverage, that we could avoid the morbidity of the connective tissue graft for these cases.

Effectiveness of connective tissue graft substitutes for the treatment of gingival recessions compared with coronally advanced flap: a network meta-analysis.

OBJECTIVES: This study aimed to conduct a network comparison of the clinical effect of connective tissue graft (CTG) substitutes on the treatment of gingival recessions using coronally advanced flap. MATERIALS AND METHODS: An electronic search without language or dates restrictions was performed in five databases and in Grey literature for articles published until May, 2020. The eligibility criteria comprised randomized controlled trials (RCTs) that analyzed the clinical outcomes of CTG substitutes when compared with coronally advanced flap (CAF) for the treatment of Miller class I and II (Cairo RT I) gingival recessions. A pairwise and network meta-analysis were conducted for each periodontal parameters to assess and compare the outcomes among different treatment arms for the primary and secondary outcomes. This systematic review (SR) was registered in INPLASY under number INPLASY202060075. RESULTS: Twenty-seven studies were included in the present SR. All analyzed CTG substitutes showed superior results when comparing with CAF alone for all periodontal parameters. However, when compared in a network, the acellular dermal matrix (ADM) demonstrated the best treatment ranking of probability results, followed by platelet-rich fibrin (PRF), enamel matrix derivative (EMD), and xenogeneic collagen matrix (XCM) for root coverage (RC). CONCLUSION: This SR observed that the association of biomaterials increases the effectiveness of RC in comparison with CAF alone. Based on the treatment ranking, although all the biomaterials analyzed showed a positive effect for RC, the ADM demonstrated the best results. CLINICAL RELEVANCE: To know the effectiveness of CTG substitutes for the treatment of gingival recessions.

Ineffectiveness of ozone therapy in nonsurgical periodontal treatment: a systematic review and metaanalysis of randomized clinical trials.

OBJECTIVE: This systematic review (SR) aimed at assessing the adjunctive clinical effect of ozone therapy (OT) on nonsurgical periodontal treatment. MATERIALS AND METHODS: Articles published prior to September 2019 were electronically searched in four databases without any other date or language restrictions and manually searched in regular journals and in gray literature. This review was performed according to the PICO format. The eligibility criteria comprised randomized controlled trials (RCTs) that analyzed the adjunctive effect of OT on nonsurgical periodontal treatment. RESULTS: Twelve studies published between 2010 and 2019 were included in this SR. A metaanalysis of ten reports showed that there was no statistically significant difference in the periodontal parameters analyzed when scaling and root planing (SRP) plus sulcus irrigation with ozonated water or sulcus insertion of ozonated gas were used when compared to SRP alone. Additionally, there was no significant difference when the effect of SRP plus ozonated water was compared with SRP plus 2% chlorhexidine gluconate (CLX). No studies reported significant microbiological differences when the use of ozone was compared with SRP alone. CONCLUSIONS: The results of this SR do not support the use of OT for nonsurgical periodontal treatment. However, due to the potential heterogeneity across the studies, the presence of confounding factors, and the short follow-up of some included RCTs, these results should not be considered definitive. CLINICAL RELEVANCE: The current evidence indicates that ozone has antimicrobial activity and good biocompatibility with periodontal cells and gingival fibroblasts. However, no evidence was found for a positive effect of OT as an adjunct to scaling and root planing.

Evaluation of the insertion torque, implant stability quotient and drilled hole quality for different drill design: an in vitro Investigation.

OBJECTIVE: The purpose of the present study was to compare the insertion torque and implant stability quotient between different drill design for implant site preparation. MATERIALS AND METHODS: Synthetic blocks of bone (type I density) were used for drilling procedures. Three groups were evaluated: Group G1 - drilling with a single bur for a 4.2 mm conical implant; Group G2 and Group G3 - drilling with three consecutive burs for a 4.1 mm cylindrical implant and for a 4.3 mm conical implant respectively. For each group, 15 drilling procedures were performed without irrigation for 10-mm in-depth. The drilled hole quality (HQ) after the osteotomy for implant site preparation was measured in the five-first holes through a fully automated roundness/cylindricity instrument at three levels (top, middle, and bottom of the site). The insertion torque value (ITV) was achieved with a computed torquimeter and the implant stability quotient (ISQ) values were measured using a resonance frequency apparatus. RESULTS: The single drill (group 1) achieved a significantly higher ITV and ISQ than the multiple drills for osteotomy (groups 2 and 3). Group 1 and 3 displayed significantly better HQ than group 2. CONCLUSIONS: Within the limitations of the study, the results suggest that the hole quality, in addition to the insertion torque, may significantly affect implant primary stability.

Effects of a toothpaste containing 0.3% triclosan in the maintenance phase of peri-implantitis treatment: 2-Year randomized clinical trial.

OBJECTIVE: To evaluate the effects of a toothpaste containing 0.3% triclosan in volunteers that have been treated for peri-implantitis and were enrolled in a maintenance program. MATERIAL AND METHODS: Subjects presenting at least one implant with peri-implantitis were selected. They received anti-infective surgical therapy, and sixty days post-surgery (baseline) were randomized into two groups, brushing twice/day for 2 years (a) with a toothpaste containing 0.3% triclosan+2.0% PVM/MA copolymer (GantrezTM )+1,450 ppm fluoride (test) or (b) with a toothpaste containing 1,450 ppm fluoride (control). They received clinical and microbiological monitoring at baseline, 3, 6, 12, 18, and 24 months, and professional maintenance every 3 months. RESULTS: A total of 102 subjects were enrolled (test: 48; control: 54). The control group showed loss of clinical attachment (CA) around treated implants over the course of the study (p < 0.05), while the test group was stable for this parameter. The difference between groups (0.55 mm) for CA change between baseline and 24 months (primary outcome variable) was statistically significant (p < 0.05). Red complex pathogens were only reduced in the test group at 24 months. The implants with no history of peri-implantitis in the test group had a significant reduction in the percentage of sites with bleeding on probing and in mean probing depth, throughout the study (p < 0.05). This improvement was not observed in the control group. CONCLUSION: A toothpaste containing 0.3% triclosan was more effective than a toothpaste without triclosan in maintaining a healthy peri-implant environment around treated implants and implants with no history of peri-implantitis during a 2-year maintenance program (ClinicalTrials.govNCT03191721).

Transforming growth factor-ß, interleukin-17, and IL-23 gene expression profiles associated with human peri-implantitis.

OBJECTIVES: The mRNA expression profiles of IL-23/Th17 and the Treg-associated cytokine TGF-ß in peri-implantitis are currently under research. This study characterized the IL-17, IL-23, and TGF-ß gene expression levels in healthy and diseased peri-implant tissues and correlated these data with radiographic bone loss. MATERIAL AND METHODS: Peri-implant soft tissues from 40 subjects (20 healthy controls with mean age of 59.4 ± 6.3, and 20 with peri-implantitis with mean age of 56.6 ± 5.5) were enrolled in this study, and real-time PCR (RT-PCR) was used to define the profile of IL-17, IL-23, and TGF-ß gene expression. RESULTS: Higher levels of TGF-ß mRNA were observed in biopsies taken from healthy controls, and the IL-23 mRNA levels were significantly increased in the peri-implantitis group (P < 0.0001). No differences in IL-17 mRNA levels were observed between the two groups (P > 0.05). CONCLUSIONS: Data presented in this report demonstrated a predominant Th17 response in peri-implantitis subjects based on the higher levels of IL-23 and lower levels of TGF-ß detected.

Early bone formation around immediately loaded implants with nanostructured calcium-incorporated and machined surface: a randomized, controlled histologic and histomorphometric study in the human posterior maxilla.

OBJECTIVE: The aim of this randomized, controlled histologic/histomorphometric study was to compare the early bone formation around immediately loaded implants with nanostructured calcium-incorporated (NCI) and machined (MA) surface, placed in the human posterior maxilla. MATERIALS AND METHODS: Fifteen fully edentulous patients (six males; nine females; mean age 57.9 ± 6.7 years) were selected for this study. Each patient was installed with two temporary transmucosal implants, with different surfaces: one NCI (test) and one MA (control) implant. All temporary implants were placed in the posterior maxilla, according to a split-mouth design, to help to support an interim complete maxillary denture. After 8 weeks, all temporary transmucosal implants were retrieved for histologic/histomorphometric evaluation. The bone-to-implant contact (BIC%) and the bone density (BD%) were calculated. The Wilcoxon matched-pairs signed-rank test was used to evaluate differences (BIC%, BD%) between the surfaces. The level of significance was set at 0.05. RESULTS: Eight weeks after placement, 24 clinically stable implants (12 test, 12 control) were subjected to histologic/histomorphometric evaluation. In the MA implants, the histomorphometric evaluation revealed a mean BIC(±SD)% and BD(±SD)% of 21.2(±4.9)% and 29.8(±7.8)%, respectively. In the NCI implants, the histomorphometric analysis revealed a mean BIC(±SD)% and BD(±SD)% of 39.7(±8.7)% and 34.6(±7.2)%, respectively. A statistically significant difference was found between the two surfaces with regard to BIC% (p < 0.001), while no significant difference was found with regard to BD% (p = 0.09). CONCLUSIONS: The NCI surface seems to increase the peri-implant endosseous healing properties in the native bone of the posterior maxilla, under immediate loading conditions, when compared with the MA surface. CLINICAL RELEVANCE: Under immediate loading conditions in the human posterior maxilla, the nanostructured calcium-incorporated surface has led to better histologic and histomorphometric results than the machined surface; therefore, the clinical use of implants with nanostructured calcium-incorporated surface may be beneficial in the posterior maxilla, under immediate loading protocol.

Early Bone Response to Dual Acid-Etched and Machined Dental Implants Placed in the Posterior Maxilla: A Histologic and Histomorphometric Human Study.

PURPOSE: To compare the early bone response to implants with dual acid-etched (DAE) and machined (MA) surface, when placed in the posterior human maxilla. MATERIALS AND METHODS: Fourteen patients received 2 implants in the posterior maxilla: 1 DAE and 1 MA. After 2 months, the implants were retrieved for histologic/histomorphometric evaluation. The bone-to-implant contact (BIC%), bone density in the threaded area (BDTA%), and the bone density (BD%) were calculated. The Wilcoxon matched-pairs signed rank test was used to evaluate differences (BIC%, BDTA%, and BD%) between the surfaces. RESULTS: In the MA implants, a mean (±SD) BIC%, BDTA%, and BD% of 21.76 (±12.79), 28.58 (±16.91), and 21.54 (±11.67), respectively, was reported. In the DAE implants, a mean (±SD) BIC%, BDTA%, and BD% of 37.49 (±29.51), 30.59 (±21.78), and 31.60 (±18.06), respectively, was reported. Although the mean BIC% of DAE implants value was almost double than that of MA implants, no significant differences were found between the 2 groups with regard to BIC% (P = 0.198) and with regard to BDTA% (P = 0.778) and BD% (P = 0.124). CONCLUSIONS: The DAE surface increased the periimplant endosseous healing properties in the native bone of the posterior maxilla.