Cases Of Peri-implantitis Research Articles

Guided bone regeneration improves defect fill and reconstructive outcomes in 3-wall peri-implantitis defects.

This multi-center, randomized clinical trial compared the long-term outcomes of guided bone regeneration (GBR) with open flap debridement (OFD) in treating peri-implantitis-related bony defects with ≥3 osseous walls over 36 months. The study aimed to evaluate the healing potential of GBR using a deproteinized bovine bone mineral (DBBM) graft and native bilayer collagen membrane (NBCM) compared to OFD without the use of graft materials. Sixty-six individuals diagnosed with peri-implantitis were randomly assigned to either GBR (34 patients) or OFD (32 patients). The OFD group served as the control, where inflamed tissue was removed and the implant surface decontaminated using 3% hydrogen peroxide, but no bone graft was placed. The GBR group received DBBM and NBCM for defect reconstruction. Radiographic defect fill (RDF), probing pocket depth (PPD), bleeding on probing (BOP), suppuration (SUP), mucosal recession (MREC), and patient-reported outcomes (PROs) were assessed over the study duration. Post-surgical care included azithromycin, ibuprofen, and chlorhexidine rinses. The study involved baseline assessments, surgical interventions, and follow-ups at 6, 12, and 36 months. Supportive peri-implant therapy was provided every 3 months during the additional 24-month follow-up. Primary outcome was RDF at 36 months. Secondary outcomes included PPD, BOP, SUP, MREC, and PROs. Descriptive statistics and ANCOVA models were used for analysis. At 36 months, GBR resulted in a mean RDF of 2.13 ± 1.26 mm, compared to 1.64 ± 1.54 mm with OFD (p = .18). No significant differences were found in PPD, BOP, SUP, REC, or PROs between the groups. Treatment success (defined as no additional bone loss, PPD ≤ 5 mm, no BOP, and no SUP) was achieved in 46.2% of GBR cases and 20% of OFD cases (p = 0.053). GBR provided improved short-term defect fill and higher treatment success compared to OFD, although the differences were not statistically significant. Both procedures maintained clinical parameters over 36 months, with similar patient satisfaction (PROs) observed for GBR and OFD. The adjunct use of DBBM and NBCM may offer clinical benefits for peri-implantitis cases with specific bony defect morphology.

Evaluation of the Loss of Surface Roughness Following the Use of Four Different Instruments for Mechanical Debridement of Dental Implants: An In-vitro Pilot Study

To compare the dental implant surface properties such as mean surface roughness, roughness depth, and the surface loss produced by different prophylactic instrument types. Twenty-four surfaces of twelve dental implants were treated using titanium curettes, titanium-coated curettes, an air abrasion unit, and titanium brushes. The dental implants were inserted partially into a Styrofoam base, exposing one-third to simulate cases of peri-implantitis. The exposed surface was coated with artificial dental calculus (ADC) and divided into four groups for treatment. The arithmetic mean surface roughness (Ra) and the mean roughness depth (Rz) were assessed using the confocal microscope, and the surface loss (SL) area was calculated from the scanning electron microscopic images using an image analysis software. The Ra value varied between 1.08 to 0.29 µm, the Rz value between 10.3 to 70.5 µm, and the mean surface loss area between 154 to 9410 µm2. The One-way ANOVA analysis showed a statistically significant difference between the four groups (P < 0.05). The air abrasion unit showed the highest mean roughness value of 1.08 ± 0.14 µm, mean roughness depth of 70.5 ± 2.21 µm, and a minor surface area loss of 154 ± 132 µm2. In comparison, the titanium brushes showed the least Ra and Rz of 0.29 ± 0.05 µm and 10.3 ± 2.32 µm, respectively, whereas the titanium-coated curettes showed the highest loss of surface area 9410 ± 91.6 µm2. The air abrasion unit was shown to have the least detrimental effect on the implant surface when removing the artificial dental calculus compared to the other three methods.

Antibiotic resistance among Aerobic Gram-Negative Bacilli isolated from patients with oral inflammatory dysbiotic conditions—a retrospective study

IntroductionAerobic Gram-Negative Bacilli (AGNB) are not part of the resident oral microflora but are occasionally found in high abundance under inflammatory dysbiotic conditions at various oral niches. The aim of the present study was to investigate the identity and antibiotic susceptibility of AGNB isolated from patients in Sweden with mucosal lesions, periodontitis, and peri-implantitis, with special attention to antibiotic resistance and on the presence of phenotypic Extended Spectrum Beta-Lactamase (ESBL) isolates.Materials and methodsMicrobiolgical samples were harvested from 211 patients in total, experiencing mucosal lesions (N = 113), periodontitis (N = 62), or peri-implantitis (N = 36). The growth of AGNB's was semiquantified by selective and non-selective culture and the strains were isolated, identified, and tested for antibiotic susceptibility. A total of 251 AGNB strains, occurring in moderate to heavy growth (&amp;gt;100 CFU/ml sample), indicating a dysbiotic microbiota, were identified. The disc diffusion method was used for screening of the antibiotic susceptibility of the isolates. Phenotypic identification of ESBL isolates was based on resistance to ceftazidime and/or cefotaxime.ResultsThe most commonly detected AGNB isolates in oral inflammatory dysbiotic conditions were fermentative species belonging to Enterobacteriaceae e.g. Citrobacter spp., Enterobacter spp., Escherichia coli, Klebsiella spp, and the non-fermentative environmental Burkholderia cepacia, Pseudomonas spp., and Stenotrophomonas maltophilia. No clear trends were seen in frequency of the various species in samples from mucosal lesions, severe periodontitis, and peri-implantitis cases. The 138 Enterobacteriaceae isolates and 113 environmental AGNB isolated showed a high antibiotic resistance in general against antibiotics commonly used in dentistry (Amoxicillin, Amoxicillin + Clavulanic acid, Ampicillin, Clindamycin, Doxycycline, Erythromycin, Oxacillin, PenicillinV, and Tetracycline). The majority of these isolates were susceptible to ciprofloxacin. Ten isolates (4.1%) were phenotypically classified as ESBL positive. The ESBL isolates were predominantly found among isolates of S. maltophilia, while only one ESBL positive isolate was found among Enterobacteriaceae.ConclusionsPhenotypically identified ESBL isolates can occasionally be present among oral AGNB strains isolated in abundance from the dysbiotic microbiota occurring in cases with oral mucosal lesions, severe periodontitis, or peri-implantitis.

The Peri-Implant Microbiome-A Possible Factor Determining the Success of Surgical Peri-Implantitis Treatment?

The objective was to assess the effect of peri-implantitis surgery on the peri-implant microbiome with a follow-up of one year. A total of 25 peri-implantitis patients in whom non-surgical treatment has failed to solve peri-implantitis underwent resective surgical treatment. Their peri-implant pockets were sampled prior to surgical treatment (T0) and one year post treatment (T12). The natural dentition was sampled to analyse similarities and differences with the peri-implantitis samples. Treatment success was recorded. The change in microbial relative abundance levels was evaluated. The microbiota was analysed by sequencing the amplified V3-V4 region of the 16S rRNA genes. Sequence data were binned to amplicon sequence variants that were assigned to bacterial genera. Group differences were analysed using principal coordinate analysis, Wilcoxon signed rank tests, and t-tests. Beta diversity analyses reported a significant separation between peri-implantitis and natural dentition samples on T0 and T12, along with significant separations between successfully and non-successfully treated patients. Eubacterium was significantly lower on T12 compared to T0 for the peri-implantitis samples. Treponema and Eubacterium abundance levels were significantly lower in patients with treatment success on T0 and T12 versus no treatment success. Therefore, lower baseline levels of Treponema and Eubacterium seem to be associated with treatment success of peri-implantitis surgery. This study might aid clinicians in determining which peri-implantitis cases might be suitable for treatment and give a prognosis with regard to treatment success.

The Successful Treatment of Peri-implantitis with Guided Bone Regeneration with an 8-Year Follow-up: Case Report and Literature Analysis

Replacement of missing teeth or unrestorable ones with dental implant-supported restorations is a substantial part of the clinical treatment protocol. However, with the increase in dental implants being placed worldwide, complications with this treatment have also risen in numbers. Complications may result from poor selection of cases with inappropriate treatment planning, occlusal overloading, or with poor follow-up care. The most common complications are the ones related to the presence of inflammation and include perimucositis and peri-impantitis. Peri-implantitis is an inflammatory condition that affects the soft and hard tissues around osseointegrated implants and results in the establishment of a peri-implant pocket and the loss of supporting bone. Nonsurgical therapy, the use of locally and systemically given antibiotics, and surgical regimens intended to replace the lost bone and soft tissue around the implants are among the documented treatment options. The aim of this article is to present a case report on the successful management of a case of peri-implantitis with nonsurgical and surgical approach following the ITI treatment protocol with a 5-year follow-up, along with a review of some of the treatment options used in their management.

NON-SURGICAL TREATMENT OF PERI-IMPLANTITIS: CASE REPORT

Background: Dental implants are an effective, reliable and widely implemented clinical treatment option for the replacement of missing teeth. But although showing predictable successful outcomes, problems are not rare, and nowadays intensively are discussed the related biological complications. And while peri-implant diseases are becoming frequent health issues in dental offices, commonly accepted and applied treatment protocols are still missing. Materials and methods: In this article, we present a case of acute peri-implantitis. A male patient, 50 years old, systemically healthy and non-smoker, complained of pain, oedema and bleeding in the site of an implant placed 5 years ago. The clinical evaluation revealed red and swollen mucous and the presence of a peri-implant abscess. After probing, extensive bleeding and suppuration were observed. The probing depth on the distal site of 4.5 implant was 7mm and the X-ray evaluation showed significant bone loss at this site. The case was resolved completely with non-surgical mechanical debridement combined with systemic antibiotic therapy and subsequent regular peri-implant maintenance therapy. Results: The case demonstrates satisfactory results with a gain of radiographic bone level as it is seen on the X ray imaging, comparing the initial bone level and the bone level 6 months after active treatment. Resolution of peri-implant soft tissue inflammation (no bleeding on probing, no suppuration) is also observed. Conclusion: Non-surgical therapy of peri-implantitis is effective in arresting progressive bone loss and can achieve radiographic bone fill.

Influence of the Number of Microthreads on Marginal Bone Loss: A Five-Year Retrospective Clinical Study in Humans

The purpose of the present study was to evaluate the clinical and radiographic outcomes of the number of microthreads on marginal bone over 5 years. Thirty-two implants were placed in 32 patients with partially edentulous maxillae or mandibles. Two implants with the same characteristics were placed: the first one had a 1 mm crest module and 3 microthreads (Q); and the second one had a 3 mm crest module and nine microthreads (S). The prosthesis was inserted 3 months after implant placement. Clinical and radiographic examinations were performed at the one-week, one-month, and three-month follow-up visits and then every six months until a five-year follow-up period was completed. After 5 years of follow-up, five patients withdrew from the study. Complete data were available for 27 implants, with a 100% implant survival rate. No cases of peri-implantitis were diagnosed. The average bone loss was 0.65 mm (C.I. 0.21–1.09) for Q implants and 0.86 mm (C.I. 0.39–1.33) for S implants, with no statistically significant difference. The bone level does not vary between implants with three and nine microthreads or with a 1 mm and 3 mm crest module. No differences in clinical parameters were found.

Multiprotocol treatment modality in chronic peri-implantitis utilizing decontaminating, single phase bio-ceramic and autologous fibrin matrix

Introduction: Peri-implant diseases are defined as pathological inflammatory reactions in the tissue surrounding osseointegrated implants. They are classified into two categories: mucositis—defined as peri-implant soft tissue inflammation and peri-implantitis—bone loss in the peri-implant region. Case Report: A clinical case of a 61-year-old woman with an implant in the 46 anatomical position presented with peri-implantitis after a 5-year follow-up. A probe depth of 5 mm and a bone defect length of 35% was observed. The Implacure Protocol was applied, with the main objective of eliminating the biofilm present on the exposed implant surface. There are multiple approaches to treat peri-implant diseases. While non-surgical treatment is essentially sufficient for mucositis control, the treatment in most cases of peri-implantitis should be surgery. Regenerative bone reconstruction promotes bone repair in the defect area and reduces bleeding during probing. To achieve that, autologous fibrin combined with Cerasorb M was used. Conclusion: The proposed approach in the presented clinical case involves the application of Implacure Protocol, whose combination of the physical decontamination technique, together with the use of chlorhexidine and orthophosphoric acid, added with the combination Piperacillin + Tazobactam together with hyaluronic acid, provided a base that allows to regenerate bone using platelet-rich fibrin with Cerasorb M and increase the implant survival time.

Prosthetically guided oral implant surgery. A retrospective cohort study evaluating the 5-year surgical outcome.

This study primarily evaluated the 5-year implant survival and success rate of prosthetically guided inserted implants. The secondary aim was to evaluate the impact of clinical variables on the development of mucositis, peri-implant bone resorption, peri-implantitis, as well as early and late implant failure. An observational retrospective single-centre study was conducted on patients who were treated with dental implants in the department of oral and plastic maxillofacial surgery of the military hospital of Ulm University between 2008 and 2010. In all patients, computer-assisted 3D planning after wax-up of the prosthetic restoration and template-guided surgery with titanium implants were performed. Bone augmentation procedures were performed primarily if needed. Intraoperative and postoperative complications as well as technical and mechanical complications after prosthesis loading were evaluated. In a 5-year clinical and radiological follow-up, implant success and implant survival were assessed using descriptive statistics. A multivariable regression analysis evaluated the potential impact of augmentation procedures, wound healing complications, smoking, history of periodontitis, and preoperative API (approximal plaque index) and SBI (sulcus bleeding index) values on peri-implant mucositis, peri-implant bone resorption, peri-implantitis, as well as early and late implant failure. In this study, 466 implants in 283 patients were considered for inclusion, and sufficient data were obtained for analysis from 368 (78.9%) implants in 229 (80.9%) patients. An overall implant survival rate of 98.1% (n=361/368) at the 5-year follow-up was revealed. According to the success criteria of the study, the 5-year success rate was 97.04% (n=263/271). An early implant failure of 1.07% (n=5/466) was recorded. 48.2% of the implants were affected by peri-implant mucositis (n=122/253), while peri-implant bone resorption was detected in 21.7% of the radiologically examined implants (n=59/271). Fifteen cases of peri-implantitis (5.5%) were detected. Peri-implant bone resorption increased significantly after bone augmentation procedures (p=0.028). Wound healing complications after implantation significantly increased the prevalence of late implant failure in the maxilla (p<0.001). Peri-implant bone resorption and peri-implantitis were significantly more prevalent in smokers (p=0.022/p=0.043). Implants in patients with API>20% presented significantly higher rates of peri-implant mucositis (p=0.042). Wound healing complications after augmentation, history of periodontitis, and SBI>20% had no significant impact on the study parameters. The study confirms the reliability of prosthetically guided implant surgery, showing a high implant survival and success rate in a 5-year follow-up. Intraoperative complications and technical or mechanical complications after prosthesis loading remain within acceptable clinical limits. The rate of peri-implant mucositis, peri-implant bone resorption, and peri-implantitis was within the current literature range. Optimizing periodontal health and reducing smoking would improve the outcome. Further studies need to clarify the clinical indications and investigate the long-term surgical outcome of this treatment concept.

Clinical evaluation and patient related outcomes of one- and two-piece zirconia implants at five years of loading: A case series study.

The objective of this study was to investigate the survival and biological and mechanical complications of one-piece and two-piece zirconia implants at five years of loading. Consecutive patients receiving zirconia implants were studied, collecting data at five years of loading on their clinical history, peri-implant health status, mechanical complications, esthetic results, and patient related outcomes. The study included 18 patients with 29 implants. The survival rate was 86% in implant-based analysis and 78% in patient-based analysis. There were no cases of peri-implantitis, but mucositis was present in 53% of implants. A mean of 4.1 ± 0.81 mm was obtained for probing depth and 1.6 ± 0.9 mm for crestal bone loss (radiographic assessment). There were no implant fractures. Major (10%) and minor (10%) prosthesis complications were observed. The esthetic outcome was moderate to almost perfect, with a high level of patient satisfaction. No significant association was found between survival rate and the presence of mucositis around one- or two-piece implants or any other study variable. The survival rate is low for one- and two-piece zirconia implants. Both types of implants demonstrated a low mechanical complication rate. The incidence of periimplantitis is low but mucositis is present in 50%. Patient satisfaction related to esthetics and function is moderate to high. They represent a good option for patients requiring an alternative to titanium implants. Zirconia implants appear to be an alternative to the titanium option and may be indicated for patients requiring "metal-free" restorations.

A Comparative Study on the Effect of Peri-Implant Infection Management Lasers (1064-nm Q-Switch Nd:YAG, 1064-nm Nd:YAG and 980-nm Diode) on Titanium Grade 4 Surface

Over the past 10 years, the number of dental implants has grown significantly. This increase has consequently led to an elevation of the statistics related to cases of peri-implantitis. Laser therapy has conquered a place among the therapies of excellence to treat peri-implantitis. However, the laser device used could influence the therapy’s success. The aim of this comparative experimental work was to highlight the differences in the work on grade 4 titanium surfaces of the most commonly used laser lights in this field, taking into consideration any structural damage that lasers could cause to implant surfaces. The lasers examined were a 980 nm diode laser; a 1064 nm Nd:YAG laser; and a new generation of 1064 nm Nd:YAG Q-switch nano pulsed laser. We evaluated the titanium temperature increase, the pre- and post-treatment two-dimensional surface appearance observed under the scanning electron microscope; finally, the three-dimensional pre- and post-treatment topographic analysis was assessed using atomic force microscopy. We showed that the 1064-nm Q-switch Nd:YAG nanosecond pulsed laser appears to be more suitable for the preservation of implant morphology because of the absence of the induction of metal damage.

The study of genetic predisposition on periodontitis and peri-implantitis.

Peri-implant mucositis and peri-implantitis cases increase in number with the increase of implant applications. Peri-implant mucositis and peri-implantitis are defined as inflammatory diseases with inflammation and loss in soft and hard tissue, similar to the other periodontal diseases. As observed in many diseases, genetic predisposition factors also affect the progress of periodontitis and peri-implantitis. This study examines if there is any solid genetic predisposition causing periodontitis and peri-implantitis formation in Turkish patients. In order to evaluate single nucleotide polymorphism (SNP), Interleukin-8 (IL-8) and N-formyl-L-methionyl-L-leucyl-phenylalanine (fMLP), playing a role in the chemotaxis of neutrophils, and Fc Gamma Receptor IIA (FcγRIIA) and Fc Gamma Receptor IIIA (FcγRIIIA), playing a role in the antigen-antibody complexes and phagocytosis, were selected. Thirty-two Turkish non-smoking subjects, having periodontitis, thirty-three Turkish non-smoking subjects, having peri-implantitis and thirty-three Turkish non-smoking healthy subjects were selected. In total 98 adults participated in our study. Collected saliva samples from the participants were used for DNA isolation. SNPs were determined in these subgroups of the study by means of genotype-specific polymerase chain reactions. When IL-8 A-251T, FcγRIIa -H131 and FcγRIIIa -V158 polymorphism were evaluated, no significant difference was found between periodontitis, peri-implantitis and healthy groups. However, this study observed that fMLP Receptor (FPR1) gene polymorphism creates a significant difference in individuals at higher risk of periodontitis or peri-implantitis. Results show that individuals with the G genotype have a higher risk of periodontitis, while individuals with G / C genotype have higher risk of peri-implantitis.

Two-piece zirconia implants in the posterior mandible and maxilla: A cohort study with a follow-up period of 9 years.

Long-term follow-up observations of zirconia implants are rare. This study aimed at evaluating the clinical performance of two-piece zirconia implants in the posterior jaws over 9 years. Sixty partially edentulous patients were treated with two-piece zirconia implants. In eight no primary stability could be achieved. Fifty-two patients received the final restoration (i.e., cemented fibreglass abutments and all-ceramic crowns). After 2 years, 2 implants failed and 4 dropouts were recorded. The remaining 46 patients with one target implant each were recalled at 9 years. Besides implant survival, clinical parameters at the implant level (plaque index-PI, bleeding on probing-BOP, probing depth-PD, mucosal recession-MR) were recorded and compared with previously collected data. Mechanical and technical complications were assessed. Thirty patients responded. The mean observation period was of 111.1 ± 2.2months. One implant was lost. Data recorded from the remaining 29 implants were analysed. PI values increased overtime. Mean BOP and PD remained unchanged during follow-up. No additional cases of peri-implantitis were recorded over the 10 diagnosed during the first 2 years of follow-up. No significant changes in mean MR values were detected over time, with 65% of the all included implants exhibiting no recession at 9 years and all the others, but one, a maximum MR of 1 mm. Three technical and 6 mechanical complications occurred in 7 patients between 2- and 9-years (6.9% and 20.7%, respectively, at patient level). Within the limitations of the present study, a high survival rate was registered. Albeit frequent mechanical and technical complications, two-piece zirconia implants could represent a valid solution for the replacement of single teeth in the posterior jaws.

Retreatment of a Case of Severe Peri-Implantitis Using a Minimally Invasive Approach: Atraumatic Extraction and Transcrestal Sinus Lift

Since the beginning of implantology in the 70’s with the advances made by Branemark [1], dental implants have been consolidated as the therapeutic option of choice in many cases of partial or total edentulism for the rehabilitation of patients.

Sodium Bicarbonate Jet Reduces Contamination of Dental Implants In Vitro Without Causing Visible Surface Changes.

The increasing use of dental implants in oral rehabilitation has contributed to the increase of cases of peri-implantitis, a complex clinical condition that persists without an ideal treatment protocol. Therefore, this study aimed to verify the decontaminating action of the sodium bicarbonate jet in vitro, using different protocols, and the presence of visible changes on the surface of dental implants. Sixteen titanium implants (BioHE, Bioconnect) were used, divided into four groups (four implants per group): sterile implants (S)-negative control; implants contaminated with oral biofilm (C)-positive control; and implants contaminated with oral biofilm and decontaminated with a sodium bicarbonate jet for 30 seconds (J30) or 60 seconds (J60). The implants of groups C, J30, and J60 were contaminated in vitro with oral biofilm, then groups J30 and J60 received the respective decontamination treatments. Microbiologic analysis was performed by counting the colony-forming units (CFUs), and a qualitative descriptive analysis of the implant surface was performed after microbiologic analysis using scanning electron microscopy (SEM). Statistical analysis included one-way analysis of variance (ANOVA) and Tukey tests and the independent t test, with a .05 significance level. There was a significant reduction (P < .01) in the number of CFUs in groups J30 (3.63 × 106 ± 0.32) and J60 (2.74 × 106 ± 0.21) compared with group C (5.05 × 106 ± 0.43). Both decontaminated groups were statistically different from group S, which did not show bacterial growth (P < .01). When groups J30 and J60 were compared, there was also a significant difference between them (P < .01), and the group J60 showed greater decontaminating potential. The descriptive qualitative analysis did not show any visible changes on the surface of the implants. The sodium bicarbonate jet was effective in decontaminating titanium implants in vitro, causing no visible damage to the implant surface.

Peri-Implantitis: A New Definition Proposal Based on Unnatural Spatial Arrangement and Late Mechanical Coupling between Two Cortical Bone Layers during Osseointegration Phase: Part I

Scientists have been speculating for three decades about the reasons for the occurrence of peri-implantitis around dental implants. Many theories have been proposed since the beginning of 1990. Since then, the dental profession has been exposed to a vast number of peri-implantitis cases, whereas the “disease” had been unknown before this time. However, the situation has not improved because we focus more on how to treat the problem instead of trying to understand it completely. The aim of this paper is to present a purely bone-based explanation for the beginning of the “bone loss” process around already “osseointegrated” implants. Conclusion: There are a number of possible chain reactions of physiological bone response to dental implants which may explain the occurrence of peri-implantitis. Bacteria and “immunological reactions” may not be the main causes of this disease. In the first part, the authors present the principles of bone biology and physiology based on the theories of Donath, Jansen and Frost and transfer them to the field of implantology. They describe the stages of “osseointegration”, explaining the subsequent changes in the bone at the implant–bone interface.

Evaluation of dentists' clinical approaches in implant applications and periimplantitis cases

Evaluation of dentists' clinical approaches in implant applications and periimplantitis cases

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 5-7years. Despite surgical treatment, cases of further disease progression that required retreatment or led to implant loss were reported.

Evaluation of Soft-Tissue Grafting in Peri-implantitis - An Original Research.

Introduction:With the increased application of the implants for the restoration of the lost teeth, the peri-implantitis cases are seen on a rise. Hence, we conducted a study retrospectively to evaluate, among the peri-implantitis cases, the success of the soft-tissue grafting.Material and Methods:We piloted a retrospective study among 50 subjects of both genders who underwent the soft-tissue grafting for the treatment of the peri-implantitis of a total of 69 implants. The clinical parameters noted were at the baseline and at various years of follow-ups. The data of the clinical parameters were noted, and the data thus noted were compared deliberating P < 0.05 as significant.Results:Thin soft-tissue biotype was noted among all the subjects, with the increased width of the keratinized mucosa. Significant lowering of the probing depth, bleeding on probing, and the mobility of the tissue were noted.Conclusions:We can conclude that soft-tissue grafting Is a benificial method for the peri-implantitis treatment.

Chlorhexidine for the Treatment of Peri-Implantitis: Is it a Benison?

Chlorhexidine is the most favored and widely used antimicrobial agent for the treatment of peri-implantitis. But, not many clinicians are aware of its side effects on dental implants and its cytotoxic effects on osteoblasts. The objectives of this review are to study the effect of chlorhexidine on osteoblasts as well as on the surface topography of dental implants. MEDLINE-PubMed (The National Library of Medicine, Washington DC) was used as a search engine. Databases were searched from 2010 to 2020 were explored using the following terms: "dental implant surface," "chlorhexidine mouthwash," "osteoblast cells," "osseointegration." From the total hits obtained, each article along with its cross-reference was manually read and filtered based on the focused question. The inclusion criteria included articles published only in English language involving human studies, randomized control trials, in vitro studies, and review articles. Exclusion criteria included studies published in languages other than English, orthodontic mini-implants, and pilot studies. The final process involved scrutinizing for any duplicate content of the hand searched articles. Following this, data was extracted from the compiled hand searched articles to obtain relevant information for the review. Chlorhexidine alters the surface topography of dental implants and causes cell cytotoxicity. This, in turn, can hinder the re-osseointegration potential and hence cause dental implant failure. It is, therefore, recommended to discourage the use of chlorhexidine as a surface decontaminant for peri-implantitis cases and practice implementing other antimicrobial agents.