Development Of Peri-implant Disease Research Articles

Influence of crestal and sub-crestal implant position on development of peri-implant diseases: a 5-year retrospective analysis.

The aim of the present study was to evaluate the influence of crestal and subcrestal implant position on development of peri-implant diseases. The study was designed as a retrospective clinical and radiographic analysis. Implant-supported fixed dental prostheses were allocated in two groups: with the shoulder (i) placed in sub-crestal level and (ii) placed at bone level. For each patient, the following clinical variables were assessed: FMPS, FMBS, PlI, BOP, and PD. After prothesis delivery, an intraoral radiograph was obtained; this exam was performed also at 5years of observation period. No statistically significant difference was found in terms of FMPS and FMBS at baseline and after 5years follow-up (P < 0.05). A statistically significant difference was assessed between PD of control group and test group (P = 0.042). Patient-based analysis showed a 25.6% of peri-implant mucositis and 32.6% of peri-implantitis for implants placed with the shoulder in crestal position, while for implants inserted in sub-crestal position the percentage of peri-implant-mucositis and peri-implantitis were 19%; no statistically significant difference was found between groups after 5years (P < 0.05). Within the limitation of the present study, the clinical and radiographic outcomes showed that the percentage of peri-implant mucositis and peri-implantitis was not statistically significant for both groups after 5years follow-up. The outcomes of present study clinically demonstrated that a deep position of implant shoulder did not provide any benefits. On the contrary, it may be considered a possible risk indicator for implant diseases.

Prosthetic Design Factors Influencing Peri-Implant Disease: A Comprehensive Review.

Peri-implant disease, encompassing peri-implant mucositis and peri-implantitis, presents a growing challenge in implant dentistry. This comprehensive review explores the intricate interplay between prosthetic design factors and the development of peri-implant disease. By analyzing the impact of prosthetic components on microbial colonization, mechanical stress, and soft tissue health, the review highlights their crucial role in disease prevention and management. Additionally, it emphasizes the significance of maintenance protocols, prosthetic adjustments, and patient education in ensuring favorable long-term outcomes. The review underscores the potential for future advancements in prosthetic design, including innovative materials and digital technologies, and stresses the importance of interdisciplinary collaboration in optimizing patient care. Overall, the review underscores the critical role of prosthetic design in addressing the complexities of peri-implant disease, offering insights for clinicians and researchers to enhance the success and longevity of implant-supported restorations.

Copper-bearing titanium alloy prepared by two-wire electron beam additive manufacturing with enhanced antibacterial activity

Bacterial biofilms on titanium implant surfaces may lead to the development of peri-implant diseases. For the first time, Ti6Al4V/Cu prepared by double-wire electron beam additive manufacturing (EBAM) were subjected to in-vitro antimicrobial test. The antimicrobial activity of the materials was investigated against S.aureus and C.albicans strains depending upon the amount of copper added. Increasing the copper content in material to 9.7 wt% allowed achieving 99% bacterial population reduction on the copper-containing substrate. Such an enhanced antimicrobial acivity of the substrate was caused by the release of copper ions from the Ti6Al4/Cu alloys.

Prevention and treatment of peri-implant diseases-The EFP S3 level clinical practice guideline.

The recently published Clinical Practice Guidelines (CPGs) for the treatment of stages I-IV periodontitis provided evidence-based recommendations for treating periodontitis patients, defined according to the 2018 classification. Peri-implant diseases were also re-defined in the 2018 classification. It is well established that both peri-implant mucositis and peri-implantitis are highly prevalent. In addition, peri-implantitis is particularly challenging to manage and is accompanied by significant morbidity. To develop an S3 level CPG for the prevention and treatment of peri-implant diseases, focusing on the implementation of interdisciplinary approaches required to prevent the development of peri-implant diseases or their recurrence, and to treat/rehabilitate patients with dental implants following the development of peri-implant diseases. This S3 level CPG was developed by the European Federation of Periodontology, following methodological guidance from the Association of Scientific Medical Societies in Germany and the Grading of Recommendations Assessment, Development and Evaluation process. A rigorous and transparent process included synthesis of relevant research in 13 specifically commissioned systematic reviews, evaluation of the quality and strength of evidence, formulation of specific recommendations, and a structured consensus process involving leading experts and a broad base of stakeholders. The S3 level CPG for the prevention and treatment of peri-implant diseases culminated in the recommendation for implementation of various different interventions before, during and after implant placement/loading. Prevention of peri-implant diseases should commence when dental implants are planned, surgically placed and prosthetically loaded. Once the implants are loaded and in function, a supportive peri-implant care programme should be structured, including periodical assessment of peri-implant tissue health. If peri-implant mucositis or peri-implantitis are detected, appropriate treatments for their management must be rendered. The present S3 level CPG informs clinical practice, health systems, policymakers and, indirectly, the public on the available and most effective modalities to maintain healthy peri-implant tissues, and to manage peri-implant diseases, according to the available evidence at the time of publication.

Prevention and management of peri-implant disease.

As more patients choose dental implants as their primary treatment option to restore edentulous ridges or to replace compromised dentition, preventive strategies for peri-implant diseases and complications have become an important topic. The aim of the review article is to summarize the current available evidence on the potential risk factors/indicators for peri-implant disease development and then focus on the preventive strategies for peri-implant diseases and conditions. After reviewing the diagnostic criteria and the etiology of peri-implant diseases and conditions, evidence on the possible associated risk factors/indicators for peri-implant diseases were searched and identified. Recent studies were also surveyed to explore the preventive measures for peri-implant diseases. The possible associated risk factors of peri-implant diseases can be divided into the following categories: patient-specific factors, implant-specific factors, and long-term factors. Patient-specific factors such as history of periodontitis and smoking have been conclusively associated with peri-implant diseases, whereas findings on others, such as diabetes and genetic factors, remain inconclusive. It has been suggested that both implant-specific factors, such as implant position, soft tissue characteristics, and the type of connection used, and long-term factors, such as poor plaque control and a lack of maintenance program, have a strong impact on maintaining the health of a dental implant. Assessment tool for evaluating the risk factors can be a potential preventive measure for peri-implant disease prediction, and it is needed to be properly validated. Proper maintenance program for early intervention to control peri-implant diseases at the initial stage and pretreatment assessment of the potential risk factors is the best strategy to prevent implant diseases.

Periimplantitis, periodontitis, endodontics: A dental market analysis and future trends

Background: The ageing of the population and the importance of aesthetics has put pressure on the delivery of dental care. Bacterial infection in intra-oral cavities can develop into a pathogenic biofilm, which then induces inflammatory processes. One of the necessary dental treatment steps is the disinfection of the infected area, whether it is in the root canal, or in the periodontal, periapical, or peri-implant regions. The objective of this review was to assess the actual situation and trends in the treatments for three of the most important areas of dental health: peri-implantitis, periodontitis, and endodontics. Methods: Results from clinical studies, reports from dental associations, national health insurance records, and market reports were used to quantify the number of treatment needs. For peri-implantitis, the number of inserted implants and the prevalence of peri-implantitis build the basis for the computation. For periodontitis and root canal treatments (RCTs), health insurance figures, and reports on dental instrument orders are the data sources for the estimations. Results: The data show that the number of performed periodontitis and RCTs increase linearly over the year, mainly driven by demographic changes, i.e., increase in size and age of populations. The computed values show that the treatment need for peri-implantitis follows an exponential growth and may surpass that of periodontitis by 2023 in Europe and in the USA. Conclusion: Where dental implantology is growing, the rapid development of peri-implant diseases will burden the health systems. This should be addressed at different levels. At the practitioners’ level, this includes continuous training of staff and (re)investment in adequate material and infrastructures. At the governmental level, it includes policy development and reimbursement strategies as well as information dissemination in health insurance and dental associations. Last, but not least, R&amp;D efforts in the public and private sectors should be implemented/boosted.

The Stages and Grades of Periodontitis Are Risk Indicators for Peri-Implant Diseases-A Long-Term Retrospective Study.

The aim of this study is to evaluate the factors of implant failure in patients with periodontitis and their impact on the prognosis of having a peri-implant disease and/or implant failure. Data regarding 325 implants among 84 patients with periodontitis were retrospectively examined. Patients were classified by Stage (I, II, III, IV) and Grade (A, B, C), implant failures for peri-implant disease and lack of osseointegration. Clinical data, including implant- and patient-related variables were evaluated by principal components analysis (PCA) and two-step cluster analysis (CA). Survival and success rates were 96.3% and 87.1%, respectively. Prevalence of peri-implant disease was significantly higher in Stage IV patients (p < 0.05), and incidence of lost implant due to peri-implantitis was significantly higher in patients with bone augmentation (BA) (p < 0.05). PCA and CA revealed five of eleven variables and four clusters at patient level, and six of fourteen variables and three clusters at implant level. Stage and Grade are useful indicators for the development of peri-implant diseases in which BA and the number of implants are involved.

A Retrospective Analysis of Biological Complications of Dental Implants.

Methods A retrospective analysis of patients aged ≥18 years and having dental implants placed at Dubai Health Authority in 2010. Relevant information related to systemic-, patient-, implant-, site-, surgical- and prosthesis-related factors were collected. The strength of association between the prevalence of peri-implant mucositis and peri-implantitis and each variable was measured by chi-square analysis. A binary logistic regression analysis was performed to identify possible risk factors. Results A total of 162 patients with 301 implant-supported restorations were included in the study. The age of the patients ranged between 19 and 72 with a mean age of 46.4 ± 11.7 years. The prevalence of peri-implant mucositis at the patient and implant levels were 44.4% and 38.2%, respectively. For peri-implantitis, the prevalence at the patient level was 5.6%, while the prevalence at the implant level was 4.0%. The binary logistic regression identified three risk factors (smoking habits, histories of treated periodontitis and lack of peri-implant maintenance) for peri-implantitis. Conclusion Within the limitations of this study, smoking habits, history of treated periodontitis and lack of peri-implant maintenance were significant risk factors for peri-implantitis. Early detection of these factors would ensure appropriate planning and care of patients at high risk of developing peri-implant diseases.

Fusobacterium nucleatum: The Opportunistic Pathogen of Periodontal and Peri-Implant Diseases.

Peri-implant diseases are considered to be a chronic destructive inflammatory destruction/damage occurring in soft and hard peri-implant tissues during the patient’s perennial use after implant restoration and have attracted much attention because of their high incidence. Although most studies seem to suggest that the pathogenesis of peri-implant diseases is similar to that of periodontal diseases and that both begin with microbial infection, the specific mechanism of peri-implant diseases remains unclear. As an oral opportunistic pathogen, Fusobacterium nucleatum (F. nucleatum) has been demonstrated to be vital for the occurrence and development of many oral infectious diseases, especially periodontal diseases. More notably, the latest relevant studies suggest that F. nucleatum may contribute to the occurrence and development of peri-implant diseases. Considering the close connection between peri-implant diseases and periodontal diseases, a summary of the role of Fusobacterium nucleatum in periodontal diseases may provide more research directions and ideas for the peri-implantation mechanism. In this review, we summarize the effects of F. nucleatum on periodontal diseases by biofilm formation, host infection, and host response, and then we establish the relationship between periodontal and peri-implant diseases. Based on the above aspects, we discuss the importance and potential value of F. nucleatum in peri-implant diseases.

Prevalence and risk of peri-implant diseases based on the type of prosthetic restoration: A retrospective study after 17 to 23 years

Statement of problemInformation on the epidemiology and etiopathology of peri-implant diseases in reference to prostheses is sparse. PurposeThe purpose of this retrospective clinical study was to analyze the prevalence and risk of peri-implant diseases based on the type of prosthesis. Material and methodsA total of 274 implants in 106 patients were evaluated by clinical and radiological examination. Peri-implant mucositis was defined by bleeding on probing, whereas peri-implantitis was defined by additional bone loss ≥1.5 mm since seating of the definitive prosthesis. Prosthetic design and anamnestic risk factors were assessed in a regression analysis, whereas clinical and radiological differences between the prosthesis groups were compared by the Pearson chi-squared test (α=.05 for all procedures). ResultsThe median observation period was 18 years. Seventy-two implants were restored with single crowns, 138 implants with fixed partial dentures, and 64 implants with removable prostheses. Peri-implant mucositis was diagnosed more often in implants supporting fixed partial dentures (42.8%), whereas peri-implantitis was found more frequently in implants supporting removable prostheses (31.3%) (overall distribution pattern: P<.001). The type of prosthetic restoration was confirmed to be an independent prognostic risk factor regarding peri-implant diseases (P=.005). Additionally, increased bone loss was found with implant-supported removable prostheses, regardless of peri-implantitis (P<.001). ConclusionsThe type of prosthetic restoration was identified as an independent risk factor for the development of peri-implant diseases. Particularly, implants supporting double crown-retained removable prostheses might be at risk.

Screwed and cement implant prosthesis: current clinical considerations

ABSTRACT Introduction: There is no consensus as to which cemented or screwed retention system is best to avoid bone loss around the implant from a fixed implant-supported restoration. Objective: To evaluate the prosthesis retention systems on screw and cemented implants, regarding: bone loss, survival and failure rate, biological complications and microbiological analysis. Methods: A search was made for scientific articles that contemplated the subject through the databases Pubmed and SciELO, without period restriction. The titles, abstracts and then access to the full text has been verified. Results: It was found that excess cement may play an important role in the development of peri-implant disease. Technical failures are most seen in prosthesis retained by screws, and biological complications in cemented crowns. The success rate for both restraint systems is high, and retention-independent implant prosthesis treatment provides predictability. Conclusion: The appropriate retention system for the patient depends on several factors, including indication, advantages and disadvantages, retention provided, aesthetics and clinical performance.

Modification of in situ Biofilm Formation on Titanium by a Hydroxyapatite Nanoparticle-Based Solution.

Oral biofilms play an essential role on peri-implant disease development. Synthetic hydroxyapatite nanoparticles (nHAP) are a bioinspired material that has structural and functional similarities to dental enamel apatite and may provide preventive properties against biofilm formation. This study aimed to investigate the effects of an experimental nHAP solution on biofilm formation on polished and non-polished titanium under oral conditions. Five volunteers carried maxillary splints with non-polished and polished titanium and followed a 48 h rinsing protocol with the proposed nHAP solution, and with chlorhexidine 0.2% (CHX) and water, as controls. Samples were analyzed by fluorescence microscopy (FM), scanning electron microscopy (SEM) and transmission electron microscopy (TEM). FM showed a significant reduction of biofilms on polished samples treated with nHAP (p = 0.0485) compared with water, without differences between nHAP and CHX (p > 0.9999). Analyzing biofilm viability, polished samples rinsed with nHAP showed significantly fewer dead bacteria than CHX (p = 0.0079), but there was no significant difference in viability between polished samples rinsed with water and nHAP (p = 0.9268). A significantly higher biofilm coverage was observed on the non-polished surfaces compared to the polished surfaces when nHAP was applied (p = 0.0317). This difference between polished and non-polished surfaces was not significant when water (p = 0.1587) or CHX (p = 0.3413) rinsing were applied. SEM and TEM analysis supported the FM findings, that polished samples rinsed with nHAP presented fewer biofilm coverage compared to samples rinsed with water. In conclusion, the nHAP solution reduced the biofilm formation on polished Ti surfaces without altering bacterial viability, providing a novel approach for the management of biofilm formation on biomaterials.

Tobacco-product usage as a risk factor for dental implants.

The oral cavities of tobacco smokers and users of smokeless tobacco products are exposed to high concentrations of nicotine. A limited number of animal studies have assessed the effect of nicotine on osseointegration. Results from experimental studies have reported a statistically significant decrease, at 4weeks of follow-up, in bone-to-implant contact among rats exposed to nicotine compared with unexposed rats. Nicotine increases the production of inflammatory cytokines (such as interleukin-6 and tumor necrosis factor-alpha) by osteoblasts. Waterpipe, pipe, and cigarette smokers are at increased risk of developing oral cancer, periodontal disease, and alveolar bone loss. One explanation for this is that smokers (regardless of the type of tobacco product) are exposed to similar chemicals, such as nicotine, tar, oxidants, polyaromatic hydrocarbons, and carbon monoxide. Moreover, raised levels of proinflammatory cytokines have been identified in the gingival crevicular fluid of cigarette smokers with peri-implant diseases. Therefore, it is hypothesized that nicotine and chemicals in tobacco smoke induce a state of oxidative stress in peri-implant tissues (gingiva and alveolar bone), thereby increasing the likelihood of peri-implant disease development via an inflammatory response, which if left uncontrolled, will result in implant failure/loss. In this regard, tobacco smoking (including cigarettes, waterpipe, and pipe) is a significant risk factor for peri-implant diseases. The impact of vaping electronic cigarettes using nicotine-containing e-juices remains unknown. Habitual use of smokeless tobacco products is associated with oral inflammatory conditions, such as oral precancer, cancer, and periodontal disease. However, the effect of habitual use of smokeless tobacco products on the success and survival of dental implants remains undocumented.

Smoking as a Risk Factor for the Development of Periimplant Diseases

Risk factors associated with periimplant disease have been exhaustively explored in many studies. However, despite the high incidence of smokers in the general population, it is still unclear whether smoking is a risk factor for the development of periimplant diseases. The aim of this review was to analyze all pertinent literature, including systematic reviews, clinical trials, and long-term follow-up, to evaluate smoking as a real risk factor for periimplant diseases. A comprehensive search was conducted on MEDLINE through PubMed database of the US National Library of Medicine, for articles published until March 2018. All searches were performed using medical subject headings or free-text words. After screening, data extraction, and duplicate removal from 972 found articles, 19 were included in this review. The influence of smoking on the healing process around implants has been explored for potential disruption of the healing process and periimplant disease development. Despite the discussed results in many studies, most of the analyzed literature shows a scientific basis to determine smoking as a risk factor for periimplant disease development, considering that smoking increases the susceptibility to periimplant disease. However, future studies excluding confounding factors need to be performed. This review showed that smoking is a real risk factor that increases the likelihood of development of periimplant disease.

Peri-implant Mucosal Tissues and Inflammation: Clinical Implications.

The purpose of this review was to explore the available literature and compile studies that discuss the relevance of the biofilm, onset and progression of disease, critical peri-implant pocket depth, frequency of supportive implant therapy, excess cement, and keratinized peri-implant tissues as related to peri-implant disease. PubMed, Cochrane Oral Health Group Specialized Trial Register, and hand searches of related journals were performed in relationship to the focused question. Reports describing techniques, preclinical studies, and case reports were excluded. Due to the absence of controlled studies, a meta-analysis could not be performed. Summaries of relevant publications were completed for each topic area. Clinical recommendations were developed to provide guidance to the practitioner. The importance of proper diagnosis, planning, and clinical treatment cannot be overstated. Patient factors including systemic disease, periodontal status, and oral hygiene significantly impact peri-implant health. Clinician factors such as implant position, excess cement, and restorative design can contribute to development of peri-implant disease. Surveillance of implant status is essential and can be assisted by the assessment of risk factors, establishment of a proper recall program, and monitoring changes in bone and peri-implant pocket depths.

Evaluation of 0.2% delmopinol mouth rinse for prevention of peri-implant mucositis and peri-implantitis: A randomized controlled canine study.

To evaluate the effectiveness of 0.2% delmopinol mouth rinse in maintenance of peri-implant tissue health and prevention or inhibition of peri-implant mucositis and peri-implantitis. Four weeks following tooth extraction, eight titanium dental implants, were placed in six dogs' mandibles. Three dogs were assigned to the test or placebo mouth rinse. Eight weeks following implant installation (T2) ligature was placed to induce peri-implant disease. Clinical and radiographic assessment was performed during the study period as well as micro-CT analysis and histologic assessment to evaluate Bone-Implant Contact at the end of the follow-up (T4). Plaque at implant sites before ligature placement (T2) was lower for the test group (0.7 ± 1.0 vs 1.5 ± 1.3, P < .05). The ratio of affected implant (PD ≧4 mm) at T2 and T4 in the test group was significantly smaller than that of the placebo group (T2, 17% vs 47%, P < .01; T4, 67% vs 83%, P < .05). The test agent also seemed to be effective in partially preventing bone loss induced by ligature placement according to the Computed Tomography and histologic analysis (test, 1.1 ± 0.8 mm; placebo, 1.5 ± 0.9 mm). Within the limits of this animal model study, the results of the study indicate that the 0.2% delmopinol rinse might play a role in prevention of peri-implant disease development.

Häusliche und professionelle Maßnahmen zur Prävention periimplantärer Erkrankungen

The maintenance of peri-implant health and the prevention of peri-implant diseases are essential for a long-term implant success. Considering both issues, a consequent implementation of an individual, risk-oriented prevention concept must be developed prior to implant placement. Therefore, a targeted patient management in the so-called supportive implant therapy (SIT) is an important contribution to healthy implants.Apart from an adequate individual oral hygiene at home, a professional dental team that performs clinical diagnostics and implant cleaning is just as necessary and important for the patient. Thus, SIT must not only consist of a mechanical cleaning of the implants but must also cover a regular re-motivation and re-instruction for individual oral hygiene. Regular intervals of (at least) six months are recommended.A mechanical bio film management–at home as well as in the dental office–can be performed with well-established tools, such as tooth brushes (manual or electric), interdental brushes, or floss as well as with specific instruments or systems for implant cleaning (manual instruments, oscillating sonic or ultra-sonic scalers, air-flow polishing device). The additional use of chemical agents does not offer an additional clinical benefit. Up to now, no superiority of one of the aforementioned procedures has been documented. Accordingly, a regular mechanical implant cleaning is the most important tool in implant follow-up care, independent from the instruments applied. However, even with regular professional care, the development of peri-implant diseases cannot be avoided completely.

Parameters to Define Peri-Implantitis: A Review and a Proposed Multi-Domain Scale.

Peri-implant diseases have received much attention since dental implants are generally used in contemporary dentistry. Several contributing factors associated with the development of peri-implant diseases have also been investigated. The prevalence of peri-implantitis has been reported but with great heterogeneity because of a lack of a universally accepted classification system that could define the extent and severity of peri-implantitis. Several parameters-including radiographic bone loss, probing depth, bleeding on probing, and suppuration-have been introduced in these reports to assist with clinical diagnosis. This article provides an objective evaluation of these parameters based on currently available evidence, offers further recommendations, and proposes a multidomain scale for diagnosis of peri-implantitis. Future investigations and modifications may be needed to develop a comprehensive, evidence-based classification system that addresses the multifactorial etiology of peri-implant diseases.

High Mobility Group Box 1 Protein Level as a Novel Biomarker for the Development of Peri-Implant Disease

Peri-implant disease is a chronic inflammation of the soft and hard tissues around a dental implant, resulting from bacterial infection. Recent evidence indicates that some pro-inflammatory cytokines and chemokines released by immunocytes are substantially responsible for the progress and consequence of inflammation. High mobility group box 1 (HMGB1) is released into the extracellular matrix and acts as a key pro-inflammatory factor during injury, necrosis and inflammation. A higher concentration of HMGB1 has been found in gingival crevicular fluid from inflammatory gingival tissue than from healthy sites. HMGB1 mRNA and protein are overexpressed in murine periodontal ligament fibroblasts stimulated with lipopolysaccharide (LPS) and IL-1β. Thus, this study sought to assess HMGB1 expression in peri-implant crevicular fluid (PICF) at each stage of peri-implant disease and to investigate the correlation between HMGB1 and peri-implant disease progress. The results demonstrated that the HMGB1 expression level in PICF is indicative of the progress of peri-implant disease and hence may be a useful diagnostic and prognostic biomarker for peri-implant tissue.

Antibacterial effect of copper-bearing titanium alloy (Ti-Cu) against Streptococcus mutans and Porphyromonas gingivalis.

Formation of bacterial biofilms on dental implant material surfaces (titanium) may lead to the development of peri-implant diseases influencing the long term success of dental implants. In this study, a novel Cu-bearing titanium alloy (Ti-Cu) was designed and fabricated in order to efficiently kill bacteria and discourage formation of biofilms, and then inhibit bacterial infection and prevent implant failure, in comparison with pure Ti. Results from biofilm based gene expression studies, biofilm growth observation, bacterial viability measurements and morphological examination of bacteria, revealed antimicrobial/antibiofilm activities of Ti-Cu alloy against the oral specific bacterial species, Streptococcus mutans and Porphyromonas gingivalis. Proliferation and adhesion assays with mesenchymal stem cells, and measurement of the mean daily amount of Cu ion release demonstrated Ti-Cu alloy to be biocompatible. In conclusion, Ti-Cu alloy is a promising dental implant material with antimicrobial/antibiofilm activities and acceptable biocompatibility.