Diagnosis Of Peri-implant Diseases Research Articles

Biomaterials and Biological Parameters for Fixed-Prosthetic Implant-Supported Restorations: A Review Study

Because of the increasing use of dental implants, dental practitioners should understand the treatment and nature of peri-implant diseases (PIDs). This disease is a serious problem of dentistry, regarding epidemiology and therapy. Due to the increase in the practice of implantology as well as the increased number of implants placed every year, the rate of PID has widely increased. Peri-implant mucositis and peri-implantitis, gingivitis, and periodontitis are common clinical manifestations of the disease. PIDs are caused by chronic inflammatory processes in the tissues around an intraoral implant, with increasing incidence, and have become a health concern. Bacterial infections are involved in the pathogenesis of these diseases. The imbalance between the host response and bacterial biofilm results in tissue destruction. New challenges lie in the prevention, treatment, and diagnosis of PIDs. The aim of this overview was to focus on the nature of the disease itself, useful diagnostic criteria, common responsible bacteria, and the prosthetic effects of fixed restorations on the health of the periodontium since recognizing the parameters involved in the development of periodontal and PIDs will play a crucial role in preventing the progression and minimizing the complications of these diseases having a fixed prosthesis.

Ultrasonographic Tissue Perfusion in Peri-implant Health and Disease

Color flow ultrasonography has played a crucial role in medicine for its ability to assess dynamic tissue perfusion and blood flow variations as an indicator of a pathologic condition. While this feature of ultrasound is routinely employed in various medical fields, its intraoral application for the assessment of tissue perfusion at diseased versus healthy dental implants has never been explored. We tested the hypothesis that quantified tissue perfusion of power Doppler ultrasonography correlates with the clinically assessed inflammation of dental implants. Specifically, we designed a discordant-matched case-control study in which patients with nonadjacent dental implants with different clinical diagnoses (healthy, peri-implant mucositis, or peri-implantitis) were scanned and analyzed with real-time ultrasonography. Forty-two posterior implants in 21 patients were included. Ultrasound scans were obtained at the implant regions of midbuccal, mesial/distal (averaged as interproximal), and transverse to compute the velocity- and power-weighted color pixel density from color velocity (CV) and color power (CP), respectively. Linear mixed effect models were then used to assess the relationship between the clinical diagnoses and ultrasound CV and CP. Overall, the results strongly suggested that ultrasound’s quantified CV and CP directly correlate with the clinical diagnosis of dental implants at health, peri-implant mucositis, and peri-implantitis. This study showed for the first time that ultrasound color flow can be applicable in the diagnosis of peri-implant disease and can act as a valuable tool for evaluating the degree of clinical inflammation at implant sites.

Self-administered proximal implant-supported hygiene measures and the association to peri-implant conditions.

Dental plaque biofilm is considered to be the underlying cause of peri-implant diseases. Moreover, it has been corroborated recently the association between the presence of these diseases and deficiently designed implant-supported prostheses. In this regard, professional-administered oral hygiene measures have been suggested to play a dominant role in prevention. A cross-sectional study was conducted in dental implant patients according to accessibility for self-performed oral hygiene using a 0.5mm interproximal brush. Periodontal and peri-implant status were assessed based on clinical and radiographic variables to determine the prevalence of peri-implant diseases. In addition, the participants completed a questionnaire on the efficiency and accessibility for self-performed proximal hygiene. Associations of descriptive data were analyzed using the chi-squared test and Mann-Whitney U-test. Correlations of the variables with the primary outcome (accessibility) were assessed by means of generalized estimation equations and multilevel logistic regression models. Based on an a priori power calculation, a total of 50 patients (171 implants) were consecutively recruited. From these, 46% of the prostheses allowed proper access for performing proximal hygiene whereas 54% of the prostheses precluded proper access. Poor access for proximal hygiene displayed tendency towards statistical significance with peri-implant disease (OR=2.31; P=0.090), in particular with peri-implant mucositis (OR=2.43; P=0.082) when compared to good access. In addition, an association was observed to increased levels of mucosal redness (P=0.026) and the full-mouth bleeding score (P=0.018). On the other hand, the presence of peri-implant disease was related to self-reported assessment of oral hygiene measures (P=0.015) and to patient perception of gingival/mucosal bleeding when performing oral hygiene (P=0.026). In turn, the diagnosis of peri-implant disease was significantly associated to the quantity and quality of information provided at the time of implant therapy (P=0.004), including the influence of confounders upon disease occurrence (P=0.038) CONCLUSIONS: To a certain extent, accessibility for self-performed proximal hygiene is associated to the peri-implant condition. On the other hand, the information received by the patient from the dental professional is essential for self-monitoring of the peri-implant conditions and for alerting to the possible presence of disorders.

Peri-Implantitis Diagnosis and Prognosis Using Biomarkers in Peri-Implant Crevicular Fluid: A Narrative Review.

Dental implant diseases, peri-implantitis (PI) and peri-implant mucositis (PIM), have shown wide prevalence in recent studies. Despite the prevalence, diagnosing peri-implant disease (PID) remains challenging as common diagnostic methods of periodontal probing and radiographs may be inaccurate. These methods only document pre-existing destruction rather than current disease activity. Furthermore, there is no current model to predict the progression of PID. Though a predictive model is lacking, biomarkers may offer some potential. Biomarkers are commonly used in medicine to objectively determine disease state, or responses to a therapeutic intervention. Gingival crevicular fluid (GCF) biomarkers have moderate diagnostic validity in periodontitis. Biomarkers in peri-implant crevicular fluid (PICF) also show promising results in regard to their diagnostic and prognostic value. The aim of this review is to summarize the current knowledge of PICF biomarkers in the diagnosis of PID and evaluate their validity to predict disease progression. This review found that PICF studies utilize different methods of sampling and interpretation with varying validity (sensitivity and specificity). A number of promising diagnostic techniques were identified. Commercially available chair-side tests for MMP-8 to diagnose periodontal disease and PID activity are now available. Future directions include proteomics and metabolomics for accurate, site-specific diagnosis and prediction of PID progression. Although more research is needed, this review concludes that the assessment of proinflammatory cytokines (IL-1β, TNFα, MMP-8) in the PICF may be of value to diagnose PI and PIM but current research remains insufficient to indicate whether biomarkers predict peri-implant disease progression.

Calprotectin and cross-linked N-telopeptides of type I collagen levels in crevicular fluid from implant sites with peri-implant diseases: a pilot study

BackgroundPeri-implant crevicular fluid (PICF) contains calprotectin and NTx, which are markers for inflammation and bone resorption, respectively. The aims of this pilot study were to compare calprotectin and NTx levels in PICF from implant sites with or without peri-implant diseases and to evaluate the usefulness of calprotectin and NTx as diagnostic markers for peri-implant diseases.MethodsThirty-five patients with dental implants participated in this pilot study. PICF samples were collected from peri-implant disease sites (n = 40) and non-diseased (healthy) sites (n = 34) after clinical indicators including probing depth (PD), bleeding on probing (BOP), gingival index (GI), and bone loss (BL) rate were investigated. Calprotectin and NTx amounts in PICF were measured using their respective ELISA kits and then compared between diseased and healthy samples. The relationship between PICF calprotectin or NTx levels and clinical indicator levels was investigated. A receiver operating characteristic (ROC) curve analysis of calprotectin and NTx was performed to predict peri-implant diseases.ResultsCalprotectin and NTx levels in PICF were significantly higher from peri-implant disease sites than from healthy sites. PICF calprotectin amounts correlated with PD, and its levels were significantly higher in the GI-1 and GI-2 groups than in the GI-0 group. PICF NTx amounts correlated with PD and the BL rate. ROC curves indicated that PICF calprotectin and NTx are useful biomarkers for peri-implant diseases.ConclusionsCalprotectin and NTx in PICF have potential as biomarkers for the diagnosis of peri-implant diseases.

Diagnostic accuracy of clinical parameters to monitor peri‐implant conditions: A matched case‐control study

The aim of this case-control study was to estimate the diagnostic accuracy of the standard clinical parameters in diagnosing healthy peri-implant tissues, peri-implant mucositis, and peri-implantitis. A case-control study was designed to compare the clinical parameters used in the diagnosis of peri-implant diseases such as: probingdepth (PD), bleeding on probing (BOP), mucosal redness (MR), suppuration (SUP), and plaque index (PI). Furthermore, the influence of patient- (sex, age) and implant-related variables (implant neck configuration, time in function after loading) were evaluated to investigate the association with the clinical findings. The inferential analysis consisted of estimation by generalized estimating equations (GEE) of multilevel logistic regression models. In total, 1,572 sites were evaluated around 262 implants from 141 patients. Sites with implant mucositis showed significant levels of BOP (OR=3.56), MR (OR=7.66) and PD (OR=1.48) compared to healthy sites. The specificity was 90.3% while the sensitivity was only 43.6%. Likewise, sites exhibiting peri-implantitis showed significant levels of BOP (OR=2.32), MR (OR=7.21), PD (OR=2.43) and SUP (OR=6.81) compared to healthy sites. Again, the multiple logistic regressions showed high specificity (92.1%) but modest sensitivity (52.5%). PD was the only diagnostic marker displaying significance comparing peri-implant mucositis and peri-implantitis sites (OR=1.76). Moreover, tissue-level compared to bone-level implants were less associated with SUP+ (OR=0.20), and PI (OR=0.36) and demonstrated statistical significance. In addition, age, sex, and function time significantly influenced the tested clinical parameters. The diagnosis of peri-implant diseases cannot rely solely upon individual clinical parameters but rather require a combination of criteria. The clinical parameters, particularly probing depth, might accurately discern between diagnoses among peri-implant conditions. Nevertheless, the specificity of the clinical parameters surpasses the sensitivity in the detection of peri-implant diseases, validating its potential use as a diagnostic tool.

Correlations between clinical parameters in implant maintenance patients: analysis among healthy and history-of-periodontitis groups

BackgroundThe pathophysiology and pathology of peri-implantitis remain unclear; however, its similarity to periodontitis has been described. The evaluation of peri-implant tissue and the diagnostic criteria of peri-implant disease are not currently standardized as they are for periodontitis. In this study, we evaluated clinical parameters during the implant maintenance period to determine significant correlations between these parameters.MethodsWe examined 55 implant patients at the time of maintenance visits between April and September 2016 and classified patients into a healthy group (H) and a history-of-periodontitis group (HP). For each implant, we evaluated the modified plaque index, probing pocket depth, and bleeding on probing as clinical parameters. Statistical analyses were performed with Spearman’s rank correlation coefficient.ResultsA total of 130 implants were assessed. The mean time since implant placement was 6 years and 6 months. The prevalence of implant-based peri-implantitis was 10.8% of all the implants. All cases of implant-based peri-implantitis came from the HP group, and many were present in patients with a history of severe periodontitis. The probing pocket depth around the implant was significantly greater in the HP group than in the H group. We found weak positive correlations between the probing pocket depth and bleeding on probing (rs = 0.401, p < 0.05) in the H group and between the probing pocket depth and bleeding on probing (rs = 0.241, p < 0.05) and the modified plaque index (rs = 0.228, p < 0.05) in the HP group.ConclusionsOur findings suggest that probing pocket depth and bleeding on probing as clinical parameters are important indicators for the diagnosis of peri-implant disease during the maintenance period among healthy and history-of-periodontitis groups.

Inter-rater agreement in the diagnosis of mucositis and peri-implantitis.

The objective was to assess the inter-rater agreement in the diagnosis of mucositis and peri-implantitis. Adult patients with ≥ 1 dental implant were eligible. Three operators examined the patients. One examiner allocated the patients to three groups of nine as follows: nine implants with peri-implantitis, nine implants with mucositis, and 9 implants with healthy mucosa. Each examiner recorded on all 27 patients (one implant per patient) recessions, probing depth, bleeding on probing, suppuration, keratinized tissue depth and bone loss, leading to a final diagnosis of mucositis, peri-implantitis or healthy mucosa. Examiners were independent and blinded to each other. Fleiss k-statistic with quadratic weight in the diagnosis of peri-implantitis and mucositis was 0.66 [CI95%: 0.45-0.87]. A complete agreement was obtained only in 14 cases (52%). Fleiss k-statistics in bleeding on probing and bone loss were respectively 0.31 [CI95%: 0.20-0.41] and 0.70 [CI95%: 0.45-0.94]. Intra-class correlation coefficients for recession, probing depth and keratinized tissue depth were respectively 0.69 [CI95%: 0.62-0.75], 0.54 [CI95%: 0.44-0.63] and 0.56 [CI95%: 0.27-0.77]. The inter-rater agreement in the diagnosis of peri-implant disease was qualified as merely good. This could also be due in part to the unclear definition of peri-implantitis and mucositis.

Is bleeding on probing a differential diagnosis between periimplant health and disease?

As far as the periimplant anatomy is considered, the question raised is whether or not healthy periimplant tissues present bleeding on probing (BOP). AIM: To assess if the criterion BOP is strictly related to periimplant disease (PID). METHODS: 134 patients were included in this study. All periimplant regions were clinically and radiographically evaluated. Patients were assigned to 3 groups based on radiographic and clinical aspects in the periimplant region: Group A (healthy-sites) - no signs of mucosal inflammation or bone loss; Group B (mucositis) - red and swollen mucosa, but no radiographic bone loss; Group C (periimplantitis) - radiographically confirmed pathological bone loss. After this classification, all periimplant sulci were probed at 4 sites (mesial, distal, buccal, lingual/palatal). Patients' mean age was 51.7±12.4 years, 77 women and 57 men, with a total of 486 osseointegrated endosseous implants. RESULTS: Groups A and C showed significant difference in age and implant region distribution (p=0.009 and p=0.008, respectively). After initial clinical and radiographic diagnosis of periimplant status, 33 (20.1%) regions showed BOP in group A. All regions in Group B presented BOP. In Group C, 41 (19.9%) regions showed no BOP. All groups differed significantly considering BOP as diagnosis parameter (p<0.0001). CONCLUSIONS: BOP was always present in inflamed mucosa, but it was not always absent in healthy mucosa. Not all periimplantitis regions showed BOP. Clinical and radiographic aspects must always be considered together for diagnosis of PID, even if BOP is absent.

Implant hygiene and soft tissue management: Dentist′s perspective

Osseointegration is the treatment modality opted in the rehabilitation of partially or fully edentulous patients. However, the surrounding tissues may be subject to inflammatory conditions, similar to periodontal disease, and so requires maintenance. The dental personnel should have current knowledge about methods of safely instrumenting implants and knowledge of available products, which could be safely recommended to patients to initiate effective home care of implants. It can be challenging to achieve effective oral hygiene around dental implants over the long term, and the patient, dentist, and dental hygienist must exercise considerable effort to achieve the desired results. This article discusses the background, etiology, diagnosis of peri-implant diseases, maintenance, care of osseointegrated implants.

On site noninvasive assessment of peri-implant inflammation by optical spectroscopy

Optical spectroscopy has been proposed to measure regional tissue hemodynamics in periodontal tissue. The objective of this study was to further evaluate the diagnostic potential of optical spectroscopy in peri-implant inflammation in vivo by assessing multiple inflammatory parameters (tissue oxygenation, total tissue hemoglobin, deoxyhemoglobin, oxygenated hemoglobin and tissue edema) simultaneously. A cross-sectional study was performed in a total of 64 individuals who presented with dental implants in different stages of inflammation. In brief, visible-near-infrared spectra were obtained, processed and evaluated from healthy (n = 151), mucositis (n = 70) and peri-implantitis sites (n = 75) using a portable spectrometer. A modified Beer-Lambert unmixing model that incorporates a nonparametric scattering loss function was employed to determine the relative contribution of each inflammatory component to the overall spectrum. Tissue oxygenation at peri-implantitis sites was significantly decreased (p < 0.05) when compared with that at healthy sites, which was largely due to an increase in deoxyhemoglobin and a decrease in oxyhemoglobin at the peri-implantitis sites compared with the mucositis and healthy sites. In addition, the tissue hydration index derived from the optical spectra in mucositis was significantly higher than that in other groups (p < 0.05). In summary, the results of this study revealed that hemodynamic alterations can be detected around diseased peri-implant sites by optical spectroscopy, and this method may be considered an alternative and feasible approach for the monitoring and diagnosis of peri-implant diseases.

Understanding Peri-implantitis: A Strategic Review

The high survival rate of osseointegrated dental implants is well documented, but it is becoming increasingly clear that successfully integrated implants are susceptible to disease conditions that may lead to loss of the implant. Although placement and restoration usually are included in the domain of the periodontal, oral and maxillofacial surgery, or prosthetic specialist, given the increasing numbers of patients treated with osseointegrated fixtures, it is increasingly likely that maintenance of these implants by the general dentist will become much more common. However, the surrounding tissues may be subject to inflammatory conditions similar to periodontal disease and so require maintenance. This article discusses the background, cause, and diagnosis of peri-implant disease, as well as the maintenance, care, and treatment of peri-implant infection in osseointegrated implants.