Maintenance Of Dental Implants Research Articles

Enzymes in Peri-implant Sulcular Fluid: A Window into Periodontal Health - A Comprehensive Review.

Enzymes in peri-implant sulcular fluid (PISF) have emerged as essential biomarkers in the field of periodontics, providing critical insights into the health and stability of dental implants. This essay explores the significance of various enzymes in PISF, including matrix metalloproteinases (MMPs), elastase, alkaline phosphatase, acid phosphatase, aspartate aminotransferase (AST), and alanine aminotransferase (ALT), in assessing the local inflammatory environment and diagnosing peri-implant diseases. The analysis of these enzymes facilitates early detection of complications, personalized treatment planning, and long-term monitoring, emphasizing the need for a multidisciplinary approach to patient care. Collaboration among dental professionals and patient education is crucial in ensuring the successful management and maintenance of dental implants. Understanding the role of enzymes in PISF and their implications in periodontal health underscores their significance in contemporary periodontics and emphasizes the need for ongoing research and technological advancements.

Behaviour of the Peri-Implant Soft Tissue with Different Rehabilitation Materials on Implants.

(1) Background: Mucointegration seems to gain interest when talking about success in the maintenance of dental implants. As we well know, collagen fibres cannot be inserted due to the lack of root structure on the implant surface, so the structural integration of peri-implant tissues that provide a firm seal around implants seems to be of interest when it comes to ensuring the survival of dental implants. To achieve a good epithelial barrier, the physicochemical characteristics of the surfaces of the restorative materials are of vital importance; therefore, the objective of this study is to analyse the histological behaviour of the peri-implant soft tissues in three different restorative materials. (2) Methods: Histological analysis of biopsied peri-implant keratinised mucosa, inflammatory epithelium and connective tissue in contact with a reinforced composite (BRILLIANT Crios), a cross-linked polymethylmethacrylate (TELIO CAD), and a hybrid ceramic (Vita Enamic), restored on a customised Atlantis-type abutment (Dentsply Sirona) between 60 and 180 days after restoration. (3) Results: A greater number of cells per mm2 of keratinised epithelium is observed in the reinforced composite, which could indicate greater surface roughness with greater inflammatory response. In this way, the greater number of lymphocytes and the lateral cellular composition of the inflammatory cells confirm the greater inflammatory activity towards that material. The best material to rehabilitate was hybrid ceramic, as it shows a better cellular response. (4) Conclusions: Knowing the limitations of the proposed study, despite the fact that greater inflammation is observed in the reinforced composite relative to the other materials studied, no statistically significant differences were found.

Effect of antimicrobial photodynamic therapy on the treatment of peri-implantitis: narrative review

Background and Objective: The greatest challenge of implantology is the maintenance of dental implants, with peri-implantitis being the main cause of implant loss. Studies highlight the importance of dental biofilm control, reduction of the inflammatory process in the peri-implant mucosa and decontamination of the implant surface, as well as the need for surgical intervention. Recently, low-level laser therapy (LLLT) has been introduced in different dental specialties, especially those related to oral mucosa lesions and the treatment of periodontal disease. The combination of LLLT and a photosensitizer dye promotes antimicrobial activity (aPDT) and may be used as a noninvasive treatment of peri-implantitis. The objective of this study was to conduct a literature review on the use of antimicrobial photodynamic therapy (aPDT) in the treatment of peri-implantitis.

Dentists' Attitudes Toward Dental Implant Maintenance in Thailand.

As implant therapy is a widely applied treatment modality, general dentists are in the frontline of maintaining health in patients with implants. It is however unknown to what extent general dentists are competent and feel prepared to deliver maintenance of implants to patients. The aim of this study was to investigate the attitudes and self-reported and objectively assessed competences of general dentists with maintenance of dental implants in patients. A questionnaire designed and validated for the purpose of the study, including attitudes and self-reported and objectively assessed competences, was distributed by means of an online platform. Data from 429 questionnaires were included in the study. Half of the participants were 28 to 33 y old and 78% had been working <10 y. Seventy-eight percent believed that dental implant maintenance should be performed by general dentists, but only 51% were prepared to do this, citing obstacles such as insufficient knowledge and limitations of their working environment. The mean ± SD objectively assessed competence score was 8.97 ± 2.74 of 17. There were significant differences (P < 0.001, 1-way analysis of variance) in the scores among dentists who offered the full range of maintenance and management of complications (10.83 ± 2.45) with those willing to provide comprehensive oral examination and implant maintenance only (9.31 ± 2.73), those offering comprehensive examination but unwilling to conduct maintenance (8.22 ± 2.28), and those who refer all dental implant patients elsewhere (7.2 ± 2.66). Around half of the dentists believed that implants last for life. While general dentists appeared to largely acknowledge the importance of providing implant maintenance care and present with positive attitudes, a large portion was unwilling to engage with maintenance of implants in patients and appeared to lack essential competences to this end. The main obstacles for providing implant maintenance care included insufficient knowledge and lack of a properly equipped clinical environment. The results of this study can identify deficiencies in the currently available maintenance competences and schemes for patients with implants. These results can also help dental professionals, scientific bodies, and associations to design appropriate education and professional development strategies that can strengthen the confidence and competences of general dentists, thus offering better service to the public.

Biological efficacy of perpendicular type-I collagen protruded from TiO2-nanotubes

The aim of this study was to evaluate the biological efficacy of a unique perpendicular protrusion of type-I collagen (Col-I) from TiO2 nanotubes (NT-EPF surface). We hypothesized that the NT-EPF surface would play bifunctional roles in stimulating platelet-mediated fibroblast recruitment and anchoring fibroblast-derived Col-I to form a perpendicular collagen assembly, mimicking the connective tissue attachment around natural teeth for the long-term maintenance of dental implants. Ti surface modification was accomplished in two steps. First, TiO2 nanotubes (NT) array was fabricated via anodization. Diameters and depths of NTs were controlled by applied voltage and duration. Subsequently, an electrophoretic fusion (EPF) method was applied to fuse Col-I into nanotube arrays in a perpendicular fashion. Surface wettability was assessed by contact angle measurement. The bioactivity of modified TiO2 surfaces was evaluated in terms of NIH3T3 fibroblast attachment, platelet activation, and collagen extension. Early attachment, aggregation, and activation of platelets as well as release of platelet-related growth factors were demonstrated on NT-EPF surfaces. Platelet-mediated NIH3T3 cells migration toward NT-EPF was significantly increased and the attached cells showed a typical fibrous morphology with elongated spindle shape. A direct linkage between pseudopod-like processes of fibroblasts to NT-EPF surfaces was observed. Furthermore, the engineered EPF collagen protrusion linked with cell-derived collagen in a perpendicular fashion. Within the limitation of this in vitro study, the TiO2 nanotube with perpendicular Col-I surface (NT-EPF) promoted better cell attachment, induced a strong platelet activation which suggested the ability to create a more robust soft tissue seal.

Maintenance of dental implants: the importance of prognosis

Maintenance of dental implants: the importance of prognosis

Etiology of Peri-Implantitis

Peri-implant diseases represent the biological complications associated with implant therapy. They are defined as inflammatory responses of the peri-implant soft tissues with or without progressive loss of marginal bone. The term peri-implantitis is used when the bone loss extends beyond initial bone remodeling after loading. Knowledge of the etiology and case definitions of peri-implant diseases are used to evaluate the impact of peri-implant diseases on the long-term survival and maintenance of dental implants. The present review summarizes the current knowledge about case definitions and contemporary understanding of the etiopathogenesis of peri-implant diseases. Recent studies have evaluated the instigation of peri-implant mucositis and its natural deterioration to peri-implantitis. Animal models, similar to the ones used for showcasing biofilm-induced periodontal disease, have been utilized to understand the inflammatory response of supporting soft and hard tissue around dental implants. In addition, similarities have been drawn regarding the microbial composition around diseased natural teeth and implants. A better insight of the pattern of disease progression and understanding of the host response to the increased inflammatory overload provides a foundation on which future research studies can focus on host-microbial interactions and therapies that could lead to more favorable outcomes in prevention and treatment of peri-implant diseases.

Maintenance of Dental Implants: A Review

Maintenance of Dental Implants: A Review

Quality of YouTube TM videos on dental implants.

BackgroundPatients search YouTube for health-care information.PurposeTo examine what YouTube offers patients seeking information on dental implants, and to evaluate the quality of provided information.Material and MethodsA systematic search of YouTube for videos containing information on dental implants was performed using the key words “Dental implant” and “Tooth replacement”. Videos were examined by two senior Oral and Maxillofacial Surgery residents who were trained and calibrated to perform the search. Initial assessment was performed to exclude non- English language videos, duplicate videos, conference lectures, and irrelevant videos. Included videos were analyzed with regard to demographics and content’s usefulness. “Information for patients” available from the American Academy of Implant Dentistry, European Association of Osseointegration, and British Society of Restorative Dentistry were used for benchmarking.ResultsA total of 117 videos were analyzed. The most commonly discussed topics were related to procedures involved in dental implantology (76.1%, n=89), and to the indications for dental implants (58.1%, n=78). The mean usefulness score of videos was poor (6.02 ±4.7 [range 0-21]), and misleading content was common (30.1% of videos); mainly in topics related to prognosis and maintenance of dental implants. Most videos (83.1%, n=97) failed to mention the source of information presented in the video or where to find more about dental implants.ConclusionsInformation about dental implants on YouTube is limited in quality and quantity. YouTube videos can have a potentially important role in modulating patients’ attitude and treatment decision regarding dental implants. Key words:YouTube, Social Media, Dental Implant, Rehabilitation, Patient information, E-health.

Implant maintenance for the prevention of biological complications: Are you ready for the next challenge?

With increasing knowledge of wound biology and material sciences, the provision of dental implants as a treatment modality has become increasingly predictable and more commonly used to replace missing teeth. However, without appropriate follow up, peri-implant diseases could develop and affect the long-term success of implants. Currently, there is not enough focus on the prevention of peri-implant diseases, as compared to the definition of the disease, its prevalence, and treatment. In the present study, we aim to summarize various factors influencing the successful maintenance of dental implants and highlight current gaps in knowledge. Factors influencing the successful maintenance of dental implants can be divided into three categories: implant-, dentist-, and patient-related factors. Patients with dental implants are often more dentally aware, and this offers an advantage. Compared to gingiva, peri-implant mucosa responds at a different pace to the bacterial challenge. Dental practitioners should be aware of how treatment protocols affect long-term success, and be vigilant in detecting peri-implant diseases at an early stage. Compared to periodontal maintenance, less longitudinal studies on implant maintenance are available, and therefore, there is a tendency to rely heavily on information extrapolated from the periodontal literature. More studies on the significance of implant maintenance care are required.

Implants in the Anterior Maxilla: Aesthetic Challenges.

Esthetic outcomes have become key elements that are critical to defining success in implant restorations. Long-term studies have demonstrated that single or multiple implants are highly predictable with high survival rates. However, in the anterior maxillary zone, the aesthetic success of implant therapy is, for many, as important as the implant survival rates. Several factors contribute to this “success” and can be objectively evaluated. These include the patient's healing capabilities, the level and condition of the existing soft and hard tissues, and the provisional and final restorations. In addition to these objective factors, esthetic perception also plays a significant role in achieving this “success.” This special issue contributes to the growing body of existing literature by examining several important issues related to the aesthetic aspects of maxillary implants and their increasingly important role in implant dentistry. These include esthetic perception, surgical techniques for tissue augmentation, and the esthetics of final implant-supported restorations. One of the esthetic determinants occurring after implant placement is the lack of papilla between implants or between teeth and implants. Whether or not the lack of the interdental papilla leads to significant cosmetic deformities depends on whether shorter papillae may be esthetically tolerated under certain circumstances. Y. C. P. Yu et al. investigated the difference in the perception of aesthetics according to dental specialty. To this goal, the authors used computer assisted asymmetric alteration of the papilla length in the esthetic zone. The results of this study showed that asymmetric deficiencies in papilla length of 2 mm or more are more likely to be perceived as “unattractive.” It should be underlined that many dental professionals perceive even minor asymmetric shortening of the papilla as unattractive. The stability and health of the peri-implant soft tissues are necessary for success and long-term maintenance of dental implants. A two-millimeter wide band of keratinized tissue has long been considered clinically desirable to provide a soft tissue seal around natural teeth. The absence of periodontal ligament and supracrestal fiber attachment around dental implants may increase peri-implant tissue susceptibility to the inflammatory process caused by biofilm accumulation. Therefore, creation of a band of keratinized gingiva around implants is desirable. A. Elkhaweldi et al. in a case series presented a novel surgical technique that can be utilized to augment keratinized soft tissue around implant-supported overdentures. The authors concluded that an apically repositioned flap, a relatively simple procedure, provided good esthetic outcomes, with newly formed tissue indistinguishable from the surrounding mucosa. The disadvantages of this technique are also discussed. Full arch implant-supported prostheses have high success rates. A variety of materials have been used for this type of restoration including metal alloy-acrylic, metal alloy-composite, and metal alloy-ceramic. However, with these materials a number of complications may occur. To minimize these, using zirconia for the framework has been proposed. Several studies have shown that zirconia possesses excellent physical, mechanical, biological, and chemical properties. J. Carames et al. discuss this option and provide examples of monolithic zirconia restorations for full arch implant-supported restorations. A. E. Borgonovo et al. investigated the survival and success rates, as well as the marginal bone loss (MBL) and esthetic indices of zirconia implants positioned in the esthetic jaw areas. The results of this study emphasized that one-piece zirconia dental implants show high biocompatibility, low plaque adhesion, and an absence of a microgap that may contribute to their clinical success in the esthetic areas. Finally, A. L. Ioannou et al. provide a review of several surgical techniques aimed at optimizing anterior implant esthetics. Clinicians who practice implant dentistry need to strive for more than just osseointegration. They must also achieve excellent esthetic outcomes. Therefore, with careful treatment planning and use of a variety of esthetically focused techniques, clinicians will be able to meet patients' ever-increasing demands for ideal esthetic outcomes.

The Care and Maintenance of Dental Implants: A Team Approach

The Care and Maintenance of Dental Implants: A Team Approach

Predoctoral Dental Implant Education at Creighton University School of Dentistry

The purpose of this report is to describe the dental implant education that predoctoral students receive and to characterize the patient population receiving implants at Creighton University School of Dentistry (CDS). CDS has no postdoctoral residency programs. Therefore, clinical management of diagnosis, treatment planning, surgical aspects, restoration, complications, and maintenance of dental implants requires significant involvement by predoctoral dental students. CDS implant education involves radiology diagnostic assets of the General Dentistry Department (including the use of Cone Beam Computed Tomography), as well as faculty and equipment from the Departments of Oral and Maxillofacial Surgery, Periodontics, and Prosthodontics, with a majority of students satisfied with their didactic preparation for their clinical experiences. Focusing on a three-year window from August 2007 to August 2010 and using electronic health records, this study found that a total of 242 implants were placed, out of which six failed within one year of placement and had to be removed. The average age of the population of 153 patients was found to be 53.3 years, with a range of eighteen to eighty-nine. Treatment outcomes compared very favorably with those published in the literature.

Necessity of Keratinized Tissues for Dental Implants: A Clinical, Immunological, and Radiographic Study

Necessity of keratinized tissues (KTs) for maintaining health around dental implants (DIs) remains as a controversial issue. The aim of this study was to investigate the effects of KT width (KTW) on peri-implant tissues by evaluating peri-implant clinical and inflammatory parameters. Sixty DIs were included in this 6-month longitudinal study. After classifying DI based on the presence of KTs at the buccal aspect as with adequate/inadequate KTW, DIs were randomly assigned into three study groups. In the first group, while free gingival graft (FGG) was performed, DIs in maintenance (M) group were followed up by standardized maintenance procedures at baseline, first, third, and sixth months as with DI with adequate KTW (Control). Clinical parameters, peri-implant sulcular fluid (PISF) volume, PISF Interleukin 1β concentration, and bone loss were analyzed. Significant improvements in clinical and immunological parameters were noted only for FGG for the whole study period. Statistical differences detected between the treatment groups (FGG vs M) were for gingival index at all time points and for PISF volume at sixth month. For the other parameters evaluated, while lower values were observed for FGG, statistically no differences were noted between the groups. Based on the results of this study, it can be suggested that FGG performed around DIs lacking KT is a reliable method, leading to significant improvements in clinical and inflammatory parameters. Further long-term studies including more DIs are needed to clarify the role of KT on maintenance of DIs.

The care and maintenance of dental implants

The success of dental implants depends on a number of factors. A major reason for their failure is peri-implant disease. Careful management and advice before, during and after the implant has been fitted can minimise the risk of this and treat problems where it does occur

Bioseal: The physiological and biological barrier for osseointegrated supported prosthesis

The success of osseointegrated supported prosthesis is dependent on the establishment of a soft-tissue barrier that is able to shelter the underlying osseous structures and the osseointegration surrounding the implant body. The esthetics of dental implant prosthesis depends on the health and stability of the peri-implant mucosa. The biological seal refers to the soft tissue seal around the dental implants that prevents the ingress of toxins. A thorough understanding of soft-tissue healing and maintenance of dental implants is of paramount importance for the success of an implant. This review article describes the components of the surrounding tissue and the healing process.

Impact of Diabetes Mellitus and Glycemic Control on the Osseointegration of Dental Implants: A Systematic Literature Review

Implant treatment is an attractive substitute to traditional fixed/removable prosthetic appliances. In patients with diabetes, dental implant therapy has been considered a contraindication. Hyperglycemia augments the severity of periodontal disease, and glycemic control is an essential variable in determining the success of dental implants in subjects with diabetes. Subjects with well-controlled diabetes may not be significantly compromised and can have high dental implant success rates compared to individuals with poorly controlled diabetes. The focused questions addressed in this systematic review were as follows: Can patients with diabetes be good candidates for dental implant therapy? And how does hyperglycemia and glycemic control influence osseointegration? A systematic literature search of MEDLINE/PubMed articles published from 1982 up to and including July 2009 was independently performed by two investigators. In addition, reference lists of original and review articles were searched. The search strategy was to use the following terms in different combinations: dental implants, immediate implants, osseointegration, periodontal disease, diabetes, hyperglycemia, metabolic control, and glycemic control. The search included studies on humans and diabetes-induced animal models. The selection criteria included all levels of available evidence. Suitable variables included the implant survival rate among individuals with diabetes, effects of hyperglycemia and glycemic control on bone, and maintenance of dental implants in subjects with diabetes. Articles published only in the English language were considered, and unpublished data were not sought. We initially identified 33 studies. Fifteen studies, which did not fulfill the selection criteria, were excluded. The included studies reported that poorly controlled diabetes negatively affects implant osseointegration; however, under optimal serum glycemic control, osseointegration can successfully occur in patients with diabetes. Animal studies have confirmed that osseointegration can be successfully achieved in insulin-controlled rats with diabetes, whereas in uncontrolled rats with diabetes, the bone-to-implant contact appears to decrease with time. The use of antiseptic mouthrinses and oral-hygiene maintenance helps in achieving a successful dental implant osseointegration in subjects with diabetes. A successful dental implant osseointegration can be accomplished in subjects with diabetes with good metabolic control (serum glycemic level and hemoglobin A1c in normal range) in a similar manner as in subjects without diabetes.

Factors affecting late implant bone loss: A retrospective analysis

Prevention of late implant bone loss is a critical component in long-term success of implants. The aim of the present study was to evaluate factors affecting late implant bone loss.Three hundred thirty-nine endosseous root-form dental implants placed between April 1981 and April 2002 in 69 patients were analyzed. The implants were categorized based on the following factors: (1) surface characteristics (smooth versus rough), (2) length (short [< 10 mm] versus long [> or = 10 mm]), width (narrow [< 3.75 mm], regular [3.75 to 4.0 mm], or wide [> 4.0 mm]), (3) the amount of keratinized mucosa (< or > or = 2 mm), (4) location (anterior versus posterior; maxilla versus mandible), (5) type of prosthesis (fixed versus removable), and (6) type of opposing dentition. The effects of these factors on clinical parameters, especially average annual bone loss (ABL), were evaluated clinically and radiographically by a blinded examiner. The parameters evaluated were modified Plaque Index, Gingival Index, modified Bleeding Index, probing depth, and ABL.Shorter implants, wider implants, implants supporting fixed prostheses, and implants in smokers were found to be associated with greater ABL (P < .05). The random intercept mixed effects model showed that implant length was the most critical factor for maintenance of ABL.Shorter implants, wider implants, implants supporting fixed prostheses, and implants in smokers were associated with greater ABL. Implant length was the most significant factor in the maintenance of dental implants. Randomized controlled clinical trials are needed to confirm the results obtained from this retrospective clinical study.

Significance of Keratinized Mucosa in Maintenance of Dental Implants With Different Surfaces

The need for keratinized mucosa (KM) or immobile keratinized mucosa (i.e., attached mucosa [AM]) for the maintenance of osseointegrated endosseous dental implants has been controversial. The purpose of this study was to investigate the significance of KM in the maintenance of root-form dental implants with different surfaces. A total of 339 endosseous dental implants in place for at least 3 years in 69 patients were evaluated. The width of KM and AM, modified plaque index (mPI), gingival index (GI), modified bleeding index (mBI), probing depth (PD), and average annual bone loss (ABL) were measured clinically and radiographically by a masked examiner. Based on the amounts of KM or AM, implants were categorized as follows: 1) KM <2 mm (KL); 2) KM > or =2 mm (KU); 3) AM <1 mm (AL); and 4) AM > or =1 mm (AU). Implants were further subdivided into the following four subgroups based on their surface configurations: 1) smooth surface implants (SI) with KM <2 mm (SKL); 2) SI with KM > or =2 mm (SKM); 3) rough surface implants (RI) with KM <2 mm (RKL); or 4) RI with KM > or =2 mm (RKM); or 1) SI with AM <1 mm (SAL); 2) SI with AM > or =1 mm (SAM); 3) RI with AM <1 mm (RAL); or 4) RI with AM > or =1 mm (RAM). The effect of KM or AM on clinical parameters was evaluated by comparing the different KM/AM groups. In addition, the significance of the presence of KM on implant prostheses types (i.e., fixed versus removable) and on implant locations (i.e., anterior versus posterior) was evaluated. Comparison of ABL among the four subgroups in KM or AM failed to reveal statistically significant differences (P >0.05); however, statistically significantly higher GI and mPI were present in SKL or SAL compared to the other three subgroups (P <0.05). GI and mPI were significantly higher in KL (0.94 and 1.51) than KU (0.76 and 1.26) and higher in AL (0.95 and 1.50) than AU (0.70 and 1.19) (P <0.05), respectively. The difference in GI between posterior implants with or without an adequate amount of KM was also significant (P <0.05). The absence of adequate KM or AM in endosseous dental implants, especially in posterior implants, was associated with higher plaque accumulation and gingival inflammation but not with more ABL, regardless of their surface configurations. Randomized controlled clinical trials are needed to confirm the results obtained in this retrospective clinical study.