Peri-implant Diseases Research Articles

Awareness of peri-implantitis among general dental practitioners in the UK: a questionnaire study.

Introduction Dental implants are a predictable prosthetic option for replacement of missing teeth with good survival rates. Peri-implant diseases are the main reason for implant failure by causing bone loss around the implant leading to implant loss. General dental practitioners see patients with dental implants routinely and therefore, awareness of risk factors for peri-implant disease and early diagnosis is essential for appropriate management. The aim of this study is to assess the awareness of general dental practitioners in diagnosing peri-implantitis, with a view to identify any potential training needs.Design, setting, materials and methods A quantitative study method was designed using an online questionnaire sent to closed social media groups in the UK. The significance level was taken as p <0.05. The chi-squared tests and Kruskal-Wallis tests were used with IBM SPSS software. Descriptive statistical analysis of data was also done.Results and conclusion A total of 224 responses were received. The results show that there is lack of awareness of diagnostic criteria of peri-implantitis among general dental practitioners. However, majority of practitioners are aware of the legal implications of failing to diagnose this condition. There is a perceived need for more undergraduate training in diagnosing peri-implant diseases.

Clinical and Radiographic Outcomes of Adjunctive Phototherapy Versus Antibiotic Therapy Against Peri-Implant Diseases: A Systematic Review and Meta-Analysis.

Background: Peri-implantitis, an inflammatory condition in implant tissues, requires bacterial eradication and implant surface decontamination, with aPDT as a helpful surgical adjunct. Objective:This project was designed to investigate the effect of antibiotic therapy versus aPDT, as adjuncts to conventional mechanical debridement (MD), on the peri-implant clinical and/or radiographic parameters among patients with peri-implant diseases. Methods: A comprehensive search was conducted across electronic databases, including PubMed, Scopus, and Web of Science, up to and including April 2023, without any restriction on the language and year of publication, focusing the following research question: "Does adjunctive aPDT improve the peri-implant clinical and/or radiographic parameters in treating peri-implant diseases compared to antibiotic therapy?" Statistical analysis was performed on peri-implant clinical [plaque index (PI), probing depth (PD), and bleeding on probing (BOP)] and radiographic parameters [marginal bone loss (MBL)]. The study included six randomized controlled trials and one clinical (nonrandomized) study. Results: The systematic review findings indicate that the application of aPDT as an adjunct to MD is equally effective as adjunctive antibiotic therapy in improving peri-implant clinical parameters and radiographic parameters in patients with peri-implant diseases. Only two studies were classified as having a low risk of bias (RoB), two were assessed as having an unclear RoB, and the remaining three studies were determined to have a high RoB. However, the meta-analysis results revealed no statistically significant difference in peri-implant PI, PD, and MBL scores between patients treated with adjunct aPDT or adjunct antibiotic therapy. Notably, there was a statistically significant difference favoring adjunct aPDT in peri-implant BOP values compared to the control group. Conclusions: Despite the limited number of included studies and the significant heterogeneity among them, the findings suggest that aPDT yields comparable peri-implant clinical and radiographic outcomes to adjunctive antibiotic therapy, as adjuncts to MD, for the potential treatment of peri-implant diseases.

Influence of keratinized mucosa width on the resolution of peri-implant mucositis: A prospective cohort study.

The prevalence of peri-implant diseases, driven by biofilm accumulation and influenced by factors such as the width of keratinized mucosa (KM), underscores the need for understanding their etiology and management. To evaluate the association between the KM width and the clinical resolution of peri-implant mucositis after mechanical therapy. Patients with an implant diagnosed with peri-implant mucositis were allocated to two groups: wide band of KM (WKM ≥ 2 mm) and narrow/no band of KM (NKM < 2 mm). Data and submucosa biofilm were collected at baseline and at 8, 12, and 24 weeks after nonsurgical therapy. A Brunner-Langer model was estimated for longitudinal data to evaluate and compare changes in any clinical parameter throughout follow-up between both groups. Furthermore, the microbial profiles were evaluated by 16S rRNA gene sequencing. A total of 38 implants were analyzed. At 24 weeks, bleeding on probing was substantially reduced in both groups, reaching statistical significance (p < 0.001). Treatment resulted in 23.9% less effective in achieving success for NKM. As such, NKM reduced the odds of disease resolution by 80% compared to WKM. The rest of the explored clinical parameters yielded more favorable outcomes for WKM versus NKM. Neither the alpha nor the beta diversity of the microbial profiles were significantly modulated by KM. KM width influences the clinical resolution of peri-implant mucositis after mechanical therapy (https://clinicaltrials.gov/study/NCT04874467?cond=keratinized%20mucosa&rank=8, NCT04874467, 04/30/2021).

Involvement of interlukin-17A (IL-17A) gene polymorphism and interlukin-23 (IL-23) level in the development of peri-implantitis

BackgroundDental implantation has been practiced since ancient times and has gone through several stages. Dentists use dental implants to support dental prostheses such as crowns, bridges, dentures, face prostheses, or as an orthodontic anchor. Thus, the purpose of this study is to detect the role of the immune-genetic variation of IL-17A and related inflammatory cytokine (IL-23) in the initiation and progress of peri implantitis.Material and methodsThis cross-sectional study included 80 subjects (15 peri-implantitis patients, 35 successful implants, and 30 healthy controls); their mean age was (43.91 ± 11.33) years. Blood samples and Peri-implant sulcus fluid (PISF) were collected from all subjects (patients with peri-implantitis, successful implants, and healthy controls) attending the Department of Oral and Maxillofacial Surgery in the Dental College Teaching Hospital, Baghdad University, Baghdad, Iraq. The blood sample detects gene polymorphisms in interleukin-17A by a polymerase chain reaction (PCR). An enzyme-linked immunosorbent assay (ELISA) was carried out to estimate the Peri-implant sulcus fluid (PISF) levels of interleukin-23.ResultThe current study revealed an obvious significant elevation in the mean level of interleukin-23 in the peri-implantitis patient’s group more than its level in the successful implant and control groups (P < 0.05). In addition, the result showed that A/A genotype is associated significantly with peri-implantitis OR (95%confidence interval) =6.9 (1.7121 to 27.4638) folds increase risk of peri-implantitis) (p = 0.0065), while G/A genotype had OR 4.9 (0.9539–24.9394) folds increased risk of peri-implantitis, (p = 0.0572). But it was not statistically significant and G/G genotype had a one-fold increase risk of peri-implantitis.ConclusionThe increased level of inflammatory cytokine (interleukin-23) might add to the systemic inflammatory burden a predisposing factor, which may lead to impaired osseointegration and subsequent bone loss or implant failure. In addition, IL-17A gene polymorphism may play a role in peri-implant disease susceptibility, especially in persons carrying the rs2275913 A allele at a higher risk of developing peri-implantitits as compared with those carrying the G allele.

Critical appraisal of YouTube videos regarding peri-implant diseases and conditions: A cross-sectional analysis.

To critically appraise the quality and reliability of YouTube videos regarding peri-implant diseases and conditions as a source of information for patients, students, and young clinicians. In March 2023, electronic searches were performed on YouTube website to identify videos related to peri-implant diseases and conditions. We considered only the relevant 250 English-language videos with durations between 3 and 30 min for final analyses. Following the eligibility criteria videos were evaluated for their demographic data, including number of views; number of likes, dislikes, and comments; days since upload; duration; and number of subscribers. Moreover, two assessors independently evaluated the quality and reliability of the included videos using the DISCERN and Video Information and Quality Index (VIQI) tools. Statistical analyses were performed using the Kruskal-Wallis test and Spearman correlation analysis (∝ = 0.05). A total of 69 videos were included for profound analyses. The average DISCERN and VIQI scores were 35.04 ± 6.3 and 14.18 ± 2.46, with 53 videos categorized as "poor" quality using the DISCERN tool. A Spearman rank correlation analysis presented a strong agreement between the DISCERN and VIQI scores (r = .753; p < .001). Nevertheless, based on different sources of upload, no statistically significant differences were reported for video demographics, interaction index, and DISCERN and VIQI scores. Although YouTube videos on peri-implant diseases and conditions present accurate preliminary information, their reliability still remains uncertain. Hence, we urge respective policymakers to recognize, endorse and produce high-quality videos for accurate information dissemination.

Favorable subgingival plaque microbiome shifts are associated with clinical treatment for peri-implant diseases

We performed a longitudinal shotgun metagenomic investigation of the plaque microbiome associated with peri-implant diseases in a cohort of 91 subjects with 320 quality-controlled metagenomes. Through recently improved taxonomic profiling methods, we identified the most discriminative species between healthy and diseased subjects at baseline, evaluated their change over time, and provided evidence that clinical treatment had a positive effect on plaque microbiome composition in patients affected by mucositis and peri-implantitis.

The Influence of Hydroxyapatite, Titanium, and Yttria-Stabilized Zirconia Oxide on Diversity of Bacterial Cultures Grown from Human Dental Biofilm Specimens in an In Vitro Model

Background: Titanium (TI) and yttria stabilized-zirconia oxide (YSZ) are dental materials commonly utilized at the soft-tissue interface surrounding dental implants. The influence of these surfaces on bacterial adhesion and biofilm development may affect clinical performance and patient susceptibility to inflammatory peri-implant disease. The purpose of this study was to evaluate the influence of the substrate material on biofilm diversity. Methods: Biofilms were cultured on TI, YSZ, and hydroxyapatite (HA) surfaces (control) using plaque specimens obtained from three human donors. Duplicate cultures grew for one, two, three, six or nine days. Biofilm diversity was then analyzed using 16S rRNA sequencing. The Shannon Diversity Index (SDI) was calculated for each experimental group. Microbial profiles were intercompared in a pairwise fashion to establish dissimilarity scores, which were recorded in a distance dissimilarity matrix. Results: A total of 16 taxa were identified, and relative abundances of the predominant phyla and genera did not appear statistically different across experimental groups. Biofilms grown on HA surfaces exhibited significantly higher alpha diversity compared with those formed on TI or YSZ (p&lt;0.0001), although biofilms cultured on TI and YSG surfaces exhibited comparable diversity. Statistically significant differences in beta diversity associated with substrate (p=0.012) and growth period (p=0.001) were detected. Conclusions: Under the conditions described, biofilms grown on TI or YSZ appeared significantly less complex than those formed on HA. Transmucosal implant abutment surface characteristics represent one modifiable factor potentially influencing risk of peri-implant disease. Among risk of peri-implant disease. Among multiple considerations in abutment design, biofilm diversity performance may represent a clinically relevant benchmark.

Antimicrobial Sensitivity Associated with Porphyromonas gingivalis Present in Periodontitis Frameworks: An Integrative Review

Objectives: The Gram-negative anaerobic bacterium Porphyromonas gingivalis is identified as one of the most important causes of the chronic form of periodontitis. This work aimed to analyze the sensitivity of P. gingivalis to antibiotics and antimicrobial agents.&#x0D; Study Design: Integrative literature review.&#x0D; Methodology: Through a careful analysis of clinical trials published in the last 5 years. A bibliographic search was carried out in the PubMed, Scielo and Google Scholar databases. Three keywords were established and verified on the DeCs-Descritores em Ciências da Saúde website for the literary search “Antimicrobial resistance”, “Periodontal biotherapy” and “Porphyromonas gingivalis”. 66 articles were found. Of these, animal studies, studies that did not involve patients diagnosed with periodontitis according to the 2017 World Workshop on the Classification of Periodontal and Peri-implant Diseases and Conditions, and studies on peri-implantitis were excluded. Studies that used only surgical therapy without association with at least one antibiotic or antimicrobial and duplicate studies were excluded.&#x0D; Results: This integrative review presents the results of 19 studies. Amoxicillin, Metronidazole and Azithromycin are the most commonly used antibiotics. Photodynamic therapy has demonstrated benefits in reducing inflammation and P. gingivalis counts. It has been demonstrated that P. gingivalis is not sensitive to Lactobacillus brevis and Lactobacillus plantarum-ProlcSan probiotic gel and tablets, as no reductions in its proportion and total count were observed. Similar results were also observed in the study that investigated the effect of administering piperacillin plus Tazobactam gel and doxycycline gel.&#x0D; Conclusion: Although most of the articles presented report the sensitivity of P. gingivalis to their protocols, microbiological reduction is not always accompanied by clinical benefit, since periodontal disease is multifactorial. Based on these findings, it is concluded that there are several antimicrobial agents capable of promoting the reduction of this key pathogen in periodontitis.

Etiology, pathogenesis and treatment of peri-implantitis: A European perspective.

Peri-implantitis is a plaque-associated pathological condition occurring in tissues around dental implants. It is characterized by inflammation in the peri-implant mucosa and progressive loss of supporting bone. Over the last 30 years, peri-implantitis has become a major disease burden in dentistry. An understanding of the diagnosis, etiology and pathogenesis, epidemiology, and treatment of peri-implantitis must be a central component in undergraduate and postgraduate training programs in dentistry. In view of the strong role of European research in periodontology and implant dentistry, the focus of this review was to address peri-implantitis from a European perspective. One component of the work was to summarize new and reliable data on patients with dental implants to underpin the relevance of peri-implantitis from a population perspective. The nature of the peri-implantitis lesion was evaluated through results presented in preclinical models and evaluations of human biopsy material together with an appraisal of the microbiological characteristics. An overview of strategies and outcomes presented in clinical studies on nonsurgical and surgical treatment of peri-implantitis is discussed with a particular focus on end points of therapy and recommendations presented in the S3 level Clinical Practice Guideline for the prevention and treatment of peri-implant diseases.

Air powder waterjet technology using erythritol or glycine powders in periodontal or peri-implant prophylaxis and therapy: A consensus report of an expert meeting.

To attain a collective expert opinion on the use of air powder waterjet technology (APWT) with erythritol and glycine powders in the prophylaxis and therapy of periodontal and peri-implant diseases. In thefirst step, a modified one-round online Delphi survey including 44 five-point Likert scale questions was conducted among a group of 10 expert clinicians and researchers with thorough knowledge and experience in this topic. In the second step, the single questions and the survey results were discussed during a meeting, and consensus statements were formulated, respectively. An agreement was reached on most items, especially opinions supporting glycine and erythritol powders as favorable with respect to efficiency, safety, and comfort. More scientific evidence is needed to support the improvement in clinical attachment on teeth and implants, especially when APWT with erythritol is used. In addition, APWT needs more long-term evaluation and studies in terms of microbiome/microbiological effects as well as effects on the inflammatory response on natural teeth and implants, also in light of a guided biofilm therapy concept. In line with the expert opinions and supported by the evidence, it was concluded that the use of APWT with erythritol and glycine powders in nonsurgical periodontal and peri-implant therapy and prophylaxis is patient compliant and efficient.

Revisiting peri-implant diseases in order to rethink the future of compromised dental implants: Considerations, perspectives, treatment, and prognosis.

Once present, peri-implantitis is difficult to fully eliminate. Surgical interventions showsome promising results in fighting the disease, but for the time being, prevention remainsthe strongest tool.

The Efficacy of Ten Different Adjunctive Measures in Patients with Nonsurgically Treated Peri-Implant Disease: A Network Meta-Analysis of Randomized Controlled Trials.

Objective: This study aimed to evaluate the impact of 10 adjunctive measures on non-surgical therapy outcomes for peri-implant disease. Methods: We formulated the study question and keywords following the Population, Intervention, Comparator, Outcome framework. Randomized controlled trials were identified through searches in PubMed, Embase, the Cochrane Library, and the Web of Science. Two researchers assessed the quality of included literature according to the Cochrane Risk of Bias Assessment Tool. Data analysis and ranking were performed using Stata 15.0 software. Results: This study, involving 51 pieces of literature and 2660 samples, conducted a network meta-analysis (NMA), which revealed that photodynamic therapy (PDT) significantly reduced probing pocket depth values in patients with peri-implant mucositis (SUCRA = 96.3%) and peri-implantitis (SUCRA = 96.7%). In addition, it showed an improvement in bleeding on probing (BOP) values for peri-implantitis (SUCRA = 91.6%). Furthermore, diode lasers improved BOP values for peri-implant mucositis (SUCRA = 76.5%). Conclusions: According to the NMA results and the surface under the cumulative ranking curve (SUCRA), PDT and diode laser outperform other adjuncts in peri-implant disease.

Novel Flowchart Guiding the Non-Surgical and Surgical Management of Peri-Implant Complications: A Narrative Review.

Peri-implant diseases, such as peri-implant mucositis and peri-implantitis, are induced by dysbiotic microbiota resulting in the inflammatory destruction of peri-implant tissue. Nonetheless, there has yet to be an established protocol for the treatment of these diseases in a predictable manner, although many clinicians and researchers have proposed various treatment modalities for their management. With the increase in the number of reports evaluating the efficacy of various treatment modalities and new materials, the use of multiple decontamination methods to clean infected implant surfaces is recommended; moreover, the use of hard tissue laser and/or air abrasion techniques may prove advantageous in the future. Limited evidence supports additional effects on clinical improvement in antimicrobial administration for treating peri-implantitis. Implantoplasty may be justified for decontaminating the implant surfaces in the supracrestal area. Surgical treatment is employed for advanced peri-implantitis, and appropriate surgical methods, such as resection therapy or combination therapy, should be selected based on bone defect configuration. This review presents recent clinical advances in debridement methods for contaminated implant surfaces and regenerative materials for treating peri-implant bone defects. It also proposes a new flowchart to guide the treatment decisions for peri-implant disease.

Saliva biofilm-derived outer membrane vesicles regulate biofilm formation and immune response of oral epithelial cells on titanium surfaces.

While the significant roles of outer membrane vesicles (OMVs) from individual oral bacterial species in bacterial-host interactions are known, the involvement of saliva biofilm-derived OMVs in peri-implant disease pathogenesis remains unclear. This study aimed to investigate the effect of saliva biofilm-derived OMVs on regulating saliva biofilm formation and modulating the immune response of the epithelial cells on titanium surfaces. Saliva derivedbiofilms were cultured on tissue culture plates (TCP) for 4 days using pooled saliva from four healthy donors. OMVs secreted from the TCP bound biofilm (referred to as OMVs or healthy saliva biofilm OMVs) were enriched using the size-exclusion chromatography method. We then evaluated the effects of these OMVs on theviability, metabolic activity, and the presence oforal pathogens in saliva biofilm grownon titanium discs for 24 h and 72 h. Furthermore, the impact of OMVs on the mRNA expression and inflammatory cytokines [interleukin (IL)-6, IL-1α, and monocyte chemoattractant protein-1 (MCP-1)] in human oral epithelial cells (OKF6/TERT-2) was investigated using RT-qPCR and enzyme-linked immunosorbent assay(ELISA), respectively. Healthy saliva biofilm OMVs improved the biomass and activity of saliva biofilm cultured on the titanium surfaces, with inhibited Porphyromonas gingivalis and Fusobacterium nucleatum, and enhanced Streptococcus mutansexpression. Additionally, OMVs increased pro-inflammatory cytokine IL-6 mRNA and IL-6cytokine expression in human oral epithelial cells. However, IL-1α and MCP-1 cytokines were inhibited 24-hour post-incubation with OMVs. Healthy saliva biofilm derivedOMVs regulate the activity and pathogen composition of biofilms formed on titanium, while modulating the secretion of pro-inflammation factors of oral epithelial cells grownon titanium surfaces. Healthy saliva biofilm OMVs may regulate the early biofilm formation on abutment surfaces and modulate epithelial cell immune response, which may alter the peri-implant niche and participate in the pathogenesis of peri-implant disease.

Biofouling on titanium implants: a novel formulation of poloxamer and peroxide for in situ removal of pellicle and multi-species oral biofilm.

Eradicating biofouling from implant surfaces is essential in treating peri-implant infections, as it directly addresses the microbial source for infection and inflammation around dental implants. This controlled laboratory study examines the effectiveness of the four commercially available debridement solutions '(EDTA (Prefgel®), NaOCl (Perisolv®), H2O2 (Sigma-Aldrich) and Chlorhexidine (GUM® Paroex®))' in removing the acquired pellicle, preventing pellicle re-formation and removing of a multi-species oral biofilm growing on a titanium implant surface, and compare the results with the effect of a novel formulation of a peroxide-activated 'Poloxamer gel (Nubone® Clean)'. Evaluation of pellicle removal and re-formation was conducted using scanning electron microscope (SEM), energy-dispersive X-ray spectroscopy and X-ray photoelectron spectroscopy to assess the surface morphology, elemental composition and chemical surface composition. Hydrophilicity was assessed through contact angle measurements. The multi-species biofilm model included Streptococcus oralis, Fusobacterium nucleatum and Aggregatibacter actinomycetemcomitans, reflecting the natural oral microbiome's complexity. Biofilm biomass was quantified using safranin staining, biofilm viability was evaluated using confocal laser scanning microscopy, and SEM was used for morphological analyses of the biofilm. Results indicated that while no single agent completely eradicated the biofilm, the 'Poloxamer gel' activated with 'H2O2' exhibited promising results. It minimized re-contamination of the pellicle by significantly lowering the contact angle, indicating enhanced hydrophilicity. This combination also showed a notable reduction in carbon contaminants, suggesting the effective removal of organic residues from the titanium surface, in addition to effectively reducing viable bacterial counts. In conclusion, the 'Poloxamer gel + H2O2' combination emerged as a promising chemical decontamination strategy for peri-implant diseases. It underlines the importance of tailoring treatment methods to the unique microbial challenges in peri-implant diseases and the necessity of combining chemical decontaminating strategies with established mechanical cleaning procedures for optimal management of peri-implant diseases.

Comparative Evaluation of C-Reactive Protein Levels among Peri-Implant Health and Disease Conditions.

Peri-implant disease pathogenesis results in production of pro-inflammatory mediators, among which C-reactive protein (CRP) is one of the acute phase reactants. The aim of the study was to comparative CRP levels among peri-implant health and disease conditions. The present study was carried out in the Department of Implantology, Saveetha Dental College and Hospitals, Chennai, India. A total of 40 patients with peri-implant health (n = 10), peri-mucositis (n = 10), early peri-implantitis (n = 10) and advanced peri-implantitis (n = 10) were enrolled. Unstimulated salivary samples were collected and subjected to latex agglutination assay for CRP analysis. CRP levels were then correlated with peri-implant health and diseases. CRP level in peri-implant health, peri-implant mucositis, early peri-implantitis and advanced peri-implantitis were 0.18 ± 0.04 mg/dL, 2.05 ± 0.61 mg/dL, 4.14 ± 1.82 mg/dL and 6.21 ± 1.35 mg/dL respectively. There was a statistically significant difference in CRP levels between all the tested groups (ANOVA, P = 0.03). Pearson correlation coefficient analysis revealed a strong positive correlation between CRP and peri-implant health status. CRP level was high among patients with peri-implantitis followed by peri-implant mucositis and peri-implant health. Also, CRP level increases with severity of peri-implant diseases and there exists a positive correlation between CRP level and peri-implant health status.

Serum TNF-α level and probing depth as a combined indicator for peri-implant disease.

Peri-implant disease (PID) is a general term for inflammatory diseases of soft and hard tissues that occur around implants, including peri-implant mucositis and peri-implantitis. Cytokines are a class of small molecule proteins, which have various functions such as regulating innate immunity, adaptive immunity, and repairing damaged tissues. In order to explore the characteristics and clinical significance of tumor necrosis factor (TNF)-α, interleukin (IL)-6, IL-10, and tumor growth factor (TGF)-β1 expression levels in serum of patients with peri-implant disease, 31 patients with PID and 31 patients without PID were enrolled. The modified plaque index (mPLI), modified sulcus bleeding index (mSBI), and peri-implant probing depth (PD) were recorded. The levels of serum TNF-α, IL-6, IL-10, and TGF-β1 were detected by ELISA. TNF-α, mPLI, mSBI, and PD levels were significantly higher in the PID group. TGF-β1 levels were significantly higher in the control group. There was a significant positive correlation between TNF-α and mPLI, mSBI, and PD. TGF-β1 was negatively associated with TNF-α, mPLI, mSBI, and PD. Multiple logistic regression analysis showed that TNF-α and PD were risk factors for the severity of PID. The receiver operating curve analysis showed that high TNF-α levels (cut-off value of 140 pg/mL) and greater PD values (cut-off value of 4 mm) were good predictors of PID severity with an area under the curve of 0.922. These results indicated that TNF-α and PD can be used as a biological indicator for diagnosing the occurrence and progression of PID.

Correlation of C-Reactive Protein and Severity of Peri-Implant Diseases.

Peri-implant disease pathogenesis is similar to periodontal disease pathogenesis resulting in production of pro-inflammatory mediators. These mediators are released during the inflammation phase, among which C-reactive protein (CRP) is one of the acute phase reactants. The aim of the study was to correlate the levels of CRP with the severity of peri-implant diseases. The present observational study was carried out from June 2022 to December 2022 in the Department of Implantology, Saveetha Dental College and Hospitals, Chennai, India. A total of 60 patients with peri-implant health (n = 20), peri-mucositis (n = 20) and peri-implantitis (n = 20) were enrolled. Unstimulated salivary samples were collected and subjected to latex agglutination assay for CRP analysis. CRP levels were then correlated with severity of peri-implant diseases. The mean CRP level in peri-implant health, peri-implant mucositis, peri-implantitis were 0.25 ± 0.36 mg/dl, 3.56 ± 0.85 mg/dl and 5.07 ± 0.74 mg/dl, respectively. Pearson correlation coefficient analysis revealed a strong positive correlation between CRP and peri-implant parameters suggesting that the CRP level increased as the severity of peri-implant disease increased. CRP level increases with severity of peri-implant diseases and there exists a positive correlation between CRP level and peri-implant parameters. Therefore, CRP can be used as a diagnostic marker for peri-implant diseases.

Clinical Efficacy of Ozone Therapy in Peri-implant Diseases: A Systematic Review

Introduction: With an increasing number of dental implants being placed each year, there has been a consequent rise in the frequency of peri-implant diseases. Ozone, a potent antibacterial agent, eliminates the microbes that cause infections around implants. Aim: To assess ozone therapy’s effectiveness of ozone therapy as an adjunct in the treatment of peri-implant diseases. Materials and Methods: A complete search was conducted in electronic databases such as PubMed, Google Scholar, and Cochrane, employing the eligibility criteria. After a thorough review, six studies published from 2013 to 2023 that evaluated the effectiveness of ozone therapy in clinical trials for the management of peri-implant diseases were included in this systematic review. Results: The six selected studies evaluated ozone therapy as a treatment for peri-implant diseases and evaluated relevant clinical indices. Four studies were in-vivo, out of which one evaluated peri-implantitis and three on peri-implant mucositis. Three studies showed a reduction in the Plaque Index (PI) during follow-up, while one study stated that it showed improvement at one month, with no significant further reduction seen. Two invitro studies stated that ozone therapy helped reduce bacterial adherence to the implant surface. Conclusion: Considering the findings of the previous studies, the present systematic review concludes that ozone therapy shows progressive improvement in the management of periimplant diseases.

Association of the severity and progression rate of periodontitis with systemic medication intake.

Information on the systemic medication profiles of patients with periodontitis is limited. Therefore, this retrospective cross-sectional study aimed to analyze the relationship between the severity and rate of progression of periodontitis and systemic medication intake using a database of patients who attended the Clinic of Periodontics of the Faculty of Dentistry of the University of Costa Rica. Electronic health records of patients diagnosed with periodontitis based on the Classification of Periodontal and Peri-Implant Diseases and Conditions (2017) were evaluated. Individuals were further categorized based on the severity (stage) and rate of progression (grade). Data extracted from the patient records included age, sex, and self-reported medication intake. In total, 930 records were included. Most of the studied population was middle-aged (36-64 years old); 43.01% were male, and 56.99% were female. Four hundred and fifty-seven patients (49.14%) reported taking at least one systemic medication for a chronic condition. Regarding the periodontal treatment phase, 62.37% underwent steps 1-3, and 37.63% underwent step 4. The most common systemic medications taken were for cardiovascular diseases (42.28%), followed by medications for diabetes (14.46%) and neurologic disorders (14.46%). Most patients (59.35%) were diagnosed with Stage III periodontitis. Grade B (48.28%) was the most prevalent. Calcium channel blockers demonstrated a disease severity-dependent association with the periodontal stage (p = 0.021). In addition, systemic medications for diabetes mellitus were associated with periodontal disease severity and rate of progression (all Ps < 0.05). This study provides indirect evidence of the association between systemic diseases and periodontitis. The positive association between medications used to treat diabetes and the severity and rate of progression of periodontitis may be due to the underlying disease rather than the medications per se.