Peri-implant Pocket Depth Research Articles

Comparison of peri-implant clinical outcomes of digitally customized and prefabricated abutments: A systematic review and meta-analysis.

Digitally customized abutments are increasingly used in contemporary implant prosthodontics. This systematic review and meta-analysis aimed at comparing the peri-implant clinical outcomes of digitally customized and prefabricated abutments. The search strategies included electronic databases (PubMed, Embase, Scopus, and Cochrane clinical trials database) and related journals up to September, 2020. A qualitative and quantitative synthesis was performed on data extracted from the included studies. Three RCTs (number of patients = 120; number of dental implants = 120) and two prospective cohort studies (number of patients = 144; number of dental implants = 144) with one to three-year follow-up periods were included. The quantitative analyses did not demonstrate a significant difference between digitally customized and prefabricated abutments for peri-implant pocket depth (P = 0.62), plaque index (P = 0.67), bleeding on probing (P = 0.43), keratinized mucosa width (P = 0.75), and pink aesthetic score (P = 0.30) at one-year follow-up visit. The qualitative analyses for marginal bone level change, calculus accumulation, implant survival rate, implant success rate, white aesthetic score, and patient-reported outcomes did not demonstrate a significant difference between two groups during 1 to 3-year follow-up visits. The current data do not provide evidence of significant differences between two abutment fabrication methods in terms of peri-implant clinical outcomes within short-term period (CRD42020170807).

Fixed Partial Restorations Made of a New Zirconia-Reinforced Lithium Silicate Material: A 2-Year Short-Term Report.

To evaluate the 2-year performance of definitive implant- or tooth-supported three-unit fixed dental prostheses made of zirconia-reinforced lithium silicate placed to restore premolars and molars in clinical cases of partial edentulism. All patients received a three-unit fixed restoration made of monolithic, hot-pressed, zirconia-reinforced lithium silicate glass-ceramic. The restoration was cemented to two natural teeth or attached to two 3.5- or 4.5-mm-diameter square threaded, grit-blasted, acid-etched integrated implants with a Morse taper connection. Peri-implant pocket depth and bone and soft tissue remodeling were recorded for 2 years at each follow-up visit. Esthetic, functional, and biologic United States Public Health Services (USPHS) parameters modified by the World Dental Federation study design were assessed yearly until the final follow-up appointment. At the time of placement of the definitive restorations and at the 2-year follow-up visit, the opposing dentitions were identified by type of restoration and supporting structures. A total of 100 patients were consecutively enrolled in the period between June 2016 and July 2017, and 50 patients each received an implant-supported restoration (Group A) or a tooth-supported restoration (Group B). One (2%) of the 50 implant-supported prostheses fractured after 21 months of function. None of the other prostheses failed or became loose or detached. No significant differences involving probing levels or bone and soft tissue remodeling were found between the follow-up times. No cases of inflammation or infection of the mucosal cuff around the neck of the implants were recorded. The most common issue occurred immediately after placement of the prosthesis, when 3 patients (6%) from Group A and 4 patients (8%) from Group B asked for a modification of tooth shade. Implant-supported or tooth-supported three-unit fixed dental prostheses made of zirconia-reinforced lithium silicate can be used to successfully restore cases of posterior partial edentulism. The 2-year results of this report will be studied more in depth in ongoing long-term research.

Genetic association of the epidermal growth factor gene polymorphisms with peri-implantitis risk in Chinese population

ABSTRACT Peri-implant disease is an inflammatory disease and is related to genetic heterogeneity. Considering the genetic association of epidermal growth factor (EGF) gene polymorphisms with the susceptibility of periodontitis, its genetic association with peri-implantitis risk in a Chinese Han population was explored. Three hundred individuals who underwent dental implants were recruited, and divided into healthy implant group and peri-implantitis group. The genotype and allele distribution of EGF gene rs2237051 and rs4444903 polymorphisms were analyzed via direct sequencing and the frequencies were compared between the two groups using chi-square test. No significant difference was detected for the clinical information between healthy implant group and peri-implantitis group, including lifestyle habits platform type and position, peri-implant phenotype, brushing time, dental floss, and mouth washing frequencies. Individuals with peri-implantitis had poor periodontal status. The GG genotype and G allele of rs2237051 showed significant increasing trend in peri-implantitis group compared with the healthy implant group. Compared with the AA genotype carriers, rs2237051 GG genotype carriers showed lower risk to suffer from peri-implantitis (OR = 0.236, 95%CI = 0.089–0.624), and possessed low values of gingival index, plaque index and calculus index, peri-implant pocket depth (PPD) and clinical attachment level (CAL). But there was no significant difference for the rs4444903 genotype distributions between the case and control groups. In summary, EGF rs2237051 polymorphism showed close association with the genetic background of peri-implantitis. Rs2237051 GG genotype and G allele might be protective factors for the onset of peri-implantitis.

The use of non‐surgical interventions in patients with peri‐implantitis; a systematic review and meta‐analysis

AbstractObjectivesTo systematically assess the efficacy of different non‐surgical treatment methods to manage peri‐implantitis reported to date in the literature, together with its correlation with time following therapy.Materials and MethodsA systematic literature review was undertaken to identify randomised control trials of the non‐surgical management of peri‐implantitis published up to November 2019. The search was limited to English language human studies containing follow‐up periods of ≥3 months and for sample size of 10 or more patients. A meta‐analysis was implemented for the following clinical parameters: Peri‐implant pocket depth (PPD), bleeding on probing (BOP), clinical attachment level (CAL), radiographic bone loss (RBL) and mucosal recession (MR).ResultsTwelve articles met the inclusion criteria. Two principal treatment modalities were identified; mechanical debridement and laser therapy, with two adjunctive therapies antimicrobial and antiseptic agents. Non‐surgical interventions (ultrasonic scalers, Er:YAG laser and powdered air‐abrasive devices) showed significant clinical improvement in the short term (<3 months). Clinical benefit was demonstrated with the adjunctive use of antimicrobial agents in the short term but diminished with time. Antiseptic agents alone have no significant effect. Non‐surgical therapies applied in these studies failed to arrest mucosal recession, peri‐implant bone loss or reduce the counts of viable pathogens in the long term.ConclusionThe evidence demonstrate that the clinical parameters of peri‐implantitis, i.e. BOP, PPD and CAL may all be improved by simple mechanical debridement, using either ultrasonic instrumentation or Er:YAG laser therapy; adjunctive antimicrobial and antiseptic therapy. Further randomised control trials in this area are, however, required.

Treatment of Peri-Implant Mucositis with Repeated Application of Chlorhexidine Chips or Gel during Supportive Therapy - A Randomized Clinical Trial.

Running headPeri-implant maintenance with CHXBackground: To assess the effect of chlorhexidine (CHX) chip application in patients with peri-implant mucositis as compared to CHX gel application. Methods: In peri-implant sites with mucositis, CHX gel was applied in the control group (GC) and CHX chips in the test group (CC) at baseline and after three months. At baseline and after six months, peri-implant pocket depths (PPD), bleeding-on-probing (BOP) and activated matrix metalloproteinase-8 (aMMP8) were assessed. Longitudinal changes were tested for inter-group differences. Results: Thirty-two patients were treated. BOP was more reduced (p = 0.006) in CC than in GC, with means and standard deviations of 46 ± 28% and 17 ± 27%, respectively. PPD was more reduced (p = 0.002) in CC than in GC with 0.65 ± 0.40 mm and 0.18 ± 0.32 mm, respectively. Regarding BOP, the percentages of improved, unchanged and worsened sites accounted for 32%, 61% and 7% in GC and 46%, 53% and 1% in CC, respectively. For probing pocket depth, the according values were 26%, 66% and 8% (GC) versus 57%, 38% and 5% (CC). Conclusions: During supportive therapy, repeated CHX chip application might resolve marginal peri-implant inflammation in terms of bleeding better than CHX gel.

Analysis of the association of TNF-α, IL-1A, and IL-1B polymorphisms with peri-implantitis in a Chinese non-smoking population.

The purpose of this study was to investigate whether the genetic variations which could regulate inflammatory responses were associated with the risk of peri-implantitis. We evaluated three genetic variants including tumor necrosis factor-alpha (TNF-α) - 308G/A, interleukin-1 alpha (IL-1A) - 889C/T, and IL-1 beta (IL-1B) + 3954C/T, as risk factors for peri-implantitis, in a total of 144 patients with peri-implantitis and 174 healthy controls in a Chinese non-smoking population. Logistic regression analyses revealed that subjects carrying the T allele of IL-1A - 889C/T and IL-1B + 3954C/T had a significant 2.27-2.47-fold (CT, OR [95% CI] = 2.27 [1.12-4.58], p = 0.021; TT, OR [95% CI] = 2.47 [1.32-4.69], p = 0.006) and 1.9-1.99-fold (CT, OR [95% CI] = 1.99 [1-3.93], p = 0.041; TT, OR [95% CI] = 1.9 [1.08-3.43], p = 0.03) increased risk of peri-implantitis, respectively, when using the CC genotype as a reference point. And subjects carrying the TT genotype of IL-1A - 889C/T or IL-1B + 3954C/T also had significantly higher periodontal variables including peri-implant pocket depth (PPD), bleeding on probing (BOP), gingival index (GI), plaque index (PI), calculus index (CI), and clinical attachment level (CAL) (p < 0.05). However, no associations were found between the TNF-α - 308G/A polymorphism and the risk of peri-implantitis. Our results suggest that the IL-1A - 889C/T or IL-1B + 3954C/T genetic polymorphisms were associated with the risk of peri-implantitis and periodontal status. Genetic polymorphisms are constant and can be measured before disease onset, thus it could be of great benefit for treatment planning and prognosis in an early stage.

Non-surgical therapeutic outcomes of peri-implantitis: 12-month results

To assess the clinical and radiographic outcomes of implants treated by means of non-surgical debridement with systemic antibiotic therapy. A prospective case series study evaluating the 12-month clinical and radiographic outcomes of peri-implantitis lesions treated with ultrasonic scaler debridement, a glycine air abrasive, and metronidazole followed by supportive maintenance. Clinical and radiographic variables and success criteria were defined a priori. Overall, 21 patients were included. One implant failed during the study period (implant survival rate 95.24%). Substantial changes occurred at 12months in all the clinical and radiographic variables, reaching strong statistical significance in the majority of them. According to the success criteria applied, 40.90% of the peri-implantitis were arrested and resolved, while 59.1% presented with at least one probed site with bleeding on probing (BoP). Moreover, 95.45% exhibited peri-implant pocket depth (PPD) < 5mm at the end of the study. None of the implants presented with progressive bone loss. Non-surgical therapy of peri-implantitis is effective to arrest progressive bone loss, reduce PPD and suppuration, and achieve radiographic bone fill in the majority of cases. Nevertheless, it failed to be completely efficacious in the achievement of successful therapeutic outcomes as BoP remained frequently present. Non-surgical therapy achieved significant clinical and radiological improvements.

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.

Analyses of clinical and osteoimmunological parameters on keratinized mucosa around dental implants

This study investigated the effects of keratinized mucosa width (KMW) on peri-implant tissues by evaluating peri-implant clinical and bone resorption parameters. Seventy-one dental implants (DIs) were separated based on adequacy/inadequacy of KMW. DIs with inadequacy KMW were grouped as peri-implant plastic surgery (PIPS) (free gingival graft/free periosteal graft groups) and maintenance (M) groups. DIs with adequacy KMW were grouped as the controls. Peri-implant clinical parameters were measured at the baseline and 6th month. Levels of receptor activator of nuclear factor κB ligand (RANKL) and osteoprotegerin (OPG) in peri-implant sulcular fluid were determined after clinical measurements using enzyme-linked immunosorbent assay. In baseline, gingival index, bleeding on probing, and plaque index (PI) were lower in controls compared to the PIPS and M groups, and KMW was higher. At 6th month, peri-implant pocket depth and PI were lower in the PIPS groups and controls compared to the M group, and KMW was higher. While RANKL and OPG values and RANKL/OPG ratio at baseline were not significantly different between groups, OPG concentration and RANKL/OPG ratio in the 6th month were higher in the PIPS group compared to the M group (P < 0.05). The RANKL/OPG ratio decreased at 6th month in the PIPS groups and controls (P < 0.05). Positive and negative correlations were observed between peri-implant clinical and osteoimmunological parameters. This study demonstrated that adequate KMW and PIPS techniques exhibited positive effects on clinical peri-implant parameters and osteoimmunological mediators.

The severity of human peri-implantitis lesions correlates with the level of submucosal microbial dysbiosis.

To cross-sectionally analyse the submucosal microbiome of peri-implantitis (PI) lesions at different severity levels. Microbial signatures of 45 submucosal plaque samples from untreated PI lesions obtained from 30 non-smoking, systemically healthy subjects were assessed by 16s sequencing. Linear mixed models were used to identify taxa with differential abundance by probing depth, after correction for age, gender, and multiple samples per subject. Network analyses were performed to identify groups of taxa with mutual occurrence or exclusion. Subsequently, the effects of peri-implant probing depth on submucosal microbial dysbiosis were calculated using the microbial dysbiosis index. In total, we identified 337 different taxa in the submucosal microbiome of PI. Total abundance of 12 taxa correlated significantly with increasing probing depth; a significant relationship with lower probing depth was found for 16 taxa. Network analysis identified two mutually exclusive complexes associated with shallow pockets and deeper pockets, respectively. Deeper peri-implant pockets were associated with significantly increased dysbiosis. Increases in peri-implant pocket depth are associated with substantial changes in the submucosal microbiome and increasing levels of dysbiosis.

VEGF, Microvessel Density, and CD44 as Inflammation Markers in Peri-implant Healthy Mucosa, Peri-implant Mucositis, and Peri-implantitis: Impact of Age, Smoking, PPD, and Obesity

Several biologic processes affect the supporting peri-implant tissue leading to implant failure and complications, mainly referred to inflammation that is still poorly investigated in the peri-implant soft tissues. Our aim was to investigate in peri-implant healthy mucosa, peri-implant mucositis, and peri-implantitis the expression of some angiogenesis markers highly associated with inflammation, and evaluate its relationships with age, smoking, peri-implant pocket depth (PPD), and body max index (BMI). Moreover, we wanted to study the impact of these clinical parameters in the disease pathogenesis. Forty-eight total patients were recruited. Sixteen had at least one successfully osteointegrated dental implant (group A) and 32 had at least one osseointegrated implant in need of a peri-implant treatment for inflammatory/infectiveous reasons: precisely 16 for mucositis (group B) and 16 for peri-implantitis (group C). VEGF, CD34, and CD44 immunohistochemical expression was evaluated in the interproximal biopsies of marginal peri-implant tissue and correlated with the clinical parameters. A significant difference between groups in mean PPD was found, while the distribution by age, gender, smoking, and BMI resulted similar. Group C had significantly higher levels of VEGF, CD34, and CD44 expression compared to the other groups. VEGF, CD34, CD44, and peri-implant pocket depth were all positively correlated. Our study revealed that peri-implantitis is a condition characterized by unique and distinctive features. Our results supported that PPD has a great impact on the peri-implantitis and it is closely related to the inflammation marker expression. The identification of specific biomarkers might help in choosing distinct treatment approaches for target individuals.

The Conometric Concept: A Two-Year Follow-Up of Fixed Partial CEREC Restorations Supported By Cone-In-Cone Abutments.

To evaluate the performance of definitive, implant-supported, lithium disilicate fixed dental prostheses (LS2 FDPs) manufactured with a computer-assisted design/computer-assisted manufacturing (CAD/CAM) system. All patients received two-unit restorations placed in posterior regions, supported by osseointegrated implants with cone-in-cone connection abutments. Two implants (Ankylos) were placed into healed sites or fresh extraction sockets in the maxillary/mandibular posterior regions of partially edentulous patients. Definitive digital impressions were made 3 months after surgery. Twenty-four patients received fixed monolithic LS2 restorations manufactured with the CEREC system. All restorations were connected to the implants using cone-in-cone connection abutments. Peri-implant pocket depths were recorded for 2 years at each follow-up visit. Esthetic, functional, and biologic United States Public Health Services (USPHS) parameters modified by the FDI World Dental Federation study design were assessed yearly until the last follow-up appointment. The opposing dentitions were identified by type of restoration and supporting structures at the time of placement of the definitive restorations and at the 2-year follow-up visits. One patient (4.16%) moved to an unknown location during the study. A total of 23 FDPs (95.8%) supported by 46 implants reached the 2-year follow-up. None of the prostheses failed, or became loose or detached. No significant difference involving probing levels between the experimental times were found. The results of this research indicated that the abutment-prostheses connection using a cone-in-cone approach was successful within the 2-year period of this study. None of the studied monolithic LS2 glass-ceramic prostheses milled using the CEREC CAD/CAM system fractured or became detached.

Effect of antimicrobial photodynamic therapy in open flap debridement in the treatment of peri-implantitis: A randomized controlled trial.

To evaluate the effects of single application of antimicrobial photodynamic therapy (aPDT) as an adjunct to open flap debridement (OFD) and OFD alone in patients with peri-implantitis (PI). Twenty four patients with PI were divided into 2 groups receiving aPDT with OFD and OFD alone respectively. Peri-implant plaque index (PI), bleeding on probing (BOP), pocket depth (PD) and marginal bone level (MBL) were assessed at baseline, 6 and 12 months post-therapy. Digital periapical radiographs were taken and viewed on a calibrated computer screen using a software for the assessment of MBL. Only single implant from each patient was included in the study protocol (intent to treat analysis). At baseline, peri-implant PI, BOP, PD and MBL were comparable among individuals in aPDT and OFD groups. All patients had localized peri-implant PD ≥5 mm. At 6 months, aPDT and OFD significantly reduced peri-implant PI, BOP, PD and MBL. Similarly, after 12 months post-therapy, both groups reduced PI, BOP, PD and MBL. However, there was no significant difference between aPDT and OFD groups over time. Single application of aPDT as an adjunct to OFD does not provide additional benefit in improving clinical and radiographic peri-implant parameters in peri-implantitis.

Effect of Implant Position on Clinical and Radiographic Outcomes of Locator-Retained Mandibular Overdentures: A 1-Year Prospective Study.

To evaluate the influence of implant position on clinical and radiographic outcomes of Locator-retained mandibular overdentures MATERIALS AND METHODS: Fifteen edentulous participants with compromised bone at canine regions of the mandible were given 2 implants in the premolar areas (study group, PM). The control group (CA) consisted of 15 participants who received 2 implants in the canine regions, matched to PM and assigned as historical control. For study and control groups, mandibular dentures were constructed and attached to the fixtures with Locator attachments using the delayed loading protocol. Clinical (plaque scores, gingival scores, pocket depth, and implant stability) and radiographic (marginal bone loss) outcomes were assessed after denture delivery (T0), 6 months (T6), and 12 months (T12) later. The survival rate was 100% in both groups. All clinical and radiographic parameters increased significantly with time. No significant difference in plaque scores, gingival scores, or implant stability between groups was observed. PM group recorded significantly higher pocket depth and marginal bone loss than CA group at T6 and T12. Within the limits of this short-term clinical study, canine position for implants retaining mandibular overdentures with Locator attachments is preferred over the first premolar position, as it was associated with reduced peri-implant pocket depth and marginal bone loss after 1 year.

Fabricating a stent for accurate and reproducible measurement of peri-implant pocket depth

Pocket probing around dental implants is an important diagnostic procedure for the assessment of peri-implant status and evaluation of periodontal therapy. Conventionally, probing is done arbitrarily in the center of four aspects (mesial, distal, facial, and lingual/palatal) of implant without removal of the prosthesis. The prosthesis design leads to a steep convergence angle of probe insertion or possible penetration of peri-implant tissues which leads to incorrect measurement. The present technique describes a vacuum formed polyvinyl chloride stent that allows peri-implant pocket depth measurements to be performed repeatedly and reproducibly at pre- and post-rehabilitative recall appointments.

Association of Cytokine Gene Polymorphism with Peri-implantitis Risk.

To investigate whether polymorphisms of cluster of differentiation 14 (CD14), tumor necrosis factor alpha (TNFα), interleukin (IL)6, IL10, and IL1ra genes are associated with the risk of peri-implantitis susceptibility in patients with dental implants in the Serbian population. Isolated DNA from the blood was used for IL10-1082, TNFα-308, IL6-174, CD14-159, and interleukin 1 receptor antagonist (IL1ra) genotyping using polymerase chain reaction (PCR)-based methodology. Clinical parameters included: peri-implant pocket depth (PPD), Plaque Index (PI), Gingival Index (GI), bleeding on probing (BOP), and radiologic bone loss. The study included 98 patients with dental implants in function for at least 1 year, divided into peri-implantitis (34) and healthy peri-implant tissue (64) groups. The percentage distribution of smokers was significantly different between patients who developed peri-implantitis and patients with healthy peri-implant tissue (71% vs 42%, respectively) and associated with increased peri-implantitis risk (OR: 3.289, 95% CI: 1.352 to 8.001; P = .007). A positive history of periodontitis was more frequent in the peri-implantitis group (62%) than in the healthy peri-implant tissue (20%) group and associated with increased peri-implantitis risk (OR: 6.337, 95% CI: 2.522 to 15.927; P = .0001). Frequencies of CD14-159, TNFα-308, IL10-1082, and IL6-174 genotypes were significantly different between patients with and without peri-implantitis. However, logistic regression revealed only TNFα-308 polymorphic GA/AA genotypes (OR: 8.890, 95% CI: 2.15 to 36.7; P = .003) and smoking (OR: 6.2, 95% CI: 1.44 to 26.7; P = .014) as independent factors associated with increased peri-implantitis risk, while CD14-159 polymorphic CT/TT genotypes were associated with decreased risk for peri-implantitis (OR: 0.059, 95% CI: 0.009 to 0.355; P = .002). The findings suggest that smoking and the presence of TNFα-308 GA/AA genotypes may increase the risk for peri-implantitis, while CD14-159 polymorphic CT/TT genotypes decrease the risk. The results also indicate significant association of CD14-159, TNFα-308, and IL6-174 genotypes and clinical parameters in the Serbian population. However, future studies in larger patient groups are necessary to confirm these observations.

Peri-implant soft-tissue parameters and crestal bone levels among narghile smokers and nonsmokers

This retrospective convenient sample case–control study investigated the peri-implant soft-tissue inflammatory parameters and crestal bone loss (CBL) among narghile smokers (NS) (Group I) and nonsmoking controls (Group II). Demographic data were collected using a questionnaire. Peri-implant plaque index (PI), bleeding-on-probing (BOP) and pocket-depth (PD) were assessed; and peri-implant CBL was measured on standardized digital bite-wing radiographs. Sample-size was estimated and statistical analysis were done using Mann–Whitney U-test. Level of significance was set at p < .05. Seventy-two male individuals (35 in Group I and 37 in Group II) were included. The mean age of individuals in Groups I and II were 45.3 ± 5.2 and 42.6 ± 3.3 years, correspondingly. In Group 1, the duration and daily frequency of narghile smoking was 17.5 ± 1.6 years and 6.3 ± 0.5 times per day, respectively. The mean duration of each narghile smoking session was 28.5 ± 0.6 min. The mean peri-implant PI (p < .05), PD (p < .05) and mesial (p < .05) and distal (p < .05) CBL were statistically significantly higher among individuals in Group I compared with Group II. BOP was significantly higher in Group II than Group I (p < .05). Narghile smoking increases peri-implant soft-tissue inflammation and CBL.

Peri-implant and Paracrestal Inflammatory Biomarkers at Failing Versus Surviving Implant Sites in a Beagle Dog Study.

This study sought to quantify three biochemical mediators of inflammation (tumor necrosis factor alpha [TNF-α], superoxide anion [SOA], and myeloperoxidase [MPO]) by analyzing crestal (peri-implants) and paracrestal gingival biopsy samples obtained from an experimental study on beagle dogs treated with implants inserted immediately into fresh sockets with circumferential defects. In 10 beagle dogs, 4 roughened titanium implants (3.8 mm wide × 8 mm high) were placed in the distal sockets of the third and fourth premolars, where a circumferential defect (5 mm wide and 5 mm deep) had been previously created by trephination. After varying follow-up periods, ranging from 80 to 190 days, the dogs were explored clinically to assess implant survival, peri-implant pocket depth, and implant stability. The levels of three biochemical mediators of inflammation (MPO, TNF-α, and SOA) were investigated using the crestal and paracrestal gingival biopsy samples with ELISA tests. It was found that 37.5% of the implants were either absent or mobile. Higher levels of the inflammatory mediators were found in the crestal samples than in the paracrestal samples. The final implant stability values were significantly correlated with the final probing depth (r = -0.83, P < .01), but neither of the clinical measures were significantly correlated with any biochemical marker. The risk of implant failure was significantly proportional to the level of MPO (odds ratio: 1.1) and TNF-α (odds ratio: 1.1) in both the crestal and paracrestal regions. All the inflammatory mediators studied were higher in the crestal areas than in the paracrestal regions, but only the values of MPO and TNF-α were significant predictors of implant failure.

The association between shallow vestibular depth and peri-implant parameters: a retrospective 6 years longitudinal study.

The aim of this study was to retrospectively evaluate the association between shallow vestibular depth (VD) and peri-implant parameters. Peri-implant parameters were evaluated in 61 periodontal patients under regular supportive periodontal therapy. Clinical parameters included gingival index (GI), plaque index (PI), bleeding on probing (BOP), peri-implant pocket depths (PPD), mucosal recession (MR), relative attachment level (RAL), width and thickness of keratinized mucosa (KMW, KMT) and VD. Radiographic bone level (RBL) was measured on peri-apical radiographs. Sites with shallow VD (≤ 4 mm) were associated with higher MR (0.91 mm versus 0.47 mm, p ≤ 0.009), higher RAL (4.23 mm versus 3.59 mm, p ≤ 0.0001) and higher RBL (2.18 mm versus 1.7 mm, p = 0.05) when compared with adequate vestibular depth sites (VD > 4 mm). Moreover, sites with shallow VD presented lower KMW compared with sites with adequate VD (1.24 mm versus 2.38 mm, respectively, p ≤ 0.0001). Slightly greater BOP, and GI were recorded for the shallow VD compared with adequate sites. According to multivariate analysis, factors that could predict RAL included: VD, GI, age, supporting periodontal therapy, implant type and design. Based on this study, inadequate vestibular depth around dental implants may be associated with increased peri-implant bone loss and mucosal recession. Further prospective and intervention studies will be required to fully understand this phenomenon.

Peri‐implant evaluation of immediately loaded implants placed in esthetic zone in patients with diabetes mellitus type 2: a two‐year study

The aim of this study was to evaluate implant survival and primary stability parameters in patients with diabetes with different levels of glycosylated hemoglobin Alc (HbA1c) treated with immediate placement and provisionalization of implant-supported, single-tooth replacements over 2years. Eighty-five patients were divided into three groups according to their HbA1c levels: 33 patients in Group 1 (<6, control group); 30 patients in Group 2 (6.1-8); and 22 patients in Group 3 (8.1-10). Each patient received one-one-piece implant in the anterior zone of the upper maxillary. The implant survival rate was analyzed for each group, together with three variables to evaluate the general state of peri-implant health: probe depth, bleeding on probing, marginal bone loss. Marginal bone loss increased in relation with higher HbA1c levels. For marginal bone loss in Group 1, mean resorption values ranged from 0.51 after 6months to 0.72 after 2years in comparison with respective values of 1.33 and 1.92 in Group 3. This pattern was repeated for bleeding on probing, both parameters showing significant differences between groups. For bleeding on probing, mean bleeding levels varied from 0.36 in Group I at 6months after implant placement, to 0.59 in Group 3 (P=0.041 between the three groups). Peri-implant pocket depth showed the same tendency to increase in relation to HbA1C but differences between groups did not reach statistical significance. Patients with diabetes can receive implant-based treatments with immediate loading safely, providing they present moderate HbA1c values.