Management Of Peri-implantitis Research Articles

Periodontal Endoscopy for Mechanical Debridement in the Non-Surgical Management of Peri-Implantitis: A Narrative Review.

Background: The aim of the present narrative review is to synthesize the available scientific evidence on the effects of submarginal instrumentation with periodontal endoscopy and evaluate its' potential efficacy in terms of the non-surgical therapy of peri-implantitis. Methods: The literature search was performed via electronic databases, including PubMed, Web of Science, Cochrane, and Scopus, and was supplemented by manual searching. A literature review was conducted addressing the following PICOS questions: (1) What is the efficacy of non-surgical submarginal instrumentation of the implant surface with the aid of a periodontal endoscope in patients with peri-implantitis? (2) What is the efficacy of non-surgical subgingival instrumentation performed with the aid of a periodontal endoscope compared with conventional subgingival instrumentation in patients with periodontitis, in terms of clinical parameters and patient-reported outcomes? Mechanical decontamination of the implant surface is crucial for resolving inflammation and arresting further bone loss. However, there is no consensus on the most effective treatment. Non-surgical therapy remains the initial intervention, focused on biofilm removal to control the disease, although with limited capability to achieve complete disease resolution as the presence of threads and the complex-structured implant surface hinder effective biofilm removal. This evokes the need for providing supporting technologies such as periodontal endoscopy, which enables direct visualization and precision, potentially enhancing the outcomes and reducing the necessity for surgical procedures and their associated risks. Within the limitations of this narrative review, periodontal endoscopy may offer a less tissue-invasive approach. Larger prospective studies and RCTs are needed to confirm these findings and guide clinicians in determining periodontal endoscopy's suitability based on specific case characteristics.

Erbium-Doped Yttrium Aluminium Garnet (Er:YAG) Lasers in the Treatment of Peri-Implantitis.

Erbium-doped yttrium-aluminum-garnet (Er:YAG) lasers have emerged as a promising tool for the treatment of peri-implantitis, a pathological condition characterized by inflammation and bone loss around dental implants. Peri-implantitis, often associated with bacterial biofilms, leads to significant clinical complications, including pocket depth, bleeding, and pain. While traditional treatments such as mechanical debridement have shown limited effectiveness, Er:YAG lasers, with their high absorption by water, are believed to offer enhanced bacterial decontamination and tissue healing through photothermal effects. Studies indicate that Er:YAG lasers can reduce probing depths and improve biofilm removal, though the effects on clinical attachment levels and bone regeneration remain inconsistent. The use of Er:YAG lasers in peri-implantitis treatment is not without challenges, including risks of heat-related tissue damage, undertreatment, and technical limitations such as insufficient penetration into intricate implant surfaces. Additionally, the lack of standardized treatment protocols complicates the widespread adoption of this technology. Research highlights potential improvements when Er:YAG lasers are combined with other modalities, such as antimicrobial photodynamic therapy (aPDT) and ultrasonic devices. Future advancements in laser technology, such as flexible fibers and optimized energy settings, may enhance their clinical application. Despite the promising results, further large-scale randomized controlled trials with extended follow-up periods are required to confirm the long-term benefits of Er:YAG lasers in peri-implantitis management, especially in terms of bone regeneration and bacterial control.

Photo Dynamic Therapy as An Adjunct to Mechanical Debridement on Non-Surgical Management of Peri-Implantitis - A Systematic Review

Dental implants have become much more widely used in medical practice over the past few decades. Due to its excellent success rates, it is regarded as a secure and practical treatment option for people who are partially or completely edentulous [1,2,3]. The prevalence of related implant problems and diseases has increased as a result of the large rise in implant placements [4]. Peri implantitis

Residual bone level as a prognostic factor in the surgical treatment of peri-implantitis.

Peri-implantitis is a progressive inflammatory disease affecting the tissues surrounding dental implants and leading to bone loss. The severity of this disease is typically classified based on the depth of the bone defect or the percentage of bone loss around the implant. Marginal bone loss is a critical factor in the surgical management of peri-implantitis, as it can complicate access for implant decontamination and hinder efforts to stabilize the condition. In cases where bone loss exceeds 50% of the implant length, explantation is often recommended due to significantly reduced success rates after treatment. This narrative review seeks to examine the scientific evidence on marginal bone loss as a prognostic factor in the surgical treatment of peri-implantitis.

Modified CIST protocol. Management of peri-implantitis based on scientific evidence.

Modified CIST protocol. Management of peri-implantitis based on scientific evidence.

Unraveling the Applicability of LbL Coatings for Drug Delivery in Dental Implant-Related Infection Treatment.

Peri-implantitis is an inflammatory condition caused by bacterial biofilms adhered on dental implant surfaces that cause progressive tissue destruction from the host's inflammatory response. The adverse effects of peri-implantitis progression can go beyond just losing the implant. This highlights the importance of implementing strategies to stabilize disease in the short term. Layer-by-layer (LbL) assembly is a promising avenue in the field of peri-implantitis management due to its applicability with a variety of substances, in addition to being an easy, versatile, and flexible process for multilayer formation to act directly in the affected site. In this Review, our objective is to offer comprehensive chemical and biological insights into the LbL system, clarifying its specific application as antimicrobial coatings, with concern for the physical site and purpose. Additionally, we delve deeper into the concepts of onset and progression of peri-implantitis, aiming to elucidate the precise indications for employing the LbL system as a coating for implant abutments in peri-implantitis treatment. Finally, we correlate the chemical composition of the LbL system with its functionality while also addressing the challenges posed by the uncontrolled environment of the oral cavity, which ultimately restricts its clinical applicability.

Dental Practitioners' Knowledge and Attitudes Toward the Etiology, Diagnosis, and Treatment of Peri-Implantitis.

Objectives: The objective of this study was to assess the level of knowledge and attitude about the etiology, diagnosis, and management of peri-implantitis among dental practitioners. Methods: An online cross-sectional study on 303 dentists in Saudi Arabia was conducted. A closed-ended survey consisting of 28 questions was designed. Three sections were created, i.e., (1) participants' characteristics; (2) knowledge of peri-implantitis etiology, risk factors, diagnosis, and complications; and (3) the use of antibiotics to manage peri-implantitis and methods used for diagnosis and treatment. The data were analyzed using mean and percentages. Results: A total of 303 dentists participated in this study with a 78.8% response rate, comprising 80% general dentists and 20% specialists. The majority of dentists demonstrated knowledge about peri-implantitis, with 85.5% identifying bacterial plaque as an etiologic factor and 83.8% recognizing it as an inflammatory reaction. Regarding risk factors, 88.1% identified smoking and 86.1% recognized periodontitis as contributors to peri-implant disease development. In terms of clinical decision making, 63% of participants considered implant mobility as a definitive indication for implant removal, and more than half reported using crater-like bone defects surrounding implants as a diagnostic criterion for peri-implantitis. For antimicrobial therapy, amoxicillin alone (30%) was the most commonly prescribed antibiotic, followed by the combination of amoxicillin with metronidazole (29%). Despite these treatment approaches, it is important to note that currently there are no established, predictable protocols for treating any phase of peri-implant disease. Conclusion: While participating dentists demonstrated a strong understanding of peri-implantitis etiology and risk factors, particularly regarding bacterial plaque and smoking as major contributors, there was considerable variation in antibiotic selection and usage patterns. These findings suggest the need for standardized guidelines and further research to establish evidence-based protocols for managing peri-implant diseases.

Evaluation of a single non-surgical approach in the management of peri-implantitis: glycine powder air-polishing versus ultrasonic device

Evaluation of a single non-surgical approach in the management of peri-implantitis: glycine powder air-polishing versus ultrasonic device

The efficacy of reconstructive therapy in the surgical management of peri-implantitis: A 3-year follow-up of a randomized clinical trial.

To assess whether guided bone regeneration (GBR) treatment of peri-implantitis-related bony defects could improve healing compared to open flap debridement (OFD) at 36 months. In a multi-centre, randomized clinical trial, 32 individuals received OFD (control group [CG]) and 34 GBR treatment (test group [TG]). Radiographic defect fill (RDF), probing pocket depth (PPD), bleeding on probing (BOP) suppuration (SUP), mucosal recession (MREC) and patient-reported outcomes (PROs) were evaluated at 36 months. Fifty individuals attended a supportive peri-implant therapy program and completed the 36-month follow-up. GBR treatment resulted in an RDF of 2.13 ± 1.26 mm compared to 1.64 ± 1.54 mm following OFD (p = .18). No difference was found in PPD, BOP, SUP, REC or PROs between the groups. Successful treatment (no additional bone loss, PPD ≤ 5 mm, no BOP and no SUP) was achieved in 46.2% in TG and 20% in CG (p = .053). Treatment results obtained at 12 months were generally maintained up to 36 months. No significant changes were noticed between 12 and 36 months. At 36 months, treatment results obtained at 1 year were sustained following both GBR and OFD in patients attending supportive peri-implant therapy. GBR resulted in more RDF and higher composite treatment success rate than OFD (ClinicalTrials.gov Identifier [NCT02375750]).

Advancements in dental implant technology: the impact of smart polymers utilized through 3D printing

The field of dental implantology has witnessed significant advancements in recent years, driven by innovations in materials science and manufacturing technologies. One such innovation that holds promise for revolutionizing dental implant generation is the mixing of smart polymers thru three-D printing. This evaluation article affords a comprehensive overview of the effect of clever polymers in enhancing the performance and functionality of dental implants. We begin by using elucidating the fundamental residences of smart polymers, which include their stimuli-responsive conduct, biocompatibility, and mechanical strength. sooner or later, we discover the evolution and programs of 3ِD printing, e.g. like direct metallic laser sintering (DMLS) and selective laser melting (SLM), in dentistry, highlighting its position in fabricating custom designed dental implants. the combination of smart polymers into dental implants is discussed in element, overlaying surface modification techniques, incorporation of bioactive dealers, and customization for affected person-particular desires. furthermore, we look at how smart polymers make contributions to enhancing aspects such as osseointegration, peri-implantitis management, and average implant toughness. clinical insights and case studies are presented to illustrate the real-global applications and results of clever polymer-based dental implants. ultimately, this evaluation objectives to offer valuable insights for clinicians, researchers, and industry specialists worried within the improvement and utilization of advanced dental implant technologies.

Surgical treatment of peri-implantitis

As utilisation of dental implants continues to rise, so does the incidence of biological complications. When peri-implantitis has already caused extensive bone resorption, the dentist faces the dilemma of which therapy is the most appropriate to maintain the implant. Since non-surgical approaches of peri-implantitis have shown limited effectiveness, the present paper describes different surgical treatment modalities, underlining their indications and limitations. The primary goal in the management of peri-implantitis is to decontaminate the surface of the infected implant and to eliminate deep peri-implant pockets. For this purpose, access flap debridement, with or without resective procedures, has shown to be effective in a large number of cases. These surgical treatments, however, may be linked to post-operative recession of the mucosal margin. In addition to disease resolution, reconstructive approaches also seek to regenerate the bone defect and to achieve re-osseointegration.

Artificial intelligence applications in dental implantology: A narrative review

Artificial intelligence (AI) has a substantial impact on various domains of society, including its significant role in revolutionizing dental care. These technological innovations have transformed dental treatment, expediting efficiency and innovation in the field. This review focuses on the substantial advancements in AI-based research in dental implantology, exploring the various applications of AI to enhance dental implant care. Comprehensive data from databases, including PubMed, Scopus, Web of Science, Cochrane, and Google Scholar, was thoroughly scrutinized and presented. AI has significantly impacted healthcare and dental implantology by enhancing efficiency, diagnosis, and clinical decision-making. In dental implantology, AI plays a crucial role in several aspects, such as implant identification, implant planning, prediction, and peri-implantitis management. AI models, including machine learning and deep learning, have been applied to identify implant brands accurately, outperforming dental professionals in some cases. Implant planning has been streamlined using AI to evaluate bone dimensions and locate critical anatomical landmarks. Using patient data and radiographic features, AI-driven prediction models proved as powerful tools for predicting implant success and peri-implantitis risk. Additionally, AI helps in the early recognition of complications like fractured implants and bio-tribocorrosion.

Peri-implantitis: Knowledge and attitudes of implantology clinicians regarding the disease management: Peri-implantitis knowledge.

Since peri-implantitis is an increasing and prevalent concern in clinical practice and there is no consensus regarding the best therapeutic protocol, this study evaluated the knowledge and behaviours of dentists working in Implantology regarding implant-related infections modulating factors and therapeutic protocols used in the management of peri-implantitis. Cross-sectional study was conducted with 86 Brazilian Implantology clinicians. Data were collected using a structured and online questionnaire evaluating socioeconomic characteristics, education, work/clinical practice, knowledge and attitudes regarding the risk factors and management of peri-implantitis. The reliability of the questionnaire was evaluated by test-retest technique. The questionnaire was developed based on the last consensus on peri-implant diseases (2018) and the current evidence related to implant-related infections. Descriptive, bivariate and logistic regression analyses were conducted adopting a significance level of 5%. In this study, 89.5% of included dentists reported that already treated patients with peri-implantitis. Approximately 80% of dentists use antibiotics and mouth rinses during the treatment, and surgical procedures seem the main choice to treat peri-implantitis (91.8%) by dentists. As a preventive approach, 94.2% of dentists reported that routinely assessedbiofilm accumulation in the follow-up visits after implant placement. Logistic regression showed that the self-reported ability to treat peri-implantitis was statistically (p < 0.05) higher among dentists who reported abilities to diagnose the disease and use laser for peri-implantitis treatment. Dentists working in Implantology have a good level of knowledge and behaviors in the management of peri-implantitis. However, the lack of consensus regarding the best treatment protocols may reflect dentist's behaviours because different treatment protocols have been used by evaluated clinicians.

Clinical and Biochemical Evaluation of Chlorohexidine Gel Versus Propolis Gel in Non-Surgical Management of Peri-Implantitis (Randomized clinical trial)

Clinical and Biochemical Evaluation of Chlorohexidine Gel Versus Propolis Gel in Non-Surgical Management of Peri-Implantitis (Randomized clinical trial)

Management of Infected Tissues Around Dental Implants: A Short Narrative Review.

Dental implants have become the most effective treatment option for replacing missing teeth, worldwide. The popularity and demand for dental implants are continually increasing. Nevertheless, its complications are undeniable. Peri-implant diseases, including peri-implant mucositis and peri-implantitis, are a multifaceted clinical condition. Therefore, it is in the best interest to optimize the management of peri-implantitis, and there are still numerous methods to treat and manage infections in the vicinity of dental implants. The main goal of peri-implantitis treatment is to arrest disease progression, eliminate infection, and reconstruct damaged tissues around the implant. The clinical evidence on treating peri-implantitis that is available in PubMed was reviewed. Additionally, we presented the most comprehensive management strategies. As a result, numerous clinical trials recommended mechanical debridement and local administration of antimicrobial agents as well as topical oxygen therapy to mitigate bacterial biofilm and manage infection. The regenerative (bone grafting) approach for the treatment of peri-implantitis is another effective method. Finally, implant surface engineering can address high antibacterial efficacy and site-specific biofilm reduction.

Advancements and applications of laser technology in modern dentistry.

The use of lasers in dentistry has revolutionized dental procedures, providing signif i cant advantages over traditional techniques. Lasers offer enhanced precision, reduced bleeding, faster healing times, and improved patient comfort. This review explores CO2 lasers, diode lasers, Er, and Er, Cr lasers, and Photobiomodulation and Low-Level Laser Therapy (LLLT). CO2 Lasers: Introduced in the 1970s, CO2 lasers are ef f ective for soft tissue surgeries such as gingivectomy and frenectomy due to their high water absorption, which allows for precise cutting with minimal damage. They also enhance enamel and dentin resistance, treat gingival hyperpigmentation, and manage peri-implantitis. Diode Lasers: These are suitable for soft tissue procedures, emitting wavelengths of 800-980 nm. Diode lasers are widely used for periodontal therapy and peri-implantitis management due to their antimicrobial properties, offering benef i ts like reduced bleeding and faster healing. Er and Er, Cr Lasers: Emitting at 2940 nm and 2780 nm respectively, these lasers are absorbed by water and hydroxyapatite, making them ideal for caries removal and bone contouring. They provide precise ablation with minimal thermal damage. Photobiomodulation and LLLT: These therapies use low-level lasers or LEDs to stimulate cellular function, promote healing, and reduce pain without thermal damage, making them effective for managing pain and inflammation. Overall, lasers offer significant benefits in precision, patient comfort, and healing, making them a valuable tool in modern dentistry.

Management of peri-implantitis using local drug delivery among Indian patients.

It is of interest to compare 0.2% chlorhexidine gel, 0.2% chlorhexidine chip, minocycline microspheres and slow-release doxycycline gel and tetracycline fibers as drug delivery systems in the management of peri-implantitis. The study comprised of 105 Indian participants who had a minimum of one dental implant with a probing depth of 4 mm, along with exudate and/or bleeding upon probing along with the presence of potentially harmful germs. The use of minocycline microspheres and 0.2% chlorhexidine gel resulted in significant improvements in probing depths at 1 month, 3 months and 6 months and all treatments showed decline in the indicator bacteria. Thus, minocycline microspheres and 0.2% chlorhexidine gel is useful as an adjuvant for mechanical debridement in management of peri-implantitis.

Clinical and radiographic outcomes of a combined surgery approach to treat peri-implantitis

Peri-implant infra-bony defects are difficult to treat, and data on the management of peri-implantitis are lacking. The aim of this study was to evaluate the effect of a combined surgical approach to manage peri-implantitis: implantoplasty with xenogeneic bone grafting and a concentrated growth factor membrane. Two independent examiners analysed the medical records and radiographs taken before surgery and at the last follow-up. Data were analysed at the implant level; some patient-level data (age, sex, smoking habit) were also considered. Linear regression analysis with generalized estimating equations (GEE) was used to explore the effect of variables of interest (including marginal bone level (MBL)) on implantitis treatment success and resolution rates. The effect of the prosthesis type on postoperative clinical and radiographic parameters was also explored by GEE, with adjustment for age, sex, tooth site, location, follow-up duration, and implant length (model IV including all). Thirty patients with 72 implants were investigated. The implant survival rate was 100% over a mean observation period of 3.3 years (range 2–11 years). The treatment success rate (bone loss <0.5 mm, no bleeding on probing (BOP), no suppuration, probing depth (PD) < 5 mm) was higher in females than males (50% vs 19.0%; P = 0.008). At the last postoperative follow-up, the MBL (1.51 ± 1.07 vs 4.01 ± 1.13 mm), PD (3.61 ± 0.84 vs 6.54 ± 1.01 mm), and BOP (23.38 ± 23.18% vs 79.17 ± 15.51%) were significantly reduced when compared to pre-surgery values (all P < 0.001). Furthermore, a significantly higher PD reduction (β = −1.10 mm, 95% confidence interval −1.97 to −0.23 mm, P = 0.014) was observed for implants with a single crown than a full-arch prosthesis (GEE model IV). Preliminary clinical and radiographic data indicate that implantoplasty in combination with surgery could be an effective treatment option for peri-implantitis.

Treatment of peri-implantitis: Fiction or reality? Part 2: Adjuncts and decontamination approaches in the non-surgical and surgical management of peri-implantitis

Treatment of peri-implantitis: Fiction or reality? Part 2: Adjuncts and decontamination approaches in the non-surgical and surgical management of peri-implantitis

Efficacy of phthalocyanine dye in antimicrobial debridement by photodynamic therapy as an adjunct to mechanical management of peri-implantitis: an in vitro study

Objective: The aim of the present in vitro study was to evaluate the efficacy of phthalocyanine dye in photodynamic therapy (PDT) as an adjunct to mechanical debridement in the management of peri-implantitis. Methods: S. aureus, F. nucleatum, and P. gingivalis were coated on titanium (Ti) discs and divided into control and test groups. In the control group, mechanical debridement + laser was performed, while in the test group, PDT with hydroxyaluminium phthalocyanine (AIPcOH) dye as photosensitizer was used. Bacterial colony counts and surface hardness were assessed post-operatively. Results: There was a significant difference in the bacterial count reduction at different time intervals in the test group (p=0.01) compared to the control group; no significant difference was observed in surface hardness (p=0.7). Conclusion: This present in vitro study concluded that PDT with AIPcOH dye was effective in eradicating S. aureus, F. nucleatum, and P. gingivalis on Ti discs. This study also concluded that PDT with a photosensitizer can be used as an adjunct in the management of peri-implantitis.