Peri-implant Bone Defects Research Articles

Peri-implant bone regeneration in pigs.

To review the current literature to answer the focused question: in the experimental pig model (population), which types of peri-implant bone defects (exposure) have been used evaluate different modes of therapy and what is their capacity for spontaneous healing and regeneration (outcome)? Following PRISMA guidelines, electronic databases were searched for studies reporting peri-implant bone defects in the maxillae or mandibles of pigs. Those studies which reported a control group of untreated defects with assessment of spontaneous regeneration [new bone area (BA)] and/or re-osseointegration [new bone-to-implant contact (BIC)] via quantitative radiography or histomorphometry were included in a random effects meta-analysis for the outcomes BA and BIC. Overall, 21 studies, mostly performed in the mandibles of minipigs, were included. Most studies reported 'acute' intrabony (circumferential and/or dehiscence; n = 12) or supra-alveolar defects (horizontal; n = 4). Five studies attempted to induce 'chronic' peri-implantitis lesions using ligatures with conflicting results. Meta-analyses revealed pooled estimates (with 95% confidence intervals) of 48.07% BIC (30.14-66%) and 64.31% BA (42.71-85.91%) in intrabony defects, and 52.09% BIC (41.83-62.35%) and 28.62% BA (12.97-44.28%) in supra-alveolar defects. Heterogeneity in the meta-analysis was high (I2 > 90%). Current evidence for peri-implant bone regeneration in pigs is mainly based on acute intrabony defects, which demonstrate a high capacity for spontaneous regeneration and re-osseointegration. The evidence for chronic peri-implantitis is limited and does not clearly indicate a spontaneous progression of the disease in this animal model.

Sonification of Deproteinized Bovine Bone Functionalized with Genistein Enhances Bone Repair in Peri-Implant Bone Defects in Ovariectomized Rats

Estrogen deficiency is one of several contributing factors to catabolic changes in bone surrounding dental implants, impairing bone repair in defects requiring bone regeneration. Functionalizing bone substitutes is an alternative approach among various strategies to address this challenge. In this study, the aim was to evaluate the effect of functionalizing deproteinized bovine bone (Bio-Oss®, BO) with genistein via sonication on peri-implant bone defects in ovariectomized rats. The animals were randomly distributed according to the treatment into the following four groups (n = 10): BO sonicated with genistein (BOS + GEN), BO sonicated alone (BOS), untreated BO (BO), and blood clot only (CLOT). After twenty-eight days, implant removal torque was determined, and the peri-implant bone parameters were calculated based on computed microtomography. Additionally, the gene expression of bone turnover markers was evaluated. As a main result, the functionalization with genistein increased implant removal torque and the peri-implant bone volume in the BOS + GEN group compared to both BOS and BO groups (both p < 0.05). These findings suggest that the sonification of deproteinized bovine bone functionalized with genistein improves bone repair in peri-implant bone defects in ovariectomized rats.

Applications of Tooth Graft in Treating Peri-Implant Bone Defects

Applications of Tooth Graft in Treating Peri-Implant Bone Defects

Do the number of zirconia implants and the thickness of CBCT image reconstruction affect the detection of peri-implant bone defect? A diagnostic accuracy exvivo study.

To evaluate the influence of multiplanar reconstruction thickness on the detection of peri-implant bone defects with a standalone zirconia implant and compare it to when another implant is in the vicinity using cone-beam computed tomography (CBCT). Five dry human mandibles were used to create twenty implant sites in the second premolar and first molar regions. The OP300 Maxio was used to acquire CBCT images (90 kVp, 6.3 mA, 5 × 5 cm FOV, and 0.125 mm3 voxel size) before and after creating 3 mm peri-implant bone defects in the buccal aspect of the premolar region. Half of the scans featured a single zirconia implant in the premolar region, while the others had two implants in the premolar and molar regions. Three reconstruction thicknesses (0.125 mm, 1 mm, and 2 mm) were considered for the multiplanar reconstruction analyses. Five oral and maxillofacial radiologists assessed the detection of peri-implant bone defects using a 5-point scale. Diagnostic parameters were calculated and compared using Two-way ANOVA (α = .05). The studied factors showed no significant influence on the diagnosis of peri-implant bone defects (p > .05). Diagnostic performance was notably higher with a single implant, especially with a 2-mm reconstruction thickness (AUC = 0.88, sensitivity = 0.68, specificity = 0.94). Although the differences were not statistically significant, the results were more modest when two implants were present (AUC = 0.80, sensitivity = 0.58, specificity = 0.82). The presence of an adjacent zirconia implant and variations in reconstruction thickness did not influence the detection of 3 mm buccal peri-implant bone defects on CBCT images.

In vivo experimental study comparing alveolar ridge preservation versus guided bone regeneration after unassisted socket healing at intact and damaged sites in narrow alveolar ridges.

To compare bone regeneration and dimensional alteration of alveolar ridge at intact and damaged extraction sockets after alveolar ridge preservation (ARP) and implant placement versus unassisted socket healing followed by guided bone regeneration (GBR) with simultaneous implant placement. In 6 beagle dogs, 3 types of extraction sockets in the mandible were created: (1) intact sockets, (2) 1-wall defect sockets and (3) 2-wall defect sockets. The sockets were allocated to undergo either (1) ARP and implant placement 8weeks later (ARP group) or (2) GBR with simultaneous implant placement after 8weeks of unassisted socket healing (GBR group). After an additional healing period of 8weeks, bone regeneration and dimensional changes were evaluated radiographically and histologically. GBR showed superior bone formation and greater bone gains compared to ARP, regardless of the initial extraction-socket configuration. Although ARP maintained the preexisting alveolar ridge dimensions, peri-implant bone defects were still detected at 8weeks of follow-up. Histomorphometric analyses confirmed that GBR increased dimensions of the alveolar ridge compared to baseline, and the augmentation and bone regeneration were greater with GBR than with ARP. Early implant placement with ARP can mitigate alveolar ridge changes in the narrow alveolar ridge. However, early implant placement with simultaneous GBR creates the conditions for enhanced bone regeneration around the implant and greater ridge augmentation compared to ARP, irrespective of the extraction-socket configuration.

Sonography in the diagnosis of peri-implant bone defects: An invitro study on native human mandibles.

The aim of this study on native human cadavers was to compare clinical, sonographic, and radiological measurements of fenestrations, dehiscences, and 3-wall bone defects on implants. The examination was carried out on five human mandibles. After the insertion of 27 implants, dehiscences (n = 14), fenestrations (n = 7) and 3-wall bone defects (n = 6) were prepared in a standardized manner. The direct measurement of the bone defects was carried out with a periodontal probe and the radiological examination was carried out using digital volume tomography (DVT). The ultrasound examination (US) was performed using a clinical 24-MHz US imaging probe. Means and standard deviations of the direct, US, and DVT measurements were calculated. Measurements were statistically compared using the Pearson correlation coefficient and Bland-Altman analysis. Bone defects were on average 3.22 ± 1.58 mm per direct measurement, 2.90 ± 1.47 mm using US, and 2.99 ± 1.52 mm per DVT assessment. Pairwise correlations of these measurements were R = .94 (p < .0001) between direct and US, R = .95 (p < .0001) between DVT and US, and R = .96 (p < .0001) between direct and DVT. The mean differences of the measurements (and 95% CI) between direct and US was 0.41 (-0.47 to 1.29), US and DVT 0.33 (-0.30 to 0.97), and direct and DVT 0.28 (-0.50 to 1.07). All peri-implant bone defects could be identified and sonographically measured. US measurements showed a strong correlation with direct and DVT measurements. The sonographic measurement accuracy was highest for dehiscences, followed by fenestrations and 3-wall bone defects.

A Comparison of Guided Bone Regeneration vs. the Shell Technique Using Xenogeneic Bone Blocks in Horizontal Bone Defects: A Randomized Clinical Trial.

In cases of severe horizontal atrophy, implant placement requires bone reconstruction procedures. The aim of this randomized controlled trial is to compare the outcomes of bone augmentation with simultaneous implant placement using the shell technique to the outcomes of guided bone regeneration (GBR) in cases of severely horizontal bone atrophy. This study was designed as a monocentric, parallel-group, randomized controlled trial with a six-month follow-up. Among the primary outcomes of this study, peri-implant bone regeneration and peri-implant bone defect closure were selected. Forty-four patients were recruited and equally divided between two groups. In the GRB group, a horizontal regeneration of 2.31 ± 0.23 mm was observed opposed to a horizontal regeneration of 2.36 ± 0.17 mm in the shell group (p = 0.87). A volumetric increase was observed in both groups, with an increase of 0.30 ± 0.12 cm3 in the GBR group and an increase of 0.39 ± 0.09 cm3 in the shell group, highlighting a significant difference between the two groups (p = 0.02). In conclusion, bone augmentation with simultaneous implant placement using the shell technique or guided bone regeneration in horizontal bone atrophy are both predictable therapeutic options.

Micro-Computed Tomography Analysis of Peri-Implant Bone Defects Exposed to a Peri-Implantitis Microcosm, with and without Bone Substitute, in a Rabbit Model: A Pilot Study.

Peri-implantitis is an inflammatory condition characterized by inflammation in the peri-implant connective tissue and a progressive loss of supporting bone; it is commonly associated with the presence of biofilms on the surface of the implant, which is an important factor in the development and progression of the disease. The objective of this study was to evaluate, using micro-CT, the bone regeneration of surgically created peri-implant defects exposed to a microcosm of peri-implantitis. Twenty-three adult New Zealand white rabbits were included in the study. Bone defects of 7 mm diameter were created in both tibiae, and a cap-shaped titanium device was placed in the center, counter-implanted with a peri-implantitis microcosm. The bone defects received a bone substitute and/or a resorbable synthetic PLGA membrane, according to random distribution. Euthanasia was performed 15 and 30 days postoperatively. Micro-CT was performed on all samples to quantify bone regeneration parameters. Bone regeneration of critical defects occurred in all experimental groups, with a significantly greater increase in cases that received bone graft treatment (p < 0.0001), in all measured parameters, at 15 and 30 days. No significant differences were observed in the different bone neoformation parameters between the groups that did not receive bone grafts (p > 0.05). In this experimental model, the presence of peri-implantitis microcosms was not a determining factor in the bone volume parameter, both in the groups that received regenerative treatment and in those that did not.

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.

Osseointegration Potential Assessment of Bone Graft Materials Loaded with Mesenchymal Stem Cells in Peri-Implant Bone Defects.

Many studies have been exploring the use of bone graft materials (BGMs) and mesenchymal stem cells in bone defect reconstruction. However, the regeneration potential of Algipore (highly purified hydroxyapatite) and Biphasic (hydroxyapatite/beta-tricalcium phosphate) BGMs combined with bone marrow-derived mesenchymal stem cells (BMSCs) remains unclear. Therefore, we evaluated their osseointegration capacities in reconstructing peri-implant bone defects. The cellular characteristics of BMSCs and the material properties of Algipore and Biphasic were assessed in vitro. Four experimental groups-Algipore, Biphasic, Algipore+BMSCs, and Biphasic+BMSCs-were designed in a rabbit tibia peri-implant defect model. Implant stability parameters were measured. After 4 and 8 weeks of healing, all samples were evaluated using micro-CT, histological, and histomorphometric analysis. In the energy-dispersive X-ray spectroscopy experiment, the Ca/P ratio was higher for Algipore (1.67) than for Biphasic (1.44). The ISQ values continuously increased, and the PTV values gradually decreased for all groups during the healing period. Both Algipore and Biphasic BGM promoted new bone regeneration. Higher implant stability and bone volume density were observed when Algipore and Biphasic BGMs were combined with BMSCs. Biphasic BGM exhibited a faster degradation rate than Algipore BGM. Notably, after eight weeks of healing, Algipore with BSMCs showed more bone-implant contact than Biphasic alone (p < 0.05). Both Algipore and Biphasic are efficient in reconstructing peri-implant bone defects. In addition, Algipore BGM incorporation with BSMCs displayed the best performance in enhancing implant stability and osseointegration potential.

Influence of the Tube Angle on the Measurement Accuracy of Peri-Implant Bone Defects in Rectangular Intraoral X-ray Imaging.

Intraoral radiography in the right-angle technique is the standard procedure to examine the peri-implant bone level in implant follow-up and implant-related studies. For the implementation of the right-angle or parallel technique, mostly ready-made image receptor holders are used. The aim of this experimental study is to analyze changes in the measurement of standardized peri-implant defects caused by a deviation in the position of the image receptor. Eleven Xive® implants (Dentsply Sirona, Bensheim, Germany) were placed in bovine bone, and peri-implant defects of varying depths were created. The preparations were fixed in a specially made test stand, and intraoral radiographs were taken using the right-angle technique with standard film holders at various horizontal and vertical projection angles. Defect measurement was carried out with the imaging software Sidexis 4 V 4.3 (Dentsply Sirona, Bensheim, Germany). With increasing angular deviation, larger deviations between the measured and the real extent of the defect occurred. Vertical tilting caused significant distortion, while horizontal rotation showed less effect. Intraoral radiography only provides a valid representation of the peri-implant bone level for follow-up or as a tool in implant-related studies if a reproducible projection direction is assured.

Evaluation of peri-implant bone defects on cone-beam computed tomography and the diagnostic accuracy of detecting these defects on panoramic images.

This study was conducted to identify the typical sites and patterns of peri-implant bone defects on cone-beam computed tomography (CBCT) images, as well as to evaluate the detectability of the identified bone defects on panoramic images. The study population included 114 patients with a total of 367 implant fixtures. CBCT images were used to assess the presence or absence of bone defects around each implant fixture at the mesial, distal, buccal, and lingual sites. Based on the number of defect sites, the presentations of the peri-implant bone defects were categorized into 3 patterns: 1 site, 2 or 3 sites, and circumferential bone defects. Two observers independently evaluated the presence or absence of bone defects on panoramic images. The bone defect detection rate on these images was evaluated using receiver operating characteristic analysis. Of the 367 implants studied, 167 (45.5%) had at least 1 site with a confirmed bone defect. The most common type of defect was circumferential, affecting 107 of the 167 implants (64.1%). Implants were most frequently placed in the mandibular molar region. The prevalence of bone defects was greatest in the maxillary premolar and mandibular molar regions. The highest kappa value was associated with the mandibular premolar region. The typical bone defect pattern observed was a circumferential defect surrounding the implant. The detection rate was generally higher in the molar region than in the anterior region. However, the capacity to detect partial bone defects using panoramic imaging was determined to be poor.

Comparative analysis of the in vivo kinetic properties of various bone substitutes filled into a peri-implant canine defect model.

Deproteinized bovine bone or synthetic hydroxyapatite are 2 prevalent bone grafting materials used in the clinical treatment of peri-implant bone defects. However, the differences in bone formation among these materials remain unclear. This study evaluated osteogenesis kinetics in peri-implant defects using 2 types of deproteinized bovine bone (Bio-Oss® and Bio-Oss/Collagen®) and 2 types of synthetic hydroxyapatite (Apaceram-AX® and Refit®). We considered factors including newly generated bone volume; bone, osteoid, and material occupancy; and bone-to-implant contact. A beagle model with a mandibular defect was created by extracting the bilateral mandibular third and fourth premolars. Simultaneously, an implant was inserted into the defect, and the space between the implant and the surrounding bone walls was filled with Bio-Oss, Bio-Oss/Collagen, Apaceram-AX, Refit, or autologous bone. Micro-computed tomography and histological analyses were conducted at 3 and 6 months postoperatively (Refit and autologous bone were not included at the 6-month time point due to their rapid absorption). All materials demonstrated excellent biocompatibility and osteoconductivity. At 3 months, Bio-Oss and Apaceram-AX exhibited significantly greater volumes of formation than the other materials, with Bio-Oss having a marginally higher amount. However, this outcome was reversed at 6 months, with no significant difference between the 2 materials at either time point. Apaceram-AX displayed notably slower bioresorption and the largest quantity of residual material at both time points. In contrast, Refit had significantly greater bioresorption, with complete resorption and rapid maturation involving cortical bone formation at the crest at 3 months, Refit demonstrated the highest mineralized tissue and osteoid occupancy after 3 months, albeit without statistical significance. Overall, the materials demonstrated varying post-implantation behaviors in vivo. Thus, in a clinical setting, both the properties of these materials and the specific conditions of the defects needing reinforcement should be considered to identify the most suitable material.

Five-Year Follow-Up of 8 and 6 mm Locking-Taper Implants Treated with a Reconstructive Surgical Protocol for Peri-Implantitis: A Retrospective Evaluation

Peri-implant infections, in the absence of adequate treatment, can finally lead to premature loss of the implant. Among targeted protocols recently proposed for the treatment of peri-implant bone defects, and in the case of short implants, reconstructive surgery represents a recommended option. The purpose of this study was to evaluate the outcomes, in terms of maintenance, of a reconstructive treatment for peri-implantitis in locking-taper plateau-design single-crown implants, followed for 5 years after surgery. A retrospective evaluation was conducted in 20 patients treated with access flap surgery, concomitant chemical and mechanical surface decontamination, and bone grafting (using a self-hardening mixture of bone substitutes and biphasic calcium sulfate without the use of membranes). Of the 21 implants assessed, 9 were 8 mm-length, and 12 were 6 mm-length. Implant loss and treatment success were, respectively, 0% and 80.95% after 5 years from surgery. All parameters related to bone levels and soft tissue conditions significantly improved after 3 years and remained stable at the 5-year follow-up. The proposed protocol, followed by an effective supporting periodontal therapy, demonstrated the maintenance of the function of all implants, providing adequate stability during the healing process after surgery and limiting the onset of disease recurrence.

Zirconia implants interfere with the evaluation of peri-implant bone defects in cone beam computed tomography (CBCT) images even with artifact reduction, a pilot study.

Three-dimensional cone beam computed tomography (CBCT) imaging can be considered, especially in patients with complicated peri-implantitis (PI). Artifacts induced by dense materials are the drawback of CBCT imaging and the peri-implant bone condition may not be assessed reliably because the artifacts are present in the same area. This pilot study investigates the performance of the artifact reduction algorithm (ARA) of the Planmeca Viso G7 CBCT device (Planmeca, Helsinki, Finland) with three different implant materials and imaging parameters. Three pairs of dental implants consisting of titanium, zirconia, and fiber reinforced composite (FRC) were set into a pig mandible. A vertical defect simulating peri-implantitis bone loss was made on the buccal side of one of each implant. The defect was identified and measured by two observers and compared to the actual dimensions. In addition, the bone structure and the marginal cortex visibility between the implants were estimated visually. The bone defect and its dimensions with the zirconia implant could not be identified in any image with or without the metal artifact reduction algorithm. The bone defect of titanium and FRC implants were identified with all three imaging parameters or even without ARA. The interobserver agreement between the two observers was almost perfect for all categories analyzed. Peri-implantitis defect of the zirconia implant and the peri-implant bone structure of the zirconia implants cannot be recognized reliably with any ARA levels, or any imaging parameters used with the Planmeca Viso G7. The need for ARA when imaging the peri-implant bone condition of the titanium and FRC implants may be unnecessary.

(Invited) Bio-Applications of Carbon Nanotubes for NIR Imaging Probes and Guided Bone Regeneration Membranes

Single-walled carbon nanotubes (CNTs) have been expected for biological and medical applications because of their unique optical and chemical properties. One of the promising applications is imaging probes because CNTs show fluorescence in the near-infrared (NIR) region, which is highly transparent for biomaterials. We have reported the synthesis method of the epoxide-type oxygen-doped CNTs (Ep-CNTs) and their application as a near-infrared fluorescent probe [1-3]. Treated (6, 5) nanotubes show photoluminescence at ~1280 nm, which corresponds to the most transparent regions for biomaterials [1]. Immunoassay and fluorescence vascular angiography of mice were demonstrated by using the produced Ep-CNTs as infrared fluorescent labels [1,3] and imaging agents [1,2], respectively. From a practical point of view, the biodistributions of the Ep-CNTs imaging probe after administration to mice were investigated in detail [2]. In addition, the biological responses of mice following administration, which are relevant to safety, were also introduced [2].More recently, we found that CNTs exhibit high compatibility with bone tissue [4]. The guided bone regeneration (GBR) technique is commonly applied to reconstruct alveolar bone and treat peri-implant bone defects. It was found that CNT-based membrane for GBR exhibits high strength to provide a space for bone formation and provide cellular shielding to induce osteogenesis.In this meeting, we will report above biological and medical applications of CNTs in detail.1. Y. Iizumi, M. Yudasaka, J. Kim, H. Sakakita, T. Takeuchi, T. Okazaki, Oxygen-doped carbon nanotubes for near-infrared fluorescent labels and imaging probes, Sci. Rep., 8, 6272 (2018).2. T. Takeuchi, Y. Iizumi, M. Yudasaka, S. K. Kondoh, T. Okazaki, Characterization and biodistribution analysis of oxygen-doped single-walled carbon nanotubes used as in vivo fluorescence imaging probes, Bioconjugate Chem., 30, 1323−1330 (2019). (Cover Article)3. K. Kojima, Y. Iizumi, M. Zhang, T. Okazaki, Streptavidin-conjugated oxygen-doped single-walled carbon nanotubes as near-infrared labels for immunoassays, Langmuir, 38, 1509-1513 (2022).4. Y. Xu, E. Hirata, Y. Iizumi, N. Ushijima, K. Kubota, S. Kimura, Y. Maeda, T. Okazaki, A. Yokoyama, Single-walled Carbon Nanotube Membranes Accelerate Active Osteogenesis in Bone Defects: Potential of Guided Bone Regeneration Membranes, ACS Biomater. Sci. Eng., 8, 1667-1675 (2022).

Factors Affecting Implant Surface Roughness and Platform Alterations After Implantoplasty: An In Vitro Study Simulating Different Clinical Scenarios.

Purpose: To determine which clinical factors might affect the postimplantoplasty presence of residual threads, platform alterations, and level of surface roughness. Materials and Methods: A total of 60 implants were placed in 20 resin models (10 edentulous maxillary models and 10 partially dentate mandibular models), and 5-mm peri-implant bone defects were created. These models were then placed in simulation mannequins. A single researcher performed the implantoplasties, which were divided into the following groups: favorable situation (FS; maxillary incisors without adjacent teeth), unfavorable situation (US; mandibular molars with adjacent teeth), crown (C; mandibular premolars with a prosthetic crown and adjacent teeth), and noncrown (NC; mandibular premolars with adjacent teeth and without a prosthetic crown). The presence of residual threads, gaps in the implant-abutment interface, and silicone debris was assessed using a scanning electron microscope (SEM), and the surface roughness (Sa and Sz) was analyzed with a confocal optical microscope. A descriptive and bivariate analysis was conducted. Results: The postimplantoplasty surfaces were significantly smoother than the original implant surfaces. The surface roughness was significantly higher in the US group than in the FS group. Gaps in the implant-abutment interface were infrequent (6.67%; 95% CI = 2.62 to 15.93) and only appeared in the posterior zone. The odds ratio for the presence of residual threads and silicone debris (US group vs FS group) was 7.1 (95% CI = 4.15 to 12.14; P < .001) and 5.53 (95% CI = 3.21 to 9.53; P < .001), respectively. When a prosthetic crown was present, residual threads were 7 times more likely to be found (OR = 7.0; 95% CI = 3.5 to 13.99; P < .001). Conclusions: Implantoplasty leads to a significant reduction in the surface roughness of implants but is affected by several variables. Performing implantoplasty on posterior mandibular implants with adjacent teeth seems to be more challenging compared to implants placed in the anterior region of a fully edentulous maxilla. The presence of a prosthetic crown should also be considered as a relevant factor. Furthermore, implantoplasty can sometimes cause gaps in the implant-abutment interface and an accumulation of silicone debris, especially in areas with limited access.

Effect of implant-abutment connections with peri-implant bone defect models under removal torque force: A 3D finite element analysis

Effect of implant-abutment connections with peri-implant bone defect models under removal torque force: A 3D finite element analysis

Current Regenerative Surgical Approaches for the Treatment of Periimplantitis: A Systematic Review

The treatment of peri-implantitis is a significant challenge due to the various strategies proposed in the literature, involving different types of grafts and membranes in the regenerative surgical technique. Purpose: The objective of this review is to describe the different regenerative surgical techniques currently used to treat peri-implant defects and their efficacy. Materials and Methods: Literature in the Pubmed and Scopus databases was evaluated to rescue ECCAs that described regenerative surgical treatment for peri-implantitis. The inclusion criteria included patients with at least one osseointegrated implant affected by a pathological condition compatible with the definition of peri-implantitis, describing a clinical intervention aimed at regenerative surgical treatment of the condition, with a minimum follow-up period of 6 months. . The Cochrane Collaboration tool for risk of bias assessment was used and the synthesis of the results was done by means of a tabulation. Results: A total of 11 RCTs were included, taking into account clinical and radiographic parameters to later evaluate the efficacy of regenerative surgical therapy for peri-implant bone defects. Conclusion: It was shown that regenerative surgical therapies for the treatment of peri-implantitis were effective, achieving an improvement in clinical and radiographic parameters. Results were determined against the background of varying definitions of peri-implantitis and study heterogeneity. For future RCTs, it is necessary to unify the definition and the initial clinical and radiographic parameters of peri-implant disease to achieve homogeneity of the studies.

Evaluation of the clinical and radiographic effectiveness of treating peri-implant bone defects with a new biphasic calcium phosphate bone graft: a prospective, multicenter randomized controlled trial.

Biphasic calcium phosphate (BCP), a widely used biomaterial for bone regeneration, contains synthetic hydroxyapatite (HA) and β-tricalcium phosphate (β-TCP), the ratio of which can be adjusted to modulate the rate of degradation. The aim of this study was to evaluate the clinical and radiographic benefits of reconstructing peri-implant bone defects with a newly developed BCP consisting of 40% β-TCP and 60% HA compared to demineralized bovine bone mineral (DBBM). This prospective, multicenter, parallel, single-blind randomized controlled trial was conducted at the periodontology departments of 3 different dental hospitals. Changes in clinical (defect width and height) and radiographic (augmented horizontal bone thickness) parameters were measured between implant surgery with guided bone regeneration (GBR) and re-entry surgery. Postoperative discomfort (severity and duration of pain and swelling) and early soft-tissue wound healing (dehiscence and inflammation) were also assessed. Data were compared between the BCP (test) and DBBM (control) groups using the independent t-test and the χ² test. Of the 53 cases included, 27 were in the test group and 26 were in the control group. After a healing period of 18 weeks, the full and mean resolution of buccal dehiscence defects were 59.3% (n=16) and 71.3% in the test group and 42.3% (n=11) and 57.9% in the control group, respectively. There were no significant differences between the groups in terms of the change in mean horizontal bone augmentation (test group: -0.50±0.66 mm vs. control groups: -0.66±0.83 mm, P=0.133), postoperative discomfort, or early wound healing. No adverse or fatal complications occurred in either group. The GBR procedure with the newly developed BCP showed favorable clinical, radiographic, postoperative discomfort-related, and early wound healing outcomes for peri-implant dehiscence defects that were similar to those for DBBM. Clinical Research Information Service Identifier: KCT0006428.