Prevalence Of Peri-implantitis Research Articles

The impact of a change in classification criteria on the prevalence of peri-implantitis: A cross-sectional analysis.

Peri-implantitis is a frequent finding but estimates of its prevalence vary widely. This may be due to the wide variety of disease definitions. In 2017 the World Workshop on Periodontal and Peri-implant Diseases and Conditions established new criteria for disease definitions. The aim of this study is to assess the potential impact of a new definition on the future reporting of peri-implant disease. Data from a 2015 report of peri-implant prevalence were examined using the new diagnostic criteria. This cross-sectional study was performed on 95 patients with 220 implants who had their implants placed between 1998 and 2003. An examiner masked to the previous diagnosis examined the radiographs and patient data to make a diagnosis based on 3mm of bone loss from the expected level of bone. This reanalysis was used to calculate the prevalence of peri-implant disease and generate new relative risk indicators. The mean follow-up time for the patients was 10.9 years. Using the 2017 criteria, peri-implant mucositis was found in 35.3% of the implants and 52.2% of the subjects, and peri-implantitis occurred in 8.7% of the implants and 15.2% of the subjects. This constituted a drop in peri-implantitis at both patient and implant level of nearly 50% from the prior analysis. Smoking at time of implant placement emerged as a new risk factor in this analysis that was not identified in the prior analysis. The new diagnostic criteria significantly reduce the reported prevalence of peri-implantitis and bring new risk factors into focus.

Factors influencing the prevalence of peri-implantitis in implants inserted in augmented maxillary sinuses: A multicenter cross-sectional study.

Peri-implantitis is widely recognized as a major cause of late implant failure, both in pristine and regenerated bone. The present study aims to evaluate the prevalence of peri-implantitis in implants inserted in augmented maxillary sinuses and to analyze possible risk factors. A cross-sectional study was conducted in four centers including patients who underwent lateral or transcrestal sinus augmentation and received dental implants. Clinical and anamnestic data were collected using a standardized form. Univariate and multivariate logistic regression analyses have been performed for both implant-level and patient-level variables. Subsequently, a multilevel logistic mixed-effect model was built to analyze variables correlated with the occurrence of peri-implantitis. A total of 156 patients (61 males and 95 females; mean age: 60.9 ± 11.6 years) with 315 implants inserted into augmented maxillary sinuses with a follow-up ranging from 1 to 18 years were evaluated. Seven implants in seven patients were previously lost for peri-implantitis (2.2% and 4.5% at implant- and patient-level, respectively); 250 implants showed no signs of peri-implant diseases (79.4%), 34 implants presented mucositis (10.8%), and 24 implants exhibited peri-implantitis (7.6%). Corresponding data evaluated at patient-level were 125 (80.1%), 17 (10.9%), and 14 (9.0%), respectively. At the multilevel analysis, history of periodontitis, sinus elevation with lateral approach, and one-stage sinus floor elevation significantly correlated with the occurrence of peri-implantitis (P<0.001). History of periodontitis confirmed its well-known role as a risk factor for peri-implant pathologies. In addition, both lateral window technique and one-stage sinus floor elevation seemed to represent significant risk factors for peri-implantitis.

Assessment of Peri-Implant Soft Tissues Conditions around Short and Ultra-Short Implant-Supported Single Crowns: A 3-Year Retrospective Study on Periodontally Healthy Patients and Patients with a History of Periodontal Disease.

The aim of this retrospective study was to evaluate implant survival, marginal bone loss and peri-implant complications in 326 short and ultra-short implants. Implants were placed in the maxillary and mandibular posterior regions of 140 patients with (PP) and without (NPP) a history of periodontal disease. Clinical and radiographic examinations were performed at 3-year recall appointments. The 8.0, 6.0 and 5.0 mm-length implants placed in PP and NPP were respectively 43.75% and 38.46%, 35.10% and 34.19%, 21.15% and 27.35%; 325 implants (one early failure) were rehabilitated with single crowns in 139 patients. Overall implant survival after 3 years of follow-up was 97.55%, 98.08% and 96.61% for PP and NPP (p = 0.46). Crestal bone level variations were not statistically different among PP and NPP; 15.41% of implants presented signs of mucositis, 14.71% and 16.67% in PP and NPP (p = 0.64). Setting the threshold for bone loss at 2 mm after 36 months, peri-implantitis prevalence was 2.2%, 1.96% and 2.63% in PP and NPP (p = 0.7). Overall implant success was 82.39%, 83.33% and 80.7% for PP and NPP (p = 0.55). Short-term outcomes suggest that short and ultra-short locking-taper implants can successfully be restored with single crowns in the posterior jaws both in PP and NPP.

Multivariate analysis of the influence of peri-implant clinical parameters and local factors on radiographic bone loss in the posterior maxilla: a retrospective study on 277 dental implants

ObjectivesThe aim of the present study was to investigate whether peri-implant clinical parameters (modified plaque index (mPI), bleeding and/or suppuration on probing (B/SOP)) and local factors (type of prostheses, screw emergence, platform diameter, and abutment angulation) might contribute to the development of additional bone loss and peri-implantitis around dental implants.Materials and methodsTwo hundred seventy-seven external hex connection implants placed in the posterior maxilla of 124 patients were retrospectively evaluated. They were divided into two groups: physiologic bone loss < 2 mm (PBL) or additional bone loss ≥ 2 mm (ABL). GEE logistic regression was applied to evaluate the influence of type of prostheses (implant-supported single crown (ISSC), fixed partial denture (ISFPD), and full denture (ISFD)) and clinical parameters (mPI and S/BOP) on bone loss.ResultsAmong the 277 implants, 159 (57.4%) presented PBL and 118 (42.6%) presented ABL. Within the ABL group, 20.6% implants were diagnosed with peri-implantitis. mPI significantly correlated with the type of prosthesis and the highest value of mPI (index = 3) was observed in ISFD (23.8%). Moreover, peri-implantitis was more frequently associated with ISFD (32.79%) than ISSC and ISFDP (13.79% and 13.48, respectively)ConclusionsISFD in the posterior maxilla presented high rates of ABL and showed a higher prevalence of peri-implantitis. None of the local factors seemed to contribute to the development of these conditions. Further investigations are needed to prospectively support the results of the present study.Clinical relevancePatients rehabilitated with ISFD should be carefully monitored and have more frequent maintenance visits to prevent or control peri-implant bone loss.

Long-Term Efficacy of Variable-Thread Tapered Implants-A Retrospective, Clinical and Radiological Evaluation.

Background and Objective: There is multifaceted evidence that variable-thread tapered implants (VTTIs) offer high primary stability but few regarding the long-term success. This retrospective clinical and radiological cohort study assessed the long-term outcome of VTTIs. Material and Methods: All patients treated in an OMFS practice with NobelActive Internal® VTTI between October 2007 and September 2011 were invited for clinical examination. The outcome variables were (i) survival rate, (ii) implant success according to the “Health Scale for Dental Implants” and (iii) prevalence of peri-implantitis. Furthermore, the effect of local and systemic risk factors was investigated. Results: In 81 subjects (46 females and 35 males, mean age 65.6 years) 270 implants (157 VTTIs and 113 others as a control group) were analyzed. In 7 out of 81 patients (8.6%), 8 out of 157 VTTIs (5.1%) and 5 out of 113 other implants (4.4%) were lost. Peri-implantitis, defined as (i) presence of bleeding on gentle probing (0.25 N) or exudation and (ii) radiographic bone loss exceeding 0.5 mm since implant insertion to last follow-up, was the most common reason for implant loss (11 out of 13, 84.6%). Sixty-six out of 87 VTTIs (75.9%) were successful. Seventeen out of 42 patients (40.5%) developed peri-implantitis on 29 out of 79 VTTI sites (36.7%). Plaque and missing keratinized peri-implant mucosa were identified as potential risk factors for the development of peri-implantitis. Conclusion: Variable-thread tapered implants showed good long-term results, even in low bone quality. Peri-implantitis was the most common reason for implant failure and may be connected to certain risk factors.

Prevalence and risk indicators of peri‐implantitis: an university‐representative cross‐sectional study

Background: Despite some epidemiological studies are available on the prevalence and risk indicators of peri-implant diseases, there is still a need of studies in different settings since the role of some risk factors is still putative. To minimize selection bias, representative samples should be used. However, only two epidemiological studies have analysed the epidemiology of peri-implantitis using representative samples so far, both referring to private settings and not to university clinics. Aim/Hypothesis: The aim of this cross-sectional study was to analyse the prevalence of peri-implantitis and its risk indicators in a university-based representative sample. Materials and Methods: 240 patients who received at least one dental implant in an EFP Program in Periodontology between the years 2000 and 2017 and in function by at least 1 year were randomly selected. Those who accepted to participate received a detailed medical and dental history assessment, a clinical examination and a standardized peri-apical radiograph. Peri-implantitis was both defined according to the 2018 World Workshop (bone levels≧3 mm & BoP/SoP) and according to the case definitions of Sanz & Chapple 2012 (bone levels≧2 mm & BoP/SoP). The prevalence of peri-implantitis was then calculated, as well as a multilevel multivariate logistic regression analysis was carried out to identify the risk indicators associated with peri-implantitis. Results: 109 patients with a total of 508 implants accepted to participate. The prevalence of peri-implantitis according to the definition of the 2018 World Workshop was 6.52% at implant-level and 16.19% at patient-level. The prevalence of peri-implantitis according to the Sanz & Chapple 2012 case definition was 33.86% at implant-level and 60.75% at patient level. The following factors were identified as risk indicators for peri-implantitis (Sanz & Chapple 2012 case definition): - smoking (OR = 3.3; 95% CI: 1.2–8.9); - diabetes (OR = 12.66; 95% CI: 1.78–90.16); - moderate/severe periodontitis (AAP) (OR = 3.7; 95% CI: 1–40–9.74); - use of interproximal brushes (OR = 0.18; 95% CI: 0.06–0.62); - implant brand (Nb vs. S: OR = 5.12; 95% CI: 1.90 – 13.90); - type of super-structure (multi-unit restorations vs. single crown: OR = 2.37; 95% CI: 1.22–4.60); - plaque (six sites vs. 0 sites: OR = 3.4; 95% CI: 1.02–11.32). Conclusions and Clinical Implications: According to the present study, peri-implantitis is a highly prevalent disease at patient-level. Diabetes, smoking, moderate/severe periodontitis, implant brand, multi-unit restorations and plaque were identified as risk indicators for peri-implantitis, while the use of interproximal brushes was inversely associated. Randomized clinical studies or, when not possible for ethical reasons prospective cohort studies, are needed to demonstrate true causality of the identified risk indicators. Keywords: peri-implantitis, cross-sectional, risk indicators, risk factor, prevalence.

Prevalence of Peri-Implantitis: A Multi-Centered Cross-Sectional Study on 248 Patients.

The aim of this multicenter cross-sectional study was to determine the prevalence of peri-implantitis and to assess its association with several patient- and implant-related factors. Patients with at least one implant, who came for a recall visit to one of the four centers over a period of five months, were enrolled. Presence of peri-implantitis (defined as bleeding on probing, exudate/suppuration, bone loss > 0.2 mm/year and increased pocket depth) and several other variables (e.g., smoking habits, history of periodontitis, diabetes) were recorded. Out of 248 enrolled patients (1162 implants), 10 patients had at least one implant with peri-implantitis (4.03%); a total of 14 implants were affected (1.20%). A statistically significant association between peri-implantitis and diabetes was found (OR 8.65; CI: 1.94–38.57). Smoking more than 10 cigarettes per day (OR: 0.53; CI 0.03–9.45) and history of periodontitis (OR: 2.42; CI: 0.49–11.89) were not found to be statistically associated with peri-implantitis. Even if implant therapy is a consolidated treatment, biological complications do happen. Strict supportive therapy recalls could lead to lower rates of peri-implantitis and earlier diagnosis.

Implant and Peri-implant Tissue Maintenance: Protocols to Prevent Peri-implantitis

In the absence of prevention protocols, early diagnosis and predictable treatment options for peri-implant diseases, the long-term survival of dental implants may be compromised. The purpose of the present review is to outline risk factors/indicators for peri-implantitis and propose current protocols (2015–present) for their control and disease prevention. Recent evidence suggests that factors including use of proton-pump and selective serotonin-reuptake inhibitors, titanium-particle release, disruption of the implant-abutment connection, and prosthesis material/dimensions may increase peri-implantitis prevalence. Although the literature is still scarce, identifying these factors and developing appropriate maintenance protocols is imperative to prevent disease development. Peri-implantitis can be influenced by several risk factors/indicators that can be classified as patient related, clinical, and/or implant related. To facilitate the individualized patient risk profile assessment and guide clinical decisions, this review describes the impact of identified risk factors/indicators on peri-implant health and proposes preventive protocols based on the latest evidence.

The lack of keratinized mucosa is associated with poor peri-implant tissue health: a cross-sectional study

ObjectivesThe aim of this cross-sectional study is to determine the association between the absence of keratinized mucosa and peri-implant tissue health.Methods and materialsThis cross-sectional study comprised 412 implants from 200 patients from faculty-based clinics. Demographic, medical, and clinical information were collected. The modified sulcus bleeding index, modified plaque index, mucosal recession, probing depth, bone level, the width of keratinized mucosa, and implant status were evaluated by three calibrated examiners. Each implant was categorized into either of two peri-implant mucosa groups: keratinized mucosa (KM) or non-keratinized mucosa (NKM). The chi-square test was performed to the association between the keratinized mucosa groups and peri-implant clinical parameters and peri-implant status. Multiple logistic regression models were analyzed to test potential associations between peri-implant clinical parameters and the presence or absence of keratinized mucosa.ResultsThirty-two implants (7.8%) were categorized into the NKM group. The prevalence of peri-implantitis was 12.5% and 8.3% at the subject level and implant level, respectively. The NKM group was associated with more plaque accumulation, mucosal recession, interproximal bone level ≥ 3 mm, and peri-implantitis (p < 0.05). After controlling for confounding factors, the NKM group demonstrated higher plaque accumulation, mucosal recession, and interproximal bone level ≥ 3 mm with adjusted odds ratios of 2.98 (1.33–6.66), 3.20 (95% CI, 1.03–9.90), and 4.62 (1.70–12.58), respectively.ConclusionWithin the limitation of this study, the lack of keratinized mucosa around the dental implants was significantly associated with more plaque accumulation, mucosal recession, interproximal bone level ≥ 3 mm, and peri-implantitis.

Influence of periodontal maintenance and periodontitis susceptibility on implant success: A 5-year retrospective cohort on moderately rough surfaced implants.

To investigate the effect of defined versus undefined periodontal maintenance after implant therapy on the prevalence of peri-implant complications. Two hundred patients who underwent dental implant therapy in the National Dental Centre Singapore (NDCS) from 2005 to 2012 were recruited. One hundred patients had regular periodontal maintenance (defined maintenance programme group, DMP), and the other 100 patients had no documentation of periodontal maintenance (undefined maintenance programme group, UMP). Full-mouth bleeding scores (FMBS), periodontal probing depths (PPD) and peri-implant probing depths (PiPD) were evaluated within 6months of prostheses delivery (T0 ) and at re-examination (T1 ). Peri-implant bone level changes were analysed radiographically. The mean follow-up time was 6.8years. Five out of 289 implants were lost (cumulative survival rate=98.3%). 6.0% of DMP patients and 20.0% of UMP patients had peri-implantitis (p=.003). Peri-implantitis was defined as bleeding on probing, increase in PiPD and peri-implant bone loss≥0.5mm. At the implant level, 4.0% of the DMP group implants and 17.2% of the UMP group implants were diagnosed with peri-implantitis (p=.0003). One implant in the DMP group and 13 implants in the UMP group had bone loss≥2mm (p<.0001). Multivariate regression showed that absence of regular maintenance (OR=0.24, p=.003) was significantly associated with peri-implantitis. Regular periodontal maintenance was associated with a lower prevalence of peri-implantitis and peri-implant bone loss. Patients with treated periodontitis without regular maintenance after implant placement were at higher risk for developing peri-implantitis.

Influence of Diabetes on Implant Failure and Peri-Implant Diseases: A Retrospective Study.

Diabetes is an important modifying factor of periodontitis, but its association with peri-implant diseases has not been fully explored and the existing literature reports controversial results. The aim of this retrospective study was to evaluate the influence of diabetes on peri-implantitis and implant failure. Smoking status, history of periodontal disease, presence of diabetes, diabetes type, therapy and glycaemia levels were collected in a total of 204 subjects treated with 929 implants, with a mean follow-up time of 5.7 ± 3.82 years after loading. Odds ratio (OR) for diabetes as a direct cause of peri-implantitis and implant failure were calculated, adjusted for smoking status and history of periodontitis. Nineteen patients were diabetic and most of them presented a good control of the disease at the time of surgery. The overall patient-level prevalence of peri-implantitis was 11.3%. Among diabetic patients, one developed peri-implantitis, whereas one experienced multiple implant failures. The calculated ORs, adjusted for smoking status and periodontitis, were not statistically significant. The results revealed no association between diabetes and peri-implantitis or implant failure coherently with the existing scientific literature. The actual influence of hyperglycemia on implant failure is still uncertain and new studies with larger cohorts of patients are needed.

Q-Switch Nd:YAG Laser-Assisted Elimination of Multi-Species Biofilm on Titanium Surfaces

(1) Background: The relatively high prevalence of peri-implantitis (PI) and the lack of a standard method for decontamination of the dental implant surface have pushed us to conduct further research in the field. Bacterial biofilms were found to play a primordial role in the etiology of PI. Therefore, the aim is to evaluate the efficacy of a laser-assisted elimination of biofilm protocol in the removal of a multi-species biofilm on titanium surfaces. (2) Methods: In total, 52 titanium discs (grade 4) were used. The study group consisted of 13 titanium disks contaminated with multi-species biofilms and subsequently irradiated with the laser (T + BF + L). The control groups consisted of the following types of titanium disks: 13 contaminated with multi-species biofilms (T + BF), 13 sterile and irradiated (T + L), 13 sterile and untreated (T). Q-Switch Nd:YAG laser Irradiation parameters were the following: energy density equal to 0.597 J/cm2 per pulse, power equal to 270 milliwatt per pulse, 2.4 mm of spot diameter, and 10 Hz repetition rate for pulse duration of six nanoseconds (ns). The laser irradiation was made during 2 s of total time in non-contact and at 0.5 mm away from the titanium disc surface. After treatment, presence of biofilms on the disks was evaluated by staining with crystal violet (CV), which was measured as optical density at six hundred thirty nm, and statistical analyses were done. (3) Results: the optical density values were 0.004 ± 0.004 for the study group T + BF + L, 0.120 ± 0.039 for group T + BF, 0.006 ± 0.003 for group T + L, and 0.007 ± 0.007 for group T. For the study group, laser treatment resulted in a total elimination of the biofilm, with mean values statistically significantly lower than those of contaminated titanium surfaces and similar to those of sterile titanium surfaces. (4) Conclusions: Our irradiation protocol provided a significant elimination of the multi-species biofilm on titanium surfaces. Laser treated titanium surfaces were biofilm-free, similar to the sterile ones.

A retrospective cohort study on peri-implant complications in implants up to 10 years of functional loading in periodontally compromised patients.

Prevalence of peri-implantitis is directly proportional to the time of functional loading. The aim of this retrospective study was to assess the survival and success rates as well as the incidence of peri-implantitis among patients with a history of periodontitis and among implants with 1 to 10 years of functional loading. We evaluated clinical records of periodontally compromised patients treated between January 1998 and July 2002, with implants enrolled in a supportive periodontal and peri-implant treatment follow-up program. The following assessment indexes during follow-up were recorded: suppuration on probing, modified bleeding on probing, probing depth, implant mobility, bone changes, and criteria of success of Albrektsson. Clinical data of 475 patients with 1,991 implants were analyzed for a period of 10 years of functional loading. The survival and success rates were 91.8% and 75.4%, respectively, and the cumulative incidence of peri-implantitis among patients was 24.4%. The survival rate was 96.1%, and the success rate was 83.7% among implants. The incidence of peri-implantitis exhibited a peak rate after the seventh year (2.1%). The prevalence of peri-implantitis increased from 3.2% to 9.7% between 5 and 10years of follow-up, and the peri-implantitis rate among implants was 12.9% after 10 years of functional loading. Peri-implantitis begins to appear more frequently after the fifth year of functional loading, especially between the seventh and eighth years of function.

Peri-implantitis and Severity Level.

Objectives Different diagnostic criteria were used for diagnosis of peri-implant diseases. The aim of this cross-sectional study was to explore prevalence of peri-implant diseases and subclassify peri-implantitis based on different levels of radiographic and clinical findings. Materials and Methods Two hundred patients having 655 dental implants were included in this study. In addition to clinical measurements, standard long-cone parallel technique was used to evaluate marginal bone level around implants. Following diagnosis of peri-implant diseases, peri-implantitis was further subclassified using a severity leveling in terms of marginal bone level and probing depth. Results Mean age of 200 subjects was 52.8 ± 12.2 years and 63% were females. In total, bleeding on probing was present in 93% and suppuration in 27% of implants. On subject basis, 2.5% were diagnosed as healthy, 28% with peri-implant mucositis (PM), and 69.5% with peri-implantitis, whereas on implant basis, 3.6% were healthy, 36% presented PM, and 60.4% peri-implantitis. Furthermore, when severity leveling was applied, peri-implantitis prevalence changed markedly and ranged from 14.5 to 31.0% at the subject level and from 10.0 to 22.0% at the implant level. Subgingival restoration margins were observed in 70.6% of patients for implants with PM and in 44% patients for implants with peri-implantitis. Most of the implants with peri-implantitis were with platform match (71.5%). Conclusions Applying different thresholds to the peri-implantitis definition yielded different prevalence rates ranging from 10 to 31%. As no established diagnostic criteria are being used today, results from clinical studies may not reflect the true disease prevalence.

Association of prosthetic features and peri-implantitis: A cross-sectional study.

To identify the influence of prosthetic features through a comprehensive analysis with other known risk factors. A total of 169 patients (n=implants: 349) was retrospectively included in the present study. Peri-implantitis was diagnosed based on peri-implant bone loss and probing depth. Using radiographs taken 1 and 5years following prosthesis insertion, the following features were determined: peri-implant marginal bone loss (MBL), emergence angle (EA), emergence profile (EP) and crown/implant ratio (CIR). The splinted position of prosthesis was also recorded. Multivariable generalized estimating equation was used to analyse the influence of each feature on the prevalence of peri-implantitis. The final prediction model was constructed by Cox proportional hazard regression analysis. The EA showed a significant correlation with MBL. A statistically greater prevalence of peri-implantitis was observed if EA≥30 degrees, when EP is convex and in middle implant splinted with both mesial and distal adjacent implants in bone-level implant. A similar correlation was not observed in tissue-level implants. CIR had no significant effect on the prevalence of peri-implantitis. Over-contoured implant prosthesis is a critical local confounder for peri-implantitis. The implant splinted to both mesial and distal adjacent implant has a higher risk of peri-implantitis.

Dental Malpractice in Implant Dentistry in Saudi Arabia

Aim: The aim of this study was to detect and analyze dental malpractice in the field of implant dentistry in the Kingdom of Saudi Arabia.&#x0D; Materials and Methods: 106 patients aged ≥ 18 years with at least one professional malpractice in implant dentistry done in dental health premises in Saudi Arabia were included in the study. Clinical and radiographic examinations were used to detect preoperative (diagnosis and treatment planning), intraoperative (implant insertion), and postoperative (post surgery and prosthesis) complications. The data obtained including age and gender were documented in a patient examination form then statistically analyzed using Chi-Square Test and Spearman’s Correlation Coefficient.&#x0D; Results: The percentages of patients were equally divided among the preoperative, intraoperative, and postoperative phases p &gt; 0.05. More than half of the patients were females (61.3%). The majority of the patients were in the age group 50-60 years. Also, the majority of the patients had implants with malpractice placed in the posterior region. Exactly half of the patients had implants with malpractice placed in the maxilla. In addition, exactly half of the patients had technical errors violating the surrounding structures; (37.7%) of the patients had damage to adjacent tooth and (11.3%) had inferior alveolar nerve damage; also, (4.7%) of them had sinus penetration. Furthermore, at the patient level, age and gender were not related to implant failure, and (75.5%) of the patients had implant failure. With respect to peri-implantitis, patients ≥ 50 years of age were more than patients &lt; 50 years of age. However, gender and maxilla were not related to peri-implantitis. The prevalence of peri-implantitis was 20.8% at the patient level. In partially edentulous patients, implant fracture was (1.17%) at the implant level.&#x0D; Conclusion: Implant malpractice equally occurred among the preoperative, intraoperative, and postoperative phases.&#x0D; Keywords: Failure, Implant, Intraoperative, Malpractice, Peri-implantitis, Postoperative, Preoperative.

Peri-Implantitis – A Growing Complication of Dental Implant Prosthesis

Contemporarily, dental implant is considered as the gold standard for managing complete or partially edentulous patients. Even though with meagre rates of failure, peri-implantitis is one complication that is worth deciphering. The prevalence of peri-implantitis is reportedly increasing with time so correct diagnosis is the most important factor for proper management of peri-implant disease. Regular evaluation and elimination of risk factors (history of periodontitis, poor oral hygiene, diabetes, smoking, alcohol consumption, genetic traits, absence of keratinized mucosa and implant surface) are effective precautions against peri implantitis. The management of peri-implant mucositis is also considered as an important preventive measure for the onset of peri- implantitis. In addition to aspects of osseointegration, type and structure of the implant surface are of importance. For the treatment of peri-implant disease multiple conservative and surgical methods are available. To minimize its detrimental effects, it is important to take a holistic view of the condition. Therefore, this review gives an overview on the prevalence, etiology, risk factors, prevention and treatment of peri-implantitis.

Incidence and prevalence of peri-implantitis and peri-implant mucositis 17 to 23 (18.9) years postimplant placement.

To evaluate the prevalence of peri-implantitis (PI) and peri-implant mucositis (PM) in a long-term follow-up with comparison among different PI and PM definitions, and to report on the incidence of PI. In a retrospective clinical study five different PI and PM definitions were applied onto a population with 274 implants 17 to 23 years postimplant placement. Recommendations by the Eighth European Workshop on Periodontology (EWOP) were used as base reference. Clinical and radiological measurements were considered. Risk factors were evaluated in a regression analysis. After an average observation period of 18.9 years, 40.1% of the implants were diagnosed with PM and 15.0% with PI (Eighth EWOP). PI incidence reached 7.9% on implant level and 13.2% on patient level. Implants diagnosed with PI and progressive bone loss displayed exceptionally vertical bone defect configuration (BDC). Diabetes mellitus, smoking, regular maintenance, or a former periodontal infection did not show significant influence on the prevalence of peri-implant diseases. Patients with bruxism displayed significantly less PM and PI. Vertical BDC seems to correspond with active PI, wherefore we estimate such a defining factor of importance. Diagnosis of PM and evaluation of probing pocket depths might be only of descriptive interest as they could lead to false-positive results.

A Clinical and Radiographic Retrospective Study on 223 Anodized Surface Implants with a 5- to 17-Year Follow-up.

The aim of this study is to evaluate the long-term performance of anodized surface implants placed in native bone and followed-up for up to 17 years. Success and survival rates, prevalence of peri-implantitis, and the correlation between the presence of peri-implantitis and other clinical and demographic variables were calculated. After a mean follow-up time of 10.4 years (range: 5 to 17 years), 91.7% of 223 analyzed implants were still in function. Peri-implantitis affected 63 implants (28.3%) in 26 patients (44%). Eleven implants with peri-implantitis (4.9%) failed. Within the limits of this retrospective analysis, anodized implants appear to be prone to peri-implantitis, mainly in the posterior mandible and in patients with unsatisfactory plaque control.

Bone gain through implantoplasty without graft material

Background The prevalence of peri-implantitis is high. All surgical treatment approaches include a surface decontamination protocol but implantoplasty goes one step beyond. The removal of all macro and microstructures on the exposed implant surface creates a radical change of environment. Several reports indicate that implantoplasty can stop further bone loss but, at this stage, significant bone gain obtained without graft material has never been associated with implantoplasty. Aim/Hypothesis The aim of this study was to assess the clinical outcome of peri-implantitis lesions after using a peri-implantitis resective surgical treatment protocol that included systematic removal of all prosthetic components in order to create optimal conditions for implantoplasty. Material and Methods Forty eight patients (60 implants) were included in the study and were followed for a mean observation time of 20 months. Surgical technique- after removal of all prosthetic components, flaps were elevated, granulation tissue removed and implantoplasty performed on all the exposed implant surfaces using special helical cylindrical carbide burs (H375 and HK375, Dexter) and a high speed turbine. Titanium particles were carefully removed, the prosthesis was placed and flaps sutured. No additional decontamination protocol was used, nor grafting material. The implants were evaluated through a clinical and radiographic analysis the day of treatment and, at least, 6 months later. The measurement system used known implant sizes and inter thread distances. Results Three implants were lost (5%) due to further bone loss and recurrence of the disease. 6 implants (10%) presented bone loss up to 2 mm, 27 implants (45%) showed no change in marginal bone levels and 24 implants (40%) presented bone gain up to 3 mm. This outcome was observed without the use any graft material. The mean marginal bone level change was a bone gain of 0.52 mm. No inflammation and or suppuration were observed for all remaining implants. Conclusion and Clinical Implications Implantoplasty is a reliable surgical treatment option for peri-implantitis bone lesions. A bone regeneration process can be observed without graft material.