Prevention Of Peri-implantitis Research Articles

The Microbiome of Peri-Implantitis: A Systematic Review of Next-Generation Sequencing Studies.

(1) Introduction: Current evidence shows that mechanical debridement augmented with systemic and topical antibiotics may be beneficial for the treatment of peri-implantitis. The microbial profile of peri-implantitis plays a key role in identifying the most suitable antibiotics to be used for the treatment and prevention of peri-implantitis. This systematic review aimed to summarize and critically analyze the methodology and findings of studies which have utilized sequencing techniques to elucidate the microbial profiles of peri-implantitis. (2) Results: Fusobacterium, Treponema, and Porphyromonas sp. are associated with peri-implantitis. Veillonella sp. are associated with healthy implant sites and exhibit a reduced prevalence in deeper pockets and with greater severity of disease progression. Streptococcus sp. have been identified both in diseased and healthy sites. Neisseria sp. have been associated with healthy implants and negatively correlate with the probing depth. Methanogens and AAGPRs were also detected in peri-implantitis sites. (3) Methods: The study was registered with the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42023459266). The PRISMA criteria were used to select articles retrieved from a systematic search of the Scopus, Cochrane, and Medline databases until 1 August 2023. Title and abstract screening was followed by a full-text review of the included articles. Thirty-two articles were included in the final qualitative analysis. (4) Conclusions: A distinct microbial profile could not be identified from studies employing sequencing techniques to identify the microbiome. Further studies are needed with more standardization to allow a comparison of findings. A universal clinical parameter for the diagnosis of peri-implantitis should be implemented in all future studies to minimize confounding factors. The subject pool should also be more diverse and larger to compensate for individual differences, and perhaps a distinct microbial profile can be seen with a larger sample size.

Efficacy of Chlorhexidine Gel in Single Crown Implant Rehabilitation

Chlorhexidine gel is a commonly utilized topical antiseptic within the field of dentistry, renowned for its efficacy in managing the proliferation of bacteria, viruses, and fungi in the vicinity of dental treatment sites. The objective of this study is to investigate the effectiveness of chlorhexidine gel in the context of single-crown implant rehabilitation. The procedure of doing a literature search was performed on multiple databases, including PubMed, Web of Sciences, EMBASE, Cochrane Libraries, and Google Scholar, in order to investigate the effectiveness of chlorhexidine gel in the context of single crown implant recovery. The application of chlorhexidine gel has been found to be effective in mitigating the potential danger of infection in the vicinity of the implant, thereby minimizing any potential disruptions to the healing process and overall stability of the implant. This holds particular significance throughout the phase of implantation commencement and the subsequent time of initial recovery. The utilization of chlorhexidine gel has been shown to be effective in the prevention of peri-implantitis through its ability to regulate bacterial proliferation in the vicinity of the implant. It is imperative to mitigate inflammation and tissue damage in order to safeguard the sustained efficacy of the implant. In conclusion, the utilization of chlorhexidine gel is effective in managing bacterial plaque on the external surface of natural teeth as well as in the vicinity of dental implants.

Peri-implantitis after 40 years: Evidence, mechanisms, and implications: A mapping review

Statement of problemThe high prevalence of peri-implantitis (PI) continues to plague patients and the disease is resistant to present treatment regimens. An analysis of the available research is lacking. PurposeGiven the abundance and diversity of research on the topic of PI, the purpose of this mapping review was to synthesize the literature on the prevention of PI, the histopathology of the disease, the state of present therapeutics, and any emerging treatments. Material and methodsAn extensive literature search was undertaken by using the electronic databases of PubMed, Web of Science, and Science Direct. The keyword strings were peri-implantitis, dental implant, risk assessment, histopathology, prosthesis design, and treatment. The filters applied were time interval from 2000 to 2002; language, English. ResultsA total of 3635 articles were taken from PubMed, 3686 articles from Web of Science, and 2450 articles from Science Direct. After applying the inclusion and exclusion criteria to the titles and abstracts of selected investigations, 214 studies were retrieved. ConclusionsThe evidence reflects a concerning incidence of PI, without a predictable treatment protocol. An in-depth patient risk assessment considering risk modification, emphasis on surgical and restorative expertise, and strict recall and maintenance is essential to minimize PI.

Comparative Transcriptome Analysis of Gingival Immune-Mediated Inflammation in Peri-Implantitis and Periodontitis Within the Same Host Environment

ObjectiveThis investigation aimed to determine whether and to what extent there are transcriptional differences between periodontitis and peri-implantitis in the same susceptible host.BackgroundAs an immune-mediated inflammatory disease resulting in aggressive bone resorption around dental implants, peri-implantitis constitutes a major threat to dental implants’ long-term success. Compared to periodontitis, its etiological molecular mechanism remains elusive. Currently, there are few investigations on these two diseases at the transcriptional level within the same basal environment.MethodsLigature-induced peri-implantitis and periodontitis were generated in the same mice. Gingival tissues of healthy, periodontitis, and peri-implantitis sites from the same oral cavity were collected and used for RNA sequencing. Differentially expressed genes (DEGs) were screened between periodontitis/peri-implantitis and healthy sites. Enrichment analysis of DEGs was performed. The comprehensive immune landscape was annotated by seq-ImmuCC. Hub genes from peri-implantitis-specific DEGs were filtered using the STRING database and Cytoscape. Validation of the selected hub genes was performed on the GEO106090 dataset (gingival tissues from six periodontitis patients, six peri-implantitis patients, and six healthy controls).ResultsThe results indicated that peri-implantitis and periodontitis exhibited significantly distinct transcriptional signatures, with the complement and coagulation cascade pathways and osteoclast differentiation predominating in peri-implantitis mucosa. Compared with periodontitis, peri-implantitis sites exhibited elevated macrophage proportions and relatively enriched macrophage activation and bone loss. Hub genes were selected, and IL1B, CCL3, and CLEC4E were significantly highly expressed in human peri-implantitis mucosa.ConclusionThe study suggests that the interplay between macrophages and bone resorption seems to be more robust than in periodontitis. IL1B, CCL3, and CLEC4E may be considered promising therapeutic targets for peri-implantitis. These critical biological processes and identified genes may contribute to the etiology of peri-implantitis, which is unique from periodontitis. This work may make way for deeper exploration and contribute significantly to the treatment and prevention of peri-implantitis.

The Effect of Maintenance on the Prevention of Peri-implantitis

The Effect of Maintenance on the Prevention of Peri-implantitis

Influence of Titanium Surface Treatments on Viability of Periodontal Fibroblasts Grown in an Osteogenic Culture Medium.

Background:The integrity of the protective seal provided by the gingiva in direct contact with the implant surface is one of the main factors involved in the prevention of peri-implantitis.Aim:The aim of this study was to assess the viability of periodontal fibroblasts grown in an osteogenic culture medium in contact with titanium surfaces treated either with acid etching alone or with acid etching + anodizing.Materials and Methods:Periodontal fibroblasts grown in an osteogenic culture medium were distributed in a control group, with cells grown in culture bottles, and two experimental groups, with cells grown in contact with titanium disks measuring 6 mm in diameter. The surface of the disks was subjected to acid etching alone (AEG, n = 25) or to acid etching + anodizing (ANG, n = 25), and then evaluated using scanning electron microscopy (SEM). Cell viability was assessed by the [3-(4,5-dimethylthiazol-2yl)-2,5-diphenyl tetrazolium] bromide test on days 1, 2, 3, 7, and 14 of the cell culture. The Mann–Whitney test was used for the statistical analysis (P < 0.05).Results:The SEM assessment revealed that the surface of AEG specimens had micrometric characteristics, whereas the surface of ANG specimens had nanometric characteristics. No significant difference was observed among the groups regarding cell viability at any of the evaluation time points.Conclusion:The titanium surface treatments tested did not affect the viability of periodontal fibroblasts in an osteogenic culture medium.

Clinical Prevention of peri-implantitis (Risk Indicators, Diagnosis, and Treatment)

Clinical Prevention of peri-implantitis (Risk Indicators, Diagnosis, and Treatment)

Effects of 2% sodium fluoride solution on the prevention of streptococcal adhesion to titanium and zirconia surfaces

Streptococci are associated with dental plaque formation as the early-colonizing bacteria that adhere to titanium (CpTi) and zirconia (TZP) implant abutment surfaces. Effective prevention of peri-implantitis may be possible by removing streptococci as target. This study aimed to evaluate the effects of 2% NaF on the prevention of streptococcal adhesion to CpTi and TZP. After immersion in 2% NaF for 90 min, surface characterization of mirror-polished CpTi and TZP disks were assesed using XPS, EPMA, and SEM. S. sanguinis, S. gordonii, and S. oralis were used as the streptococcal bacterial strains. After 24 h culture, bacterial adhesion was evaluated using an ATP-bioluminescent assay and SEM. In XPS, EPMA, and SEM analyses, fluoride was detected on the CpTi and TZP surfaces after 2% NaF immersion with no signs of localization, and no corrosion on the CpTi disks. Based on the adhesion assay, the adherences of S. sanguinis, S. gordonii, and S. oralis were significantly lower with NaF than without NaF in CpTi (p = 0.005, 0.001, and 0.001, respectively) and TZP (p = 0.003, 0.002, and 0.001). This was also confirmed by SEM. In conclusion, 2% NaF reduced the adhesion of streptococci to the CpTi and TZP surfaces.

Implant functionalization with mesoporous silica: A promising antibacterial strategy, but does such an implant osseointegrate?

ObjectivesNew strategies for implant surface functionalization in the prevention of peri‐implantitis while not compromising osseointegration are currently explored. The aim of this in vivo study was to assess the osseointegration of a titanium‐silica composite implant, previously shown to enable controlled release of therapeutic concentrations of chlorhexidine, in the Göttingen mini‐pig oral model.Material and MethodsThree implant groups were designed: macroporous titanium implants (Ti‐Porous); macroporous titanium implants infiltrated with mesoporous silica (Ti‐Porous + SiO2); and conventional titanium implants (Ti‐control). Mandibular last premolar and first molar teeth were extracted bilaterally and implants were installed. After 1 month healing, the bone in contact with the implant and the bone regeneration in the peri‐implant gap was evaluated histomorphometrically.ResultsBone‐to‐implant contact and peri‐implant bone volume for Ti‐Porous versus Ti‐Porous + SiO2 implants did not differ significantly, but were significantly higher in the Ti‐Control group compared with Ti‐Porous + SiO2 implants. Functionalization of titanium implants via infiltration of a SiO2 phase into the titanium macropores does not seem to inhibit implant osseointegration. Yet, the importance of the implant macro‐design, in particular the screw thread design in a marginal gap implant surgery set‐up, was emphasized by the outstanding results of the Ti‐Control implant.ConclusionsNext‐generation implants made of macroporous Ti infiltrated with mesoporous SiO2 do not seem to compromise the osseointegration process. Such implant functionalization may be promising for the prevention and treatment of peri‐implantitis given the evidenced potential of mesoporous SiO2 for controlled drug release.

Anti-Oral Microbial Activity and Anti-Inflammatory Effects of Rosmarinic Acid in Lipopolysaccharide-Stimulated MC3T3-E1 Osteoblastic Cells on a Titanium Surface

Background: The purpose of this study was to investigate the anti-oral microbial activity and anti-inflammatory effects of rosmarinic acid (RA) in lipopolysaccharide (LPS)-stimulated MC3T3-E1 osteoblastic cells on a titanium (Ti) surface during osseointegration, and to confirm the possibility of using RA as a safe natural substance for the control of peri-implantitis (PI) in Ti-based dental implants. Methods: A disk diffusion test was conducted to confirm the antimicrobial activity of RA against oral microorganisms. In order to confirm the anti-inflammatory effects of RA, inflammatory conditions were induced with 100 ng/ml of LPS in MC3T3-E1 osteoblastic cells on the Ti surface treated with or without 14μg/ml of RA. The production of nitric oxide (NO) and prostaglandin E2 (PGE2) in LPS-stimulated MC3T3-E1 osteoblastic cells on the Ti surface was confirmed using an NO assay kit and PGE2 enzyme-linked immunosorbent assay kit. Reverse transcription polymerase chain reaction and western blot analysis were performed to confirm the expression of interleukin (IL)-1β and tumor necrosis factor (TNF)-α in total RNA and protein. Results: RA showed weak antimicrobial effects against Streptococcus mutans and Escherichia coli, but no antimicrobial activity against the bacteria Aggregatibacter actinomycetemcomitans and the fungus Candida albicans. RA reduced the production of pro-inflammatory mediators, NO and PGE2, and proinflammatory cytokines, TNF-α and IL-1β, in LPS-stimulated MC3T3-E1 osteoblastic cells on the Ti surface at the protein and mRNA levels. Conclusion: RA not only has anti-oral microbial activity, but also anti-inflammatory effects in LPS-stimulated MC3T3-E1 osteoblasts on the Ti surface, therefore, it can be used as a safe functional substance derived from plants for the prevention and control of PI for successful Ti-based implants.

Dental implants as risk factors for patients with medication-related osteonecrosis of the jaws (MRONJ).

An increasing number of patients with medication-related osteonecrosis of the jaws (MRONJ) has recently been reported. It is still being debated whether the presence or placement of dental implants can lead to MRONJ, so the aim of this study was to find out whether dental implants are a risk factor for MRONJ. From January 2003-January 2019 180 patients with MRONJ were seen at the Leiden University Medical Center. Luxating moments for the onset of MRONJ were calculated retrospectively. We collected clinical data and details of antiresorptive medication and found 22 patients with both dental implants and MRONJ. In 18 patients the implants were in the region of the MRONJ and they were included in this study, 14 who had had implants before using antiresorptive drugs and four who had had antiresorptive drugs before or at the time that the implants were placed. The median times between the placement of implants and the diagnosis of MRONJ in these two groups were 24 months and 6 months, respectively. Among the 47 implants, 30 were located in the necrotic region, and all 30 were either lost spontaneously or had to be removed during treatment of MRONJ. Our results show an increased risk for developing MRONJ in patients with dental implants. Both peri-implantitis around previously placed implants, and insertion of dental implants, are risk factors. Prevention of peri-implantitis and caution when inserting dental implants in patients who take antiresorptive medication are therefore important.

Patient-Centered Perspectives and Understanding of Peri-Implantitis.

Patients undergoing dental treatment have an uncertain understanding about dental implant therapy and its complications. Therefore, the aims of this study assess the following: 1) level of knowledge, awareness, and attitudes about peri-implantitis; 2) information provided by dentists/specialists who perform the treatment; and 3) perceptions, level of satisfaction, and impact on patient quality of life (QoL). Patients with implant restorative therapy currently undergoing peri-implant maintenance therapy were recruited. Participants completed an anonymous questionnaire that included general aspects of prognosis, including the following: 1) peri-implantitis; 2) etiology; 3) awareness; 4) attitudes; 5) treatment; 6) prevention; 7) risk factors; 8) quality of information; 9) level of patient satisfaction; and 10) QoL. Associations among questionnaire data were identified using univariate and multivariate analyses. Overall, 411 implants were included from 135 patients with implants. Frequency of peri-implantitis in the survey was 17.8% at the participant level, with 70% of them reporting high level of post-surgical satisfaction. Worry and concern were frequent findings among patients with peri-implantitis (64%), and 32% reported that living with the disease was terrible. The vast majority of patients (74.1%) did not have knowledge about peri-implant pathology. Patients with peri-implantitis showed statistically significantly better understanding of implant therapy (P <0.001) and also higher average concern (P = 0.004). Patients generally have a poor understanding and perception of peri-implantitis and its impact. QoL was impaired by the presence of peri-implantitis with high level of concern and low level of therapeutic satisfaction. Therefore, it is important to develop standardized information brochures to educate patients on risk factors and indicators of the disease to assist in the prevention of peri-implantitis.

Transmission of Periodontopathic Bacteria from Natural Teeth to Implants

Prevention of peri-implantitis is essential for the success of implant rehabilitation. Infection by periodontopathic bacteria is a major cause of peri-implantitis. The aim of the present study was to identify the source of peri-implant colonization by periodontopathic bacteria. Twenty-one patients with implants were enrolled in the study. Subgingival plaque samples from the adjacent, occluding, and contralateral natural teeth were collected prior to second-stage surgery. Samples from implant sulci were then obtained 2 weeks later. Detection of periodontopathic bacteria was performed by the polymerase chain reaction. The detection rates for Aggregatibacter actinomycetemcomitans, Prevotella intermedia, Porphyromonas gingivalis, Treponema denticola, Tannerella forsythia, and Fusobacterium nucleatum in all subgingival samples from natural teeth were similar to that in the peri-implant sulci. Multiple logistic regression analysis revealed an association between the detection of A. actinomycetemcomitans, Prevotella intermedia, Porphyromonas gingivalis, Treponema denticola, and F. nucleatum in the gingival crevices of adjacent teeth and that of the peri-implant sulcus, but no association for Tannerella forsythia. The present findings suggest that colonization by A. actinomycetemcomitans, Prevotella intermedia, Porphyromonas gingivalis, Treponema denticola, and F. nucleatum at the implant sulcus was affected by these microorganisms in the gingival crevice of adjacent teeth rather than those on occluding and contralateral teeth.

Systematic review of quality of reporting, outcome measurements and methods to study efficacy of preventive and therapeutic approaches to peri‐implant diseases

To systematically review the literature and to assess the quality of reporting, outcome measurements and methods in both preventive and therapeutic approaches to peri-implant mucositis (PM) and peri-implantitis (PI). Randomized (RCT) and Controlled Clinical Trials (CCT), evaluating preventive or therapeutic interventions in patients with PM or PI, were identified through searching in electronic databases and in relevant journals. Reporting and methods were evaluated through an analysis of the risk of biases and quality score. Sub-analysis was performed in four subgroups: prevention of PM and PI, treatment of PM, and non-surgical and surgical treatment of PI. Thirty-two trials (29 RCT) were identified as accomplishing inclusion criteria after full-text reading. Seven focused on prevention, and among those dealing with therapy, six were related to PM and 19 related to PI therapy (10 non-surgical and 9 surgical). Analysis found that quality of reporting and methods was generally low and surrogate outcomes were often chosen. Current literature on PM and PI prevention and treatment does not allow extracting applicable clinical information. Quality of methods and reporting guidelines should be encouraged. In particular, ad hoc guidelines should be designed for peri-implant diseases.