Treatment Of Peri-implant Bone Defects Research Articles

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.

Use of biomaterials in the surgical regenerative treatment of peri-implantitis: systematic review

The aim of this study was to review the scientific literature regarding the effectiveness of different biomaterials in the regenerative treatment of peri-implantitis. A systematic literature search was performed in PubMed/Medline, Web of Science, Science Direct, Embase, and the Cochrane Collaboration Library. Studies on the use of biomaterials in the regenerative treatment of peri-implantitis were selected. The search strategy retrieved 253 articles. After selection, six articles met all inclusion criteria and were included in the present systematic review. The studies showed that an initial therapeutic approach consisting of plaque control and implant surface decontamination and subsequent surgery for biomaterial placement were essential for the successful regenerative treatment of peri-implantitis defects. Analysis of all biomaterials used in surgical regenerative treatment showed that bovine bone grafts provided superior outcomes in terms of new bone formation compared to autogenous grafts and nanocrystalline hydroxyapatite. It is important to note that porous titanium granules have emerged as a promising biomaterial for the regenerative treatment of peri-implantitis. In conclusion, biomaterials are promising for the treatment of peri-implant bone defects and the number of in silico biomaterials that can provide treatment of excellence to patients with this condition is expected to increase in the near future.

Evaluation of Effectiveness of Synthetic Bone Graft using with Injectable Platelet-Rich Fibrin on Treatment of Peri-implant Bone Defects: A Retrospective Study

Evaluation of Effectiveness of Synthetic Bone Graft using with Injectable Platelet-Rich Fibrin on Treatment of Peri-implant Bone Defects: A Retrospective Study

Evaluation of bone substitutes for treatment of peri-implant bone defects: biomechanical, histological, and immunohistochemical analyses in the rabbit tibia.

PurposeWe sought to evaluate the effectiveness of bone substitutes in circumferential peri-implant defects created in the rabbit tibia.MethodsThirty rabbits received 45 implants in their left and right tibia. A circumferential bone defect (6.1 mm in diameter/4 mm depth) was created in each rabbit tibia using a trephine bur. A dental implant (4.1 mm × 8.5 mm) was installed after the creation of the defect, providing a 2-mm gap. The bone defect gaps between the implant and the bone were randomly filled according to the following groups: blood clot (CO), particulate Bio-Oss® (BI), and Bio-Oss® Collagen (BC). Ten animals were euthanized after periods of 15, 30, and 60 days. Biomechanical analysis by means of the removal torque of the implants, as well as histologic and immunohistochemical analyses for protein expression of osteocalcin (OC), Runx2, OPG, RANKL, and TRAP were evaluated.ResultsFor biomechanics, BC showed a better biological response (61.00±15.28 Ncm) than CO (31.60±14.38 Ncm) at 30 days. Immunohistochemical analysis showed significantly different OC expression in CO and BC at 15 days, and also between the CO and BI groups, and between the CO and BC groups at 60 days. After 15 days, Runx2 expression was significantly different in the BI group compared to the CO and BC groups. RANKL expression was significantly different in the BI and CO groups and between the BI and BC groups at 15 days, and also between the BI and CO groups at 60 days. OPG expression was significantly higher at 60 days postoperatively in the BI group than the CO group.ConclusionsCollectively, our data indicate that, compared to CO and BI, BC offered better bone healing, which was characterized by greater RUNX2, OC, and OPG immunolabeling, and required greater reversal torque for implant removal. Indeed, along with BI, BC presents promising biomechanical and biological properties supporting its possible use in osteoconductive grafts for filling peri-implant gaps.

Treatment of Peri-Implant Defects in the Rabbit's Tibia with Adipose or Bone Marrow-Derived Mesenchymal Stems Cells.

Mesenchymal stem cell (MSC) treatment in conjunction with bone graft materials or space filler can be an alternative to autogenous bone grafts in the treatment of peri-implant bone defects. To evaluate the success of bone regeneration capacity of adipose-derived and bone marrow-derived MSCs for the treatment of peri-implant bone defects when applied with a beta-tricalcium phosphate/collagen-based scaffold. Forty implants were placed into the tibiae of 10 rabbits bilaterally. Surgical defects created around the implants were treated with one the following treatment modalities: 1) adipose-derived MSC transplanted scaffold + collagen membrane; 2) bone marrow-derived MSC transplanted scaffold + collagen membrane; 3) autogenous bone + collagen membrane; and 4) collagen membrane only. The bone regeneration capacity of each technique was determined by histomorphometry, micro-CT, and measuring the implant stability by resonance frequency analysis. One limb of one rabbit was excluded because of fracture, and another limb was excluded because of infection. All parameters on 36 implants revealed that both sources of MSC can form equivalently new bone that is comparable with autogenous bone. The defects treated with membrane only had significantly less bone formation compared with other groups. Both adipose-derived and bone marrow-derived MSC treatments are feasible alternatives to autogenous bone grafts in the treatment of peri-implant osseos defects.

Treatment of Peri-implant Bone Defects with Platelet-Rich Fibrin.

The objective of this study was to investigate and compare the clinical effectiveness of the application of platelet-rich fibrin (PRF) and conventional flap surgery for the treatment of peri-implant bone loss. Nineteen patients (8 women, 11 men) with peri-implant bone loss were randomly allocated to two groups, with the PRF group comprising patients who received fibrin scaffold and the control group made up of those who received only the access flap. At 3 and 6 months after surgery, respectively, the PRF group demonstrated higher mean probing depth reductions (2.41 ± 1.06 and 2.82 ± 1.03 mm versus 1.65 ± 1.02 and 2.05 ± 0.77 mm) and more gains in clinical attachment level (2.89 ± 1.01 and 3.31 ± 1.08 mm versus 1.43 ± 1.08 and 1.84 ± 0.81 mm) compared with the control group. In addition, the increase in the amount of keratinized mucosa from baseline to 6 months postoperatively was statistically significant for the PRF group (P < .001). Hence, the data from the current study led to the conclusion that PRF application in periimplant bone loss provided better clinical results than conventional flap surgery.

Dental implants with versus without peri-implant bone defects treated with guided bone regeneration.

Background The guided bone regeneration (GBR) technique is highly successful for the treatment of peri-implant bone defects. The aim was to determine whether or not implants associated with GBR due to peri-implant defects show the same survival and success rates as implants placed in native bone without defects. Material and Methods Patients with a minimum of two submerged dental implants: one suffering a dehiscence or fenestration defect during placement and undergoing simultaneous guided bone regeneration (test group), versus the other entirely surrounded by bone (control group) were treated and monitored annually for three years. Complications with the healing procedure, implant survival, implant success and peri-implant marginal bone loss were assessed. Statistical analysis was performed with non-parametric tests setting an alpha value of 0.05. Results Seventy-two patients and 326 implants were included (142 test, 184 control). One hundred and twenty-five dehiscences (average height 1.92±1.11) and 18 fenestrations (average height 3.34±2.16) were treated. At 3 years post-loading, implant survival rates were 95.7% (test) and 97.3% (control) and implant success rates were 93.6% and 96.2%, respectively. Mean marginal bone loss was 0.54 (SD 0.26 mm) for the test group and 0.43 (SD 0.22 mm) for the control group. No statistically significant differences between both groups were found. Conclusions Within the limits of this study, implants with peri-implant defects treated with guided bone regeneration exhibited similar survival and success rates and peri-implant marginal bone loss to implants without those defects. Large-scale randomized controlled studies with longer follow-ups involving the assessment of esthetic parameters and hard and soft peri-implant tissue stability are needed. Key words:Guided bone regeneration, peri-implant defects, dental implants, marginal bone level, success rate, survival rate.

Use of buccal fat pad to repair post-extraction peri-implant bone defects in the posterior maxilla. A preliminary prospective study.

BackgroundExtensive literature exists about the use of the BFP in the treatment of oral defects but, to our knowledge, no article refers to the use of the BFP as a substitute of the membrane barriers for treatment of peri-implant bone defects. The aim was to evaluate the use of the buccal fat pad as a coating material for bone grafting in the peri-implant bone defect regeneration of immediate implants placed in the posterior maxilla.Material and MethodsA preliminary prospective study of patients involving immediate implants in which the buccal fat pad was used as a coating material to peri-implant bone defects was carried out. The outcome measures assessed were: postoperative pain and swelling, complications related to buccal fat pad surgery, implant survival and success rates and peri-implant marginal bone loss at 12 months of prosthetic loading.ResultsTwenty-seven patients (17 women and 10 men) with a mean age of 55.3 ± 8.9 years, and a total of 43 implants were included. Two-thirds of the patients reported either no pain or only mild intensity pain and moderate inflammation, two days after surgery. Post-operative period was well tolerated by the patients and no serious complications occurred. None wound dehiscence occurred. Implant survival and success rates were 97.6% and the average marginal bone loss 1 year after loading was 0.58 ± 0.27 mm.ConclusionsWithin the limits of this preliminary study, the use of the buccal fat pad as a coating material for bone grafting in peri-implant bone defects placed in the upper posterior maxilla was a well-tolerated technique by patients; high implant success rate was achieved with a minimal peri-implant marginal bone loss at 12 months of prosthetic loading. Key words:Buccal fat pad, immediate implant, peri-implant bone defect.

Current Knowledge and Perspectives for the Use of Platelet-Rich Plasma (PRP) and Platelet-Rich Fibrin (PRF) in Oral and Maxillofacial Surgery Part 2: Bone Graft, Implant and Reconstructive Surgery

Platelet concentrates for surgical use are innovative tools of regenerative medicine, and were widely tested in oral and maxillofacial surgery. Unfortunately, the literature on the topic is contradictory and the published data are difficult to sort and interpret. In bone graft, implant and reconstructive surgery, the literature is particularly dense about the use of the various forms of Platelet-Rich Plasma (PRP) - Pure Platelet-Rich Plasma (P-PRP) or Leukocyte- and Platelet-Rich Plasma (L-PRP) - but still limited about Platelet-Rich Fibrin (PRF) subfamilies. In this second article, we describe and discuss the current published knowledge about the use of PRP and PRF during implant placement (particularly as surface treatment for the stimulation of osseointegration), the treatment of peri-implant bone defects (after peri-implantitis, during implantation in an insufficient bone volume or during immediate post-extraction or post-avulsion implantation), the sinuslift procedures and various complex implant-supported treatments. Other potential applications of the platelet concentrates are also highlighted in maxillofacial reconstructive surgery, for the treatment of patients using bisphosphonates, anticoagulants or with post-tumoral irradiated maxilla. Finally, we particularly insist on the perspectives in this field, through the description and illustration of the use of L-PRF (Leukocyte- and Platelet-Rich Fibrin) clots and membranes during the regeneration of peri-implant bone defects, during the sinus-lift procedure and during complex implant-supported rehabilitations. The use of L-PRF allowed to define a new therapeutic concept called the Natural Bone Regeneration (NBR) for the reconstruction of the alveolar ridges at the gingival and bone levels. As it is illustrated in this article, the NBR principles allow to push away some technical limits of global implant-supported rehabilitations, particularly when combined with other powerful biotechnological tools: metronidazole solution, adequate bone substitutes and improved implant designs and surfaces (for example here AstraTech Osseospeed or Intra-Lock Ossean implants). As a general conclusion, we are currently living a transition period in the use of PRP and PRF in oral and maxillofacial surgery. PRPs failed to prove strong strategic advantages that could justify their use in daily practice, and the use of most PRP techniques will probably be limited to some very specific applications where satisfactory results have been reached. Only a few simple, inexpensive and efficient techniques such as the L-PRF will continue to develop in oral and maxillofacial surgery in the next years. This natural evolution illustrates that clinical sciences need concrete and practical solutions, and not hypothetical benefits. The history of platelet concentrates in oral and maxillofacial surgery finally demonstrates also how the techniques evolve and sometimes promote the definition of new therapeutical concepts and clinical protocols in the today's era of regenerative medicine.