Publications by authors named "Alberto Monje"

122 Publications

Long-term effectiveness of 6 mm micro-rough implants in various indications: A 4.6- to 18.2-year retrospective study.

Clin Oral Implants Res 2021 Jun 15. Epub 2021 Jun 15.

Department of Oral Surgery & Stomatology, School of Dental Medicine, University of Bern, Bern, Switzerland.

Objectives: To evaluate the long-term effectiveness of 6 mm implants in various indications with a micro-rough surface after 4.6-18.2 years in function and to assess key factors associated with implant survival, success, and biologic/technical complications.

Materials And Methods: Fifty-five patients with seventy-four 6 mm implants placed from 2000 to 2013 attended the re-examination assessing well-established clinical and radiographic parameters, biologic and prosthetic complications, and patient-reported outcome measures.

Results: Five implants were lost after a mean follow-up period of 9.1 years resulting in a survival rate of 93.2%. All losses occurred in free-end situations in the mandible. Smoking habit significantly reduced implant survival (hazard ratio 36.25). Two implants exhibited a history of peri-implantitis, and one implant showed progressive marginal bone loss (MBL) resulting in a success rate of 89.2%. The mean MBL amounted to 0.029 mm. Increased MBL was found for implants placed in the maxilla (0.057 mm) and for implants with a diameter of 4.1 mm (0.043 mm). Soft tissue thickness (1.39 mm) and width of keratinized mucosa (1.91 mm) had no effect on MBL. Patient-reported outcome measures showed high satisfaction (mean VAS scores 88%) and high quality of life (mean OHIP-G14 score 2.2).

Conclusion: The present study demonstrated survival and success rates of 93.2% and 89.2% for 6 mm implants used in various indications. A factor leading to higher implant failure was smoking, whereas modulating factors increasing annual MBL included implants placed in the maxilla and implants with a diameter of 4.1 mm compared to 4.8 mm.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/clr.13795DOI Listing
June 2021

Comprehension and recall of information about factors associated with peri-implantitis: A randomized controlled trial.

J Periodontol 2021 May 5. Epub 2021 May 5.

CIBER of Epidemiology and Public Health (CIBERSP), Madrid, Spain.

Background: To evaluate the effect of different communication strategies on comprehension and recall of information about factors associated to peri-implantitis.

Materials: A prospective, randomized controlled trial was conducted in consecutive patients diagnosed with peri-implantitis. The sample was divided into three groups according to the communication strategy used: Test group 1-Written communication via leaflet with visual aids (L-VA); Test group 2-Written communication via leaflet with no visual aids (L-NVA); and control group-only verbal communication with no leaflet (NL). A questionnaire assessing comprehension at baseline (T0) and recall at 3 months (T1) and 6 months (T2) was administered following the fuzzy trace theory with a combination of 11 "gist" and seven "verbatim" items. The "health belief model" dimensions were further examined to test the influence of the communication strategy upon perceived severity, susceptibility, benefits, barriers, self-efficacy, and behavioral intentions.

Results: Ninety-nine patients that fulfilled the eligibility criteria were included. Gist and verbatim comprehension of the control, risk factors, and preventive measures for peri-implantitis overall was significantly greater in the test groups, in particular in L-VA at T0 (n = 99). Nevertheless, recall was not influenced by the communication strategy at T1 (n = 85) or T2 (n = 78). No significant differences were noted between groups or as a function of time for any of the "health belief model" constructs with the sole exception of perceived barriers (P = 0.045), which proved lower in the test groups.

Conclusion: The comprehension of information about factors associated to peri-implantitis can be efficiently improved by using written communicative strategies, in particular when supplemented with visual aids. Nevertheless, this approach failed to show effectiveness in modulating recall or in changing behavioral intentions over follow-up (NCT04543604).
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/JPER.21-0018DOI Listing
May 2021

Hard tissue dimensional changes following implant removal due to peri-implantitis: A retrospective study.

Clin Implant Dent Relat Res 2021 Jun 4;23(3):432-443. Epub 2021 May 4.

Department of Periodontology, Universitat Internacional de Catalunya, Barcelona, Spain.

Background: The current evidence regarding the alterations experienced by the alveolar ridge (hard tissue changes) after implant removal due to peri-implantitis is limited.

Purpose: To assess the hard tissue dimensional changes following implant removal due to peri-implantitis.

Material And Methods: Clinical records were examined to identify patients with implants that had to be removed due to a hopeless prognosis secondary to peri-implantitis due to expendability of peri-implantitis implants for functional reasons. Patients with preoperative and postoperative cone-beam computed tomography (CBCT) scans were included. Patient-related, implant-related, and surgery-related factors were assessed based on the clinical records. Linear measurements were made to evaluate the influence of bone plate thickness (BPT), ridge width (RW), and ridge height (RH) at various levels upon the outcome of implant removal. A descriptive statistical analysis of the quantitative and qualitative variables was performed. Correlations of the variables with the primary outcome (dimensional changes) were tested using univariate and multivariate analyses (multinomial random intercept mixed model linear regressions).

Results: A total of 26 patients (n = 79) met the eligibility criteria. The mean decrease in RW at 1 and 3 mm below the crest was 11.3% and 4.4%, respectively (P < 0.001). Buccal and lingual RH was significantly reduced by 2.2% and 6.3%, respectively (P < 0.001). Few patient-related, implant-related, and surgery-related factors appeared to have an impact upon the hard tissue dimensional changes. Bone regeneration simultaneous to implant removal minimized the dimensional changes of the ridge both vertically (5% lesser buccal RH reduction) and horizontally (12% lesser RW reduction) when compared with spontaneous healing. The use of a reverse-torque removal kit seemed to be critical in limiting the dimensional changes of the ridge.

Conclusions: Minimal hard tissue changes can be expected following implant removal due to peri-implantitis. Simultaneous bone regeneration procedures and the use of a removal kit may considerably reduce the impact upon the dimensional changes (NCT04534361).
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/cid.13004DOI Listing
June 2021

Resolution of peri-implantitis by means of implantoplasty as adjunct to surgical therapy: A retrospective study.

J Periodontol 2021 Apr 26. Epub 2021 Apr 26.

Department of Periodontology, Universidad Internacional de Catalunya, Barcelona, Spain.

Background: There is a paucity of data on the effectiveness of implantoplasty as adjunct to the surgical management of peri-implantitis.

Purpose: To evaluate the resolution of peri-implantitis by means of implantoplasty as adjunct to surgical resective (RES) and reconstructive (REC) therapies and supportive maintenance.

Methods: Patients that underwent surgical therapy to manage peri-implantitis with a follow-up of ≥12 months and enrolled in a regular peri-implant supportive care were recruited. RES group consisted of two interventions that included osseous recontouring and apically position flap (APF) and soft tissue conditioning (STC). REC was performed in the infra-osseous compartment of combined defects. Implant survival rate was recorded. Clinical and radiographic parameters were evaluated to define a "dogmatic" (case definition #1) and a "flexible" (case definition #2) therapeutic success. Univariate and multivariate multilevel backward logistic regression were applied for statistical analysis.

Results: Overall, 43 patients (n = 135) were retrospectively assessed. Mean observational period was ∼24 months. Implant survival rate was 97.8%, being significantly higher for APF, STC, and APF + STC (RES) when compared with REC (P = 0.01) therapy, in particular for advanced lesions (>50% of bone loss). The overall therapeutic success rate at implant-level was 66% and 79.5% for case definition #1 and #2, respectively. APF group displayed more efficient disease resolution when considered success definition #1 (72%). Contrarily, when the data were adhered to success definition #2, STC group showed a slightly higher disease resolution rate (87%). For RES group, location, favoring anterior (P = 0.04) and defect type, favoring class II (P = 0.02) displayed statistical significance for therapeutic success. For REC group, implants exhibiting a wider band of keratinized mucosa (KM) demonstrated higher therapeutic success (P = 0.008).

Conclusion: Implantoplasty as an adjunct to surgical therapy proved effective in terms of disease resolution and implant survival rate. Implant location, defect morphology as well as the buccal width of KM are indicators of therapeutic success.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/JPER.21-0103DOI Listing
April 2021

Pedicle Flap Designs for Soft Tissue Conditioning in the Therapy of Peri-implantitis.

Int J Periodontics Restorative Dent 2021 Mar-Apr;41(2):295-301

Keratinized mucosa (KM) is regarded as a key factor in peri-implant health. A lack of KM has been associated with discomfort, higher plaque accumulation, and mucosal inflammation. Persistent inflammation might lead to progressive peri-implant bone loss. Several approaches to manage peri-implantitis have been advocated. Despite the effectiveness shown by surgical therapeutic modalities, soft tissue conditioning seems pivotal for long-term peri-implant health and stability. Free epithelial grafts have been demonstrated to efficiently augment the band of KM. Nevertheless, morbidity, dynamic soft tissue changes, and longer healing periods are shortcomings to be considered. The purpose of this technical note is to provide an alternative therapeutic modality for the surgical management of peri-implantitis combined with simultaneous soft tissue conditioning by means of pedicle flaps. Three main clinical scenarios are provided to conceive pedicle epithelial or connective tissue flaps, combined or not with collagen matrices, as predictable approaches to augment KM in the surgical therapy of peri-implantitis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.11607/prd.4988DOI Listing
April 2021

Peri-Implantitis: A Clinical Update on Prevalence and Surgical Treatment Outcomes.

J Clin Med 2021 Mar 6;10(5). Epub 2021 Mar 6.

Department of Periodontology, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010 Bern, Switzerland.

Dental implants may be considered a reliable routine procedure in clinical practice for the replacement of missing teeth. Results from long-term studies indicate that implant-supported dental prostheses constitute a predictable treatment method for the management of fully and partially edentulous patients. Implants and their restorations, however, are not free from biological complications. In fact, peri-implantitis, defined as progressive bone loss associated to clinical inflammation, is not a rare finding nowadays. This constitutes a concern for clinicians and patients given the negative impact on the quality of life and the sequelae originated by peri-implantitis lesions. The purpose of this narrative review is to report on the prevalence of peri-implantitis and to overview the indications, contraindications, complexity, predictability and effectiveness of the different surgical therapeutic modalities to manage this disorder.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/jcm10051107DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7962026PMC
March 2021

Exploring the relationship among dental caries, nutritional habits, and peri-implantitis.

J Periodontol 2021 Feb 18. Epub 2021 Feb 18.

Department of Periodontology, Universitat Internacional de Catalunya, Barcelona, Spain.

Background: A study was made of the prevalence, co-occurrence and association among caries, nutritional habits, and peri-implant disease, with an analysis of the influence of other patient and implant factors upon peri-implant disease.

Methods: The included subjects underwent a clinical examination and were asked to complete a questionnaire. Demographic data and potential lifestyle/behavioral variables were collected. Clinical and radiographic assessment allowed calculation of the decayed, missing and filled teeth (DMFT) index and peri-implant diagnosis. Uni- and multivariate multinomial logistic regression analyses were applied to identify predictors of peri-implant disease.

Results: A total of 169 patients with 311 implants were studied. At patient level, 92.2% of the subjects presented at least one carious lesion, whereas 22.5% and 56.2% were diagnosed with peri-implantitis and mucositis, respectively. Those patients with more than two caries had a higher risk of mucositis (OR = 3.33). Statistically significant associations for peri-implantitis included full mouth periodontal indexes, sugar-rich diets, keratinized mucosa width, number of missing teeth and interproximal untreated caries or fillings adjacent to implants.

Conclusion: High caries risk profiles and mucositis/peri-implantitis tended to accumulate within subjects. A sugar-enriched diet and untreated caries or fillings adjacent to implant sites may be further considered as risk indicators of peri-implantitis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/JPER.20-0879DOI Listing
February 2021

Soft Tissue Conditioning for the Surgical Therapy of Peri-implantitis: A Prospective 12-Month Study.

Int J Periodontics Restorative Dent 2020 Nov/Dec;40(6):899-906

The significance of keratinized mucosa around dental implants for the prevention of biologic complications has been a subject of controversy. Agreement, however, exists on the benefits provided to achieve more satisfactory oral hygiene measures and reduced clinical inflammation. A prospective interventional case series of 14 patients (31 implants) were examined every 3 months for up to 12 months. The effect of soft tissue conditioning by means of free autologous epithelial graft on the management of peri-implantitis with supracrestal and/or dehiscence-type defect morphology was evaluated. All clinical parameters were significantly reduced ( < .001), with complete disease resolution in 78.6% of the patients and 87.1% of the peri-implantitis implants. Unsuccessful cases were associated with less gain of keratinized mucosa, deep probing pocket depths, bleeding on probing, and less satisfaction during brushing at 12 months. Dimensional changes following soft tissue grafting were more significant during the first 3 months and led to a 42.4% shrinkage at 12 months. Soft tissue conditioning by means of free autologous epithelial graft in combination with apically positioned flap is a viable and effective therapy to manage peri-implantitis associated with deficient keratinized mucosa.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.11607/prd.4554DOI Listing
November 2020

Clinical sequelae and patients' perception of dental implant removal: A cross-sectional study.

J Periodontol 2021 Jun 21;92(6):823-832. Epub 2020 Oct 21.

Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA.

Background: A cross-sectional study was designed to shed light on the clinical sequelae and patient satisfaction after dental implant removal (IR).

Methods: Patients undergoing ≥1 IRs were eligible. The reasons for implant failure, clinical and radiological parameters before and after IR, and the surgical and prosthetic treatments offered after IR was assessed. Patient satisfaction was recorded and the Oral Health Impact Profile (OHIP)-14 was used to document patient self-reported dysfunction and discomfort attributed to IR. Lastly, patient expectations after IR were also evaluated.

Results: Thirty-one patients with 45 implants were analyzed. Peri-implantitis was the main reason for IR (64.5%). The average implant survival time before IR was 120.3 ± 88.2 months. Signs of infection (51.7%) and bleeding on probing (37.5%) were common signs detected at the time of IR. Guided bone regeneration was the intervention most commonly applied simultaneously to IR (74.1%). The reported degree of satisfaction was high, and the overall OHIP-14 score was low. However, a certain patient reluctance to undergo future implant placement in the same clinic or with the same professional was recorded, and a statistically significant increase in adherence to the implant maintenance routine was observed after IR.

Conclusions: Peri-implantitis is the leading cause for IR. Guided bone regeneration is commonly applied to attenuate the clinical sequelae of IR. Nonetheless, IR does not seem to affect patients' satisfaction nor their quality of life, though a certain patient reluctance to undergo future implant placement in the same clinic or with the same professional was reported.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/JPER.20-0259DOI Listing
June 2021

Microbial and host-derived biomarker changes during ligature-induced and spontaneous peri-implantitis in the Beagle dog.

J Periodontal Res 2021 Jan 3;56(1):93-100. Epub 2020 Sep 3.

Department of Periodontology, University of Bern, Bern, Switzerland.

Objective: To evaluate microbial and host-derived biomarker changes during experimental peri-implantitis in the Beagle dog.

Background: Limited data exist on the microbial and biomarker changes during progressive bone loss as result of experimental peri-implantitis.

Methods: In total, 36 implants (n  = 6) were assessed over 3 episodes of ligature-induced peri-implantitis followed by a period of spontaneous progression. Implants with hybrid (H) and completely rough (R) surface designs were used. Clinical and radiographic parameters were recorded at 4 timepoints. Peri-implant sulcus fluid was collected from the buccal and lingual aspects of the implants. The presence of 7 bacterial species and 2 host-derived biomarkers was assessed during the study period.

Results: Total bacterial counts were significantly correlated with marginal bone loss (MBL) (r = .21; P = .009). Further, Phorphyromonas gulae (Pg) and Tannerella forsythia (Tf) were commonly correlated with MBL, suppuration (SUP) and the sulcular bleeding index scores (mSBI) (P < .05). Other bacteria were further correlated with SUP, mSBI, and MBL. While the analyzed bacteria dropped, Prevotella intermedia (Pi) further increased during the spontaneous progressive phase (P < .05). Total bacterial load did not differ significantly between H and R implants. Host-derived IL-10 was undetected along the study period. IL-1β positively correlated with probing pocket depth (r = .18; P = .03). During spontaneous progression, H implants displayed statistically significant lower levels of IL-1β (P = .003).

Conclusion: Experimental peri-implantitis is associated with an increase in bacterial counts. While Pg and Tf are associated with ligature-induced disease progression, Pi augmented its load during the spontaneous progressive phase. IL-1β is associated with pocket probing depth and influenced by implant surface characteristics during the spontaneous progression phase.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/jre.12797DOI Listing
January 2021

Self-administered proximal implant-supported hygiene measures and the association to peri-implant conditions.

J Periodontol 2021 03 18;92(3):389-399. Epub 2020 Aug 18.

Department of Periodontology, Universitat Internacional de Catalunya, Barcelona, Spain.

Background: Dental plaque biofilm is considered to be the underlying cause of peri-implant diseases. Moreover, it has been corroborated recently the association between the presence of these diseases and deficiently designed implant-supported prostheses. In this regard, professional-administered oral hygiene measures have been suggested to play a dominant role in prevention.

Methods: A cross-sectional study was conducted in dental implant patients according to accessibility for self-performed oral hygiene using a 0.5 mm interproximal brush. Periodontal and peri-implant status were assessed based on clinical and radiographic variables to determine the prevalence of peri-implant diseases. In addition, the participants completed a questionnaire on the efficiency and accessibility for self-performed proximal hygiene. Associations of descriptive data were analyzed using the chi-squared test and Mann-Whitney U-test. Correlations of the variables with the primary outcome (accessibility) were assessed by means of generalized estimation equations and multilevel logistic regression models.

Results: Based on an a priori power calculation, a total of 50 patients (171 implants) were consecutively recruited. From these, 46% of the prostheses allowed proper access for performing proximal hygiene whereas 54% of the prostheses precluded proper access. Poor access for proximal hygiene displayed tendency towards statistical significance with peri-implant disease (OR = 2.31; P = 0.090), in particular with peri-implant mucositis (OR = 2.43; P = 0.082) when compared to good access. In addition, an association was observed to increased levels of mucosal redness (P = 0.026) and the full-mouth bleeding score (P = 0.018). On the other hand, the presence of peri-implant disease was related to self-reported assessment of oral hygiene measures (P = 0.015) and to patient perception of gingival/mucosal bleeding when performing oral hygiene (P = 0.026). In turn, the diagnosis of peri-implant disease was significantly associated to the quantity and quality of information provided at the time of implant therapy (P = 0.004), including the influence of confounders upon disease occurrence (P = 0.038) CONCLUSIONS: To a certain extent, accessibility for self-performed proximal hygiene is associated to the peri-implant condition. On the other hand, the information received by the patient from the dental professional is essential for self-monitoring of the peri-implant conditions and for alerting to the possible presence of disorders.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/JPER.20-0193DOI Listing
March 2021

Suppuration as diagnostic criterium of peri-implantitis.

J Periodontol 2021 02 21;92(2):216-224. Epub 2020 Aug 21.

Department of Periodontology, Universitat Internacional de Catalunya, Barcelona, Spain.

Background: Suppuration (SUP) as a diagnostic parameter for monitoring dental implants is not yet well understood. The retrospective clinical and radiographic study was therefore performed to investigate the patient, implant, and site characteristics among individuals exhibiting SUP.

Methods: Demographic characteristics and clinical parameters were recorded. Radiographic features were analyzed using cone-beam computed tomography. Peri-implantitis was defined based on the consensus report of Workgroup 4 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions: probing depth (PD) ≥6 mm, presence of bleeding and/or SUP on gentle probing, and radiographic marginal bone loss (MBL) ≥3 mm. SUP was graded according to profuseness (dot versus line/drop) and time after probing (≥15 seconds versus <15 seconds after probing versus spontaneous). Simple binary logistic regression models were estimated using generalized estimation equations to explain the probability of SUP based on demographic, clinical, and radiographic variables.

Results: A total of 111 eligible patients (n  = 501) were assessed. Of them, 57 (n  = 334) were diagnosed with peri-implantitis according to the established case definition, and of these individuals, 31 (n  = 96) presented SUP. Therefore, the prevalence of SUP was 27.92% in the total sample size and 54.38% in peri-implantitis patients. Overall, 28.74% implants displayed SUP within patients with peri-implantitis. SUP was more frequently found at buccal sites (51%) and proved less prevalent at mesio-lingual sites (16.7%). Defect morphology (OR = 6.59; P = 0.004), PD (OR = 1.63; P = 0.024), and MBL (OR = 1.35; P = 0.010) were significantly associated with the presence of SUP. Likewise, defect morphology (P = 0.02), PD (P = 0.003), and MBL (P = 0.01) were significantly correlated with the grade of SUP.

Conclusion: The presence and grade of SUP are associated with peri-implant bone loss, probing depth, and defect morphology in patients with peri-implantitis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/JPER.20-0159DOI Listing
February 2021

Reconstructive therapy for the management of peri-implantitis via submerged guided bone regeneration: A prospective case series.

Clin Implant Dent Relat Res 2020 Jun 14;22(3):342-350. Epub 2020 May 14.

Department of Periodontology, Universitat Internacional de Catalunya, Barcelona, Spain.

Background: The present case series assesses the response to reconstructive therapy for the management of 2/3-wall peri-implantitis bone defects following submerged-healing guided bone regeneration.

Material And Methods: Fifteen consecutive patients with 27 implants presenting peri-implantitis were included. Guided bone regeneration was applied by means of autogenous bone/deproteinized bovine bone mineral grafting mixture and collagen membrane. Patients were assessed at baseline (T0) and at 6 (T1) and 12 months (T2). Clinical and radiographic variables defined the composite success criteria (probing pocket depth [PPD] ≤ 5 mm, no bleeding on probing/suppuration (SUP), no further radiographic bone loss). Patient site-specific comfort was scored using a visual analog scale (VAS). Descriptive statistics was carried out to assess the changes along the study period. Outcomes are reported in terms of mean values (5%-95% percentile values).

Results: All the clinical variables substantially changed from T0 through T2. In particular, PPD decreased 3.7 mm (0.7-5.9) from T0 to T2. Likewise, the scores for the modified plaque index (mPI) and modified sulcular bleeding index (mBI) were reduced by 0.5 (-0.5-1.1) and 1.6 (0.4-2.4), respectively. SUP did not display at any implant site at T2 (59.2% implants in 29.2% patients suppurated at T0). Keratinized mucosa decreased 0.6 mm (-0.2-4.4) and while mucosal recession increased 2.5 mm (1.0-4.3). Alike, the radiographic parameters varied significantly from T0 through T2. Infrabony defects were filled by 2.2 mm (0.0-8.6) at T2 and marginal bone loss was reduced by 2.3 mm (-1.1-8.1). The mean VAS score significantly increased from T0 (56.7) through T1 to T2, reaching a score of 96 at T2. At this timepoint, 85.2% of the peri-implantitis lesions were resolved.

Conclusions: The proposed surgical approach followed by submerged healing to reconstruct peri-implant bone defects may offer one therapeutic option for failing dental implants. Given the nature of the present study, its effectiveness in comparison to less invasive treatments needs investigation in randomized controlled trials.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/cid.12913DOI Listing
June 2020

Influence of keratinized mucosa on the surgical therapeutical outcomes of peri-implantitis.

J Clin Periodontol 2020 04 3;47(4):529-539. Epub 2020 Feb 3.

Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA.

Aim: To assess the impact of keratinized mucosa (KM) width around dental implants on surgical therapeutic outcomes when treating peri-implantitis.

Material And Methods: Surgically treated peri-implantitis implants were divided into two groups (KM width < 2 mm and ≥2 mm). Retrospective data were obtained after implant placement (T0) and the day of peri-implantitis surgical treatment (T1). Patients were later recruited (≥1 year after T1) for clinical and radiographic examination (T2). Outcomes were analysed using generalized estimating equation (GEE) models.

Results: A total of 40 patients (68 implants) (average follow-up: 52.4 ± 30.5 months) were included in this study. From T0 to T1, no differences were found between KM groups in terms of peri-implant probing depths (PPD) and bleeding on probing (BOP). However, sites with <2 mm KM exhibited significantly higher suppuration (SUP) and lower marginal bone level (MBL) (p > .01). Between T1 and T2, no major differences were noted on PPD reduction, BOP and MBL changes between the two groups. GEE modelling demonstrated that MBL severity prior to surgical therapy was a better predictor for implant survival than KM width.

Conclusion: Surgical outcome in treating peri-implantitis was influenced by the severity of bone loss present at the time of treatment and not by the presence of KM at the time of treatment.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/jcpe.13250DOI Listing
April 2020

Is the personalized approach the key to improve clinical diagnosis of peri-implant conditions? The role of bone markers.

J Periodontol 2020 07 20;91(7):859-869. Epub 2020 Jan 20.

Military Medical Academy, Belgrade, Serbia.

Background: Study objectives were 1) to estimate diagnostic capacity of clinical parameters, receptor activator of nuclear factor kappa-B (RANKL) and osteoprotegerin (OPG) to diagnose healthy peri-implant condition (HI), peri-implant mucositis (PIM) and peri-implantitis (PIMP) by assessing respective diagnostic accuracy, sensitivity, specificity and diagnostic ranges 2) to develop personalized diagnostic model (PDM) for implant monitoring.

Methods: Split-mouth study included 126 patients and 252 implants (HI = 126, PIM = 57, and PIMP = 69). RANKL and OPG concentrations were estimated in peri-implant crevicular fluid using enzyme-linked immunosorbent assay method and assessed with clinical parameters using routine statistics, while the diagnostic capacity of individual parameters and overall clinical diagnosis were estimated using classifying algorithms. PDM was developed using decision trees.

Results: Bleeding on probing (BOP), plaque index, and probing depth (PD) were confirmed reliable discriminants between peri-implant health and disease, while increase in PD (PD > 4 mm) and suppuration were good discriminants amongst PIM/PIMP. Bone turnover markers (BTMs) demonstrated presence of bone resorption in PIM; between comparable diagnostic ranges PIM/PIMP, PIMP was clinically distinguished from PIM in about 60% of patients while 40% remained diagnosed as false negatives. PDM demonstrated highest diagnostic capacity (accuracy: 96.27%, sensitivity: 95.00%, specificity: 100%) and defined HI: BOP ≤0.25%; PIM: BOP >0.25%, PD ≤4.5 mm; PIMP: BOP >0.25%, PD >4.5 mm and RANKL ≤19.9 pg/site; PIM: BOP >0.25%, PD >4.5 mm, and RANKL >19.9 pg/site.

Conclusions: BTMs demonstrated capacity to substantially improve clinical diagnosis of peri-implant conditions. Considering lack of difference in BTMs between PIM/PIMP and cluster of PIM with exceeding BTMs, a more refined definition of peri-implant conditions according to biological characteristics is required for further BTMs validation and appropriate PIMP management.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/JPER.19-0283DOI Listing
July 2020

Role of epigenetics in alveolar bone resorption and regeneration around periodontal and peri-implant tissues.

Eur J Oral Sci 2019 12 7;127(6):477-493. Epub 2019 Nov 7.

Department of Periodontology, Institute of Odontology, University of Gothenburg, Göteborg, Sweden.

Periodontitis and peri-implantitis are multifactorial diseases characterized by alveolar bone destruction mediated by the host response to a microbial challenge. Alveolar bone resorption mediated by epigenetics could be one of the mechanisms responsible for this destruction of alveolar bone. The relationship between epigenetic modifications and bone metabolism has been thoroughly investigated in bone remodeling, cancer, and rheumatoid arthritis, but evidence is low regarding the relationship between epigenetic modifications and alveolar bone loss related to periodontal and peri-implant diseases. Therefore, we conducted a review of the pertinent literature based on a priori-formulated focused questions and a screening strategy, in an attempt to comprehend the role of different epigenetic mechanisms in alveolar bone loss and to determine the current state with respect to their possible therapeutic applications in regenerative medicine. The review showed that the roles of DNA methylation, histone modifications, and non-coding RNAs in bone loss have been investigated. The results indicate that epigenetic mechanisms can participate in periodontal and peri-implant alveolar bone breakdown, suggesting their potential as therapeutic targets in alveolar bone regeneration. However, there is still only preliminary information regarding the possible therapeutic utility of these epigenetic mechanisms, suggesting a need for basic and translational research to assess the potential of such mechanisms in promoting alveolar bone regeneration.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/eos.12657DOI Listing
December 2019

Compliance with supportive periodontal/peri-implant therapy: A systematic review.

J Clin Periodontol 2020 01 13;47(1):81-100. Epub 2019 Nov 13.

Department of Periodontology, Universitat Internacional de Catalunya, Barcelona, Spain.

Aim: The present systematic review aimed at assessing the degree of compliance with supportive periodontal/peri-implant therapy as well as identifying patient-related factors that could potentially play a role on patient compliance.

Methods: Electronic and manual literature searches were carried out to assess patient compliance during maintenance. Main outcomes were compliance definition, degree of compliance and patient-related factors. Owing to the heterogeneity of the data reported across the studies, descriptive statistics were performed to shed light on compliance rate and the patient-related factors.

Results: A total of 39 articles were included. No consensus regarding the definition of "compliance" was found in the analysed literature. The percentage of fully compliers and non-compliers ranged between 3.3%-86.8% and 1.69%-64.4%, respectively. Smoking habit and history of periodontal disease were found to be associated with patients' compliance. Inadequate information/motivation was found as the main patient-reported reason for non-compliance.

Conclusions: Despite the high variability across studies, compliance with the supportive periodontal/peri-implant maintenance therapy was found to be unsatisfactory. Attitudes, psychological traits and construct associated with compliance remain largely unknown, and still, lack of information and motivation are paramount to be addressed during the periodontal/implant therapy to increase patient compliance.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/jcpe.13204DOI Listing
January 2020

The Critical Peri-implant Buccal Bone Wall Thickness Revisited: An Experimental Study in the Beagle Dog.

Int J Oral Maxillofac Implants 2019 November/December;34(6):1328–1336. Epub 2019 Sep 18.

Purpose: There is a lack of knowledge concerning the critical buccal bone thickness required for securing favorable functional and esthetic outcomes, conditioned to the dimensional changes after implant placement. A preclinical study was therefore carried out to identify the critical buccal bone wall thickness for minimizing bone resorption during physiologic and pathologic bone remodeling.

Materials And Methods: A randomized, two-arm in vivo study in healthy beagle dogs was carried out. The first group of dogs was sacrificed 8 weeks after implant placement for histomorphometric examination of postsurgical resorption of the buccal bone wall. The second group of dogs was monitored during three ligature-induced peri-implantitis episodes and a spontaneous progression episode. Morphometric and clinical variables were defined for the study of physiologic and pathologic buccal and lingual bone loss.

Results: Seventy-two implants were placed in healed mandibular ridges of 12 beagle dogs. Two groups were defined: 36 implants were placed in sites with a thin buccal bone wall (< 1.5 mm), and 36 were placed in sites with a thick buccal bone wall (≥ 1.5 mm). No implants failed during the study period. For the great majority of the histomorphometric parameters, a critical buccal bone wall thickness of at least 1.5 mm seemed to be essential for maintaining the buccal bone wall during physiologic and pathologic bone resorption. Suppuration (+) and mucosal recession (-) were more often associated with implants placed in sites with a thin buccal bone wall.

Conclusion: A critical buccal bone wall thickness of 1.5 mm at implant placement is advised, since a thicker peri-implant buccal bone wall (> 1.5 mm) is exposed to significantly less physiologic and pathologic bone loss compared with a thinner buccal bone wall (< 1.5 mm).
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.11607/jomi.7657DOI Listing
December 2019

Soft tissue response to dental implant closure caps made of either polyetheretherketone (PEEK) or titanium.

Clin Oral Implants Res 2019 Aug 12;30(8):808-816. Epub 2019 Jun 12.

Department of Oral Surgery and Stomatology, School of Dental Medicine, University of Bern, Bern, Switzerland.

Objective: Polyetheretherketone (PEEK) is a popular synthetic thermoplastic polymer for medical applications, but its clinical use suffers from several limitations. Therefore, the aim was to compare the soft tissue response to dental implant closure caps made of PEEK or titanium as evaluated by the occurrence of multinucleated giant cells (MNGCs).

Material And Methods: Forty-two implants were placed in the maxilla of seven miniature pigs. While commercially pure titanium (Ti) implants had a Ti closure cap, ceramic implants made of either zirconia (Zr) or alumina-toughened zirconia (Zr + Al) received a PEEK closure cap. Histomorphometry was performed to evaluate the number of small and large MNGCs being in contact with the PEEK or the Ti in different compartments of the implant systems.

Results: No histological signs of inflammation were noticed, and MNGCs were observed on both PEEK and Ti closure caps and on all three implant types. Significantly higher numbers of MNGCs were found on closure caps made of PEEK than on closure caps made of Ti on the external closure cap surface facing both soft (p = 0.0008 for PEEK on Zr and p = 0.0016 for PEEK on Zr + Al) and hard tissues (p = 0.016 for PEEK on Zr and p = 0.003 for PEEK on Zr + Al) as well as in the internal closure cap surface (p = 0.014 for PEEK on Zr and p = 0.0088 for PEEK on Zr + Al). No statistically significant differences in the number of MNGCs were observed on the three implant types.

Conclusions: Significantly more MNGCs were in contact with PEEK than with Ti closure caps.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/clr.13487DOI Listing
August 2019

Non-surgical therapeutic outcomes of peri-implantitis: 12-month results.

Clin Oral Investig 2020 Feb 23;24(2):675-682. Epub 2019 May 23.

Department of Periodontology, School of Dentistry, Universitat Internacional de Catalunya, C/ Josep Trueta s/n, 08195, Sant Cugat del Vallès, Barcelona, Spain.

Objectives: To assess the clinical and radiographic outcomes of implants treated by means of non-surgical debridement with systemic antibiotic therapy.

Materials And Methods: A prospective case series study evaluating the 12-month clinical and radiographic outcomes of peri-implantitis lesions treated with ultrasonic scaler debridement, a glycine air abrasive, and metronidazole followed by supportive maintenance. Clinical and radiographic variables and success criteria were defined a priori.

Results: Overall, 21 patients were included. One implant failed during the study period (implant survival rate 95.24%). Substantial changes occurred at 12 months in all the clinical and radiographic variables, reaching strong statistical significance in the majority of them. According to the success criteria applied, 40.90% of the peri-implantitis were arrested and resolved, while 59.1% presented with at least one probed site with bleeding on probing (BoP). Moreover, 95.45% exhibited peri-implant pocket depth (PPD) < 5 mm at the end of the study. None of the implants presented with progressive bone loss.

Conclusion: Non-surgical therapy of peri-implantitis is effective to arrest progressive bone loss, reduce PPD and suppuration, and achieve radiographic bone fill in the majority of cases. Nevertheless, it failed to be completely efficacious in the achievement of successful therapeutic outcomes as BoP remained frequently present.

Clinical Relevance: Non-surgical therapy achieved significant clinical and radiological improvements.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00784-019-02943-8DOI Listing
February 2020

Relationship Between Primary/Mechanical and Secondary/Biological Implant Stability.

Int J Oral Maxillofac Implants 2019 Suppl;34:s7-s23

Purpose: This systematic review was prepared as part of the Academy of Osseointegration (AO) 2018 Summit, held August 8-10 in Oak Brook Hills, Illinois, to assess the relationship between the primary (mechanical) and secondary (biological) implant stability.

Materials And Methods: Electronic and manual searches were conducted by two independent examiners in order to address the following issues. Meta-regression analyses explored the relationship between primary stability, as measured by insertion torque (IT) and implant stability quotient (ISQ), and secondary stability, by means of survival and peri-implant marginal bone loss (MBL).

Results: Overall, 37 articles were included for quantitative assessment. Of these, 17 reported on implant stability using only resonance frequncy analysis (RFA), 11 used only IT data, 7 used a combination of RFA and IT, and 2 used only the Periotest. The following findings were reached: ·Relationship between primary and secondary implant stability: Strong positive statistically significant relationship (P < .001). ·Relationship between primary stability by means of ISQ and implant survival: No statistically significant relationship (P = .4). ·Relationship between IT and implant survival: No statistically significant relationship (P = .2). ·Relationship between primary stability by means of ISQ unit and MBL: No statistically significant relationship (P = .9). ·Relationship between IT and MBL: Positive statistically significant relationship (P = .02). ·Accuracy of methods and devices to assess implant stability: Insufficient data to address this issue.

Conclusion: Data suggest that primary/mechanical stability leads to more efficient achievement of secondary/biological stability, but the achievement of high primary stability might be detrimental for bone level stability. While current methods/devices for tracking implant stability over time can be clinically useful, a robust connection between existing stability metrics with implant survival remains inconclusive.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.11607/jomi.19suppl.g1DOI Listing
August 2019

Morphology and severity of peri-implantitis bone defects.

Clin Implant Dent Relat Res 2019 Aug 14;21(4):635-643. Epub 2019 May 14.

Department of Oral Surgery and Implantology, Carolinum, Johann Wolfgang Goethe-University Frankfurt, Frankfurt, Germany.

Background: Peri-implant defect morphology has shown to potentially impact upon the reconstructive outcomes for the management of peri-implantitis. Given the role that defect morphology plays upon the decision-making in the treatment of peri-implantitis, the present study aimed at assessing the morphology and severity of peri-implantitis bone defects and to insight on the patient-, implant- and site-related variables associated to these.

Material And Methods: A cone-beam computed tomography study was carried out to classify peri-implantitis defects according to the type of defect, number of remaining bony walls and severity according to the extension of vertical bone loss. Three major defect categories were proposed: class I-infraosseous; class II-horizontal; class III-combined of class I and II. These were then subclassified into: (a) dehiscence; (b) 2/3-wall; and (c) circumferential-type defect. According to the severity the defects were further subclassified into: A: advanced; M: moderate; and S: slight. In addition, 20 site-, implant-, and patient-related variables were analyzed by generalized estimating equations (GEEs) of multilevel logistic regression models.

Results: Based on an a priori power calculation, 332 implants were screened in 47 peri-implantitis patients. Of these, 158 peri-implantitis implants were eligible. The most prevalent defect morphology type was class Ib (55%) followed by class Ia (16.5%), and class IIIb (13.9%). On the contrary, the less frequent defect was class II (1.9%). The most frequent degree of severity was M (50.6%) with S (10.1%) being the least prevalent. Buccal bone loss was significantly greater compared to the other bony walls in class I and class III defects. Age was associated with the type of defect. Age and smoking habit were associated with the morphology of the defects, while smoking habit, type of prosthesis and distance to adjacent implant were associated with the severity of the defects (vertical bone loss).

Conclusion: Peri-implantitis defects frequently course with an infraosseous component and often with buccal bone loss. Certain patient-, implant-, and site-specific variables are related with defect morphology and severity. However, morphological patterns for peri-implantitis bone defects could not be proven (NCT NCT03777449).
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/cid.12791DOI Listing
August 2019

Guided Bone Regeneration in Alveolar Bone Reconstruction.

Oral Maxillofac Surg Clin North Am 2019 May;31(2):331-338

Department of Periodontology, Universitat Internacional de Catalunya, Barcelona, Spain.

Guided bone regeneration is an effective alternative for the reconstruction of atrophic ridges. Adequate flap management together with immobilization of the barrier membrane and graft are crucial to ensure successful regenerative radiographic and clinical outcomes. Moreover, tension-free flap closure should be accomplished to guarantee to maximize the effectiveness of guided bone regeneration.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.coms.2019.01.003DOI Listing
May 2019

Understanding Peri-Implantitis as a Plaque-Associated and Site-Specific Entity: On the Local Predisposing Factors.

J Clin Med 2019 Feb 25;8(2). Epub 2019 Feb 25.

Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI 48109, USA.

The prevalence of implant biological complications has grown enormously over the last decade, in concordance with the impact of biofilm and its byproducts upon disease development. Deleterious habits and systemic conditions have been regarded as risk factors for peri-implantitis. However, little is known about the influence of local confounders upon the onset and progression of the disease. The present narrative review therefore describes the emerging local predisposing factors that place dental implants/patients at risk of developing peri-implantitis. A review is also made of the triggering factors capable of inducing peri-implantitis and of the accelerating factors capable of interfering with the progression of the disease.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/jcm8020279DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6406659PMC
February 2019

Effectiveness of vertical ridge augmentation interventions: A systematic review and meta-analysis.

J Clin Periodontol 2019 06;46 Suppl 21:319-339

ETEP (Etiology and Therapy of Periodontal Diseases) Research Group, University Complutense, Madrid, Spain.

Aim: The primary aim of this systematic review was to evaluate the effect of various techniques used for vertical ridge augmentation on clinical vertical bone gain.

Material And Methods: A protocol was developed to answer the following focused question: "In patients with vertical alveolar ridge deficiencies, how effective are different augmentation procedures for clinical alveolar ridge gain?" Randomized and controlled clinical trials and prospective and retrospective case series were included, and meta-analyses were performed to evaluate vertical bone gain based on the type of procedure and to compare bone gains in controlled studies.

Results: Thirty-six publications were included. Results demonstrated a significant vertical bone gain for all treatment approaches (n = 33; weighted mean effect = 4.16 mm; 95% CI 3.72-4.61; p < 0.001). Clinical vertical bone gain and complications rate varied among the different procedures, with a weighted mean gain of 8.04 mm and complications rate of 47.3% for distraction osteogenesis, 4.18 mm and 12.1% for guided bone regeneration (GBR), and 3.46 mm and 23.9% for bone blocks. In comparative studies, GBR achieved a significant greater bone gain when compared to bone blocks (n = 3; weighted mean difference = 1.34 mm; 95% CI 0.76-1.91; p < 0.001).

Conclusions: Vertical ridge augmentation is a feasible and effective therapy for the reconstruction of deficient alveolar ridges, although complications are common.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/jcpe.13061DOI Listing
June 2019

Significance of keratinized mucosa/gingiva on peri-implant and adjacent periodontal conditions in erratic maintenance compliers.

J Periodontol 2019 05 7;90(5):445-453. Epub 2018 Dec 7.

Department of Periodontology, International University of Catalonia, Barcelona, Spain.

Background: Given the fact that most patients are not regular compliers in supportive peri-implant maintenance programs, it is of interest to examine the significance of the peri-implant soft tissue characteristics in relationship to the onset of peri-implant diseases.

Methods: Based on an a priori statistical power calculation, a cross-sectional study was conducted on erratic peri-implant maintenance compliers (<2 times/year) to examine the significance of keratinized mucosa (KM) and gingival tissue (KT) on peri-implant and adjacent periodontal conditions in implants restored ≥3 years. Seven clinical parameters were recorded around implants and the adjacent buccal sites. Radiographic assessment was performed using periapical X-rays. In addition, a visual analog scale (VAS) was used to evaluate the impact of KM upon brushing comfort. The case definition used for peri-implant diseases was in accordance with the 2017 World Workshop on the classification of periodontal and peri-implant diseases and conditions.

Results: Overall, 37 patients with 45 edentulous gaps restored with 66 implants and 90 adjacent teeth were analyzed. On comparing a KM band of <2 mm versus ≥2 mm, with the exception of suppuration (P = 0.6), all the clinical and radiographic parameters were significantly increased when the KM band was <2 mm (P < 0.001). A significant correlation was observed between KM and KT (r = 0.55), though a lack of KM did not condition a lack of KT. In the presence of peri-implantitis, only bleeding on probing at the adjacent dentate sites was identified to be increased.

Conclusions: The presence of <2 mm of KM around dental implants in erratic maintenance compliers seems to be associated with peri-implant diseases. The lack of KM constitutes a site-specific phenomenon independent of the keratinized tissue present in the adjacent dentition (NCT03501537).
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/JPER.18-0471DOI Listing
May 2019

Medication-related dental implant failure: Systematic review and meta-analysis.

Clin Oral Implants Res 2018 Oct;29 Suppl 16:55-68

Department of Oral Surgery and Stomatology, School of Dental Medicine, University of Bern, Bern, Switzerland.

Objectives: The aim of this systematic review was to investigate the association between the intake of systemic medications that may affect bone metabolism and their subsequent impact on implant failures.

Material And Methods: Electronic and manual literature searches were conducted. Implant failure (IF) was the primary outcome, while biological/mechanical and the causes/timing associated with IF were set as secondary outcomes. Meta-analyses for the binary outcome IF and odds ratio were performed to investigate the association with medications.

Results: A final selection of 17 articles was screened for qualitative assessment. As such, five studies focused on evaluating the association of implant failure and non-steroidal anti-inflammatory drugs (NSAIDs), two on selective serotonin reuptake inhibitors (SSRIs), two on proton pump inhibitors (PPIs), seven on bisphosphonates (BPs), and one on anti-hypertensives (AHTNs). For PPIs, the fixed effect model estimated a difference of IF rates of 4.3%, indicating significantly higher IF rates in the test compared to the control group (p < 0.5). Likewise, for SSRIs, the IF was shown to be significantly higher in the individuals taking SSRIs (p < 0.5) as estimated a difference of 7.5%. No subset meta-analysis could be conducted for AHTNs medications as only one study fulfilled the inclusion criteria, which revealed an increased survival rate of AHTN medication. None of the other medications yielded significance.

Conclusions: The present systematic review showed an association of PPIs and SSRIs with an increased implant failure rate. Hence, clinicians considering implant therapy should be aware of possible medication-related implant failures.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/clr.13137DOI Listing
October 2018

Group 1 ITI Consensus Report: The influence of implant length and design and medications on clinical and patient-reported outcomes.

Clin Oral Implants Res 2018 Oct;29 Suppl 16:69-77

Department of Prosthodontics, Tufts University School of Dental Medicine, Boston, Massachusetts.

Objectives: The aim of Working Group 1 was to address the influence of different local (implant length, diameter, and design) and systemic (medications) factors on clinical, radiographic, and patient-reported outcomes in implant dentistry. Focused questions on (a) short posterior dental implants (≤6 mm), (b) narrow diameter implants, (c) implant design (tapered compared to a non-tapered implant design), and (d) medication-related dental implant failures were addressed.

Materials And Methods: Four systematic reviews were prepared in advance of the Consensus Conference and were discussed among the participants of Group 1. Consensus statements, clinical recommendations, and recommendations for future research were based on structured group discussions until consensus was reached among the entire expert Group 1. The statements were then presented and accepted following further discussion and modifications as required by the plenary.

Results: Short implants (≤6 mm) revealed a survival rate ranging from 86.7% to 100%, whereas standard implant survival rate ranged from 95% to 100% with a follow-up from 1 to 5 years. Short implants demonstrated a higher variability and a higher Risk Ratio [RR: 1.24 (95% CI: 0.63, 2.44, p = 0.54)] for failure compared to standard implants. Narrow diameter implants (NDI) have been classified into three categories: Category 1: Implants with a diameter of <2.5 mm ("Mini-implants"); Category 2: Implants with a diameter of 2.5 mm to <3.3 mm; Category 3: Implants with a diameter of 3.3 mm to 3.5 mm. Mean survival rates were 94.7 ± 5%, 97.3 ± 5% and 97.7 ± 2.3% for category 1, 2 and 3. Tapered versus non-tapered implants demonstrated only insignificant differences regarding clinical, radiographic, and patient-reported outcomes. The intake of certain selective serotonin reuptake inhibitors and proton pump inhibitors is associated with a statistically significant increased implant failure rate. The intake of bisphosphonates related to the treatment of osteoporosis was not associated with an increased implant failure rate.

Conclusions: It is concluded that short implants (≤6 mm) are a valid option in situations of reduced bone height to avoid possible morbidity associated with augmentation procedures; however, they reveal a higher variability and lower predictability in survival rates. Narrow diameter implants with diameters of 2.5 mm and more demonstrated no difference in implant survival rates compared to standard diameter implants. In contrast, it is concluded that narrow diameter implants with diameters of less than 2.5 mm exhibited lower survival rates compared to standard diameter implants. It is further concluded that there are no differences between tapered versus non-tapered dental implants. Certain medications such as selective serotonin reuptake inhibitors and proton pump inhibitors showed an association with a higher implant failure rate.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/clr.13342DOI Listing
October 2018

Long-term biological complications of dental implants placed either in pristine or in augmented sites: A systematic review and meta-analysis.

Clin Oral Implants Res 2018 Oct;29 Suppl 16:294-310

Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.

Aim: To investigate and compare the prevalence of biological complications and failure of implants placed in pristine vs. augmented sites after a mean observation period of at least 10 years.

Materials And Methods: The focused question "In patients with osseointegrated dental implants, are there differences in biological complications and implant failure at implants placed in pristine vs. augmented sites?" was addressed using the Population, Exposure, Comparison and Outcome criteria. Electronic and manual searches supplemented by the screening of the grey literature were carried out. A case definition of peri-implant mucositis and peri-implantitis had to be specified. The binary random-effects method was chosen to conduct meta-analyses. Results are presented as Forest plots with weighted mean values and 95% confidence intervals (CI). The I statistic test was applied to quantify heterogeneity. The Newcastle-Ottawa Scale and the parameters provided in the Cochrane Center and CONSORT statement were used for quality assessment. The results are reported according to the PRISMA guidelines.

Results: No randomized clinical trial (RCT) comparing the outcomes of implants placed in pristine vs. augmented sites was identified. Five case-series studies, one case-control study, one cross-sectional study and one RCT were eligible for qualitative and quantitative analyses. No statistically significant differences (p > .05) were observed between implants placed in pristine vs. augmented sites for any outcome variables both at patient and at implant levels, respectively. High heterogeneity concerning patient sampling, case definitions of biological complications and eligibility criteria was observed.

Conclusion: The studies included in the present systematic review did not directly address the focused questions. Hence, the outcomes of the meta-analysis should be interpreted with caution due to high variability with respect to study design.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/clr.13123DOI Listing
October 2018

Diagnostic accuracy of the implant stability quotient in monitoring progressive peri-implant bone loss: An experimental study in dogs.

Clin Oral Implants Res 2018 Oct 28;29(10):1016-1024. Epub 2018 Sep 28.

Department of Oral Surgery and Stomatology, ZMK School of Dental Medicine, University of Bern, Bern, Switzerland.

Objectives: To investigate the impact of progressive bone loss in an experimental peri-implantitis model in the dog upon the implant stability quotient (ISQ) measured in the course of induced and spontaneous conditions of disease, and to evaluate the association between the clinical parameters and ISQ.

Materials And Methods: Seventy-two implants were placed in 12 Beagle dogs. Of these, 36 implants in six dogs were assessed during ligature-induced peri-implantitis (three timepoints) and at one timepoint following a period of spontaneous progression. The ISQ was recorded using resonance frequency analysis (RFA). Furthermore, the clinical peri-implant parameters were registered at four sites per implant at each timepoint. Marginal bone loss (MBL) was determined using computed tomography at four sites per implant and bone-to-implant contact (BIC) was assessed from histological samples. A linear regression model was estimated by generalized estimation equations (GEEs) in order to study the MBL-ISQ values at each measurement timepoint. Pearson's correlation test was applied.

Results: None of the implants failed during the study period. At implant level, a strong negative correlation was found for all timepoints between ISQ and MBL (r = -0.58; p < 0.001). Accordingly, as follow-up progressed, lower ISQ and higher MBL values were observed. A prediction of MBL depending on the ISQ values and timepoints showed a decrease in one ISQ unit to be related to ~1 mm of MBL. Likewise, a statistically significant correlation was found between BIC and ISQ evaluated after spontaneous chronification of peri-implantitis (r = 0.34; p = 0.04). Nevertheless, the ISQ values failed to correlate to any of the clinical parameters recorded.

Conclusion: Resonance frequency analysis seems accurate in diagnosing progressive bone loss, as a statistically significant decrease in ISQ was recorded in the course of peri-implant disease. Nevertheless, the clinical relevance of this observation as a diagnostic tool is debatable, since implant stability remains high.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/clr.13368DOI Listing
October 2018