Comparison of peri‐implant clinical and radiographic inflammatory parameters among cigarette and waterpipe (narghile) smokers and never‐smokers

1 Background

The authors hypothesized that peri‐implant clinical and radiographic inflammatory parameters are worse in waterpipe smokers (WS) and cigarette smokers (CS) compared with never‐smokers (NS). The aim of the present retrospective study is to compare peri‐implant clinical and radiographic inflammatory parameters among WS, CS, and NS.

2 Methods

Forty‐four CS (group 1), 41 WS (group 2), and 43 NS (group 3) were included. Demographic data were collected using a questionnaire. Peri‐implant plaque index (PI), bleeding on probing (BOP), and probing depth (PD) were measured, and crestal bone loss (CBL) was assessed on standardized digital radiographs. Sample size was estimated, and statistical analyses were performed using Kruskal–Wallis and Wilcoxon rank‐sum tests. For multiple comparisons, Bonferroni post hoc test was performed. P values < 0.05 were considered statistically significant.

3 Results

Peri‐implant PI and PD were higher in groups 1 (P < 0.05) and 2 (P < 0.05) compared with group 3. Peri‐implant BOP was significantly higher in group 3 compared with individuals in groups 1 (P < 0.01) and 2 (P < 0.01). Peri‐implant total marginal bone loss was significantly higher in groups 1 (P < 0.05) and 2 (P < 0.05) compared with group 3. There were differences in PI, BOP, PD, and CBL among participants in groups 1 and 2.

4 Conclusions

Peri‐implant soft tissue inflammatory parameters and CBL are worse in CS and WS compared with NS. There is no difference in these parameters between CS and WS.     

Peri‐implant soft tissue inflammatory parameters and crestal bone loss among waterpipe (narghile) smokers and never‐smokers with and without type 2 diabetes mellitus

1 Background

Peri‐implant soft tissue inflammatory parameters and crestal bone loss (CBL) among waterpipe smokers (WS) with and without type 2 diabetes mellitus (T2DM) remains uninvestigated. The aim of the present study was to assess peri‐implant soft tissue inflammatory parameters and CBL among WS and never smokers (NS) with and without T2DM.

2 Methods

Demographic data and information regarding duration of implants in function, daily frequency of smoking, duration and treatment of T2DM, and daily toothbrushing was collected using a questionnaire. Peri‐implant plaque index (PI), bleeding on probing (BOP), probing depth (PD) ≥4 mm, CBL, and hemoglobin A1c (HbA1c) levels were assessed in all individuals. Level of significance was set at 5%.

3 Results

Seventy‐nine male individuals (39 patients with T2DM [20 WS and 19 NS] and 40 systemically healthy individuals [21 WS smokers and 19 NS]) were included. The mean age was comparable among individuals in all groups. The mean HbA1c levels were significantly higher among patients with T2DM compared to controls (P < 0.01). Peri‐implant PI, BOP, PD, and CBL were comparable among WS and NS with T2DM. Among patients without T2DM, PI (P < 0.05), PD ≥4 mm (P < 0.05) and mesial and distal CBL (P < 0.05) were significantly higher in WS than NS. Among individuals without T2DM, BOP was significantly higher among NS (P < 0.05) than WS. In patients with T2DM, BOP was comparable among WS and NS.

4 Conclusions

Peri‐implant soft tissue inflammatory parameters and CBL were comparable among WS and NS with T2DM. Among individuals without T2DM, these parameters were worse among WS than NS.     

Laser therapy for treatment of peri‐implant mucositis and peri‐implantitis: An American Academy of Periodontology best evidence review

1 Background

Peri‐implant diseases are prevalent, with numerous therapies studied in an attempt to combat this condition. The present review aims to systematically evaluate the effectiveness of laser therapy with non‐surgical or surgical therapy in managing peri‐implant mucositis and peri‐implantitis.

2 Methods

An electronic search of three databases and a hand search of peer‐reviewed journals for relevant articles published (in English) from January 1980 to June 2016 were performed. Human clinical trials of ≥ 10 patients with peri‐implant diseases, treated with surgical or non‐surgical approaches and laser therapy, and a follow‐up period of ≥ 6 months, were included. Random‐effects meta‐analyses were performed to analyze weighted mean difference (WMD) and confidence interval for the recorded variables according to PRISMA guidelines. Risk of bias assessment was also performed for randomized controlled trials included.

3 Results

From 22 articles selected, 11 were included in the meta‐analyses. The outcomes of using lasers as a monotherapy could not be evaluated since no controlled studies were identified. Therefore, all reported results were the outcomes of applying lasers as an adjunct to surgical/non‐surgical treatment. For the non‐surgical approach, WMD of probing depth (PD), clinical attachment level (CAL), bleeding on probing (BOP), plaque index (PI), marginal bone level (MBL) and recession (REC) was 0.15 mm (P = 0.50), ?0.10 mm (P = 0.32), 21.08% (P = 0.02), ?0.07 (P = 0.002), ?0.22 mm (P = 0.04) and ?0.11 mm (P = 0.34), respectively. For the surgical approach with a long‐term follow up, WMD of PD, CAL, BOP, and PI was 0.45 mm (P = 0.11), 0.22 mm (P = 0.56), 7.26% (P = 0.76) and ?0.09 (P = 0.84), respectively.

4 Conclusions

Current evidence shows laser therapy in combination with surgical/non‐surgical therapy provided minimal benefit in PD reduction, CAL gain, amount of REC improvement, and PI reduction in the treatment of peri‐implant diseases. Lasers when used as an adjunct to non‐surgical therapy might result in more BOP reduction in the short term. However, current evidence allowed for analysis of only Er:YAG, CO₂, and diode lasers. Studies on others failed to have controlled evidence supporting their evaluation.     

Diagnostic accuracy of clinical parameters to monitor peri‐implant conditions: A matched case‐control study

1 Background

The aim of this case‐control study was to estimate the diagnostic accuracy of the standard clinical parameters in diagnosing healthy peri‐implant tissues, peri‐implant mucositis, and peri‐implantitis.

2 Methods

A case‐control study was designed to compare the clinical parameters used in the diagnosis of peri‐implant diseases such as: probingdepth (PD), bleeding on probing (BOP), mucosal redness (MR), suppuration (SUP), and plaque index (PI). Furthermore, the influence of patient‐ (sex, age) and implant‐related variables (implant neck configuration, time in function after loading) were evaluated to investigate the association with the clinical findings. The inferential analysis consisted of estimation by generalized estimating equations (GEE) of multilevel logistic regression models.

3 Results

In total, 1,572 sites were evaluated around 262 implants from 141 patients. Sites with implant mucositis showed significant levels of BOP (OR = 3.56), MR (OR = 7.66) and PD (OR = 1.48) compared to healthy sites. The specificity was 90.3% while the sensitivity was only 43.6%. Likewise, sites exhibiting peri‐implantitis showed significant levels of BOP (OR = 2.32), MR (OR = 7.21), PD (OR = 2.43) and SUP (OR = 6.81) compared to healthy sites. Again, the multiple logistic regressions showed high specificity (92.1%) but modest sensitivity (52.5%). PD was the only diagnostic marker displaying significance comparing peri‐implant mucositis and peri‐implantitis sites (OR = 1.76). Moreover, tissue‐level compared to bone‐level implants were less associated with SUP+ (OR = 0.20), and PI (OR = 0.36) and demonstrated statistical significance. In addition, age, sex, and function time significantly influenced the tested clinical parameters.

4 Conclusions

The diagnosis of peri‐implant diseases cannot rely solely upon individual clinical parameters but rather require a combination of criteria. The clinical parameters, particularly probing depth, might accurately discern between diagnoses among peri‐implant conditions. Nevertheless, the specificity of the clinical parameters surpasses the sensitivity in the detection of peri‐implant diseases, validating its potential use as a diagnostic tool.     

Combination of ultrasonic decontamination,soft tissue curettage,and submucosal air polishing with povidone‐iodine application for non‐surgical therapy of peri‐implantitis: 12‐month clinical outcomes

1 Background

The aim of this study is to evaluate clinical outcomes of a concept for non‐surgical peri‐implantitis combining stepwise mechanical debridement measures with adjuvant povidone‐iodine application with and without systemic antibiotics.

2 Methods

Forty‐five patients with chronic periodontitis and a total of 164 screw‐typed implants with peri‐implantitis were included. Peri‐implantitis was defined as radiographic bone loss of > 2 mm, probing depth (PD) ≥5 mm with bleeding on probing (BOP). Stepwise treatment of implants was performed with ultrasonic debridement, soft tissue curettage (STC), glycine powder air polishing (GPAP), and a repeated submucosal application of povidone‐iodine. Teeth with PD > 4 mm were treated simultaneously according to the same concept except STC. In cases with severe periodontitis (n = 24), amoxicillin and metronidazole (AM) were prescribed for 7 days.

3 Results

After 12 months, implants treated without AM showed significant reductions (P < 0.05) of mean PD (1.4 ± 0.7 mm), clinical attachment level (CAL) (1.3 ± 0.8 mm), and BOP (33.4% ± 17.2%). In deep pockets (PD > 6 mm) changes of mean PD (2.3 ± 1.3 mm), CAL (2.0 ± 1.6 mm), and BOP (44.0% ± 41.7%) were more pronounced. Intake of AM did not significantly influence the changes in these parameters. However, the reduction of implant sites with PD > 4 mm and BOP was significantly higher in patients with AM than in those without AM (31.8% ± 12.6% versus 20.8% ± 14.7%; P < 0.05).

4 Conclusions

The combination of ultrasonic debridement, STC, and GPAP with adjuvant povidone‐iodine led to significant clinical improvements at implants. Systemic antibiotics had limited effects on the reduction of persisting implant sites with treatment need.     

Comparison of peri‐implant clinical and radiographic status around short (6 mm in length) dental implants placed in cigarette‐smokers and never‐smokers: Six‐year follow‐up results

Background

It is hypothesized that peri‐implant clinical and radiographic inflammatory parameters (probing depth [PD], bleeding on probing [BOP] and plaque index [PI]; and radiographic (crestal bone loss [CBL]) are worse among cigarette‐smokers (CS) compared with never‐smokers (NS) with short implants.

Purpose

The present 6‐year follow‐up retrospective study compared the peri‐implant clinical and radiographic parameters in CS and NS with short dental implants (6 mm in length).

Materials and methods

Fifty‐six male individuals were included. These individuals divided into 2 groups as follows: (a) Group‐1: 29 self‐reported systemically healthy CS with 48 short‐implants; and (b) Group‐2: 27 self‐reported systemically healthy NS with 43 short implants. Peri‐implant PD, PI, BOP, and CBL were measured. Group comparisons were done using the Kruskal‐Wallis test and sample size was estimated. Level of significance was set at P values < .05.

Results

In groups 1 and 2, the follow‐up durations were 6.2 ± 0.1 years and 6.1 ± 0.3 years, respectively. A cigarette smoking history of 8.9 ± 3.6 pack years was reported by individuals in Group‐1. At follow‐up, scores of peri‐implant PD, BOP, PI, and mesial and distal CBL were comparable around short implants in both groups.

Conclusion

Under strict oral hygiene maintenance protocols, short dental implants can remain functionally stable in CS in a manner similar to NS.     

Influence of Laser‐Microtextured Surface Collar on Marginal Bone Loss and Peri‐Implant Soft Tissue Response: A Systematic Review and Meta‐Analysis

Background: A laser‐microtextured surface (LMS) dental implant collar appears to promote a more tooth‐like gingival collagen fiber attachment, which may help to stabilize peri‐implant tissues. The purpose of this systematic review is to assess the clinical effect of an LMS versus non‐LMS collar on crestal bone level and peri‐implant soft tissue response. Methods: Electronic and manual literature searches were performed by two independent reviewers for articles written in English up to December 2016. Studies were included if they were human clinical trials with the purpose of evaluating the impact of an LMS collar on peri‐implant hard and soft tissues. Cumulative marginal bone loss (MBL), probing depth (PD), and survival rate (SR) with 95% confidence intervals (CIs) were calculated to show the performance of LMS implant collars. MBL, PD, and SR data were analyzed with a random effects model to compare the influence of LMS collars with non‐LMS collars (e.g., roughened surface and machined surface). Results: Fifteen human clinical studies (three randomized controlled trials, six cohort studies, and six case series) with 772 implants met the inclusion criteria. For the overall data, the weighted mean MBL was 0.72 mm (95% CI: 0.59 to 0.85 mm), PD was 1.81 mm (95% CI: 1.13 to 2.49 mm), and SR was 0.97 (95% CI: 0.95 to 0.98). MBL around an LMS collar was significantly less than around machined‐surface collars (weighted mean difference [WMD]: ?0.77; 95% CI: ?1.01 to ?0.52; I² = 95.2%; P <0.001). PD in the LMS group was significantly shallower than in the machined‐surface group (WMD: ?1.34; 95% CI: ?1.62 to ?1.05; I² = 81.4%; P <0.001). However, no statistically significant difference was detected for MBL between the LMS and roughened‐surface groups (WMD: ?0.04; 95% CI: ?0.16 to 0.08; I² = 0.0%; P = 0.75). No statistically significant difference was found for SR between the LMS and non‐LMS groups (risk ratio: 1.01; 95% CI: 0.97 to 1.04; I² = 0.0%; P = 0.91). Conclusions: Meta‐analysis showed that an LMS collar can reduce the amount of MBL and PD compared with a machined‐surface collar. Due to high heterogeneity between the included studies, results should be interpreted cautiously.     

Association of Preventive Maintenance Therapy Compliance and Peri‐Implant Diseases: A Cross‐Sectional Study

Background: This study aims to investigate association between peri‐implant maintenance therapy (PIMT) and the frequency of peri‐implant diseases and to further identify factors that contribute to failure of PIMT compliance. Methods: A cross‐sectional study on patients who were healthy and partially edentulous was conducted. They were grouped in the following categories according to PIMT compliance: 1) regular compliers (RC) (≥2 PIMT/year); 2) erratic compliers (EC) (<2 PIMT/year); and 3) non‐compliers (NC) (no PIMT). Radiographic and clinical analyses were carried out including probing depth (PD), plaque index (PI), bleeding on probing (BOP), mucosal redness (MR), suppuration (SUP), keratinized mucosa dimension, and marginal bone loss. A multiple logistic regression model was estimated at implant and patient level to obtain adjusted odds ratios (ORs) and to control possible confounding effects among variables. Results: Overall, 206 implants in 115 patients fulfilled inclusion criteria. At patient level, it was shown that association between compliance and peri‐implant condition was statistically significant (P = 0.04). Compliance was associated with 86% fewer conditions of peri‐implantitis. The probability of PIMT compliance was substantially associated with frequency of peri‐implantitis (OR = 0.13, P = 0.01). Patients with a history of periodontal disease multiplied their probability of being EC (versus NC) 4.23 times with respect to not having a history of periodontal disease (P = 0.02). Moreover, light smokers significantly resulted to be NC compared with RC (P = 0.04) and EC (P = 0.02). Nevertheless, mucositis was not found to be statistically associated with level of compliance. In addition, PD, PI, BOP, MR, and SUP varied significantly according to PIMT compliance and peri‐implant condition. Conclusions: Peri‐implant maintenance compliance ≥2 PIMT/year seems to be crucial to prevent peri‐implantitis in healthy patients. Furthermore, history of periodontal disease and disease severity, as well as its extent and a smoking habit, appear to be factors that influence the compliance risk profile (NCT02789306).     

Occurrence of peri‐implant diseases and risk indicators at the patient and implant levels: A multilevel cross‐sectional study

Background : High prevalence rates of peri‐implant diseases have been reported; however, the lack of standardization of definition criteria has lead to variations in the observed estimates. In addition, scarce data are available concerning patient and implant related factors associated to peri‐implantitis. The aim of this study was to determine the prevalence of peri‐implant diseases and their risk indicators at the patient and implant levels. Methods : One hundred forty‐seven patients with 490 dental implants were included. Dental implants were clinically and radiographically evaluated to determine their peri‐implant conditions. Patient‐related conditions and implant and prosthetic‐related factors were recorded. Multivariable Poisson regression was fitted and prevalence ratios (PR) were reported. Results : 85.3% of implants (95%CI 80.2 to 90.4) had mucositis and 9.2% (95%CI 4.7 to 13.7) had peri‐implantitis. 80.9% (95%CI 73.8 to 86.8), and 19.1% (95%CI 12.6 to 25.5) of patients had mucositis and peri‐implantitis. At the patient level, it was observed an increased probability of peri‐implantitis in individuals with pocket depths ≥6 mm (PR = 2.47) and with ≥4 implants (PR = 1.96). Smoking increased the probability of peri‐implantitis by three times (PR = 3.49). The final multilevel Poisson regression model at the implant level indicated that platform switching reduced the probability of peri‐implantitis (PR = 0.18) and implants in function for ≥5 years increased this probability (PR = 2.11). The final model including patient and implant level indicators demonstrated that higher time of function (PR = 2.76) and smoking (PR = 6.59) were associated with peri‐implantitis. C onclusion : Peri‐implant diseases are highly prevalent in the studied sample, and factors associated with the occurrence of peri‐implantitis were presence of pockets ≥6 mm, smoking, time of function, and type of platform.     

Clinical and radiographic peri‐implant parameters and proinflammatory cytokine levels among cigarette smokers,smokeless tobacco users,and nontobacco users

Background

It is postulated that clinical and radiographic peri‐implant parameters are worse and levels of interleukin (IL)‐1β and matrix metalloproteinase (MMP)‐9 in the peri‐implant sulcular fluid (PISF) are higher in cigarette‐smokers (CS) and smokeless‐tobacco users (STU) compared with nontobacco user (NTU).

Purpose

The present study aimed to compare clinical and radiographic peri‐implant inflammatory parameters and levels of IL‐1β and MMP‐9 levels among CS, STU, and NTU.

Materials and Methods

Forty‐five CS (Group‐1), 42 STU (Group‐2), and 44 NTU (Group‐3) were included. Demographic data was collected using a structured baseline questionnaire. Peri‐implant plaque index (PI), bleeding on probing (BOP), and probing depth (PD) were recorded and crestal bone loss (CBL) were assessed using standardized digital radiographs. PISF volume and levels of IL‐1β and MMP‐9 in PISF were quantified using enzyme‐linked immunosorbent assay. Clinical peri‐implant parameters and PISF IL‐1β and MMP‐9 concentrations were analyzed with Kruskal‐Wallis test. Bonferroni post hoc adjustment test was used for multiple comparisons. P‐value was set at .05.

Results

Peri‐implant PI and PD were significantly worse in group‐1 and group‐2 patients as compared to group‐3 individuals (P < .05). Peri‐implant CBL was also significantly higher in group‐1 and group‐2 compared with group‐3 (P < .05). Peri‐implant BOP was significantly higher in group‐2 and group‐3 as compared to group‐1 individuals (P < .05). The PISF volume (P < .05) collected and levels of IL‐1β and MMP‐9 were statistically significantly elevated among individuals in group‐1 and group‐2 compared with group‐3 (P < .01). There was no significant difference in PI, PD, CBL, and PISF levels of IL‐1β and MMP‐9 among participants in groups 1 and 2.

Conclusion

Clinical and radiographic peri‐implant parameters were compromised among CS and STU as compared to NTU. Increased expression of local proinflammatory cytokines may explain greater susceptibility of CS and STU to peri‐implant breakdown.     

Impact of a triclosan‐containing toothpaste during the progression of experimental peri‐implant mucositis: Clinical parameters and local pattern of osteo‐immunoinflammatory mediators in peri‐implant fluid

1 Background

This study evaluated the influence of a triclosan‐containing toothpaste in the profile of osteo‐immunoinflammatory mediators in peri‐implant crevicular fluid (PICF) and in clinical parameters during progression of peri‐implant mucositis.

2 Methods

Twenty‐two clinically healthy patients with an implant‐supported single‐unit crown were enrolled in this double‐blind, randomized, crossover study carried out in two phases of 21 days each. During an experimental 3‐week period of undisturbed plaque accumulation in the implants, patients were randomly assigned to use three times/day: triclosan (n = 11), triclosan/copolymer/fluoride toothpaste; or placebo (n = 11), fluoride toothpaste. After a professional prophylaxis, a washout period of 30 days was established. Clinical parameters and 15 osteo‐immunoinflammatory mediators in the PICF were evaluated at baseline and at 3, 7, 14, and 21 days.

3 Results

Both groups showed increase in plaque index at implant sites from the 3rd until the 21st day (P < 0.05). Only triclosan treatment was able to avoid an increase in bleeding on probing (BOP) throughout the follow‐ups (P > 0.05), whereas a significant intensification in BOP was observed from the 14th day in the placebo‐treated sites (P < 0.05). Lower interleukin (IL)‐10 concentrations were detected in the placebo group at the 21st day when compared with triclosan‐treated implant sites (P < 0.05). IL‐10 levels were reduced and IL‐1β concentrations were increased at 21 days when compared with baseline only in placebo‐treated sites (P < 0.05). Osteoprotegerin levels significantly increased from the 14th until the 21st day only in triclosan‐treated sites (P < 0.05).

4 Conclusion

Triclosan‐containing toothpaste controls clinical inflammation and interferes positively in the profile of osteo‐immunoinflammatory mediators during progression of experimental peri‐implant mucositis.     

The evaluation of peri‐implant sulcus fluid osteocalcin,osteopontin, and osteonectin levels in peri‐implant diseases

1 Background

Peri‐implant mucositis is an inflammation of the soft tissues surrounding an implant. Peri‐implantitis refers to a process characterized by peri‐implant bone loss along with an inflammation of the soft tissues. Osteocalcin, osteopontin, and osteonectin proteins are related to bone remodeling. The aim of the present study was to investigate peri‐implant sulcus fluid (PISF) osteocalcin, osteopontin, and osteonectin levels in peri‐implant mucositis and peri‐implantitis.

2 Methods

Fifty‐two implants with peri‐implantitis, 46 implants with peri‐implant mucositis, and 47 control implants were included in the study. Clinical parameters including probing depth, modified sulcus bleeding index and modified plaque index were recorded. PISF osteocalcin, osteopontin, and osteonectin levels were analyzed by ELISA kits.

3 Results

There were no significant differences in PISF osteocalcin, osteopontin, and osteonectin total amounts between healthy controls, peri‐implant mucositis and peri‐implantitis groups (P > 0.05). Probing depths were not correlated with PISF osteocalcin, osteopontin, and osteonectin levels in the study groups (P > 0.05).

4 Conclusions

Soft tissue inflammation around dental implants does not cause a change in osteocalcin, osteopontin, and osteonectin levels in PISF. Also, peri‐implantitis does not seem to give rise to an increase in PISF levels of osteocalcin, osteopontin, and osteonectin.     

Comparison of Peri‐Implant Soft Tissue Parameters and Crestal Bone Loss Around Immediately Loaded and Delayed Loaded Implants in Smokers and Non‐Smokers: 5‐Year Follow‐Up Results

Background: The aim of this study is to compare peri‐implant soft tissue parameters (plaque index [PI], bleeding on probing [BOP], and probing depth [PD] ≥4 mm) and crestal bone loss (CBL) around immediately loaded (IL) and delayed loaded (DL) implants in smokers and non‐smokers. Methods: Thirty‐one patients with IL implants (16 smokers and 15 non‐smokers) and 30 patients with DL implants (17 smokers and 13 non‐smokers) were included. Personal data regarding age, sex, and duration and daily frequency of smoking were gathered using a questionnaire. Peri‐implant PI, BOP, and PD ≥4 mm were recorded, and mesial and distal CBL was measured on standardized digital radiographs. Multiple group comparisons were performed using the Bonferroni post hoc test (P <0.05). Results: All implants replaced mandibular premolars or molars. Mean scores of PI (P <0.05) and PD ≥4 mm (P <0.05) were statistically significantly higher in smokers compared with non‐smokers in patients with IL and DL dental implants. The mean score of BOP (P <0.05) was statistically significantly higher in non‐smokers compared with smokers in both groups. CBL (P <0.05) was statistically significantly higher in smokers compared with non‐smokers in both groups. There was no statistically significant difference in PI, BOP, PD ≥4 mm, and total CBL among smokers with IL and DL implants. Conclusions: Tobacco smoking enhances peri‐implant soft tissue inflammation and CBL around IL and DL implants. Loading protocol did not show a significant effect on peri‐implant hard and soft tissue status in healthy smokers and non‐smokers.     

Clinical Outcomes of Using Lasers for Peri‐Implantitis Surface Detoxification: A Systematic Review and Meta‐Analysis

The aim of this systematic review is to compare the clinical outcomes of lasers with other commonly applied detoxification methods for treating peri‐implantitis. An electronic search of four databases and a hand search of peer‐reviewed journals for relevant articles were conducted. Comparative human clinical trials and case series with ≥6 months of follow‐up in ≥10 patients with peri‐implantitis treated with lasers were included. Additionally, animal studies applying lasers for treating peri‐implantitis were also included. The included studies had to report probing depth (PD) reduction after the therapy. Results: Seven human prospective clinical trials and two animal studies were included. In four and three human studies, lasers were accompanied with surgical and non‐surgical treatments, respectively. The meta‐analyses showed an overall weighted mean difference of 0.00 mm (95% confidence interval = ?0.18 to 0.19 mm) PD reduction between the laser and conventional treatment groups (P = 0.98) for non‐surgical intervention. In animal studies, laser‐treated rough‐surface implants had a higher percentage of bone‐to‐implant contact than smooth‐surface implants. In a short‐term follow‐up, lasers resulted in similar PD reduction when compared with conventional implant surface decontamination methods.     

Which antibiotic regimen prevents implant failure or infection after dental implant surgery? A systematic review and meta-analysis

ObjectiveTo assess which antibiotic regimen prevents dental implant failures or postoperative infections following dental implant placement.Materials and methodsSystematic review and meta-analysis. Data sources: Pubmed, Cochrane, Science Direct, and EMBASE via OVID were searched up to August 2017. Only randomized controlled clinical trials (RCT) using antibiotics were included. Outcome measures were set on dental implant failures or postoperative infection incidence after dental implant surgery. Three reviewers independently undertook risk of bias assessment and data extraction. Stratified meta-analyses of binary data using fixed-effects models were performed using Stata 14.0. The risk ratio (RR) and 95% confidence interval (CI) were estimated.ResultsNine articles were included corresponding to 15 RCTs. All RCTs tested only oral amoxicillin. Implant-failure analysis: overall RR = 0.53 (P = .005, 95% CI: 0.34–0.82) and overall NNT = 55 (95% CI, 33–167). Single-dose oral amoxicillin preoperatively (SDOAP) is beneficial (RR = 0.50, CI: 0.29–0.86. P = .012), when compared to postoperative oral amoxicillin (POA): RR = 0.60, CI: 0.28–1.30. P = .197. Postoperative-infection analysis: overall RR = 0.76 (P = 0.250, 95% CI: 0.47–1.22). Neither SDOAP (RR = 0.82, CI = 0.46–1.45, P = .488) nor POA (RR = 0.64, CI = 0.27–1.51, P = .309) are beneficial. I² = 0.0%, chi-squared tests P ≈ 1.ConclusionOnly SDOAP is effective and efficacious at preventing implant failures, but it was not significant for postoperative infections following dental implant surgeries.     

Electromyographic assessment of jaw muscles in patients with All‐on‐Four fixed implant‐supported prostheses

This study evaluated the electromyographic (EMG) characteristics of masticatory muscles in patients with fixed implant‐supported prostheses according to All‐on‐Four^® principles and in control healthy dentate subjects. Twenty‐six subjects aged 50–74 years were examined. Eighteen were edentulous and had been successfully rehabilitated with (i) mandibular All‐on‐Four^® implant‐supported fixed prostheses and maxillary complete dentures (10 patients) and (ii) mandibular and maxillary All‐on‐Four^® implant‐supported fixed prostheses (eight patients). Eight reference subjects had natural dentition. Surface EMG recordings of the masseter and temporalis muscles were performed during maximum voluntary teeth clenching and during unilateral gum chewing. All values were standardised as percentage of a maximum clenching on cotton rolls. During clenching, a good global neuromuscular equilibrium was found in all participants. During chewing, all groups had similar values of working‐side muscle activities and of chewing frequency. No significant differences in the analysed EMG parameters were found between the patients with mandibular and maxillary All‐on‐Four^® implant‐supported prostheses and the reference subjects. In contrast, standardised pooled muscle activities and standardised muscular activities per cycle were larger in patients with a maxillary removable prosthesis than in control subjects (Kruskal–Wallis test, P < 0·01). Also, patients wearing a complete maxillary denture showed a poor neuromuscular coordination with altered muscular pattern and lower values of the index of masticatory symmetry than dentate control subjects (P < 0·01). EMG outcomes suggest that All‐on‐Four^® implant‐supported prostheses may be considered a functionally efficient treatment option for the rehabilitation of edentulous patients with reduced residual bone volume.     

Surgical treatment of peri‐implantitis: Prognostic indicators of short‐term results

Aim

To evaluate the clinical and radiographic short‐term (6 months) effect of surgical treatment of peri‐implantitis, and to identify prognostic indicators affecting the outcome using a multilevel statistical model.

Materials & Methods

A total of 143 implants (45 patients) with a diagnosis of progressive peri‐implantitis (progressive bone loss (PBL) ≥2.0 mm and bleeding on probing (BoP)/suppuration) received surgical treatment. Clinical and radiographic parameters were assessed 6 months postoperatively. Potential prognostic indicators on subject, implant and site level prior to surgery were analysed to evaluate the effect on individual and composite outcomes using multilevel logistic regression analysis.

Results

At the 6‐month evaluation, none of the implants demonstrated PBL and 14% of the implants were registered with the absence of bleeding and no pocket probing depth ≥6 mm. Multilevel regression analysis identified, among others, suppuration, pocket probing depth >8 mm, bone loss >7 mm and the presence of plaque as criteria associated with the outcome.

Conclusion

Resective peri‐implantitis surgery seemed to reduce the amount of peri‐implant inflammation. However, most of the sites continued to have BoP/suppuration. Thus, long‐term maintenance and evaluation is warranted. The effect of treatment was reduced by some prognostic indicators such as the presence of suppuration prior to interception and peri‐implant bone loss exceeding 7 mm.     

Investigation of the Association Between Cement Retention and Prevalent Peri‐Implant Diseases: A Cross‐Sectional Study

Background: The aim of this study is to examine the association between retention type (cement‐retained versus screw‐retained restorations) and prevalence of peri‐implant diseases in a German university‐treated population. Methods: Data were analyzed from individuals that underwent clinical and radiographic peri‐implant examinations as part of a university‐based cross‐sectional study from September 2011 to October 2012. Results: Data from 139 individuals (mean age: 57.59 years) having 394 implants were analyzed: 192 implants supporting single crowns and 202 fixed partial dentures. Overall, 11.9% of the participants had peri‐implantitis, whereas 68.9% had peri‐implant mucositis. Crude odds ratios (95% confidence intervals) for peri‐implantitis and peri‐implant mucositis for cement‐ versus screw‐retained restorations were 1.43 (0.45, 4.60) and 0.89 (0.53, 1.48), respectively. Results remained non‐significant in multivariable models adjusting for type of restoration and smoking (all P values >0.50). There was also no effect of splinting restorations on disease prevalence in adjusted analyses (P values >0.32). Conclusions: In this university‐treated sample, there is no association between the type of prosthesis retention and peri‐implant diseases. Current findings show that, when appropriate selection and removal of cement is performed, cement retention is not a risk indicator for peri‐implant diseases.     

The influence of different soft‐tissue grafting procedures at single implant placement on esthetics: A randomized controlled trial

1 Background

Soft‐tissue grafting to thicken the soft tissue around dental implants was proposed to ameliorate the esthetic outcome. Traditionally, connective tissue is used as a grafting material, but a xenogeneic collagen matrix was introduced as an alternative to reduce patient morbidity.

2 Methods

A total of 60 patients randomly received either no graft (n = 20, NG group), a connective tissue graft (n = 20, CTG group), or a xenogeneic collagen matrix (n = 20, XCM group) when an implant was placed in a preserved alveolar ridge. Changes in mid‐buccal mucosal level (MBML) at 1 (T₁) and 12 (T₁₂) months after final implant crown placement were compared to the pre‐extraction level. Additionally, esthetics, marginal bone level, clinical peri‐implant parameters, and patient satisfaction were assessed.

3 Results

At T₁₂, mean changes in MBML were –0.48 ± 1.5 mm, –0.04 ± 1.1 mm, and –0.17 ± 1.3 mm in the NG, CTG, and XCM groups (P = 0.56), respectively. Regarding the other outcome variables, no significant intergroup differences were observed.

4 Conclusions

Soft‐tissue grafting at single implant placement in preserved alveolar ridges does not result in a better esthetic outcome or in better peri‐implant health and should not be considered as a standard procedure.     

In vitro evaluation of controlled‐release 14% doxycycline gel for decontamination of machined and sandblasted acid‐etched implants

1 Background

Peri‐implant infections are associated with the establishment and maturation of a bacterial biofilm characterized by a predominance of Gram‐negative fusiform anaerobic species. The decontamination of implant surfaces is then crucial for a successful peri‐implant therapy.

2 Methods

Twenty‐one smooth and 21 rough implants, divided into four groups according to surface and treatment modality, were contaminated with Streptococcus sanguinis and then placed in an incubator with the atmosphere of 5% CO2 at 37°C for 24 hours to allow the bacteria to grow. After 24 hours, the test groups were treated with controlled release 14% doxycycline gel injecting the gel circumferentially over the surface of the implant for 3 minutes, while the control groups were irrigated with sterile saline for 1 minute. The implants were then vortexed into triptych soy broth to allow the bacteria to detach from the surface, diluted 1:100 and plated. Colony forming units (CFU) were counted 48 hours after incubation.

3 Results

The use of a 14% doxycycline gel minimized CFU counts compared to control groups, with the difference being statistically significant (P < 0.05). The reduction of CFUs in the smooth test group is more marked than in the rough test group, but the difference doesn't reach statistically significance (P = 0.215).

4 Conclusions

The use of 14% doxycycline gel in implant surface decontamination was efficacious in this in‐vitro study. Adjunctive use of locally delivered 14% doxycycline gel might be a viable option in the management of peri‐implantitis and peri‐implant mucositis considering its efficacy in reducing bacterial colonization.