Preventing and Treating Peri‐Implantitis: A Cost‐Effectiveness Analysis

Background: A large number of treatments for peri‐implantitis are available, but their cost‐effectiveness remains uncertain. This study evaluates the cost‐effectiveness of preventing and treating peri‐implantitis. Methods: A Markov model was constructed that followed each implant over 20 years. Supportive implant therapy (SIT) for managing peri‐implant mucositis and preventing development of peri‐implantitis was either provided or not. Risk of peri‐implantitis was assumed to be affected by SIT and the patient's risk profile. If peri‐implantitis occurred, 11 treatment strategies (non‐surgical or surgical debridement alone or combined with adjunct therapies) were compared. Treatments and risk profiles determined disease progression. Modeling was performed based on systematically collected data. Primary outcomes were costs and proportion of lost implants, as assessed via Monte Carlo microsimulations. Results: Not providing SIT and performing only non‐surgical debridement was both least costly and least effective. The next best (more costly and effective) option was to provide SIT and perform surgical debridement (additional 0.89 euros per 1% fewer implants lost). The most effective option included bone grafts, membranes, and laser treatment (56 euros per 1%). For patients at high risk, the cost‐effectiveness of SIT increased, whereas in low‐risk groups, a cost‐optimized strategy was cost‐effective. Conclusions: Although clinical decision‐making will be guided mainly by clinical condition, cost‐effectiveness analyses might add another perspective. Based on these findings, an unambiguous comparative effectiveness ranking was not established. However, cost‐effectiveness was predominantly determined by provision of SIT and initial treatment costs. Transferability of these findings to other healthcare systems needs further confirmation.     

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.     

Prevalence and Predictive Factors for Peri‐Implant Disease and Implant Failure: A Cross‐Sectional Analysis

Background: Long‐term studies worldwide indicate that peri‐implant inflammation is a frequent finding and that the prevalence of peri‐implantitis correlates with loading time. Implant loss, although less frequent, has serious oral health and economic consequences. An understanding of predictive factors for peri‐implant disease and implant loss would help providers and patients make informed decisions. Methods: A cross‐sectional study was performed on 96 patients with 225 implants that were placed between 1998 and 2003. Implant placement data were collected from patient records, and patients presented for a clinical and radiographic follow‐up examination. Implant status and periodontal status were determined, the data were analyzed to determine the prevalence of peri‐implant disease or implant loss, and a predictive model was tested. Results: The mean follow‐up time for the patients was 10.9 years. The implant survival rate was 91.6%. Peri‐implant mucositis was found in 33% of the implants and 48% of the patients, and peri‐implantitis occurred in 16% of the implants and 26% of the patients. Individuals with peri‐implantitis were twice as likely to report a problem with an implant as individuals with healthy implants. Peri‐implantitis is associated with younger ages and diabetes at the time of placement and with periodontal status at the time of follow‐up. Implant loss is associated with diabetes, immediate placement, and larger‐diameter implants. Conclusions: One in four patients and one in six implants have peri‐implantitis after 11 years. The data suggest that periodontal and diabetes status of the patient may be useful for predicting implant outcomes.     

The Frequency of Peri‐Implant Diseases: A Systematic Review and Meta‐Analysis

Background: The peri‐implant diseases, namely peri‐implant mucositis and peri‐implantitis, have been extensively studied. However, little is known about the true magnitude of the problem, owing mainly to the lack of consistent and definite diagnostic criteria used to describe the condition. The objective of the present review is to systematically estimate the overall frequency of peri‐implant diseases in general and high‐risk patients. Methods: The systematic review is prepared according to the Meta‐analysis of Observational Studies in Epidemiology statement. Studies were searched in four electronic databases, complemented by manual searching. The quality of the studies was assessed according to Strengthening the Reporting of Observational Studies in Epidemiology, and the data were analyzed using statistical software. Results: Of 504 studies identified, nine studies with 1,497 participants and 6,283 implants were included. The summary estimates for the frequency of peri‐implant mucositis were 63.4% of participants and 30.7% of implants, and those of peri‐implantitis were 18.8% of participants and 9.6% of implants. A higher frequency of occurrence of peri‐implant diseases was recorded for smokers, with a summary estimate of 36.3%. Supportive periodontal therapy seemed to reduce the rate of occurrence of peri‐implant diseases. Conclusions: Peri‐implant diseases are not uncommon following implant therapy. Long‐term maintenance care for high‐risk groups is essential to reduce the risk of peri‐implantitis. Informed consent for patients receiving implant treatment must include the need for such maintenance therapy.     

Efficacy of 0.12% Chlorhexidine Gluconate for Non‐Surgical Treatment of Peri‐Implant Mucositis

Background: Because peri‐implant mucositis may progress to peri‐implantitis, effective treatment resulting in resolution of inflammation could prevent peri‐implantitis. Current treatment protocols for this condition are still unpredictable. The purpose of this study is to analyze efficacy of non‐surgical treatment for patients with peri‐implant mucositis during a 6‐month follow‐up period. Methods: This controlled, randomized, double‐masked clinical trial included 37 patients diagnosed with peri‐implant mucositis, randomly assigned into test group (basic periodontal therapy + 0.12% chlorhexidine) with 61 implants; and control group (basic periodontal therapy + placebo) with 58 implants. Therapy consisted of adaptation of the full‐mouth scaling and root planing protocol. Clinical parameters of visible plaque index (VPI), gingival bleeding index (GBI), probing depth (PD), and bleeding on probing (BOP) were measured in implants and were evaluated at baseline and at 1, 3, and 6 months post‐therapy. Data were analyzed using the split‐plot analysis of variance and χ² tests with a significance level of 5%. Results: Intragroup analysis showed that VPI, GBI, PD, and BOP presented statistically significant improvements compared with baseline. No statistically significant differences were found between the test and control groups at any time. Conclusions: Both isolated mechanical therapy and its association with 0.12% chlorhexidine mouthwash reduced peri‐implant mucositis. Therefore, 0.12% of chlorhexidine was not more effective than placebo.     

Patient‐Centered Perspectives and Understanding of Peri‐Implantitis

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

Management of peri‐implant mucositis and peri‐implantitis

Peri‐implant diseases are defined as inflammatory lesions of the surrounding peri‐implant tissues and include peri‐implant mucositis (an inflammatory lesion limited to the surrounding mucosa of an implant) and peri‐implantitis (an inflammatory lesion of the mucosa that affects the supporting bone with resulting loss of osseointegration). This review aims to describe the different approaches to manage both entities and to provide a critical evaluation of the evidence available on their efficacy. Therapy of peri‐implant mucositis and nonsurgical therapy of peri‐implantitis usually involve mechanical debridement of the implant surface using curettes, ultrasonic devices, air‐abrasive devices or lasers, with or without the adjunctive use of local antibiotics or antiseptics. The efficacy of these therapies has been demonstrated for mucositis: controlled clinical trials show an improvement in clinical parameters, especially in bleeding on probing. For peri‐implantitis, the results are limited, especially in terms of probing pocket‐depth reduction. Surgical therapy of peri‐implantitis is indicated when nonsurgical therapy fails to control the inflammatory changes. Selection of the surgical technique should be based on the characteristics of the peri‐implant lesion. In the presence of deep circumferential and intrabony defects, surgical interventions should aim to provide thorough debridement, implant‐surface decontamination and defect reconstruction. In the presence of defects without clear bony walls or with a predominant suprabony component, the aim of the surgical intervention should be the thorough debridement and the repositioning of the marginal mucosa to enable the patient to perform effective oral‐hygiene practices, although this aim may compromise the esthetic result of the implant‐supported restoration.     

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.     

Peri‐implantitis and its prevention

This perspective article on peri‐implantitis and its prevention was produced as a supplement to a 3‐D, computer‐animated film aiming at presenting key characteristics of peri‐implant health, the build‐up of a biofilm and the ensuing host‐response resulting in peri‐implant mucositis and, subsequently, peri‐implantitis. Treatment concepts for peri‐implantitis were briefly reviewed, and prevention of the condition was brought to attention as a priority in implant dentistry. The overview also highlighted the 2017 World Workshop on Classification of Periodontal and Peri‐implant diseases and Conditions, in which new disease definitions and case definitions were presented for peri‐implant health, peri‐implant mucositis, and peri‐implantitis.     

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.     

Estimation of Bone Loss Biomarkers as a Diagnostic Tool for Peri‐Implantitis

Background: The aims of this study are to estimate the profile of bone loss biomarkers in peri‐implant tissues and to identify potential prognostic biomarkers of peri‐implantitis. Methods: Peri‐implant crevicular fluid samples collected from 164 participants (52 patients with peri‐implantitis, 54 with mucositis, and 58 with healthy peri‐implant tissues) were analyzed using enzyme‐linked immunosorbent assays to evaluate concentrations of the receptor activator of nuclear factor‐κB (RANK), soluble RANK ligand (sRANKL), osteoprotegerin (OPG), cathepsin‐K, and sclerostin. Results: Concentrations of RANK, sRANKL, OPG, and sclerostin were significantly increased in patients with peri‐implantitis compared with patients with healthy peri‐implant tissues. Comparisons between peri‐implantitis and mucositis demonstrated significantly higher values of sclerostin in peri‐implantitis samples. Comparisons between mucositis and healthy peri‐implant tissues showed significantly increased levels of RANK and cathepsin‐K in mucositis. Conclusion: These results are suggestive of a role of sRANKL, OPG, and sclerostin as prognostic biomarkers in peri‐implantitis.     

Increased Levels of Dissolved Titanium Are Associated With Peri‐Implantitis – A Cross‐Sectional Study

Background: Peri‐implantitis represents a disruption of the biocompatible interface between the titanium dioxide layer of the implant surface and the peri‐implant tissues. Increasing preclinical data suggest that peri‐implantitis microbiota not only triggers an inflammatory immune response but also causes electrochemical alterations of the titanium surfaces, i.e., corrosion, that aggravate this inflammatory response. Thus, it was hypothesized that there is an association between dissolution of titanium from dental implants, which suggests corrosion, and peri‐implantitis in humans. The objective of this study is to compare levels of dissolved titanium in submucosal plaque collected from healthy implants and implants with peri‐implantitis. Methods: Submucosal plaque from 20 implants with peri‐implantitis and 20 healthy implants was collected with sterile curets from 30 participants. Levels of titanium were quantified using inductively coupled plasma mass spectrometry and normalized for mass of bacterial DNA per sample to exclude confounding by varying amounts of plaque per site. Statistical analysis was performed using generalized estimated equations to adjust for clustering of implants per participant. Results: Implants with peri‐implantitis harbored significantly higher mean levels of titanium (0.85 ± 2.47) versus healthy implants (0.07 ± 0.19) after adjusting for amount of plaque collected per site (P = 0.033). Conclusions: Greater levels of dissolved titanium were detected in submucosal plaque around implants with peri‐implantitis compared with healthy implants, indicating an association between titanium dissolution and peri‐implantitis. Factors triggering titanium dissolution, as well as the role of titanium corrosion in the peri‐implant inflammatory process, warrant further investigation.     

Restorative design and associated risks for peri‐implant diseases

The prevalence of inflammatory conditions around dental implants is significant. Current analysis indicates that the rates for peri‐mucositis and peri‐implantitis may be as high as 40%‐65% and 20%‐47%, respectively. Over the last decade, many risk factors have been associated with peri‐mucositis and peri‐implantitis, creating a multifactorial disease etiology that complicates both diagnosis and treatment. Furthermore, additional considerations such as initial surgical implant placement position, disruption of the biologic interface associated with the implant‐abutment interface manipulation, or prosthetic design may also influence the host response to commonly employed oral prostheses or the diagnosis of inflammatory states. Coupled with the temporal nature of disease progression around implants, understanding and accounting for these additional parameters may help reduce the number of variables that the surgeon/restorative team face when incorporating implant therapy into daily practice. Therefore, this review discusses the importance of surgical and restorative design by reviewing the concepts of natural and prosthetic emergence profile and implant design and position, as well as many other restorative concepts related to potential implant complications and disease. Understanding both the inflammatory nature of peri‐implant disease and additional parameters related to both surgical and prosthetic procedures may provide the best possible approach to reducing the prevalence of both peri‐mucositis and peri‐implantitis within the realm of dental implant therapy.     

Treatment Outcome in Patients With Peri‐Implantitis in a Periodontal Clinic: A Retrospective Study

Background: The number of placed implants has grown during the past decade, and the prevalence of peri‐implantitis has increased. The purpose of the present study is to investigate the treatment outcome of peri‐implantitis and to identify factors influencing the treatment success rate. Methods: The study was conducted as a retrospective longitudinal study on a referral population. The material included 382 implants with peri‐implantitis in 150 patients. Peri‐implantitis was defined as presence of pocket depths ≥5 mm, bleeding at probing and/or suppuration, and the presence of implant radiographic bone loss ≥3 mm or bone loss comprising at least three threads of the implant. Variance analyses, χ² analyses, and logistic regression analysis were used for data analyses. Results: The mean age of the participants at baseline was found to be 64 years (range: 22 to 87 years). The mean ± SD follow‐up time was 26 ± 20 months, and the mean time between implant installation and baseline was 6.4 years (range: 1 to 20 years). Periodontal flap surgery with osteoplasty was the most common type of therapy (47%), and regenerative surgery procedures with bone substitute materials were chosen in 20% of the cases. The mean success rate at patient level was 69%. The results of the logistic regression analyses showed that the success rate was significantly lower for individuals with the diagnosis of severe periodontitis, severe marginal bone loss around the implants, poor oral hygiene, and low compliance. Conclusion: The effectiveness of the peri‐implantitis therapy was impaired by severe periodontitis, severe marginal bone loss around the implants, poor oral hygiene, and low compliance.     

Microbial Characteristics of Peri‐Implantitis: A Case‐Control Study

Background: The aim of this case‐control study is to compare oral microbiologic characteristics of patients with healthy peri‐implant conditions and patients with peri‐implantitis and to explore the influence of various patient‐ and implant‐related factors on microbiologic characteristics. Methods: Peri‐implant submucosal microbial samples were collected from 85 patients with peri‐implantitis (cases) and from 69 patients with only implants with healthy peri‐implant conditions (controls). Samples were analyzed using culturing techniques. Multivariable logistic regression was used to explore the association of disease status and various patient‐ and implant‐related factors (sex, patient age, smoking, number of remaining teeth, percentage of teeth with bone loss, implant function time, implant surface, and presence of plaque) with microbiologic characteristics. Results: Peri‐implant disease status was significantly associated with the submucosal presence of Porphyromonas gingivalis (Pg), Prevotella intermedia (Pi), Tannerella forsythia (Tf), and Fusobacterium nucleatum (Fn). The association with disease status was most obvious for Pi (odds ratio [OR]: 15.1; 95% confidence interval [CI]: 5.1 to 45.3) and Tf (OR: 13.3; 95% CI: 5.4 to 32.5). The prevalence of Aggregatibacter actinomycetemcomitans and Staphylococcus species was very low. Conclusions: The periodontal pathogens Pg, Pi, Tf, and Fn are associated with peri‐implantitis. A. actinomycetemcomitans and Staphylococcus species do not seem to play an important role in peri‐implantitis.     

A Novel Approach for Enhanced Nanoparticle‐Sized Bone Substitute Adhesion to Chemically Treated Peri‐Implantitis–Affected Implant Surfaces: An In Vitro Proof‐of‐Principle Study

Background: The objective of this study is to evaluate micro and nano‐hydroxyapatite (NHA) blended clot adhesion to citric acid–conditioned peri‐implantitis–affected surfaces. Methods: Forty hopeless implants with peri‐implantitis designated for removal were included in this study. Implants were divided into eight groups of five each: group 1 (G1) test areas were coated with hydroxyapatite of a microparticle size (MHA); group 2 (G2) test areas were coated with NHA; group 3 (G3) implants were coated with MHA after surface conditioning using citric acid; group 4 (G4) samples were treated in the same manner as in G3 except for the use of NHA; group 5 (G5) samples were coated without surface treatment with MHA mixed with whole human blood; group 6 (G6) implant samples were treated in the same manner as in G5 except for the use of NHA; group 7 (G7) implant samples were treated in the same way as in G5 plus surface conditioning using citric acid; and group 8 (G8) samples were treated in the same manner as in G7 except for the use of NHA. All implants in all groups were agitated for 3 minutes in phosphate‐buffered saline. All samples were prepared for scanning electron microscopy evaluation. Results: G1 and G2 non‐etched implants coated with MHA or NHA sizes were devoid of any bone particle adhesion to the peri‐implantitis–affected surfaces. Contrary to the lack of microparticle adhesion to the root surface that was seen in G3, G4 acid‐treated and NHA‐coated samples revealed nearly complete coverage of the peri‐implantitis–affected parts by the graft material. G5 non‐etched, clot‐blended MHA showed some areas of clot‐blended graft adhesion covering 6.7% of the examined surfaces. G6 non‐etched, clot‐blended NHA showed NHA retention within the fibrin strands in areas where the implant surface pores were exposed (24.3%). G7 acid‐treated and clot‐blended MHA‐treated implant surfaces showed partial coverage of the implant surface with detached fibrin clot–blended graft material (31.4%). G8 acid‐treated and NHA clot‐blended graft‐coated implants showed complete coverage of the implant surface by the clot‐blended graft material (93.4%). Conclusion: Peri‐implantitis–affected surface conditioning with citric acid improves NHA‐blended clot adhesion to titanium implant surfaces.     

A Novel Rat Model of Polymicrobial Peri‐Implantitis: A Preliminary Study

Background: Peri‐implantitis is a complex polymicrobial biofilm‐induced inflammatory osteolytic gingival infection that results in orofacial implant failures. To the best knowledge of the authors, there are no preclinical in vivo studies in implant dentistry that have investigated the inflammatory response to known microbial biofilms observed in humans. The aim of this study is to develop a novel peri‐implant rat model using an established model of polymicrobial periodontitis. Methods: Wistar rats were used for the study of experimental peri‐implantitis. One month after extraction of maxillary first molars, a titanium mini‐implant was inserted. Two months after implant healing, implants were uncovered, and abutment fixing was done using cyanoacrylate to prevent abutment loosening. Rats were separated into two groups (group A: polymicrobial‐infected and group B: sham‐infected). One week after healing of abutments, rats were infected with Porphyromonas gingivalis, Treponema denticola, and Tannerella forsythia for 12 weeks. Bacterial colonization, bone resorption, and implant inflammation were evaluated by polymerase chain reaction (PCR), microcomputed tomography, and histology, respectively. Results: Three rats with four implants in the infection group and two rats with three implants in the sham‐infection group were analyzed. PCR analysis revealed presence of bacterial genomic DNA, and infection elicited significant immunoglobulin (Ig)G and IgM antibody responses, indicating bacterial colonization/infection around implants. Infection induced an enhanced mean distance from implant platform to the first bone‐to‐implant contact, extensive peri‐implantitis with advanced bone resorption, and extensive inflammation with granulation tissue and polymorphonuclear leukocytes. Conclusions: To the best knowledge of the authors, this is the first study to develop a novel rat model of polymicrobial peri‐implantitis. With modifications to improve implant retention it could offer significant advantages for studies of initiation and progression of peri‐implantitis.     

Decontamination of Anodized Implant Surface With Different Modalities for Peri‐Implantitis Treatment: Lasers and Mechanical Debridement With Citric Acid

Background: Although oral rehabilitation with dental implants is a very promising and effective procedure, peri‐implantitis is an emerging concern. Surgical and non‐surgical methods have been applied to treat peri‐implantitis together with various implant surface decontamination methods. However, there is no consensus concerning the most effective treatment for peri‐implantitis. The aim of the present study is to evaluate the effects of erbium‐doped:yttrium, aluminum, and garnet (Er:YAG) laser, photodynamic therapy (PDT), and titanium bur with and without citric acid on ligature‐induced peri‐implantitis around an anodized implant surface. Methods: Thirty dental implants with anodized surface (3.3 × 10 mm) were installed in the mandibles of five beagle dogs. After 3 months, peri‐implantitis was induced by applying cotton ligatures subgingivally. After ligature removal (baseline), the implants were divided into the following treatment groups: 1) Er:YAG laser, 2) PDT, 3) titanium bur alone, and 4) titanium bur with citric acid. Animals were sacrificed after 3 months, and clinical, radiologic, histologic, and histomorphometric evaluations were conducted for all treatment modalities. The data were analyzed using one‐way analysis of variance and Tukey test. A value of P <0.05 was considered statistically significant. Results: The titanium bur with citric acid group exhibited statistically significantly greater improvement in vertical bone height than the Er:YAG laser group and significantly better bone‐to‐implant contact than the PDT group and the bur‐alone group. Conclusion: Within the limits of the study, the combination of mechanical and chemical treatment proved to be the most effective treatment for disinfection of the anodized implant surface.     

Correlation between different genotypes of human cytomegalovirus and Epstein-Barr virus and peri-implant tissue status

Background: The purpose of this study was to estimate the prevalence of different genotypes of human cytomegalovirus (HCMV) and Epstein‐Barr virus (EBV) in peri‐implantitis and mucositis sites, and to evaluate the correlation between herpesvirus presence and clinical parameters. Methods: A total of 80 dental implants (mean time of loading, 4.16 ± 1.8 years) were evaluated during the course of the study (30 peri‐implantitis, 25 mucositis and 25 healthy peri‐implant sites). The following clinical parameters were assessed: visible plaque index, bleeding on probing, suppuration and probing depth. A polymerase chain reaction (PCR) assay was used to identify the presence of different HCMV and EBV genotypes in peri‐implant tissue plaque samples. Results: HCMV‐2 was detected in 53.3% and EBV‐1 in 46.6% of the 30 peri‐implantitis sites evaluated. By contrast, HCMV‐2 was not detected in healthy periodontal sites and EBV‐1 was detected in one healthy site. A statistically significant correlation was found between the presence of HCMV‐2 and EBV‐1 genotypes and clinical parameters of peri‐implantitis. Conclusions: The results from the present study confirmed the high prevalence of HCMV‐2 and EBV‐1 in the peri‐implant tissue plaque of peri‐implantitis sites and suggests a possible active pathogenic role of the viruses in peri‐implantitis.     

General genetic and acquired risk factors,and prevalence of peri‐implant diseases – Consensus report of working group 1

For decades, oral implants have been used successfully for the replacement of missing teeth. Nevertheless, peri‐implant diseases have become an increasingly important issue in daily practice. In this working group, the prevalence of peri‐implant mucositis and peri‐implantitis, as well as different general risk factors and their impact on the onset and progression of peri‐implant diseases, were discussed based on reviews reflecting the current state of evidence. The influence of smoking on the peri‐implant bone‐healing process and its association with peri‐implantitis has been explored in the current literature, demonstrating that smoking is an important risk indicator for the development of peri‐implantitis and implant loss. Compared with non‐smokers, smokers have a higher potential for pathological peri‐implant bone loss, which is also influenced by poor oral hygiene. Despite the fact that a growing number of genetic polymorphisms have been identified and related to periodontal diseases, there are still no genetic patterns that could act as adjuncts to clinical diagnostics in order to identify patients at higher risk of peri‐implant diseases. Long‐term medications, such as bisphosphonate therapy (> 3 years), may have an impact on implant loss. A higher incidence of implant failure was reported in patients using selective serotonin reuptake inhibitors in anti‐depression therapy. Alcoholism (defined as more than 5 units a day) has been associated with implant loss in retrospective and case–control studies, as well as in animal studies.