Journal Club- January 2024
Harvest graft substitute for soft tissue volume augmentation around existing implants: A randomized, controlled and blinded multicenter trial. Clem DS, McClain PK, McGuire MK, et al. J Periodontol. 2023;11111. https://doi.org/10.1002/JPER.23-0305.
Melatonin supports nonsurgical periodontal treatment in patients with Type 2 diabetes mellitus and periodontitis: A randomized clinical trial. Sarac Gul Y, Kose O, Altin A, et al. J Periodontol. 2023; 1-10. https://doi.org/10.1002/JPER.23-0335.
Long-term outcomes and prognostic factors of surgical treatment of peri-implantitis – A retrospective study. Romandini M, Bougas K, Alibegovic L, Hosseini S, Carcuac O, Berglundh T, Derks J. Clin Oral Implants Res. 2023 Dec 19. doi: 10.1111/clr.14228. Epub ahead of print. PMID: 38112108.
Clinical outcomes of implant- versus abutment-level connection in screw-retained fixed dental prostheses: A 5-year randomized controlled trial. Toia M, Parpaiola A, Stevanello N, Tattan M, Saleh MHA, Ravidà A. Clin Oral Implants Res. 2023 Nov 27. doi: 10.1111/clr.14217. Epub ahead of print. PMID: 38012845.
Effect of periodontal therapy on glycaemic control in type 2 diabetes. Sato M, Ono S, Yamana H, Okada A, Ishimaru M, Ono Y, Iwasaki M, Aida J, Yasunaga H. J Clin Periodontol. 2024 Jan 3. doi: 10.1111/jcpe.13939. Epub ahead of print. PMID: 38171535.
Recombinant bone matrix maintains the graft space, induces vascularized bone regeneration and preserves canine tooth extraction socket structure. Okamura A, Hiratsuka T, Fushimi H, Nishimura I. J Clin Periodontol. 2023 Dec 18. doi: 10.1111/jcpe.13915. Epub ahead of print. PMID: 38110189.
Efficacy of Horizontal Alveolar Ridge Expansion Through the Alveolar Ridge Split Procedure: A Systematic Review and Meta-Analysis. Al Haydar B, Kang P, Momen-Heravi F.. Int J Oral Maxillofac Implants. 2023 Dec 12;38(6):1083-1096. doi: 10.11607/jomi.9972. PMID: 38085739.
Immediate Tooth Replacement in the Esthetic Zone with the Socket Shield Technique and a Novel Body-Shift Implant: A Pilot Study with Up to 3 Years of Follow-up. Gluckman H, Pontes CC, Chu S. Int J Periodontics Restorative Dent. 2023 Oct 24;(7):s107-s117. doi: 10.11607/prd.6446. PMID: 37552171.
Supportive care for the prevention of disease recurrence/progression following peri-implantitis treatment: A systematic review. Stiesch M, Grischke J, Schaefer P, Heitz-Mayfield LJA. J Clin Periodontol. 2023;50 Suppl 26:113-134. doi:10.1111/jcpe.13822.
Non-surgical therapy of peri-implant mucositis-mechanical/physical approaches: A systematic review. Verket A, Koldsland OC, Bunaes D, Lie SA, Romandini M.J Clin Periodontol. 2023;50 Suppl 26:135-145. doi:10.1111/jcpe.13789.
Efficacy of a novel three-step decontamination protocol for titanium-based dental implants: An in vitro and in vivo study. Costa RC, Takeda TTS, Dini C, Bertolini M, Ferreira RC, Pereira G, Sacramento CM, Ruiz KGS, Feres M, Shibli JA, Barāo VAR, Souza JGS. Clin Oral Implants Res. 2023 Dec 22. doi: 10.1111/clr.14224. Epub ahead of print. PMID: 38131526.
Ridge preservation using a self-retaining block type bone substitute for extraction sockets with buccal dehiscence defects – A preclinical study. Kwon YH, Song YW, Park JY, Cha JK, Thoma DS, Jung UW, Jung RE. Clin Oral Implants Res. 2023 Dec 21. doi: 10.1111/clr.14229. Epub ahead of print. PMID: 38126121.
Defect angle as prognostic indicator in the reconstructive therapy of peri-implantitis. Monje A, Pons R, Sculean A, Nart J, Wang H-L. Clin Implant Dent Relat Res. 2023; 25(6): 992-999. doi:10.1111/cid.13244.
Alveolar ridge changes 1-year after early implant placement, with or without alveolar ridge preservation at single-implant sites in the aesthetic region: A secondary analysis of radiographic and profilometric outcomes from a randomized controlled trial. Strauss FJ, Fukuba S, Naenni N, et al., Clin Implant Dent Relat Res. 2023; 1-13. doi:10.1111/cid.13297.
Long-term stability of gingival margin and periodontal soft-tissue phenotype achieved after mucogingival therapy: A systematic review. Carbone AC, Joly JC, Botelho J, Machado V, Avila-Ortiz G, Cairo F, Chambrone L. J Clin Periodontol. 2023 Nov 14. doi: 10.1111/jcpe.13900. Epub ahead of print. PMID: 37963451.
Effect of intraoral administration of parathyroid hormone on osseous and soft tissue healing around implants in ovariectomized rat maxillae. Al-Omari FA, Kuroshima S, Uto Y, Uchida Y, Sawase T. Clin Oral Implants Res. 2023 Dec 21. doi: 10.1111/clr.14227. Epub ahead of print. PMID: 38124678.
Abstracts
Topic: Soft tissue augmentation
Authors: Clem DS, McClain PK, McGuire MK, et al.
Title: Harvest graft substitute for soft tissue volume augmentation around existing implants: A randomized, controlled and blinded multicenter trial.
Source: J Periodontol. 2023;11111.
DOI: 10.1002/JPER.23-0305
Type: Randomized controlled trial
Reviewer: Trisha Nguyen-Luu
Keywords: dental implants, esthetics, grafts, pain, patient reported outcomes, patient satisfaction
Purpose: The purpose of this study is to compare the clinical outcomes of a volume-stable collagen matrix to a connective tissue graft when augmenting soft tissue around dental implants.
Material and methods: A total of 60 patients with a thin biotype that resulted in poor soft tissue contours for restoration and plaque control, minimal recession and had a final restoration ≥ 4 weeks prior. were included in this single blind, randomized controlled clinical trial. 31 patients were treated with a volume stable collagen matrix and another 31 patients were treated with connective tissue graft. The primary outcome evaluated is the change in soft tissue thickness 3 mm below the gingival margin. The secondary outcome evaluated is keratinized tissue width, pocket probing depth, pink esthetic score and patient reported outcomes.
Results: Based on this study there was no significant difference in keratinized tissue width, pocket probing depth, recession, gingival index, plaque score, bleeding of probing, texture and color based on the pink esthetic score between patients that received volume stable collagen matrix and connective tissue graft around the implants. The volume stable collagen matrix used was thicker and wider than the CTG harvested when treating the patients. Both groups resulted in significant improvement in grey show through from baseline to 1 year. At baseline, 75% of patients in both groups had grey show through with a periodontal probe and at 1 year approximately 90% of these patients had no show through. Volume stable collagen matrix resulted in 0.25 mm thinner peri-implant soft tissue compared to connective tissue graft 1 mm from the gingival margin. There was no significant difference in tissue thickness 3 mm below the gingival margin between the volume stable collagen matrix (0.93 mm) and connective tissue graft (1.10 mm). There was also no significant difference at 5 mm. Patients treated with the volume stable collagen matrix had significantly less post-operative pain and shorter surgical time by 7 minutes. The volume collagen matrix had 34% shrinkage from baseline to 6 months compared to 15% of the connective tissue matrix. However, from 6 months to 1 year, there was a 4% shrinkage for volume stable collagen matric compared to 10% shrinkage with connective tissue graft. The ability to visually see changes in soft tissue volume decreased as with volume changes less than 20 mm3.
Conclusions: This study found that soft tissue thickness changes did not relate to success and that the use of volume stable matrix was found to be noninferior to connective tissue graft in all clinical parameters and superior in terms of surgical time and post-operative pain.
Abstracter comment- this study was supported by Geistlich.
Topic: Non-surgical periodontal treatment
Authors: Sarac Gul Y, Kose O, Altin A, et al
Title: Melatonin supports nonsurgical periodontal treatment in patients with Type 2 diabetes mellitus and periodontitis: A randomized clinical trial.
Source: J Periodontol. 2023; 1-10.
DOI: 10.1002/JPER.23-0335
Type: Randomized Controlled Trial
Reviewer: Trisha Nguyen-Luu
Keywords: Diabetes Mellitus, host modulation therapy, matrix metalloproteinase, melatonin, non-surgical periodontal therapy, periodontitis, RANKL
Purpose: The purpose of this study was to determine the effect of melatonin supplementation as an adjunct to non-surgical periodontal treatment in diabetic patients diagnosed with periodontitis.
Material and methods: A total of 55 patients diagnosed with stage III/IV, grade C periodontitis and Type 2 diabetes (fasting plasma glucose greater than 126 mg/dL and a HbA1c level of more than 6.5%) were included in the study. 27 patients were treated with full mouth scaling and root planning alone and 28 patients were treated with 6 mg of melatonin daily for 30 days with full mouth scaling and root planning. Clinical parameters and biochemical parameters via gingival crevicular fluid were recorded at 3 and 6 months.
Results: The study found that adjunctive melatonin supplements significantly decreased gingival index, bleeding on probing and pocket probing depth at 3 months and plaque index and bleeding on probing at 6 months compared to full mouth scaling and planning alone. There was a significant decrease in gingival crevicular fluid volume at 3 months for both groups but the test group receiving melatonin with full mouth scaling root planning had a significant decrease compared to the control group. At 3 and 6 months gingival crevicular fluid MMP-8 and RANKL and serum IL-1B levels were significantly decreased in both groups. Only the full mouth scaling root planning control group had significantly lower OPG in the gingival crevicular fluid. Patients taking adjunctive melatonin supplement had a more significant decrease in MMP-8 and RANKL level and RANKL/OPG ratio at 3 months and a significant decrease only in serum IL-1B level at 6 months compared to patients that only received full mouth scaling and root planning.
Conclusions: Based on this study, full mouth scaling and root planning with adjunctive melatonin supplements results in significantly less gingival bleeding, pocket depths, MMP-8, RANKL and RANKL/OPG levels in the gingival crevicular fluids. It is hypothesized that melatonin decease proinflammatory mediators such as collagenases and RANKL-associated osteoclastogenesis which may decrease alveolar bone loss.
Topic: Long-term outcomes of peri-implantitis treatment
Authors: Romandini M, Bougas K, Alibegovic L, Hosseini S, Carcuac O, Berglundh T, Derks J
Title: Long-term outcomes and prognostic factors of surgical treatment of peri-implantitis – A retrospective study.
Source: Clin Oral Implants Res. 2023 Dec 19
DOI: 10.1111/clr.14228
Type: Retrospective cohort study
Reviewer: Erin Schwoegl
Keywords: disease recurrence, implant loss, implant survival, risk factors
Purpose: To assess prognostic factors associated with long-term outcomes of surgical treatment of peri-implantitis.
Material and methods: Included 149 patients with 267 implants with peri-implantitis. These patients underwent surgical treatment consisting of hese patients underwent surgical treatment consisting of decontamination with titanium curettes and gauze soaked in saline or 0.2% of chlorhexidine gluconate as well as osseous recontouring. Implant restorations were removed whenever possible.
Patient/ implant Characteristics of the patients and their implants were collected. Clinical and radiographic parameters were assessed at baseline. Patients were followed for an average of 7 years post-treatment. Data was used to predict 5- and 10-year rates of implant loss.
Results: There were 53 implants out of 267 that were lost (19.9%). Sixty-five of the surviving implants in 36 patients required surgical re-treatment. There were 95 implants (42.4%) of these implants with additional radiographic bone loss >1mm. A total of 141 implants (59.5%) in 83 patients (61.5%) were lost, retreated, and/or had recurrence of disease after treatment of peri-implantitis.
Conclusions: Disease recurrence of disease is common after surgical peri-implantitis treatment. The strongest prognostic factor for implant loss was the surface characteristics of the implant. Implant length, suppuration, and baseline disease severity were also important considerations.
Topic: Implant-level vs abutment-level connections
Authors: Toia M, Parpaiola A, Stevanello N, Tattan M, Saleh MHA, Ravidà A
Title: Clinical outcomes of implant- versus abutment-level connection in screw-retained fixed dental prostheses: A 5-year randomized controlled trial.
Source: Clin Oral Implants Res. 2023 Nov 27
DOI: 10.1111/clr.14217
Type: Randomized controlled trial
Reviewer: Erin Schwoegl
Keywords: abutment−/implant level, dental implant–abutment connection, dental implant–abutment design, osseointegration
Purpose: To compare marginal bone level (MBL) changes, soft tissue conditions, and complications associated with implant-level (IL) and abutment-level (AL) abutment connections.
Material and methods: The study included a total of 50 patients with 119 implants. Excluded patients with fully edentulous arches, major ridge defects, smoking habits >10 cigarettes/day, and uncontrolled systemic diseases. Patients underwent random allocation to either test group. Test groups consisted of IL or AL abutment connections. Implant placement surgery included full-thickness flaps and one quality/quantity was determined. Cover screws placed and implants were buried. Sites sutured with primary closure. Six weeks later, implants were uncovered, the cover screws were removed, and screw-retained abutments were placed. In the IL group, the cover screws were replaced with healing abutments. Impressions taken in both groups 1 week following uncovery. Definitive screw-retained prostheses installed 4-6 weeks later; this was considered baseline. Clinical and radiographic parameters obtained at 1-, 2-, 3-, and 5-years post-treatment.
Results: The IL group included 24 patients with 56 implants and the AL group had 24 patients with 59 implants. The implant survival rate was 100% for both groups. Three different lengths of abutments were used in the AL group: 1mm, 2mm, and 3mm. The 5-year MBL was 0.23 ± 0.64mm for the AL group and 0.23 ± 0.29 mm for the IL group. s was and 0.23 ± 0.29 mm, respectively. The trajectory of changes in MBL over time was comparable between the two groups. The 5-year PD was 2.91mm for AL and 3.51mm for IL; this difference was statistically significant, with the AL group showing shallower PDs. The 5-year %BOP was 44% for AL and 45.1% for IL; this difference was not statistically significant. The 5-year plaque level was 26.3 for AL and 34.4; this difference was not statistically significant. Both groups had a decrease in keratinized mucosa width (KMW) during the follow-up; <2mm of KMW not associated with an increase in MBL. For technical complications over 5 years, the AL group had 2 instances of screw loosening. In terms of biological complications, each group had a total of 3 incidences of peri-implant mucositis over the 5 years. All were successfully treated. No implants were diagnosed of peri-implantitis during the 5 years. For prosthetic complications, one IL patient had a chip fracture, and one AL patient had a veneer fracture (occurred 2x in same patient).
Conclusions: There was no difference in MBL changes between IL and AL abutment connections. Soft tissue conditions and other clinical parameters were comparable between the groups. While, the IL connections showed a greater PD, both groups were within normal healthy limits.
Topic: Perio on Glycemic Control
Authors: Sato, M., Ono, S., Yamana, H., Okada, A., Ishimaru, M., Ono, Y., Iwasaki, M., Aida, J., Yasunaga, H.
Title: Effect of periodontal therapy on glycaemic control in type 2 diabetes
Source: J Clin Periodontol. 2024 Jan 3. Epub ahead of print.
DOI: 10.1111/jcpe.13939
Type: Cohort study
Reviewer: Brook Thibodeaux
Keywords: glycemic control, health check-up, periodontal therapy, type 2 diabetes
Purpose: To analyze the variety of ways in which glycemic control is affected by periodontal therapy in patients with type 2 diabetes mellitus
Materials and methods: JMDC claims database was used to gather patients’ health insurance claims and annual checkup records, who met the following criteria: 1. Participated in an annual health checkup during 2018-2019, 2. Were enrolled in health insurance and were diagnosed at least 12months prior to the baseline health check-up with diabetes mellitus type 2. Patients who visited the dentist for reasons other than periodontal therapy and those less than 40 years old were excluded. Patients received periodontal treatment, including prophylaxis, scaling and root planning (SRP), curettage of periodontal pockets, interventions to prevent severe periodontitis, supportive periodontal therapy and periodontal surgery in-between baseline and the following checkup. 4279 patients had information collected for this study. Of these, 957 patients underwent periodontal treatment. The main outcome examined the change in HbA1c levels between baseline and the follow up health checkups.
Results: All participants in the exposure group received initial therapy consisting of prophylaxis. Additional therapy was received as needed. The average baseline HbA1c levels for the periodontal therapy group was 7.6% and for the no-dental-visit group it was 7.7%. 32.3% (1382 patients) had an HbA1c level of 6.5-7.5%, 41.3% (1767 patients) had an HbA1c level of 7.0-7.9% and 26.4% (1130 patients) had an HbA1c ≥8.0%. The mean follow-up health exam was 204.7 days following initiation of periodontal therapy. In the unweighted analysis, people who received periodontal care tended to have better glycemic control, with a -0.035 difference. In the subgroup analysis, patients with an HbA1c ≥7.0% plus periodontal therapy had increased glycemic control vs similar HbA1c patients in the nondental visiting group, with a statistically significant difference of -0.107. The weighted analysis results were similar amount the participants having a difference of -0.040. Improvement for patients with HbA1c level ≥7.0% in the periodontal therapy group were consistent in HbA1c, showing statistical significance.
Conclusion: In patients with diabetes, specifically those with an HbA1c of greater than or equal to 7, periodontal therapy can improve glycemic control.
Topic: Recombinant Bone Matrix
Authors: Okamura, A., Hiratsuka, T., Fushimi, H., Nishimura, I.
Title: Recombinant bone matrix maintains the graft space, induces vascularized bone regeneration and preserves canine tooth extraction socket structure.
Source: J Clin Periodontol. 2023 Dec 18. Epub ahead of print.
DOI: 10.1111/jcpe.13915.
Type: Animal Experiment
Reviewer: Brook Thibodeaux
Keywords: bone graft, bone regeneration, recombinant bone matrix
Purpose: To analyze the behavior in canine tooth extraction sockets of recombinant bone matrix graft.
Background: Autogenous bone graft contains both organic ECM and bone microstructure and makes it the gold standard for grafting. Autogenous grafting is accompanied by the disadvantages of additional surgical procedures, increased risk of infection, small quantity, and donor site morbidity. To oppose these obstacles, a recombinant peptide carrying the collagen triple- helix sequence containing multiple canonical RGD sequences based on the human type 1 collagen alpha 1 chain (RCPHC1) was engineered as an optimal bone graft material. Recombinant bone matrix (RBM) uses human type I collagen alpha chain as the sole material to synthesize granules with optimal porosity and microstructure.
Materials and methods: The canine tooth extraction model followed the published protocol of Araujo & Lindhe 2005, 2009. Beagle dogs participated and were assigned to the predetermined groups for mandibular harvest at 1, 3, and 6 months of healing, containing 3 dogs per group. 2 days before canine extraction, the plaque was removed with scalers. The dogs were sedated, anesthetized, the mandibular 3rd premolar site was cleaned with 20-fold iodine solution and the tooth was hemisectioned, the distal side extracted, and the mesial root was endodontically treated remaining in place. The extraction sockets were irrigated with saline, the hemisectioned mandibular 3rd molar was grafted with RBM, covered with a bio-gide collagen membrane and sutured. The opposite side extraction socket served as a non-grafted control. At assigned times, animals were euthanized, the formalin-perfused mandibles were excised and prepared for analysis. The effects if RMB were compared to that of deproteinized cancellous bovine bone (BCDD) and bovine atelocollagen plug (BACP), separately in the canine tooth extraction model at 3 months.
Results: The RBM was able to maintain the grafted socket space until new bone formed. At 1 month, the RBM grafted extraction socket buccal bone height was 94% preserved and the nongrafted buccal bone height was 91% preserved. At 3 months, RBM group was 90% and the control was 86% preserved. At 6 months the RBM socket was 88% and the control was 86% preserved. The L walls followed similar results. The most coronal extraction socket width was significantly more preserved by the RBM grafted site compared to the non-grafted site. The highly vascularized regenerated bone continued to mature and biosorption of RBM took place by 6 months. The height of the buccal and lingual alveolar ridge of the socket grafted with RBM was better preserved in comparison to the contralateral control, which was not grafted. Socket preservation by RMB was equally as effective in degree of preservation as BCDD.
Conclusion: Robust regenerative properties were seen with the bioabsorbable RMB engineered graft containing unique neovascularization and high biocompatibility with bone and gingival connective tissue.
Topic: alveolar ridge split procedure
Authors: Al Haydar B, Kang P, Momen-Heravi F
Title: Efficacy of Horizontal Alveolar Ridge Expansion Through the Alveolar Ridge Split Procedure: A Systematic Review and Meta-Analysis
Source: Int J Oral Maxillofac Implants. 2023 Dec 12;38(6):1083-1096.
DOI: 10.11607/jomi.9972
Reviewer: Amber Kreko
Type: systematic review and meta-analysis
Keywords: alveolar ridge augmentation, alveolar ridge split, dental implants, implant survival rate, narrow alveolar ridge, systematic review
Purpose: To determine the efficacy of horizontal alveolar ridge expansion and survival rates of implants in these sites when the alveolar ridge split (ARS) procedure was used.
Material and methods: An electronic and manual search was done for articles from January 1992 to January 2021. Two PICO questions were addressed: “What are the effects of the ARS technique on increasing alveolar width and implant survival?” and “What are the factors that influence the efficacy of the ARS technique?” Alveolar ridge gain, implant survival rate, and complication rate were the primary outcomes measured.
Results: Thirty-five studies were included in the review. For ARS, the mean alveolar ridge gain was 3.06mm and the implant survival rate was 98.17%. No significant difference was found between groups with (2.97mm) and without (3.06mm) bone grafting. A total of 4,446 implants were placed, 4,103 were placed at the time of ARS and 343 placed in a delayed approach with a 97.72% and 99.14% survival rates. Patients reported minor inflammation, gingival swelling, edema, and pain, but the majority were satisfied with their chewing ability, phonetic ability, and esthetic results.
Conclusions: An increase of horizontal alveolar ridge dimension with and without bone grafting and high implant survival was found with the ARS procedure. There were minimal patient-reported complications.
Topic: socket shield technique
Authors: Gluckman H, Pontes CC, Chu S
Title: Immediate Tooth Replacement in the Esthetic Zone with the Socket Shield Technique and a Novel Body-Shift Implant: A Pilot Study with Up to 3 Years of Follow-up.
Source: Int J Periodontics Restorative Dent. 2023 Oct 24;(7):s107-s117.
DOI: 10.11607/prd.6446
Reviewer: Amber Kreko
Type: clinical study
Keywords: socket shield technique, dental implants, esthetic zone
Purpose: In maxillary incisors, body-shift implants were placed in fresh extraction sockets with the socket-shield technique and the survival, complication rate, Pink Esthetic Score, and marginal bone loss were evaluated.
Material and methods: Fourteen maxillary central or lateral incisors were extracted with the socket shield technique and a body-shift implant was immediately placed. A provisional crown was fabricated, and the patients were followed up after 1 week and 3 months. At 6 months, final crowns were fabricated. Follow ups then ranged from 12 to 39 months and BOP, gingival biotype, clinical photographs and radiographs were taken. Implant survival, complication rate, marginal bone loss, and Pink Esthetic Score (PES) were the primary outcomes measured.
Results: Implant survival rate was 100%. One socket shield had a minor shield exposure and slight gingival inflammation at 6 months. Average marginal bone loss was 0.4mm and PES score had high esthetic outcomes with an average of 12.9.
Conclusions: The use of body-shift implants with socket shield technique has high esthetic outcomes and provides a stable alternative for immediate tooth replacement in the maxillary anterior preserving the facial and interproximal alveolar bone. A limitation of this approach is the high technical difficulty of the technique.
Topic: supportive peri-implant care
Authors: Stiesch M, Grischke J, Schaefer P, Heitz-Mayfield LJA
Title: Supportive care for the prevention of disease recurrence/progression following peri-implantitis treatment: A systematic review
Source: J Clin Periodontol. 2023;50 Suppl 26:113-134
DOI: 10.1111/jcpe.13822
Reviewer: Tam Vu
Type: systematic review
Keywords: supportive peri-implant care, peri-implantitis, efficacy
Purpose: to evaluate the efficacy of frequency and protocol of supportive care on peri-implantitis
Material and methods: An electronic database search was completed including studies through July 21 2022. The search focused on supportive care following treatment of peri-implantitis comparing to no supportive care, use of local antiseptic agents, and frequency of supportive care.
Results: Fifteen studies were included in this systematic review. Supportive peri-implant care (SPIC) following peri-implantitis treatment included mechanical plaque removal, oral hygiene instruction, and/or laser decontamination. No studies reported on supportive care with and without the use of local antiseptics. The recall frequency ranged from 2-3 monthly to once a year. However, no studies evaluated the effect of frequency of recall. Peri-implant tissue stability after SPIC varied and the recurrence of peri-implantitis was up to 70% in patients receiving SPIC with greater than 3 year follow up. While some studies show high survival rates in the medium to long term with SPIC, recurrence or progression of peri-implantitis may result in retreatment or implant removal.
Conclusion: Supportive peri-implant care after peri-implantitis treatment can help to prevent disease recurrence or progression. This systematic review was unable to identify 1) a specific supportive care protocol for secondary prevention of peri-implantitis, 2) the effect of adjunctive local antiseptic agents in the secondary prevention of peri-implantitis and 3) the impact of frequency of supportive care measures due to a lack of evidence. Recurrence may require retreatment or implant removal.
Topic: Peri-implant mucositis
Authors: Verket A, Koldsland OC, Bunaes D, Lie SA, Romandini M
Title: Non-surgical therapy of peri-implant mucositis-Mechanical/physical approaches: A systematic review
Source: J Clin Periodontol. 2023;50 Suppl 26:135-145
DOI: 10.1111/jcpe.13789
Reviewer: Tam Vu
Type: Systematic review
Keywords: non-surgical therapy, treatment, peri-implant mucositis
Purpose: To determine the treatment efficacy of peri-implant mucositis in terms of non-surgical therapy, superior treatment modalities, combination of treatments, and repetition of non-surgical therapy.
Material and methods: An electronic search focused on professionally administered non-surgical therapy, superior of treatment types, combination of therapies, and repetition of therapies. The outcomes measured were reduction of bleeding and probing depths, soft tissue level, onset of peri-implantitis, and bone loss.
Results: The treatment success rate after mechanical instrumentation ranged from 30.9 – 34.5% at 3 months compared to chitosan rotating brush and titanium curettes with 8.3 – 16.7% at 6 months. Reduction in bleeding on probing was 19.4 – 28.6% at 3 months for ultrasonic. Probing depths and soft tissue level remained stable at 3 months. No peri-implant bone loss observed at 6 months.
No studies reported on non-surgical therapy versus oral hygiene instructions alone or the effect of repeated therapy versus single administration. The studies comparing different procedures (glycine powder air-polishing, chitosan oscillating brush with titanium curettes, and diode laser therapy) with mechanical instrumentation found no significant difference. Also, there was no difference when treating with combination therapy, but one study found slightly higher reduction in bleeding with adjunctive use of diode laser.
Conclusion: There are several non-surgical techniques to treat peri-implant mucositis, which includes curettes, ultrasonics, lasers, rotating brushes, and air-polishing. There were no treatment methods that demonstrated superiority over one method, nor does a combination of these therapies provide added benefits.
Topic: Implant Decontamination protocol
Authors: Costa, R., Takeda, T., Dini, C., Bertolini, M., Ferreira, R., Pereira, G., Sacramento, C., Ruiz, K., Feres, M., Shibli, J., Barāo, V., Souza, J.
Title: Efficacy of a novel three-step decontamination protocol for titanium-based dental implants: An in vitro and in vivo study
Source: Clin Oral Implants Res. 2023 Dec 22.
DOI: 10.1111/clr.14224
Reviewer: Daeoo Lee
Type: Experimental
Keywords: implant, decontamination, peri-implantitis, biofilm, mechanical, chemical
Purpose: To introduce a 3-step nonsurgical implant surface decontamination protocol utilizing mechanical and chemical means that reduce biofilms and preserve the implant surface features.
Material and methods: The study comprises in vitro and in vivo experiments. In vitro tests were conducted on Titanium (Ti) discs to validate emerging mechanical and chemical protocols for decontamination. Mechanical decontamination protocol comprised instrumentation with Ti curette, Teflon curette, Ti brush, water-air jet, and Erbium (Er:YAG) laser. The chemical decontamination protocol comprised sterile saline, amoxicillin, minocycline, tetracycline, hydrogen peroxide, chlorhexidine, hydrocarbon-oxo-borate-based formula antiseptic, and sodium hypochlorite (NaOCI). In addition to the chemical and mechanical decontamination protocol, a pre-chemical therapy or biofilm matrix-degrading therapy using iodopovidone (PVPI) was conducted. After in vitro tests, an optimal protocol of combining PVPI treatment and mechanical/chemical treatment was tested in vivo. The optimal protocol comprises 3 steps: starting with mechanical debridement, followed by PVPI treatment, and finishing with chemical treatment. Four healthy subjects had palatal appliance with Ti discs for 3 days. Sucrose solution was applied to the Ti discs 4 times a day while the patient wore the appliance. After removal of the appliance on the 4th day, the established 3 step decontamination protocol was performed on random discs. Untreated discs act as control. To determine antimicrobial effectiveness of the treatment, colony forming units (CFU*) counts of treated discs were compared with the control. Statistical analysis was performed.
*CFU: unit used in microbiology to estimate number of cells in a sample.
Results: In terms of implant surface degradation, Ti brush, Ti curette, and Teflon curette generated significant surface damage. Er:YAG laser resulted in polished appearance whereas water-air jet yielded no implant surface alteration. All mechanical treatment options did not alter the roughness of the implant surface. In terms of corrosion performance, Er:YAG yielded the best result in the electrical and electrochemical test used for corrosion analysis. In terms of removing the most bacteria, Er:YAG laser and water-air jet were the most successful. The laser also slightly reduced recolonization and led to less virulent residual biofilm. In terms of effectiveness of chemical treatments, NaOCI yielded the best result in reducing bacterial load. Also, even though PVPI does not have a strong antimicrobial property by itself, when used as a pre-chemical therapy, it significantly improved the effectiveness of NaOCI. Combination of mechanical (Er:YAG laser), PVPI, and chemical (NaOCI) treatment yielded higher microbial elimination compared to each treatment being rendered by itself.
Conclusions: The 3-step protocol of mechanical debridement (Er:YAG laser), PVPI treatment, and chemical debridement (NaOCI) is an effective treatment option for peri-implantitis.
Topic: Ridge Preservation
Authors: Kwon, Y., Song, Y., Park, J., Cha, J., Thoma, D., Jung, U., Jung, R.
Title: Ridge preservation using a self-retaining block type bone substitute for extraction sockets with buccal dehiscence defects – A preclinical study
Source: Clin Oral Implants Res. 2023 Dec 21
DOI: 10.1111/clr.14229
Reviewer: Daeoo Lee
Type: Pre-Clinical experiment
Keywords: ridge augmentation, ARP, socket, self-retaining, block
Purpose: To assess the effectiveness of self-retaining synthetic bone block (srBB) for sockets with buccal dehiscence, in terms of dimensional stability at the coronal level.
Material and methods: Six male beagle dogs were recruited for the study. There were 4 groups for the experiment. Each group has a sample size of 6. The groups include 3 types of bone graft and a control group (no treatment). The 3 types of synthetic bone grafts materials (composed of 60% hydroxyapatite (HA) and 40% β-beta-tricalcium phosphate (β-TCP)) include: type 1 or particle bone (PBS), type 2 or collagenated soft block bone (csBB), and type 3 or srBB with macro pores. For each group, extraction sites were prepared by purposely removing 5×5 mm buccal plate. Bone graft materials were placed, and collagen membrane (CM) was used to cover the bone grafts. Primary wound closure was achieved. Sixteen weeks post-op, block specimens were collected including area surrounding each socket with bone graft. Micro-computed tomography (CT) was used to perform radiographic analyses. Histological analysis and statistical analysis were performed.
Results: Except for the control group, all groups with bone graft had wound dehiscence after 1-week post-op. Also, 3 sites of srBB group had significant exposure that resulted in a partial loss of bone graft; therefore, only 3 sites were included in the analysis. The radiographic analysis showed that the srBB group proved superior in terms of horizontal ridge width (AW) at all levels (distances from the CEJ), ranging 1-5 mm. In terms of vertical ridge height at post-op, srBB group showed the least amount of change in comparison with other groups. In terms of histometric analysis, srBB group had the most bone formation but also had the most residual bone material compared to other groups.
Conclusions: Self-retaining bone block showed to be highly effective for alveolar ridge preservation for providing horizontal and vertical dimensional stability. Further investigation is needed with better sample size.
Topic: Peri-implantitis defect regeneration
Authors: Monje A., Ramón P., Sculean A., Nart J., Wang HL.
Title: Defect angle as prognostic indicator in the reconstructive therapy of peri-implantitis
Source: Clin Implant Dent Relat Res. 2023;25:992–999.
DOI: 10.1111/cid.13244
Reviewer: Cyrus J Mansouri
Type: RCT
Keywords: biocompatible materials, dental implants, jaw, peri-implantitis, regeneration, wound healing
Purpose: To perform a secondary analysis of a randomized clinical trial on the influence of peri-implantitis bone defect-related features on the clinical resolution and radiographic bone gain in reconstructive therapy.
Material and methods: A total of 36 patients with 48 implants exhibiting contained peri-implantitis defects were recruited for the study. Peri-implantitis was defined as presence of bleeding and/or suppuration on gentle probing (~0.2 N), probing pocket depth (PPD) ≥ 6 mm, and radiographic bone levels ≥ 3 mm apical to the most coronal portion of the intraosseous part of the implant. Successful treatment was evaluated at the final 12-month evaluation as ≤ 1 spot of bleeding/suppuration on gentle probing, PPD ≤ 5 mm, no radiographic progressive bone loss within the standard error of 1 mm. Radiographic assessment was performed on periapical radiographs to determine marginal bone loss (MBL) as slight (S – defect < 25% implant length), moderate (M – defect 25%–50% of the implant length), or advanced (A – defect >50% of the implant length), intrabony defect width (DW), and angulation of intrabony defect (DA). Patients diagnosed with peri-implantitis were provided oral hygiene instructions and nonsurgical therapy at least 5-6 weeks prior to surgical reconstruction. Reconstructive surgery included a full-thickness flap for access, debridement of granulation tissue using a mini-five curette, Gracey curettes, and NiTi brushes, implantoplasty with a tungsten carbide bur in the presence of uncontained components of the defect, and decontamination by NiTi brushes for 2-3 min at 600 rpm followed by hydrogen peroxide (3%) for 2 min and irrigation with saline. Intrabony components were grafted using demineralized and mineralized cortical allograft to the adjacent bony peaks. Sites were either covered with a cross-linked collagen membrane or left to heal with no membrane. All sites healed via transmucosal healing. Patients were prescribed chlorhexidine and chitosan gel TID for 2 weeks and systemic amoxicillin 750 mg BID for 7 days. Patients also adhered to a 3-/4-month recall maintenance program.
Results: A total of 33 patients with 48 implants completed the study. Most implants exhibited moderate slight (27%) to moderate (58.3%) peri-implantitis defects. Disease resolution was obtained in 84.6% S, 75% M, and 71.4% A cases. The ORs of disease resolution for S, M, and A were 1, 0.55, and 0.46, respectively. DW and baseline MBL severity did not demonstrate statistical significance with bone gain. DA exhibited strong statistical significance with bone gain. For every addition of 1° of baseline DA, a negative implant of bone gain of 0.04 mm can be estimated. The mean DA of 40° in this study corresponded to 1.85 mm of bone gain. To obtain the mean bone gain of 1.72 mm, DA of < 45° was demonstrated to be necessary in this study. If ≥ 1 mm bone gain Is desired, DA must be < 57°, and if ≥ 2 mm is desired, a DA must be < 30°.
Conclusion: The effectiveness and magnitude of radiographic bone gain in reconstructive therapy of peri-implantitis relies greatly on baseline DA. For a consistent bone gain of 1.7-2.0 mm, the DA must be < 40°.
Topic: Alveolar bone contour
Authors: Strauss FJ., Fukuba S., Naenni N., Jung R., Jonker B., Wolvius E., Pijpe J.
Title: Alveolar ridge changes 1-year after early implant placement, with or without alveolar ridge preservation at single-implant sites in the aesthetic region: A secondary analysis of radiographic and profilometric outcomes from a randomized controlled trial
Source: Clin Implant Dent Relat Res. 2023;1–13.
DOI: 10.1111/cid.13297
Reviewer: Cyrus J Mansouri
Type: RCT
Keywords: alveolar ridge, alveolar ridge preservation, ARP, dental implants, early implant placement, GBR, guided bone regeneration
Purpose: To assess radiographic and profilometric outcomes of early implant placement with or without alveolar ridge preservation (ARP) after 1-year of loading.
Material and methods: A total of 75 patients with a failing tooth in the maxillary anterior planned for extraction were recruited and randomly assigned into the following groups: 1) ARP-CM (ARP with demineralized bovine bone mineral with 10% collagen (DBBM-C) and covered with a collagen matrix (CM, Mucograft)); 2) ARP-PG (ARP using DBBM-C covered with an autogenous soft tissue punch graft harvested from the palate; 3) Control (unassisted socket healing). Early implant placement was performed in all groups 8 weeks after tooth extraction. In cases of thin peri-implant buccal bone (< 2 mm), or dehiscence of the buccal plate, guided bone regeneration (GBR) was performed at the time of implant placement using locally harvested autogenous bone chips combined with DBBM granules, covered with a resorbable membrane, and closed tension-free. All implants were restored with single crowns and examined at 1-4 weeks after crown delivery, 6-months, and 1-year post-loading. Cone-bean computed tomography (CBCT) scans were made at 8 weeks after tooth extraction and 1-year post-loading. DICOM files from the CBCTs were imported into a software package and mid-sagittal and coronal sections were made to determine bone thickness at different levels of the alveolar bone, to determine presence of buccal bone, and to evaluate convexity of buccal bone 3 mm apical to the alveolar crest. Alginate impressions were taken at baseline and 1-year post-loading. Subsequent casts were scanned, and Standard Tessellation Language (STL) files were obtained to evaluate ridge contour changes between scans in mm.
Results: A total of 55 patients completed the study (ARP-CM 19; ARP-PG 17; Control 19). Mean alveolar ridge width change 3-mm and 5-mm from the ridge crest was -0.67 mm for ARP-CM, -0.33 mm for ARP-PG, and -0.74 mm for unassisted healing, and -0.58 mm for ARP-CM, -0.48 mm for ARP-PG, and -0.46 mm for unassisted healing, respectively. While changes were significant over time and the unassisted healing group was analyzed to heal in a different pattern than the ARP groups, additional cofounding factors such as GBR and residual bone height were considered in further analyses. Of the 55 patients, 24 received GBR at the time of implant placement (6/19 in APR-CM, 5/17 in ARP-PG, and 13/19 in unassisted healing). After adjusting for GBR, results demonstrated the magnitude of ridge changes depended on whether GBR was performed, where changes were attenuated if with the addition of a GBR procedure. Especially in the unassisted group, GBR led to pronounced attenuation compared to no GBR. In patients with ARP without additional GBR, the presence of bone convexity was 36% (9/25) at 1-year post-loading. For patients which received ARP and additional GBR, frequency of bone convexity was 72.7% (8/11). In patients with unassisted healing without GBR, the presence of bone convexity was 66.7% (4/6). In patients with unassisted healing with GBR at implant placement, the frequency of convexity was 61.5% (8/13). Mean changes in buccal ridge contour was 0.14 mm in ARP-CM, 0.15 mm in ARP-PG, and 0.26 mm in unassisted healing.
Conclusion: Early implant placement with ARP can attenuate alveolar changes at 1-year post-loading by minimizing radiographic and profilometric changes. However, early implant placement with simultaneous GBR yields a consistently superior radiographic and profilometric outcome, regardless of whether ARP was performed or not.
Topic: Marginal Stability following Root Coverage or Gingival Augmentation
Authors: Carbone, A. C., Joly, J. C., Botelho, J., Machado, V., Avila-Ortiz, G., Cairo, F., & Chambrone, L.
Title: Long-term stability of gingival margin and periodontal soft-tissue phenotype achieved after mucogingival therapy: A systematic review.
Source: Journal of clinical periodontology.2023
DOI: 10.1111/jcpe.13900.
Type: Systematic Review
Reviewer: Veronica Xia
Keywords: gingival marginal stability, mucogingival therapy, root coverage, gingival augmentation, free gingival graft, connective tissue graft
Purpose: This study evaluated the stability of gingival margin location, gingival thickness (GT), and keratinized tissue width (KTW) at >/= 5-year post-root coverage (RC) or gingival augmentation (GA) surgery sites, in addition to determining the effects of local factors on the stability of dental and gingival tissues. The following focus questions were asked: “What are the short- and long-term changes that affect the gingiva in sites that received RC and GA therapy?” and “Can soft-tissue phenotype modification therapy prevent the deterioration of dental and periodontal tissues in the long term?”.
Material and methods: Inclusion and exclusion criteria were detailed and applied to the 4195 articles first identified via electronic and hand searching. Risk of bias and methodological quality were assessed for the included studies, while the included data was analyzed and subject to statistical tests.
Results: After applying inclusion and exclusion criteria, 41 articles were included in this systematic review. 33 studies involved the use of RC procedures such as flap alone or in conjunction with autogenous, biologics, or substitutes in the treatment of gingival recession defects (GRD), over 5-20 year follow up periods. Overall analysis of the data showed the gingival margin being apically displaced over time. There was evidence of increased KTW of up to 1.56mm in subjects treated with autogenous connective tissue graft (CTG), while GT showed a decrease of 25-63.88% in subjects treated with either a coronally advanced flap (CAF) alone or CAF in conjunction with enamel matrix derivative (EMD). 8 studies investigated the use of GA procedures such as a free gingival graft (FGG) or soft-tissue substitutes, which were followed-up for 6.8-35 years. Evidence for creeping attachment (coronal migration of the gingival margin) was exhibited in patients with sufficient oral hygiene. The use of GA procedures allows for the modification of the gingival phenotype, which was shown to have a positive effect on KTW from baseline to follow-ups. In looking at GT, an increase of 20.2% in GT was observed when autogenous FGG was utilized. Evidence of improved comfort with toothbrushing was also evident in 79.54% of patients.
Conclusions: Overall, apical migration of the gingival margin occurs over time irrespective of surgical treatment performed. However, the more KTW present, the greater the gingival marginal stability. Specifically, utilization of autogenous grafts resulted in less RD increase, especially with FGGs that augment the gingival phenotype, resulting in improved gingival marginal stability.
Topic: PTH and Bone/Soft Tissue healing
Authors: Al-Omari, F. A., Kuroshima, S., Uto, Y., Uchida, Y., & Sawase, T.
Title: Effect of intraoral administration of parathyroid hormone on osseous and soft tissue healing around implants in ovariectomized rat maxillae.
Source: Clin Oral Implants Res. 2023.
DOI: 10.1111/clr.14227.
Type: Animal Study
Reviewer: Veronica Xia
Keywords: parathyroid hormone, intraoral, systemic, bone quantity, bone quality, soft tissue healing
Purpose: The primary objective of this study was to evaluate and compare the effects of local intraoral and systemic parathyroid hormone (PTH) on bone quality and quantity, in addition to soft tissue healing, specifically surrounding implants placed in rat maxilla models.
Material and methods: The study involved 2mm x 3.5mm titanium implants placed into 24 ovariectomized rats, modeled to simulate postmenopausal osteoporosis-like conditions. The rats were randomly categorized into receiving either local intraoral PTH via injection into the buccal vestibule or systemic subcutaneous human PTH via the neck dorsal skin area, with corresponding control groups for each group. After a 2-week administration period, the implant and surrounding bone were removed, and bone quality and quantity were analyzed via microcomputed tomography (microCT). Regarding bone quantity, bone volume fraction (BV/TV %), trabecular thickness (Tb.Th), trabecular separation (Tb.Sp mm), trabecular number (Tb.N), and bone mineral density (BMD). Bone quality was evaluated by staining and identifying osteocytes, osteoblasts, and osteoclasts. Connective tissue (CT) was also assessed to determine soft tissue healing. Various staining methods were utilized to assess collagen production, angiogenesis, and presence of macrophages.
Results: Within the intraoral group, bone mineral density, trabecular thickness, and bone volume fraction significantly increases, while trabecular separation was significantly decreased in the test versus the control group. Alternately, no significant differences were noted in any of the parameters when comparing test versus control in the systemic administration group. Observation of bone deposition between implant threads showed a significantly higher bone area fraction in both intraorally and systemically administered PTH groups. The administration of PTH also resulted in increased numbers of osteocytes, osteoblasts, and osteoclasts within the implant threads. Regarding soft tissue healing, the intraoral administration of PTH showed greater collagen production when compared to the systemic group, while both routes of administration of PTH resulted in increased angiogenesis.
Conclusions: There is evidence than administration of PTH results in improved bone quantity and quality surrounding implants, as well as superior soft tissue healing when compared to controls. Specifically, the intraoral administration of PTH results in more significant improvements in bone quality and soft tissue healing when compared to the systemic administration of PTH.