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Objective: The objective of the study was to compare resolution of inflammation of naturally occurring peri‐implant mucositis (PM) at tissue‐level (TL) and bone‐level (BL) implants after non‐surgical mechanical debridement. Materials and Methods: Fifty‐four patients with 74 Implants with PM were allocated in two groups (39 TL and 35 BL implants) and treated by means of subgingival debridement using a sonic scaler with a plastic tip without adjunctive measures. At baseline and at 1, 3, 6 months, the full‐mouth plaque score (FMPS), full‐mouth bleeding score (FMBS), probing depth (PD), bleeding on probing (BOP), and modified plaque index (mPlI) were recorded. The primary outcome was BOP change. Results: After 6 months, the FMPS, FMBS, PD, and number of implants with plaque decreased statistically significantly in each group (p <.05); however, no statistically significant differences were found between TL and BL implants (p >.05). After 6 months, 17 (43.6%) TL and 14 (40%) BL implants showed a BOP change in (17.9%) and (11.4%), respectively. No statistical difference was recorded between groups. Conclusions: Within the limitations of present study, the findings showed no statistically significant differences in terms of changes in clinical parameters following non‐surgical mechanical treatment of PM at TL and BL implants. A complete resolution of PM (i.e., no BOP at all implant sites) was not achieved in both groups. [ABSTRACT FROM AUTHOR]

Objectives: This randomized clinical trial assessed changes in protein biomarker levels and bacterial profiles after surgical reconstructive therapy of peri‐implantitis and investigated whether the adjunctive use of Er:YAG laser impacts protein biomarker and microbial outcomes. Materials and Methods: Twenty‐four patients received surgical reconstructive therapy for peri‐implantitis with guided bone regeneration following mechanical debridement with (test) or without (control) the adjunctive irradiation of Er:YAG laser. Bacterial and peri‐implant crevicular fluid (PICF) samples were collected over 6 months and analyzed with bacterial qPCR and luminex multiplex assays. Results: Surgical reconstructive treatment significantly affected the concentration of PICF protein biomarkers, including a 50% reduction in IL‐1β between 2 and 4 weeks (p <.0001). Both MMP‐9 (p <.001) and VEGF (p <.05) levels steadily decreased after treatment. In the laser group, the peak increase in IL‐1β was attenuated at 2 weeks, followed by significant reduction in MMP‐9 (p <.01) and VEGF (p <.05) across all follow‐up appointments compared with the control nonlaser group. The total bacterial load was reduced 2 weeks after treatment, especially in the laser group, but recolonized to presurgical levels after 4 weeks in both groups (p <.01). The composition of selective pathogens varied significantly over the follow‐up, but recolonization patterns did not differ between groups. Conclusions: Reconstructive therapy of peri‐implantitis significantly altered PICF protein biomarker and microbial levels during the healing process. The adjunctive use of Er:YAG laser significantly modulated the inflammatory response through reduced levels of MMP‐9 and VEGF during the postsurgical period. The bacterial load was reduced immediately after therapy, but recolonization was observed by 4 weeks in both groups. [ABSTRACT FROM AUTHOR]

Objectives: Examine the clinical and microbiological benefits of a dual-strain Lactobacillus reuteri probiotic on the non-surgical therapy of initial peri-implantitis., Materials and Methods: This randomized, double-blind study targeted patients with initial peri-implantitis, that is peri-implantitis with a maximum mean probing pocket depth of 6 mm and maximum 3 mm bone loss compared with loading. A full-mouth prophylaxis was performed and the peri-implantitis sites were debrided. Subsequently, local application of the study drops was carried out at the peri-implantitis sites and the study lozenges were handed out. The patients in the probiotic group received drops and lozenges containing L. reuteri (ATCC PTA 5289 & DSM 17938), those in the control group received placebo products. At the implant level the measurements of interest were bleeding, probing pocket depth and plaque. Full-mouth bleeding and plaque scores were also recorded. Microbiological samples were taken from the tongue, saliva and subgingivally around the implants., Results: All clinical parameters were significantly decreased after 12 and 24 weeks. At the implant level the only statistically significant difference was a greater decrease in plaque levels in the probiotic versus the control group (p = .002 at 24 weeks). At the full-mouth level, the only intergroup difference was the greater decrease in full-mouth bleeding on probing sites in the probiotic group compared with the control group (p < .001 at 24 weeks). Concerning the microbiological outcomes, no significant differences could be found at any time point, neither intra- nor intergroup., Conclusions: No adjunctive effects of the use of L. reuteri probiotics in the treatment of peri-implantitis were found., (© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objectives: This prospective, parallel‐group, examiner‐blinded, multicentre, randomized, controlled clinical trial aimed to assess the efficacy of an oscillating chitosan brush (OCB) versus titanium curettes (TC) on clinical parameters in the non‐surgical treatment of peri‐implantitis. Material and Methods: In five dental specialist clinics, 39 patients with one implant with mild to moderate peri‐implantitis, defined as 2–4 mm radiographic reduced bone level, bleeding index (BI) ≥ 2, and probing pocket depth (PPD) ≥ 4 mm were randomly allocated to test and control groups, receiving OCB or TC debridement, respectively. Treatment was performed at baseline and three months. PPD, BI, and Plaque index (PI) were measured at six sites per implant and recorded by five blinded examiners at baseline, one, three, and six month(s). Pus was recorded as present/not present. Changes in PPD and BI were compared between groups and analysed using multilevel partial ordinal and linear regression. Results: Thirty‐eight patients completed the study. Both groups showed significant reductions in PPD and BI at six months compared with baseline (p <.05). There was no statistically significant difference in PPD and BI changes between the groups. Eradication of peri‐implant disease as defined was observed in 9.5% of cases in the OCB group and 5.9% in the TC group. Conclusions: Within the limitations of this six‐month multicentre clinical trial, non‐surgical treatment of peri‐implantitis with OCB and TC showed no difference between the interventions. Eradication of disease was not predictable for any of the groups. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to evaluate the efficacy of a xenogeneic collagen matrix to augment the width of keratinized mucosa (KM), concomitantly to the surgical treatment of peri‐implantitis, when compared to the use of an autologous soft tissue graft. Material and methods: In this 12‐month parallel‐arm randomized controlled clinical trial, patients with peri‐implantitis were randomly assigned, one month after non‐surgical therapy, to surgical resective treatment of peri‐implantitis consisting on an apically positioned flap (APF) in combination with a KM augmentation procedure, either with an autologous free gingival graft (FGG) or a collagen matrix (CM). Primary outcomes were the increase in the width of KM and probing pocket depth (PPD) reduction at 12 months. As secondary outcomes, peri‐implant radiographic and patient‐reported outcomes were assessed. Results: The intention‐to‐treat population consisted of 49 subjects, assigned to either the APF + FGG (n = 23) or APF + CM (n = 26) group. PPDs were reduced by 1.6 mm (SD 1.0) and 1.7 mm (SD 1.2), respectively, being these differences non statistically significant (p =.782). However, the increase in KM was significantly higher in the APF + FGG compared with APF + CM (2.5 mm [SD 1.6] vs. 1.6 mm [SD 1.2], respectively (p =.033). Conclusion: The tested surgical modalities resulted in similar improvements of the clinical parameters. Both free gingival graft and collagen matrix significantly increased the peri‐implant keratinized mucosa, but this KM gain was significantly higher with the free gingival graft. Use of CM, however, was better appreciated by the patients, in terms of pain perception and analgesic consumption, although the surgical time was similar. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the influence of surgery start time (SST) and other patient‐ and therapy‐related variables on the risk for early implant failure (EIF) in an academic setting. Material and Methods: Data were extracted from the electronic health records of 61 patients who had at least one EIF and 140 age‐ and gender‐matched, randomly selected, non‐EIF controls. Bivariate and multivariable analyses were performed to identify relevant associations between EIF and different variables, such as SST. Results: Incidence of EIF was not significantly associated with SST (HR: 1.9 for afternoon implant placement, 95% CI: 0.9–3.9; p =.105). Other factors that were associated with a significantly increased risk for EIF in a multivariable model were pre‐placement ridge augmentation (HR: 7.5, 95% CI: 2.2–25.1; p =.001), intra‐operative complications (HR: 5.9, 95% CI: 2.2–16.3; p <.001), simultaneous soft tissue grafting (HR: 5.03, 95% CI: 1.3–19.5; p =.020), simultaneous bone grafting (HR: 3.7, 95% CI: 1.6–8.8; p =.002), and placement with sedation (HR: 3.4, 95% CI: 1.5–7.5; p =.002). Conclusions: While SST was not associated with the occurrence of EIF in our cohort, other variables, such as ridge augmentation prior to implant placement, simultaneous bone or soft tissue grafting, intra‐operative complications, implant placement with sedation, and number of implants in the oral cavity, were associated with an increased risk for this adverse event. [ABSTRACT FROM AUTHOR]

Objectives: To retrospectively evaluate the conditions of the peri‐implant tissues in treated patients with chronic periodontitis (CP) and in patients without chronic periodontitis (noCP). Materials and methods: A chart review was used to evaluate 267 implants, 134 placed in 42 CP treated patients and 133 placed in 46 noCP patients. The primary outcome was to evaluate the condition of the peri‐implant tissues (health, peri‐mucositis, and peri‐implantitis). The secondary outcome was to evaluate the possible association of some variables, such as, Plaque Index (PI), Bleeding Index (BI), probing pocket depth (PD), bleeding on probing (BoP), bone level (BL), loading time, type of implant placement and loading protocol, type of prosthesis, type of bone, implant manufacturer, and implant diameter and length, with the implant health condition. Results: The analysis of patient files revealed that after 10–15 years of loading (mean loading time 13.4 ± 2.07 years), six noCP patients (13%) experienced implant loss with a total of nine implants (6.7%) lost. The remaining 124 implants were classified: 54 (43.5%) as healthy, 45 (36.3%) with peri‐implant mucositis, and 25 (20.2%) with peri‐implantitis. Twelve CP subjects (28.5%) experienced implant loss with a total of 19 implants (14.1%) lost. The remaining 115 implants were classified: 34 (29.5%) as healthy, 40 (34.7%) with peri‐implant mucositis and 41 (35.6%) with peri‐implantitis. Compared with noCP subjects, only treated CP subjects with recurrent periodontal disease (RPD) showed differences statistically significant (p <.05). Conclusions: After 10–15 years of loading, in CP patients treated in a private practice setting, most implants (70.1%) were classified with some type of peri‐implant inflammation. In patients with RPD, a higher tendency for implant loss and peri‐implant biologic complications was found. [ABSTRACT FROM AUTHOR]

Objective: To retrospectively assess the interproximal bone loss (CBL) in external hexagon implants (EHI), with different surface micro‐topography, placed in the posterior mandible in patients with a history of periodontitis undergoing supportive periodontal care. Material and methods: 268 consecutive patients received 755 EHI implants in the mandibular molar region between 2007 and 2015 with the following surface characteristics: 72 turned, 145 hybrids (double acid‐etched/turned), and 538 anodized. CBL was yearly evaluated by analysing calibrated digital periapical radiographs, with a follow‐up of 1–6 years. Data on implant survival were also calculated. Results: At 6 years (53 patients), the mean CBL was 1.34/1.42 mm at patient/implant level, respectively (range: 0–5.2 mm). Significantly higher CBL was detected in anodized implants than in turned and hybrid implants (1.92/1.46/1.02 mm) (p <.01). The maximum CBL values were found in 2 anodized implants at 4 years (6.3 and 8.1 mm). CBL ≥2 mm was detected in 18% of implants at 3 years and 35% at 6 (p < 2.2 × 10−16), this prevalence being 2.6 times higher in the anodized than in the hybrid and turned group (40%/15.6%, p <.0094). At 6 years, 25 anodized implants presented CBL ≥3 mm (18%). 6 anodized implants (5 patients) were removed between 4 and 5 years. Conclusion: A significant higher CBL was observed in anodized, compared to hybrid and turned implants, when placed in the mandibular molar region of periodontal patients, with a follow‐up of 1 to 6 years. [ABSTRACT FROM AUTHOR]

Objectives: Conventional guided bone regeneration (GBR) limits the amount of bone graft due to limited soft tissue expansion. We hypothesize that the use of tissue expander will successfully augment soft tissue prior to bone graft, allowing for sufficient amount of grafting which will lead to a more stable and effective vertical bone graft. The authors aimed to evaluate effectiveness of the novel self‐inflating tissue expander for vertical augmentation in terms of soft tissue expansion, clinical outcomes, and related complications. Material and methods: A prospective, multicenter, randomized controlled trial was performed on patients requiring vertical augmentation. For experimental group patients, the tissue expander was subperiosteally implanted and followed by a tunneling bone graft without full flap reflection. Control patients underwent conventional vertical GBR. Primary objectives were to evaluate the dimensional changes of soft tissue and radiographic vertical bone gain and retention. As a secondary outcome, clinical complications and thickness changes of expanded overlying tissue were assessed and analyzed. Results: Twenty‐three patients in each group were included. During a 4‐week expansion, two of the experimental group showed over‐expansion and one showed mucosal perforation associated with previous severe scars. The other patients showed uneventful expansion and mean tissue augmentation was 6.88 ± 1.64 mm vertically. Ultrasonographic measurements of overlying gingiva revealed no thinning after tissue expansion (p >.05). Significantly higher vertical bone gain was shown in the experimental group (5.12 ± 1.25 mm) compared with that in the control patients (4.22 ± 1.15 mm; p <.05). After a 6‐month retention period, the mean vertical bone measurement of the controls had decreased to 1.90 mm (55.0% reduction), which was a significantly greater decrease than that in the experimental group (mean 3.55 mm, 30.7% reduction; p <.05). Conclusion: Our results demonstrated the effectiveness of tissue expanders followed by tunneling bone graft for vertical augmentation; however, studies comparing the two techniques without tissue expanders are needed to elucidate the net effect of tissue expansion. [ABSTRACT FROM AUTHOR]

Objectives: The aim of the present study was to establish a rodent peri‐implantitis model induced by a mixed bacterial infection characterized by bone loss and semi‐quantitative graduation of peri‐implant inflammation in histological sections. Materials and Methods: Two titanium implants were implanted in Sprague‐Dawley rats, bilaterally in each maxilla. After 3 weeks healing, the rats were randomized into three groups according to different treatments over the next 3 months: Antibiotic‐Group with oral lavage of antibiotics; Bacteria‐Group with oral lavage of Streptococcus oralis and Aggregatibacter actinomycetemcomitans; and Untreated Group with standard housing and no additional treatment. Maxillae were dissected to perform microscopic and histological analysis of bone height and peri‐implant tissues. Results: The bone level, measured at one implant site per animal, in the Bacteria‐Group (2.60 ± 0.39 mm) was significantly reduced compared to the Antibiotic‐Group (2.29 ± 0.32 mm) after 3 months. The differences of bone height in the Bacteria‐Group and the Untreated Group (2.46 ± 0.27 mm) did not reach statistical significance. The inflammatory response with respect to the number of inflammatory cells and fibrous tissue compartments of the peri‐implant tissues in the Bacteria‐Group was significantly increased compared with the Antibiotic‐Group (p <.05). S. oralis and A. actinomycetemcomitans DNAs were detected in the Bacteria‐Group. Conclusions: This rat model of peri‐implantitis used oral bacterial lavage for the induction of an inflammatory host response and bone loss. Additional bacterial treatment enhances the peri‐implant phenotype, so that significant differences to a reduced bacterial load similar to the human peri‐implantitis disease can be identified. [ABSTRACT FROM AUTHOR]

Objective: The aim of this systematic review was to identify, review, analyze, and summarize available evidence on the accuracy of linear measurements when using maxillofacial cone beam computed tomography (CBCT) specifically in the field of implant dentistry. Material and methods: The search was undertaken in April 2017 in the National Library of Medicine database (Medline) through its online site (PubMed), followed by searches in the Cochrane, EMBASE, ScienceDirect, and ProQuest Dissertation and Thesis databases. The main inclusion criterion for studies was that linear CBCT measurements were performed for quantitative assessment (e.g., height, width) of the alveolar bone at edentulous sites or measuring distances from anatomical structures related to implant dentistry. The studies should compare these values to clinical data (humans) or ex vivo and/or experimental (animal) findings from a "gold standard." Results: The initial search yielded 2,516 titles. In total, 22 studies were included in the final analysis. Of those, two were clinical and 20 ex vivo investigations. The major findings of the review indicate that CBCT provides cross‐sectional images that demonstrate high accuracy and reliability for bony linear measurements on cross‐sectional images related to implant treatment. A wide range of error has been reported when performing linear measurements on CBCT images, with both over‐ and underestimation of dimensions in comparison with a gold standard. A voxel size of 0.3 to 0.4 mm is adequate to provide CBCT images of acceptable diagnostic quality for implant treatment planning. Conclusions: CBCT can be considered as an appropriate diagnostic tool for 3D preoperative planning. Nevertheless, a 2 mm safety margin to adjacent anatomic structures should be considered when using CBCT. In clinical practice, the measurement accuracy and reliability of linear measurements on CBCT images are most likely reduced through factors such as patient motion, metallic artefacts, device‐specific exposure parameters, the software used, and manual vs. automated procedures. [ABSTRACT FROM AUTHOR]

Aim The primary aim of this study was to evaluate 23 pathogens associated with peri-implantitis at inner part of implant connections, in peri-implant and periodontal pockets between patients suffering peri-implantitis and participants with healthy peri-implant tissues; the secondary aim was to estimate the predictive value of microbiological profile in patients wearing dental implants using data mining methods. Material and Methods Fifty participants included in the present case─control study were scheduled for collection of plaque samples from the peri-implant pockets, internal connection, and periodontal pocket. Real-time polymerase chain reaction was performed to quantify 23 pathogens. Three predictive models were developed using C4.5 decision trees to estimate the predictive value of microbiological profile between three experimental sites. Results The final sample included 47 patients (22 healthy controls and 25 diseased cases), 90 implants (43 with healthy peri-implant tissues and 47 affected by peri-implantitis). Total and mean pathogen counts at inner portions of the implant connection, in peri-implant and periodontal pockets were generally increased in peri-implantitis patients when compared to healthy controls. The inner portion of the implant connection, the periodontal pocket and peri-implant pocket, respectively, presented a predictive value of microbiologic profile of 82.78%, 94.31%, and 97.5% of accuracy. Conclusion This study showed that microbiological profile at all three experimental sites is differently characterized between patients suffering peri-implantitis and healthy controls. Data mining analysis identified Parvimonas micra as a highly accurate predictor of peri-implantitis when present in peri-implant pocket while this method generally seems to be promising for diagnosis of such complex infections. [ABSTRACT FROM AUTHOR]

Objective To test whether or not pink veneering of the submucosal part of zirconia abutments influences clinical, microbiological and histological outcomes of cemented implant-supported single crowns ( ISSC). Materials and methods A total of 20 patients with one single-tooth implant in the esthetic zone were included. Implants were randomly restored with either pink-veneered zirconia abutments (test group; n = 10) or non-veneered white zirconia abutments (control group; n = 10) and with adhesively cemented all-ceramic crowns. At the 6-month follow-up, soft tissue biopsies were prepared for histological evaluation and microbiological samples were collected around abutments and the respective contra-lateral teeth (in 10 of 20 patients). One year after the initiation of loading, clinical parameters were assessed. Robust linear mixed model and cumulative linked mixed model analyses were performed to investigate the effect of group and time-point on clinical and biological outcomes. Results Clinical evaluations revealed stable peri-implant soft tissues in terms of probing pocket depth, but a high BOP index (87.5% control; 80.0% test). No statistically significant differences were observed between the test and control group for any outcome measure ( P > 0.05). No major biological complications occurred during the observation period. Histological samples revealed a remarkable degree of inflammation in both groups without clear differences in qualitative histological features. Microbiological evaluation demonstrated a slightly higher bacterial count at implants compared to natural teeth at one year of loading without marked differences between groups. Conclusion Limited by a small sample size and a relatively short observation period, pink-veneered zirconia abutments exhibited similar clinical, histological and microbiological outcomes as non-veneered zirconia abutments supporting cemented single crowns. [ABSTRACT FROM AUTHOR]

Objectives This retrospective cross-sectional study aimed to evaluate the prevalence of biologic complications of implants in patients treated by fixed implant supported prosthesis without regular maintenance program. Materials and methods One hundred thirty-four patients with 478 implants, installed during a 10-year period (2001-2010), were recruited for clinical and radiographic follow-up examinations. The periodontal and implant health status were assessed to determine the prevalence of peri-implant diseases. Results The mean ± SD loading time for implants was 4.43 ± 2.25 years. Fifty-five percentage of the implants were tissue-level implants. Peri-implantitis was diagnosed in 20% of patients and 8.8% of implants. Subject-based and implant-based prevalence of mucositis amounted to 48.5% and 40%, respectively. Mean crestal bone loss in tissue-level and bone-level implants were 0.28 ± 0.53 mm and 1.37 ± 1.5 mm, respectively. Smoking and lack of keratinized mucosa was associated with peri-implantitis at an odds ratio of OR = 2.57 and 3.89, respectively. Conclusions After a 5-year period of loading without any regular maintenance program, one out of five patients would experience peri-implantitis. Tissue-level implants had lower values of peri-implantitis prevalence and crestal bone loss. [ABSTRACT FROM AUTHOR]

Objectives The aim of this study was to investigate tissue destruction and inflammatory progression of ligature-induced peri-implantitis in mice and to establish an alternative murine model of peri-implantitis. Material and methods Sixty male C57 BL/6 NCrSlc mice (4-week-old) were used and the maxillary right first molars were extracted. Eight weeks after extraction, custom-made pure titanium machined screw type implants (0.8 × 1.5 mm) were placed, one implant per animal. Four weeks later, 5-0 silk ligatures were applied around implant necks to induce peri-implantitis. Animals were sacrificed at 0 (before ligature), 7, 14, 21 and 28 days after ligature. Half of the samples were analyzed radiologically and histologically to measure bone level change, osteoclast number, density, and distribution. The rest of the samples was used to determine the relative mRNA expression levels of IL-1 and TNF-α with RT- PCR analysis. Results Bone levels at all sites (buccal, palatal, mesial, distal) decreased 40-50% significantly 28 days after ligature ( P < 0.01). Osteoclast number at all post-ligature time points increased significantly ( P < 0.05). However, their density at day 28 decreased significantly compared to that of day 21 ( P < 0.05). Accordingly, IL-1 and TNF-α mRNA expression increased significantly at the early time points but decreased significantly at day 28 after ligature ( P < 0.05). Conclusions Inflammatory response followed by significant peri-implant bone resorption suggested 28 days ligation is sufficient to successfully induce peri-implantitis in the current mice model. This model might open a new avenue to study the pathogenesis and mechanism of peri-implantitis. [ABSTRACT FROM AUTHOR]

Objectives To assess the prevalence of peri-implant health or disease for a two-piece implant system with a tube-in-tube internal connection on the short-, medium- and long term. Material and methods For this cross-sectional analysis, 238 patients with a total of n = 512 implants were screened in six private practices and one university clinic in Germany. Peri-implant health and disease was assessed according to strict case definitions. Binary logistic regression was used to assess the correlation with systemic factors. Results After a median function time of 23 months, the prevalence of peri-implant mucositis and peri-implantitis amounted to 41.6% and 13.9%, corresponding to 35.6% and 7.6% at the implant level, respectively. Factors plaque (odds ratio [ OR], 8.415) and gender 'male' ( OR, 2.003) were significantly correlated with the event peri-implant mucositis. The event peri-implantitis was significantly correlated with plaque ( OR, 9.250) and smoking ( OR, 2.679). Conclusion The prevalence of peri-implant diseases was correlated with patient-specific factors. [ABSTRACT FROM AUTHOR]

Objectives The microbial composition of peri-implantitis-associated biofilms may resemble that of periodontitis, with some distinctive differences, as identified by various conventional or molecular detection methods. Yet, the complete microbiome of peri-implantitis awaits further characterization. The present clinical study was undertaken with the aim to investigate the association of Spirochaetes, and the more recently identified phylum Synergistetes, with peri-implantitis. Materials and Methods Submucosal biofilms were obtained from single sites of patients with peri-implantitis ( n = 43) or individuals with peri-implant health ( n = 41). The samples were analysed by fluorescence in situ hybridization ( FISH) and epifluorescence microscopy, using 16S rRNA-based oligonucleotide probes for Synergistetes cluster A, subclusters A1 and A2, and Treponema groups I- III and IV. Results Treponema group IV was barely detectable, whereas Treponema groups I- III were detected at low prevalence in health, but their prevalence and numbers were significantly increased in peri-implantitis by 48% and 2.4-log, respectively. Synergistetes cluster A was detected in half of the healthy sites, and its prevalence and numbers were significantly increased in peri-implantitis by 30% and 2.5-log, respectively. No quantitative differences were found between Synergistetes subclusters A1 and A2 numbers, as both increased by 2.8-log. Synergistetes cluster A displayed strong correlations with several clinical peri-implant parameters, but Treponema groups I- III only with probing pocket depth. Conclusion The present clinical cross-sectional study demonstrates that Spriochaetes of the Treponema groups I- III, but not group IV, and Synergistetes of the cluster A are highly associated with peri-implantitis. Synergistetes cluster A appears to display a stronger association with peri-implantitis than Spirochaetes. [ABSTRACT FROM AUTHOR]

Objectives Sinus augmentation is a standard procedure to increase vertical bone supply for dental implants in the atrophic posterior maxilla. Despite the longstanding application of this method, information about some basic factors that could potentially influence bone regeneration after sinus augmentation is rare. The objective of this study was therefore to quantify the impact of the maxillary region (premolar/molar) and patients' age and sex on bone regeneration after sinus grafting. Material and methods Sinus augmentation procedures were performed in 107 patients (66 female: 52.8 ± 11.0 years, 41 male: 50.6 ± 11.3 years). After 6 ± 1 months, 201 sinus biopsies were harvested and histomorphometrically analysed. Height (oldHt) and bone volume fraction of pristine bone (old BV/ TV), as well as the amount of new bone (new BV/ TV) and bone-to-bone substitute contact ( BBSC) in the augmentation area, were assessed. Results In women, new BV/ TV in the augmented sinus decreased significantly by 0.22 ± 0.08% per year. In men, no similar trend was observed. There were strong influences of the maxillary region and the dimensions of the host bone. In the premolar region, new BV/ TV was 23.1 ± 7.9% and 25.1 ± 10.1%; in the molar region, new BV/ TV averaged 20.4 ± 9.4% and 17.8 ± 8.8% for women and men, respectively. The greater the thickness of the wall of the sinus floor (mainly in the former premolar region), the greater was the amount of new bone tissue formed in the spaces in-between bone substitute particles. Conclusions These empirical results derived from a large human sample, link factors that influence the quality of biomaterial integration to the known clinical risks for the success of dental implants. [ABSTRACT FROM AUTHOR]

Objectives To assess a selection of host-derived biomarkers in peri-implant sulcus fluid ( PISF) and gingival crevicular fluid ( GCF) from adjacent teeth 10 years following implant placement. Material and methods Peri-implant sulcus fluid and GCF samples obtained from the deepest sites of 504 implants and 493 adjacent teeth were analysed for levels of interleukin ( IL)-1β, matrix metalloproteinase ( MMP)-3, MMP-8, MMP-1, and MMP-1 bound to tissue inhibitor of MMP ( TIMP)-1 ( MMP-1/ TIMP-1) by enzyme-linked immunosorbent assay ( ELISA) technique. Results Overall, MMP-8 was detected in 90% of the sites. In more than 50% of the sites, IL-1β was identified while in 30% of the sites MMP-1, MMP-1/ TIMP-1 and MMP-3 were found over the detection level. Increased biomarkers levels from PISF and GCF were positively correlated ( r = 0.375-0.702; P < 0.001). However, no qualitative and quantitative differences were found between PISF and GCF. The levels of MMP-1 were negatively correlated with those of MMP-1/ TIMP-1 at implants ( r = −0.644; P < 0.001). Median MMP-1 levels at implants were high (5.17 pg/site) in subjects with severe chronic periodontitis and low in patients with mild-to-moderate chronic periodontitis (0 pg/site; P = 0.026) or gingivitis (0 pg/site; P = 0.034). Levels of IL-1β were found to be different in GCF according to the periodontal conditions ( P = 0.001) with the highest level found in mild-to-moderate periodontitis (6.2 pg/site). Clinical attachment levels at implants demonstrated an inverse correlation with MMP-1/ TIMP-1 ( r = −0.147; P = 0.001). Conclusions Increased levels of MMP-8 and IL-1β in PISF or GCF may be associated with inflammation around teeth and implants while lower levels of MMP-1/ TIMP-1 may be an indicator of disease progression around implants. [ABSTRACT FROM AUTHOR]

Objective To determine the microbiota at implants and adjacent teeth 10 years after placement of implants with a sandblasted and acid-etched surface. Material and methods Plaque samples obtained from the deepest sites of 504 implants and of 493 adjacent teeth were analyzed for certain bacterial species associated with periodontitis, for staphylococci, for aerobic gram-negative rods, and for yeasts using nucleic acid-based methods. Results Species known to be associated with periodontitis were detectable at 6.2-78.4% of the implants. Significantly higher counts at implants in comparison with teeth were assessed for Tannerella forsythia, Parvimonas micra, Fusobacterium nucleatum/necrophorum, and Campylobacter rectus. Higher counts of periodontopathogenic species were detectable at implants of current smokers than at those of non-smokers. In addition, those species were found in higher quantities at implants of subjects with periodontitis. The prevalence of Prevotella intermedia, Treponema denticola, C. rectus, and moreover of Staphylococcus warneri might be associated with peri-implant inflammation. Selected staphylococcal species (not Staphylococcus aureus), aerobic gram-negative rods, and yeasts were frequently detected, but with the exception of S. warneri, they did not show any association with periodontal or peri-implant diseases. Conclusions Smoking and periodontal disease are risk factors for colonization of periodontopathic bacteria at implants. Those bacterial species may play a potential role in peri-implant inflammation. The role of S. warneri needs further validation. [ABSTRACT FROM AUTHOR]

Aim To examine the existing evidence in identifying risk indicators in the etiology of peri-implantitis. Material and methods A literature search was performed in MEDLINE via PubMed database of the US National Library of Medicine, for articles published until October 2014 using Medical Subject Heading search terms + free text terms and in different combinations. Results The microbiota associated with peri-implantitis is complex, demonstrating differences and similarities to the one seen at periodontitis sites. Plaque accumulation at dental implants triggers the inflammatory response leading to peri-implant mucositis/peri-implantitis. Individuals with a history of periodontal disease and smokers have an increased risk of developing peri-implantitis. There is some evidence to support the role of genetic polymorphism, diabetes, and excess cement as risk indicators for the development of peri-implantitis. There is also evidence to support that individuals on regular maintenance are less likely to develop peri-implantitis and that successful treatment of periodontitis prior to implant placement lowers the risk of peri-implantitis. Conclusions Plaque accumulation at implants will result in the development of an inflammation at implants. A history of periodontal disease, smoking, excess cement, and lack of supportive therapy should be considered as risk indicators for the development of peri-implantitis. [ABSTRACT FROM AUTHOR]

Aim To assess the presence of periodontal and opportunistic organisms in patients with peri-implantitis. Material and methods Thirty-three partially edentulous subjects (22 women, 11 men), aged 32-90 years, who had one or more implants with peri-implantitis were included. Peri-implantitis was defined as: (i) the presence of bleeding on probing and/or suppuration and (ii) radiographic images showed marginal bone loss >1.8 mm after 1 year in function. Criteria for inclusion were: (i) partially edentulous patients having at least one implant diagnosed with peri-implantitis; (ii) no antibiotic therapy for 6 months prior to clinical examination. Following this definition, a total of 48 implants were diagnosed with peri-implantitis. Subgingival bacterial samples were obtained with sterile paper points from infected implants and selected teeth of each individual. Periodontopathogens ( Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Tannerella forsythia and Treponema denticola) were detected by multiplex PCR targeting 16S rDNA. Samples were placed in reduced transport medium and cultured for opportunistic pathogens ( Staphylococcus aureus, enteric bacteria, Pseudomonas and yeasts). Results Twenty-two patients yielded positive results for P. gingivalis, 25 for T. forsythia, eight for P. intermedia and 13 for T. denticola. None of the patients yielded a positive result for A. actinomycetemcomitans. Non-periodontal species were found in five patients (15% of total). P. aeruginosa was found in four (12%) patients, and C. albicans (3%) and S. aureus in one patient (3%) each. In two cases of peri-implantitis, none of the periodontal or opportunistic microorganisms studied were detected in either implant or tooth samples. When results of the periodontopathic bacteria from the implant and tooth samples of the same patient were compared, 18 patients (54%) showed the same results for both samples and 15 (45%) patients different results. Conclusions The implant surface may be colonized with pathogens different from periodontal bacteria. Opportunistic pathogens such as P. aeruginosa, S. aureus and C. albicans may be associated with implant failure. [ABSTRACT FROM AUTHOR]

Objectives The aim of the present study was to evaluate the effect of novel silane system coatings on zirconia and titanium implant surfaces and the attachment of the fungal pathogen Candida albicans. Materials and methods Titanium and zirconia specimens were silica-coated and silanized either with a commercial silane primer (RelyX Ceramic Primer™, 3M ESPE) or a novel silane system primer. The novel silane system primer was a blend of 1.0 vol% 3-acryloxypropyltrimethoxysilane and 0.3 vol% bis-1,2-(triethoxysilyl)ethane diluted in acidified ethanol-water solvent. The surface roughness (Ra), the surface free energy and the chemical composition of substrate surfaces after treatments were evaluated. C. albcans biofilms were developed on silica-coated + silanized surfaces during 48 h of incubation time. Colony forming units ( CFU) and real-time PCR ( RT- PCR) quantified the cells on the material surfaces. Statistical analyses were carried out by 1-way ANOVA, Tukey post hoc and Games Howell post hoc test at 5% significance level (p). Results On zirconia and titanium surfaces, the Ra and the chemical composition of the specimens were equal ( P < 0.05). The surface free energy was decreased on titanium specimens and increased on zirconia specimen after silanization. CFU of C. albicans was significantly lower on zirconia coated with RelyX Ceramic Primer™, ( P < 0.001) and on titanium coated with both silanes ( P = 0.002). RT- PCR revealed no differences between the mean quantities of C. albicans ( P ≥ 0.067). Conclusion Silica-coating and silanization had modified the titanium and zirconia surfaces significantly. Both the control and experimental silane primers might inhibit the biofilm formation of C. albicans. [ABSTRACT FROM AUTHOR]

Objectives The aim of this study was to follow patient cases retrospectively in a longitudinal manner from the time of implant placement to the time they were diagnosed with peri-implant disease, and to identify associated clinical and microbiological features of peri-implant disease. Material and methods A total of 281 patient cases were chosen from the archives of the Oral Microbiological Diagnostic Laboratory, Gothenburg, Sweden, based on bacterial samples taken from diseased implants. A form was designed and filled in separately for each case including data on patient, implant and disease profile. Results Most cases were severe peri-implantitis cases (91.4%). In 41.3% of the patients, peri-implantitis was developed early, already after having implants in function less than 4 years. The type of implant surface was significantly associated with the time in years implants were in function, before disease was developed ( P < 0.05). The microbiological results by both culture and checkerboard analysis, although failed to fully correspond to the severity of the disease in terms of magnitude, proved to show that peri-implantitis is a polymicrobial anaerobic infection with increased number of AGNB (aerobic Gram-negative bacilli) in 18.6% of the patients. Conclusions Peri-implantitis is a biological complication of implants in function that poses a threat to their long-term survival. It may develop earlier around implants with rough surfaces and it may represent a true infection. Microbiological sampling methods should be improved and uniformed so as to fully unveil the microbiological profile of the disease. [ABSTRACT FROM AUTHOR]

Aim This 1-year prospective RCT compared the outcome of minimally (turned) and moderately rough (TiUnite®) implant surfaces. Material and methods Two subgroups of patients were formed; one group ( n = 10) where all teeth had been extracted due to severe periodontitis, another group ( n = 8) with teeth in the antagonistic jaw with a history of periodontitis and some remaining medium pockets (4-6 mm). Implants ( n = 85, 43 turned & 42 TiUnite®) were installed randomly in each patient. After 3-6 months of submerged healing, healing abutments were connected, followed by final abutments 2 weeks later, all with the same surface characteristics as the supporting implant. Peri-implant parameters and intra-oral radiographs were recorded up to 1 year after abutment connection. Results Two turned implants failed in the partial edentulous group during the initial healing period ( CSR: 95%) and none of the TiUnite® ( CSR: 100%) surface. No statistically significant differences in clinical parameters could be observed between both surfaces. The partial edentulous subgroup showed more bone loss compared to the full edentulous subgroup. Conclusion Moderately rough implants have a similar clinical outcome (at 1 year of loading in periodontitis susceptible patients) compared to minimally rough implants. [ABSTRACT FROM AUTHOR]

Background Most current implants have a moderately rough surface (compared with older minimally rough 'turned' implants) to facilitate osseointegration. This randomized controlled trial ( RCT), with split-mouth design, examined whether this increased surface roughness influenced the initial subgingival plaque formation. Material and methods Ten fully edentulous and eight partially edentulous patients, all with a history of severe periodontitis, received 4-6 implants (mandible or maxilla). Per jaw, both minimally (turned) and moderately rough ( TiUnite) implants ( MKIII; Nobel Biocare) were alternated. Also, the healing and final abutments had similar surface characteristics. Subgingival biofilm formation was followed up for 1 year, and samples were analyzed by culture technique, qPCR and checkerboard Results Over the entire period, no statistically significant differences could be detected in subgingival microbiota between the minimally and moderately rough surfaces. In partially edentulous patients, the biofilm matured to a higher concentration of pathogens when compared with fully edentulous patients. The subgingival implant composition and concentration in partially edentulous patients were comparable to the subgingival microbiota along teeth. Conclusion The roughness of the more modern implants did not influence the biofilm formation during the first year of implant loading. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the long-term morbidity of intraoral bone harvesting from two different donor sites (mandibular symphysis or ramus) for bone augmentation procedures before or at the time of implant placement and to evaluate the success and the survival rates of implants placed in sites augmented with mandibular bone. Methods: Seventy-eight patients who received mandibular bone grafts were recalled after 18-42 months follow-up (mean 29 months). The group consisted of 36 men and 42 women aged between 18 and 68 years old at the moment of augmentation surgery. Vitality of teeth adjacent to the harvesting sites was investigated. Soft tissue superficial sensory function was assessed by the Pointed-Blunt Test and the Two-Point-Discrimination Test. Implant health status was assessed measuring peri-implant probing depth and bleeding on probing. Implant survival and success rates were also calculated. In order to evaluate patients' perception of the morbidity of the procedures, the patients were asked to answer several questions by means of visual analogue scales (VAS). Results: Only two teeth (out of 282) in the chin harvesting group needed root canal treatment after surgery. A higher frequency of minor temporary and permanent sensorial disturbances was found in the group of patients who received chin harvesting procedures (2.3% vs. 13% P=0.03), while pain during chewing and bleeding were more frequently recorded after ramus harvesting (9.8% vs. 0% P=0.03). No permanent anesthesia of any region of the skin was reported. Implants' survival and success rate were comparable to implants placed in bone reconstructed with other techniques and were not influenced by the choice of the donor site. Patient's perception regarding the morbidity of the procedures was very low and did not differ between ramus and chin harvesting groups (mean VAS scores <4). Conclusion: The present cross-sectional retrospective study demonstrated the safety of mandibular grafts that reported excellent results in terms of implant success and survival rates with minor complications regarding the donor site area. When the chin was chosen as donor site, minor sensorial disturbances of mucosa and teeth were recorded. The majority of these disturbances were temporary; only few of them were permanent but still had no impact on patient's life. To cite this article: Cordaro L, Torsello F, Miuccio MT, Mirisola di Torresanto V, Eliopoulos D. Mandibular bone harvesting for alveolar reconstruction and implant placement: subjective and objective cross-sectional evaluation of donor and recipient site up to 4 years. Clin. Oral Impl. Res. 22, 2011; 1320-1326. doi: 10.1111/j.1600-0501.2010.02115.x [ABSTRACT FROM AUTHOR]

To study the prevalence and the degree of lingual concavity in the edentulous first molar region from cone beam computed tomography (CBCT) scans of the mandibles. Qualified cross-sectional images in mandibular first molar edentulous region taken from CBCT were selected. The mandible morphology 2 mm above the inferior alveolar canal (IAC) was classified into the convex (C), parallel (P) and undercut (U) type, based on the presence of lingual concavity and the shape of alveolar ridge. The prevalence of each group was determined. Subsequently, the lingual concavity characters, including the depth, the angulation and the vertical location were determined by the measurements of selected anatomic landmarks. One hundred and three subjects (mean age 51 with a range of 23.7-70.4 years) were studied. The U type was the most prevalent, accounting for 66% of the study population. The mean undercut depth and angulation at the level 2 mm above IAC were on average 2.4 mm and 57.7°. The mean vertical distances from the most prominent point (P) of the lingual concavity to the cemento-enamel junction of second premolar and the inferior border of the mandible were 11.7 and 14.9 mm, respectively. The anatomic location and the degree of the lingual concavity presented in this article add more information in implant treatment planning in the mandibular first molar edentulous region. Chan H-L, Brooks SL, Fu J-H, Yeh C-Y, Rudek I, Wang H-L. Cross-sectional analysis of the mandibular lingual concavity using cone beam computed tomography. Clin. Oral Impl. Res. , 2011; 201-206. doi: 10.1111/j.1600-0501.2010.02018.x [ABSTRACT FROM AUTHOR]

The Guided Bone Regeneration (GBR) treatment concept advocates that regeneration of osseous defects is predictably attainable via the application of occlusive membranes, which mechanically exclude non-osteogenic cell populations from the surrounding soft tissues, thereby allowing osteogenic cell populations originating from the parent bone to inhabit the osseous wound. The present review discusses the evolution of the GBR biological rationale and therapeutic concept over the last two decades. Further, an overview of the GBR research history is provided with specific focus on the evidence available on its effectiveness and predictability in promoting the regeneration of critical size cranio-maxillo-facial defects, the neo-osteogenesis potential and the reconstruction of atrophic alveolar ridges before, or in conjunction with, the placement of dental implants. The authors conclude that future research should focus on (a) the investigation of the molecular mechanisms underlying the wound healing process following GBR application; (b) the identification of site and patient related factors which impact on the effectiveness and predictability of GBR therapy and (c) the evaluation of the pathophysiology of the GBR healing process in the presence of systemic conditions potentially affecting the skeletal system. To cite this article: Retzepi M, Donos N. Guided Bone Regeneration: biological principle and therapeutic applications. Clin. Oral Impl. Res. 21, 2010; 567–576. doi: 10.1111/j.1600-0501.2010.01922.x [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the implant survival rate, periodontal and radiographic parameters of non-submerged screw implants with two different surfaces (TPS and SLA) in periodontally non-susceptible patients (NSP) and in patients with chronic adult periodontitis (CAP) or with generalized aggressive periodontitis (GAP). Material and methods: In 110 healthy partially edentulous subjects, 68 patients with CAP and 16 patients with GAP, a total of 513 implants were installed and followed for on average 48.1±25.9 months. Only fixed partial dentures were used as suprastructures. All patients were offered a supportive periodontal maintenance program. Smoking habits, health impairment, plaque score, bleeding on probing (BOP), type of surface, bone score, bone loss on radiographs and the number of failed implants were noted. Results: Implant survival in the NSP and CAP group was 98% and 96% after 140 months (NS), but only 80% after 100 months in the GAP group ( P=0.0026). The overall rate of implant loss was 4.7%, but 15.25% in the GAP group (6/16 patients). The average marginal bone loss for all implants was 0.12±0.71 mm on the mesial side and 0.11±0.68 mm on the distal side. Bone loss/year was 0.08±0.31 and 0.07±0.3 mm in the NSP group, but 0.17±0.2 and 0.17±0.19 mm in the GAP group. Only in the GAP group, was bone loss significantly related to BOP, age, inflammation, presence of plaque, probing depth. Implants with a TPS surface had a lower survival than implants with an SLA surface (93% vs. 97%; P=0.06), especially in the GAP group (80% vs. 83%; P=0.005). Smoking habits had a significant influence on implant survival only in the GAP group ( P=0.07), declining in current smokers to 63%, and to 78% in former smokers. Overall, impaired general health had no significant influence ( P=0.85). However, impaired health further reduced implant survival in the GAP group (survival: 71%). In a statistical model to predict the chance for implant failing, only periodontal classification ( P=0.012) and implant surface type ( P=0.027) were significant. Conclusion: Periodontally healthy patients and patients with CAP show no difference in peri-implant variables and implant survival rate, but patients with GAP have more peri-implant pathology, more marginal bone loss and a lower implant survival implant rate. SLA surface had a better prognosis than the TPS surface. [ABSTRACT FROM AUTHOR]

Background: To date, there are still no clear cut guidelines for the use of autogenous bone or bone substitutes. Aim: The aim of the present review was to analyze the current literature in order to determine whether there are advantages of using autogenous bone (AB) over bone substitutes (BS) in sinus floor augmentation. The focused question was: is AB superior to BS for sinus floor augmentation in partially dentate or edentulous patients in terms of implant survival, patient morbidity, sinusitis, graft loss, costs, and risk of disease transmission? Materials and methods: The analysis was limited to titanium implants with modified surfaces placed in sites with 6 mm of residual bone height and a lateral wall approach to the sinus. A literature search was performed for human studies focusing on sinus floor augmentation. Results: Twenty-one articles were included in the review. The highest level of evidence consisted of prospective cohort studies. A descriptive analysis of the constructed evidence tables indicated that the type of graft did not seem to be associated with the success of the procedure, its complications, or implant survival. Length of healing period, simultaneous implant placement or a staged approach or the height of the residual alveolar crest, sinusitis or graft loss did not modify the lack of effect of graft material on the outcomes. Three studies documented that there was donor site morbidity present after the harvest of AB. When iliac crest bone was harvested this sometimes required hospitalization and surgery under general anesthesia. Moreover, bone harvest extended the operating time. The assessment of disease transmission by BS was not a topic of any of the included articles. Discussion and Conclusion: The retrieved evidence provides a low level of support for selection of AB or a bone substitute. Clear reasons could not be identified that should prompt the clinician to prefer AB or BS. [ABSTRACT FROM AUTHOR]

Objective: Cytokine gene polymorphisms may modulate the host response to the bacterial challenge and influence susceptibility to peri-implantitis. Objective: To systematically review the evidence of an association between the interleukin-1 ( IL-1) composite genotype, i.e. presence of the allele 2 in the gene clusters IL-1A (−889) and in IL-1B (+3953), and peri-implantitis. Material and methods: An electronic search in the National Library of Medicine-computerized bibliographic database MEDLINE and a manual search were performed. The search was conducted for longitudinal clinical trials comparing progression of peri-implantitis in IL-1 genotype positive (carrying allele 2) with IL-1 genotype negative (not carrying allele 2) subjects. Selection of publications, extraction of data and validity assessment were made independently by two reviewers. Results: The search provided 44 titles of which two longitudinal publications were included. Conclusion: Based on the findings from this study, there is not enough evidence to support or refute an association between the IL-1 genotype status and peri-implantitis. Systematic genetic testing for the assessment of the risk of peri-implantitis cannot be recommended as a standard of care at this time. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this study was to compare the microbial composition of supra- and subgingival biofilm in subjects with and without peri-implantitis. Material and methods: Forty-four subjects (mean age 48.9 ± 13.51 years) with at least one implant restored and functional for at least 2 years were assigned to two groups: a peri-implantitis group ( n=22), consisting of subjects presenting peri-implant sites with radiographic defects >3 mm, bleeding on probing and/or suppuration; and a control group ( n=22), consisting of subjects with healthy implants. The clinical parameters evaluated were plaque index, gingival bleeding, bleeding on probing, suppuration, probing depth and clinical attachment level. Supra- and subgingival biofilm samples were taken from the deepest sites of each implant and analyzed for the presence of 36 microorganisms by checkerboard DNA–DNA hybridization. Results: Higher mean counts of Porphyromonas gingivalis, Treponema denticola and Tannerella forsythia were observed in the peri-implantitis group, both supra- and subgingivally ( P<0.05). The proportions of the pathogens from the red complex were elevated, while host-compatible beneficial microbial complexes were reduced in diseased compared with healthy implants. The microbiological profiles of supra- and subgingival environments did not differ substantially within each group. Conclusion: Marked differences were observed in the composition of supra- and subgingival biofilm between healthy and diseased implants. The microbiota associated with peri-implantitis was comprised of more periodontal pathogenic bacterial species, including the supragingival biofilm. [ABSTRACT FROM AUTHOR]

Objective: To review systematically whether supportive implant treatment during a follow-up of at least 10 years after functional loading is effective in prevention of biological complications and fixture loss. Methods: A MEDLINE search was conducted for the period of 1965 to April 2006 of longitudinal clinical studies with follow-up periods after implant function of at least 10 years. Sixty-two studies were initially screened for inclusion and read in full text. Nine studies remained for the final assessment and 53 articles were thus excluded for the following reasons: (1) no information on implant maintenance was presented, (2) the number of patients/implants assessed at 10-year follow-up/final evaluation was not presented (3) fixture loss and marginal bone loss during function were not assessed at 10-year evaluation and (4) residual inflammation and/or probing pocket depth (PPD) not assessed at 10-year examination. Results: Fifty-six percent of 62 initially screened studies did not assess clinical inflammation and PPD around implants at long-term evaluation of implants. This was the most common reason for exclusion of studies. In 28% of excluded studies, there was no information on implant maintenance during follow-up. A total of 749 fixtures were included and followed for more than 10 years of functional load. Five of the included studies gave no detailed information of the assessments or the treatment at follow-up visits during the 10 years. Only in two of the included cohorts were patients enrolled in an individualized supportive program on a 3–6-month recall interval. Conclusion: There are, to date, few available studies evaluating the long-term effect of supportive programs for implant patients. Based on the nine studies included, no evidence is available to suggest the frequency of recall intervals or to propose specific hygiene treatments. There is an urgent need for such studies to be initiated. [ABSTRACT FROM AUTHOR]

Objectives: To assess possible relationships between peri-implant crevicular fluid (PICF) volumes, biochemical markers of the peri-implant immune response, and periodontitis-associated genotype. Material and methods: PICF samples from 29 implant maintenance patients, 24 wearing overdentures, five having single crowns and bridgework (11 patients with peri-implantitis and 18 individuals with healthy peri-implant conditions), were analyzed for per site and per crevicular-fluid-volume concentrations of interleukin-1β, plasminogen activator inhibitor type 2, and prostaglandin E2 by ELISA. Associations between the three substance concentrations and to crevicular fluid flow rate were analyzed by linear regression analysis. The possible differentiating influence of the composite interleukin-1A and -1B genotype on the patients' peri-implant health and biochemical inflammatory status was checked formally with t-test statistics and the Wilcoxon' test. One implant per patient was chosen for analysis. Results: In patients with healthy peri-implant conditions, genotype-positive individuals showed elevated crevicular fluid flow rates and at the same time reduced mediator concentrations. In patients with an implant affected from peri-implantitis, no statistically significant influence of the periodontitis-associated genotype around the fixture can be stated. There was no statistical difference between per site and per crevicular-fluid-volume concentration analyses. All three mediator concentrations were positively related to each other, while there was a strong negative correlation between crevicular fluid volume and plasminogen activator inhibitor 2 or prostaglandin E2. Conclusions: The Interleukin-1 polymorphism investigated exerted only little influence on the peri-implant crevicular immune response, and this influence appeared to be of limited impact in sites with established peri-implantitis lesions. [ABSTRACT FROM AUTHOR]

A comparison between host response in teeth and dental implants was not made. Likewise, the association between host response and periodontal parameters has never been explored. The purpose of this study was to compare periodontal health around natural teeth and dental implants with different restorative platforms. Twenty-seven partially edentulous patients with dental implants, either external hex butt joint ( n=28) or tapered Morse ( n=45), were included in this study. Implants were in function for 1–6 years (mean 2.9). Plaque index (PI), gingival index (GI), probing depth (PD); and clinical attachment level (CAL), were recorded at final examination; alveolar bone loss (ABL) was measured at baseline and final examination using panoramic radiographs. Gingival crevicular fluid samples were obtained from the Ramfjord index teeth and all implants and assayed using enzyme-linked immunosorbent assay for prostaglandin E2 (PGE2), interleukin-1 (IL-1) and tumour necrosis factor α (TNFα). Differences between teeth and implants and between the two implant platforms were compared using Student's t-test. Correlations between cytokines, ABL and clinical parameters were analyzed using Pearson's co-efficient test. PI and GI were significantly higher in teeth than dental implants (1.2±0.5 vs. 0.8±0.5, P=0.0018; 1.2±0.3 vs. 1.1±0.3, P=0.048). Conversely, PD was deeper in implants (2.66±0.6 vs. 3.66±0.9, P=0.001). GI and PD around teeth and implants were positively associated ( R=0.561, P=0.0023; R=0.39, P=0.0452). Greater ABL was observed around dental implants (1.62±2.2 mm) compared with teeth (0.49±0.3 mm). A positive correlation was found between both IL-1 ( R=0.73, P=0.0064; R=0.52, P=0.0081) and TNFα ( R=0.64, P=0.0246; R=0.46, P=0.091) and ABL in teeth and implants. Both implant platforms were similar clinically and radiographically; however, TNFα (2.49±0.3 vs. 4.79±0.5, P=0.004) and IL-1 (24.52±7.3 vs. 45.41±9.9, P=0.095) were higher for the non-submerged implants. In conclusion, IL-1 and TNFα are sensitive markers of ABL around teeth and implants. The two dental implant platforms showed a similar clinical and radiographic response; however, the greater host response in the non-submerged implants might suggest future bone loss. [ABSTRACT FROM AUTHOR]

Background: From an ecological viewpoint, the oral cavity, in fact the oro-pharynx, is an ‘open growth system’. It undergoes an uninterrupted introduction and removal of both microorganisms and nutrients. In order to survive within the oro-pharyngeal area, bacteria need to adhere either to the soft or hard tissues in order to resist shear forces. The fast turn-over of the oral lining epithelia (shedding 3 ×/day) is an efficient defence mechanism as it prevents the accumulation of large masses of microorganisms. Teeth, dentures, or endosseous implants, however, providing non-shedding surfaces, allow the formation of thick biofilms. In general, the established biofilm maintains an equilibrium with the host. An uncontrolled accumulation and/or metabolism of bacteria on the hard surfaces forms, however, the primary cause of dental caries, gingivitis, periodontitis, peri-implantitis, and stomatitis. Objectives: This systematic review aimed to evaluate critically the impact of surface characteristics (free energy, roughness, chemistry) on the de novo biofilm formation, especially in the supragingival and to a lesser extent in the subgingival areas. Methods: An electronic Medline search (from 1966 until July 2005) was conducted applying the following search items: ‘biofilm formation and dental/oral implants/surface characteristics’, ‘surface characteristics and implants’, ‘biofilm formation and oral’, ‘plaque/biofilm and roughness’, ‘plaque/biofilm and surface free energy’, and ‘plaque formation and implants’. Only clinical studies within the oro-pharyngeal area were included. Results: From a series of split-mouth studies, it could be concluded that both an increase in surface roughness above the Ra threshold of 0.2 μm and/or of the surface-free energy facilitates biofilm formation on restorative materials. When both surface characteristics interact with each other, surface roughness was found to be predominant. The biofilm formation is also influenced by the type (chemical composition) of biomaterial or the type of coating. Direct comparisons in biofilm formation on different transmucosal implant surfaces are scars. Conclusions: Extrapolation of data from studies on different restorative materials seems to indicate that transmucosal implant surfaces with a higher surface roughness/surface free energy facilitate biofilm formation. [ABSTRACT FROM AUTHOR]

Objectives: To assess the microbiological outcome of local administration of minocycline hydrochloride microspheres 1 mg (Arestin®) in cases with peri-implantitis and with a follow-up period of 12 months. Material and methods: After debridement, and local administration of chlorhexidine gel, peri-implantitis cases were treated with local administration of minocycline microspheres (Arestin®). The DNA–DNA checkerboard hybridization method was used to detect bacterial presence during the first 360 days of therapy. Results: At Day 10, lower bacterial loads for 6/40 individual bacteria including Actinomyces gerensceriae ( P<0.1), Actinomyces israelii ( P<0.01), Actinomyces naeslundi type 1 ( P<0.01) and type 2 ( P<0.03), Actinomyces odontolyticus ( P<0.01), Porphyromonas gingivalis ( P<0.01) and Treponema socranskii ( P<0.01) were found. At Day 360 only the levels of Actinobacillus actinomycetemcomitans were lower than at baseline (mean difference: 1 × 105; SE difference: 0.34 × 105, 95% CI: 0.2 × 105 to 1.2 × 105; P<0.03). Six implants were lost between Days 90 and 270. The microbiota was successfully controlled in 48%, and with definitive failures (implant loss and major increase in bacterial levels) in 32% of subjects. Conclusions: At study endpoint, the impact of Arestin® on A. actinomycetemcomitans was greater than the impact on other pathogens. Up to Day 180 reductions in levels of Tannerella forsythia, P. gingivalis, and Treponema denticola were also found. Failures in treatment could not be associated with the presence of specific pathogens or by the total bacterial load at baseline. Statistical power analysis suggested that a case control study would require approximately 200 subjects. [ABSTRACT FROM AUTHOR]

Background: Periodontitis and peri-implantitis are linked to the presence of several key pathogens. The treatment of these infectious processes therefore involves the reduction/eradication of bacteria associated with periodontitis. Methods: This prospective, split-mouth, single-blind study followed the colonization of ‘pristine’ sulci created in 42 partially edentulous patients during implant surgery (e.g. abutment connection). The hypothesis was that the composition of the maturing subgingival plaque in these ‘fresh’ peri-implant pockets would soon (within 2 weeks) be comparable to the subgingival microbiota of teeth with similar clinical parameters (reference sites), including the presence of bacteria associated with periodontitis. Per patient, four subgingival plaque samples were taken from shallow and medium pockets around implants (test sites), and teeth within the same quadrant (undisturbed microbiota as control sites), 1, 2, 4, 13, 26 and 78 weeks after abutment connection, respectively. The samples were analysed by either checkerboard DNA–DNA hybridization, or cultural techniques, or real-time polymerase chain reaction (PCR) for intra-subject comparisons (teeth vs. implant, for comparable probing depths). Results: Checkerboard DNA–DNA hybridization and real-time PCR revealed a complex microbiota (including several pathogenic species) in the peri-implant pockets within 2 weeks after abutment connection. After 7 days, the detection frequency for most species (including the bacteria associated with periodontitis) was already nearly identical in samples from the fresh peri-implant pockets (5% and 20% of the microbiota belonging to red and orange complex, respectively) when compared with samples from the reference teeth. Afterwards (e.g. between weeks 2 and 13), the number of bacteria in peri-implant pockets only slightly increased (±0.1 log value), with minor changes in the relative proportions of bacteria associated with periodontitis (8% and 33% of the microbiota belonging to red and orange complex, respectively). Although small differences were seen between teeth and implants at week 2 with cultural techniques, a striking similarity in subgingival microbiota was found with this technique from month 3 on, with nearly identical detection frequencies for bacteria associated with periodontitis for both abutment types. Conclusions: This study indicates that the initial colonization of peri-implant pockets with bacteria associated with periodontitis occurs within 2 weeks. [ABSTRACT FROM AUTHOR]