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OBJECTIVES This narrative review was prepared for the 2017 World Workshop of the American Academy of Periodontology and European Federation of Periodontology to address key questions related to the clinical condition of peri-implant mucositis, including: 1) the definition of peri-implant mucositis, 2) conversion of peri-implant health to the biofilm-induced peri-implant mucositis lesion, 3) reversibility of peri-implant mucositis, 4) the long-standing peri-implant mucositis lesion, 5) similarities and differences between peri-implant mucositis at implants and gingivitis at teeth, and 6) risk indicators/factors for peri-implant mucositis. METHODS A literature search of MEDLINE (PubMed) and The Cochrane Library up to and including July 31, 2016, was carried out using the search strategy (peri-implant[All Fields] AND ("mucositis"[MeSH Terms] OR "mucositis"[All Fields])) OR (periimplant[All Fields] AND mucosits[All Fields]). Prospective, retrospective, and cross-sectional studies and review papers that focused on risk factors/indicators for peri-implant mucositis as well as experimental peri-implant mucositis studies in animals and humans were included. FINDINGS Peri-implant mucositis is an inflammatory lesion of the soft tissues surrounding an endosseous implant in the absence of loss of supporting bone or continuing marginal bone loss. A cause-and-effect relationship between experimental accumulation of bacterial biofilms around titanium dental implants and the development of an inflammatory response has been demonstrated. The experimental peri-implant mucositis lesion is characterized by an inflammatory cell infiltrate present within the connective tissue lateral to the barrier epithelium. In long-standing peri-implant mucositis, the inflammatory cell infiltrate is larger in size than in the early (3-week) experimental peri-implant mucositis lesion. Biofilm-induced peri-implant mucositis is reversible at the host biomarker level once biofilm control is reinstituted. Reversal of the clinical signs of inflammation may take longer than 3 weeks. Factors identified as risk indicators for peri-implant mucositis include biofilm accumulation, smoking, and radiation. Further evidence is required for potential risk factors, including diabetes, lack of keratinized mucosa, and presence of excess luting cement. CONCLUSIONS Peri-implant mucositis is caused by biofilm accumulation which disrupts the host-microbe homeostasis at the implant-mucosa interface, resulting in an inflammatory lesion. Peri-implant mucositis is a reversible condition at the host biomarker level. Therefore, the clinical implication is that optimal biofilm removal is a prerequisite for the prevention and management of peri-implant mucositis. An understanding of peri-implant mucositis is important because it is considered a precursor for peri-implantitis.

Background: The osseointegration could revert unpredictably into a pathological process, resulting in inflammation and progressive bone loss causing peri-implantitis onset and implant failure. Even though the implant macro-design was created to accelerate the osseointegration pro- cess, it might be considered one of the implant- based factors contributing to peri-implantitis onset. Location and region of implant placement, as well as time in function, could be also proposed to affect peri-implantitis onset. Aim/Hypothesis: The study aimed to evaluate if implant macro-design parameters including implant body shape, number and shape of implant threads, and implant collar design compared to implant time in function could influence peri-implantitis onset. Material and Methods: 139 systematically healthy patients (55.17 ± 11.2 years old) with diagnosed an early or moderate stages of peri- implantitis on one or more endosteal or transmucosal implants were included in the study. Several clinical parameters (peri-implant probing depth, PPD, clinical attachment level, CAL, keratinized tissue width, KTW, plaque index, bleeding on probe), and implant based- factors such as implant location and region, and time in function (Tf) were evaluated and compared. Tf was defined as the time interval betw een implant loading and detection of peri-implantitis. In addition, implant macro-design parameters including implant shape (conic or cylindric), shape and number of implant threads, and implant collar design (polish or micro-threads) were assessed and compared to clinical data and Tf. All data were analysed using SPSS 20.0. A p-value less than 0.05 was considered statistically significant. Results: Peri-implantitis occurred approximately about 6.1 ± 3.4 years after implant loading. Statistical analyses failed to find a correlati on between patients' ages and implant macro- design regarding peri-implantitis incidence. Results demonstrated that implants with a cylinder shape as well as implants with tripe- threads had statistically significant higher rates of peri- implantitis in the posterior part of the mandible (P = 0.037, P = 0.012). "V"-shaped threads were found on all examined implants with diagnosed peri-implantitis. There was a statistically sig- nificant correlation between implant macro-design and Tf. Threads number and implant shape had a statistically significant influence on CAL and PPD increase, regarding Tf (P < 0.05). Longer Tf until peri- implantitis diagnosis could affect KTW decrease around implants with collar micro-threads (P < 0.001). Conclusion and Clinical implications: Peri- implantitis could be defined as a time- dependent disease. Clinical parameters exacerbation with further bone loss could be related to a prolonged time of peri- implantitis diagnosis as well as implant macro-design. Consequently, implant body design, thread number and shape, and collar design might be considered as possible implant- based risk factors in peri-implantitis onset and progression.

Background : Socket shield technique was introduced by Hurzeler and associates in year 2010., which is used at immediate implantation in order to preserve buccal wall bone. During tooth extraction, buccal root with periodontal ligament should be left in alveola and implant is inserted little bit towards palatal wall bone, in direct contact with buccal part of the root. As written above preservation of buccal bone and soft tissues has a huge influence on esthetic outcome of implant prosthetic work. Aim/Hypothesis : The aim of this clinical study was to investigate clinical success of the socket shield technique and to evaluate its outcome 6 years after surgical and prosthetic rehabilitation. Materials and Methods : This clinical study constituted of 30 patients with strong indication for tooth extraction in the frontal part of the maxilla. Patients were divided due to their clinical indications: Postendodontic horizontal tooth fracture where the fracture line is prosper enough to preserve buccal tooth root and immediate implant placement ; Postendodontic submarginal fracture when patient rejects orthodontic tooth extrusion ; Crown fracture of vital tooth beyond the marginal bone surface. In each group consisted of 10 patients. Partial resection of palatal root was performed in each patient with a view to preserve buccal root as well as buccal bone wall. Before implant was inserted a buccal root was smeared with Emdogain gel. Immediate crowns were made. After 4 months a permanent implant- prosthetic substitute was made, while x- ray analysis was made after 6 months, 4 years and after 6 years and esthetic (PES) evaluation has been made on clinical photo. Results : Patients did not have any kind of complications after surgery. Immediate crowns were replaced with permanent tooth crowns after 4 months. Soft tissue contours were preserved in all cases, also buccal bone wall was preserved after 6 months and after 4 and 6 years. In a period of following 6 years there were one biological complication regarding peri- implantitis after 5 years and that implant was lost. There were mechanical complications with 4 patients regarding screw loosening. All mechanical complications occured after 1 year in function and were resolved in one visit. The mean PES of evaluations after 6 years in function were 12.23 (±3.7 SD) regarding 12.78 after 6 months post implant and crown placement. Conclusions and Clinical Implications : With buccal bone wall preservation as well as a preservation of gingival tissue using technique of immediate implant placement, very good esthetic results were achieved. By deciding which patients are candidates for this surgery indications and guidelines written above need to be followed.

Background : A recent series of animal studies employing a canine model investigated the efficacy of extracted tooth roots for lateral alveolar ridge augmentation and two- stage implant placement Histological, immunohistochemical and micro- computed tomographic analyses of various outcome measures did not reveal any significant differences between tooth roots and autologous bone grafts used for lateral ridge augmentation (Becker et al., 2017 ; Schwarz et al., 2016 ; Schwarz et al., 2016). Aim/Hypothesis : The aim of this pilot clinical study was to assess efficacy and predictability of autologous tooth roots for lateral alveolar ridge augmentation and two- stage implant placement. Materials and Methods : In this pilot clinical case series, a total of 15 patients with 20 defects were included. Inclusion criteria were : age 18 to 60 years, candidate for lateral ridge augmentation, insufficient bone ridge width at the recipient site for implant placement, sufficient bone height at the recipient site for implant placement and healthy oral mucosa. Preoperative CBCT was made for every patient. After surgical removal of impacted tooth or periodontally compromised tooth and during the same surgery, the crown was decapitated at the cemento- enamel junction using a rotating carbide bur under water cooling and the exposed pulp was preserved. The separated tooth root was adapted to match the size and shape of the bone defect area. Grafts were drilled and fixed using one to two titanium osteosynthesis screw. After 6 months of healing commercially available Straumann BLT titanium implants were inserted and 3 months after screw- retained crowns were made. Results : After 6 months post implantation CBCT scans were obtained as part of the standard procedure. The radiographic images of the target areas revealed no signs for a graft separation from the recipient site. Clinical re- entry confirmed a homogeneous integration of tooth root grafts in the former defect area. This was evidenced by a firm graft connection to the host bone and a circumferential hard tissue formation. After 6 months CBCT scans were obtained as part of the standard procedure. The radiographic images of the target areas revealed no signs for a graft separation from the recipient site. Clinical re- entry confirmed a homogeneous integration of tooth root grafts in the former defect area. This was evidenced by a firm graft connection to the host bone and a circumferential hard tissue formation. In follow up period 1 year after there was no complications regarding implants or crowns. Conclusions and Clinical Implications : Within its limitations, the present pilot clinical study revealed that autologous tooth roots may serve as an alternative graft to support lateral alveolar ridge augmentation and two- stage implant placement.

Background : Peri- implantitis is an disease affecting the soft and hard tissue around implants, resulting in the loss of supporting bone. With the increasing popularity of zirconia dental implants, the need for effective and predictable decontamination protocols of the implant surfaces is becoming more and more important. Aim/Hypothesis : The aim of this study was to evaluate the effect of antimicrobial photodynamic therapy and light- activated disinfection on contaminated zirconia dental implants and investigate if the PDT and LAD cause implant surface alterations Materials and Methods : Seventy- two zirconia dental implants were contaminated with a bacterial suspension prepared from three different bacteria. After contamination, the implants were randomly divided into four test groups ( n = 12) according to the decontamination protocol- Group 1 (PDT1)- PDT (660 nm, 100 mW) with toluidine blue ; Group 2 (PDT2)- PDT (660 nm, 100 mW) with phenothiazine chloride dye ; Group 3 (LAD)- light emitting diode (LED) with toluidine blue ; Group 4 (TB)- toluidine blue without the application of light. In addition two control groups were used- the positive control (PC) group were treated with a 0.2% chlorhexidine- based solution, and implants assigned to the negative control (NC) group, did not receive any treatment.. The implants were analyzed using scanning electron microscope (SEM) to evaluate the possible surface alterations due to the PDT or the LAD protocols. Results : All study groups reduced the number of CFUs significantly compared with the NC ( P < 0.05) with more than 99% bacterial reduction. PDT1, the PDT2 and the LAD groups had the largest bacterial reduction, and were more efficient compared with the TB group ( P < 0.05). SEM analysis did not reveal any alterations of the implant surface after the treatment procedures. Conclusion and Clinical Implications : Both PDT protocols and the LAD showed high and equal effectiveness in decontamination of zirconia dental implants. Further clinical studies are needed in order to establish a clear and effective decontamination protocol of the zirconia implant surfaces using PDT or LAD.

Background : As dental implants are becoming a common dental treatment option, there is also an increase in the frequency of peri- implantitis. The main cause of peri- implantitis is considered to be the microorganisms living on the implant surface. The goal of treating peri- implantitis is to stop the inflammatory process and the bone loss that occurred as a result of the disease. Aim/Hypothesis : The aim of this study was to evaluate and compare the effect of antimicrobial photodynamic therapy and light- activated disinfection on contaminated titanium dental implants. In addition Scanning Electron Microscopy analysis was done to evaluate possible surface alterations on the implant surfaces. Material and Methods : The study was conducted on 72 titanium dental implants contaminated with a bacterial suspension prepared from three different bacterial species and were incubated in anaerobic conditions for 72 hours. The implants were randomly divided into four experimental groups and two control groups ( n = 12 each), according to the following treatment protocols- Group 1 (PDT1)- PDT with toluidine blue ; Group 2 (PDT2)- PDT with phenothiazine chloride dye ; Group 3 (LAD)- light emitting diode (LED) with toluidine blue ; Group 4 (TB)- treatment with only toluidine blue. In the positive control (PC) group, the implants were treated with a 0.2% chlorhexidine- based solution, and in the negative control (NC) group, no treatment was used. After microbiologic analysis, one random implant was chosen from each of the treatment groups, and one sterile nontreated implant was chosen for scanning electron microscopy (SEM). Results : The highest bacterial reduction was recorded in the PDT1 (98.3%) and PDT2 (97.8%) groups both having statistically significant reduction compared to NC group (

Background : A human periodontal ligament fibroblast cell line showed a very promising growth reaction to the mineralized dentin. The mineral and organic matrix compositions of a tooth, dentin, and cementum are almost identical to membranous bone, although, compared to bone, teeth contain more mineral. This feature may be beneficial for volume maintenance since at the remodeling stage dentin graft is resorbed slowly. As a supplement of bone graft material, dentin particulate autograft could be beneficial. Aim/Hypothesis : The aim of this pilot clinical study was to assess efficacy and predictability of dentin particulate autograft as regenerative treatment for alveolar ridge augmentation and two stage implant placement using CBCT radiographic analysis. Materials and Methods : The sample of presented study consisted of 8 patients, with insufficient width of alveolar ridge in lateral lower jaw. After surgical removal of third molar or periodontally compromised tooth, a dentin autograft was prepared according to manufacturer recommendations. Clean extracted teeth were dried and ground in a sterile chamber of the Smart Dentin GrINDIAr ® unit (KometaBio Inc., Cresskill, USA). The particulate teeth were immersed in a basic alcohol cleanser to dissolve all organic remnants and bacteria and dehydrated. The particles were rinsed twice with sterile phosphate- buffered saline solution. The platelet- rich fibrin (PRF) membranes were prepared. Graft material was used for ridge augmentation and covered with PRF membranes. After 5 months of healing CBCT scan were made. During implants placement homogeneous integration of dentin particulate was found. Dental implants (BEGO Semados ® SC BEGO, Germany) were inserted and restored by titanium abutment and zirconia crown. Results : Clinical re- entry, prior to dental implants placement confirmed a homogeneous integration of dentin autograft and bone- like appearance in former grafted area. Six months after implants placement CBCT scans were obtained as part of the standard procedure. The radiographic images of the target areas revealed no grafted bone resorption around the implants. All patients were followed for 6 months after loading through clinical follow- ups and control CBCT scans. No resorption of the autograft around inserted implants were found. Conclusions and Clinical Implications : Within its limitation, the present pilot clinical study revealed that autologous dentin particulate autograft may serve as an alternative autologous bone substitute to support alveolar ridge augmentation and two- stage implant placement.

Background : Bone healing processes following osteotomy may vary according to the type of selected surgical procedures. Frictional heat caused by traditional bur osteotomies may result in thermal osteonecrosis if the temperature arises above the critical temperature of 47º C. Therefore, less invasive and precise tools for bone tissue surgery with reduced collateral tissue thermal trauma, force and friction are developed: laser- assisted bone surgery and piezoelectric surgery. Aim/Hypothesis : The purpose of the present in vivo experimental study was to determine the thermal changes of the bone tissue following osteotomies performed by piezoelectric surgery, surgical drill and Er:YAG laser- assisted ablation used in contact and NO- contact modes using infrared thermographic camera. Materials and Methods : A total number of 24 Wistar rats were randomly divided into 4 groups, each consisting of 6 rats (I- sacrificed immediately after surgery ; II- 7 days after surgery ; III- 14 days after surgery ; IV- 21 days after surgery). Osteotomies on both rat ' s tibiae were performed under general anesthesia and always in the same sequence: digitally controlled NO- contact Er:YAG laser (7.5 W, 750 mJ, 10 Hz, QSP mode), piezosurgery (round diamond tip, 1.2 mm diameter, average pressure 15 N), low- speed surgical drill (1200 rpm, round steel surgical bur 2 mm diameter) and contact Er:YAG laser (H- 14N handpiece, fiber of core diameter of 940 μm, 7.5 W, 375 mJ, 20 Hz, MSP mode). The osteotomies were 5 mm away from each other and ~2 mm deep, with a diameter ranging between 1.5–2.0 mm. Temperature measurements during each osteotomy were done using an infrared thermographic camera with a detection range of - 20º to + 650º C, a thermal sensitivity of < 50 mK, and IR resolution of 320x240 pixels. Results : For each osteotomy a thermal camera movie was recorded and movie frames were extracted as thermal camera images, and the position of the osteotomy was determined by visual inspection. Temperature readout was performed for this point in all recorded movie frames, providing the information on the temperature at the position of osteotomy while osteotomy was performed. Time evolution of the bone temperature at the point of osteotomy was measured. For each measurement, baseline temperature (Tbase), and maximum temperature measured during the osteotomy (Tmax) were determined. ΔT=Tmax- Tbase was then calculated for each measurement. Mean baseline temperature for each group of osteotomies was 29.96°C for non- contact laser, 27.98°C for contact laser, 28.34°C for surgical drill and 29.39°C for piezosurgery. Mean Tmax for contact laser was 29.92 °C (ΔT=1.94 °C), for non- contact laser was 79.11°C (ΔT=49.15 °C), for surgical drill was 27.36°C and 29.15 °C (ΔT=- 0.24 °C) for piezosurgery. Conclusions and Clinical Implications : The results of the present study showed beneficial effects of the piezosurgery and Er:YAG laser used in contact mode of working on heat generation of bone tissue during osteotomy, reducing potential overheating of the bone as registered by means of infrared thermography. Digitally controlled non- contact Er:YAG laser results in the production of temperature that is higher than the allowed border for bone tissue during osteotomy.

Background : Socket shield technique was introduced by Hurzeler and associates in year 2010., which is used at immediate implantation in order to preserve buccal wall bone. During tooth extraction, buccal root with periodontal ligament should be left in alveola and implant is inserted little bit towards palatal wall bone, in direct contact with buccal part of the root. As written above preservation of buccal bone and soft tissues has a huge influence on esthethic outcome of implant prosthetic work. Aim/Hypothesis : The aim of this clinical study was to investigate clinical success of the socket shield technique and to evaluate its outcome 4 years after surgical and prosthetic rehabilitation. Material and Methods : This clinical study constituted of 21 patients with strong indication for tooth extraction in the frontal part of the maxilla. Patients were divided due to their clinical indications: 1. Postendodontic horizontal tooth fracture where the fracture line is prosper enough to preserve buccal tooth root and immediate implant placement 2. Postendodontic submarginal fracture when patient rejects orthodontic tooth extrusion. 3. Crown fracture of vital tooth beyond the marginal bone surface, but patient is not willing to access orthodontic therapy or conservative treatment. In each group consisted of 7 patients. Partial resection of palatal root was performed in each patient with a view to preserve buccal root as well as buccal bone wall. After resection alveolar bed for implant, located more palatal regarding on buccal root left in alveola, was prepared. Before implant was inserted a buccal root was smeared with Emdogain gel (Straumann, Basel, Switzerland). After all, immediate crown was made following non- functional loading concept. Patients were threaded with antibiotic therapy during 7 days after surgery. After 4 months a permanent implantoprosthetic substitute was made, while x- ray analysis was made after 6 months and after 4 years all patients were controlled by x - ray analysis and esthethic evaluation has been made. Results : Patients did not have any kind of complications after surgery. Immediate crowns were replaced with permanent tooth crowns after 4 months. Soft tissue contours were preserved in all cases, also buccal bone wall was preserved after 6 months and after 4 years. In a period of following 4 years there were no biological complications. There were only mechanical complications with 4 patients regarding screw loosening. All complications occured after 1 year in function and were resolved in one visit. Conclusions and Clinical Implications : With buccal bone wall preservation as well as a preservation of gingival tissue using technique of immediate implant placement, very good esthetic results were achieved. By deciding which patients are candidates for this surgery indications and guidelines written above need to be followed.

Background : Bone drilling is a common step of an everyday procedure in dental implantology. Frictional heat from these osteotomies may result in thermal necrosis of bone. Bone temperature must be below the temperature of 47°C during drilling to avoid thermal osteonecrosis. Many factors (drill design, drilling parameters, coolant delivery) contribute to heat generation during osteotomy. Consequently, superior methods of bone tissue surgery, which would enable reduced collateral tissue thermal trauma, force and friction, has been developed including erbium laser ablation and piezoelectric surgery. Aim/Hypothesis : The purpose of the present experimental study was to determine the thermal changes of the bone tissue following osteotomies performed by piezoelectric surgery, and Er:YAG laser ablation used in contact and non- contact modes using infrared thermographic camera. Material and Methods : A total number of 24 Wistar rats were used in this study, randomly divided into 4 groups, based on the post- operative duration of survival of the animals. Osteotomies on both rat ’ s tibiae were performed under general anaesthesia by an intraperitoneal injection of thiopental sodium. Four osteotomies were performed always in the same sequence: digitally controlled non- contact Er:YAG laser (X- Runner™, Fotona, Slovenia), piezosurgery (Piezomed, W&H Dentalwerk Burmoos GmbH, Austria) and contact Er:YAG laser (LightWalker ® , Fotona, Ljubljana, Slovenia). The osteotomies were 5 mm away from each other and 2 mm deep, with a same diameter. Temperature measurements during each osteotomy were done using an infrared thermographic camera (FLIR T335, FLIR Systems Pty Ltd, Australia) with a detection range of −20°C to +650°C, a thermal sensitivity of

Background: Bruxism and muscular temporomandibular dysfunctions (TMD) are common in patients and are considered as a contraindication for implant prosthetic treatment. The reason for this is a high percentage of implant failure, as well as biological and technical failures on implant-retained prosthetic restorations. The standard treatment in patients diagnosed with bruxism and muscular TMD includes fabrication of an occlusal splint, which should be made of a suitable material with a precise fit and allow precise occlusal contacts. Aim of the study: The purpose of this paper is to present two clinical cases indicating benefits of CAD/CAM occlusal splint fabrication immediately after implant prosthetic treatment, as an everyday procedure for the purpose of extending implant life and reducing the possibility of biological and mechanical failures of implant-retained prosthetic restorations. Materials and methods: Bruxism and muscular TMD were diagnosed in the two patients by means of clinical functional analysis before the implant treatment. Implant-retained prosthetic restorations were made and fabrication of an occlusal splint was initiated. Impressions of the upper and lower jaw were taken for fabrication of dental stone casts. Interarch relationships were registered using the face bow and centric registration, and eccentric registrations were taken for articulator individualization. The occlusal splint was fabricated by means of the Ceramill CAD/CAM system (AG, Germany). The casts were first scanned in the Map scanner in the real interarch relationships, and they were transferred in the Mind software to the individualized virtual articulator. The occlusal splint was designed in the M-Splint software, first its shape, and then its occlusal surfaces, by creating static and dynamic occlusal contacts. The final design of the splint was milled from the Splintec PMMA material in the Motion 2 milling machine. The fabricated CAD/CAM splint was checked in the articulator and handed in to the patient, together with its fit and occlusal contacts checking. Results: In relation to the fabrication of occlusal splints by means of standard procedures of flasking and polymerization, occlusal splints from transparent PMMA material can be fabricated without contractions using the CAD/CAM system. This enables their excellent retention and stabilization, as well as precise planning and occlusal contacts fabrication. One to two occlusal contacts per a pair of antagonists were established in static occlusion, while contacts according to the concept of canine guided occlusion were established in dynamic occlusion. Four years after the fabrication of implant-retained prosthetic restorations, the two patients had no radioopaque bone loss around the implant, nor biological and technical deficiencies on implant-retained prosthetic restorations. Conclusions and clinical implications: Beside planning of the position of dental implant placement and correct surgical and prosthetic methods in fabrication of implant-retained prosthetic restorations, it is important for patients diagnosed with bruxism or muscular TMD to receive a precise occlusal splint immediately after the implant- prosthetic treatment is finished, in order to prolong the life expectancy of the implant and reduce the possibility of occurrence of biological and technical failures.