RESUMO

BACKGROUND: Peri-implantitis poses significant challenges in clinical practice, necessitating effective therapeutic strategies. This case report presents a comprehensive treatment approach for managing peri-implantitis, focusing on resective surgery, including implantoplasty and long-term maintenance. METHODS: We describe the case of a 50-year-old female patient with peri-implantitis affecting a maxillary full-arch implant-supported rehabilitation. The treatment strategy involved resective surgery with implantoplasty, a new maxillary overdenture, and a regular maintenance care schedule of three to four visits per year. Clinical and radiographic assessments were performed over a 10-year follow-up period. RESULTS: Post-treatment, all maxillary implants demonstrated no probing depths exceeding 4 mm, absence of bleeding on probing or suppuration, minimal plaque accumulation, and no further bone loss. Resective surgery with implantoplasty seems to have effectively provided submucosal decontamination and created a supra-mucosal implant surface conducive to oral hygiene. Despite regular maintenance, some mandibular implants exhibited bone loss during the follow-up period and were managed using the same approach as for the maxillary implants. CONCLUSIONS: The comprehensive treatment approach yielded favorable long-term clinical and radiographic outcomes, underscoring the effectiveness of the combined strategies in managing peri-implantitis. Nevertheless, the potential for recurrence or the development of peri-implantitis in new implants, even after a decade of successful treatment and strict maintenance, highlights the importance of ongoing, diligent care and regular evaluations to promptly diagnose and address these issues. KEY POINTS: Why is this case new information? The long-term effectiveness of peri-implantitis treatments, particularly involving implantoplasty, remains under-documented. This case provides insights from a 10-year follow-up on the efficacy of a comprehensive approach for managing peri-implantitis. Furthermore, these findings illustrate the potential for new peri-implantitis to develop, regardless of sustained peri-implant health and rigorous maintenance. This finding highlights the critical role of continuous monitoring for the early diagnosis and treatment of new implants exhibiting peri-implantitis. What are the keys to the successful management of this case? The success of this case hinged on a comprehensive treatment approach that combines surgical intervention associated with implantoplasty to remove implant threads, thereby creating smoother surfaces, less retentive for plaque accumulation. A critical aspect of this approach was also the redesign of prosthetic components to improve hygiene accessibility, continuous monitoring, and consistent maintenance care. What are the primary limitations to success in this case? The primary challenge in achieving success in this case was the prevention of new implants with peri-implantitis, despite the patient's consistent adherence to the maintenance program. Moreover, a critical evaluation of implant characteristics, particularly their susceptibility to mechanical failures, is paramount when performing implantoplasty. Furthermore, aligning patient expectations with the realistic esthetic and functional outcomes of the treatment is often challenging. PLAIN LANGUAGE SUMMARY: Peri-implantitis, an inflammatory disease affecting dental implants, is quite challenging to treat. This case report describes how a 50-year-old woman with this condition was successfully treated and maintained over 10 years. The approach included a surgical method called resective surgery, which involved reshaping the bone defect (osteoplasty) and smoothing the implant surface (implantoplasty). Additionally, she was fitted with a new upper denture and had regular follow-up visits three to four times a year. After ten years, her upper implants were stable with no signs of infection or further bone loss, and they were easy to keep clean. Some of her lower implants did experience inflammation with progressive bone loss during this time, but they were managed using the same surgical procedure as for her upper implants. This 10-year case report highlights positive and stable clinical results after resective surgery for treating peri-implantitis and the importance of an interdisciplinary approach and regular check-ups for maintenance, early diagnosis, and management of peri-implantitis over the long term.

RESUMO

INTRODUCTION: The implant disease risk assessment (IDRA) tool was designed to assess an individual's risk of developing peri-implant diseases by evaluating and integrating multiple risk factors. This study aimed to evaluate the IDRA tool to determine the risk of developing peri-implant disease in patients rehabilitated with dental implants. METHODS: A retrospective observational cross-sectional study was conducted, collecting data from 92 patients with 92 selected dental implants. Data included the history of periodontitis, sites with bleeding on probing (BoP), teeth and/or implants with probing depths (PDs) ≥ 5 mm, alveolar bone loss relative to the patient's age, susceptibility to periodontitis, the frequency of supportive periodontal therapy (SPT), the distance from the restorative margin (RM) of the implant-supported prosthesis to the marginal bone crest (MBC), and factors related to the prosthesis itself. Additionally, the validated instrument periodontal risk assessment (PRA) was employed for comparison. Statistical analyses utilized Chi-square, Mann-Whitney, and ROC curve. RESULTS: Outcomes indicated that 62 implants (67.4%) were classified as high-risk. Among the IDRA parameters, history of periodontitis was the primary factor contributing to an increased risk (p < 0.001). IDRA revealed high sensitivity (100%) and low specificity (63%) (AUC = 0.685; 95% CI: 0.554-0.816; p = 0.047), and there was a low agreement between the IDRA and PRA tools (Kappa = 0.123; p = 0.014). The peri-implant disease developed in 16 implants with 5.44 (±2.50) years of follow-up, however, no significant association was observed between the high- and low-medium risk groups and the occurrence of peri-implant diseases. CONCLUSION: Most of the evaluated implants presented high IDRA risk. The IDRA tool exhibited high sensitivity and low specificity; no significant association was observed between the risk profile and the development of peri-implant diseases.

Assuntos

Implantes Dentários , Humanos , Estudos Retrospectivos , Medição de Risco , Masculino , Feminino , Pessoa de Meia-Idade , Estudos Transversais , Implantes Dentários/efeitos adversos , Idoso , Peri-Implantite/etiologia , Adulto , Fatores de Risco , Periodontite

RESUMO

The purpose of this study was to evaluate the current scientific evidence on the effectiveness of antimicrobial photodynamic therapy (aPDT) as an adjunctive treatment to mechanical debridement in the treatment of peri-implantitis. The Preferred Reporting Items for Systematic Reviews and Meta-analyses was followed. A protocol was registered in the International Prospective Registry of Systematic Reviews (PROSPERO #CRD42022361684). The search was carried out in seven databases, with no restrictions regarding language or year of publication. Our work included studies that compared clinical periodontal parameters between individuals treated with mechanical debridement associated with aPDT and a control group of patients who had undergone mechanical debridement alone. Study selection, data extraction, and risk of bias assessment (RoB 2.0) were performed by two review authors. Meta-analysis was performed. The mean difference (MD) and a 95% confidence interval (CI) were provided. Four hundred and seven-four studies were identified, of which five studies were included. The meta-analysis demonstrated that aPDT adjunctive to mechanical debridement in subjects with peri-implantitis resulted in greater reduction in probing depth 3 months after treatment than among subjects receiving treatment with mechanical debridement. Most of the included studies exhibit a low risk of bias. Adjunctive aPDT to mechanical debridement contributes to the improvement of peri-implant clinical parameters in individuals with peri-implantitis, in particular probing depth.

Assuntos

Peri-Implantite , Fotoquimioterapia , Humanos , Peri-Implantite/tratamento farmacológico , Peri-Implantite/terapia , Fotoquimioterapia/métodos , Resultado do Tratamento , Anti-Infecciosos/uso terapêutico , Desbridamento/métodos

RESUMO

OBJECTIVES: To evaluate the influence of multiplanar reconstruction thickness on the detection of peri-implant bone defects with a standalone zirconia implant and compare it to when another implant is in the vicinity using cone-beam computed tomography (CBCT). MATERIALS AND METHODS: Five dry human mandibles were used to create twenty implant sites in the second premolar and first molar regions. The OP300 Maxio was used to acquire CBCT images (90 kVp, 6.3 mA, 5 × 5 cm FOV, and 0.125 mm3 voxel size) before and after creating 3 mm peri-implant bone defects in the buccal aspect of the premolar region. Half of the scans featured a single zirconia implant in the premolar region, while the others had two implants in the premolar and molar regions. Three reconstruction thicknesses (0.125 mm, 1 mm, and 2 mm) were considered for the multiplanar reconstruction analyses. Five oral and maxillofacial radiologists assessed the detection of peri-implant bone defects using a 5-point scale. Diagnostic parameters were calculated and compared using Two-way ANOVA (α = .05). RESULTS: The studied factors showed no significant influence on the diagnosis of peri-implant bone defects (p > .05). Diagnostic performance was notably higher with a single implant, especially with a 2-mm reconstruction thickness (AUC = 0.88, sensitivity = 0.68, specificity = 0.94). Although the differences were not statistically significant, the results were more modest when two implants were present (AUC = 0.80, sensitivity = 0.58, specificity = 0.82). CONCLUSIONS: The presence of an adjacent zirconia implant and variations in reconstruction thickness did not influence the detection of 3 mm buccal peri-implant bone defects on CBCT images.

RESUMO

During implant maintenance, preserving a smooth surface on the machined transmucosal abutment is critical to reduce biofilm attachment and colonization. The present study compared the surface roughness and bacterial colonization of machined titanium surfaces after instrumentation with various materials. Forty-four machined grade 23 titanium discs were instrumented with a round polyether ether ketone (PEEK) tip, a plastic curette tip, or a pure titanium curette tip with piezoelectric devices. Before and after instrumentation, the surface roughness (Ra and Rz) values were analyzed with a profilometer and scanning electron microscopy (SEM). Streptococcus sanguinis was cultured and incubated for 24 hours on the instrumented discs, and colony-forming units per milliliter were obtained for each group. Samples instrumented with the metal ultrasonic tip significantly increased surface roughness compared with the other groups. This resulted in greater colonization by S. sanguinis than surfaces instrumented with PEEK tips or the negative control. Samples instrumented with PEEK and plastic tips did not exhibit any statistically significant increase in surface roughness, and SEM analysis revealed a significantly rougher surface of discs instrumented with metal compared with discs instrumented with plastic or PEEK tips despite the possibility of debris from tip dissolution. Our results suggest that instrumentation with metal ultrasonic tips with piezoelectric devices significantly increased machined titanium's surface roughness and elicited higher biofilm formation in vitro. Meanwhile, instrumentation of machined titanium with PEEK or plastic ultrasonic tips did not affect the surface roughness or bacterial adhesion.

Assuntos

Biofilmes , Microscopia Eletrônica de Varredura , Streptococcus sanguis , Propriedades de Superfície , Titânio , Titânio/química , Benzofenonas , Cetonas/química , Técnicas In Vitro , Polietilenoglicóis/química , Aderência Bacteriana , Polímeros , Teste de Materiais , Implantes Dentários/microbiologia , Humanos

RESUMO

BACKGROUND: The aim of this study was to evaluate the incidence of preloading crestal bone loss (PLCBL) and to identify the patient-related and implant-related factors associated with PLCBL. METHODS: This retrospective cohort examined the dental records of patients who received at least one dental implant. PLCBL was defined as a reduction ⩾0.5 mm and severe PLCBL (primary variable) as a reduction ⩾1.5 mm in mesial and/or distal bone level, measured from the day of implant placement to uncovering or abutment installation/crown delivery. The incidence of PLCBL and patient and implant variables were recorded. Bivariate analysis and binary logistic regression identified factors associated with PLCBL ⩾0.5 mm and ⩾1.5 mm. RESULTS: A total of 746 dental implants placed in 361 patients from January 2011 to July 2021 was included in the analyses. Of the implants assessed, 24.4% (n = 182) exhibited PLCBL ⩾ 0.5 mm and 10.5% (n = 78) presented severe PLCBL (i.e., ⩾1.5 mm). Males (odds ratio [OR] = 1.85, 95% confidence interval [CI] = 1.11-3.07), patients with diabetes (OR = 3.33, 95% CI = 1.73-6.42), and those allergic to penicillin (OR = 3.13, 95% CI = 1.57-6.22) were more likely to experience severe PLCBL (p < 0.05). Implants placed in the anterior area (OR = 2.08, 95% CI = 1.16-3.73), with bone-level platform-abutment connection (OR = 4.73, 95% CI = 1.94-11.49) and inserted supracrestally (OR = 3.77, 95% CI = 1.84-7.72), presented a greater risk of developing severe PLCBL (p < 0.05). Implants placed in a previously grafted area presented a lower likelihood of developing severe PLCBL (OR = 0.489, 95% CI = 0.28-0.84). CONCLUSION: The incidence of PLCBL ⩾ 0.5 mm and ⩾1.5 mm was 24.4% and 10.5%, respectively. Male sex, diabetes, allergy to penicillin, anterior location, bone-level platform-abutment connection, and supracrestal implant placement are potential risk factors for severe PLCBL. A previously grafted area is a potential protective factor.

Assuntos

Perda do Osso Alveolar , Implantes Dentários , Humanos , Masculino , Estudos Retrospectivos , Feminino , Pessoa de Meia-Idade , Perda do Osso Alveolar/epidemiologia , Incidência , Idoso , Adulto , Fatores de Risco , Implantação Dentária Endóssea/métodos , Fatores Sexuais , Idoso de 80 Anos ou mais

RESUMO

AIM: To evaluate the adhesion of mono and duospecies biofilm on a commercially available dental implant surface coated with hydroxyapatite nanoparticles (nanoHA). MATERIAL AND METHODS: Titanium discs were divided into two groups: double acid-etched (AE) and AE coated with nanoHA (NanoHA). Surface characteristics evaluated were morphology, topography, and wettability. Mono and duospecies biofilms of Streptococcus sanguinis (S. sanguinis) and Candida albicans (C. albicans) were formed. Discs were exposed to fetal bovine serum (FBS) to form the pellicle. Biofilm was growth in RPMI1640 medium with 10% FBS and 10% BHI medium for 6 h. Microbial viability was evaluated using colony-forming unit and metabolic activity by a colorimetric assay of the tetrazolium salt XTT. Biofilm architecture and organization were evaluated by confocal laser scanning microscopy (CLSM) and scanning electron microscopy (SEM). RESULTS: AE surface had more pores, while NanoHA had even nanoHA crystals distribution. Roughness was similar (AE: 0.59 ± 0.07 µm, NanoHA: 0.69 ± 0.18 µm), but wettability was different (AE: Θw= 81.79 ± 8.55°, NanoHA: Θw= 53.26 ± 11.86°; P = 0.01). NanoHA had lower S. sanguinis viability in monospecies biofilm (P = 0.007). Metabolic activity was similar among all biofilms. In SEM both surfaces on C. albicans biofilm show a similar distribution of hyphae in mono and duospecies biofilms. AE surface has more S. sanguinis than the NanoHA surface in the duospecies biofilm. CLSM showed a large proportion of live cells in all groups. CONCLUSIONS: The nanoHA surface reduced the adhesion of S. sanguinis biofilm but did not alter the adhesion of C. albicans or the biofilm formed by both species.

Assuntos

Biofilmes , Candida albicans , Implantes Dentários , Durapatita , Microscopia Confocal , Microscopia Eletrônica de Varredura , Nanopartículas , Streptococcus sanguis , Propriedades de Superfície , Titânio , Titânio/química , Titânio/farmacologia , Candida albicans/efeitos dos fármacos , Candida albicans/fisiologia , Biofilmes/efeitos dos fármacos , Durapatita/farmacologia , Durapatita/química , Streptococcus sanguis/efeitos dos fármacos , Nanopartículas/química , Implantes Dentários/microbiologia , Técnicas In Vitro , Aderência Bacteriana/efeitos dos fármacos , Molhabilidade , Materiais Revestidos Biocompatíveis/farmacologia , Materiais Revestidos Biocompatíveis/química , Condicionamento Ácido do Dente , Viabilidade Microbiana/efeitos dos fármacos

RESUMO

OBJECTIVE: To characterize the distribution of macrophages, neutrophils, NK cells, and blood vessels in peri-implantitis compared to healthy aged gingiva samples. MATERIALS AND METHODS: This observational study included eight gingival samples from peri-implantitis and eight from periodontally healthy individuals. By immunofluorescence were identified neutrophils, NK cells, macrophages, and their pro-inflammatory or pro-healing phenotypes, and blood vessels. Two ROIs were designated as zone 1, connective tissue closest to the epithelium and zone 2, connective tissue over 200 microns from the rete ridges. Immune cells and vascular structures were quantified and characterized according to their distribution in both zones. RESULTS: Two peri-implantitis zones were characterized by unique macrophage phenotypes and blood vessel architecture. Blood vessels were larger in zone 2 in peri-implantitis. A greater number of NK cells and macrophages were found in peri-implantitis compared to healthy aged samples. A higher presence of pro-inflammatory macrophages was found in zone 1 compared to zone 2. A similar proportion of pro-inflammatory and pro-healing macrophages were found in zone 2. CONCLUSION: A specific distribution for pro-inflammatory macrophages and vascular architecture is observed in peri-implantitis. TNF-α colocalizes with macrophages in the connective tissue near rete ridges. NK cells are more abundant in peri-implantitis than in healthy samples.

RESUMO

Si bien el conocimiento científico para el tratamiento de la periimplantitis ha avanzado significativamente en los últimos años, sigue en discusión qué tipo de abordaje quirúrgico genera los mejores resultados clínicos y si el uso de biomateriales da mejoras significativas en dicho tratamiento. Este reporte de caso describe un abordaje quirúrgico reconstructivo de un defecto intraóseo por periimplantitis en una paciente que refería dolor y un intenso sangrado en sus implantes dentales, empleando un sustituto óseo anorgánico mineral bovino, sin el uso de una membrana o barrera, y con un protocolo de descontaminación de la superficie del implante mecánico y químico. Posteriormente, a las 20 semanas de realizado el procedimiento, se hizo la evaluación del defecto, obteniendo profundidades al sondeo menores a 5 mm, ausencia de sangrado al sondeo en todos los sitios y un llenado óseo radiográfico de aproximadamente 90%; cumpliendo con los criterios de éxito de la terapia periimplantaria. Lo anterior muestra que la terapia reconstructiva para los defectos por periimplantitis puede ser posible mediante el uso de un sustituto óseo xenogénico únicamente y con una correcta descontaminación de la superficie del implante (AU)

---

Although scientific knowledge for the treatment of peri-implantitis have advanced significantly in recent years, the type of surgical approach that generates the best clinical results is still under discussion and whether the use of biomaterials gives significant improvements in said treatment. This case report describes a reconstructive surgical approach for a periimplantitis intrabony defect using an anorganic bovine bone substitute, without the use of a membrane or barrier, and with a mechanical and chemical implant surface decontamination protocol. Twenty weeks after the procedure, the defect was reassessed, obtaining probing depths of less than 5 mm, no bleeding on probing in all sites, and radiographic bone filling of approximately 90%; meeting the success criteria for the peri-implant therapy. This shows that reconstructive therapy for periimplantitis defects may be possible using a xenogeneic bone substitute only and proper decontamination of the implant surface (AU)

Assuntos

Humanos , Feminino , Pessoa de Meia-Idade , Substitutos Ósseos/uso terapêutico , Procedimentos Cirúrgicos Bucais/métodos , Implantação Dentária Endóssea/efeitos adversos , Peri-Implantite/cirurgia , Bolsa Periodontal/diagnóstico , Retalhos Cirúrgicos , Escovação Dentária/métodos , Índice Periodontal , Descontaminação/métodos , México

RESUMO

Peri-implantitis (PI) is a chronic, inflammatory, and infectious disease which affects dental implants and has certain similarities to periodontitis (PD). Evidence has shown that PD may be related to several types of systemic disorders, such as diabetes and insulin resistance, cardiovascular diseases, respiratory tract infections, adverse pregnancy outcomes, and neurological disorders. Furthermore, some types of bacteria in PD can also be found in PI, leading to certain similarities in the immunoinflammatory responses in the host. This review aims to discuss the possible connection between PI and neuroinflammation, using information based on studies about periodontal disorders, a topic whose connection with systemic alterations has been gaining the interest of the scientific community. Literature concerning PI, PD, and systemic disorders, such as neuroinflammation, brain inflammation, and neurological disorder, was searched in the PubMed database using different keyword combinations. All studies found were included in this narrative review. No filters were used. Eligible studies were analyzed and reviewed carefully. This study found similarities between PI and PD development, maintenance, and in the bacterial agents located around the teeth (periodontitis) or dental implants (peri-implantitis). Through the cardiovascular system, these pathologies may also affect blood-brain barrier permeability. Furthermore, scientific evidence has suggested that microorganisms from PI (as in PD) can be recognized by trigeminal fiber endings and start inflammatory responses into the trigeminal ganglion. In addition, bacteria can traverse from the mouth to the brain through the lymphatic system. Consequently, the immune system increases inflammatory mediators in the brain, affecting the homeostasis of the nervous tissue and vice-versa. Based on the interrelation of microbiological, inflammatory, and immunological findings between PD and PI, it is possible to infer that immunoinflammatory changes observed in PD can imply systemic changes in PI. This, as discussed, could lead to the development or intensification of neuroinflammatory changes, contributing to neurodegenerative diseases.

Assuntos

Peri-Implantite , Humanos , Peri-Implantite/microbiologia , Peri-Implantite/imunologia , Periodontite/microbiologia , Periodontite/imunologia , Implantes Dentários , Doenças Neuroinflamatórias/imunologia , Barreira Hematoencefálica

RESUMO

The control of infectious diseases caused by biofilms is a continuing challenge for researchers due to the complexity of their microbial structures and therapeutic implications. Photodynamic therapy as an adjunctive anti-infective treatment has been described as a possible valid approach but has not been tested in polymicrobial biofilm models. This study evaluated the effect of photodynamic therapy in vitro with methylene blue (MB) 0.01% and red LEDs (λ = 660 nm, power density ≈ 330 mW/cm2, 2 mm distance from culture) on the metabolic activity and composition of a multispecies subgingival biofilm. Test Groups LED and MB + LED showed a more significant reduction in metabolic activity than the non-LED application group (~50 and 55%, respectively). Groups LED and MB equally affected (more than 80%) the total bacterial count in biofilms. No differences were noted in the bacterial biofilm composition between the groups. In vitro LED alone or the MB + LED combination reduced the metabolic activity of bacteria in polymicrobial biofilms and the total subgingival biofilm count.

RESUMO

Peri-implantitis is an inflammatory condition characterized by inflammation in the peri-implant connective tissue and a progressive loss of supporting bone; it is commonly associated with the presence of biofilms on the surface of the implant, which is an important factor in the development and progression of the disease. The objective of this study was to evaluate, using micro-CT, the bone regeneration of surgically created peri-implant defects exposed to a microcosm of peri-implantitis. Twenty-three adult New Zealand white rabbits were included in the study. Bone defects of 7 mm diameter were created in both tibiae, and a cap-shaped titanium device was placed in the center, counter-implanted with a peri-implantitis microcosm. The bone defects received a bone substitute and/or a resorbable synthetic PLGA membrane, according to random distribution. Euthanasia was performed 15 and 30 days postoperatively. Micro-CT was performed on all samples to quantify bone regeneration parameters. Bone regeneration of critical defects occurred in all experimental groups, with a significantly greater increase in cases that received bone graft treatment (p < 0.0001), in all measured parameters, at 15 and 30 days. No significant differences were observed in the different bone neoformation parameters between the groups that did not receive bone grafts (p > 0.05). In this experimental model, the presence of peri-implantitis microcosms was not a determining factor in the bone volume parameter, both in the groups that received regenerative treatment and in those that did not.

RESUMO

PURPOSE: The objective of this retrospective study was to evaluate the effect of the interproximal contour of single external hexagon implant restorations on the prevalence of peri-implantitis. MATERIAL AND METHODS: Records of 96 patients and 148 external hexagon (EH) implants with time in function ranging from 1 to 17 years were included in the study. The most recent clinical and radiographic data were collected from records and the prevalence of peri-implantitis was defined according to the 2017 World Workshop on the Classification of Periodontal and Peri-implant Diseases and Conditions. Marginal bone level (MBL), emergence angle (EA), emergence profile (EP), and crown/implant platform horizontal ratio (CIHR) were obtained from periapical radiographs. Dichotomous variables at the patient- and implant level were compared with association tests. Mann-Whitney U-Test was performed to compare continuous quantitative values between the studied groups. Binomial logistic regression was conducted to identify risk indicators associated with the peri-implantitis event at the patient- and implant level, with the significance level set at 5% for all tests. RESULTS: Nineteen patients (19.2%) and 24 implants (16.2%) with a mean time in function of 5.0 ± 4.7 years were classified as having peri-implantitis. No statistically significant differences concerning gender, mean age, implant location in the jaw, or time in function were observed between patients with or without peri-implantitis (p > 0.05). Of 24 implants with peri-implantitis 10 (41.7%) displayed EA ≤ 30° (16.4%) while 14 (58.3%) presented EA > 30° with no statistical difference between the groups (p > 0.05). No statistically significant associations were identified between EA, EP, or CIHR and the prevalence of peri-implantitis. CONCLUSION: The findings seem to indicate that the EA, EP, and CIHR of single restorations over external hexagon implants are not associated with the presence of peri-implantitis. However, prospective studies with larger samples are required to better ascertain such an association in the long term.

Assuntos

Peri-Implantite , Humanos , Peri-Implantite/etiologia , Peri-Implantite/epidemiologia , Estudos Retrospectivos , Masculino , Feminino , Pessoa de Meia-Idade , Prevalência , Adulto , Idoso , Planejamento de Prótese Dentária

RESUMO

OBJECTIVES: Since peri-implantitis is an increasing and prevalent concern in clinical practice and there is no consensus regarding the best therapeutic protocol, this study evaluated the knowledge and behaviours of dentists working in Implantology regarding implant-related infections modulating factors and therapeutic protocols used in the management of peri-implantitis. METHODS: Cross-sectional study was conducted with 86 Brazilian Implantology clinicians. Data were collected using a structured and online questionnaire evaluating socioeconomic characteristics, education, work/clinical practice, knowledge and attitudes regarding the risk factors and management of peri-implantitis. The reliability of the questionnaire was evaluated by test-retest technique. The questionnaire was developed based on the last consensus on peri-implant diseases (2018) and the current evidence related to implant-related infections. Descriptive, bivariate and logistic regression analyses were conducted adopting a significance level of 5%. RESULTS: In this study, 89.5% of included dentists reported that already treated patients with peri-implantitis. Approximately 80% of dentists use antibiotics and mouth rinses during the treatment, and surgical procedures seem the main choice to treat peri-implantitis (91.8%) by dentists. As a preventive approach, 94.2% of dentists reported that routinely assessed biofilm accumulation in the follow-up visits after implant placement. Logistic regression showed that the self-reported ability to treat peri-implantitis was statistically (p < 0.05) higher among dentists who reported abilities to diagnose the disease and use laser for peri-implantitis treatment. CONCLUSION: Dentists working in Implantology have a good level of knowledge and behaviors in the management of peri-implantitis. However, the lack of consensus regarding the best treatment protocols may reflect dentist's behaviours because different treatment protocols have been used by evaluated clinicians.

Assuntos

Odontólogos , Conhecimentos, Atitudes e Prática em Saúde , Peri-Implantite , Humanos , Peri-Implantite/terapia , Estudos Transversais , Masculino , Feminino , Inquéritos e Questionários , Brasil , Adulto , Odontólogos/psicologia , Padrões de Prática Odontológica/estatística & dados numéricos , Pessoa de Meia-Idade , Antibacterianos/uso terapêutico , Fatores de Risco , Atitude do Pessoal de Saúde , Implantes Dentários , Biofilmes

RESUMO

The treatment of peri-implantitis is challenging in the clinical practice of implant dentistry. With limited therapeutic options and drug resistance, there is a need for alternative methods, such as photodynamic therapy (PDT), which is a minimally invasive procedure used to treat peri-implantitis. This study evaluated whether the type of photosensitizer used influences the results of inflammatory control, reduction in peri-implant pocket depth, bleeding during probing, and reduction in bone loss in the dental implant region. We registered the study in the PROSPERO (International Prospective Register of Systematic Review) database. We searched three main databases and gray literature in English without date restrictions. In vivo randomized clinical studies involving individuals with peri-implantitis, smokers, patients with diabetes, and healthy controls were included. PDT was used as the primary intervention. Comparators considered mechanical debridement with a reduction in pocket depth as the primary outcome and clinical attachment level, bleeding on probing, gingival index, plaque index, and microbiological analysis as secondary outcomes. After reviewing the eligibility criteria, we included seven articles out of 266. A great variety of photosensitizers were observed, and it was concluded that the selection of the most appropriate type of photosensitizer must consider the patient's characteristics and peri-implantitis conditions. The effectiveness of PDT, its effects on the oral microbiome, and the clinical patterns of peri-implantitis may vary depending on the photosensitizer chosen, which is a crucial factor in personalizing peri-implantitis treatment.

RESUMO

Introducción: se considera la osteomielitis mandibular un proceso patológico poco frecuente. La mayor parte de los casos presentados involucran pacientes con osteorradionecrosis y aquellos pacientes con ingesta de algunos medicamentos antirresortivos. El objetivo es informar un caso inusual de una paciente con osteomielitis, perimplantitis y fractura vertical radicular con antecedentes de fibromialgia. Presentación del caso: mujer de 70 años de edad, no fumadora ni consumidora de alcohol, que acudió con un dolor posteroinferior izquierdo de un año de evolución. Presentaba una profundidad de son-deo mayor de 12 mm en el órgano dental (od) 37, sangrado a la palpación, dolor y movilidad grado ii. En el od 36 fue notoria la exposición clínica del tercio superior del implante dental, sin movilidad, con una profundidad de 4 mm. El tratamiento consistió en una exodoncia atraumática del od 37, donde se identificó una fractura radicular vertical. Discusión: actualmente, los implantes dentales permiten restablecer la salud bucodental. Sin embargo, ellos también pueden inducir una osteomielitis en los maxilares. La terapia instaurada redujo ostensiblemente la morbilidad del implante dental implicado y regeneró la zona intervenida.

---

Introduction: Mandibular osteomyelitis is considered a rare pathological process. Most of the cases pre-sented involve patients with osteoradionecrosis and those patients with intake of some antiresorptive drugs. The objective of this report is to report an unusual case of a patient with osteomyelitis, peri-im-plantitis and vertical root fracture with a history of fibromyalgia. Case presentation: A 70-year-old female patient, non-smoker or alcohol consumer, who presented with lower left postero-pain of one year's evolution. She presented a probing depth greater than 12 mm in dental organ (od) 37, bleeding on palpation, pain and grade II mobility. At the level of do 36, the clinical exposure of the upper third of the dental implant was notorious, without mobility, with a depth of 4 mm. The treatment consisted of an atraumatic extraction of do 37, where a vertical root fracture was identified. Discussion: Currently, dental implants make it possible to restore oral health. However, they can also induce osteomyelitis in the jaws. The established therapy ostensibly reduced the morbidity of the involved dental implant and regeneration of the intervened area

---

Introdução: a osteomielite mandibular é considerada um processo patológico raro. A maioria dos casos apresentados envolve pacientes com osteorradionecrose e aqueles pacientes com uso de alguns medi-camentos antirreabsortivos. O objetivo deste relato é relatar um caso incomum de um paciente com osteomielite, periimplantite e fratura radicular vertical com histórico de fibromialgia. Apresentação do caso: paciente do sexo feminino, 70 anos, não fumante ou etilista, que apresentou dor póstero-infe-rior esquerda com um ano de evolução. Apresentava profundidade de sondagem maior que 12 mm no órgão dentário (od) 37, sangramento à palpação, dor e mobilidade grau ii. Ao nível de do 36, foi notória a exposição clínica do terço superior do implante dentário, sem mobilidade, com profundidade de 4 mm. O tratamento consistiu em uma extração atraumática de do 37, onde foi identificada uma fratura vertical da raiz. Discussão: atualmente, os implantes dentários possibilitam o restabelecimento da saúde bucal. No entanto, eles também podem induzir osteomielite nos maxilares. A terapia instituída reduziu ostensivamente a morbidade do implante dentário envolvido e a regeneração da área intervencionada

Assuntos

Humanos

RESUMO

OBJECTIVE: To analyze bibliometrics, characteristics, and the risk of bias of randomized controlled trials (RCTs) on dental implants published in six high-impact factor journals and to identify factors contributing to citation number. MATERIALS AND METHODS: A systematic electronic search was conducted in four databases (PubMed, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials) to identify RCTs on dental implants published in six dental journals between 2016 and 2017. Twenty-five bibliometric variables and paper characteristics were extracted to evaluate their contribution to the citation count. Risk of bias analysis was performed using the RoB2 tool. Negative binomial regression was used to examine the effects of predictor variables on the Citation count. Significance level was set to 5%. RESULTS: A total of 150 RCTs included received a cumulative citation count of 3452 until July 2022. In the negative binomial regression analysis, open-access RCTs exhibited 60% more citations, and RCTs that presented statistical significance received 46% more citations. Conversely, first author affiliations from Africa, Asia and Oceania continents showed 49% fewer citations than publications from Europe. Regarding the risk of bias, 73.3% of the RCTs had some concerns, while 26% were deemed to have a high risk of bias. Only one RCT (0.07%) showed a low risk of bias. CONCLUSION: Within the limitation of the study, factors such as open access, statistically significant results, and country influence the number of citations received by the RCTs on dental implants.

Assuntos

Bibliometria , Implantes Dentários , Ensaios Clínicos Controlados Aleatórios como Assunto , Humanos

RESUMO

OBJECTIVE: The present study aimed to assess the relationship between keratinized mucosa width and peri-implant diseases, namely peri-implant mucositis and peri-implantitis. MATERIALS AND METHODS: Ninety-one dental implants in function for ≥ 6 months from 40 partially or completely edentulous non-smoker subjects (24 females and 16 males) were evaluated clinically and radiographically. The width of keratinized mucosa, probing depth, plaque index, bleeding on probing, and marginal bone levels were assessed. Keratinized mucosa width was categorized as ≥ 2 mm or < 2 mm. RESULTS: There was no statistically significant association between keratinized buccal mucosa width and peri-implant mucositis or peri-implantitis (p ≥ 0.37). In the regression analysis, peri-implantitis was associated with longer implant function time (RR: 2.55, 95% CI: 1.25-11.81, p = 0.02) and implants in the maxilla (RR: 3.15, 95% CI: 1.61-14.93, p = 0.003). Mucositis was not associated with any of the factors analyzed. CONCLUSION: In conclusion, in the present sample, keratinized buccal mucosa width was not associated with peri-implant diseases, suggesting that a band of keratinized mucosa may not be necessary to maintain peri-implant health. Prospective studies are required to better understand its role in the maintenance of peri-implant health.

Assuntos

Implantes Dentários , Mucosite , Peri-Implantite , Masculino , Feminino , Humanos , Peri-Implantite/etiologia , Estudos Retrospectivos , Mucosa Bucal

RESUMO

This study evaluated the association between keratinized mucosa (KM) and peri-implant health of external hexagon implants in the posterior region in 84 patients with 242 implants. Modified plaque index (MPI), modified sulcular bleeding index (MSBI), probing depth (PD), keratinized mucosa (KM) width, and peri-implant bone loss were evaluated. The implants were divided according to the KM: (1) absence of KM, (2) KM width >0 and <2 mm, and (3) KM width ≥2 mm. Of the 242 implants evaluated, 63 (26.0%) had no KM band, 56 (23.1%) had KM width <2 mm, and 123 (50.8%) had KM width ≥2 mm. One hundred and sixty-seven (69.0%) were used in multiple unit restorations and 75 (31.0%) in single tooth restorations; 66.9% were placed in the mandible and 33.1% in the maxilla. For single tooth and multiple unit implant restorations, MPI (P=0.069 and P=0.387, respectively), MSBI (P=0.695 and P=0.947, respectively), PD (P=0.270 and P=0.258, respectively), and mesial bone loss (P=0.121 and P=0.239, respectively) were not affected by the KM width. On the distal surface, bone loss was influenced by the absence of KM when single tooth implant restorations were used (P=0.032). No association was found between KM width and the peri-implant tissue health.

Assuntos

Implantes Dentários , Humanos , Estudos de Coortes , Maxila/cirurgia , Mucosa , Mandíbula

RESUMO

PURPOSE: Ozone is a potent antioxidant agent which presents an important antimicrobial action and many other biological effects. Although ozone therapy has been widely described and summarized in several other Dentistry areas recently, the studies concerning Dental Implantology have not been systematically compiled and evaluated. Thus, the present study aimed to evaluate the effectiveness of ozone therapy in dental implant procedures. METHODS: MEDLINE (via PUBMED), Cochrane Central Register of Controlled Trials (CENTRAL), and OpenGrey databases were searched (up to, and including, January 23, 2023) for studies in the English language. In addition, the reference lists of the articles were manually examined. Only interventional studies (controlled clinical trials, randomized or not) were considered eligible for inclusion. The risk of bias in each included study was assessed using the Cochrane tool for assessing risk of bias in randomized trials - version 2. RESULTS: 71 potentially eligible records were retrieved but only 5 articles were evaluated and considered eligible for inclusion. Among the studies, 2 addressed clinical situations related to implant insertion, and 3 involved pathological conditions affecting implants in function. Furthermore, only one randomized clinical trial was categorized as low risk of bias. CONCLUSION: The adjuvant use of ozone therapy may positively affect some outcomes in Implant Dentistry, both in treating pathological conditions and conducting rehabilitation (implant installation, secondary implant stability). However, as most studies have a high risk of bias and high heterogeneity, a definitive conclusion cannot be drawn.

Assuntos

Implantes Dentários , Humanos , Implantação Dentária Endóssea/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto