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sTREM-1 and its ligand PGLYRP1 play an essential role in the inflammatory process around teeth and implants. In this study, we aimed to evaluate the impact of peri-implant treatment on the salivary levels of the sTREM-1/PGLYRP-1/MMP-8 axis after 3 months. A total of 42 participants (with a mean age of 61 years old ± 7.3) were enrolled in this longitudinal study, 24 having peri-implant mucositis (MU) and 18 having peri-implantitis (PI). Clinical peri-implant parameters, such as probing pocket depth (PPD), % of plaque, and bleeding on probing (BOP), and the whole unstimulated saliva samples were evaluated at baseline and 3 months after treatment. The MU group received nonsurgical peri-implant treatment, while the PI group received open-flap procedures. The levels of sTREM-1, PGLYRP-1, MMP-8, and TIMP-1 were analyzed using enzyme-linked immunosorbent assays. BOP, plaque levels, and PPD significantly reduced after treatment in both groups. A significant decrease in the salivary levels of sTREM-1, MMP-8, and TIMP-1 in the PI group and PGLYRP1 and TIMP-1 in the MU group were observed. Salivary levels of sTREM-1 were significantly reduced in patients with PI but not with MU. Additionally, peri-implant treatment had a significantly higher impact on MMP-8 reduction in patients with PI than in those with MU.

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A Mucosite peri-implantar é considerada a precursora da peri-implantite, ela é uma lesão inflamatória da mucosa peri-implantar na ausência de perda óssea marginal contínua. O objetivo desse relato de caso, foi descrever o tratamento da mucosite periimplantar através da cirurgia de enxerto gengival livre. Foi proposto, portanto, um tratamento reabilitador envolvendo uma abordagem multidisciplinar de forma a resgatar e restabelecer estética, função e bem-estar através do enxerto gengival livre para melhorar as características de mucosa e viabilizar uma previsibilidade de uma prótese definitiva implantosuportada em condições teciduais mais estáveis. O uso do EGL para aumento da gengiva queratinizada na cirurgia de implantes em paciente idosos é uma solução prática e segura para a manutenção da saúde periodontal ao redor do implante... (AU)

Peri-implant mucositis is considered the precursor of peri-implantitis, it is an inflammatory lesion of the peri-implant mucosa in the absence of continuous marginal bone loss. The purpose of this case report was to describe the treatment of peri-implant mucositis through free gingival graft surgery. Therefore, a rehabilitation treatment involving a multidisciplinary approach was proposed in order to rescue and reestablish aesthetics, function and well-being through the free gingival graft to improve the characteristics of the mucosa and enable a predictability of a permanent implant prosthesis under more stable tissue conditions. The use of EGL to increase keratinized gingiva in implant surgery in elderly patients is a practical and safe solution for maintaining periodontal health around the implant... (AU)

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BACKGROUND: Shifts in microbial communities are common over time, but they may disturb the host-microbiome homeostasis and result in inflammation of the peri-implant issues if a dysbiotic biofilm is established. PURPOSE: Considering that different oral substrate surfaces may have a relevant impact on the microbial adhesion and colonization, the aim of this study was to investigate the microbial communities of the biofilm formed on single-implant restorations using titanium or zirconia abutments and how they correlate with clinical parameters after 3-years of implant loading. MATERIALS AND METHODS: MiSeq sequencing of 16S rRNA amplicons was used to characterize the oral biofilms of individuals (n = 20) who were sampled longitudinally during 3 years of masticatory loading. Bioinformatics analysis and multivariate statistical analysis were used to evaluate the microbial diversity and clinical outcomes. RESULTS: Microbiomes of both abutment materials presented high alpha-diversity indices during all the experimental period, irrespective of the time of sampling. Microbial communities of titanium and zirconia were quite different over time, differing about 30% after 3 years of functional loading. Similarity of microbiomes between tested abutments and contralateral teeth was also low, ranging between 45% and 50% after 3 years of investigation. Periodontal pathogens commonly associated with peri-implantitis were found in both groups. Furthermore, both abutment materials presented strong correlations of diversity indices and microbial taxa with clinical outcomes. CONCLUSIONS: The type of abutment substrate significantly influenced diversity and clustering of communities during 3 years of functional loading. The time of sampling had no effect on the variables. Large correlations were found between microbial findings and clinical outcomes.

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Pathologies in peri-implant tissues are common and may disturb long-term implant supported rehabilitation. We aimed to evaluate the occurrence of such peri-implant diseases and their associated factors in this study. Peri-implantitis and mucositis were diagnosed based on clinical and radiological findings. Statistical analysis was performed with the X2 and logistic regression. Peri-implant mucositis and peri-implantitis were observed in 43.4% and 13.8% of patients with implants evaluated, respectively. Univariate analysis found associations with systemic changes (P = .016; yes), medication use (P = .010; yes), implant location (P < .0001; upper jaw), implant region (P = .008; posterior), previous augmentation procedure (P = .023; yes), time of prostheses use (P < .0001; >2 years), keratinized mucosa (P < .0001; absence); and gingival bleeding index (P = .005; >30%). In the multiple analysis, independent predictors were: >2 years of prostheses use (P < .0001; PR = 1.720), upper jaw location (P < .0001; PR = 1.421), gingival bleeding index >30% (P = .001; PR = 1.496), and use of medication (P < .0001; PR = 1.261). The frequency of peri-implant pathologies is high (approximately 57.2%) with several aspects of the occurrence being related to the patients' prosthesis. Prostheses type and the complexity of rehabilitation are worth highlighting. Factors include the location of the dental implant, gingival bleeding index, patient's use of medication(s), and the time of prostheses use.

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Despite the long-term survival rates of osseointegrated dental implants, several biological complications are known to affect the peri-implant tissues, such as peri-implant mucositis and peri-implantitis. Occasionally, the clinical features of these more common benign lesions, or others nonrelated to implants, might be similar to oral malignancies, leading to misdiagnosis. The objective of this study was to present a case series of oral cancer located adjacent to dental implants, aimed to identify the reasons for initial misinterpretation of diagnosis. Thirteen patients, 10 females and 3 males, aged 59 to 90, were assessed. Among the differential diagnoses established, a malignant or premalignant lesion was not considered in 10 out of the 13 patients. Peri-implantitis was the most common preliminary diagnosis, followed by fungal infection, viral infections, and traumatic ulcers. The meantime for the diagnosis of oral cancer was 21.5 months. The clinical presentation of peri-implant malignancy, such as ulceration, white and red plaques, and exophytic lesions, might mimic benign diseases that are more common in the oral cavity. Suspicious lesions with treatment failure that persist for more than 2 weeks require biopsy and histopathological analysis to establish an early definitive diagnosis to improve the prognosis and quality of life of the patients.

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BACKGROUND: To explore the diagnostic usefulness of extracellular vesicles (EVs), and their subpopulations (micro-vesicles and exosomes), and microRNAs (miRNA-21-3p, miRNA-150-5p, and miRNA-26a-5p) in peri-implant crevicular fluid (PICF) of subjects with healthy, peri-implant mucositis and peri-implantitis implants. METHODS: A total of 54 patients were enrolled into healthy, peri-implant mucositis, and peri-implantitis groups. PICF samples were collected, EVs subpopulations (MVs and Exo) were isolated and characterized by nanoparticle tracking analysis and transmission electron microscopy. The expression of miRNA-21-3p, miRNA-150-5p and miRNA-26a-5p was quantified by qRT-PCR. Logistic regression models and accuracy performance tests were estimated. RESULTS: PICF samples show the presence of EVs delimited by a bi-layered membrane, in accordance with the morphology and size (< 200 nm). The concentration of PICF-EVs, micro-vesicles and exosomes was significantly increased in peri-implantitis implants compared to healthy implants (P = 0.023, P = 0.002, P = 0.036, respectively). miRNA-21-3p and miRNA-150-5p expression were significantly downregulated in patients with peri-implantitis in comparison with peri-implant mucositis sites (P = 0.011, P = 0.020, respectively). The reduced expression of miRNA-21-3p and miRNA-150-5p was associated with peri-implantitis diagnosis (OR:0.23, CI 0.08-0.66, P = 0.007 and OR:0.07, CI 0.01-0.78, P = 0.031, respectively). The model which included the miRNA-21-3p and miRNA-150-5p expression had a sensitivity of 93.3%, a specificity of 76.5%, a positive predictive value of 77.8%, and a negative predictive value of 92.9%. The positive and negative likelihood ratios were 3.97 and 0.09, respectively. The area under the receiver operating characteristics curve for the model was 0.84. CONCLUSIONS: An increase concentration of EVs with a downregulation expression of miRNA-21-3p and miRNA-150-5p could be related with the peri-implantitis development.

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Streptococci from the mitis group (represented mainly by Streptococcus mitis, Streptococcus oralis, Streptococcus sanguinis, and Streptococcus gordonii) form robust biofilms with Candida albicans in different experimental models. These microorganisms have been found in polymicrobial biofilms forming on titanium biomaterial surfaces in humans with peri-implant disease. The purpose of this work was to study mutualistic interactions in biofilms forming on titanium and their effect on the adjacent mucosa, using a relevant infection model. Single and mixed biofilms of C. albicans and each Streptococcus species were grown on titanium disks. Bacterial and fungal biovolume and biomass were quantified in these biofilms. Organotypic mucosal constructs were exposed to preformed titanium surface biofilms to test their effect on secretion of proinflammatory cytokines and cell damage. C. albicans promoted bacterial biofilms of all mitis Streptococcus species on titanium surfaces. This relationship was mutualistic since all bacterial species upregulated the efg1 hypha-associated gene in C. albicans Mixed biofilms caused increased tissue damage but did not increase proinflammatory cytokine responses compared to biofilms comprising Candida alone. Interestingly, spent culture medium from tissues exposed to titanium biofilms suppressed Candida growth on titanium surfaces.IMPORTANCE Our findings provide new insights into the cross-kingdom interaction between C. albicans and Streptococcus species representative of the mitis group. These microorganisms colonize titanium-based dental implant materials, but little is known about their ability to cause inflammation and damage of the adjacent mucosal tissues. Using an in vitro biomaterial-mucosal interface infection model, we showed that mixed biofilms of each species with C. albicans enhance tissue damage. One possible mechanism for this effect is the increased fungal hypha-associated virulence gene expression we observed in mixed biofilms with these species. Interestingly, we also found that the interaction of multispecies biofilms with organotypic mucosal surfaces led to the release of growth-suppressing mediators of Candida, which may represent a homeostatic defense mechanism of the oral mucosa against fungal overgrowth. Thus, our findings provide novel insights into biofilms on biomaterials that may play an important role in the pathogenesis of mucosal infections around titanium implants.

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A mucosite peri-implantar é uma condição inflamatória sem perda de tecido ósseo, que ocorre nos tecidos moles ao redor do implante. O tratamento não-cirúrgico combina a terapia básica associada ou não ao uso de agentes químicos. O objetivo desse estudo foi avaliar a eficácia do oxigênio ativo (Bluem®) como coadjuvante químico no tratamento não-cirúrgico da mucosite peri­implantar em um protocolo de tratamento não­cirúrgico. Sendo assim, 20 implantes foram tratados, 9 no grupo teste (Bluem®) e 11 no grupo controle (placebo), em indivíduos reabilitados com implantes. Desta forma, os pacientes foram divididos aleatoriamente em grupo teste e grupo controle. Os parâmetros clínicos peri-implantares de índice de placa visível (IPV), índice de sangramento gengival (ISG), profundidade de sondagem (PS), sangramento à sondagem (SS) e mucosa ceratinizada foram avaliados no baseline e em diferentes períodos após o tratamento. Para análise estatística, foram utilizados os testes de Mann-Whitney, Friedman, Wilcoxon e Exato de Fisher com nível de significância de 5%. Os resultados mostraram que houve diminuição significativamente estatística para: IPV geral (56,81% para 27,27%) e ISG geral (32,95% para 28,41%) do grupo teste; IPV geral (42,86% para 15,18%) e ISG geral (31,25% para 2,32%) do grupo controle; IPV do implante no grupo controle (21,42% para 0%); profundidade de sondagem para o grupo teste (2,83mm para 2mm) e SS para o grupo controle (33,33% para 16,67%). No entanto, não houve diferenças significativas entre os dois grupos quando foram comparados em cada período. Pode-se concluir que o Bluem pode ser utilizado como adjuvante químico no tratamento da mucosite peri-implantar, entretanto a sua real eficácia necessita de estudos adicionais para comprovação científica (AU).

Peri-implant mucositis is an inflammatory condition without loss of bone tissue, which occurs in the soft tissues around the implant. Non-surgical treatment combines basic periodontal therapy with or without the use of chemical agents. The objective of this study was to evaluate the efficacy of the active oxygen (Bluem®) as a chemical adjuvant in the non-surgical treatment of peri-implant mucositis. Twenty implants in 9 patients were ramdomly treated, 9 in the test group (Bluem®) and 11 in the control group (placebo), in individuals rehabilitated with dental implants. Peri-implant clinical parameters of visible plaque index (VPI), gingival bleeding index (GBI), probing depth (PD), bleeding on probing (BOP) and keratinized mucosa were evaluated at baseline and one and six months. For the statistical analysis, Mann-Whitney, Friedman, Wilcoxon and Fisher's Exact tests were used with a significance level of 5%. The results showed that there was a statistical decrease for full mouth VPI (56.81% to 27.27%) and full mouth GBI (32.95% to 28.41%) of the test group; full mouth VPI (42.86% to 15.18%) and full mouth GBI (31.25% to 2.32%) of the control group; Implant VPI in the control group (21.42% to 0%); probing depth for the test group (2.83mm to 2mm) and BOP for the control group (33.33% to 16.67%). However, there were no significant differences between the two groups. It can be concluded that Bluem can be used as a chemical adjuvant in the treatment of peri-implant mucositis (AU).

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ABSTRACT Introduction: the incidence of peri-implant diseases is high, and their optimal management is still debated. The purpose was to explore the levels of available evidence and to suggest evidence-based recommendations for the treatment of peri-implant mucositis and peri-implantitis. Methods: a clinical practice guideline was developed using the Scottish Intercollegiate Guidelines Network (SIGN) criteria. A search strategy was formulated, and a critical review of the following evidence was performed: 1) prevention of peri-implant diseases, 2) treatment of peri-implant mucositis, and 3) treatment of peri-implantitis. Systematic reviews and randomized controlled clinical trials were the primary study types identified in the literature. Current levels of evidence were established and recommendations were provided. Results: a total of 67 articles were included. Regarding the prevention of peri-implant diseases, there is strong evidence for the involvement of patients in a regular maintenance program according to their risk profile. Regarding the treatment of peri-implant mucositis, infection control measures are recommended; controversy exists over the usefulness of antimicrobial agents, and there is evidence against the use of antibiotics. Selection of the peri-implantitis treatment method depends on the severity of the condition and patient-related factors. Resective and regenerative therapies may be used for treatment. The use of systemic antibiotics favors the response of clinical parameters. There is conditional evidence for the use of other adjunctive therapies. Conclusions: the best way to prevent peri-implantitis is to prevent peri-implant mucositis through adherence to supportive periodontal therapy. Treatment of peri-implant diseases depends on local and systemic conditions that affect the success of other treatment options.

RESUMEN Introducción: la incidencia de las enfermedades periimplantarias es alta, y todavía existe polémica en torno a su óptima administración. El propósito del presente estudio consistió en explorar los niveles de evidencia disponibles y ofrecer recomendaciones basadas en la evidencia para el tratamiento de la mucositis periimplantaria y la periimplantitis. Métodos: se elaboró una guía de práctica clínica utilizando los criterios de la Red de Directrices Intercolegiales Escocesas (Scottish Intercollegiate Guidelines Network, SIGN). Se formuló una estrategia de búsqueda y se realizó una revisión crítica de las siguientes evidencias: 1) prevención de enfermedades periimplantarias, 2) tratamiento de la mucositis periimplantaria y 3) tratamiento de la periimplantitis. Las revisiones sistemáticas y los ensayos clínicos controlados aleatorios fueron los principals tipos de estudio identificados en la literatura. Se establecieron los niveles actuales de evidencias y se ofrecieron recomendaciones. Resultados: se incluyeron 67 artículos. En cuanto a la prevención de enfermedades periimplantarias, hay claras evidencias de la participación de los pacientes en los programas de mantenimiento regular, de acuerdo con su perfil de riesgo. En cuanto al tratamiento de la mucositis periimplantaria, se recomiendan medidas de control de infecciones; existe controversia sobre la utilidad de los agentes antimicrobianos, y hay evidencia en contra del uso de antibióticos. La selección del método de tratamiento de la periimplantitis depende de la gravedad de la afección y de los factores relacionados con el paciente. Para el tratamiento se pueden utilizar terapias resectivas y regenerativas. El uso de antibióticos sistémicos favorece la respuesta de los parámetros clínicos. Hay evidencia condicional en cuanto al uso de otras terapias adyuvantes. Conclusiones: la mejor manera de prevenir la periimplantitis es prevenir la mucositis periimplantar mediante la adherencia a la terapia periodontal de apoyo. El tratamiento de las enfermedades periimplantarias depende de las condiciones locales y sistémicas que afectan el éxito de otras opciones de tratamiento.

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OBJECTIVES: Clinical and microbiological longitudinal changes in individuals with peri-implant mucositis (PM) with or without preventive maintenance therapy (PMT) have not been reported, especially in long periods of monitoring. This 5-year follow-up study aimed to assess the clinical and microbiological changes along time in individuals initially diagnosed with PM. MATERIALS AND METHODS: Eighty individuals diagnosed with PM (T1) and followed during 5 years (T2) were divided into one group with PMT during the study period (GTP; n = 39) and another group without PMT (GNTP; n = 41). Full-mouth periodontal/peri-implant examinations were performed. Peri-implant microbiological samples were collected and analyzed through qPCR for Tannerella forsythia, Treponema denticola, Porphyromonas gingivalis, Prevotella intermedia, Fusobacterium nucleatum, and Actinomyces naeslundii at T1 and T2. RESULTS: GNTP presented higher incidence of peri-implantitis than GTP. Moreover, GNTP showed significantly higher total bacterial load and higher frequency of the evaluated orange complex bacteria than GTP. Individuals who progressed to peri-implantitis presented significantly higher total bacterial load and higher frequencies of P. gingivalis, T. denticola, and F. nucleatum. CONCLUSIONS: The absence of regular appointments for PMT was associated with a higher incidence of peri-implantitis and a significant increase in total bacterial load. CLINICAL RELEVANCE: Regular visits during PMT positively influenced subgingival microbiota and contributed to peri-implant homeostasis and clinical status stability during a 5-year monitoring period. Compliance with PMT programs should be reinforced among individuals rehabilitated with dental implants.

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Atualmente, a busca por saúde permeia desde o bem estar físico até conceitos estéticos, para se alcançar os parâmetros pessoais de cada indivíduo. Para um correto planejamento reabilitador, devemos considerar várias possibilidades para evitar falhas funcionais e estéticas. Dentre as falhas tardias observamos as doenças peri-implantares, como por exemplo a Mucosite Peri-implatar e a Peri-implantite. Considerando a complexidade e importância da compreensão das doenças Peri implantares, este trabalho tem como objetivo, através de uma revisão da literatura, discutir os aspectos inerentes à etiologia, diagnóstico e classificação das doenças peri-implantares. O tecido peri-implantar e o tecido periodontal possuem estruturas anatômicas similares, mas possuem diferenças estruturais também. Estes fatos também determinam semelhanças e diferenças nas doenças periodontais e peri-implantares. Sabe-se que o principal fator etiológico das doenças periodontais é o biofilme bacteriano, e nas doenças peri-implantares este também é o principal fator etiológico. O mesmo padrão prevalece para alguns fatores etiológicos secundários ou modificadores. Várias são as propostas de classificação das doenças e condições peri-implantares baseadas na gravidade dos comprometimentos clínicos, nos fatores etiológicos, na associação com outras enfermidades e até com fatores iatrogênicos determinantes. Mas nenhuma contempla estes fatores etiológicos juntos e sabe-se que um correto diagnóstico é determinante para um bom plano de tratamento e determinação de sucesso e longevidade das reabilitações peri-implantares (AU)

Currently, the pursuit for health permeates from the physical well-being to aesthetic concepts, in order to achievethe personal parameters of each individual. For a correct rehabilitation planning we must consider several possibilities to avoid functional and aesthetic failures. Among late failures, there are peri-implant diseases, such as Periimplantar Mucositis and Peri-implantitis. Considering the complexity and importance of the understanding of periimplant diseases, this paper aims, through a literature review, to discuss the inherent aspects of the etiology, diagnosis and classification of these peri-implant diseases. Although they have similar anatomical structure, periodontal and peri-impant tissues have some structural diferences. These facts determine similarities and diferences between periodontal and periimplant diseases. It is known that the main etiological factor of periodontal diseases is bacterial biofilm, and in peri-implant diseases this is also the main etiological factor. The same pattern prevails for some secondary or modifiers etiological factors. There are several suggestions for the classification of peri-implant conditions and diseases based on theseverity of clinical complications, etiological factors, association with other diseases and even iatrogenic factors. But none considers these factors together and it is knownthat a correct diagnosis is determinant for a good treatment plan and determination of success and longevity of the peri-implant rehabilitations (AU)

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Abstract Objective The aim of this study was to evaluate the levels of salivary biomarkers IL-1β, IL-10, RANK, OPG, MMP-2, TG-β and TNF-α in individuals with diagnosis of peri-implant mucositis in the absence or presence of periodontal and peri-implant maintenance therapy (TMPP) over 5 years. Material and Methods Eighty individuals diagnosed with peri-implant mucositis were divided into two groups: one group that underwent periodontal and peri-implant regularly maintenance therapy, called GTP (n=39), and a second group that received no regular maintenance GNTP (n=41). Each participant underwent a complete periodontal and peri-implant clinical examination. Collection of saliva samples and radiographic examination to evaluate peri-implant bone levels were conducted at two times: initial examination (T1) and after 5 years (T2). The salivary samples were evaluated through ELISA for the following markers: IL-1β, IL-10, RANK, OPG, MMP-2, TGF and TNF-α. Results A higher incidence of peri-implantitis was observed in the GNTP group (43.9%) than in the GTP group (18%) (p=0.000). All individuals (n=12) who presented peri-implant mucositis and had resolution at T2 were in the GTP group. After 5 years, there was an increase in the incidence of periodontitis in the GNTP group compared to the GTP group (p=0.001). The results of the study revealed an increase in the salivary concentration of TNF-α in the GNTP group compared to the GTP group. The other salivary biomarkers that were evaluated did not show statistically significant differences between the two groups. Conclusions The salivary concentration of TNF-α was increased in individuals with worse periodontal and peri-implant clinical condition and in those with a higher incidence of peri-implantitis, especially in the GNTP group. Longitudinal studies in larger populations are needed to confirm these findings and elucidate the role of this biomarker in peri-implant disease.

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En junio de 2018 se propuso una nueva clasificación de enfermedades y condiciones periodontales y peri-im-plantares, en una reunión realizada conjuntamente por la Academia Americana de Periodoncia y la Federación Europea de Periodoncia, con el objetivo de actualizar la clasificación de 1999 en uso durante los últimos 19 años. El objetivo del artículo es introducir esta nueva clasificación para que tanto clínicos e investigadores pue-dan aplicarla. La nueva clasificación incorporará nuevos conceptos a medida que se reporten nuevos resultados sobre estudios que sean realizados en el futuro.

A new classification of periodontal and peri-implant diseases and conditions was proposed in June 2018, in a meeting jointly held by the American Academy of Periodontology and European Federation of Periodontology, with the aim to update the 1999 classification in use for 19 years. The article aimed at introducing the most re-cent periodontal and peri-implant classification to clinicians and scientific investigators. The new classification has an in-built plan for periodic revisions while upcoming studies are carried out.

Uma nova classificação das condições e doenças periodontais e peri-implantares foi proposta em junho de 2018, em um encontro que reuniu a Academia Americana de Periodontia e a Federação Europeia de Periodontia, que teve como objetivo atualizar a classificação de 1999, amplamente utilizada nos últimos 19 anos. Este artigo tem como objetivo introduzir a mais nova classificação periodontal e peri-implantar aos clínicos e pesquisadores. A nova classificação possui um planejamento para revisões periódicas a medida que novos estudos são realizados.

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A literatura recente apresenta inúmeros estudos sobre associação entre as doenças peri-implantares (DPi) e níveis de marcadores inflamatórios no fluido do sulco peri-implantar, em biópsias de tecido gengival e sangue. Surpreendentemente, poucos são os estudos de marcadores salivares relacionados à presença e progressão das DPi, uma vez que a saliva representa um meio não invasivo, de fácil coleta e baixo custo. Neste contexto, esta tese apresenta dois estudos distintos: (1) Estudo observacional longitudinal sobre a condição clínica peri-implantar associada aos níveis dos marcadores salivares IL-1ß, IL-10, RANK, OPG, MMP-2, TGF e TNF-α em indivíduos com diagnóstico de mucosite peri-implantar (MP) na ausência e presença de terapia regular de manutenção periodontal e peri-implantar (TMPP); e (2) Revisão sistemática com a seguinte questão focal: "Os níveis de biomarcadores salivares podem ajudar a distinguir implantes saudáveis de implantes com doença peri-implantar ?" A metodologia do estudo longitudinal envolveu 80 indivíduos diagnosticados com MP, que foram divididos em dois grupos: um que realizou terapia de manutenção periodontal e peri-implantar, chamado de GTP (n=39), e um outro sem manutenção (GNTP, n=41). Cada participante submeteu-se a um exame clínico periodontal e peri-implantar completo [registro do nível clínico de inserção (NCI); profundidade de sondagem periodontal (PS) e peri-implantar (PSi); sangramento à sondagem periodontal (SS) e peri-implantar (SSi); supuração (Si); índice de placa periodontal (IP) e peri-implantar (IPi)], exame radiográfico, para avaliação dos níveis ósseos peri-implantares e coleta de amostras de saliva em dois tempos: exame inicial (T1) e decorridos 5 anos (T2). As amostras salivares foram congeladas e posteriormente avaliadas através do teste de ELISA. Observou-se uma maior incidência de peri-implantite (PI) no grupo GNTP (43,9%) do que no grupo GTP (18%) (p = 0.000). Todos os indivíduos (n = 12) que apresentaram resolução da MP em T2 estavam no GTP. Houve um aumento no número de indivíduos com periodontite no GNTP quando comparado T1 (22,0%) e T2 (41.5%) (p = 0.001). Os resultados imunológicos revelaram um aumento na concentração salivar do TNF-α no GNTP comparado ao GTP. Os demais marcadores salivares avaliados não mostraram alteração estatisticamente significativa entre os dois grupos. Concluiu-se que a ausência de consultas regulares para manutenção periodontal/peri-implantar foi associada com pior condição clínica periodontal e peri-implantar, maior incidência de PI e um aumento significativo nos níveis de TNF-α, sugerindo ser este um marcador salivar promissor para a progressão das DPi. Adicionalmente, a revisão sistemática demonstrou que não há evidências sólidas para concluir que os biomarcadores salivares poderiam ajudar a distinguir entre implantes saudáveis de implantes com PI. Além disso, sugere-se que os resultados devem ser interpretados com cautela devido a inclusão de muitos estudos na revisão sistemática com um alto risco de viés.(AU)

Recent literature presents numerous studies on the association between peri-implant diseases (DPi) and levels of inflammatory biomarkers in peri-implant sulcus fluid, in gingival tissue and blood biopsies. Surprisingly, rare are studies on salivary markers related to the presence and progression of DPi, since saliva is abundant, its collection is an easy, low cost and, non-invasive method. In this sense, this thesis presents two distinct studies. The first (longitudinal) study that aimed to evaluate the peri-implant clinical condition and levels of the salivary markers IL 1ß, IL-10, RANK, OPG, MMP-2, TGF, and TNF-α in individuals in the presence and absence of periodontal/ peri-implant maintenance (TMPP). The second study, a systematic review, focused in answer the following question: Could biomarker levels in the saliva help to distinguish between healthy implants and implants with peri-implant disease? The longitudinal study methodology involved 80 individuals diagnosed with mucositis (MP), who were divided into two groups: a group that underwent periodontal and peri-implant maintenance therapy, called GTP (n = 39), and a second group without regular maintenance, called GNTP (n = 41). Each participant underwent a complete periodontal and peri-implant clinical examination [recording of the clinical level of insertion (NCI), periodontal probing depth (PS) and peri-implant probing depth (PSI), periodontal bleeding (SS) and peri-implant bleeding (SSi), suppuration (SU); periodontal plaque (IP) and peri-implant plaque (IPi) indexes], radiographic examination for evaluation of peri-implant bone levels and collection of saliva samples at two times: initial examination (T1) and after 5 years (T2). The salivary samples were frozen and then evaluated by ELISA's method for the following markers: IL 1ß, IL-10, RANK, OPG, MMP- 2, TGF and TNF-α. Results: A higher incidence of peri-implantitis (PI) was noted in the GNTP group (43.9%) than in the GTP group (18%) (p = 0.000). All the individuals (n = 12) who presented resolution of MP in T2 were from the GTP group. There was an increase in the number of individuals with periodontitis in GNTP when comparing T1 (22.0%) to T2 (41.5%) (p = 0.001). The result of the study revealed an increase in the salivary concentration of TNF-α in GNTP compared to GTP. The other salivary markers evaluated did not show statistically significant alteration between the two groups. Conclusion: The absence of regular consultations for periodontal / peri-implant maintenance was associated with worse periodontal and peri-implant clinical condition, higher incidence of PI, and a significant increase in TNF-α levels: suggesting this promising salivary marker for the prognosis and diagnosis of DPi.Additionally, the systematic review has shown that there is no solid evidence to conclude that salivary biomarkers could help distinguish between healthy implant implants with PI. Besides that, it is suggested that the results should be interpreted with caution due to the inclusion of many studies, in the systematic review, with a high risk of bias.(AU)

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OBJECTIVE: To evaluate the frequency of peri-implant diseases and factors associated with its occurrence. MATERIAL AND METHODS: One hundred and fifty-five patients with dental implants were evaluated in this cross-sectional study. Dental implants were clinically and radiographically evaluated to diagnose their peri-implant condition, according to Mombelli (Proceedings of the 3rd European Workshop on Periodontology, 1999, Quintessence, London). Associations between peri-implant diseases and independent variables (socioeconomic, demographic and periodontal characteristics) were evaluated through bivariate analysis with chi-squared and Fisher's exact tests, as well as by multiple logistic regression. The significance level was set at 5%. RESULTS: The frequencies of the peri-implant diseases, mucositis and peri-implantitis, in individuals were 54% and 28% (CI, 95%), respectively. The sample was almost exclusively of patients with untreated periodontal disease (93%). Bivariate analysis showed that these peri-implant diseases were associated with male patients (prevalence ratio [PR], 3.38), medication use (PR, 2.94), systemic diseases (PR, 2.25), number of implants (PR, 2.53), visible plaque index (PR, 2.49) and gingival index (PR, 2.70). Multiple logistic regression analysis showed that medication use (prevalence ratio adjusted [PRadj], 1.23; 95% CI: 1.04-1.46; P = 0.017), having two or more implants (PRadj, 1.22; 95% CI: 1.02-1.46; P = 0.029) and gingival bleeding index > 10% (PRadj, 1.22; 95% CI: 1.03-1.44; P = 0.022) were associated with the presence of peri-implant disease. CONCLUSION: Peri-implant diseases were diagnosed in 54% of patients; gingival index of greater than 10%, having more than two implants and use of medication were associated with the frequency of peri-implant disease.

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El uso de implantes ha tomado un gran auge en los últimos años, sin embargo así como se ha visto un aumento en la demanda también se ha visto un incremento en el fracaso de los mismos, existen múltiples razones que intervienen para esto como son; deficiencias en la cantidad y calidad de hueso, patologías óseas preexistentes, mala técnica quirúrgica, implante inadecuado, hábito tabáquico, entre otras. La mucositis periimplantaria y la periimplantitis son las primeras causas de complicaciones en los implantes, los pacientes con enfermedades crónico degenerativas, fumadores y con mala higiene son considerados pacientes de riesgo para presentar periimplantitis. La literatura ofrece tratamientos quirúrgicos y no quirúrgicos los cuales van enfocados a la eliminación de microorganismos y a la desinfección de la superficie del implante, el tratamiento quirúrgico como la debridación y curetaje tienen la finalidad de eliminar la placa bacteriana, desinfectar la superficie del implante así como retirar el tejido dañado por el proceso inflamatorio, el realizar una adecuada historia clínica y valoración previa, permitirá identificar a los pacientes con mayor o menor riesgo de desarrollar periimplantitis, las citas de mantenimiento ayudan a detectar oportunamente posibles complicaciones.

The use of implants has taken a giant leap in recent years, however, greater demand has also resulted in an increase in the failure of these procedures. There are multiple reasons involved such as; deficiencies in the amount and quality of bone, preexisting bone disease, poor surgical technique, improper implant, tobacco habit, among others. The peri-implant mucositis and peri-implantitis are the main causes of complications in implants, patients with chronic degenerative diseases, smokers and patients with poor oral hygiene are considered risk patients to present peri-implantitis. The literature provides surgical and nonsurgical treatments which are focused on the elimination of microorganisms and the disinfection of the implant surface; surgical treatment as debridement and curettage are designed to remove plaque, disinfect the implant surface and remove damaged tissue caused by the inflammatory process, the performance of an adequate medical history and prior assessment will identify patients with greater or lesser risk of developing peri-implantitis, maintenance appointments help in the early detection of possible complications.

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Resumen Introducción y objetivo: Los tejidos que soportan los implantes osteointegrados son susceptibles a patologías como la periimplantitis y la mucositis periimplantar. Su detección y tratamiento temprano son importantes para prevenir la progresión de la enfermedad y que llegue a comprometerse la estabilidad del implante. Por lo tanto, este estudio retrospectivo tiene como objetivo determinar los factores asociados a la prevalencia de mucositis periimplantar en pacientes tratados en la Clínica de la Maestría en Periodoncia de la Universidad de San Martín de Porres. Materiales y métodos:De 318 historias clínicas correspondientes a un total de 955 implantes colocados entre los años 2001 y 2010, se evaluaron 212 implantes dentales colocados en un total de 74 pacientes. Se utilizó la presencia de sangrado al sondaje como parámetro de diagnostico para la mucositis periimplantar. Resultados: La prevalencia de Mucositis periimplantar obtenida para el total de 212 implantes evaluados fue 58,96%. Adicionalmente, se encontró diferencias estadísticamente significativas al comparar los grupos de implantes con y sin mucositis periimplantar en relación al nivel de higiene oral. Conclusión: La prevalencia de mucositis periimplantar en la Clínica de la Maestría en Periodoncia de la Universidad de San Martin de Porres entre los años 2001 y 2010 fue de 58.96%. Además, se encontró asociación entre la presencia de mucositis periimplantar y el nivel de higiene oral.

Abstract Introduction and objective: Tissues supporting osseointegrated implants are susceptible to diseases such as periimplantitis and periimplant mucositis. Early detection and treatment are important to prevent disease progression and loss of implant stability. Therefore, the aim of this retrospective study was determine the factors associated with the prevalence of peri-implant mucositis of subjects treated at the Clinic of the Master in Periodontics at the University of San Martín de Porres. Materials and methods: 318 medical records with a total of 955 implants were placed from 2001 to 2010. Of these, 212 dental implants evaluated in a total of 74 medical records were included in this study. We used the presence of bleeding on probing as a diagnostic parameter for peri-implant mucositis. Results: The prevalence of peri-implant mucositis obtained for the total of 212 implants was 58,96%. Additionally, statistically significant differences were found when comparing the groups of implants with peri-implant mucositis and without regard to the oral hygiene level. Conclusion:The prevalence of peri-implant mucositis at the University of San Martin De Porres is 58.96%. It has been found statistically significant association between the presence of peri-implant mucositis and oral hygiene level.

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Tem sido demonstrado que o desenvolvimento da mucosite peri-implantar está associado ao acúmulo de biofilme dentário. Acredita-se que as abordagens terapêuticas utilizadas nas doenças periodontais podem apresentar efeito positivo nos casos de doenças peri-implantares. O objetivo desse estudo foi avaliar a eficácia do tratamento não cirúrgico da mucosite peri-implantar em 119 implantes, sendo 61 no grupo teste (digluconato de clorexidina a 0,12%) e 58 no grupo controle (placebo), em indivíduos reabilitados com implantes. Desta forma, os pacientes foram divididos aleatoriamente em grupo teste (terapia não cirúrgica + clorexidina) e controle (terapia não cirúrgica). Esta terapia consistiu de uma adaptação do protocolo não-cirúrgico FMSRP (Full Mouth Scalling and Root Planing), porém, sem a utilização do ultrassom. Os parâmetros clínicos índice de placa visível (IPV), índice de sangramento gengival (ISG), profundidade de sondagem (PS), sangramento à sondagem (SS) e mucosa queratinizada foram avaliados no baseline e em diferentes períodos após o tratamento. Os dados não apresentaram distribuição normal e o implante foi considerado a unidade amostral. Os dados foram analisados por meio dos testes de Friedman, Wilcoxon e Qui-quadrado (=5%), utilizando o Statistical Package for Social Sciences 17.0 (SPSS). Os resultados mostraram que houve diferença estatisticamente significativa (p<0,05) para as variáveis: média do IPV dos implantes em ambos os grupos; média do ISG dos implantes tanto no grupo teste, como controle dos implantes; PS para o grupo teste e controle e SS dentro dos dois grupos de tratamento. No entanto, não houve diferença estatisticamente significativa quando os grupos foram comparados. As variáveis PS e SS não mostraram diferença estatisticamente significativa com nenhuma variável independente de interesse para este estudo (idade, sexo, fumo, grupo de tratamento, mucosa ceratinizada nos diferentes tempos, biótipo peri-implantar, média do IPV e ISG nos implantes). Desta forma, pode-se concluir que tanto a terapia mecânica isolada como sua associação com bochechos de digluconato de clorexidina a 0,12% podem ser usados para o tratamento da mucosite periimplantar. Além disso, a condição de higiene bucal melhorou entre o baseline e seis meses e a profundidade e sangramento à sondagem reduziram após três e seis meses. (AU)

It has been shown that the development of peri-implant mucositis is associated with biofilm accumulation. It is believed that the therapeutic approaches used in periodontal disease may have a positive effect in the cases of peri-implant disease. The aim of this study was to evaluate the effectiveness of non-surgical treatment of peri-implant mucositis, with or without the use of chlorhexidine 0,12% in subjects rehabilitated with osseointegrated implants. Thus, patients were randomly divided into test group (chlorhexidine surgical therapy) and control (non-surgical treatment). This therapy consisted of an adaptation of the (Full Mouth scalling and Root Planing) nonoperative protocol FMSRP, but without the use of ultrasound. The visible plaque index (VPI), gingival bleeding index (GBI), probing depth (PD), bleeding on probing (BOP) and keratinized mucosa clinical parameters were evaluated at baseline and at different times after treatment. The data were not normally distributed and the implant was considered the sampling unit. Data were analyzed using Friedman and Wilcoxon chi-square (=5%), tests using the Statistical Package for Social Sciences 17.0 (SPSS). Thus, 119 implants were evaluated, 61 in the test group and 58 in the control group. The results showed statistically significant differences for the variables: average BTI implants in both groups (p<0,001), mean ISG implants both in the test group (p<0,001), and control (p= 0,006) of implants; PS for the test group (p< 0,001) and control (p = 0,015) and SS (p<0,001) in the two treatment groups. However, there was no statistically significant difference when the groups were compared. The PS and SS variables showed no statistically significant difference in any of independent interest to the study (age, sex, smoking, treatment group, keratinized mucosa at different times, peri-implant biotype, average VPI implants and GBI). Thus, it can be concluded that both the mechanical treatment isolated as its association with chlorhexidine mouthwash 0.12% can be used for the treatment of peri-implant mucositis. Moreover, the condition of oral hygiene has improved between baseline and six months and the depth and bleeding on probing decreased after three and six months. (AU)

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Os parâmetros clínicos e radiográficos estão sendo amplamente utilizados no diagnóstico das doenças peri-implantares. O exame dos tecidos peri-implantares através desses parâmetros permite a detecção de sinais e sintomas da mucosite peri-implantar e da peri-implantite. Além disso, os estudos atuais mostram um aumento na prevalência dessas alterações, o que sugere a necessidade de um diagnóstico precoce. Os parâmetros clínicos que podem ser utilizados neste diagnóstico são os índices de placa, gengival e de sangramento, a profundidade de sondagem, a posição da margem gengival, o nível de inserção clínica, a presença ou ausência de supuração, a quantidade de mucosa queratinizada, o teste de mobilidade e a verificação de perda óssea radiográfica. O objetivo deste estudo foi, através de uma revisão da literatura sobre os parâmetros clínicos e radiográficos, discutir e indicar quais os índices que podem ser utilizados na prática clínica diária a fim de diagnosticar as doenças peri-implantares.

Clinical and radiographic parameters have been widely used on periimplant diseases diagnoses. Peri-implant examination, through these parameters, allows detection of signs and symptoms of Peri-implant Mucositis and Peri-implantitis. Moreover, several studies have shown an increase in the prevalence of those diseases suggesting a necessity for early diagnoses. Peri-implant plaque index, gingival and bleeding index, probing deep, gingival margin position, clinical attachment level, presence or absence of suppuration, keratinized mucosa, mobility test, and radiographic peri-implant bone loss are the most commonly used parameters in peri-implant disease diagnosis. The aim of this literature review is to describe clinical and radiographic parameters, and to discuss and indicate which parameters can be used to diagnose peri-implant diseases.

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