Patientâ Centered Perspectives and Understanding of Periâ Implantitis

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/141085/1/jper1153.pd

Basis of bone metabolism around dental implants during osseointegration and periâ implant bone loss

Despite the growing number of publications in the field of implant dentistry, there are limited studies to date investigating the biology and metabolism of bone healing around dental implants and their implications in periâ implant marginal bone loss. The aim of this review article is to provide a thorough understanding of the biological events taking place during osseointegration and the subsequent early and late phases of bone remodeling around dental implants. An update on the coupling mechanism occurring during bone resorptionâ bone remodeling is provided, focused on the relevance of the osteocytes, bone lining cells and immune cells during bone maintenance. An electronic and manual literature search was conducted by three independent reviewers in several databases, including MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Cochrane Oral Health Group Trials Register databases for articles up to September 2016 with no language restriction. Local bone metabolism is subject to signals from systemic calciumâ phosphate homeostasis and bone remodeling. Three areas of interest were reviewed due to recent reported compromises in bone healing including the putative effects of (1) cholesterol, (2) hyperlipidemia, and (3) low vitamin D intake. Moreover, the prominent influence of osteocytes and immune cells is discussed as being key regulators during dental implant osseointegration and maintenance. These cells are of crucial importance in the presence of biofilm accumulation and their associated byproducts that leads to hard and soft tissue breakdown; the so called periâ implantitis. Factors that could negatively impact osteoclastogenesis or osteal macrophage activation should be monitored in future research including implant placement/torque protocols, bone characteristics, as well as meticulous maintenance programs to favor osseointegration and future longâ term stability and success of dental implants. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 105A: 2075â 2089, 2017.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/137387/1/jbma36060.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/137387/2/jbma36060_am.pd

Emerging factors affecting peri-implant bone metabolism.

Implant dentistry has evolved to the point that standard implant osseointegration is predictable. This is attributed in part to the advancements in material sciences that have led toward improvements in implant surface technology and characteristics. Nonetheless, there remain several cases where implant therapy fails (specifically at early time points), most commonly attributed to factors affecting bone metabolism. Among these patients, smokers are known to have impaired bone metabolism and thus be subject to higher risks of early implant failure and/or late complications related to the stability of the peri-implant bone and mucosal tissues. Notably, however, emerging data have unveiled other critical factors affecting osseointegration, namely, those related to the metabolism of bone tissues. The aim of this review is to shed light on the effects of implant-related factors, like implant surface or titanium particle release; surgical-related factors, like osseodensification or implanted biomaterials; various drugs, like selective serotonin reuptake inhibitors, proton pump inhibitors, anti-hypertensives, nonsteroidal anti-inflammatory medication, and statins, and host-related factors, like smoking, diet, and metabolic syndrome on bone metabolism, and aseptic peri-implant bone loss. Despite the infectious nature of peri-implant biological complications, these factors must be surveyed for the effective prevention and management of peri-implantitis

Morphology and severity of peri-implantitis bone defects

BackgroundPeri-implant defect morphology has shown to potentially impact upon the reconstructive outcomes for the management of peri-implantitis. Given the role that defect morphology plays upon the decision-making in the treatment of peri-implantitis, the present study aimed at assessing the morphology and severity of peri-implantitis bone defects and to insight on the patient-, implant- and site-related variables associated to these.Material and MethodsA cone-beam computed tomography study was carried out to classify peri-implantitis defects according to the type of defect, number of remaining bony walls and severity according to the extension of vertical bone loss. Three major defect categories were proposed: class I-infraosseous; class II-horizontal; class III-combined of class I and II. These were then subclassified into: (a) dehiscence; (b) 2/3-wall; and (c) circumferential-type defect. According to the severity the defects were further subclassified into: A: advanced; M: moderate; and S: slight. In addition, 20 site-, implant-, and patient-related variables were analyzed by generalized estimating equations (GEEs) of multilevel logistic regression models.ResultsBased on an a priori power calculation, 332 implants were screened in 47 peri-implantitis patients. Of these, 158 peri-implantitis implants were eligible. The most prevalent defect morphology type was class Ib (55%) followed by class Ia (16.5%), and class IIIb (13.9%). On the contrary, the less frequent defect was class II (1.9%). The most frequent degree of severity was M (50.6%) with S (10.1%) being the least prevalent. Buccal bone loss was significantly greater compared to the other bony walls in class I and class III defects. Age was associated with the type of defect. Age and smoking habit were associated with the morphology of the defects, while smoking habit, type of prosthesis and distance to adjacent implant were associated with the severity of the defects (vertical bone loss).ConclusionPeri-implantitis defects frequently course with an infraosseous component and often with buccal bone loss. Certain patient-, implant-, and site-specific variables are related with defect morphology and severity. However, morphological patterns for peri-implantitis bone defects could not be proven (NCT NCT03777449).Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/151323/1/cid12791.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/151323/2/cid12791_am.pd

Accuracy of Schneiderian membrane thickness: a coneâ beam computed tomography analysis with histological validation

ObjectivesConeâ beam computed tomography (CBCT) has been used in the literature to evaluate Schneiderian membrane thickness (SMT), but its accuracy has never been validated. The primary aim of this study was to compare the SMT measured by CBCT to the gold standard histological assessment. The correlations between SMT and anatomical structures of the maxillary sinus and alveolar bone were also tested.Materials and MethodsFourteen fresh cadaver heads were used for the study, and 28 sinus lift augmentation procedures were performed to obtain the membrane samples. Samples were fixed in formalin and stained with hematoxylinâ eosine and Masson trichrome. Specimens were measured by optic microscope at three points, and a mean was obtained. Anatomical landmarks were used to accurately position the CBCT slice, so the SMT could be measured in predetermined locations. Wilcoxon signedâ rank test was used to compare values of histological and CBCT measurements, and Spearman’s correlation coefficient was calculated to examine the relationship between thickness and anatomical parameters.ResultsA total of 597 histological measurements were performed, and the mean SMT thickness was 0.30 ± 0.17 mm. The mean CBCT membrane thickness was 0.79 ± 0.52 mm. A statistically significant difference from histological and radiological readings was observed (P = 0.000). Interestingly, 87.77% histological measurements had membrane less than 0.5 mm in thickness compared to 26.66% in CBCT assessment.ConclusionsWithin the limitation of this study, the median histological Schneiderian membrane thickness was 0.30 mm. Coneâ beam computed tomography assessment was 2.6 times higher than the histological examination.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/137465/1/clr12856_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/137465/2/clr12856.pd

Schneiderian Membrane Thickness and Clinical Implications for Sinus Augmentation: A Systematic Review and Metaâ Regression Analyses

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/141205/1/jper0888-sup-0001.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/141205/2/jper0888.pd

Available web-based teaching resources for health care professionals on screening for oral cancer

Objectives: To identify websites with adequate information on oral cancer screening for healthcare professionals (HCPs) and to assess both their quality and contents. Study Design: Websites were identified using Google and HON medical professional search engines using the terms “screening for oral cancer”. The first 100 sites retrieved by each engine were analysed using the DISCERN questionnaire (reliability), the V instrument (contents on oral cancer) and further by the Flesch-Kinkaid Reading Grade Level and the Flesch Reading Ease (readability). Results: The overall rating showed minimal shortcomings in the quality of the information in the websites. The coverage and correctness of information on “visual examination” was rated as fair/good, whereas updating of contents resulted very variable (eg: 81% for visual examination and 18.2% for molecular biomarkers). These results permitted to rank the websites housing relevant information for oral cancer. Top ranking websites were affiliated to the Oral Cancer Foundation (USA), WHO Collaborating Centre for oral cancer (UK) whose webpage is entitled “Oral Cancer Education and Research”, and the Clinical Guidelines maintained by the British Columbia Cancer Agency (Canada) and the British Dental Association (UK) respectively. Conclusions: There are web-based, HCP-addressed, resources on screening for oral cancer housing heterogeneous information both in quality and contents. The use of specific evaluation tools permits the selection of reliable websites on this topic with a potential to improve the existing educational gaps among HCPs

Noninvasive early detection of colorectal cancer by hypermethylation of the LINC00473 promoter in plasma cell-free DNA

Background Current noninvasive assays have limitations in the early detection of colorectal cancer. We evaluated the clinical utility of promoter methylation of the long noncoding RNA LINC00473 as a noninvasive biomarker to detect colorectal cancer and associated precancerous lesions. Methods We evaluated the epigenetic regulation of LINC00473 through promoter hypermethylation in colorectal cancer cell lines using bisulfite genomic sequencing and expression analyses. DNA methylation of LINC00473 was analyzed in primary colorectal tumors using 450K arrays and RNA-seq from The Cancer Genome Atlas (TCGA). Tissue-based findings were validated in several independent cohorts of colorectal cancer and advanced colorectal polyp patients by pyrosequencing. We explored the clinical utility of LINC00473 methylation for the early detection of colorectal cancer in plasma cell-free DNA by quantitative methylation-specific PCR and droplet digital PCR. Results LINC00473 showed transcriptionally silencing due to promoter hypermethylation in colorectal cancer cell lines and primary tumors. Methylation of the LINC00473 promoter accurately detected primary colorectal tumors in two independent clinical cohorts, with areas under the receiver operating characteristic curves (AUCs) of 0.94 and 0.89. This biomarker also identified advanced colorectal polyps from two other tissue-based clinical cohorts with high diagnostic accuracy (AUCs of 0.99 and 0.78). Finally, methylation analysis of the LINC00473 promoter in plasma cell-free DNA accurately identified patients with colorectal cancer and advanced colorectal polyps (AUCs of 0.88 and 0.84, respectively), which was confirmed in an independent cohort of patients. Conclusions Hypermethylation of the LINC00473 promoter is a new promising biomarker for noninvasive early detection of colorectal cancer and related precancerous lesions

Emerging factors affecting peri-implant bone metabolism

Implant dentistry has evolved to the point that standard implant osseointegration is predictable. This is attributed in part to the advancements in material sciences that have led toward improvements in implant surface technology and characteristics. Nonetheless, there remain several cases where implant therapy fails (specifically at early time points), most commonly attributed to factors affecting bone metabolism. Among these patients, smokers are known to have impaired bone metabolism and thus be subject to higher risks of early implant failure and/or late complications related to the stability of the peri-implant bone and mucosal tissues. Notably, however, emerging data have unveiled other critical factors affecting osseointegration, namely, those related to the metabolism of bone tissues. The aim of this review is to shed light on the effects of implant-related factors, like implant surface or titanium particle release; surgical-related factors, like osseodensification or implanted biomaterials; various drugs, like selective serotonin reuptake inhibitors, proton pump inhibitors, anti-hypertensives, nonsteroidal anti-inflammatory medication, and statins, and host-related factors, like smoking, diet, and metabolic syndrome on bone metabolism, and aseptic peri-implant bone loss. Despite the infectious nature of peri-implant biological complications, these factors must be surveyed for the effective prevention and management of peri-implantitis

Diagnostic accuracy of the implant stability quotient in monitoring progressive peri-implant bone loss: An experimental study in dogs.

OBJECTIVES To investigate the impact of progressive bone loss in an experimental peri-implantitis model in the dog upon the implant stability quotient (ISQ) measured in the course of induced and spontaneous conditions of disease, and to evaluate the association between the clinical parameters and ISQ. MATERIALS AND METHODS Seventy-two implants were placed in 12 Beagle dogs. Of these, 36 implants in six dogs were assessed during ligature-induced peri-implantitis (three timepoints) and at one timepoint following a period of spontaneous progression. The ISQ was recorded using resonance frequency analysis (RFA). Furthermore, the clinical peri-implant parameters were registered at four sites per implant at each timepoint. Marginal bone loss (MBL) was determined using computed tomography at four sites per implant and bone-to-implant contact (BIC) was assessed from histological samples. A linear regression model was estimated by generalized estimation equations (GEEs) in order to study the MBL-ISQ values at each measurement timepoint. Pearson's correlation test was applied. RESULTS None of the implants failed during the study period. At implant level, a strong negative correlation was found for all timepoints between ISQ and MBL (r = -0.58; p < 0.001). Accordingly, as follow-up progressed, lower ISQ and higher MBL values were observed. A prediction of MBL depending on the ISQ values and timepoints showed a decrease in one ISQ unit to be related to ~1 mm of MBL. Likewise, a statistically significant correlation was found between BIC and ISQ evaluated after spontaneous chronification of peri-implantitis (r = 0.34; p = 0.04). Nevertheless, the ISQ values failed to correlate to any of the clinical parameters recorded. CONCLUSION Resonance frequency analysis seems accurate in diagnosing progressive bone loss, as a statistically significant decrease in ISQ was recorded in the course of peri-implant disease. Nevertheless, the clinical relevance of this observation as a diagnostic tool is debatable, since implant stability remains high