Decontamination using a desiccant with air powder abrasion followed by biphasic calcium sulfate grafting: a new treatment for peri-implantitis.

Peri-implantitis is characterized by inflammation and crestal bone loss in the tissues surrounding implants. Contamination by deleterious bacteria in the peri-implant microenvironment is believed to be a major factor in the etiology of peri-implantitis. Prior to any therapeutic regenerative treatment, adequate decontamination of the peri-implant microenvironment must occur. Herein we present a novel approach to the treatment of peri-implantitis that incorporates the use of a topical desiccant (HYBENX), along with air powder abrasives as a means of decontamination, followed by the application of biphasic calcium sulfate combined with inorganic bovine bone material to augment the intrabony defect. We highlight the case of a 62-year-old man presenting peri-implantitis at two neighboring implants in positions 12 and 13, who underwent access flap surgery, followed by our procedure. After an uneventful 2-year healing period, both implants showed an absence of bleeding on probing, near complete regeneration of the missing bone, probing pocket depth reduction, and clinical attachment gain. While we observed a slight mucosal recession, there was no reduction in keratinized tissue. Based on the results described within, we conclude that the use of HYBENX and air powder abrasives, followed by bone defect grafting, represents a viable option in the treatment of peri-implantitis

Successful management of peri-implantitis around short and ultrashort single-crown implants: a case series with a 3-year follow-up

Introduction and Aim. In case of peri-implantitis, resective surgery is contraindicated for short and ultrashort implants, limiting the treatment options to regenerative surgery or to implant removal. 'is retrospective case series presents the clinical and radiographic outcomes of a surgical regenerative procedure to treat peri-implantitis around short and ultrashort implants. Materials and Methods. The study is a retrospective evaluation of patients suffering from peri-implantitis and those who underwent access flap surgery, concomitant chemical and mechanical decontamination of implant surface, and bone grafting using a self-hardening mixture of bone substitutes and biphasic calcium sulfate. No membranes were applied to cover the grafting material, and primary tension-free closure was achieved. The retrospective protocol was reviewed and approved by the Ethics Committee for Clinical Sperimentation (CESC) of Verona and Rovigo, Italy (based in the University of Verona) (Prog. 1863CESC. Date of approval: 2018-07-04). Results. 15 patients (17 implants) have been diagnosed with peri-implantitis after a mean follow-up of 24 months after loading. Implant length was between 5 and 8 mm. 8 patients (10 implants) had a history of periodontitis. At baseline, the mean PD (probing pocket dept) at the deepest site was 8.12 mm, with an average mBI (modified bleeding index) of 2.35 and a mean BD (bone defect depth) of 3.04 mm. At the 3-year follow-up, the CSR was 100%, the mean mBI was 0.88 (average reduction: - 1.47), the mean PD was 3.35 mm (mean PD reduction: 4.77 mm), and the mean bone defect was reduced by 1.74 mm, with a mean bone fill of 55%. Conclusions. The results of the present case series suggest that if accurate surface decontamination is achieved, high survival rate and good clinical and radiographic results can be obtained after 3 years. However, only the histological examination could confirm the growth of new bone in direct contact with the implant surface or if the grafted material only fills the space left by the peri-implant defect

Phosphatidylinositol 3-kinase δ blockade increases genomic instability in B cells

Activation-induced cytidine deaminase (AID) is a B-cell specific enzyme that targets immunoglobulin (Ig) genes to initiate class switch recombination (CSR) and somatic hypermutation (SHM)(1). Through off-target activity, however, AID has a much broader impact on genomic instability by initiating oncogenic chromosomal translocations and mutations involved in lymphoma development and progression(2). AID expression is tightly regulated in B cells and its overexpression leads to enhanced genomic instability and lymphoma formation(3). The phosphatidylinositol 3-kinase (PI3K) δ pathway plays a key role in AID regulation by suppressing its expression in B cells(4). Novel drugs for leukemia or lymphoma therapy such as idelalisib, duvelisib or ibrutinib block PI3Kδ activity directly or indirectly(5–8), potentially affecting AID expression and, consequently, genomic stability in B cells. Here we show that treatment of primary mouse B cells with idelalisib or duvelisib, and to a lesser extent ibrutinib, enhanced the expression of AID and increased somatic hypermutation (SHM) and chromosomal translocation frequency to the Igh locus and to several AID off-target sites. Both these effects were completely abrogated in AID deficient B cells. PI3Kδ inhibitors or ibrutinib increased the formation of AID-dependent tumors in pristane-treated mice. Consistently, PI3Kδ inhibitors enhanced AID expression and translocation frequency to IgH and AID off-target sites in human chronic lymphocytic leukemia (CLL) and mantle cell lymphoma (MCL) cell lines, and patients treated with idelalisib, but not ibrutinib, showed increased SHM in AID off-targets. In summary, we show that PI3Kδ or BTK inhibitors increase genomic instability in normal and neoplastic B cells by an AID-dependent mechanism, an effect that should be carefully considered as such inhibitors are administered for years to patients

Quantitative aortography for assessment of aortic regurgitation in the era of percutaneous aortic valve replacement

Paravalvular leak (PVL) is a shortcoming that can erode the clinical benefits of transcatheter valve replacement (TAVR) and therefore a readily applicable method (aortography) to quantitate PVL objectively and accurately in the interventional suite is appealing to all operators. The ratio between the areas of the time-density curves in the aorta and left ventricular outflow tract (LVOT-AR) defines the regurgitation fraction (RF). This technique has been validated in a mock circulation; a single injection in diastole was further tested in porcine and ovine models. In the clinical setting, LVOT-AR was compared with trans-thoracic and trans-oesophageal echocardiography and cardiac magnetic resonance imaging. LVOT-AR > 17% discriminates mild from moderate aortic regurgitation on echocardiography and confers a poor prognosis in multiple registries, and justifies balloon post-dilatation. The LVOT-AR differentiates the individual performances of many old and novel devices and is being used in ongoing randomized trials and registries

Percutaneous mitral valve edge-to-edge Repair: In-hospital results and 1-year follow-up of 628 patients of the 2011-2012 pilot European Sentinel Registry

The use of transcatheter mitral valve repair (TMVR) has gained widespread acceptance in Europe, but data on immediate success, safety, and long-term echocardiographic follow-up in real-world patients are still limited

Quantitative aortography for assessment of aortic regurgitation in the era of percutaneous aortic valve replacement

Paravalvular leak (PVL) is a shortcoming that can erode the clinical benefits of transcatheter valve replacement (TAVR) and therefore a readily applicable method (aortography) to quantitate PVL objectively and accurately in the interventional suite is appealing to all operators. The ratio between the areas of the time-density curves in the aorta and left ventricular outflow tract (LVOT-AR) defines the regurgitation fraction (RF). This technique has been validated in a mock circulation; a single injection in diastole was further tested in porcine and ovine models. In the clinical setting, LVOT-AR was compared with trans-thoracic and trans-oesophageal echocardiography and cardiac magnetic resonance imaging. LVOT-AR > 17% discriminates mild from moderate aortic regurgitation on echocardiography and confers a poor prognosis in multiple registries, and justifies balloon post-dilatation. The LVOT-AR differentiates the individual performances of many old and novel devices and is being used in ongoing randomized trials and registries

The impact of subcrestal placement on short locking-taper implants placed in posterior maxilla and mandible: a retrospective evaluation on hard and soft tissues stability after 2 years of loading.

Objective of this study was to assess the influence of the subcrestal placement level of short implants with a locking-taper connection design on crestal bone levels and soft tissues health. After two years of observation, the implant of this study have shown minimal peri-implant bone resorption. The greater subcrestal implant placement has resulted in a higher level of the peri-implant bone crest, both after the osseointegration period and after the loading period. Both the study implants groups have shown good health of peri-implant soft tissues

The impact of subcrestal placement on short locking-taper implants placed in posterior maxilla and mandible: a retrospective evaluation on hard and soft tissues stability after 2 years of loading.

AIM: Objective of this study was to assess the influence of the subcrestal placement level of short implants with a locking-taper connection design on crestal bone levels and soft tissues health. METHODS: A clinical retrospective case-control study was conducted between May 2013 and September 2013. The sample was composed of patients who had received at least one 5-to-8-mm-long, plateau-design implant with a locking-taper connection system (Bicon LLC, Boston, MA, USA) in posterior areas of maxilla and mandible, in the period between January 2009 and Dicember 2011. A radiographic evaluation of the degree of subcrestal positioning(t0) was conducted to identify two implant groups: Group 1 was composed of implants placed less than 2 mm under the crestal bone; Group 2 was composed of implants placed 2 mm or more under the crest. The primary outcome variables were the crestal bone levels and the peri-implant bone loss between prosthetic loading and last control visit (t1àt2). Clinical parameters including the keratinized gingival (KG) width, modified bleeding index (mBI), modified plaque index (mPI), and probing depth (PD) were assessed at the follow-up visit. T tests were conducted to identify statistically significant differences between implants groups. Linear regression models were developed to test the dependence of the study variables by the degree of subcrestal surgical implant placement. Significance level was set at P<0.05. RESULTS: One hundred and thirty-seven implants were followed for an average period of 31 months. At the surgery, the implants were placed, on average, 2.04 mm (mesial) and 1.86 mm (distal) subcrestally. Eighty implants were placed less than 2 mm under the crest (average 1.28 mm), while fifty-seven implants were placed more than 2 mm under the crestal bone (average 2.97 mm). At the prosthetic loading (t1), the average crestal bone level was 1.11 mm, 0.79 mm in Shallow group and 1.86 mm in Deep group, with statistically significant differences between implant groups (P<0.05). At the follow-up visit (t2) the mean crestal bone levels were respectively 0.51 mm and 1.35 mm, with statistically significant differences between implant groups (P<0.05). The average peri-implant bone loss between prosthetic loading and control visit (t1àt2) was 0.04 mm in the Group 1 and 0.33 mm in Group 2. The average keratinized mucosa width was 2.16 mm, the average mBI was 0.24 , the average mPI was 0.17 and the average PD was 2.34 mm. Significant difference between groups was observed regarding to keratinized gingival width (Group 1: 1.97 mm; Group 2: 2.41 mm; P<0.05) but not for the other clinical parameters. Linear regression models confirmed the dependence of crestal bone levels by the degree of subcrestal placement (P<0.05). CONCLUSION: After two years of observation, the implant of this study have shown minimal peri-implant bone resorption. The greater subcrestal implant placement has resulted in a higher level of the peri-implant bone crest, both after the osseointegration period and after the loading period. Both the study implants groups have shown good health of peri-implant soft tissues