Dental implant outcomes in grafted sockets: a systematic review and meta-analysis

Objectives: To assess the treatment outcomes of the dental implants placed in the grafted sockets.Material and Methods: A search protocol was developed to evaluate the treatment outcomes of dental implants placed in the grafted sockets in terms of implant survival rates (primary outcome), marginal-bone-level (MBL) changes, clinical parameters (i.e., bleeding on probing, probing depth), occurrence of peri-implant diseases, and aesthetic outcomes (secondary outcomes). Randomized controlled clinical trials (RCTs), controlled clinical trials, and prospective studies with at least 12 months of follow-up and a minimum of 10 patients having at least one dental implant inserted into the grafted socket were conducted. MEDLINE (PubMed) was searched for relevant articles published until 1st April 2019. A meta-analysis was performed using the random-effects model on the selected qualifying articles.Results: The present analysis included 7 RCTs. The survival rate of the implants inserted into the grafted sockets ranged from 95 to 100% after 1 to 4 years of follow-up. MBL loss was found to be significantly greater for the implants placed in the non-grafted healed sites than for those placed in the previously grafted sockets (weighted mean difference = -1.961 mm, P < 0.0001). In terms of MBL changes, no difference was detected between immediately inserted implants versus implants placed in previously grafted sockets. None of the included studies reported on the clinical parameters or occurrence of peri-implant diseases.Conclusions: Implants inserted into the previously grafted sockets showed high survival rates and lower marginal-bone-level loss than the implants inserted into the non-grafted sites.info:eu-repo/semantics/publishedVersio

Surgical Treatment of Periimplantitis With Augmentative Techniques.

OBJECTIVES To address the focused question: "In patients with osseointegrated implants diagnosed with periimplantitis, what are the clinical and radiographic outcomes of augmentative surgical interventions compared with nonaugmentative surgical measures"? MATERIAL AND METHODS Literature screening was performed in MEDLINE through the PubMed database, for articles published until January 1, 2018. Human studies reporting on the clinical (ie, bleeding on probing [BOP] and probing depth [PD] changes) and/or radiographic (ie, periimplant defect reduction and/or fill) treatment outcomes after surgical augmentative periimplantitis therapy, and/or comparing augmentative and nonaugmentative surgical approaches were searched. RESULTS Thirteen comparative and 11 observational clinical studies were included. Surgical augmentative periimplantitis therapy resulted in mean BOP and PD reduction ranging from 26% to 91%, and 0.74 to 5.4 mm, respectively. The reported mean radiographic fill of intrabony defects ranged between 57% and 93.3%, and defect vertical reduction varied from 0.2 to 3.77 mm. Three randomized controlled clinical studies failed to demonstrate the superiority of augmentative therapy compared with nonaugmentative approach in terms of PD and BOP reduction. CONCLUSIONS The available evidence to support superiority of augmentative surgical techniques for periimplantitis management on the treatment outcomes over nonaugmentative methods is limited

The 2nd Baltic Osseointegration Academy and Lithuanian University of Health Sciences Consensus Conference 2019. Summary and consensus statements: Group II - Extraction socket preservation methods and dental implant placement outcomes within grafted sockets

Introduction: The task of Group II was to review and update the existing data concerning extraction socket preservation with or without membranes and soft tissue influence on post-extraction alveolar ridge preservation; extraction socket preservation using different biomaterials as bone grafts, growth factors, and stem cells. Special interest was paid to the dental implant placement outcomes within grafted sockets.Material and Methods: The main areas evaluated by this group were as follows: quantitative and qualitative assessment of the effect of different alveolar preservation techniques performed immediately after tooth extraction, with or without membranes and/or soft tissue grafting, and the use of different bone substitutes, stem cells or growth factors in the postextraction socket. Evaluation of the treatment outcomes of dental implants placed in the grafted sockets in terms of primary and secondary outcomes were assessed. The systematic reviews and/or meta-analyses were registered in PROSPERO, an international prospective register of systematic reviews: http://www.crd.york.ac.uk/PROSPERO/. TThe literature in the corresponding areas of interest was screened and reported following the PRISMA guidelines (Preferred Reporting Item for Systematic Review and Meta-Analysis) Statement: http://www.prisma-statement.org/. Method of preparation of the systematic reviews, based on comprehensive search strategies, was discussed and standardized. The summary of the materials and methods employed by the authors in preparing the systematic reviews and/or meta-analyses is presented in the Preface chapter.Results: The results and conclusions of the review process are presented in the respective papers. Three systematic reviews and one systematic review and meta-analysis were performed. The group's general commentaries, consensus statements, clinical recommendations and implications for research are presented in this article.info:eu-repo/semantics/publishedVersio

Diagnostic Principles of Peri-Implantitis: a Systematic Review and Guidelines for Peri-Implantitis Diagnosis Proposal

Objectives: To review and summarize the literature concerning peri-implantitis diagnostic parameters and to propose guidelines for peri-implantitis diagnosis. Material and Methods: An electronic literature search was conducted of the MEDLINE (Ovid) and EMBASE databases for articles published between 2011 and 2016. Sequential screening at the title/abstract and full-text levels was performed. Systematic reviews/guidelines of consensus conferences proposing classification or suggesting diagnostic parameters for peri-implantitis in the English language were included. The review was recorded on PROSPERO system with the code CRD42016033287. Results: The search resulted in 10 articles that met the inclusion criteria. Four were papers from consensus conferences, two recommended diagnostic guidelines, three proposed classification of peri-implantitis, and one suggested an index for implant success. The following parameters were suggested to be used for peri-implantitis diagnosis: pain, mobility, bleeding on probing, probing depth, suppuration/exudate, and radiographic bone loss. In all of the papers, different definitions of peri-implantitis or implant success, as well as different thresholds for the above mentioned clinical and radiographical parameters, were used. Current evidence rationale for the diagnosis of peri-implantitis and classification based on consecutive evaluation of soft-tissue conditions and the amount of bone loss were suggested. Conclusions: Currently there is no single uniform definition of peri-implantitis or the parameters that should be used. Rationale for diagnosis and prognosis of peri-implantitis as well as classification of the disease is proposed

The Efficacy of Supportive Peri-Implant Therapies in Preventing Peri-Implantitis and Implant Loss: a Systematic Review of the Literature

Objectives: To study the efficacy of supportive peri-implant therapies in preventing clinical and radiological signs of peri-implantitis and implant loss. Material and Methods: Longitudinal human studies, published between January 1, 2006, and February 1, 2016, were included based on an electronic search using MEDLINE and EMBASE databases and complemented by a manual search. Articles were included only if 1) they comprised a group of patients involved in/adhering to regular supportive peri-implant therapies (SPTs) and a control group without such therapies or with poor adherence to them, 2) the protocol of the SPTs was clearly described and 3) the outcome was indicated by means of clinical/radiological changes or implant loss. Results: After initially identifying a total of 710 titles and abstracts, 12 full text articles were selected for eligibility assessment. Seven studies, three prospective and four retrospective, fulfilled the inclusion criteria for this review. The frequency of recall visits varied between the studies from a minimum of one visit every three months to an individually tailored regimen. In all the studies a lack of SPTs or poor adherence to them resulted in significantly higher frequencies of sites with mucosal bleeding, deepened peri-implant pockets or alveolar bone loss. In line with the above, a lack of/poor adherence to SPTs was associated with higher implant loss. Conclusions: To prevent peri-implantitis, an individually tailored supportive programme based on patient motivation and re-instruction in oral hygiene measures combined with professional implant cleaning seem to be crucial

Efficacy of alternative or adjunctive measures to conventional non-surgical and surgical treatment of peri-implant mucositis and peri-implantitis: a systematic review and meta-analysis

Purpose: To evaluate the efficacy of alternative or adjunctive measures to conventional non-surgical or surgical treatment of peri-implant mucositis and peri-implantitis. Material and methods: Prospective randomized and nonrandomized controlled studies comparing alternative or adjunctive measures, and reporting on changes in bleeding scores (i.e., bleed0ing index (BI) or bleeding on probing (BOP)), probing depth (PD) values or suppuration (SUPP) were searched. Results: Peri-implant mucositis: adjunctive use of local antiseptics lead to greater PD reduction (weighted mean difference (WMD) = − 0.23 mm; p = 0.03, respectively), whereas changes in BOP were comparable (WMD = − 5.30%; p = 0.29). Non-surgical treatment of peri-implantitis: alternative measures for biofilm removal and systemic antibiotics yielded higher BOP reduction (WMD = − 28.09%; p = 0.01 and WMD = − 17.35%; p = 0.01, respectively). Surgical non-reconstructive peri-implantitis treatment: WMD in PD amounted to − 1.11 mm favoring adjunctive implantoplasty (p = 0.02). Adjunctive reconstructive measures lead to significantly higher radiographic bone defect fill/reduction (WMD = 56.46%; p = 0.01 and WMD = − 1.47 mm; p = 0.01), PD (− 0.51 mm; p = 0.01) and lower soft-tissue recession (WMD = − 0.63 mm; p = 0.01), while changes in BOP were not significant (WMD = − 11.11%; p = 0.11). Conclusions: Alternative and adjunctive measures provided no beneficial effect in resolving peri-implant mucositis, while alternative measures were superior in reducing BOP values following non-surgical treatment of peri-implantitis. Adjunctive reconstructive measures were beneficial regarding radiographic bone-defect fill/reduction, PD reduction and lower soft-tissue recession, although they did not improve the resolution of mucosal inflammation

Clinical outcomes following surgical treatment of peri-implantitis at grafted and non-grafted implant sites: a retrospective analysis

Abstract Background This retrospective analysis aimed at comparing the clinical outcomes following combined surgical therapy of peri-implantitis at initially grafted and non-grafted (i.e., pristine) implant sites. Methods A total of 39 patients exhibiting 57 implants diagnosed with peri-implantitis (i.e., 16 implants at grafted and 41 implants at non-grafted sites) were included. Each subject had received a combined (i.e., implantoplasty and augmentative therapy) surgical treatment procedures at respective implants (grafted sites: 10 patients, 16 implants, non-grafted sites: 29 patients, 41 implants). A chi-squared test (χ2) was used to assess whether the initial grafting procedure did affect the treatment outcomes (i.e., disease resolution, bleeding on probing (BOP), probing pocket depths (PD)). The mean follow-up period was 41.9 ± 34.75 months. Results At the patient level, disease resolution (i.e., absence of BOP and PD ≥ 6 mm) was obtained in 4/10 (40%) at grafted and in 7/27 (24.1%) at non-grafted implant sites (p = 0.579). BOP reductions was found to be 60.64 ± 40.81% at non-grafted and 77.45 ± 30.92% at grafted sites (p = 0.778). PD reductions amounted to 2.20 ± 2.22 mm at non-grafted and 1.57 ± 1.54 mm at grafted sites (p = 0.969). Conclusions The initial bone-grafting procedures at the implant sites did not influence the effectiveness of combined surgical therapy of peri-implantitis

Efficacy of rehabilitation with different approaches of implant-supported full-arch prosthetic designs: A systematic review

Aim: To evaluate the efficacy of different types of rehabilitation with fixed or removable full-arch implant-supported prosthesis designs in terms of implant loss and success in patients with at least one edentulous jaw, with tooth loss mainly due to periodontitis. Materials and methods: Clinical studies with at least 12 months reporting on implant loss and implant success were searched. Meta-analysis was conducted to estimate cumulative implant loss considering different prostheses designs. Results: A total of 11 studies with unclear to low risk of bias were included in the analysis. Estimated cumulative implant loss for fixed prostheses within 1 year and 5 years was 0.64% (95% confidence interval [CI]: 0.31%–1.31%) and 1.85% (95% CI: 0.85%–3.95%), respectively. The corresponding values for removable prostheses amounted to 0.71% (95% CI: 0.22%–2.28%) and 4.45% (95% CI: 2.48%–7.85%). Peri-implantitis affected 10%–50% of the patients restored with implant-supported fixed prostheses. Conclusions: Based on the limited low-quality data, the present analysis points to a low and similar cumulative implant loss within 1 year for patients with tooth loss mainly due to stage IV periodontitis restored with either removable or fixed implant-supported full-arch prosthesis. At 5 years of functioning, there was a tendency for better outcomes using fixed designs

Implant Surface Decontamination by Surgical Treatment of Periimplantitis: A Literature Review.

INTRODUCTION The purpose of this review was to evaluate the available published clinical studies to understand the current data on the decontamination efficacy of various agents used in the treatment of periimplantitis and reosseointegration. MATERIALS AND METHODS An electronic PubMed literature search was conducted for studies published from 1998 until 2018. Literature on clinical studies was included in the review. Of the 189 studies retrieved from the literature search, 33 articles were selected for the review. DISCUSSION The available studies reviewed had great heterogeneity to conclude a single treatment of choice for implant surface decontamination for the surgical treatment of periimplantitis. CONCLUSIONS Existent data do not favor any decontamination approaches and fail to show the influence of a particular decontamination protocol on surgical therapy. Further clinical investigations are needed to determine the superiority of a decontamination method if existing

Surgical Non-Regenerative Treatments for Peri-Implantitis: a Systematic Review

OBJECTIVES: The purposes of the present study were 1) to systematically review the literature on the surgical non-regenerative treatments of peri-implantitis and 2) to determine a predictable therapeutic option for the clinical management of peri-implantitis lesions. MATERIAL AND METHODS: The study search was performed on primary database MEDLINE and EMBASE from 2005 until 2016. Sequential screenings at the title, abstract, and full-text levels were performed. Clinical human studies in the English language that had reported changes in probing depth (PD) and/or bleeding on probing (BOP) and/or radiologic marginal bone level changes after peri-implantitis surgical non-regenerative treatment at 6-month follow-up or longer were included accordingly PRISMA guidelines. RESULTS: The first electronic and hand search resulted in 765 citations. From 16 full-text articles reviewed, 6 were included in this systematic review. Surgical non-regenerative methods were found to be efficient in reducing clinical parameters. BOP and PD values were significantly decreased following implantoplasty and systematic administration of antibacterials, but not after local application of chemical compounds or diode laser. Similarly, significant improvement in clinical and radiographic parameters was found only after implantoplasty compared with resective surgery alone. We found significant heterogeneity in study designs and treatments provided among the pooled studies. All of the studies revealed an unclear or high risk of bias. CONCLUSIONS: Surgical non-regenerative treatment of peri-implantitis was found to be effective to reduce the soft tissue inflammation and decrease probing depth. More randomized controlled clinical trials are needed to assess the efficacy of surgical non-regenerative therapy of peri-implantitis. KEYWORDS: alveolar bone loss; nonsurgical periodontal debridement; oral surgery; peri-implantitis; revie