Peri-implant infections

Peri-implantaire infecties vormen een risico voor de overleving en het succes op lange termijn van tandheelkundige implantaten. Doordat de positie van de implantologie in de algemene tandheelkundige praktijk steeds belangrijker wordt, is een continue toename van het aantal geplaatste implantaten zichtbaar. Het is daarom te verwachten dat er de komende jaren ook een toename in de prevalentie van peri-implantaire infecties te zien zal zijn. Dit benadrukt de noodzaak voor wetenschappelijk onderbouwde klinische richtlijnen voor de preventie en behandeling. Doel van dit proefschrift was het onderzoeken van epidemiologische en microbiologische aspecten van peri-implantaire infecties en het evalueren van het effect van diverse behandelprotocollen voor peri-implantitis. Aangetoond werd dat peri-implantitis niet vaak voorkomt gedurende de eerst 5 jaren na implanteren, maar na die periode wel. Peri-implantitis komt vaker voor bij rokers en patiënten met een voorgeschiedenis van parodontitis. Bepaalde bacteriën die geassocieerd zijn met parodontitis zijn ook geassocieerd met peri-implantitis. Het extraheren van elementen met een slechte (parodontale) prognose kan helpen om deze bacteriën te reduceren en kan kolonisatie van nieuwe implantaten met potentieel virulente bacteriën beperken/vertragen. Het schoonmaken van het implantaatoppervlak met chloorhexidine, na mechanische reiniging, leidt niet tot betere klinische resultaten van een chirurgische peri-implantitis behandeling. Factoren die wel invloed hebben op het behandelresultaat zijn: ervaring van het behandelteam, ernst van de aandoening en gedragsfactoren (roken, mondhygiëne). In het algemeen kan gesteld worden dat peri-implantitis lastig te behandelen is, zelfs met een chirurgische behandeling. Dit, gecombineerd met het vaak agressieve ziekteverloop van peri-implantitis, benadrukt de noodzaak van preventieve maatregelen

Psychological risk indicators for peri-implantitis:a cross-sectional study

AIM: The aim of this analytical cross-sectional study was to evaluate the association between peri-implantitis and psychological distress, and potentially related/mediating factors such as general health, bruxism and lifestyle factors. MATERIAL AND METHODS: Patients having received dental implants at a private practice in the Netherlands between January 2011 and January 2014 were recalled on a 5-year clinical and radiographic follow-up examination. Presence of peri-implantitis was examined and patients completed questionnaires measuring psychological distress (Symptom Checklist-90), bruxism, general health and lifestyle factors. Associations between the self-reported factors and peri-implantitis were analyzed with univariable and multivariable logistic regression models. RESULTS: A total of 230 patients (with 347 implants) were included in the analysis. Prevalence of (mild to severe) peri-implantitis was 30% (69 patients). Variables that showed a significant univariable association with peri-implantitis (p<0.10) were: SCL-90 subdomain depression, smoking, current medical treatment and lung problems. In the multivariable regression analysis, only the variable depression was significantly associated with peri-implantitis (p<0.05). CONCLUSIONS: The presence of depressive symptoms is a risk indicator for peri-implantitis. Recognizing the potential negative impact of depressive symptoms may allow for better identification of high risk patients

Systemic antibiotic therapy as an adjunct to non-surgical peri-implantitis treatment:A single-blind RCT

Aim The aim of this single-blind RCT was to evaluate the adjunctive clinical and microbiological effect of systemic amoxicillin (AMX) plus metronidazole (MTZ) to non-surgical treatment of peri-implantitis. Material and methods Patients (N = 62) with peri-implantitis were randomly assigned to receive full-mouth mechanical debridement and decontamination and use of chlorhexidine (control group) or combined with antibiotic therapy of AMX/MTZ (test group). Primary outcome was change in bleeding score from baseline (T-0) to 3-month follow-up (T-3). Secondary parameters were plaque, suppuration, PPD, CAL, bone level, microbiology, adverse events and need for additional surgery. Data were analysed with linear multiple regression analysis. Results 57 patients with 122 implants completed 3-month follow-up. Both groups showed major clinical improvements at T-3 in both peri-implant and periodontal parameters. However, no significant differences were observed between both groups for any of the primary or secondary parameters. Conclusions Systemic antibiotic therapy of AMX/MTZ does not improve clinical and microbiological outcomes of non-surgical peri-implantitis treatment and should not be routinely recommended. Although complete disease resolution may be difficult to achieve, meticulously performed full-mouth non-surgical treatment, achieving a high level of daily oral hygiene and healthy periodontal tissues, can significantly improve the starting position of the subsequent (surgical) peri-implantitis treatment phase

Influence of Cervical Crown Contour on Marginal Bone Loss Around Platform-Switched Bone-Level Implants:A 5-Year Cross-Sectional Study

To evaluate the influence of the cervical crown contour on marginal bone loss and soft tissue health around platform-switched, posteriorly placed, two-piece implants. Materials and Methods: A dataset from two previously conducted studies was used. Patients with single two-piece, platform-switched implants in between two natural teeth or adjacent to one natural tooth were included. Clinical parameters and standardized periapical radiographs from 1 month and 5 years after final crown placement were assessed. A new measurement method was developed to analyze geometric values of the cervical crown contour. Interand intraexaminer reliability were assessed. Emergence angles were measured at 1, 2, and 3 mm above the implant shoulder. Linear correlations between variables were determined by calculating Pearson correlation coefficients. Results: A total of 64 patients with 67 posterior implants met the inclusion criteria. At 1, 2, and 3 mm above the implant shoulder, mean emergence angles at the mesial implant sites were 0.5 ± 2.8, 12.8 ± 12.8, and 18.0 ± 11.3 degrees, respectively. At the distal sites, the corresponding values were 2.8 ± 8.3, 16.2 ± 16.6, and 18.7 ± 13.8 degrees, respectively. Mean marginal bone loss between 1 month and the 5-year evaluations was 0.14 ± 0.34 mm at the mesial aspect and 0.26 ± 0.47 at the distal aspect of implants. No correlation with peri-implant bone loss or soft tissue health could be found. No implants showed signs of peri-implantitis. Conclusion: The cervical crown contour at platform-switched, posteriorly placed, two-piece implants showed no correlation with peri-implant marginal bone loss or soft tissue health up to 5 years after implant placement. Int J Prosthodont 2020;33:373-379. doi: 10.11607/ijp.6365

Non-surgical peri-implantitis treatment using a pocket irrigator device; clinical, microbiological, radiographical and patient-centred outcomes-A pilot study

Aim: The aim of this prospective cohort study was to assess the effect of a pocket irrigator/evacuator device (IED) in the non-surgical treatment of peri-implantitis. Material and Methods: In total 24 patients having 38 implants diagnosed with peri-implantitis were included in this study. Peri-implant pockets were irrigated six times in three consecutive weeks. The primary outcome was bleeding on probing (BoP). Secondary outcome parameters included plaque index (Pl), suppuration on probing (SoP), probing pocket depth (PPD), marginal bone loss (MBL), presence and numbers of periodontal pathogens. Parameters were assessed at baseline and 3 months after the last treatment. Treatment pain perception was scored using the visual analog scale (VAS) after the first and last treatment. Results: At 3 months, IED treatment revealed significant reduction of peri-implant BoP (71% [±20] vs 57% [±28] [P =.014]) and peri-implant plaque scores (10 [±14] to 5 [±9] [P =.039] [T0 vs T3 respectively]). Significant reduction in mean peri-implant PPD from 4.92 mm (SD ± 1.28) to 4.66 mm (SD ± 1.35) (P =.041) was observed. In addition, a reduction in VAS pain score between the first and the last (6th) treatment was found (P =.039). No reduction in SoP (P =.088) was found. No changes in mean periodontal full mouth plaque, BOP, SOP and PPD levels, MBL and microbiological outcomes were found. Conclusion: Beneficial clinical effects in terms of BoP, PPD and PI were found at 3 months after IED treatment. However, the IED does not seem to effectively treat peri-implantitis in terms of disease resolution

Erythritol airpolishing in the non-surgical treatment of peri-implantitis:A randomized controlled trial

OBJECTIVES: To compare erythritol air-polishing with piezoelectric ultrasonic scaling in the non-surgical treatment of peri-implantitis. MATERIAL AND METHODS: Eighty patients (n=139 implants) with peri-implantitis (probing pocket depth (PPD) ≥5mm, marginal bone loss (MBL) ≥2mm as compared to bone level at implant placement, bleeding and/or suppuration on probing (BoP/SoP)) were randomly allocated to air-polishing or ultrasonic treatment. The primary outcome was mean BoP (%) at 3 months after therapy (T3). Secondary outcomes were mean SoP (%), plaque score (Plq) (%), PPD (mm), MBL (mm), full mouth periodontal scores (FMPS) (%), levels of 8 classical periodontal pathogens and treatment pain/discomfort (Visual Analog Scale, VAS). Patients who were considered successful at T3 were additionally assessed at 6, 9 and 12 months. Differences between both groups were analysed using multilevel statistics. RESULTS: Three months after therapy, no significant difference in mean BoP (%) between the air-polishing and ultrasonic therapy was found (crude analysis β (95% CI) -0.037 (-0.147; 0.073), p = 0.380). Neither secondary outcomes SoP (%), Plq (%), PPD (mm), MBL (mm), FMPS (%) and periodontal pathogens showed significant differences. Treatment pain/discomfort was low in both groups (VAS score air-polishing group 2.1 (±1.9), ultrasonic 2.6 (±1.9); p = 0.222). All successfully treated patients at T3 (18.4%) were still considered successful at 12 months follow-up. CONCLUSIONS: Erythritol air-polishing seems as effective as piezoelectric ultrasonic scaling in the non-surgical treatment of peri-implantitis, in terms of clinical, radiographical and microbiological parameters. However, neither of the proposed therapies effectively resolved peri-implantits. Hence, the majority of patients required further surgical treatment

Erythritol air polishing in the surgical treatment of peri-implantitis:A randomized controlled trial

Objectives: To compare erythritol air polishing with implant surface cleansing using saline during the surgical treatment of peri-implantitis. Material and Methods: During a resective surgical intervention, implant surfaces were randomly treated with either air polishing (test group n = 26 patients/53 implants) or saline-soaked cotton gauzes (control group n = 31 patients/ 40 implants). Primary outcome was change in mean bleeding on probing (BoP) from baseline to 12 months follow-up. Secondary outcomes were changes in mean suppuration on probing (SoP), plaque score (Plq), probing pocket depth (PPD), marginal bone loss (MBL), periodontal full-mouth scores (PFMS), and levels of 8 classical periodontal pathogens. Clinical and radiographical parameters were analyzed using multilevel regression analyses. Microbiological outcomes were analyzed using the Mann-Whitney U test. Results: No differences between the test and control group were found for BoP over 12 months of follow-up, nor for the secondary parameters Plq, PPD, and MBL. Between both groups, a significant difference was found for the levels of SoP (p = 0.035). No significant effect on microbiological levels was found. A total number of 6 implants were lost in the test group and 10 in the control group. At 1-year follow-up, a successful treatment outcome (PPD0.5 mm) was achieved for a total of 18 implants (19.2%). Conclusions: Erythritol air polishing as implant surface cleansing method was not more effective than saline during resective surgical treatment of peri-implantitis in terms of clinical, radiographical, and microbiological parameters. Both therapies resulted in low treatment success

The Peri-Implant Microbiome-A Possible Factor Determining the Success of Surgical Peri-Implantitis Treatment?

The objective was to assess the effect of peri-implantitis surgery on the peri-implant microbiome with a follow-up of one year. A total of 25 peri-implantitis patients in whom non-surgical treatment has failed to solve peri-implantitis underwent resective surgical treatment. Their periimplant pockets were sampled prior to surgical treatment (T0) and one year post treatment (T12).The natural dentition was sampled to analyse similarities and differences with the peri-implantitis samples. Treatment success was recorded. The change in microbial relative abundance levels was evaluated. The microbiota was analysed by sequencing the amplified V3-V4 region of the 16S rRNA genes. Sequence data were binned to amplicon sequence variants that were assigned to bacterial genera. Group differences were analysed using principal coordinate analysis, Wilcoxon signed rank tests, and t-tests. Beta diversity analyses reported a significant separation between peri-implantitis and natural dentition samples on T0 and T12, along with significant separations between successfully and non-successfully treated patients. Eubacterium was significantly lower on T12 compared to T0 for the peri-implantitis samples. Treponema and Eubacterium abundance levels were significantly lower in patients with treatment success on T0 and T12 versus no treatment success. Therefore, lower baseline levels of Treponema and Eubacterium seem to be associated with treatment success of peri-implantitis surgery. This study might aid clinicians in determining which peri-implantitis cases might be suitable for treatment and give a prognosis with regard to treatment success