Profiles and differences of submucosal microbial in peri-implantitis and health implants: A cross-sectional study / 北京大学学报(医学版)

OBJECTIVE@#To describe the submucosal microbial profiles of peri-implantitis and healthy implants, and to explore bacteria that might be correlated with clinical parameters.@*METHODS@#In the present cross-sectional study, 49 patients were recruited. Each patient contributed with one implant, submucosal biofilms were collected from 20 healthy implants and 29 implants with peri-implantitis. DNA was extracted and bacterial 16S ribosomal RNA (16S rRNA) genes were amplified. Submucosal biofilms were analyzed using 16S rRNA sequencing at Illumina MiSeq platform. Differences between the groups were determined by analyzing α diversity, microbial component and microbial structure. The potential correlation between the bacteria with pocket probing depth (PPD) of peri-implant calculated by Spearman correlation analysis.@*RESULTS@#The α diversity of submucosal microbial of health group was significantly lower than that in peri-implantitis group (Chao1 index: 236.85±66.13 vs. 150.54±57.43, P < 0.001; Shannon index: 3.42±0.48 vs. 3.02±0.65, P=0.032). Principal coordinated analysis showed that the submucosal microbial structure had significant difference between healthy and peri-implantitis groups [R2=0.243, P=0.001, analysis of similarities (ANOSIM)]. Compared with healthy implants, relative abundance of periodontal pathogens were higher in peri-implantitis, including members of the red complex (Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola) and some members of orange complex (Precotella intermedia, Eubacterium nodatum, Parvimonas micra), as well as some new periodontal pathogens, such as Fillifactor alocis, Fretibacterium fastidiosum, Desulfobulbus sp._HMT_041, and Porphyromonas endodontalis. Spearman correlation analysis revealed that the relative abundance of Treponema denticola (r=0.686, P < 0.001), Tannerella forsythia (r=0.675, P < 0.001), Fretibacterium sp. (r=0.671, P < 0.001), Desulfobulbus sp._HMT_041 (r=0.664, P < 0.001), Filifactor alocis (r=0.642, P < 0.001), Fretibacterium fastidiosum (r=0.604, P < 0.001), Porphyromonas gingivalis (r=0.597, P < 0.001), Porphyromonas endodontalis (r=0.573, P < 0.001) were positive correlated with PPD. While the relative abundance of Rothia aeria (r=-0.615, P < 0.001) showed negatively correlation with PPD.@*CONCLUSION@#Marked differences were observed in the microbial profiles of healthy implants and peri-implantitis. The members of red and orange complex as well as some new periodontal pathogens seem to play an important role in peri-implant disease. Compared with healthy implants, the submucosal microbial of peri-implantitis were characterized by high species richness and diversity.

Doenças peri-implantares e fatores de risco associados ao paciente, que levam a perda do implante - uma revisão / Peri-implant diseases and risk fatores associated with the patient, leading to loss of the implant - a review

Os tecidos moles periodontais e peri- implantares possuem muitas características em comum, tanto clínicas como histológicas. Para controle e manutenção adequados destes tecidos, é necessário melhor entendimento das diferenças e similaridades que existem entre eles. Os biofilmes se formam em todas as superfícies aderentes em sistemas fluidos, tanto em dentes como em implantes orais. Como um resultado da presença bacteriana, o hospedeiro responde desenvolvendo um mec anismo de defesa que levará à inflamaç ão dos tecidos moles. Na unidade dentogengival, os resultados são as lesões de gengivite. Na unidade implantar, essa inflamaç ão é denominada de muc osite. Se for permitido o acúmulo de placa por períodos prolongados de tempo, pesquisas experimentais demonstraram que a muc osite pode evoluir para peri-implantite, isto na dependência dos fatores e indicadores de risc o, afetando o osso peri- implantar de suporte circunferencialmente. Embora o osso de suporte seja perdido coronalmente, o implante ainda permanec erá ósseo integrado e, portanto, clinicamente estável. Essa é a razão pela qual a mobilidade representa uma característica de diagnóstico de peri-implantite pouco sensível, mas específica. Parâmetros mais sensíveis e confiáveis do desenvolvimento e da presença de infecções peri- implantares são o sangramento a sondagem, profundidade de sondagem e a interpretações radiográficas , visam detectar o mais cedo possível as lesões peri-implantares, possibilitando assim que o tratamento, que nessa revisão é descrito como sendo cumulativo, começ ando por procedimentos mais simples até os mais avançados, tendo em vista, paralisar e evitar a progressão dessas lesões, o que fatalmente resultaria no fracasso do implante.

Microbiological and clinical effects of adjunctive systemic metronidazole and amoxicillin in the non-surgical treatment of peri-implantitis: 1 year follow-up

Abstract The aim of this study was to evaluate the effects of adjunct systemic antibiotic treatment with metronidazole (MTZ) and amoxicillin (AMX) in patients receiving non-surgical subgingival debridement (NSD) for peri-implantitis. Forty subjects presenting with at least one implant with severe peri-implantitis were randomized into an experimental group [treated with NSD plus MTZ (400 mg) and AMX (500 mg) three times a day for 14 days] and a control group treated with NSD plus placebo. Clinical parameters and submucosal biofilm profiles were evaluated up to 1 year post-treatment. Overall, both treatments improved clinical parameters over time. At 1 year, mean probing depth (PD), mean clinical attachment (CA) level and proportions of red complex pathogens did not differ significantly between the two groups. In addition, mean PD and CA changes to 1-year posttreatment did not differ significantly between the two groups between baseline and 1-year post-treatment. These results suggest that the addition of MTZ and AMX to the treatment protocol of patients undergoing NSD for with severe peri-implantitis does not improve the clinical and microbiological outcomes of NSD. The fact that half of the implants in both groups did not achieve clinical success (PD < 5 mm, no BoP, no bone loss) suggest that neither of the tested protocols were effective for treating severe peri-implantitis.

Host response and peri-implantitis

Abstract Considering the absence of predictable and effective therapeutic interventions for the treatment of peri-implantitis, scientific evidence concerning the host response profile around dental implants could be important for providing in the future a wider preventive and/or therapeutic window for this peri-implant lesion, indicating biomarkers that provide quantifiable measure of response to peri-implant therapy. Moreover, a better knowledge of pattern of host osteo-immunoinflammatory modulation in the presence of peri-implantitis could either benefit the early diagnostic of the disease or to cooperate to prognostic information related to the status of the peri-implant breakdown. Finally, new evidences concerning the host profile of modulators of inflammation and of osseous tissue metabolism around dental implants could explain the individual susceptibility for developing peri-implant lesions, identifying individuals or sites with increased risk for peri-implantitis. The focus of this chapter was, based on a systematically searched and critically reviewed literature, summarizing the existing knowledge in the scientific research concerning the host osteo-immunoinflammatory response to the microbiological challenge related to periimplantitis.

Does subgingival bacterial colonization differ between implants and teeth? A systematic review

Abstract The aim was of this study was to determine the current weight of evidence for the existence of specific differences between the microbiota of healthy teeth and healthy implants, or of teeth with periodontitis and implants with peri-implantitis. A systematic review was conducted according to the PRISMA statement. The MEDLINE, EMBASE and Cochrane databases were searched up to February 2018 for studies comparing microbiological data of biofilm samples collected from healthy teeth and implants or from teeth with periodontitis and implants with peri-implantitis. The weight of evidence was defined in three categories (strong, moderate and mild/some), according to the difference in number of studies showing statistically significantly higher counts and/or proportions and/or abundance and/or prevalence of microorganisms in health or in disease. Of the 132 articles identified, 8 were included. A wide range of microorganisms were present in different conditions but no microorganisms showed strong, moderate or mild/some evidence for a specific association with either teeth or implants. The results of this systematic review indicated that there is insufficient evidence in the literature to support specific differences between microorganisms colonizing teeth and implants, either in health or in disease.

Gram-negative enteric rods associated to early implant failure and peri-implantitis: case report and systematic literature review / Bacilos entéricos gram-negativos asociados a fracaso temprano de implantes y peri-implantitis: reporte de un caso y revisión sistemática de literatura

The microbiota associated with failed implants includes Pseudomonas and Gram-negative enteric rods. The present study reports a case of Escherichia coli associated to early implant failed that was resistant in vitro to doxycycline, amoxicillin, metronidazole, and clindamycin, but was susceptible in vitro to ciprofloxacin and aminoglycosides. The literature concerning the prevalence of the opportunistic microorganisms in early implant failure and peri-implantitis patients, and the usual treatment of these patients harboring Pseudomonas and enteric rods was also revised.

La microbiota asociada con los implantes fallidos incluye Pseudomonas y bacilos entéricos Gram-negativos. En el presente estudio se informa acerca de un caso de Escherichia coli asociada a un fallo temprano del implante resistente in vitro a la doxiciclina, amoxicilina, metronidazol y clindamicina, pero susceptible in vitro a ciprofloxacina y aminoglucósidos. Se realizó una revisión de la literatura sobre la prevalencia de los microorganismos oportunistas en pacientes con insuficiencia temprana del implante y periimplantitis, y el tratamiento habitual de estos pacientes portadores de Pseudomonas y bacilos entéricos.