Serum TNF-α level and probing depth as a combined indicator for peri-implant disease

Peri-implant disease (PID) is a general term for inflammatory diseases of soft and hard tissues that occur around implants, including peri-implant mucositis and peri-implantitis. Cytokines are a class of small molecule proteins, which have various functions such as regulating innate immunity, adaptive immunity, and repairing damaged tissues. In order to explore the characteristics and clinical significance of tumor necrosis factor (TNF)-α, interleukin (IL)-6, IL-10, and tumor growth factor (TGF)-β1 expression levels in serum of patients with peri-implant disease, 31 patients with PID and 31 patients without PID were enrolled. The modified plaque index (mPLI), modified sulcus bleeding index (mSBI), and peri-implant probing depth (PD) were recorded. The levels of serum TNF-α, IL-6, IL-10, and TGF-β1 were detected by ELISA. TNF-α, mPLI, mSBI, and PD levels were significantly higher in the PID group. TGF-β1 levels were significantly higher in the control group. There was a significant positive correlation between TNF-α and mPLI, mSBI, and PD. TGF-β1 was negatively associated with TNF-α, mPLI, mSBI, and PD. Multiple logistic regression analysis showed that TNF-α and PD were risk factors for the severity of PID. The receiver operating curve analysis showed that high TNF-α levels (cut-off value of 140 pg/mL) and greater PD values (cut-off value of 4 mm) were good predictors of PID severity with an area under the curve of 0.922. These results indicated that TNF-α and PD can be used as a biological indicator for diagnosing the occurrence and progression of PID.

An Insight Performance of Zirconia Implant Abutment: A Systematic Review and Meta?Analysis of Randomized Controlled Clinical Trial

To determine the clinical performance of zirconia abutment (ZA) by comparing with a titanium abutment (TA) and sub?mucosal?modified zirconia abutment. A systematic search was conducted to retrieve eligible randomised controlled trials (RCTs) from Medline, Cochrane Library, SCOPUS, Embase, Web of Science, and Google Scholar. A search was further divided in two parts. Part I comprises eligible RCTs between zirconia abutment and titanium abutment, and part II included RCTs of zirconia abutment with sub?mucosal modified, pink?veneered glass ceramic versus non?veneered zirconia abutment. Esthetic, biological, and abutment survival was a primary outcome, and technical complications were included as an additional outcome. Fifteen eligible RCTs (Part I: N = 9 and Part II: N = 6) were evaluated, and a total of 362 abutments in 364 subjects were analysed for outcome variables. A sub?group meta?analysis reported no significant difference for Esthetic outcome. However, the overall mean (p =0.03) was higher for zirconia group in those of thin gingival phenotype. Spectrophotometric evaluation of peri?implant mucosal Esthetic does not show any significant difference. Similarly, pink?veneered versus non?veneered group reported no significant difference for thin (<2 mm) and thick (>2 mm) mucosal attachment. Biological outcome does not show any significant difference for comparable groups in both parts. There is marginally lower abutment survival for internally connected zirconia abutment (ZA: 95.4% TA: 100%). Zirconia abutment exhibited excellent Esthetic compared to titanium abutment in those of thin gingival phenotype. Sub?mucosa veneering of zirconia abutment with pink glass c

A comparative study of the clinical application of anatomical healing abutments versus finished healing abutments for mandibular first molar implants / 口腔疾病防治

Objective @#To evaluate the effect of anatomical healing abutments for mandibular first molars on the morphological changes of gingival soft tissue after implant restoration, as well as on peri-implant gingival molding, food ingrowth and patient satisfaction, to provide a basis for clinical selection. @*Methods @# Twenty-six patients who received implant restoration for a single missing mandibular first molar between September 2020 and September 2021 at the Oral Implant Center of Changsha Stomatological Hospital were randomly divided into a control group (13 cases with 14 implants) and a trial group (13 cases with 14 implants), of which 12 were male and 14 were female; the trial group had anatomical healing abutments applied for 4 weeks and then underwent crown restoration, while the control group finished five time points (before the second stage surgery, 4 weeks after the second stage surgery, immediately after the crown restoration, 4 weeks after the crown restoration, and 12 weeks after the crown restoration). A 3Shape intraoral scanner was used to scan the jaw before and 4 weeks after the second stage surgery to quantify the soft tissue changes and compare the effect of the healing abutment on gingival molding between the two groups. The incidence of food impaction was recorded and compared between the two groups at 4 weeks and 12 weeks after crown restoration. Patient satisfaction was recorded and compared between the two groups immediately after crown restoration, 4 weeks after crown restoration and 12 weeks after crown restoration@*Results @# Four weeks after implant surgery, it was observed that the gingival proximal and distal gingival papillae increased on the coronal side in the test group compared to the control group, 0.50 (0.26, 0.72) mm in the near-medium test group and 0.27 (0.24, 0.38) mm in the control group, with a statistically significant difference (P = 0.029), and 0.48 (0.26, 0.62) mm in the far-medium test group and 0.23 (0.13, 0.39) mm in the control group, with a statistically significant difference (P = 0.004). There was no statistically significant difference (P>0.05) in the buccolingual to gingival margin apex to coronal molding or in the buccolingual to lingual soft tissue at 0, 1, or 2 mm of the root of the middle 1/3 apex of the buccal and lingual gingival margins between the two groups. Compared to the control group, there was no statistically significant difference in the incidence of food impaction observed 4 weeks and 12 weeks after crown restoration in the test group (P>0.05). The satisfaction scores were higher in the trial group than in the control group immediately, 4 weeks, and 12 weeks after crown restoration, and the difference between the groups was statistically significant (P < 0.05). @*Conclusion @# The anatomical healing abutment for the implant mandibular first molar was superior to the finished healing abutment in terms of soft tissue contouring with an increase in the coronal aspect of the proximal and distal gingival papillae, resulting in high patient satisfaction.

Application of soft tissue augmentation in labial contour aesthetics of anterior dental implants / 口腔疾病防治

@#After tooth extraction, labial contour collapses due to inevitable physiologic bone remodeling. To achieve optimal outcomes for pink esthetic treatment at anterior implant sites, bone or soft tissue augmentation has been advocated to maintain or reconstruct the labial tissue contour. When choosing soft tissue augmentation for esthetic restoration, it is necessary to strictly grasp the indications for surgery. Soft tissue augmentation to maintain or reconstruct the labial tissue contour could be considered in patients with healthy soft tissue and no bone defects or only mild horizontal bone defects. In immediate, early and late implant placement, the timing of soft tissue augmentation may vary. In immediate implantation, the labial bone plate is intact, so it is highly recommended to simultaneously manage soft tissue during implant placement. However, patients may have large bone defects with early or late implant placement. The risk of augmenting bone and soft tissue simultaneously is likely too high, and bone augmentation surgery is often performed at the first stage while soft tissue augmentation surgery is performed at the second stage. Therefore, soft tissue surgery is often carried out simultaneously with abutment connection. Currently, soft tissue augmentation is achieved mostly with adjacent autologous soft tissue grafts, such as free gingival grafts, subepithelial connective tissue grafts or pedicle palatal flaps, which are often accompanied by a second surgical area. The replacement of autogenous soft tissue grafting with new biological materials will become an inevitable trend. In this article, we analyze and summarize the indications, timing and different methods of soft tissue augmentation to maintain and reconstruct the labial contour.

Peri-implant femoral fractures: Challenges, outcomes, and proposal of a treatment algorithm / 中华创伤杂志(英文版)

PURPOSE@#Non-prosthetic peri-implant fractures are challenging injuries. Multiple factors must be carefully evaluated for an adequate therapeutic strategy, such as the state of bone healing, the type of implant, the time and performed personnel of previous surgery, and the stability of fixation. The aim of this study is to propose a rationale for the treatment.@*METHODS@#The peri-implant femoral fractures (PIFFs) system, a therapeutic algorithm was developed for the management of all patients presenting a subtype A PIFF, based on the type of the original implant (extra- vs. intra-medullary), implant length and fracture location. The adequacy and reliability of the proposed algorithm and the fracture healing process were assessed at the last clinical follow-up using the Parker mobility score and radiological assessment, respectively. In addition, all complications were noticed. Continuous variables were expressed as mean and standard deviation, or median and range according to their distribution. Categorical variables were expressed as frequency and percentages.@*RESULTS@#This is a retrospective case series of 33 PIFFs, and the mean post-operative Parker mobility score was (5.60 ± 2.54) points. Five patients (15.1%) achieved complete mobility without aids (9 points) and 1 (3.0%) patient was not able to walk. Two other patients (6.1%) were non-ambulatory prior to PPIF. The mean follow-up was (21.51 ± 9.12) months (range 6 - 48 months). There were 7 (21.2%) complications equally distributed between patients managed either with nailing or plating. There were no cases of nonunion or mechanical failure of the original implant.@*CONCLUSION@#The proposed treatment algorithm shows adequate, reliable and straightforward to assist the orthopaedic trauma surgeon on the difficult decision-making process regarding the management of PIFF occurring in previously healed fractures. In addition, it may become a useful tool to optimize the use of the classification, thus potentially improving the outcomes and minimizing complications.

Application and research progress of diode laser in the treatment of peri-implant diseases / 口腔医学

@#Laser therapy has become an important means of treating peri-implant diseases, and diode laser shows unique advantages in the adjuvant therapy of peri-implant diseases due to its excellent biological regulation, sterilization effect and biological safety. This article reviews the principle, characteristics, safety, biological effects of and clinical research on diode laser, in order to provide reference for its clinical application in the treatment of peri-implant diseases.

A faixa de mucosa queratinizada é importante para a saúde peri-implantar? Uma discussão crítica da literatura / Is the keratinized mucosa attached important for peri-implant health? A discussion critic of literature

A gengiva oral pode ser dividida em inserida ou livre. A gengiva inserida é queratinizada e apresenta grande importância na proteção do periodonto contra inflamações, sendo importante na proteção mecânica durante à escovação e ao acúmulo de biofilme. Uma faixa de gengiva queratinizada aderida é importante para a saúde dos tecidos periodontais. Os tecidos peri-implantares tem aspecto e estruturas parecidas com o epitélio ao redor dos dentes. A faixa de mucosa queratinizada ao redor da área peri-implantar de 1 a 2mm pode diminuir o acúmulo de placa e consequentemente a peri-implantite que é um dos fatores responsáveis pela perda de implantes. Diversas técnicas têm sido utilizadas para se ter um aumento dessa faixa de mucosa queratinizada favorecendo um aumento da taxa de sucesso instalações de implantes como: enxertos gengivais livres, de tecido conjuntivo, de matriz dérmica acelular, de matriz de colágeno, membranas e implantes imediatos ao invés da técnica comum. O objetivo do estudo foi discutir as características anatômicas da mucosa aderida ao redor de implantes e sua importância para saúde peri-implantar. Para o desenvolvimento do estudo proposto de revisão da literatura, foram realizadas pesquisas em diferentes plataformas de bases de dados bibliográficos sendo: Scielo (scientific Eletronic Library online), PubMed e Google Acadêmico e livros de referência na área da Periodontia. Com base, na revisão crítica realizada, conclui-se que, quando há a presença de uma mucosa queratinizada aderida ao redor do implante maior que 1mm, os implantes apresentam melhor selamento biológico, menor acúmulo de biofilme e baixo risco para a peri-implantite.

The oral gingiva can be divided into attached or free. The attached gingiva is keratinized and is of great importance in protecting the periodontium against inflammation, being also important in mechanical protection during brushing and biofilm accumulation. A range of keratinized mucosa is important for the health of periodontal tissues. Peri-implant tissues have an appearance and structures similar to the epithelium around the teeth. The keratinized mucosa range around the peri-implant area of ​​1 to 2 mm can reduce plaque accumulation and consequently peri-implantitis, which is one of the factors responsible for implant loss. Several techniques have been used to increase this range of keratinized gingiva, favoring an increase in the success rate of implant installations such as: free gingival grafts, connective tissue, acellular dermal matrix, collagen matrix, membranes, and immediate implants. instead of the common technique. The aim of the present study was to discuss, based on the scientific literature, the anatomical characteristics of the keratinized attached mucosa around implants and their importance for peri-implant health. For the development of the proposed study of literature review, searches were carried out on different platforms of bibliographic databases, namely: Scielo (scientific Electronic Library online), PubMed and Google Scholar and reference books in ​​Periodontics. Based on the critical review performed, it was concluded that when there is a keratinized mucosa adhered around the implant greater than 1mm, the implants present better biological sealing, less biofilm accumulation and low risk for peri-implantitis.

Thigh Pain and Peri-Implant Fractures with the Use of Short Cephalo-medullary Nails: A Retrospective Study of 122 Patients

@#Introduction: To assess the incidence and causes of persistent thigh pain and peri-implant fractures after union in patients of intertrochanteric fractures treated with short cephalo-medullary nails. Materials and methods: A retrospective observational study conducted at a Level 1 Trauma centre. A total of 122 patients of intertrochanteric fractures who were operated using short cephalo-medullary nails (170mm and 200mm lengths) between January 2018 to June 2019 were included in the study. Main outcomes measured were the incidence of thigh pain and peri-implant fractures. Results: Out of the 122 patients with a mean follow-up of 14.1 month, 12 patients had persistent thigh pain. Six patients had the helical blade protruding from the lateral cortex, two of them had distal tip of nail abutting on the anterior cortex and four cases had prominent proximal segment of nail which may explain the cause of their pain. Five of these patients had a combination of these findings. Two patients had pain for which no other obvious cause was found. There were no cases of peri-implant fractures in our study. Conclusion: Thigh pain associated with the use of short cephalon-medullary nails is often unrelated to nail length and can be prevented by using proper surgical technique. There seems to be no association between the use of short nails and peri-implant fractures.

Efficacy of combined application of glycine powder air-polishing in non-surgical treatment of peri-implant diseases / 北京大学学报(医学版)

OBJECTIVE@#To compare the clinical efficacy of combined application of glycine powder air-polishing and mechanical submucosal debridement in non-surgical treatment of peri-implant diseases.@*METHODS@#A randomized controlled clinical study was carried out on patients diagnosed with peri-implant diseases in the Department of Periodontology, Peking University School and Hospital of Stomatology, between May of 2020 and June of 2021.Twenty-eight patients with totally sixty-two implants were enrolled.The patients were randomly divided into the test group and control group. The patients in the test group (13 subjects/32 implants) received mechanical submucosal debridement using titanium curettes combined with application of glycine powder air-polishing, while the control group (15 subjects/30 implants) received mechanical submucosal debridement using titanium only. Clinical parameters, such as plaque index (PLI), pocket probing depth (PPD), bleeding index (BI) and the percentage of suppuration on probing on implants' level (SoP%) were measured at baseline and 8 weeks after non-surgical intervention. Changes and group differences of clinical parameters of the implants before and 8 weeks after non-surgical intervention were compared.@*RESULTS@#Mean PLI, PPD, BI of both the test group and control group significantly reduced 8 weeks after non-surgical intervention (P < 0.05). Compared with the control group, the test group achieved lower BI (2.7±0.8 vs. 2.2±0.7, P < 0.05), more reduction of BI (0.6±0.7 vs. 1.1±0.6, P < 0.01) and more reduction of SoP% (21.9% vs. 10%, P < 0.05) after non-surgical intervention. Both the control and test groups exhibited comparable PLI and PPD reductions (P>0.05). For the implants diagnosed with peri-implant mucositis, the test group revealed more signi-ficant reduction in BI and SoP% than the control group (1.0±0.7 vs. 0.4±0.7, P=0.02; 6.3% vs. 0, P=0.012). There was no significant difference existing in PLI and PD improvement between the control group and test group (P>0.05). For the implants diagnosed with peri-implantitis, there was no significant difference existing in PLI, PPD, BI and SoP% improvement values between the test and control groups (P>0.05). No complications or discomforts were reported during the study.@*CONCLUSION@#Both treatment procedures could relieve the inflammation of peri-implant soft tissue. Non-surgical mechanical submucosal debridement combined application of glycine powder air-polishing is associated with significant reduction of soft tissue bleeding and suppuration on probing especially in the implants diagnosed with peri-implant mucositis.

Tratamento de mucosite periimplantar pela técnica de enxerto gengival livre: relato de caso / Treatment of peri-implant mucositis through free gingival graft technique: case report

A Mucosite peri-implantar é considerada a precursora da peri-implantite, ela é uma lesão inflamatória da mucosa peri-implantar na ausência de perda óssea marginal contínua. O objetivo desse relato de caso, foi descrever o tratamento da mucosite periimplantar através da cirurgia de enxerto gengival livre. Foi proposto, portanto, um tratamento reabilitador envolvendo uma abordagem multidisciplinar de forma a resgatar e restabelecer estética, função e bem-estar através do enxerto gengival livre para melhorar as características de mucosa e viabilizar uma previsibilidade de uma prótese definitiva implantosuportada em condições teciduais mais estáveis. O uso do EGL para aumento da gengiva queratinizada na cirurgia de implantes em paciente idosos é uma solução prática e segura para a manutenção da saúde periodontal ao redor do implante... (AU)

Peri-implant mucositis is considered the precursor of peri-implantitis, it is an inflammatory lesion of the peri-implant mucosa in the absence of continuous marginal bone loss. The purpose of this case report was to describe the treatment of peri-implant mucositis through free gingival graft surgery. Therefore, a rehabilitation treatment involving a multidisciplinary approach was proposed in order to rescue and reestablish aesthetics, function and well-being through the free gingival graft to improve the characteristics of the mucosa and enable a predictability of a permanent implant prosthesis under more stable tissue conditions. The use of EGL to increase keratinized gingiva in implant surgery in elderly patients is a practical and safe solution for maintaining periodontal health around the implant... (AU)

Peri-Implant Diseases and Gastrointestinal Diseases

ABSTRACT@#Peri-implant diseases are serious problems that plagues today’s dentistry, both in terms of therapy and epidemiology. With the expansion of implantology practice and the increasing number of implants placed annually, the frequency of peri-implant diseases has greatly expanded. The clinical manifestations, in the absence of a globally established classification, are peri-implant mucositis and peri-implantitis, the counterparts of gingivitis and periodontitis, respectively. However, many doubts remain about their features. Official diagnostic criteria, globally recognised by the dental community, have not yet been introduced. The review presented possible association between gastrointestinal diseases and peri-implant diseases. Previous studies had revealed the association with significantly higher levels of bacteria in patient’s gastrointestinal disease at either gingivitis or in periodontitis site. Additionally, pathogenesis of the periodontitis is similar to peri-implant diseases.

Estabilidad y nivel óseo periimplantario de implantes postextractivos en pacientes de la tercera edad / Stability and peri-implant bone level of post-extractive implants in elderly patients

Introducción: Los implantes postextractivos acortan el tiempo en lograr la rehabilitación del paciente, resulta esta condicionante un factor esencial para devolver la calidad de vida en corto plazo a un adulto mayor y mejorar rápidamente su función masticatoria. Objetivo: Determinar los valores de estabilidad y la pérdida ósea periimplantaria en implantes postextractivos en pacientes de la tercera edad. Material y Método: Se realizó un estudio cuasi-experimental en 99 pacientes de la tercera edad en la Facultad de Estomatología ¨Raúl González Sánchez¨, 2017-2019. Bajo su consentimiento se colocaron 173 implantes postextractivos. Se determinó tipo de hueso de soporte, estabilidad primaria y secundaria según análisis de frecuencia de resonancia con Osstel Mentor. Se midió el nivel óseo periimplantario y la pérdida ósea hasta 12 meses de colocada la rehabilitación. Resultados: Se posicionaron mayoritariamente implantes en el sitio de implantación incisivo maxilar en 43,3 por ciento de los casos. Los valores promedio de estabilidad primaria y secundaria fueron 48 ISQ y 68 ISQ respectivamente. La pérdida ósea promedio tras un año de rehabilitación fue de 1,04±0,22mm. Conclusiones: Los implantes dentales postextractivos en pacientes de la tercera edad se insertaron preferentemente en el grupo incisivo maxilar y en hueso tipo D2, registraron una estabilidad primaria promedio moderada y una estabilidad secundaria promedio substancial. La pérdida ósea vertical periimplantaria exhibió valores semejantes a los implantes en zonas curadas y dentro del valor estandarizado para pérdida ósea periimplantaria para el primer año tras su colocación(AU)

Introduction: Post-extractive implants shorten the time in achieving the rehabilitation of the patient, being this condition an essential factor to restore the quality of life to elderly patients at short term. Objective: To determine the stability values and peri-implant bone loss in post-extractive implants in elderly patients. Material and Method: A cohort study was carried out in 99 elderly patients at Raúl González Sánchez Dental School of Havana from 2017 to 2019. Under the consent of the patients, 173 post-extractive implants were placed. Bone support type, and primary and secondary stability were determined on the basis of a resonance frequency analysis with Ostell Mentor®. The peri-implant bone level and peri-implant bone loss were measured until 12 months after rehabilitation. Results: Implants were mainly positioned in the maxillary incisive site in 43,3 percent of the cases. The average values of primary and secondary stability were 48 ISQ and 68 ISQ, respectively. The average bone loss after 12 months of rehabilitation was 1,04 ± 0,22 mm. Conclusions: Post-extractive dental implants were inserted preferably in the maxillary incisive site and in D2 bone type, registering moderated average values of primary stability and substantial average values of secondary stability. The peri-implant vertical bone loss exhibited implants with similar values than those in the healed areas and within the standardized value for peri-implant bone loss within the first year after implant placement(AU)

Criterios Clínicos para el Manejo de las Complicaciones del Tejido Blando Periimplantar / Clinical Criteria for the Management of Peri-implant Soft Tissue Complications

Las complicaciones del tejido blando periimplantar condicionan la apariencia estética y el pronóstico clínico de los implantes y son, en la actualidad, cada vez más diagnosticadas. Los defectos gingivales asociados a implantes dentales incluyen recesiones, fenestraciones o dehiscencias en la superficie mucosa vestibular, inflamación gingival, ausencia de encía insertada/queratinizada, falta de volumen y presencia de concavidades gingivales que generan sombras y oscuridad en la mucosa. La detección de éstas en forma temprana permite establecer un plan de tratamiento en busca de soluciones eficaces. Mediante la presentación de una serie de casos, abordaremos distintos procedimientos para aumento de los tejidos blandos periimplantarios y la corrección de defectos. La ganancia de encía queratinizada ha demostrado tener un impacto positivo en la estabilidad a largo plazo de todos los tejidos implantarios (AU)

Effect of Different Immediate Implant Loading Protocols on Peri-implant Soft Tissue Health / Efeito de diferentes protocolos de implante com carga imediata no tecido mole peri-implantar

Objectives: This clinical study was conducted to evaluate the effect of immediate loading on peri-implant soft tissue health using three protocols: I) Immediate functional loading using polymer infiltrated ceramic (PIC) material (IFLV). II) Immediate functional loading using polymethyl methacrylate (PMMA) followed by delayed functional loading using PIC material (IFLP). III) Immediate non-functional loading using PMMA followed by delayed functional loading using PIC material (INFLP). Material & Methods: 30 Implants were placed in the upper premolar area and divided randomly according to the immediate loading protocol. In the control group (INFLP), CAD/CAM PMMA crowns were placed out of occlusion for 3 months, and then replaced by CAD/CAM VITA ENAMIC crowns in functional occlusion. For (IFLV) group, CAD/CAM VITA ENAMIC crowns were immediately loaded in functional occlusion; while in (IFLP) group, CAD/CAM PMMA crowns were placed in functional occlusion for 3 months, and then replaced by CAD/CAM VITA ENAMIC crowns. Modified pink esthetic score (MPES) and probing depth were used for evaluation of peri-implant soft tissue at base line and follow up periods. Results: INFLP showed higher MPES results compared to IFLV and IFLP. Moreover, the INFLP probing depth at 3 months showed higher results compared to the other groups. Conclusions: Immediate non-functional loading showed the best outcomes. However, peri-implant soft tissue health of the immediate functional loading using the PIC crown material was clinically acceptable (AU)

Objetivo: Este estudo clínico foi realizado para avaliar o efeito da carga imediata na saúde do tecido mole peri-implantar usando três protocolos: I) Carga imediata funcional usando material de cerâmica infiltrada com polímero (PIC) (IFLV). II) Carga imediata funcional usando polimetilmetacrilato(PMMA) seguida por carga funcional retardada usando material PIC (IFLP). III) Carga imediata não funcional usando PMMA seguida por carga funcional retardada usando material PIC (INFLP). Material e Métodos: 30 implantes foram colocados na área dos pré-molares superiores e divididos aleatoriamente de acordo com o protocolo de carga imediata. No grupo controle (INFLP), as coroas CAD / CAM PMMA foram colocadas sem oclusão por 3 meses, e então substituídas pelas coroas CAD / CAM VITA ENAMIC na oclusão funcional. Para o grupo (IFLV), as coroas CAD / CAM VITA ENAMIC foram carregadas imediatamente em oclusão funcional; enquanto no grupo (IFLP), as coroas CAD / CAM PMMA foram colocadas em oclusão funcional por 3 meses, e então substituídas por coroas CAD / CAM VITA ENAMIC. O escore da estética rosa modificado (PESM) e a profundidade de sondagem foram realizados para avaliação do tecido mole peri-implantar no início e nos períodos de acompanhamento. Resultados: INFLP apresentou resultados de PESM superiores em comparação com IFLV e IFLP. Além disso, a profundidade de sondagem INFLP em 3 meses apresentou resultados superiores em comparação com os outros grupos. Conclusões: A carga imediata não funcional apresentou os melhores resultados. No entanto, a integridade do tecido mole peri-implantar da carga imediata funcional usando o material da coroa PIC foi clinicamente aceitável. (AU)

Advances in Treponema denticola and oral diseases / 口腔疾病防治

@#Treponema denticola is an important pathogenic Treponema pathogen in the human oral cavity. Early studies have found that Treponema denticola is closely related to the occurrence and development of periodontal diseases. With the development of technical methods in recent years, many studies have shown that Treponema denticola not only can participate in periodontal diseases through a variety of mechanisms but also can play an important role in the development of various oral diseases. Treponema denticola is detected in high concentrations in peri-apical diseases and peri-implant diseases, and its surface protein is also prevalent in oral tumor samples. This paper reviews the research progress of Treponema denticola in periodontal diseases, pulp peri-apical diseases, peri-implant diseases and oral tumors, and summarizes the relevant mechanisms. For example, Treponema denticola can cause immune regulation disorder, destroy the epithelial barrier, induce bone absorption, promote the occurrence and development of inflammation through a variety of surface proteins, including chymotrypsin-like protease complex (CTLP), major outer sheath protein (Mosp), Td92, and LOS. It can also escape complement-mediated killing effects through surface FhbB lipoproteins and promote the occurrence and development of oral tumors by regulating the tumor microenvironment. These theories provide a theoretical basis for further understanding the development of oral diseases, controlling the infection of Treponema denticola, and exploring more effective treatment strategies.

Clinical observation of cement-retained and screw-retained implant-supported denture in edentulous patients / 口腔疾病防治

Objective@# To evaluate the clinical effects of full-arch cement-retained implant-supported combined crowns and screw-retained implant-supported bridge dentures in complete or half edentulous patients. @*Methods @#A total of 25 patients with complete or partial edentulous dentures followed up for 1, 3, and 5 years in our hospital from June 2013 to June 2018 and were treated with Straumann bone horizontal implantation, cobalt-chromium stenting and cobalt-chromium porcelain restoration with cement-retained and screw-retained implant-supported fixed dental prostheses to evaluate the accumulative implant survival rate, accumulative prosthesis survival rate, mechanical complications, and biological complications in both groups. @*Results @#There were 25 complete or half edentulous patients who received 165 Straumann implants and 28 implant-supported fixed dental prostheses in this study. There were 11 cases with 69 implants in the cement group and 17 cases with 96 implants in the screw group. The accumulative implant survival rate was 100% in the cement group and 96.9% in the screw group. The accumulative prosthesis survival rate was 100% in both groups. The cumulative peri-implant mucositis rate was 23.2% in the cement group and 29.2% in the screw group, and the peri-implantitis rate was 6.8% in the cement group and 7.3% in the screw group. There was 1 case of porcelain collapse (n=1/11) and no screw of abutment loosening in the cement group and 4 cases of porcelain collapse (n=4/17) and 1 case of screw loosening in the screw group. No fracture of abutment was observed in either group. There was no difference in bone loss between the two groups in the first year (P > 0.05), and a higher rate of bone loss was found in the screw group in the third and fifth years (P < 0.05). There was no difference in the sulcus bleeding index(mSBI) between the two groups in the first year and the third year (P > 0.05) and a higher modified mSBI value in the cement group in the fifth year (P < 0.05).@*Conclusion @#The survival rates of the implant and prosthesis for cement-retained or screw-retained implant-supported fixed dental prostheses were both high, but there were more mechanical and biological complications in the traditional cobalt-chromium alloy screw-retainer group. The removal of residual adhesives must be reasonably considered when choosing the cement retention method.

A clinical practice guideline for the prevention and treatment of peri-implant diseases / Guía de práctica clínica para la prevención y el tratamiento de enfermedades periimplantares

ABSTRACT Introduction: the incidence of peri-implant diseases is high, and their optimal management is still debated. The purpose was to explore the levels of available evidence and to suggest evidence-based recommendations for the treatment of peri-implant mucositis and peri-implantitis. Methods: a clinical practice guideline was developed using the Scottish Intercollegiate Guidelines Network (SIGN) criteria. A search strategy was formulated, and a critical review of the following evidence was performed: 1) prevention of peri-implant diseases, 2) treatment of peri-implant mucositis, and 3) treatment of peri-implantitis. Systematic reviews and randomized controlled clinical trials were the primary study types identified in the literature. Current levels of evidence were established and recommendations were provided. Results: a total of 67 articles were included. Regarding the prevention of peri-implant diseases, there is strong evidence for the involvement of patients in a regular maintenance program according to their risk profile. Regarding the treatment of peri-implant mucositis, infection control measures are recommended; controversy exists over the usefulness of antimicrobial agents, and there is evidence against the use of antibiotics. Selection of the peri-implantitis treatment method depends on the severity of the condition and patient-related factors. Resective and regenerative therapies may be used for treatment. The use of systemic antibiotics favors the response of clinical parameters. There is conditional evidence for the use of other adjunctive therapies. Conclusions: the best way to prevent peri-implantitis is to prevent peri-implant mucositis through adherence to supportive periodontal therapy. Treatment of peri-implant diseases depends on local and systemic conditions that affect the success of other treatment options.

RESUMEN Introducción: la incidencia de las enfermedades periimplantarias es alta, y todavía existe polémica en torno a su óptima administración. El propósito del presente estudio consistió en explorar los niveles de evidencia disponibles y ofrecer recomendaciones basadas en la evidencia para el tratamiento de la mucositis periimplantaria y la periimplantitis. Métodos: se elaboró una guía de práctica clínica utilizando los criterios de la Red de Directrices Intercolegiales Escocesas (Scottish Intercollegiate Guidelines Network, SIGN). Se formuló una estrategia de búsqueda y se realizó una revisión crítica de las siguientes evidencias: 1) prevención de enfermedades periimplantarias, 2) tratamiento de la mucositis periimplantaria y 3) tratamiento de la periimplantitis. Las revisiones sistemáticas y los ensayos clínicos controlados aleatorios fueron los principals tipos de estudio identificados en la literatura. Se establecieron los niveles actuales de evidencias y se ofrecieron recomendaciones. Resultados: se incluyeron 67 artículos. En cuanto a la prevención de enfermedades periimplantarias, hay claras evidencias de la participación de los pacientes en los programas de mantenimiento regular, de acuerdo con su perfil de riesgo. En cuanto al tratamiento de la mucositis periimplantaria, se recomiendan medidas de control de infecciones; existe controversia sobre la utilidad de los agentes antimicrobianos, y hay evidencia en contra del uso de antibióticos. La selección del método de tratamiento de la periimplantitis depende de la gravedad de la afección y de los factores relacionados con el paciente. Para el tratamiento se pueden utilizar terapias resectivas y regenerativas. El uso de antibióticos sistémicos favorece la respuesta de los parámetros clínicos. Hay evidencia condicional en cuanto al uso de otras terapias adyuvantes. Conclusiones: la mejor manera de prevenir la periimplantitis es prevenir la mucositis periimplantar mediante la adherencia a la terapia periodontal de apoyo. El tratamiento de las enfermedades periimplantarias depende de las condiciones locales y sistémicas que afectan el éxito de otras opciones de tratamiento.

Doenças peri-implantares, etiologia, diagnóstico e classificação. Revisão de literatura / Peri-implant diseases, etiology, diagnosis and classification. Literature review

Atualmente, a busca por saúde permeia desde o bem estar físico até conceitos estéticos, para se alcançar os parâmetros pessoais de cada indivíduo. Para um correto planejamento reabilitador, devemos considerar várias possibilidades para evitar falhas funcionais e estéticas. Dentre as falhas tardias observamos as doenças peri-implantares, como por exemplo a Mucosite Peri-implatar e a Peri-implantite. Considerando a complexidade e importância da compreensão das doenças Peri implantares, este trabalho tem como objetivo, através de uma revisão da literatura, discutir os aspectos inerentes à etiologia, diagnóstico e classificação das doenças peri-implantares. O tecido peri-implantar e o tecido periodontal possuem estruturas anatômicas similares, mas possuem diferenças estruturais também. Estes fatos também determinam semelhanças e diferenças nas doenças periodontais e peri-implantares. Sabe-se que o principal fator etiológico das doenças periodontais é o biofilme bacteriano, e nas doenças peri-implantares este também é o principal fator etiológico. O mesmo padrão prevalece para alguns fatores etiológicos secundários ou modificadores. Várias são as propostas de classificação das doenças e condições peri-implantares baseadas na gravidade dos comprometimentos clínicos, nos fatores etiológicos, na associação com outras enfermidades e até com fatores iatrogênicos determinantes. Mas nenhuma contempla estes fatores etiológicos juntos e sabe-se que um correto diagnóstico é determinante para um bom plano de tratamento e determinação de sucesso e longevidade das reabilitações peri-implantares (AU)

Currently, the pursuit for health permeates from the physical well-being to aesthetic concepts, in order to achievethe personal parameters of each individual. For a correct rehabilitation planning we must consider several possibilities to avoid functional and aesthetic failures. Among late failures, there are peri-implant diseases, such as Periimplantar Mucositis and Peri-implantitis. Considering the complexity and importance of the understanding of periimplant diseases, this paper aims, through a literature review, to discuss the inherent aspects of the etiology, diagnosis and classification of these peri-implant diseases. Although they have similar anatomical structure, periodontal and peri-impant tissues have some structural diferences. These facts determine similarities and diferences between periodontal and periimplant diseases. It is known that the main etiological factor of periodontal diseases is bacterial biofilm, and in peri-implant diseases this is also the main etiological factor. The same pattern prevails for some secondary or modifiers etiological factors. There are several suggestions for the classification of peri-implant conditions and diseases based on theseverity of clinical complications, etiological factors, association with other diseases and even iatrogenic factors. But none considers these factors together and it is knownthat a correct diagnosis is determinant for a good treatment plan and determination of success and longevity of the peri-implant rehabilitations (AU)

Periodontal disease, peri-implant disease and levels of salivary biomarkers IL-1ß, IL-10, RANK, OPG, MMP-2, TGF-ß and TNF-α: follow-up over 5 years

Abstract Objective The aim of this study was to evaluate the levels of salivary biomarkers IL-1β, IL-10, RANK, OPG, MMP-2, TG-β and TNF-α in individuals with diagnosis of peri-implant mucositis in the absence or presence of periodontal and peri-implant maintenance therapy (TMPP) over 5 years. Material and Methods Eighty individuals diagnosed with peri-implant mucositis were divided into two groups: one group that underwent periodontal and peri-implant regularly maintenance therapy, called GTP (n=39), and a second group that received no regular maintenance GNTP (n=41). Each participant underwent a complete periodontal and peri-implant clinical examination. Collection of saliva samples and radiographic examination to evaluate peri-implant bone levels were conducted at two times: initial examination (T1) and after 5 years (T2). The salivary samples were evaluated through ELISA for the following markers: IL-1β, IL-10, RANK, OPG, MMP-2, TGF and TNF-α. Results A higher incidence of peri-implantitis was observed in the GNTP group (43.9%) than in the GTP group (18%) (p=0.000). All individuals (n=12) who presented peri-implant mucositis and had resolution at T2 were in the GTP group. After 5 years, there was an increase in the incidence of periodontitis in the GNTP group compared to the GTP group (p=0.001). The results of the study revealed an increase in the salivary concentration of TNF-α in the GNTP group compared to the GTP group. The other salivary biomarkers that were evaluated did not show statistically significant differences between the two groups. Conclusions The salivary concentration of TNF-α was increased in individuals with worse periodontal and peri-implant clinical condition and in those with a higher incidence of peri-implantitis, especially in the GNTP group. Longitudinal studies in larger populations are needed to confirm these findings and elucidate the role of this biomarker in peri-implant disease.

A review of peri-implant microbiology / 华西口腔医学杂志

Dental implants represent the majority of treatment strategies used to replace missing teeth. However, peri-implant diseases caused by disturbance in peri-implant microbiological balance are among the reasons for implant failure. Since the 1980s, peri-implant microorganisms have been a hot research topic in dental microbiology. The bacterial ecology between the disease and health largely differs, which directly or indirectly increases the risk of peri-implant diseases. Accordingly, the determination of the 'core microbiome' of peri-implantitis and peri-implant mucositis is a key point of recent research.