Tratamento da periimplantite por meio da descontaminação do implante: um relato de caso / Treatment of peri-implantitis through implant decontamination: a case report

Os implantes dentários osseointegrados representam uma parte da reabilitação oral, sendo uma alternativa cada vez mais utilizada na Odontologia a fim de substituir dentes perdidos. À semelhança das doenças periodontais, o fator etiológico das doenças periimplantares é o acúmulo de biofilme ao redor dos implantes dentários. Esta patologia também é classificada de acordo com os tecidos acometidos por ela, em mucosite e periimplantite. Para um correto tratamento e sucesso na terapia periimplantar, o diagnóstico deve ser baseado na sua etiologia e, seu tratamento segue variando de acordo com cada caso e estágio da doença. O presente trabalho tem como objetivo relatar o tratamento de um caso de periimplantite por meio da descontaminação da superfície do implante através de uma cirurgia de acesso. Paciente leucoderma, com 56 anos, sexo feminino, procurou atendimento no curso de graduação em Odontologia do centro Universitário da Serra Gaúcha ­ FSG, com queixa de sangramento/supuração, dor e edema na região dos dentes 15 e 16, reabilitados com implantes, e exposição de componentes protéticos. A paciente foi diagnosticada com periimplantite. O plano de tratamento proposto foi de promover a descontaminação da superfície do implante por meio de acesso cirúrgico. Com base no caso clínico apresentado, foi possível concluir que a técnica de tratamento utilizada foi eficaz para a resolução da periimplantite, no período de acompanhamento do estudo (90 dias), demonstrando melhora nos parâmetros clínicos e radiográficos(AU)

Osseointegrated dental implants represent a part of oral rehabilitation, being an increasingly used alternative in Dentistry in order to replace lost teeth. Similar to periodontal diseases, the etiological factor of peri-implant diseases is the accumulation of biofilm around dental implants. This pathology is also classified according to the tissues affected by it, in mucositis and peri-implantitis. For a correct treatment and success in peri-implant therapy, the diagnosis must be based on its etiology, and its treatment continues to vary according to each case and stage of the disease. The present work aims to report the treatment of a case of peri-implantitis through the decontamination of the implant surface through an access surgery. Caucasian female patient, 56 years old, sought care at the graduation course in Dentistry at Centro Universitário da Serra Gaúcha ­ FSG, complaining of bleeding/suppuration, pain and edema in the region of teeth 15 and 16, rehabilitated with implants, and exposure of prosthetic components. The patient was diagnosed with peri-implantitis. The proposed treatment plan was to promote decontamination of the implant surface through surgical access. Based on the presented clinical case, it was possible to conclude that the treatment technique used was effective for the resolution of periimplantitis, in the follow-up period of the study (90 days), demonstrating improvement in clinical and radiographic parameters(AU)

Abordaje reconstructivo para un defecto de periimplantitis / Reconstructive approach for a peri-implantitis defect

Si bien el conocimiento científico para el tratamiento de la periimplantitis ha avanzado significativamente en los últimos años, sigue en discusión qué tipo de abordaje quirúrgico genera los mejores resultados clínicos y si el uso de biomateriales da mejoras significativas en dicho tratamiento. Este reporte de caso describe un abordaje quirúrgico reconstructivo de un defecto intraóseo por periimplantitis en una paciente que refería dolor y un intenso sangrado en sus implantes dentales, empleando un sustituto óseo anorgánico mineral bovino, sin el uso de una membrana o barrera, y con un protocolo de descontaminación de la superficie del implante mecánico y químico. Posteriormente, a las 20 semanas de realizado el procedimiento, se hizo la evaluación del defecto, obteniendo profundidades al sondeo menores a 5 mm, ausencia de sangrado al sondeo en todos los sitios y un llenado óseo radiográfico de aproximadamente 90%; cumpliendo con los criterios de éxito de la terapia periimplantaria. Lo anterior muestra que la terapia reconstructiva para los defectos por periimplantitis puede ser posible mediante el uso de un sustituto óseo xenogénico únicamente y con una correcta descontaminación de la superficie del implante (AU)

Although scientific knowledge for the treatment of peri-implantitis have advanced significantly in recent years, the type of surgical approach that generates the best clinical results is still under discussion and whether the use of biomaterials gives significant improvements in said treatment. This case report describes a reconstructive surgical approach for a periimplantitis intrabony defect using an anorganic bovine bone substitute, without the use of a membrane or barrier, and with a mechanical and chemical implant surface decontamination protocol. Twenty weeks after the procedure, the defect was reassessed, obtaining probing depths of less than 5 mm, no bleeding on probing in all sites, and radiographic bone filling of approximately 90%; meeting the success criteria for the peri-implant therapy. This shows that reconstructive therapy for periimplantitis defects may be possible using a xenogeneic bone substitute only and proper decontamination of the implant surface (AU)

Análise mecânica comparativa do destorque de parafusos de minipilar com um novo componente protético, juntamente com avaliação microbiológica do vedamento para implantes de plataforma Cone Morse / Comparative mechanical analysis of the untorsion of miniabutment screws with a new prosthetic component, together with microbiological evaluation of the seal for Cone Morse platform implants

A interface implante pilar (IAI) por se constituir de duas peças inevitavelmente apresentam micro lacuna (GAP), na qual pode ocorrer infiltração bacteriana, permitindo a penetração de microorganismos que colonizam na parte interna do implante levando ao acúmulo de biofilme e, podendo levar ao desenvolvimento da periimplantite. O desgaste da conexão interna do implante é algo que ocorre com frequência, muitas vezes pela fratura do parafuso e/ou, pela perda da rosca interna do implante. A ausência de informações prévias também pode gerar a necessidade da remoção do implante, devido a estas intercorrências, surge a possibilidade da criação de um novo componente para implantes para possibilitar a reabilitação protética, sem ter que passar por uma nova cirurgia de remoção e instalação do implante. O objetivo do trabalho foi mensurar o nível de afrouxamento do parafuso do pilar protético e do minipilar comparando com novo componente protéticos, na tentativa de simular o comportamento do conjunto implante/pilar/prótese. Foram utilizados vinte implantes de plataforma cone morse (CM) da DSP® com seus respectivos mini pilares, na qual foram distribuídos em 2 grupos(n=10): Grupo 1 - implante CM + mini pilar FlexCone® DSP + coroa simplificada pirâmide invertida carga aplicada 3 mm do centro da coroa. E Grupo 2 - implante CM + mini pilar novo + coroa simplificada pirâmide invertida carga aplicada 3 mm do centro da coroa. Foram realizados ciclagem mecânica com carga 133 N, durante 2x106 ciclos, com frequência 2 Hz e temperatura de 37ºC em ambos grupos. Um torquímetro digital foi usado para medir os valores de torque reverso do parafuso protético da coroa e também do pilar protético, antes e após o carregamento. Os resultados do modelo de regressão demonstraram diferenças estatisticamente significativas em função do envelhecimento comparando os grupos da coroa sobre o pilar protético (p = 0.020) e entre os grupos do pilar sobre o implante (p = 0.048), indicando que após o envelhecimento de 2.000.000 de ciclos ao longo do tempo está associado de maneira significativa a essas variáveis no contexto deste estudo. O segundo objetivo deste estudo foi avaliar in vitro a taxa de infiltração bacteriana através da IAI, entre o novo componente protético e a superfície interna do implante, juntamente foi analisado a permeabilidade do IAI para colonização bacteriana. Um total de oitenta implantes foram testados. As estruturas montadas para grupo 1 foi torqueado com 20 N/cm e do G2 foram torqueados com 45 N, ambos imersos em microtubos contendo 200 µl de saliva humana. Após 14 dias de incubação da amostra de bactéria nos implantes, foi realizada uma análise qPCR (reação da cadeia da polimerase em tempo real). O teste revelou que não houve diferenças estatisticamente significativas no crescimento bacteriana entre os grupos em qualquer um dos pontos temporais analisados. Conclui-se que o novo componente testado apresentou um destoque menor do que comparado ao mini pilar FlexCone DSP® e apresentou infiltração bacteriana no GAP da conexão implante-pilar semelhante comparado ao mini pilar original da empresa (AU)

The abutment implant interface (IAI), as it consists of two pieces, inevitably presents a micro gap (GAP), in which bacterial infiltration can occur, allowing the penetration of microorganisms that colonize in the internal part of the implant, leading to the accumulation of biofilm and, which can lead to development of peri-implantitis. Wear of the implant's internal connection is something that occurs frequently, often due to screw fracture and/or loss of the implant's internal thread. The lack of prior information can also generate the need to remove the implant, due to these complications, the possibility arises of creating a new component for implants to enable prosthetic rehabilitation, without having to undergo a new surgery to remove and install the implant. implant. The objective of the work was to measure the level of screw loosening of the prosthetic abutment and the mini-abutment compared with the new prosthetic component, in an attempt to simulate the behavior of the implant/ abutment/prosthesis set. Twenty DSP® morse cone (CM) platform implants were used with their respective mini pillars, which were distributed into 2 groups (n=10): Group 1 - CM implant + FlexCone® DSP mini pillar + simplified crown inverted pyramid load applied 3 mm from the center of the crown. And Group 2 - CM implant + new mini abutment + simplified crown inverted pyramid load applied 3 mm from the center of the crown. Mechanical cycling was carried out with a load of 133 N, for 2x106 cycles, with a frequency of 2 Hz and a temperature of 37ºC in both groups. A digital torque wrench was used to measure the reverse torque values of the prosthetic crown screw and also the prosthetic abutment, before and after loading. The results of the regression model demonstrated statistically significant differences as a function of aging comparing the crown-on-prosthetic abutment groups (p =0.020) and between the abutment-on-implant groups (p = 0.048), indicating that after aging 2,000 ,000 cycles over time is significantly associated with these variables in the context of this study. The second objective of this study was to evaluate in vitro the rate of bacterial infiltration through the IAI, between the new prosthetic component and the internal surface of the implant, together with the permeability of the IAI for bacterial colonization. A total of eighty implants were tested. The assembled structures for group 1 were torqued with 20 N/cm and G2 were torqued with 45 N, both immersed in microtubes containing 200 µl of human saliva. After 14 days of incubation of the bacteria sample in the implants, a qPCR (real-time polymerase chain reaction) analysis was performed. The test revealed that there were no statistically significant differences in bacterial growth between groups at any of the time points analyzed. It is concluded that the new component tested presented a lower impact compared to the FlexCone DSP® mini abutment and presented bacterial infiltration in the GAP of the implant-abutment connection similar to the company's original mini abutment.(AU)

Periimplantite e a importância do especialista em periodontia na manutenção dos tecidos / Periimplantitis and the importance of the periodontic specialist in tissue maintenance

Introdução: A peri-implantite é uma condição patológica associada a placa que ocorre nos tecidos de suporte ao redor de implantes dentários. Se caracteriza pela presença de sinais clínicos proveniente de inflamação na mucosa periimplantar conhecido como mucosite e subsequente perda progressiva do osso de suporte denominado como periimplatite. Objetivo: Classificar os principais sinais e sintomas clínicos da doença periimplantar a fim de estabelecer um diagnóstico, apresentar quais fatores devem ser avaliados durante o planejamento e manutenções de implantes dentários, os fatores de risco locais e sistêmicos, o tratamento e a importância do implantodontista com o periodontista realizar planejamento correto visando um prognostico favorável. Metodologia: Revisão de literatura foi realizada no PubMed, buscando artigos dos anos de 2010 a 2021. Resultado: Os estudos mostraram que o acúmulo de placa bacteriana nos implantes resultará no desenvolvimento de mucosite e podendo posteriormente se estabelecer a peri-implantite. Uma história de doença periodontal, tabagismo e falta de terapia de suporte devem ser considerados como indicadores de risco para o desenvolvimento de peri-implantite. Conclusão: É de suma importância o trabalho simultâneo do implantodontista com o periodontista com o intuito de se obter um bom planejamento e consequentemente reduzir danos a curto e longo prazo nos tecidos periimplantares. O sucesso do tratamento de doenças periimplantares está na prevenção, envolvendo reforço de higiene oral e manutenções periódicas(AU)

Introduction: A peri-implantitis is a plaqueassociated pathological condition that occurs in the supporting tissues around dental implants. If indifferent to the presence of proven clinical signs of inflammation in the peri-implant mucosa known as mucosite and subsequent progressive loss of supporting bone termed as peri-implatite. Objective: To classify the main signs and clinical signs of peri-implant disease an objective to establish a diagnosis, present the factors to be adopted during the planning and maintenance of dental implants, the local and systemic risk factors, the treatment and the importance of the implantodontist with the periodontist carrying out correct planning, a favorable prognosis. Methodology: A literature review was performed in PubMed, looking for articles from 2010 to 2021. Results: Advanced studies show that the accumulation of bacterial plaque in implants will result in the development of mucositis and may subsequently establish peri-implantitis. A history of periodontal disease, smoking and lack of supportive therapy should be considered as risk indicators for the development of peri-implantitis. Conclusion: The simultaneous work of the implantodontist with the periodontist is of paramount importance in order to obtain a good planning and consequently reduce short and long-term damage to the peri-implant tissues. The successful treatment of peri-implant diseases lies in prevention, involving reinforcement of oral hygiene and periodic maintenance(AU)

Resolución de peri-implantitis en una paciente con múltiples implantes comprometidos. Reporte de caso / Resolution of peri-implantitis in a patient with multiple compromised implants. Case report

El propósito de este reporte es describir el tratamiento no quirúrgico y quirúrgico en una paciente con múltiples implantes con peri-implantitis. Inflamación, sangrado espontáneo, supuración y pérdida ósea fueron los signos clínicos y radiográficos observados en los 21 implantes presentes en su boca. Las profundidades al sondaje oscilaban entre 5 y 15 mm. Se llevó a cabo la terapia no quirúrgica asociada a antibióticos sistémicos (Metronidazol 500 mg) y antiséptico (Clorhexidina 0,12%) con la finalidad de reducir los signos de inflamación y sangrado. Durante la re-evaluación se colocaron gránulos de Minociclina de liberación controlada en las bolsas residuales. Los sitios que no respondieron fueron abordados quirúrgicamente, realizando además la implantoplastia de las espiras que quedaron expuestas al medio bucal. Uno de los implantes debió ser explantado. A los 9 meses, no presentaba signos de inflamación peri-implantar, sangrado al sondaje ni pérdida ósea progresiva.

The aim of this report is to describe the non-surgical and surgical treatment of a patient with multiple implants with peri-implantitis. Inflammation, spontaneous bleeding, suppuration and bone loss were the clinical and radiographic signs observed in the 21 implants present in her mouth. Probing depths ranged from 5 to 15 mm. Non-surgical therapy with systemic antibiotics (Metronidazole 500 mg) and antiseptic (Chlorhexidine 0.12%) was carried out in order to reduce the signs of inflammation and bleeding. During re-evaluation, controlled-release minocycline granules were placed in the residual pockets. The sites that did not respond were approached surgically. Also, the implantoplasty of the threads that were exposed to the oral environment was performed. One of the implants had to be explanted. At 9 months, there were no signs of peri-implant inflammation, bleeding on probing or progressive bone loss.

Factores pronósticos que influyen en los resultados de tratamiento de la periimplantitis: Una revisión sistemática / Prognostic factors influencing peri-implantitis treatment outcomes: A systematic review

Objetivo: Esta revisión sistemática tiene como objetivo identificar los factores pronósticos y/o determinantes del éxito del tratamiento de la periimplantitis. Materiales y métodos: Se realizó una búsqueda bibliográfica estructurada y exhaustiva para identificar referencias relevantes en las bases de datos MEDLINE (PubMed), Scielo y Springerlik. La estrategia de búsqueda se realizó combinando los términos periimplantitis con factores pronósticos y / o determinantes del éxito del tratamiento como MeSH y texto libre combinando con los operadores booleanos AND y OR. Se utilizó la clasificación de SIGN (Scottish Intercollegiate Guidelines Network) para analizar el nivel de evidencia. Resultados: De los 239 artículos revisados, 17 cumplieron con los criterios de selección para el análisis cualitativo de la evidencia. Conclusiones: El tipo de implante (macro y microgeometría) y la morfología del defecto, los cuales dificulta el acceso a las superficies contaminadas, son factores que influyen en el resultado del tratamiento de la periimplantitis. No hay evidencia sobre el método de descontaminación más eficaz. Las condiciones generales como la diabetes mellitus y la presencia de enfermedad periodontal activa afectan el resultado del tratamiento, así como la frecuencia de un programa de mantención de higiene profesional postquirúrgica, la cual mejora la sobrevida del implante.

Objective: This systematic review aimed at identifying prognostic factors influencing periimplantitis treatment outcomes. Materials and methods: A structured and comprehensive literature search was performed to identify relevant references from MEDLINE (PubMed), Scielo and Springerlik databases. The search strategy was carried out combining the search terms periimplantitis with prognostic factors and/or determinants of treatment success as MeSH and free text combining with the boolean logical operators AND and OR. The SIGN (Scottish Intercollegiate Guidelines Network) was used to analyze the level of evidence. Results: From 239 articles reviewed, 18 fulfilled the selection criteria for the qualitative analysis of the evidence. Conclusions: The type of implant (macro and microgeometry) and the defect morphology, which make access to contaminated surfaces difficult, are factors that influence the outcome of peri-implantitis treatment. There is no evidence on the most effective decontamination method. General conditions such as diabetes mellitus and the presence of active periodontal disease affect the outcome of the treatment. as Also, the frequency of a post-surgical professional hygiene maintenance program improves the dental implant survival post-treatment.

Comparison of three methods for establishing rat peri-implantitis model / 北京大学学报(医学版)

OBJECTIVE@#To compare the efficiency and effect of establishing rat peri-implantitis model by traditional cotton thread ligation and local injection of Porphyromonas gingivalis lipopolysaccharide (LPS) around the implant, as well as the combination of the two methods.@*METHODS@#Left side maxillary first molars of 39 male SD rats were extracted, and titanium implants were implanted after four weeks of healing. After 4 weeks of implant osseointegration, 39 rats were randomly divided into 4 groups. Cotton thread ligation (n=12), local injection of LPS around the implant (n=12), and the two methods combined (n=12) were used to induce peri-implantitis, the rest 3 rats were untreated as control group. All procedures were conducted under 5% isoflurane inhalation anesthesia. The rats were sacrificed 2 weeks and 4 weeks after induction through carbon dioxide asphyxiation method. The maxilla of the rats in the test groups were collected and marginal bone loss was observed by micro-CT. The gingival tissues around the implants were collected for further real time quantitative PCR (RT-qPCR) analysis, specifically the expression of tumor necrosis factor-alpha (TNF-α) as well as interleukin-1β (IL-1β). The probing depth (PD), bleeding on probing (BOP) and gingival index (GI) of each rat in the experimental group were recorded before induction of inflammation and before death.@*RESULTS@#After 4 weeks of implantation, the osseointegration of implants were confirmed. All the three test groups showed red and swollen gums, obvious marginal bone loss around implants. After 2 weeks and 4 weeks of inflammation induction, PD, GI and BOP of the three test groups increased compared with those before induction, but only BOP was statistically significant among the three test groups (P < 0.05). At the end of 2 weeks of inflammation induction, marginal bone loss was observed at each site in the cotton thread ligation group and the combined group. At each site, the bone resorption in the combined group was greater than that in the cotton thread ligation group, but the difference was not statistically significant (P > 0.05), bone resorption was observed at some sites of some implants in LPS local injection group. At the end of 4 weeks of inflammation induction, marginal bone loss was observed at all sites in each group. The marginal bone loss in the cotton thread ligation group and the combined group was greater than that in the LPS local injection group, and the difference was statistically significant (P < 0.05). At the end of 2 weeks and 4 weeks of induction, the expression of TNF-α and IL-1β in the test groups were higher than those in the control group (P < 0.05).@*CONCLUSION@#Compared with local injection of LPS around the implant, cotton thread ligature and the two methods combined can induce peri-implantitis in rats better and faster.

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.

Research progress in the association of peri-implant diseases and metabolic syndrome / 中华口腔医学杂志

Peri-implant disease, an important group of diseases that cause implant failure, are associated with metabolic abnormality. Metabolic syndrome (MetS) is a common metabolic disorder comprising abdominal obesity, hyperglycemia, systemic hypertension and atherogenic dyslipidemia. Previous studies had reported that MetS and its diversified clinical manifestations might be associated with peri-implant diseases, but the relationship and underlying mechanisms were unclear. This review aims to explore the relationship between MetS and peri-implant disease, in order to provide beneficial reference for the prevention and treatment of peri-implant disease in patients with MetS.

In vitro research of oral microscope-assisted implant surface decontamination / 华西口腔医学杂志

OBJECTIVES@#To investigate the effect of oral microscope-assisted surface decontamination on implants in vitro.@*METHODS@#Twelve implants that fell off because of severe peri-implantitis were collected, and decontamination was carried out on the surfaces of implants through curetting, ultrasound, titanium brushing, and sandblasting at 1×, 8×, or 12.8× magnifications. The number and sizes of residues on the implants' surfaces after decontamination were determined, and the decontamination effect was analyzed according to the thread spacing in the different parts of the thread.@*RESULTS@#1) The 8× and 12.8× groups scored lower for implant surface residues than the 1× group (P<0.000 1), and the 12.8× group scored lower than the 8× group (P<0.001); 2) no difference in residue score was found between the wide and narrow thread pitch (P>0.05), and the 8× and 12.8× groups had lower scores than the 1× group (P<0.001); 3) the lowest number of contaminants was observed at the tip of the thread, whereas the highest was observed below the thread, and the difference was significant (P<0.001). However, the thread pitch had no effect on the number of contaminants in different areas (P>0.05); 4) the residue scores of the 8× and 12.8× groups were lower than those of the 1× group at the thread tip and above, sag, and below the thread of the implants (P<0.05).@*CONCLUSIONS@#Residues on the surfaces of contaminated implants can be effectively removed by using an oral microscope. After decontamination, the residues of pollutants were mainly concentrated below the thread of the implants, and the thread pitch of the implants had no significant effect on the residues.

Titanium particles in peri-implantitis: distribution, pathogenesis and prospects / 国际口腔科学杂志·英文版

Peri-implantitis is one of the most important biological complications in the field of oral implantology. Identifying the causative factors of peri-implant inflammation and osteolysis is crucial for the disease's prevention and treatment. The underlying risk factors and detailed pathogenesis of peri-implantitis remain to be elucidated. Titanium-based implants as the most widely used implant inevitably release titanium particles into the surrounding tissue. Notably, the concentration of titanium particles increases significantly at peri-implantitis sites, suggesting titanium particles as a potential risk factor for the condition. Previous studies have indicated that titanium particles can induce peripheral osteolysis and foster the development of aseptic osteoarthritis in orthopedic joint replacement. However, it remains unconfirmed whether this phenomenon also triggers inflammation and bone resorption in peri-implant tissues. This review summarizes the distribution of titanium particles around the implant, the potential roles in peri-implantitis and the prevalent prevention strategies, which expects to provide new directions for the study of the pathogenesis and treatment of peri-implantitis.

Tratamento cirúrgico da osteomielite dos maxilares: relato de caso / Surgical treatment of osteomyelitis of the jaws: Case report / Tratamento quirúrgico de la osteomielitis de los maxilares: reporte de um caso

A Osteomielite dos Maxilares (OM) é uma inflamação óssea, de origem na maioria infecciosa, podendo atingir a porção medular e cortical dos ossos maxilares. Apresenta-se em maior extensão na mandíbula, devido ao pobre suprimento sanguíneo que essa possui, sendo mais prevalente em homens entre a faixa etária de 40 a 60 anos. Sua etiologia está relacionada principalmente às infecções odontogênicas, infecções secundárias e corpos estranhos ocasionais, como os implantes dentários. Tem-se por objetivo apresentar um relato de caso clínico sobre OM na região posterior da mandíbula, bem como sua associação a uma insatisfatória implantação dentária onde houve desenvolvimento de lesão peri-implantar. Paciente do gênero feminino, 53 anos, melanoderma, apresentou dor crônica, abaulamento ósseo sem outros sinais significativos na região de molares inferiores no lado direito, radiograficamente visualizava-se imagem mista sendo sugestiva de sequestro ósseo. Na história pregressa relatou ter realizado explantação na referida região após ser diagnosticada com peri implantite. Ao final do estudo concluiu-se que a afecção teve como causa a infecção bacteriana proveniente de contaminação durante a inserção de implante dentário. Optou-se por remoção cirúrgica do osso necrótico e inflamado... (AU)

Osteomyelitis of the Jaws (OM) is a bone inflammation, of mostly infectious origin, which can affect the medullary and cortical portion of the maxillary bones. It presents itself to a greater extent in the mandible, due to the poor blood supply that it has, being more prevalent in men between the age group of 40 to 60 years. Its etiology is mainly related to odontogenic infections, secondary infections and occasional foreign bodies, such as dental implants. The objective is to present a clinical case report on OM in the posterior region of the mandible, as well as its association with an unsatisfactory dental implantation, where there was development of a peri-implant lesion. Female patient, 53 years old, melanoderma, presented chronic pain, bone bulging without other significant signs in the region of lower molars on the right side, radiographically a mixed image was visualized, suggesting bone sequestration. In her previous history, she reported having performed explantation in that region after being diagnosed with peri-implantitis. At the end of the study, it was concluded that the disease was caused by bacterial infection from contamination during dental implant insertion. We opted for surgical removal of the necrotic and inflamed bone... (AU)

La osteomielitis de los maxilares (OM) es una inflamación de los huesos, en su mayoría de origen infeccioso, que puede afectar la porción medular y cortical de los huesos maxilares. Se presenta en mayor medida en la mandíbula, debido a la escasa irrigación sanguínea que tiene, siendo más prevalente en hombres entre el grupo de edad de 40 a 60 años. Su etiología se relaciona principalmente con infecciones odontogénicas, infecciones secundarias y cuerpos extraños ocasionales, como los implantes dentales. El objetivo es presentar un reporte de caso de OM en la región posterior de la mandíbula, así como su asociación con una implantación dentaria insatisfactoria a partir de la cual desarrollamos una lesión periimplantaria. Paciente femenina, 53 años, melanodermia, presenta dolor crónico, tumefacción ósea con otros signos significativos en región molar inferior del lado derecho, radiográficamente se visualiza imagen mixta sugestiva de pérdida ósea. En su historia previa menciona haber realizado una explantación en esa región tras ser diagnosticada de periimplantitis. Al final del estudio, se concluyó que la enfermedad fue causada por una infección bacteriana provocada por la contaminación durante la inserción del implante dental. Se optó por la extirpación quirúrgica de la piel necrótica e inflamada... (AU)

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.

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.

Role of decontamination treatment for implant surface in the treatment of peri-implantitis / 中南大学学报(医学版)

Peri-implantitis, characterized by inflammation of tissues around implants and gradual loss of supporting bone tissue, has become one of the main causes for implant failure. Thoroughly removing the plaque biofilm on the implant surface is the first principle in the treatment of peri-implantitis. For this reason, various decontamination methods have been proposed, which can be divided into 2 categories: Removing biofilm and killing microorganisms according to the effect of plaque biofilm on the implant surface. However, at present, there is no decontamination method that can completely remove the plaque biofilm on the implant surface, and it lacks of clinical recommended guidelines. To understand the advantages and disadvantages, effectiveness and safety for different implant surface decontamination methods is of great significance to guide the clinical selection for peri-implantitis treatment.

Diagnosis, etiology, prevention and treatment in retrograde peri-implantitis / 中华口腔医学杂志

Retrograde peri-implantitis (RPI), a kind of rare biological complication in implant-supported prosthetic rehabilitation, has been reported more frequently in recent years. RPI is defined as the periapical lesion that occurs following implant placement while the coronal part of the implant achieves normal osseointegration. Due to the possibilities of asymptomatic clinical scenarios, RPI can easily be ignored if routine radiographic examination is absent postoperatively, which may postpone treatment and affect long-term outcome. The common cause is infection originating from the periapical lesion of the neighboring teeth, the residual bacteria at the implant site, the contaminated implant apex and etc. Treatment methods rely on the infection source and severity of defect. This article discusses the diagnosis, classification, etiology, and pathology as well as prevention and treatment of RPI in order to provide evidence for clinical decisions in the future.

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.

Peri-implantitis and Practical Management: A Review

ABSTRACT@#At present, with an increasing number of implants placed, peri-implant diseases are also increasing. The inclusion of peri-implant disease in the latest classification of periodontal disease shows the global significance of the disease in addition to periodontal disease. Management for peri-implantitis is more complicated and similar to periodontitis, and bone loss is irreversible. Numerous studies throughout the decades were conducted using various techniques investigating the best method in treating peri-implantitis. Therefore, this article will explore the latest evidence for peri-implantitis and its management.

The referral pattern of patients to periodontists by general dentists / O padrão de encaminhamento de pacientes para periodontistas por clínicos gerais

Objetivo: O sucesso da terapia periodontal requer um relacionamento adequado entre o clínico geral e o periodontista. O objetivo deste estudo foi determinar, por meio de um questionário, o padrão de encaminhamento de pacientes por dentistas clínicos gerais a periodontistas em Yazd, Irã. Material e Métodos: Este estudo transversal descritivo foi realizado na forma de uma pesquisa incluindo 145 dentistas licenciados em Yazd. Foi elaborado um questionário composto por sete questões com subquestões. Resultados: 89% dos cirurgiões-dentistas encaminham o paciente ao periodontista. A recessão gengival foi o motivo mais frequente de encaminhamento (69,7%), enquanto o sangramento gengival foi o menos frequente (13,1%). Em termos de procedimentos cirúrgicos, os procedimentos mais frequentes para encaminhamentos foram terapias de periimplantite e aumento de rebordo. O encaminhamento realizado por dentistas do gênero feminino foi de 95,9% e pelo gênero masculino foi de 81,7%. O número de pacientes encaminhados por dentistas que atuavam simultaneamente em clínicas privadas e públicas foi maior do que aqueles que atuavam apenas em clínicas privadas ou públicas. O maior percentual de encaminhamento foi no grupo de cirurgiões-dentistas com menos de 5 anos de experiência, com ligeira diferença daqueles com mais de 10 anos de experiência. Apenas 26,1% dos entrevistados relataram ter participado de programas de reciclagem. Conclusão: É necessário que os dentistas gerais considerem os sinais primários da doença periodontal e encaminhem os pacientes mais graves em estágios iniciais para fornecer um resultado ideal a longo prazo para os pacientes.(AU)

Objective: The successful periodontal therapy needs a proper relationship between general dentist and periodontist. The aim of this study was to determine the referral pattern of patients to periodontists by general dentists in Yazd, Iran, by means of a questionnaire. Material and Methods: This descriptive cross-sectional study was carried out in the form of a survey among 145 licensed general dental practitioners in Yazd, Iran. A questionnaire comprising of seven questions with sub-questions was prepared. Results: 89% of dentists have referred patient to periodontist. Gingival recession was the most frequent reason for referring (69.7%) and the least was gingival bleeding (13.1%). The most frequent surgical procedure for what patients have been referred were peri-implantitis therapy and ridge augmentation. Referral status to periodontist for female dentists was 95.9% and for male dentists was 81.7%. The number of referred patients form the dentists who were practicing simultaneously at both private and public clinics was higher than those who were practicing only at private or public clinics. The most referral percentage was in the group of dentists with less than 5 years of experience with a slight difference from those with more than 10 years of experience. Only 26.1% of the respondents have participated in retraining programs. Conclusion: There is a need for general dentists to consider the primary signs of periodontal disease and necessity of referring the patients in early stages more serious, to provide an optimal long-term outcome for patients. (AU)

Eficácia da implantoplastia adjuvante no tratamento cirúrgico da peri-implantite / Efficacy of adjuvant implantoplasty in the surgical treatment of peri-implantitis

A terapia cirúrgica tem sido apontada como a estratégia mais apropriada para o tratamento da peri-implantite. Uma dessas técnicas é a implantoplastia, cuja proposta é a modificação da superfície do implante através da remoção de roscas expostas, tornando-a menos aderente ao biofilme. O estudo objetivou avaliar o efeito da implantoplastia no tratamento da peri-implantite, através da comparação entre dois grupos de intervenção: um com e outro sem implantoplastia. Assim, trata-se de um ensaio clínico prospectivo, controlado, randomizado e cego. 13 participantes com 33 implantes foram alocados aleatoriamente em dois grupos: acesso cirúrgico + debridamento mecânico (grupo controle-I) e acesso cirúrgico + debridamento mecânico + implantoplastia (grupo teste- II). Os desfechos primários foram avaliados no baseline e aos 3 meses: Índice de Placa Visível -IPV, Índice de Sangramento Gengival -ISG, Profundidade de Sondagem -PS, Sangramento à Sondagem -SS e Faixa de Mucosa Ceratinizada -MC. Avaliou- se a qualidade de vida pelo Oral Health Impact Profile -OHIP14 e também os marcadores de estresse oxidativo pelas amostras salivares. Os resultados apontaram que 69,2% eram mulheres, com idade média de 60,6 anos. Dos 32 implantes, 16 receberam a terapia I e 16 a terapia II. De todas as reabilitações, 53,8% foram totais e 30,8% foram parciais, sendo as demais unitárias. O teste de Mann-Whitney apontou que os valores de IPV e do ISG no grupo II foram maiores do que no grupo I aos 3 meses, mas não foram significativos (p=0,193; p=0,419). O SS foi maior no grupo I (50%) do que no grupo II (41,6%) aos 3 meses, porém, sem significância (p=0,759). Aos 3 meses, todos os parâmetros - exceto SS no grupo II - diminuíram de valor, sendo significativos para o IPV no grupo I (p=0,038), ISG nos grupos I e II (p=0,011 e p=0,015) e PS no grupo II (p=0,041). O ANOVA Split-Plot não mostrou interação entre tempo e tratamento. O OHIP14 mostrou que no baseline houve predomínio da "Dor física", "Desconforto psicilógico" e "Incapacidade física", enquanto que aos 3 meses houve melhora dos itens avaliados. A análise salivar mostrou que houve uma redução dos níveis de marcadores de estresse oxidativo após o tratamento, sendo significativo para o superóxido dismutase (Z=-2,701; p=0,007). Conclusão: não há evidências suficientes de que a adição da implantoplastia melhore os parâmetros clínicos no tratamento cirúrgico da peri-implantite aos 3 meses, em relação ao debridamento mecânico realizado de forma isolada (AU).

Surgical therapy has been identified as the most appropriate strategy for the treatment of peri-implantitis. One of these techniques is implantoplasty, whose proposal is to modify the surface of the implant by removing exposed threads, making it less adherent to the biofilm. The study aimed to evaluate the effect of implantoplasty in the treatment of peri-implantitis, by comparing two intervention groups: one with and the other without implantoplasty. Thus, it is a prospective, controlled, randomized and blinded clinical trial. 13 participants with 33 implants were randomly allocated into two groups: surgical access + mechanical debridement (control-I group) and surgical access + mechanical debridement + implantoplasty (test-II group). The primary outcomes were assessed at baseline and at 3 months: Plaque Index -PI, Gingival Bleeding Index -GBI, Probing Depth -PD, Bleeding on Probing -BoP, and Keratinized Mucosal Band -MK. Quality of life was evaluated by the Oral Health Impact Profile -OHIP14 and oxidative stress markers by salivary samples. The results showed that 69.2% were women, with an average age of 60.6 years. Of the 32 implants, 16 received therapy I and 16 received therapy II. Of all rehabilitations, 53.8% were total and 30.8% were partial, with the rest being single. The Mann-Whitney test showed that the values of PI and GBI in group II were higher than in group I at 3 months, but they were not significant (p=0,193; p=0,419). The BoP was higher in I group (50%) than in II group (41.6%) at 3 months, however, without significance (p=0,759). At 3 months, all parameters - except BoP in II group - decreased in value, being significant for PI in I group (p=0,038), GBI in I and II groups (p=0,011 and p=0,015) and PD in II group (p=0,041). Split-Plot ANOVA showed no interaction between time and treatment. The OHIP14 showed that at baseline there was a predominance of "Physical pain", "Psychological discomfort" and "Physical disability", while at 3 months there was an improvement in the evaluated items. Salivary analysis showed that there was a reduction in the levels of oxidative stress markers after treatment, being significant for superoxide dismutase (Z=-2,701; p=0,007). Conclusion: there is insufficient evidence that the addition of implantoplasty improves clinical parameters in the surgical treatment of peri-implantitis at 3 months, in relation to mechanical debridement alone (AU).