Immediate implant placement with immediate or delayed provisionalization in the maxillary aesthetic zone: A 10-year randomized trial.

AIM: To compare the marginal bone level of immediately placed implants, with either immediate or delayed provisionalization (IP or DP), in the maxillary aesthetic zone after 10 years of function. MATERIALS AND METHODS: Participants with a failing tooth in the maxillary aesthetic zone were randomly assigned to immediate implant placement with either IP (n = 20) or DP (n = 20) after primary wound closure with a free gingival graft. The final restoration was placed 3 months after provisionalization. The primary outcome was change in marginal bone level. In addition, implant survival, restoration survival and success, peri-implant tissue health, mucosa levels, aesthetic indices, buccal bone thickness and patient satisfaction were evaluated. RESULTS: After 10 years, the mean mesial and distal changes in marginal bone level were -0.47 ± 0.45 mm and -0.49 ± 0.52 mm in the IP group and -0.58 ± 0.76 mm and -0.41 ± 0.72 mm in the DP group (p = .61; p = .71). The survival rate was 100% for the implants; for the restorations, it was 88.9% in the IP group and 87.5% in the DP group. Restoration success, according to modified USPHS criteria, was 77.8% in the IP group and 75.0% in the DP group. The prevalence of peri-implant mucositis was 38.9% and 35.7% and of peri-implantitis 0.0% and 6.3%, respectively, in the IP group and DP group (p = 1.0; p = .40). The Pink Esthetic Score and White Esthetic Score was 15.28 ± 2.32 in the IP group and 14.64 ± 2.74 in the DP group, both clinically acceptable (p = .48). The buccal bone thickness was lower in the DP group. Patient satisfaction was similar in both groups (p = .75). CONCLUSIONS: The mean marginal bone level changes after immediate implant placement with IP were similar to those after immediate placement with DP. CLINICAL TRIAL REGISTRATION: Registered in the National Trial Register (NL9340).

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

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

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

OBJECTIVES: To compare erythritol air polishing with implant surface cleansing using saline during the surgical treatment of peri-implantitis. MATERIAL AND METHODS: During a resective surgical intervention, implant surfaces were randomly treated with either air polishing (test group n = 26 patients/53 implants) or saline-soaked cotton gauzes (control group n = 31 patients/ 40 implants). Primary outcome was change in mean bleeding on probing (BoP) from baseline to 12 months follow-up. Secondary outcomes were changes in mean suppuration on probing (SoP), plaque score (Plq), probing pocket depth (PPD), marginal bone loss (MBL), periodontal full-mouth scores (PFMS), and levels of 8 classical periodontal pathogens. Clinical and radiographical parameters were analyzed using multilevel regression analyses. Microbiological outcomes were analyzed using the Mann-Whitney U test. RESULTS: No differences between the test and control group were found for BoP over 12 months of follow-up, nor for the secondary parameters Plq, PPD, and MBL. Between both groups, a significant difference was found for the levels of SoP (p = 0.035). No significant effect on microbiological levels was found. A total number of 6 implants were lost in the test group and 10 in the control group. At 1-year follow-up, a successful treatment outcome (PPD<5 mm, max 1 out of 6 sites BoP, no suppuration and no progressive bone loss >0.5 mm) was achieved for a total of 18 implants (19.2%). CONCLUSIONS: Erythritol air polishing as implant surface cleansing method was not more effective than saline during resective surgical treatment of peri-implantitis in terms of clinical, radiographical, and microbiological parameters. Both therapies resulted in low treatment success. TRIAL REGISTRY: https://www.trialregister.nl/ Identifier: NL8621.

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

OBJECTIVES: To compare erythritol air polishing with piezoelectric ultrasonic scaling in the non-surgical treatment of peri-implantitis. MATERIAL AND METHODS: Eighty patients (n = 139 implants) with peri-implantitis (probing pocket depth (PPD) ≥5 mm, marginal bone loss (MBL) ≥2 mm as compared to bone level at implant placement, bleeding, and/or suppuration on probing (BoP/SoP)) were randomly allocated to air polishing or ultrasonic treatment. The primary outcome was mean BoP (%) at 3 months after therapy (T3). Secondary outcomes were mean SoP (%), plaque score (Plq) (%), PPD (mm), MBL (mm), full mouth periodontal scores (FMPS) (%), levels of 8 classical periodontal pathogens, and treatment pain/discomfort (Visual Analog Scale, VAS). Patients who were considered successful at T3 were additionally assessed at 6, 9, and 12 months. Differences between both groups were analyzed using multilevel statistics. RESULTS: Three months after therapy, no significant difference in mean BoP (%) between the air polishing and ultrasonic therapy was found (crude analysis ß (95% CI) -0.037 (-0.147; 0.073), p = .380). Neither secondary outcomes SoP (%), Plq (%), PPD (mm), MBL (mm), FMPS (%), and periodontal pathogens showed significant differences. Treatment pain/discomfort was low in both groups (VAS score airpolishing group 2.1 (±1.9), ultrasonic 2.6 (±1.9); p = .222). All successfully treated patients at T3 (18.4%) were still considered successful at 12-month follow-up. CONCLUSIONS: Erythritol air polishing seems as effective as piezoelectric ultrasonic scaling in the non-surgical treatment of peri-implantitis, in terms of clinical, radiographical, and microbiological parameters. However, neither of the proposed therapies effectively resolved peri-implantitis. Hence, the majority of patients required further surgical treatment.

Immediate single-tooth implant placement with simultaneous bone augmentation versus delayed implant placement after alveolar ridge preservation in bony defect sites in the esthetic region: A 5-year randomized controlled trial.

BACKGROUND: It is unclear if an intact buccal bony plate is a prerequisite for immediate implant placement in post-extraction sockets. The aim of this 5-year randomized controlled trial was therefore comparison of peri-implant soft and hard tissue parameters, esthetic ratings, and patient-reported satisfaction of immediate implant placement in post-extraction sockets with buccal bony defects of ≥ 5 mm in the esthetic zone, with delayed implant placement after ridge preservation. METHODS: Patients presenting a failing tooth in the esthetic region and a buccal bony defect of ≥ 5 mm after extraction were randomly assigned to immediate (Immediate group, n = 20) or delayed (Delayed group, n = 20) implant placement. Second-stage surgery and placement of a provisional restoration occurred 3 months after implant placement in both groups, followed by definitive restorations 3 months thereafter. The follow-up was 5 years. Marginal bone level (primary outcome), buccal bone thickness, soft tissue parameters, esthetics, and patient-reported satisfaction were recorded. RESULTS: Mean marginal bone level change was -0.71 ± 0.35 mm and -0.54 ± 0.41 mm in respectively the Immediate group and the Delayed group after 5 years (P = 0.202). This difference, and in other variables, was not significant. CONCLUSIONS: Marginal bone level changes, buccal bone thickness, clinical outcomes, esthetics, and patients' satisfaction following immediate implant placement, in combination with bone augmentation in post-extraction sockets with buccal bony defects of ≥ 5 mm, were comparable to those following delayed implant placement after ridge preservation in the esthetic zone.

Biomarker levels in peri-implant crevicular fluid of healthy implants, untreated and non-surgically treated implants with peri-implantitis.

AIM: To compare biomarker levels in peri-implant crevicular fluid (PICF) of healthy implants with levels in PICF of implants with peri-implantitis (before and after non-surgical treatment). MATERIALS AND METHODS: Samples were taken from 20 healthy implants (n = 17 patients) and from 20 implants with peri-implantitis (n = 19 patients) before and 3 months after non-surgical treatment using the Airflow Master Piezon® (EMS). A Luminex™ assay was used to evaluate pro-inflammatory and anti-inflammatory cytokines IL-1ß, TNF-α, IL-6 and G-CSF, collagen degradation enzyme MMP-8, chemokines MCP-1 & MIP-1α/CCL3, bone markers OPG and sRANKL and interferon-γ. Clinical and radiographical characteristics were assessed. A Mann-Whitney U and Wilcoxon signed-rank test analysed between- and within-group differences. RESULTS: IL-1ß and MMP-8 levels were found significantly elevated in implants with peri-implantitis (p = .007; p = <.001, respectively). No difference in levels of TNF-α, IL-6, MCP-1 and MIP-1α/CCL3, OPG and G-CSF between healthy and diseased implants was found. Levels of sRANKL and INF-γ were under the level of detection. None of the biomarker levels improved after non-surgical therapy, and levels of IL-1ß and MMP-8 remained high. CONCLUSION: Implants diagnosed with peri-implantitis have higher levels of IL-1ß and MMP-8 in PICF compared to healthy implants. Non-surgical therapy did not influence the inflammatory immune response.

Immediate placement of single implants with or without immediate provisionalization in the maxillary aesthetic region: A 5-year comparative study.

AIM: To compare marginal bone level changes around immediately placed and immediately provisionalized implants with immediately placed and delayed provisionalized implants in the aesthetic region after five years of function. MATERIALS AND METHODS: Forty patients with a failing tooth in the maxillary anterior region were randomly assigned immediate implant placement with immediate (Group A: n = 20) or delayed (Group B: n = 20) provisionalization. Definitive crown placement occurred three months after provisionalization. The primary outcomes were changes in marginal bone level. In addition, survival rates, buccal bone thickness, soft peri-implant tissues, aesthetics and patient-reported outcomes were assessed. RESULTS: After 5 years, the mean mesial and distal marginal bone level changes were 0.71 ± 0.68 mm and 0.71 ± 0.71 mm, respectively, in group A and 0.49 ± 0.52 mm and 0.54 ± 0.64 mm, respectively, in group B; the difference between the groups was not significant (p = .305 and p = .477, respectively). Implant and restoration survivals were 100%. No clinically relevant differences in buccal bone thickness or in mid-facial peri-implant mucosal level, aesthetic and patient outcomes were observed. CONCLUSIONS: The mean marginal bone level changes following immediate implant placement and provisionalization were comparable with immediate implant placement and delayed provisionalization. (www.isrctn.com: ISRCTN57251089 and www.trialregister.nl: NL8255).

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

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

Implant decontamination with phosphoric acid during surgical peri-implantitis treatment: a RCT.

BACKGROUND: Peri-implantitis is known as an infectious disease that affects the peri-implant soft and hard tissue. Today, scientific literature provides very little evidence for an effective intervention protocol for treatment of peri-implantitis. The aim of the present randomized controlled trial is to evaluate the microbiological and clinical effectiveness of phosphoric acid as a decontaminating agent of the implant surface during surgical peri-implantitis treatment. METHODS: Peri-implantitis lesions were treated with resective surgical treatment aimed at peri-implant granulation tissue removal, bone recontouring, and pocket elimination. Fifty-three implant surfaces in 28 patients were mechanically cleaned and treated with either 35% phosphoric etching gel (test group) or sterile saline (control group). Microbiological samples were obtained during surgery; clinical parameters were recorded at baseline and at 3 months after treatment. Data were analyzed using multi-variable linear regression analysis and multilevel statistics. RESULTS: Significant immediate reductions in total anaerobic bacterial counts on the implant surface were found in both groups. Immediate reduction was greater when phosphoric acid was used. The difference in log-transformed mean anaerobic counts between both procedures was not statistical significant (p = 0.108), but there were significantly less culture-positive implants after the decontamination procedure in the phosphoric acid group (p = 0.042). At 3 months post-surgery, 75% of the implants in the control group and 63.3% of the implants in the test group showed disease resolution. However, no significant differences in clinical and microbiological outcomes between both groups were found. CONCLUSIONS: The application of 35% phosphoric acid after mechanical debridement is superior to mechanical debridement combined with sterile saline rinsing for decontamination of the implant surface during surgical peri-implantitis treatment. However, phosphoric acid as implant surface decontaminant does not seem to enhance clinical outcomes on a 3-month follow-up. TRIAL REGISTRATION: Netherlands National Trial Register, NTR5185 (www.trialregister.nl).