Concepto actual de la patogénesis de la periimplantitis y el papel que ocupan las bacterias / Actual concept of the pathogenesis of the periimplantitis and the role that bacterial have

A través de una extensa revisión de la literatura, nuestro objetivo será esclarecer el concepto actual que existe sobre la patogénesis de la periimplantitis, así como las implicaciones que pueden tener las bacterias sobre la misma. Hasta la fecha diferentes estudios longitudinales y transversales han identificado algunos de los factores de riesgo o indicadores de riesgo de la periimplantitis. Historia previa de enfermedad periodontal, diabetes, carga genética, pobre higiene oral, tabaco, consumo de alcohol, ausencia de encía queratinizada y la superficie de los implantes son algunos de factores que han sido analizados en detalle en la literatura. La colonización de nuevas superficies implantadas quirúrgicamente suponen una situación de riesgo en pacientes parcialmente edéntulos, donde las bacterias periodontopatógenas de la bolsa residual tienen un importante papel

With the intention of clarifaying the current concept of the pathogenesis of the periimplantitis and the implications that bacteria could have in it, an extensive literature review has been made. Till the date, different longuitudinal and cross-sectional studies have identified some of the periimplantitis risk factors or risk indicators. Factors as history of periodontitis, diabetes, genetic traits, poor oral hygiene, smoking, alcohol consumption, absence of keratinized mucosa and implant surface have been analyzed in detail. The colonization of the surgical implanted new surfaces act as a risky situation for partial edentulous patients, where periodontopathogenic bacteria of the residual pocket have and important role

Reconstruction of Peri-implant Osseous Defects: A Multicenter Randomized Trial.

There is a paucity of data for the effectiveness of reconstructive procedures in the treatment of peri-implantitis. The objective of this study was to compare reconstruction of peri-implant osseous defects with open flap debridement (OFD) plus porous titanium granules (PTGs) compared with OFD alone. Sixty-three patients (36 female, 27 male; mean age 58.4 y [SD 12.3]), contributing one circumferential peri-implant intraosseous defect, were included in a multinational, multicenter randomized trial using a parallel-group design. After OFD and surface decontamination using titanium brushes and hydrogen peroxide, 33 defects received PTGs. The implants were not submerged. All patients received adjunctive perioperative systemic antibiotics. The primary outcome variable (defect fill) was assessed on digitalized radiographs. Clinical measurements of probing depth (PPD), bleeding on probing (BoP), suppuration, and plaque were taken by blinded examiners. After 12 mo, the test group (OFD plus PTG) showed a mean radiographic defect fill (mesial/distal) of 3.6/3.6 mm compared with 1.1/1.0 in the control group (OFD). Differences were statistically significant in favor of the test group (P < 0.0001). The OFD plus PTG group showed a mean reduction in PPD of 2.8 mm compared with 2.6 mm in the OFD group. BoP was reduced from 89.4% to 33.3% and from 85.8% to 40.4% for the test and control groups, respectively. There was no significant difference in complete resolution of peri-implantitis (PPD ≤4 mm and no BoP at six implant sites and no further bone loss), because this finding was accomplished at 30% of implants in the test group and 23% of implants in the control group. Reconstructive surgery using PTGs resulted in significantly enhanced radiographic defect fill compared with OFD. However, limitations in the lack of ability to discern biomaterial from osseous tissue could not be verified to determine new bone formation. Similar improvements according to clinical measures were obtained after both surgical treatment modalities (ClinicalTrials.gov NCT02406001).

Effectiveness of Lateral Bone Augmentation on the Alveolar Crest Dimension: A Systematic Review and Meta-analysis.

Lateral ridge augmentation procedures are aimed to reconstruct deficient alveolar ridges or to build up peri-implant dehiscence and fenestrations. The objective of this systematic review was to assess the efficacy of these interventions by analyzing data from 40 clinical studies evaluating bone augmentation through either the staged or the simultaneous approach. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guideline for systematic reviews was used. The primary outcomes were the changes at reentry, in the ridge width, and in the vertical and horizontal dimensions of the peri-implant defect, measured in millimeters, in the staged and simultaneous approaches, respectively. The results of the meta-analysis showed, for the simultaneous approach, a statistically significant defect height reduction when all treatments were analyzed together (weighted mean difference [WMD] = -4.28 mm; 95% confidence interval: [CI] -4.88, -3.69; P < 0.01). The intervention combining bone replacement grafts with barrier membranes was associated with superior outcomes The most frequently used intervention was the combination of xenograft and bioabsorbable membrane. Similarly, for the staged approach, there was a statistically significant horizontal gain when all treatment groups were combined (WMD = 3.90 mm; 95% CI: 3.52, 4.28; P < 0.001). The most frequently used intervention was the use of autogenous bone blocks. Both treatment strategies led to high survival and success rates (>95%) for the implants placed on the regenerated sites. Nonexposed sites gained significantly more in the simultaneous and staged approaches (WMD = 1.1 and 3.1 mm).

Tratamiento no quirúrgico en el tratamiento de periimplantitis. Revisión narrativa / Non-surgical therapy in treating peri-implantitis

Existen una gran variedad de protocolos terapéuticos a la hora de tratar la periimplantitis, desde tratamientos desinfectantes, desbridación mecánica hasta procedimientos quirúrgicos. Estudios han demostrado discordancias en sus resultados con respecto a cual es el método ideal para tratar una periimplantitis. El uso de instrumentos de desbridamiento mecánico, el método láser, antibioterapia, enfoques quirúrgicos ya sean resectivas o regenerativas muestran resultados heterogéneos. Al presente, no existe suficiente evidencia científica para poder valer un tratamiento específico no quirúrgico a la hora de enfrentarnos a una periimplantitis. El objetivo de esta revisión narrativa será analizar la literatura actual sobre el tratamiento no quirúrgico de la periimplantitis y sus indicaciones y eficacia como tratamiento. No se ha visto que tratando una la lesión periimplantaria mediante un enfoque terapéutico no quirúrgico haya dado resultados efectivos y el uso de antisépticos locales como auxiliar sólo ha mostrado efectos limitados sobre las variables clínicas y microbiológicas. Se necesitan más estudios randomizados y controlados con resultados a largo plazo para poder validar el protocolo de terapia no quirúrgico de la periimplantitis

There are multitude of treatment regimens for the peri-implant lesion, including anti-infective therapy, mechanical debridement, and surgical procedure. The laser model, the mechanical devise and the antibiotic regimens varied between studies as the different types of surgical therapies, ressective or regenerative approach. The outcomes following the treatment of peri-implantitis are highly variable and there are no data available to support specific treatment protocols in non-surgical therapy of peri-implantitis. The aim of this review is analyze the literature on non-surgical treatment of peri-implantitis and find the possible indications and the efficacy of this therapy. In peri-implantitis lesions non-surgical therapy was not found to be effective and the adjunctive use of local antiseptic had only limited effects on clinical and microbiological parameters. It is necessary to develop more randomized-controlled clinical studies evaluating treatment protocols of non-surgical therapy of peri-implantitis