Evaluation of adjunctive efficacy of diode laser in the treatment of peri-implant mucositis: a randomized clinical trial.

Peri-implant disease may affect survival of dental implants. The aim of the study is to analyze the effectiveness of diode laser as a supportive modality to the non-surgical conventional treatment of peri-implant mucositis (PiM) and initial peri-implantitis (PI). Twenty-three patients with single implants suffering from PiM or initial PI were selected and randomly divided into two groups; control group (CG) received non-surgical conventional treatment, and test group (TG) received non-surgical conventional treatment and diode laser application with wavelength of 980 nm. Probing pocket depth (PPD) and bleeding on probing (BOP) were recorded at baseline (T0) and at 3 months follow-up (T1). The average of PPD value for TG was 4.04 ± 0.54 mm at T0 and it was 2.98 ± 0.70 mm at T1. In the CG, PPD average was 3.8 ± 1.24 mm at T0 and was 3.54 ± 0.35 mm at T1. In TG, the BOP was positive in 44 sites at T0 and in 6 sites at T1. In CG, the BOP was positively observed in 52 sites at T0 and in 28 sites at T1. The 980-nm diode laser may be considered an adjunct to the conventional non-surgical treatments of PiM and initial PI.

Survival and success of implants in a private periodontal practice: a 10 year retrospective study.

BACKGROUND: To assess long-term results of implants (XiVE/Frialit-2 Synchro) in a private periodontal practice according to survival and success rates (biological and technical complications) and to detect possible influencing factors, retrospectively. METHODS: Implant placement of at least one implant took place 10 years ±6 months before clinical and radiographic re-examination. Incidence of implant loss as main and incidence of mucositis/ peri-implantitis as secondary outcome were detected. Also, patient-related and implant-related influencing factors were determined by regression analyses. RESULTS: 100 patients (59.0% female) with 242 implants were included into analysis. Survival rate was 94.0% (XiVE: 97.7%; Frialit-2-Synchro: 66.7%). Mucositis was found in 77.6% of all patients, moderate/severe peri-implantitis in 16.3%. In logistic regression analyses statistically significant influencing factors for implant loss was implant type (p < 0.001), for mucositis a wider implant diameter (p = 0.0438) and a high modified Plaque Index (p = 0.0253), for peri-implantits number of implants per patient (p = 0.0075) and a wider implant diameter (p = 0.0079). Technical complications were found in 47 implants (19.4%). CONCLUSIONS: XiVE implants showed a high survival rate over a 10-year follow-up, on the other hand Frialit-2 Synchro implants had worse survival rates. Success rates regarding biological complications are in line with other implant systems.

Nutritional Status of Hematological Patients before Hematopoietic Stem Cell Transplantation and in Early Posttransplantation Period.

Hematopoietic stem cell transplantation (HSCT) is an aggressive method of treatment affecting patient's homeostasis. The aim of the study was to evaluate the initial nutritional status of HSCT patients and nutritional status in early posttransplantation period. The prospective study included 100 consecutive patients with hematological malignancies subjected to HSCT. The nutritional status evaluation was made using the nutritional screening scales, anthropometric and biochemical parameters, as well. On the day +7 following HSCT significant decrease in concentration of total protein (5.8 g/dl), albumin (3.6 g/dl) and transferrin (165 mg/dl) were observed (P < 0.001), although the mean body mass/BMI were within the normal range. On the day +14, the biochemical parameters of the nutritional status were even lower (P < 0.001). Poorer nutritional status was associated with worse performance status and mucositis escalation. The adequate nutritional support plan is important element of the whole transplantation procedure.

Novel treatment of a septal ulceration using an extracellular matrix scaffold (septal ulceration treatment using ECM).

BACKGROUND: Septal ulceration is a mucositis involving the mucous membranes of the nasal septum. Patients often complain of nasal irritation, crusting, and epistaxis. Presently, there is no gold standard for the treatment of septal ulcerations. Currently described therapies include local debridement, septal dermoplasty, septal flap reconstruction, and cadaveric dermal graft repair; however, no therapy has demonstrated a consistent improvement of symptoms. We present a novel approach for the treatment of chronic septal ulceration, using an extracellular matrix scaffold (MatriStem® Wound Care Matrix, ACell, Inc.) to repair unilateral partial septal mucosal defects. METHODS: This is a retrospective chart review of three patients with age range from 42 to 74years. All three patients underwent several years of unsuccessful conservative medical management and two patients had prior unsuccessful septoplasty and septal ulcer debridement procedure. There are no complications noted in the post-operative period. RESULT: All three patients had complete symptom relief on post-operative visit after chronic septal ulceration repair using an extracellular matrix scaffold mechanism. Patients were able to manage with conservative nasal regiment after surgery with significant improvement on quality of life. CONCLUSION: The use of extracellular matrix scaffolding provides the nasal septum with a framework for the in-growth of healthy mucosa over ulcerated areas. We propose this as a new treatment approach for patients who failed conservative medical management. Chronic septal ulcerations can be healed to provide improved quality of life to patients.

Salvaging Implants With an Nd:YAG Laser: A Novel Approach to a Growing Problem.

As the incidence of implant placement expands, so too does the occurrence of implant-related pathological conditions such as peri-implant mucositis and peri-implantitis. This article will discuss implementation of a laser protocol that serves as a treatment modality designed specifically to help save ailing and failing implants. This multi-stage approach incorporates application of laser energy from a particular Nd:YAG laser with variable pulse width. This laser wavelength has demonstrated a variety of capabilities that may contribute to its clinical effectiveness. Representative long-term results of this treatment method are described, and a case depicting the protocol is presented.

Idiopathic lymphoplasmacellular mucositis-dermatitis of the eyelid.

Idiopathic lymphoplasmacellular mucositis-dermatitis is a rare mucosal or cutaneous disorder characterized clinically by papules or plaques with variable erosion and microscopically by dense dermal inflammatory cell infiltrates with numerous plasma cells. It has been described in the oral and upper aerodigestive tracts, male and female genitalia, and other mucosal surfaces. In this article, the authors describe a case of idiopathic lymphoplasmacellular mucositis-dermatitis occurring in the skin of the eyelid that was removed by excisional biopsy and has not recurred in the 19-month follow-up period.

[Pyogenic granuloma of the oral mucosa]. / Granuloma pyogenicum der Mundschleimhaut.

Pyogenic granuloma is regarded as a vascular proliferation that may result from trauma or local irritation. The most common intraoral site is the gingiva, affected in 75 % of cases. Therapy of pyogenic granuloma consists of surgical excision. Recurrence after excision may occur. In our patient, there were no post-operative complications.

The comparison of two techniques to increase the amount of peri-implant attached mucosa: free gingival grafts versus vestibuloplasty. One-year results from a randomised controlled trial.

AIMS: The objective of this randomised controlled trial was to compare the efficacy of two techniques for increasing the amount of keratinised mucosa around implants: free gingival grafts versus classic vestibuloplasty. MATERIALS AND METHODS: Sixty-four patients with 64 implants presenting keratinised mucosa <1.5 mm and showing signs of peri-implant mucositis were randomly assigned to two groups. Thirty-two implants received free gingival grafts (FGG group) while 32 implants were treated via vestibuloplasty (VP group). Plaque Index (PI), Gingival Index (GI), probing depth (PD) and the width of attached mucosa (WAM) were measured at baseline and 1, 3, 6 and 12 months following surgery. RESULTS: WAM in the FGG group was significantly greater than the VP group at 3, 6 and 12 months (P = 0.000). In the FGG group, the final gain in WAM was greater (2.36 mm in FGG group, 1.15 mm in VP group) (P = 0.000) and the postoperative relapse was smaller (2.00 mm in FGG group, 3.06 mm in VP group) (P = 0.000). The VP group had higher PD values at 3, 6 and 12 months (P = 0.02, P = 0.024, P = 0.000, respectively). CONCLUSIONS: The application of FGG is a more predictable method for enhancing the width of attached mucosa in the vicinity of implants compared with classic vestibuloplasty.

Long time follow up of implant therapy and treatment of peri-implantitis.

Dental implants have become an often used alternative to replace missing teeth, resulting in an increasing percentage of the adult population with implant supported prosthesis. Although favourable long-term results of implant therapy have been reported, infections occur. Until recently few reports included data on peri-implant infections, possibly underestimating this complication of implant treatment. It is possible that some infections around implants develop slowly and that with time peri-implantitis will be a common complication to implant therapy as an increasing number of patients have had their implants for a long time (>10 years). Data on treatment of peri-implant lesions are scarce leaving the clinician with limited guidance regarding choice of treatment. The aim of this thesis was to study the frequency of implant loss and presence of peri-implant lesions in a group of patients supplied with Brånemark implants 9-14 years ago, and to relate these events to patient and site specific characteristics. Moreover three surgical treatment modalities for peri-implantitis were evaluated. The thesis is based on six studies; Studies I-III included 218 patients and 1057 implants followed for 9-14 years evaluating prevalence of, and factors related to implant loss (Paper I) and prevalence of peri-implant infections and related factors (Paper I-III). Study IV is a review describing different treatment modalities of peri-implant infections. Study V is a prospective cohort study involving 36 patients and 65 implants, evaluating the use of a bone substitute with or without the use of a resorbable membrane. Study VI is a case series with 12 patients and 16 implants, evaluating a bone substitute in combination with a resorbable membrane and submerged healing. This thesis demonstrated that: After 9-14 years the survival rates of dental implants are high (95.7%). Implant loss seems to cluster within patients and are related to periodontitis evidenced as bone loss on radiographs at remaining teeth before implant placement. (Paper I) Peri-implantitis is a common clinical entity after 9-14 years. (Paper II) Using the implant as the statistical unit the level of keratinized mucosa and pus were explanatory for a bone level at > or =3 threads (1.8 mm). When the patient was used as a statistical unit a history of periodontitis and smoking were explanatory for peri-implantitis. (Paper III) Animal research has demonstrated that re-osseointegration can occur. The majority of human studies were found to be case reports. Using submerged healing and bone transplants, bone fill can occur in peri-implant defects. (Paper IV) Surgical treatment of peri-implantitis using a bone substitute with or without a resorbable membrane resulted in similar pocket depth reduction, attachment gain and defect fill. (Paper V) Bone substitute in combination with a resorbable membrane and a submerged healing resulted in defect fill > or =2 threads (1.2 mm) in 81% of the implants. (Paper VI) In conclusion: 9-14 years after implant installation peri-implant lesions are a common clinical entity. Smokers and patients with a history of periodontal disease are at higher risk to develop peri-implantitis. Clinical improvements and defect fill can be obtained with various surgical techniques using a bone substitute.