Peri-implantitis: from diagnosis to therapeutics.

Peri-implantitis is an infection of the tissue around an implant, resulting in the loss of supporting bone. Risk factors for peri-implantitis consist of a history of periodontitis, dental plaque, poor oral hygiene, smoking, alcohol consumption and diabetes. A clinical diagnosis indicates inflammatory signs including bleeding on probing with or without suppuration and a peri-implant pocket depth ≥5 mm. A radiograph shows images of marginal bone loss ≥2 mm. A differential diagnosis of peri-implant mucositis, occlusal overload, retrograde peri-implantitis and inflammatory implant periapical lesions suggests the appropriate treatment in each case. The non-surgical treatment of peri-implantitis, including a mechanical treatment alone or combined with antiseptics or antibiotics can improve clinical parameters in the short term but residual defects may still persist. Surgical treatment such as guided bone regeneration results in a gain of clinical attachment level and bone reconstruction in the long term. The limited effect of laser-assisted therapy needs to be further evaluated. The concept of prevention based on early detection and regular maintenance plays a principal role in reducing the occurrence of peri-implantitis.

A retrospective study of root coverage procedures using an image analysis system.

AIM: To investigate the efficacy of root coverage procedures and factors that may affect the clinical outcomes in non-experimental patients. MATERIAL AND METHODS: Two hundred and eighty-seven root coverage surgical procedures in 215 adult patients were evaluated retrospectively. Descriptive statistics were used to determine the patient profile. Comparisons between surgeries were assessed, and the impact of different parameters on the probability of mean/complete root coverage and gingival augmentation was explored. RESULTS: The mean percentage of root coverage was 72.29 (+/- 28)%. Complete root coverage was observed in 35.56% of the defects. The difference between the surgical procedures was not significant. The mean percentage of gingival augmentation was 106.18 (+/- 260)%. The difference between non-submerged grafts and the other techniques was significant (p<10(-3)). A significant negative impact of smoking, and maxillary teeth for both mean and complete root coverage were found. A significant positive impact of the tuberosity donor site was found for complete root coverage. Maxillary teeth and Miller's Class II and III were positive predictive factors for gingival augmentation. CONCLUSIONS: Under non-experimental conditions, root coverage procedures are effective. Smoking, maxillary teeth, donor site, and Miller's Classes are prognostic factors that may affect the results.

Connective tissue graft for gingival recession treatment: assessment of the maximum graft dimensions at the palatal vault as a donor site.

BACKGROUND: The palatal masticatory mucosa is widely used as a connective tissue donor site in gingival recession treatment. However, concern has been raised regarding the potential risk of damaging the greater palatine artery (GPA) due to anatomical variations in the palatal vault. The anatomy of the palatal vault in terms of size and shape may affect the maximum dimensions of the graft that can be safely taken from the palatal vault. In a cohort of patients free of periodontal disease, the purpose of this study was to assess the maximum dimensions of the graft, particularly the height and length, that could be safely taken from the palatal vault. METHODS: Plaster impressions were made from 198 patients free of periodontal disease. Because the connective tissue graft is usually taken from an area extending from the mid-palatal aspect of the canine to the mid-palatal aspect of the second molar, this interval was measured and represented the maximum length dimension. The emergence of the GPA was assumed to be localized at the junction of the vertical and horizontal palatal walls of vault, and its course was marked on the plaster casts. The maximum height of the graft corresponded to the distances measured from the gingival margin to the marked course of the GPA of each tooth at its interproximal and mid-palatal aspects. RESULTS: The length of the maximum available tissue graft was 31.7 +/- 4.0 mm. The distance extending from the gingival margin to the greater palatine artery ranged from 12.07 +/- 2.9 mm at the canine level to 14.7 +/- 2.9 mm at the mid-palatal aspect of the second molar level. Therefore, in the premolar area, it was possible to harvest a connective tissue graft measuring 5 mm in height in all cases and 8 mm in height in 93% of cases. CONCLUSION: Our findings suggest that the maximum available tissue graft as measured in the palatal vault was large enough to allow a safe withdrawal from this donor site in a high percentage of our patient population free of periodontal disease.