Reconstructive treatment of peri-implantitis infrabony defects of various configurations: 5-year survival and success.

AIM: To present the 5 years outcomes of a reconstructive surgical protocol for peri-implantitis defects with different morphologies, by means of deproteinized bovine bone mineral with 10% collagen (DBBMC). MATERIAL AND METHODS: The original population of this case series consisted of 75 patients with one crater-like defect and probing depth (PD) ≥6 mm. After flap elevation, defects were assigned to one characteristic class and treated by means of DBBMC. Following healing, patients were enrolled in an individualized supportive periodontal/peri-implant (SPT) program. RESULTS: Fifty-one patients reached the 5 years examination, as 11 patients were lost to follow-up and 13 implants were removed. Overall treatment success was registered in 29 patients (45.3%). Mean PD and BOP significantly decreased at one year and remained stable for the rest of observation period. No correlation was found between implant survival rate and defect configuration (p = 0.213). Patients, who did not fully adhere to the SPT, experienced more complications and implant loss than those who regularly attended recall appointments (p = 0.009). CONCLUSIONS: The proposed reconstructive treatment resulted in a high 5 years implant survival rate in patients who fully adhered to SPT. The resolution of the peri-implantitis defect does not seem significantly associated with the defect configuration at the time of treatment.

Implant survival after surgical treatment of peri-implantitis lesions by means of deproteinized bovine bone mineral with 10% collagen: 10-year results from a prospective study.

OBJECTIVES: To evaluate the 10-year outcomes of a regenerative surgical treatment of single peri-implantitis intrabony defects, by means of deproteinized bovine bone mineral with 10% collagen (DBBMC). MATERIAL AND METHODS: The original population consisted of 26 patients with one crater-like defect, around either SLA or TPS dental implants, with a probing depth ≥6 mm and no implant mobility. After debridement and surface decontamination, the defects were filled with DBBMC. Subsequently, patients were placed in an individualized supportive peri-implant/periodontal therapy (SPT) program. RESULTS: Fourteen patients (eight SLA and six TPS) reached the 10-year examination. The overall implant survival rate was 67%, 80% for the SLA, and 55% for the TPS implants. During SPT, five patients were lost to follow-up, eight patients needed additional antibiotic and/or surgical therapy, and seven patients had the implant removed. PD was reduced from 6.6 ± 1.3 to 3.2 ± 0.7 mm in SLA and from 7.2 ± 1.5 to 3.4 ± 0.6 mm in TPS. BOP decreased from 75.0 ± 31.2% to 7.5 ± 12.1% (SLA) and from 90.0 ± 12.9% to 30.0 ± 19.7% (TPS). Treatment success was found in 5 of the 12 SLA (42%) and in 4 of the 14 TPS (29%). CONCLUSIONS: The proposed reconstructive treatment, followed by SPT, was able to maintain in function the majority of SLA implants, although the overall treatment success was limited and many of TPS implants were removed. Therefore, the decision to treat implants affected by peri-implantitis should be based on several factors, including surface characteristics.

Treatment of buccal soft tissue dehiscence around single implant: 5-year results from a prospective study.

OBJECTIVES: The aim of this study is to report the 5-year outcomes of a coverage procedure of shallow maxillary soft tissue dehiscences, around single tissue-level implants. MATERIAL AND METHODS: The original population consisted of 16 patients presenting a single maxillary buccal implant soft tissue recession. A connective tissue graft, taken from the maxillary tuberosity, was inserted underneath a split-thickness envelope flap. After treatment, patients received individually tailored supportive periodontal therapy (SPT). RESULTS: Two patients were lost to follow-up, while one implant was removed due to peri-implantitis, before the final examination. At 5 years, complete implant soft tissue coverage was depicted in 8 out of 13 cases (62%). Mean soft tissue dehiscence coverage was 86%. Patients' esthetic evaluation showed the persistency of high VAS scores. CONCLUSIONS: Treatment of buccal soft tissue dehiscence around single implant, followed by regular supportive therapy, resulted in good esthetic and functional results in the majority of patients. CLINICAL RELEVANCE: Within the limits of this study, the positive results suggest that the proposed technique may be a reliable option in selected cases.

Surgical treatment of peri-implantitis intrabony lesions by means of deproteinized bovine bone mineral with 10% collagen: 7-year-results.

OBJECTIVES: The aim of this study was to evaluate the long-term results of the surgical treatment of single peri-implantitis intrabony defects, by means of deproteinized bovine bone mineral with 10% collagen (DBBMC). MATERIAL AND METHODS: The original population consisted of 26 patients with one crater-like defect, around either sandblasted and acid-etched (SLA) or titanium plasma-sprayed (TPS) dental implants, with a probing depth (PD) ≥6 mm and no implant mobility (Roccuzzo et al. J Clin Periodontol. 2011; 38: 738). Implants were mechanically debrided and treated using EDTA gel and chlorhexidine gel. The bone defects were filled with DBBMC, and the flap was sutured around the non-submerged implant. Patients were placed on an individually tailored supportive periodontal therapy (SPT). RESULTS: Two patients were lost to follow-up. During SPT, additional antibiotic and/or surgical therapy was necessary in eight implants, and four of these were removed for biologic complications. At 7-year, the survival rate was 83.3% for SLA implants and 71.4% for TPS. PD was significantly reduced from 6.6 ± 1.3 to 3.2 ± 0.7 mm in SLA and 7.2 ± 1.5 to 3.4 ± 0.6 mm in TPS. Bleeding on probing decreased from 75.0 ± 31.2% to 7.5 ± 12.1% (SLA) and from 90.0 ± 12.9% to 30.0 ± 19.7% (TPS). When successful therapy was defined as PD ≤5 mm, absence of bleeding/suppuration on probing, and no further bone loss, treatment success was obtained in 2 of 14 (14.3%) of the TPS and in 7 of 12 (58.3%) of the SLA implants. CONCLUSIONS: Seven years after surgical treatment with DBBMC, patients, in an adequate SPT, maintained sufficient peri-implant conditions in many cases, particularly around SLA implants. Nevertheless, some patients required further treatment and some lost implants. The clinical decision on whether implants should be treated or removed should be based on several factors, including implant surface characteristics.

Management of 112 hospitalized patients with spreading odontogenic infections: correlation with DMFT and oral health impact profile 14 indexes.

OBJECTIVE: The aim of this study was to report our experience in treating patients affected by spreading odontogenic infections and to discuss their management and outcome. STUDY DESIGN: Demographic and clinical information was collected from hospitalized patient records. Decayed, missing, and filled teeth (DMFT) index was calculated for 45 randomly selected patients. Statistical analysis was used to search for associations among multiple variables. RESULTS: Statistical analysis of the variance by univariate test found significant associations between a longer hospital stay and patients >30 years old (P < .05) and patients with the presenting symptoms of dysphagia and/or dyspnea (P < .05). Statistical analysis using Fisher exact test found significant associations between patients with a DMFT index >10 and female patients (P < .05), patients >30 years old (P < .005), and a hospital stay >4 days (P < .0005). CONCLUSIONS: Rapid resolution of the infection was appreciated when removal of the cause, drainage of the infection, and intravenous antibiotics were performed.