Abstract Aim To evaluate the efficacy of a 0.03% chlorhexidine and 0.05% cetylpyridinium chloride mouth rinse, as an adjunct to professionally and patient‐administered mechanical plaque removal, in the treatment of peri‐implant mucositis (PiM). Material and Methods Patients displaying PiM in, at least, one implant were included in this randomized, double‐blinded, clinical trial. Subjects received professional prophylaxis (baseline and 6 months) and were instructed to regular oral hygiene practices and to rinse, twice daily, with the test or placebo mouth rinses, during one year. Clinical, radiographic and microbiological outcomes were evaluated at baseline, 6 and 12 months. Disease resolution was defined as absence of bleeding on probing ( BOP ). Data were analysed by repeated measures ANOVA , Student's t and chi‐square tests. Results Fifty‐four patients were included and 46 attended the final visit (22 in control and 24 in test group). In the test group, there was a 24.49% greater reduction in BOP at the buccal sites (95% confidence interval [3.65–45.34%]; p = 0.002) than in controls. About 58.3% of test implants and 50% controls showed healthy peri‐implant tissues at final visit ( p > 0.05). Conclusions The use of the test mouth rinse demonstrated some adjunctive benefits in the treatment of PiM. Complete disease resolution could not be achieved in every case.
Implants can be colonized by microorganisms from oral biofilms and may affect peri-implant tissues health. Among these bacteria, pathogens typically associated with periodontitis can be found, such as Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis, as well as Gram negative enteric bacilli not typically associated with periodontal diseases.Superinfecting bacteria were characterized from peri-implant lesions in patients with history of periodontitis.Sixty-eight implants were studied in 55 patients; the average patient age was 56 years. Forty-nine implants had peri-implant lesions and 19 were considered stable. Subgingival samples were obtained in affected and stable implants. The samples were streaked on Mac-Conkey agar and incubated at 37°C for 24 hours. The colonies were identified with the kit-BD BBL Crystal E/NF®.Superinfecting organisms were detected in 20 patients--they were seen more frequently at diseased implants (n=15) than at healthy implants (n=5). The prevalence of superinfecting bacteria on the selected implants was 33.8% (n=23/68). These bacteria were more prevalent among affected implants (n=17 or 25%) than those with stable implants n=6 (8.8%). Klebsiella pneumoniae was the most frequent Gram negative rod detected (n=12).One-third of the implants had superinfecting organisms. Implants with a peri-implant lesion had a higher frequency of superinfecting bacteria. Klebsiella pneumoniae was the most common superinfecting organism isolated. A multiple infection caused by superinfecting bacteria was present only at diseased implants. These microbial agents potentially affect implant stability.
Abstract Objectives The aim of the present study was to evaluate the efficacy of a supportive peri‐implant care (SPIC) protocol after surgical therapy of peri‐implantitis, combining ultrasonic mechanical debridement and glycine powder air polishing. Materials and Methods Thirty subjects diagnosed with peri‐implantitis and treated by means of access flap were randomized 6 months later into two different SPIC groups: the test group combined a piezoelectric ultrasonic instrumentation with a specific implant PEEK tip and glycine powder air polishing, while control group received the same ultrasonic instrumentation together with a rubber cup and a polishing paste. Patients were followed for 12 months, with intermediate SPIC visits every 3 months. Clinical, radiological, microbiological and biochemical outcome variables were registered and calculated. Results After 12 months of SPIC, probing depths (PD) showed a mean reduction of 0.33 ± 0.11 mm, with significant differences ( p < .001) between the test (−0.84 ± 0.43 mm) and the control group (+0.18 ± 0.73 mm). Healthy peri‐implant tissues defined by PD <5 mm, absence of BoP (or in only one site around the implant), and no additional bone loss (<0.5 mm), were observed at the final visit in 83% of the implants (87% in the test group and 80% in the control group, p = .255). No adverse events were reported by the subjects participating in the study. Conclusions The SPIC protocol including mechanical ultrasonic debridement and glycine powder air‐polishing demonstrated significantly better efficacy in terms of PD reductions. A strict SPIC protocol can maintain for 1 year, or even improve, the results obtained after surgical treatment of peri‐implantitis.
Abstract Open and closed sinus lifting procedures are predictable methods to augment the bone needed for appropriate implant placement in the posterior maxilla in cases where available bone is limited. However, these techniques may give rise to complications and associated comorbidities. In the case of open sinus lifting, perforation of the Schneiderian membrane during osteotomy is the most common complication, with an incidence rate of around 20%‐25%. Apart from those complications associated with oral surgery in general (such as swelling or hematoma), there are specific complications of open sinus lifting procedures that may arise less frequently (chronic rhinosinusitis, hemorrhage, or ostium blockage by overfilling) but which may nevertheless compromise the viability of the graft and/or the implants and cause substantial discomfort to the patient. Closed sinus lifting is a less invasive approach that allows transcrestal placement of the implants in cases where there is sufficient residual bone height. However, it may also be associated with specific complications, including membrane perforation, benign paroxysmal positional vertigo, and implant displacement to the sinus cavity. New technologies have been proposed to reduce these complications and comorbidities associated with conventional sinus lifting procedures, such as the use of piezoelectric devices and hydraulic sinus lift or reamer burs. The evidence supporting their effectiveness and safety, however, is still lacking. A detailed medical history together with a thorough radiographic and clinical examination are essential prior to any kind of bone regenerative augmentation involving the maxillary sinus. Moreover, it is recommended to employ the most appropriate surgical technique for the specific characteristics of the case and, at the same time, accommodating the experience and skills of the surgeon.
Background: The aim of this study, a prospective case series, was to evaluate the clinical, microbiological, and biochemical impact of the surgical treatment of peri-implantitis. Methods: Thirty subjects with diagnosis of peri-implantitis were treated following a surgical protocol including access flaps, surface decontamination with ultrasonics and glycine powder air-polishing, and systemic antibiotics. Disease resolution was defined by the composite outcome including presence of probing depths (PD) ≤5 mm, absence of bleeding on probing (BoP)/suppuration, and no additional radiographic bone loss (>1 mm). Regression analysis was used to evaluate the patient-, implant-, and prosthetic-related factors possibly influencing treatment outcomes. Results: Patients were evaluated at 6 months post treatment, demonstrating statistically significant reductions in PD (2.14 ± 1.07 mm) and increase in mucosal recession (1.0 ± 0.77 mm). Plaque, BoP, and suppuration were also reduced by 40.56%, 62.22%, and 7.78%, respectively. Disease resolution was achieved in 56.67% of patients. No significant changes were detected in microbiological parameters except for a significant reduction in proportions of Parvimonas micra. Similarly, the levels of the biomarker interleukin-8 in crevicular fluid were significantly lower at 6 months. Conclusions: The proposed surgical treatment of peri-implantitis demonstrated statistically significant clinical improvements although the impact on microbiological and biochemical parameters was scarce.
The aim of the present randomized, controlled clinical multicenter trial was to compare a polyethylene glycol (PEG) and a native collagen membrane (BG) for simultaneous guided bone regeneration at bony dehiscence-type defects around bone level titanium implants.The study enrolled 117 patients requiring implant treatment in the posterior maxilla or mandible with expected buccal bony dehiscence-type defects at the placed titanium implants. According to a parallel groups design, defects were filled with a synthetic bone filler and randomly assigned to either PEG or BG membrane. As primary parameter, the relative vertical bone fill was assessed at baseline and at re-entry after 6 months of healing. As secondary parameters, the marginal bone level (MBL) was assessed radiographically and soft tissue conditions were recorded up to 18 months postloading.Both groups showed comparable vertical bone fill revealing a relative change in defect height of 59.7% (PEG) and 64.4% (BG). The absolute mean reduction in defect size was 2.5 mm in the PEG group and 3.2 mm in the BG group. Although both groups revealed a statistically significant mean defect reduction (p < .001), a comparison between the two groups did not show statistical significances. The non-inferiority test with inferiority limit of -5% could not be rejected, based on the 90% confidence interval of the differences of the two means with lower limit -15.4%. After 18 months, an MBL increase of 0.45 ± 0.43 mm in the PEG group and 0.41 ± 0.81 mm in the BG group was detected (p < .001). Soft tissue complications were observed in both groups without showing statistical significance.Both membranes supported bone regeneration at dehiscence-type defects and obtained vertical bone fill with a relative change in defect height of 59.7% (PEG) and 64.4% (BG); however, the non-inferiority of PEG could not be shown.
Abstract Aim To evaluate outcome measures and methods of assessment in clinical studies on bone augmentation/preservation procedures for the placement of dental implants. Materials and Methods A systematic search was performed on three databases from January 2011 to April 2021 to identify clinical studies reporting on any type of bone augmentation/preservation procedure. The outcomes that have been used to assess efficacy or performance in each study were registered and assigned to different domains (group of outcomes). The review followed the Preferred Reporting Items for Systematic Review and Meta‐Analyses statement. Results Seven‐hundred and eighty‐three publications were included. Only 81.8% of the papers had a clear definition of their primary outcome. The rate of complications (59.3%), implant survival (58.2%), 3D radiographic bone gain/change (30%), marginal bone level (MBL; 29%), and histological outcomes (25.5%) were the most frequently reported outcome domains. The most commonly used primary outcome was 3D radiographic bone gain/change (25.8%), followed by implant survival (13.0%). Patient‐reported outcome measures (PROMs) were reported in 15.7% of studies. Differences in the reported outcomes were observed among different types of bone preservation/augmentation interventions (i.e., alveolar ridge preservation, immediate implants, horizontal and/or vertical ridge augmentation, and sinus floor augmentation). Conclusion Within the past decade, great heterogeneity was observed among the outcomes considered in studies evaluating bone preservation/augmentation procedures. Three‐dimensional radiographic bone gain/change was the most routinely reported main outcome variable, while PROMs were rarely reported.
espanolLa caries dental y las enfermedades periodontales son unas de las enfermedades mas prevalentes del ser humano. En la actualidad, las enfermedades periimplantarias estan adquiriendo mucha importancia por sualta prevalencia. El principal agente causal de todas estas patologias es el biofilm, ya sea por cambios cualitativos o cuantitativos en su composicion. Ademas, hay que tener en cuenta que los biofilms no solo se van a desarrollar alrededor de los dientes o de los implantes, sino que van a existir otros nichos dentro de la cavidad oral, especialmente en los tejidos blandos. El alto coste del tratamiento de estas patologias, la irreversibilidad de las formas mas avanzadas de la enfermedad y la baja predictibilidad en el caso de la terapia de la periimplantitis, hace que su prevencion sea el principal factor a tener en cuenta. Las principales medidas preventivas en el control de estas enfermedades son los cuidados que debe tener el paciente para mantener una correcta higiene oral. Dentro de estos, el cepillado es el que ha mostrado una mayor evidencia en la eliminacion del biofilm. Sin embargo, esta sujeto a ciertas limitaciones, por lo que el uso coadyuvante de un agente en el control quimico de la placa podria ofrecer un beneficio adicional. De entre todos los productos evaluados, el triclosan/copolimero es uno de los que ha mostrado tener propiedades de inhibir la placa con suficiente potencia como para poder actuar sobre los niveles de gingivitis y/o caries. El objetivo de la ultima seccion de este articulo es revisar las ventajas que puede ofrecer un dentifrico o un colutorio de triclosan/copolimero sobre uno convencional a base de fluor o un control negativo en el biofilm alrededor de los dientes, implantes y otros nichos de la cavidad oral como la lengua, mucosas o saliva. El analisis de la literatura demuestra como los dentifricos y los colutorios con triclosan/copolimero reducen mas los indices de placa alrededor de los dientes, de los implantes y la carga bacteriana de otros nichos de la cavidad oral. EnglishDental caries and periodontal diseases are one of the most prevalent pathologies of the human being. Currently, peri-plant diseases are becoming very important because of their high prevalence. The main etiologic agent of all these pathologies is biofilm, whether due to qualitative or quantitative changes in its composition. In addition, biofilms will not only develop around teeth or implants, but there will be other niches within the oral cavity, especially soft tissues. The high treatment cost of these pathologies, the irreversibility of the more advanced forms of the disease and the low predictability in the case of the the-rapy of periimplantitis, makes prevention the main focus in its control. The main preventive measures to control these diseases are the cares that the patient must have to maintain a correct oral hygiene. Within these, brushing is the one that has shown the greatest evidence to remove biofilm. However, it is subject to certain limitations, and the adjunctive use of an agent for the chemical control of plaque could offer an additional benefit. Among all evaluated products, triclosan/copolymer is one of those that have shown to have plaque inhibiting properties with sufficient power to act on levels of gingivitis and/or caries. The objective of the last section of this article is to review the advantages that a dentifrice or mouth rinse with triclosan/copolymer can offer over a conventional fluoride or a negative control in the biofilm around teeth, im plants and other niches of the oral cavity such as the tongue, mucous membranes or saliva. The literature review demonstrated how toothpaste and mouth rinses with triclosan/copolymer were better reducing plaque indexes around teeth, implants and bacterial load of other niches in the oral cavity.
Background: Selecting the appropriate implant is one of the most important and demanding decisions in breast augmentation with anatomical implants, because different widths, heights, and projections can be found for a given volume. Most of the related literature and surgeons’ concern have focused on width and projection. Implant height selection, however, has remained deeply overlooked, and it has been assumed that it depended on the suprasternal notch–to-nipple distance and, to a large extent, on the patient’s height. Methods: With more than 5123 breast augmentations performed over the past 15 years, the authors performed an analysis of the breast and implant height with consequences in aesthetic augmentation of the breast. Two concepts—breast implantation base (or breast footprint) and somatotype—were explored. Their influence in the selection of the appropriate anatomical implant height is investigated. Results: Selection of implant height should follow the patient’s breast implantation base, which is highly influenced by her somatotype. With this assumption, a “number Y” is proposed that correlates the suprasternal notch–to-nipple distance with the thoracic perimeter and unveils the shape of the breast implantation base in the particular patient. Conclusions: Adjusting the implant shape/footprint to the breast implantation base/breast footprint gives the surgeon control over the upper pole of the breast and allows a predictable postoperative result. The number Y rationalizes the selection of the implant height in breast augmentation. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
In spite of the remarkable success of current preventive efforts, periodontitis remains one of the most prevalent diseases of mankind. The objective of this workshop was to review critical scientific evidence and develop recommendations to improve: (i) plaque control at the individual and population level (oral hygiene), (ii) control of risk factors, and (iii) delivery of preventive professional interventions.Discussions were informed by four systematic reviews covering aspects of professional mechanical plaque control, behavioural change interventions to improve self-performed oral hygiene and to control risk factors, and assessment of the risk profile of the individual patient. Recommendations were developed and graded using a modification of the GRADE system using evidence from the systematic reviews and expert opinion.Key messages included: (i) an appropriate periodontal diagnosis is needed before submission of individuals to professional preventive measures and determines the selection of the type of preventive care; (ii) preventive measures are not sufficient for treatment of periodontitis; (iii) repeated and individualized oral hygiene instruction and professional mechanical plaque (and calculus) removal are important components of preventive programs; (iv) behavioural interventions to improve individual oral hygiene need to set specific Goals, incorporate Planning and Self monitoring (GPS approach); (v) brief interventions for risk factor control are key components of primary and secondary periodontal prevention; (vi) the Ask, Advise, Refer (AAR) approach is the minimum standard to be used in dental settings for all subjects consuming tobacco; (vii) validated periodontal risk assessment tools stratify patients in terms of risk of disease progression and tooth loss.Consensus was reached on specific recommendations for the public, individual dental patients and oral health care professionals with regard to best action to improve efficacy of primary and secondary preventive measures. Some have implications for public health officials, payers and educators.
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