| 1. |
- Abrahamsson, Ingemar, 1953, et al.
(author)
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Early bone healing to implants with different surface characteristics. A pre-clinical in vivo study
- 2023
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In: Clinical Oral Implants Research. - : Wiley. - 0905-7161 .- 1600-0501. ; 34:4, s. 312-9
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Journal article (peer-reviewed)abstract
- AimTo examine early bone healing around implants with non-modified and modified surfaces. Material & MethodsFour implants with 4 different surface characteristics were installed in one side of the mandible following tooth extraction in 6 dogs. Implants in group A had a non-modified, turned surface, while implants in group B had a surface modification consisting of TiO-blasting and sequential acid-etching in oxalic and hydrofluoric acid. The surface modification of implants in group C was confined to sequential acid-etching in oxalic and hydrofluoric acid and Group D implants had a surface modification of TiO-blasting and acid-etching in hydrofluoric acid. The implant installation procedures were repeated in the opposite side of the mandible 4 weeks later. Biopsies were obtained and prepared for histological analysis 2 weeks later. ResultsB and C implants had a higher degree of bone-to-implant contact (BIC%) than A and D implants at 2 weeks of healing. At 6 weeks of healing, the BIC% was higher at B than at A, C and D implants, and higher at C implants than at A implants. The amount of newly formed bone in contact with the implant within the defect area at 2 weeks was higher at implants with modified surfaces (groups B, C and D) than at implants with a non-modified surface (group A). Corresponding results at 6 weeks were superior at B implants. ConclusionIt is suggested that an implant surface modification with acid-etching in oxalic and hydrofluoric acid promotes early formation of bone-to-implant contact.
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| 2. |
- Almohandes, Ahmed, et al.
(author)
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Surgical treatment of experimental peri-implantitis using mechanical and chemical decontamination procedures: A pre-clinical in vivo study
- 2022
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In: Journal of Clinical Periodontology. - : Wiley. - 0303-6979 .- 1600-051X. ; 49:5, s. 518-525
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Journal article (peer-reviewed)abstract
- Aim: To evaluate the effect of surgical treatment of experimental peri-implantitis at implants with different surface characteristics using mechanical and chemical decontamination methods. Materials and Methods: Following extraction of mandibular premolars, four implants with two different surface characteristics (A, moderately rough and B, smooth) were placed in each side of the mandible of six dogs. Experimental peri-implantitis was induced. Surgical treatment of the peri-implantitis sites was carried out using four implant surface decontamination protocols: (i) deposition of a citric acid gel, (ii) mechanical cleaning using a rotating titanium brush, (iii) a combination of the mechanical and chemical procedures, and (iv) saline (control). Clinical and radiographic examinations were performed. Block biopsies were obtained 6months after therapy and prepared for histological analysis. Results: Irrespective of the treatment group, treatment resulted in 0.63 ± 0.92 and 0.65 ± 0.67 mm radiographic bone gain around implants A and B, respectively. Histological analyses revealed that persisting soft tissue inflammation as assessed using an infiltrated connective tissue (ICT) score was significantly lower at implant type B than at implant type A for all treatment groups. The test decontamination procedures did not demonstrate better results regarding resolution of peri-implantitis lesions, as indicated by the ICT scores, than the control procedure. The control treatment resulted in significantly superior outcomes of resolution of peri-implantitis lesions than the citric acid regimen. Conclusions: It is concluded that decontamination procedures including citric acid gel or rotating titanium brush did not improve outcomes following surgical treatment of experimental peri-implantitis. Results were, however, influenced by the implant surface characteristics. © 2022 John Wiley & Sons A/S.
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| 3. |
- Derks, Jan, 1977, et al.
(author)
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Prevention and management of peri-implant mucositis and peri-implantitis: A systematic review of outcome measures used in clinical studies in the last 10 years
- 2023
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In: JOURNAL OF CLINICAL PERIODONTOLOGY. - : Wiley. - 0303-6979 .- 1600-051X. ; 50:Suppl 25, s. 55-66
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Research review (peer-reviewed)abstract
- Objectives To evaluate outcome measures, methods of assessment, and analysis in clinical studies on the prevention and management of peri-implant mucositis and peri-implantitis. Methods Systematic electronic searches (CENTRAL/MEDLINE/SCOPUS) up to April 2021 were conducted to identify longitudinal clinical studies with >= 10 patients on either the prevention or management of peri-implant diseases. Outcome measures of this analysis were the choice of outcome measures, methods of assessment, and analytical methods. Risk of bias was evaluated according to study design. Data were extracted into evidence tables and outcomes were analysed in a descriptive manner. Results The analysis of the 159 selected studies revealed that probing pocket depth (PPD) and bleeding/suppuration on probing (BOP) were reported in 89% and 87% of all studies, respectively. Additional outcome measures included plaque scores (reported in 64% of studies), radiographic outcomes (49%), soft tissue dimensions (34%), and composite outcomes (26%). Adverse events (8%) and patient-reported outcomes (6%) were only rarely mentioned. A primary outcome measure was clearly defined only in 36% of studies. Data on PPD, radiographic outcomes, and soft tissue dimensions were primarily reported as mean values and rarely as frequency distributions. For radiographic outcomes and soft tissue dimensions, it was frequently unclear how clustered data were handled. Conclusions PPD and BOP were routinely reported in studies on the prevention and management of peri-implant mucositis and peri-implantitis, while composite outcomes, adverse events, and patient-reported outcomes were only infrequently described.
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| 4. |
- Derks, Jan, 1977, et al.
(author)
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Prevention and management of peri-implant mucositis and peri-implantitis: A systematic review of outcome measures used in clinical studies in the last 10 years
- 2023
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In: Clinical Oral Implants Research. - : Wiley. - 0905-7161 .- 1600-0501. ; 34:Suppl. 25, s. 55-67
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Research review (peer-reviewed)abstract
- Objectives To evaluate outcome measures, methods of assessment, and analysis in clinical studies on the prevention and management of peri-implant mucositis and peri-implantitis. Methods Systematic electronic searches (CENTRAL/MEDLINE/SCOPUS) up to April 2021 were conducted to identify longitudinal clinical studies with >= 10 patients on either the prevention or management of peri-implant diseases. Outcome measures of this analysis were the choice of outcome measures, methods of assessment, and analytical methods. Risk of bias was evaluated according to study design. Data were extracted into evidence tables and outcomes were analysed in a descriptive manner. Results The analysis of the 159 selected studies revealed that probing pocket depth (PPD) and bleeding/suppuration on probing (BOP) were reported in 89% and 87% of all studies, respectively. Additional outcome measures included plaque scores (reported in 64% of studies), radiographic outcomes (49%), soft tissue dimensions (34%), and composite outcomes (26%). Adverse events (8%) and patient-reported outcomes (6%) were only rarely mentioned. A primary outcome measure was clearly defined only in 36% of studies. Data on PPD, radiographic outcomes, and soft tissue dimensions were primarily reported as mean values and rarely as frequency distributions. For radiographic outcomes and soft tissue dimensions, it was frequently unclear how clustered data were handled. Conclusions PPD and BOP were routinely reported in studies on the prevention and management of peri-implant mucositis and peri-implantitis, while composite outcomes, adverse events, and patient-reported outcomes were only infrequently described.
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| 5. |
- Derks, Jan, 1977, et al.
(author)
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Reconstructive surgical therapy of peri-implantitis: A multicenter randomized controlled clinical trial
- 2022
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In: Clinical Oral Implants Research. - : Wiley. - 0905-7161 .- 1600-0501. ; 33:9, s. 921-944
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Journal article (peer-reviewed)abstract
- Objective To evaluate the potential benefit of the use of a bone substitute material in the reconstructive surgical therapy of peri-implantitis. Methods In this multicenter randomized clinical trial, 138 patients (147 implants) with peri-implantitis were treated surgically, randomized by coin toss to either a control (access flap surgery) or a test group (reconstructive surgery using bone substitute material). Clinical assessments, including probing pocket depth (PPD), bleeding and suppuration on probing (BOP & SOP) as well as soft tissue recession (REC), were recorded at baseline, 6 and 12 months. Marginal bone levels (MBL), measured on intra-oral radiographs, and patient-reported outcomes (PROs) were recorded at baseline and 12 months. No blinding to group allocation was performed. The primary outcome at 12 months was a composite measure including (i) implant not lost, (ii) absence of BOP/SOP at all aspects, (iii) PPD <= 5 mm at all aspects and (iv) <= 1 mm recession of mucosal margin on the buccal aspect of the implant. Secondary outcomes included (i) changes of MBL, (ii) changes of PPD, BOP%, and buccal KM, (iii) buccal REC and (iv) patient-reported outcomes. Results During follow-up, four implants (one in the test group, three in the control group) in four patients were removed due to disease progression. At 12 months, a total of 69 implants in the test and 68 implants in the control group were examined. Thus, 16.4% and 13.5% of implants in the test and control group, respectively, met all predefined criteria of the composite outcome. PPD reduction and MBL gain were 3.7 mm and about 1.0 mm in both groups. Reduction in mean BOP% varied between 45% (test) and 50% (control), without significant differences between groups. Buccal REC was less pronounced in the test group (M = 0.7, SD = 0.9 mm) when compared to controls (M = 1.1, SD = 1.5 mm). PROs were favorable in both groups without significant differences. One case of allergic reaction to the antibiotic therapy was recorded. No other adverse events were noted. Conclusions Surgical therapy of peri-implantitis effectively improved the clinical and radiographic status at 12 months. While the use of a bone substitute material did not improve reductions of PPD and BOP, buccal REC was less pronounced in the test group. Patient satisfaction was high in both groups.
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| 6. |
- Dionigi, Carlotta, et al.
(author)
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Cellular expression of DNA damage/repair and reactive oxygen/nitrogen species in human periodontitis and peri-implantitis lesions
- 2020
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In: Journal of Clinical Periodontology. - : Wiley. - 0303-6979 .- 1600-051X. ; 47:12, s. 1466-1475
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Journal article (peer-reviewed)abstract
- Aim of the study To evaluate differences in the cellular expression of DNA damage/repair and reactive oxygen/nitrogen species between human periodontitis and peri-implantitis lesions. Material and methods 40 patients presenting with generalized severe periodontitis and 40 patients with severe peri-implantitis were included. Soft tissue biopsies were collected from diseased sites in conjunction with surgical therapy and prepared for histological analysis. Four regions of interest were identified: the pocket epithelium (PE), the infiltrated connective tissue (ICT), which was divided into one inner area facing the PE (ICT-1) and one outer area (ICT-2). A non-infiltrated connective tissue area (NCT) lateral of the ICT was also selected. Results It was demonstrated that the ICT of peri-implantitis specimens was considerably larger and contained significantly larger area proportions and densities of CD68-, MPO- and iNOS-positive cells than that of periodontitis samples. Cellular densities were overall higher in the inner ICT zone lateral of the PE (ICT-1) than in the outer ICT compartment (ICT-2). While the NCT area lateral of the ICT comprised significantly larger proportions and densities of y-H2AX-, iNOS-, NOX2-, MPO- and PAD4/MPO-positive cells in peri-implantitis than in periodontitis sites, a reverse difference was noted for the area proportion and density of 8-OHdG-positive cells in the PE. Conclusions It is suggested that peri-implantitis lesions are associated with an enhanced and upregulated host response and contain larger numbers of neutrophils, macrophages and iNOS-positive cells than periodontitis lesions.
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| 7. |
- Dionigi, Carlotta, et al.
(author)
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Cellular expression of epigenetic markers and oxidative stress in periodontitis lesions of smokers and non-smokers
- 2022
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In: Journal of Periodontal Research. - : Wiley. - 0022-3484 .- 1600-0765. ; 57:5, s. 952-959
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Journal article (peer-reviewed)abstract
- Objective To evaluate differences in the cellular expression of epigenetic markers and oxidative stress in periodontitis lesions between current smokers and non-smokers. Background Tobacco smoking is recognized as one of the major risk factors for periodontitis. However, the mechanisms by which smoking affects the progression of the disease remain to be determined. Methods Twenty-five current smokers and 21 non-smokers with generalized severe periodontitis were included. From each patient, one soft tissue biopsy from a periodontitis site was harvested and prepared for histological analysis. The infiltrated connective tissue (ICT) was selected as the region of interest to assess the cellular expression of epigenetic markers and reactive oxygen/nitrogen species (RONS) by immunohistochemistry. Results Although the ICT of smokers and non-smokers did not differ in size or in the expression of markers for DNA damage or oxidative stress, current smokers presented with significantly lower area proportions and densities of cells positive for the epigenetic markers DNMT1 and AcH3. In addition, periodontitis lesions in current smokers presented with a diminished antimicrobial activity, as indicated by significantly lower densities and area proportions of NOX2- and iNOS-positive cells. Conclusions Components of the host response and epigenetic mechanisms in periodontitis lesions in smokers are downregulated as opposed to lesions of non-smokers.
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| 8. |
- Dionigi, Carlotta
(author)
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Functional characteristics of periodontitis and peri-implantitis lesions in humans
- 2023
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Doctoral thesis (other academic/artistic)abstract
- In the current series of studies functional characteristics of periodontitis and peri-implantitis lesions in humans were investigated. Cell markers for antimicrobial activity were used to evaluate differences between periodontitis and peri-implantitis lesions (Study I), while epigenetic and oxidative stress markers were used to compare periodontitis lesions in smokers and non-smokers (Study II). The occurrence and localization of titanium micro-particles were assessed in tissue samples obtained from dental implant sites with and without peri-implantitis and the influence of titanium particles on gene expression profiles was investigated in peri-implantitis lesions (Study III). Gene expression profiles were analyzed in tissue samples obtained from dental implant sites with and without peri-implantitis by integrating spatial transcriptomics and RNA-sequencing data (Study IV). It was demonstrated that: - Peri-implantitis lesions were larger and presented with significantly larger densities of cells with antimicrobial activity than periodontitis lesions. In both lesions, cellular densities were higher in the inner zone, lateral to the pocket epithelium, than in the outer compartment of the lesion. The non-infiltrated connective tissue in peri-implantitis specimens showed significantly higher densities of cells with antimicrobial activity than that in periodontitis specimens (Study I). - Although periodontitis lesions did not differ in size between smokers and non-smokers, differences in cellular functions were observed. Periodontitis lesions in smokers presented with diminished antimicrobial activity and lower levels of epigenetic markers than lesions in non-smokers (Study II). - Densities of titanium micro-particles in peri-implant tissues varied across patients but not between dental implant sites with and without peri-implantitis within the same individual. The titanium micro-particles were of similar size and morphology and mainly located in a 2-mm wide tissue zone close to the implant, in samples with and without peri-implantitis. Out of >36000 analyzed genes, only 14 were differentially expressed when comparing peri-implantitis specimens with high and low densities of titanium micro-particles (Study III). - A clear association was observed between distinct gene clusters and specific compartments in peri-implant tissues. Peri-implantitis specimens showed overall higher levels of gene activity than specimens from reference implant sites. Several pathways specific for the activation of the host response towards bacterial insults were clearly dysregulated in peri-implantitis specimens (Study IV).
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| 9. |
- Ichioka, Yuki, et al.
(author)
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Factors influencing outcomes of surgical therapy of peri-implantitis: A secondary analysis of 1-year results from a randomized clinical study
- 2023
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In: JOURNAL OF CLINICAL PERIODONTOLOGY. - 0303-6979. ; 50:10, s. 1282-1304
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Journal article (peer-reviewed)abstract
- Aim: To identify predictors of treatment outcomes following surgical therapy of peri-implantitis.Materials and Methods: We performed a secondary analysis of data from a randomized controlled trial (RCT) comparing access flap with or without bone replacement graft. Outcomes at 12 months were probing pocket depth (PPD), bleeding on probing (BOP), soft-tissue recession (REC) and marginal bone level (MBL) change. Multilevel regression analyses were used to identify predictors. We also built an explanatory model for residual signs of inflammation.Results: Baseline PPD was the most relevant predictor, showing positive associations with final PPD, REC and MBL gain, and negative association with probability of pocket closure. Smokers presented higher residual PPD. Absence of keratinized mucosa at baseline increased the probability of BOP but was otherwise not indicative of outcomes. Plaque at 6 weeks was detrimental in terms of residual PPD and BOP. Treatment allocation had an effect on REC. Final BOP was explained by residual PPD & GE;6 mm and plaque at more than two sites.Conclusions: Baseline PPD was the most relevant predictor of the outcomes of surgical therapy of peri-implantitis. Pocket closure should be a primary goal of treatment. Bone replacement grafts may be indicated in aesthetically demanding cases to reduce soft-tissue recession. The importance of smoking cessation and patient-performed plaque control is also underlined.
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| 10. |
- Regidor, E., et al.
(author)
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The adjunctive effect of a resorbable membrane to a xenogeneic bone replacement graft in the reconstructive surgical therapy of peri-implantitis: A randomized clinical trial
- 2023
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In: Journal of Clinical Periodontology. - : Wiley. - 0303-6979 .- 1600-051X. ; 50:6, s. 765-783
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Journal article (peer-reviewed)abstract
- Aim: To evaluate the potential adjunctive effect of a resorbable collagen membrane covering a xenogeneic bone replacement graft in the reconstructive surgical therapy of peri-implantitis. Materials and Methods: Forty-three patients (43 implants) diagnosed with peri-implantitis associated with intra-bony defects were treated with a surgical recon-structive approach that included a xenogeneic bone substitute material. Additionally, resorbable collagen membranes were placed over the grafting material at sites ran-domly allocated to the test group; conversely, no membranes were placed in the con-trol group. Clinical outcomes, namely probing pocket depth (PPD), bleeding and suppuration on probing (BoP and SoP), marginal mucosal level (REC) and keratinized mucosa width (KMW), were recorded at baseline and 6 and 12 months after surgery. Radiographic marginal bone levels (MBLs) and patient-reported outcomes (PROs) were assessed at baseline and 12 months. A composite outcome (success) was evalu-ated at 12 months, which included the absence of BoP/SoP, PPD <= 5 mm and reduction of buccal marginal mucosal level (buccal REC) of <= 1 mm.Results: At 12 months, no implants were lost and treatment success was observed at 36.8% and 45.0% of implants in the test and control groups, respectively (p = .61). Similarly, there were no significant differences between groups in terms of changes of PPD, BoP/SoP, KMW, MBL or buccal REC. Post-surgical complications were observed in the test group only (e.g., soft tissue dehiscence, exposure of particulate bone graft and/or resorbable membrane). Longer surgical times (similar to 10 min; p < .05) and higher levels of self-reported pain at 2 weeks (p < .01) were observed in the test group.Conclusions: This study failed to demonstrate the presence of added clinical or radio-graphic benefits of the use of a resorbable membrane to cover a bone substitute material within the reconstructive surgical therapy of peri-implantitis associated with intra-bony defects.
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