Implant Dentistry最新文献

Purpose: To report the prevalence of periimplant diseases (ie, periimplant mucositis and periimplantitis).

Material and methods: A literature search was performed in MEDLINE through PubMed database of the US National Library of Medicine for articles published until March 2018 using Medical Subject Heading (MeSH) search terms complemented by free terms and in different combinations.

Results: A wide range of prevalences of periimplant diseases has been reported in the literature. Subject-based estimated weighted mean prevalences and ranges were reported to amount to 43% (range: 19%-65%) for periimplant mucositis and to 22% (range: 1%-47%) for periimplantitis.

Conclusion: Differences in case definitions impact on extent and severity of periimplant diseases and make comparisons among studies difficult. Convenience samples rather than randomly selected population samples are often analyzed to estimate prevalence of periimplant diseases. More recent studies report implant- and subject-based prevalences of periimplant diseases.

Introduction: Periimplantitis etiology is multifactorial. The aim of this review is to identify the available data so far concerning the association between genetic polymorphisms and periimplantitis risk.

Materials and methods: A literature search was performed in MEDLINE using the PubMed database of the US National Library of Medicine for articles published until March 2018. In addition, a manual search was performed. Our search and application of eligibility criteria provided 23 articles. Genes in these 23 studies could be divided into 3 overlapping categories: genes associated with (a) immune function, (b) bone growth, and (c) regulation of gene expression.

Discussion: The pathogenesis of periimplantitis is not currently well understood. There are some polymorphisms, for which different studies state consistent results. However, there are many polymorphisms with conflicting results, which could be attributed to differences in study design.

Conclusion: The identification of genetic biomarkers associated with periimplantitis risk could be valuable in daily clinical practice. However, no robust conclusions could be drawn from the current literature. The inequality of these studies' design necessitates the conduction of further studies using larger population samples and from different ethnic groups.

Background: The data on the importance of soft-tissue management during surgical treatment of periimplantitis are still limited, and no clinical recommendations are yet available.

Aim: To give an overview on the rationale for periimplant soft-tissue augmentation procedures in the light of potential benefits/risks of the presence/absence of keratinized/attached mucosa (KAM) providing recommendations for the clinician.

Results: The available evidence indicates that the presence of KAM favors periimplant tissue health evidenced by improved bleeding scores and facilitation of self-performed plaque removal, less mucosal recessions, and more stable marginal bone levels over time. Therefore, the rationales to augment KAM are (a) to optimize the possibility for performing an adequate level of oral hygiene, (b) to help maintaining periimplant soft-tissue health and stability, and (c) to improve esthetics. Various techniques with autogenous or xenogeneic membranes have been described so far for KAM augmentation. Additional soft-tissue grafting in conjunction with a combined regenerative and resective surgical procedure seems to be effective in treating and controlling advanced periimplantitis lesions and improving or maintaining the esthetic outcomes.

Conclusions: The limited available data seem to indicate that the best outcome to improve the width of KAM, and the bleeding and plaque scores, as well as to maintain the periimplant marginal bone level is the use of an apically positioned flap combined with a free gingival graft in nondiseased periimplant sites. However, at present, it is unknown: (a) to what extent soft-tissue grafting may additionally improve the outcomes after surgical (resective or regenerative) treatment of periimplantitis compared with the same approaches without soft-tissue grafting, and (b) if considered, when should soft-tissue grafting be performed (eg, before or during surgical treatment of periimplantitis).

Clinical recommendations: Both soft-tissue resective and regenerative approaches may lead to successful outcomes depending on the clinical indication and defect location. However, the selection of one or another surgical approach should be based on defect type (eg, intrabony and suprabony) and location (esthetic or nonesthetic areas). The presence of an adequate width and thickness of KAM may facilitate soft-tissue (flap) management. In patients with a thin phenotype or lack of an adequate width of KAM, soft-tissue grafting may improve the clinical outcomes.

Purpose: Although periimplantitis results from the tissue destructive effects of a dysbiotic periimplant microbiome, several factors may either contribute to the dysbiosis or influence the host response to this bacterial challenge and thereby increase the risk of disease. The goal of this narrative review is examine extrinsic factors that might increase the risk at both subject and site levels.

Materials and methods: The PubMed (MEDLINE) database was searched for articles examining the influence of systemic conditions on periimplantitis or implant failure. Key search terms included "systemic," "medications," "periodontitis," "dental implant," "periimplantitis," "implant failure" and related terms. Manual searches were also performed for the following journals: Clinical Oral Implants Research, International Journal of Periodontics and Restorative Dentistry, Journal of Clinical Periodontology, International Journal of Oral and Maxillofacial Implants, Implant Dentistry, and Journal of Periodontology. The inclusion criteria were cohort studies and case-control studies with at least 10 participants per group and with at least 6 months of follow-up.

Results: Certain systemic diseases, medications, radiotherapy, and behavioral factors, such as oral hygiene and compliance with periodontal maintenance therapy, appear to significantly increase the risk of disease.

Background: Risk factors associated with periimplant disease have been exhaustively explored in many studies. However, despite the high incidence of smokers in the general population, it is still unclear whether smoking is a risk factor for the development of periimplant diseases.

Purpose: The aim of this review was to analyze all pertinent literature, including systematic reviews, clinical trials, and long-term follow-up, to evaluate smoking as a real risk factor for periimplant diseases.

Material and methods: A comprehensive search was conducted on MEDLINE through PubMed database of the US National Library of Medicine, for articles published until March 2018. All searches were performed using medical subject headings or free-text words. After screening, data extraction, and duplicate removal from 972 found articles, 19 were included in this review.

Results: The influence of smoking on the healing process around implants has been explored for potential disruption of the healing process and periimplant disease development. Despite the discussed results in many studies, most of the analyzed literature shows a scientific basis to determine smoking as a risk factor for periimplant disease development, considering that smoking increases the susceptibility to periimplant disease. However, future studies excluding confounding factors need to be performed.

Conclusion: This review showed that smoking is a real risk factor that increases the likelihood of development of periimplant disease.

Objectives: To address the focused question: "In patients with osseointegrated implants diagnosed with periimplantitis, what are the clinical and radiographic outcomes of augmentative surgical interventions compared with nonaugmentative surgical measures"?

Material and methods: Literature screening was performed in MEDLINE through the PubMed database, for articles published until January 1, 2018. Human studies reporting on the clinical (ie, bleeding on probing [BOP] and probing depth [PD] changes) and/or radiographic (ie, periimplant defect reduction and/or fill) treatment outcomes after surgical augmentative periimplantitis therapy, and/or comparing augmentative and nonaugmentative surgical approaches were searched.

Results: Thirteen comparative and 11 observational clinical studies were included. Surgical augmentative periimplantitis therapy resulted in mean BOP and PD reduction ranging from 26% to 91%, and 0.74 to 5.4 mm, respectively. The reported mean radiographic fill of intrabony defects ranged between 57% and 93.3%, and defect vertical reduction varied from 0.2 to 3.77 mm. Three randomized controlled clinical studies failed to demonstrate the superiority of augmentative therapy compared with nonaugmentative approach in terms of PD and BOP reduction.

Conclusions: The available evidence to support superiority of augmentative surgical techniques for periimplantitis management on the treatment outcomes over nonaugmentative methods is limited.

Purpose: The aim of this review is to describe the current guidelines for the differential diagnosis of periimplant diseases.

Materials and methods: Synopsis reviews were conducted to define the differential diagnosis of periimplant disease through an electronic literature search in MEDLINE up to February 2018.

Discussion: Periimplant mucositis is defined by the presence of bleeding and/or suppuration on gentle probing with or without an increased probing depth compared with previous examinations and by the absence of bone loss beyond crestal bone-level changes resulting from initial bone remodeling. Periimplantitis is defined by the presence of bleeding and/or suppuration on gentle probing with an increased probing depth compared with previous examinations and by the presence of bone loss beyond crestal bone-level changes resulting from initial bone remodeling. Thus, a combination of clinical registrations (probing pocket depth, bleeding on probing, and presence of pus) combined with radiographic signs of possible bone loss is needed for differential diagnosis.

Conclusions: An accurate baseline registration at the time of placement of the prosthesis (probing pocket depth and bone level) with ongoing yearly monitoring is essential for diagnosis and appropriate disease management.

Purpose: Periimplantitis has become an emerging challenge faced by practicing dentists worldwide. When treating periimplantitis, we should attempt to manage this problem via nonsurgical therapies that include addressing all modifiable systemic risk factors and local contributing factors. Hence, the aim of this narrative review was to examine published studies on nonsurgical treatment of periimplantitis and evaluate their effectiveness and limitations.

Materials and methods: A literature search was performed in MEDLINE via PubMed database up to December 31, 2017. Current published clinical approaches focused on mechanical debridement, adjunctive antiseptic therapy, adjunctive antibiotic therapy, laser-assisted therapy, and combination approaches were included in this analysis.

Results: Nonsurgical therapy of periimplantitis may result in complete healing of the disease and the patient is then placed on a supportive maintenance program. If the disease is not resolved and surgical intervention is not an option, active nonsurgical retreatment may be considered. In many cases where disease is not resolved, surgical therapy or implant removal could be considered.

Conclusions: Nonsurgical treatment of periimplantitis usually provides clinical improvements in reducing bleeding tendency and in some cases pocket reduction. Early diagnosis, detection, and intervention remain the key for managing periimplantitis.