Journal of Periodontal and Implant Science最新文献

The morphogenesis of peri-implant soft tissues following surgical trauma, along with the nature, topography, and design of implant-prosthetic material surfaces, leads to peri-implant tissues that exhibit unique histological and morphological characteristics. It has been shown that mucosal phenotypes with a mucosal thickness of at least 2 mm and a keratinised mucosa width of at least 2 mm promote proper integration and a biological seal at the mucosa-implant interface. This seal prevents pathogen penetration, protects the underlying peri-implant bone, and reduces susceptibility to inflammatory peri-implant diseases (IPDs). Furthermore, even under ideal conditions, peri-implant soft tissues demonstrate less mechanical resistance, stability, and hermeticity compared to periodontal tissues. These deficiencies are directly associated with both the onset and progression of IPDs such as peri-implant mucositis (PM) and peri-implantitis (PI). Over recent decades, the prevalence of PM and PI has risen, making them the primary causes of implant failure. Given that the characteristics of peri-implant mucosa are closely linked to the progression of these diseases, a deep understanding of the biology of peri-implant soft tissues is crucial for developing strategies to either avoid or minimise the impact of IPDs on implant therapy outcomes. This comprehensive review of the literature aims to provide a precise and detailed description of the structure, biology, and function of peri-implant soft tissues, starting from their formation process and linking their morphogenic characteristics to the establishment and evolution of IPDs. Additionally, the composition of the microbiome and the most relevant anti/pro-inflammatory mediators involved in the development of IPDs are summarised.

Purpose: This retrospective study aimed to evaluate the long-term survival rate and marginal bone loss (MBL) of tapered-straight-tapered dental implants, considering various associated factors, over an observational period of ≥5 years.

Methods: This study included 186 patients who underwent tapered-straight-tapered dental implant placement at Seoul National University Dental Hospital from 2014 to 2019. Digital panoramic radiographic images and dental records were examined. We evaluated multiple variables, such as sex, age, diabetes mellitus (DM), smoking status, placement region, jaw type (maxilla and mandible), implant diameter, implant length, staged surgery, immediate placement, splinted prosthesis, and implant placement depth (IPD). We first determined the implant survival rate using Kaplan-Meier analysis and analyzed potential risk factors for implant survival using mixed-effects Cox proportional hazards regression. Next, the Mann-Whitney and Kruskal-Wallis tests were used to examine differences in MBL across variables. Linear mixed-effects models with backward stepwise selection were used to identify associations between risk factors and MBL.

Results: This study included 316 implants in 186 patients, monitored over a follow-up period of 7.0±1.36 years. The cumulative survival rate of the implants was 98.1%. The average mesial and distal MBLs were 0.59±1.36 mm and 0.68±1.36 mm, respectively. Linear mixed-effects models indicated that MBL exhibited statistically significant positive correlations with DM (Coeff.=0.614, P=0.026) and staged surgery (Coeff.=0.410, P=0.002). Additionally, greater mesial IPD was associated with reduced MBL (Coeff.=-0.143, P=0.046), and a similar trend was observed for distal IPD (Coeff.=-0.316, P=0.068).

Conclusions: This study demonstrated a high cumulative survival rate for tapered-straight-tapered dental implants over a 5-year period. DM, staged surgery, and IPD showed strong associations with increased MBL. The results suggest that tapered-straight-tapered implants offer advantages in terms of peri-implant MBL and consistent clinical outcomes. These findings underscore the importance of considering these variables in clinical decision-making to optimize implant outcomes.

Purpose: Odontogenic ameloblast-associated protein (ODAM) is a small secretory protein produced by the junctional epithelium (JE) and mature ameloblasts. It plays a role in odontogenesis and mediates the adhesion of JE to enamel. We used human gingival epithelial cells to evaluate the mechanism of ODAM gene expression regulation in the JE by interleukin (IL)-6.

Methods: Ca9-22, Sa3, and HSY cells were stimulated with IL-6 (10 ng/mL), after which total RNA and proteins were extracted. Real-time polymerase chain reaction and Western blot analyses were performed to assess the expression levels of ODAM mRNA and protein. Luciferase (LUC) assays were employed using LUC constructs with varying lengths of the ODAM gene promoter sequence. Gel mobility shift and chromatin immunoprecipitation (ChIP) analyses were conducted to investigate the binding of transcription factors to response elements within the gene promoter.

Results: Treatment with IL-6 increased the expressions of ODAM mRNA and protein. Additionally, it induced promoter activity of the ODAM gene, while LUC activity was suppressed by inhibitors of protein kinase A, tyrosine kinase, MEK1/2, phosphatidylinositol 3-kinase, nuclear factor-κB, signal transducer and activator of transcription (STAT) 3, and glycoprotein 130. Gel mobility shift and ChIP analyses revealed that IL-6 induced the binding of yin yang 1 (YY1), CCAAT/enhancer-binding protein (C/EBP) β, GATA binding protein (GATA), and phospho-STAT3 to the YY1, C/EBP, GATA, and interferon-γ activated transcriptional element (GATE) 1-3 elements.

Conclusions: These findings indicate that IL-6 upregulates ODAM gene expression by targeting the YY1, C/EBP, GATA, and GATE1-3 elements in the promoter region of the human ODAM gene.

Purpose: Chronic low-grade inflammation is linked to the biology of aging; however, evidence supporting a causal relationship between periodontitis-a dysbiotic biofilm-initiated inflammatory disease-and accelerated aging remains limited. This study investigated the causality between periodontitis and biological aging and identified potentially shared genomic loci, genes, and pathways.

Methods: We conducted a 2-sample Mendelian randomization (MR) analysis to explore the causality of periodontitis on age acceleration measures (DNAm PhenoAge acceleration, GrimAge acceleration, Hannum age acceleration, and intrinsic epigenetic age acceleration) using a dataset from genome-wide association studies of European ancestry populations. Independent genetic variants associated with each trait were used as instrumental variables. The inverse variance-weighted (IVW) method served as the primary MR approach, supplemented by sensitivity testing. We also performed additional statistical genetic analyses to identify pleiotropic loci, shared functional genes, and potential biological pathways, integrating large-scale expression quantitative trait loci data from blood samples.

Results: The MR analysis indicated a causal relationship between periodontitis and DNAm PhenoAge acceleration (IVW β=0.308; 95% confidence interval, 0.056-0.561; P=0.017), a finding corroborated by sensitivity analyses. There was a significant genetic overlap between periodontitis and age acceleration. Pleiotropic analysis revealed 24 shared SNPs associated with 242 genes, predominantly involved in immune functions and pathways related to cellular processes. Further integration analysis showed that 91 of these pleiotropic genes were causally linked to both conditions, with C6orf183 identified as a potential mediator.

Conclusions: This study presents compelling genetic evidence supporting a causal relationship between periodontitis and accelerated aging. Further research is required to validate these findings and investigate the underlying mechanisms.

Purpose: The aim of this study was to conduct a bibliometric analysis of the periodontal plastic surgery literature to identify trends, research gaps, and key themes within the field and to establish a perspective on documented research.

Methods: This bibliometric study examined research outputs on mucogingival surgery indexed in the Web of Science database from 1990 to 2023. The Science Mapping Analysis Tool (SciMAT) software was used to visualize and predict research trends on this topic.

Results: An analysis of publication distribution by year revealed a decline in the number of publications between 1984 and 1995, followed by an overall upward trend after 1996 despite occasional decreases. The United States contributed the most with 593 publications, and Wang HL (n=74) was the most prolific author. The most frequently used keyword was "gingival recession" (n=625). Overall, the publications received 44,859 citations, averaging 25.49 citations per publication.

Conclusions: Researchers have made significant efforts to improve clinical practices and procedures in periodontal plastic surgery, resulting in an increase in studies over recent years. By analyzing thematic maps and clusters-using indicators such as frequency, citations, and centrality-researchers can identify the strengths, weaknesses, and gaps in current research.

This systematic review compares xenogeneic collagen matrices (XCMs) and autogenous graft-based techniques, focusing on 1) the effectiveness of XCMs (non-crosslinked XCM [XCM*] and crosslinked XCM [VCMX]) vs. connective tissue graft (CTG) for increasing buccal mucosal thickness (MT), and 2) the effectiveness of XCM* vs. free gingival graft (FGG) in augmenting buccal keratinised mucosa width (KMW) at implant sites. MEDLINE (PubMed), Web of Science, and Scopus were searched from inception to August 2024. Randomised controlled trials (RCTs) involving systemically healthy patients with peri-implant mucosal deficiencies (MT <2 mm and/or KMW <2 mm) were included. Studies were required to have 2 parallel control groups comparing XCMs with CTG and/or XCM* with FGG, and a minimum follow-up of 3 months. Data were extracted and analysed using a random-effects model, with risk of bias evaluated via the Cochrane risk of bias tool 2. Seventeen RCTs met inclusion criteria for qualitative synthesis (XCMs vs. CTG, n=12; XCMs vs. FGG, n=5), with 14 RCTs included in the meta-analysis (XCMs vs. CTG, n=9; XCMs vs. FGG, n=5). Subgroup analysis of XCM* or VCMX vs. CTG showed a significantly greater MT increase with CTG than with XCM* (pooled mean difference [MD], 0.27; 95% confidence interval [CI], 0.05 to 0.49; P=0.01). No significant difference in MT was observed between VCMX and CTG (pooled MD, 0.02; 95% CI, -0.17 to 0.22; P=0.83). For KMW, FGG provided a significantly greater increase than XCM* (pooled MD, 1.47; 95% CI, 0.63 to 2.30; P=0.0006). RCTs on XCMs vs. CTG showed moderate risk of bias, while those on XCM* vs. FGG showed low risk. XCM* is less effective than CTG for increasing MT at buccal implant sites, and less effective than FGG for increasing buccal KMW. No statistical difference was found between VCMX and CTG for MT augmentation.

Purpose: This study aimed to establish a proof of concept for the guided bone regeneration (GBR) procedure using molded collagenated equine bone mineral (CEBM) combined with recombinant human bone morphogenetic protein-2 (rhBMP-2) in a canine peri-implantitis model, and to identify the key factors essential for effective bone regeneration in peri-implant defects.

Methods: Twelve dental implants were placed in the mandibles of 4 adult male beagle dogs. Each implant was randomly assigned to 1 of 3 groups: GBR with molded CEBM soaked in rhBMP-2 solution (CEBM/BMP2 group, n=4); GBR with molded CEBM alone (CEBM group, n=4); or open flap debridement (OFD group, n=4). Peri-implantitis was induced using cotton retraction cords following osseointegration. After ligature removal, all groups underwent OFD with implant surface decontamination, and GBR was subsequently performed according to group allocation. No further treatment was provided in the OFD group. Clinical and radiographic evaluations were conducted at 4-week intervals, and at 16 weeks, histological, fluorescent labeling, and micro-computed tomographic (micro-CT) analyses were performed.

Results: The CEBM/BMP2 group demonstrated a significantly higher bone volume fraction in micro-CT analysis, alongside superior histomorphometric outcomes, including greater first bone-to-implant contact height, crestal height, and new bone area. The mean re-osseointegration ratio was notably higher in the CEBM/BMP2 group (buccal: 74%, lingual: 94%) compared to both the CEBM (buccal: 20%, lingual: 35%) and OFD groups (buccal: 12%, lingual: 45%).

Conclusions: The GBR procedure using molded CEBM with rhBMP-2 substantially enhanced new bone formation and implant re-osseointegration in peri-implantitis-associated defects, compared to molded CEBM alone or OFD without GBR.

Purpose: This study was conducted to evaluate the 3-year predictability and validity of the modified tunnel technique, both with and without the use of enamel matrix derivative (EMD), for treating deep and narrow gingival recession defects (GRDs) in the mandibular anterior region.

Methods: Overall, 31 GRDs were treated using the modified tunnel technique combined with subepithelial connective tissue graft. The cohort was divided into 2 groups: one with the adjunctive use of EMD (n=16) and the other without EMD (n=15). Clinical outcomes, including recession depth (RD), keratinized tissue width (KTW), mean root coverage (MRC), and complete root coverage (CRC), were evaluated at baseline, as well as at 6 months, 1 year, and 3 years postoperatively. Patient discomfort was assessed with a self-report questionnaire 2 weeks after surgery.

Results: At the 3-year follow-up, no statistically significant differences were observed between the 2 treatment modalities in clinical parameters, including RD (EMD, -6.47±2.23 mm; non-EMD, -5.10±3.23 mm), KTW (EMD, 1.03±0.96 mm; non-EMD, 1.00±1.02 mm), MRC (EMD, 86.62%±21.18%; non-EMD, 80.24%±38.73%), and CRC (EMD, 62.5%; non-EMD, 73.3%). Furthermore, no significant differences were found between the groups in terms of early and subjective postoperative discomfort, including pain and swelling.

Conclusions: Within the limitations of this study, the modified tunnel technique, whether used alone or in conjunction with EMD, demonstrated benefits in the treatment and maintenance of deep and narrow GRDs.

Purpose: This clinical study evaluated differences in bone quality within the maxillary sinus when either alloplast or xenograft material was applied.

Methods: Twenty participants requiring lateral sinus approach augmentation for delayed implant placement were divided into 2 groups. The first group received a silica-calcium phosphate composite (SCPC) alloplast, while the second received a bovine bone xenograft (Bio-Oss). Cone-beam computed tomography (CBCT) was used to measure changes in bone height and area immediately after surgery and 5 months after augmentation. Picrosirius red staining of bone biopsies, obtained during implant placement, was analyzed under polarized microscopy. A MATLAB algorithm was used for analysis following image acquisition.

Results: CBCT measurements revealed a statistically significant reduction in linear bone height among xenograft recipients (P≤0.001). This finding indicated greater resorption compared to the alloplast group, which exhibited no significant difference in bone height at 5 months following sinus augmentation. Furthermore, 40% of xenograft recipients displayed an absence of mineralized tissue formation, indicating a limited osteoconductive effect compared to the alloplast group, in which mineralized bone tissue was present in all samples. Polarized light microscopy and color intensity measurements of picrosirius red-stained bone biopsies revealed a significantly higher ratio of mineralized collagen I to collagen III in the newly formed bone for alloplast compared to xenograft recipients. Trichrome staining demonstrated collagen I mineralization with the presence of osteoblasts and osteocytes, indicating new bone formation. The newly formed bone in the alloplast group exhibited markers of maturation, including the formation of reversal lines, Haversian systems, and blood vessels. Resorption of the SCPC alloplast-grafted granules was also observed.

Conclusions: The increased formation and maturation of new bone appear responsible for the preservation of bone height in alloplast group recipients.

Purpose: This study investigated the reliability of partial-mouth periodontal examinations (PMPEs) for 1) identifying the presence of periodontitis, 2) staging periodontal disease, and 3) reflecting mean clinical parameters.

Methods: All patients were diagnosed using 8 different exam types: (A) full-mouth periodontal examination (FMPE), (B) Community Periodontal Index of Treatment Needs (CPITN) codes, (C) panoramic radiographs only, (D) clinical parameters only, (E) 6 teeth, including the first molar (#11, #16, #26, #31, #36, #46), (F) CPITN index teeth (#11, #16, #17, #26, #27, #31, #36, #37, #46, #47), (G) Ramfjord teeth (#16, #21, #24, #36, #41, #44), and (H) 10 modified Ramfjord teeth, including all first premolars and first molars (#16, #14, #21, #24, #26, #36, #34, #41, #44, #46). Case definitions were established according to the criteria outlined in the 2018 American Academy of Periodontology/European Federation of Periodontology classification of periodontal diseases. The accuracy of diagnosis and diagnostic performance were assessed using the kappa coefficient and area under the curve (AUC)/receiver operating characteristic analyses, respectively. To compare the mean clinical parameters, intraclass correlation coefficients (ICCs) were calculated between 4 types of PMPEs (E, F, G, H) and FMPE.

Results: In total, 218 subjects (130 female, 88 male) were included in this study. Exam type F achieved perfect agreement (kappa coefficient: 1.0) in identifying the presence of periodontitis, and it showed almost perfect agreement in staging periodontal disease (0.85≤ kappa ≤0.98) except for the healthy category, with AUCs ≥0.97. Exam type H demonstrated the highest correlations of all mean clinical parameters with FMPE (ICCs ≥0.96).

Conclusions: PMPEs using the CPITN index teeth can be an excellent alternative for diagnosing periodontitis and staging its severity.