Peri-Implantitis: A Clinical Update on Prevalence and Surgical Treatment Outcomes

Monje A., Blasi G., Nart J., Urban I., Nevins M., Wang H.

Carcuac O., Derks J., Abrahamsson I., Wennström J.L., Berglundh T.

Objectives The aim of the present prospective study was to assess the risk for disease recurrence following surgical therapy of peri-implantitis. Material & methods 73 patients (130 implants) treated surgically for peri-implantitis were examined at 1 and 5 years after therapy. The primary outcome was recurrence/progression of disease defined as any of the following events: (a) bone loss >1.0 mm, (b) surgical retreatment, (c) implant removal/loss after year 1. Patient- and implant-related parameters as well as 1-year outcomes were evaluated as potential predictors through multiple logistic regression analysis. Results 57 implants (44%) displayed recurrence/progression of peri-implantitis during follow-up. Among these, 27 implants were removed. Residual deep probing pocket depth (≥6 mm; odds ratio 7.4; 95% confidence interval 2.8-19.3) and reduced marginal bone level (OR 1.4; 95%CI 1.1-1.7) at 1 year after surgery constituted risk factors for recurrence/progression of disease. Furthermore, implants with modified surfaces were at higher risk than implants with non-modified surfaces (OR 5.1; 95%CI 1.6-16.5). Conclusion Implants with (a) residual deep probing pocket depth, (b) reduced marginal bone level, or (c) modified surfaces following surgical therapy of peri-implantitis present with increased risk for recurrence/progression.

Roccuzzo A., De Ry S.P., Sculean A., Roccuzzo M., Salvi G.E.

Peri-implant diseases are inflammatory reactions to bacterial infections affecting osseointegrated dental implants. In recent years, scientific interest on this topic has increased, as demonstrated by the appearance of a large number of protocols for treating peri-implant mucositis (PIM) and peri-implantitis (PI). The aim of the present narrative review is to provide an overview of the recent (e.g., 2014–present) published protocols for the non-surgical treatment of peri-implant diseases. Several adjunctive measures for mechanical debridement have been proposed and investigated to achieve implant surface decontamination and resolution of mucosal inflammation. However, none of the adjunctive measures has been shown to significantly improve peri-implant conditions compared with non-surgical mechanical debridement alone. Non-surgical approaches for the treatment of peri-implant diseases have been proved to be reliable in reducing clinical signs of peri-implant inflammation (e.g., BoP), although with limited capability to achieve complete disease resolution. Due to the limited benefits from the use of currently proposed adjunctive methods (e.g., chlorhexidine, lasers, photodynamic therapy, systemic probiotics) their application is not recommended until further investigations prove their clinical utility.

Roccuzzo M., Fierravanti L., Pittoni D., Dalmasso P., Roccuzzo A.

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).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.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%).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.

Parma-Benfenati S., Tinti C., Romano F., Roncati M., Aimetti M.

Monje A., Pons R., Roccuzzo A., Salvi G.E., Nart J.

The present case series assesses the response to reconstructive therapy for the management of 2/3-wall peri-implantitis bone defects following submerged-healing guided bone regeneration.Fifteen consecutive patients with 27 implants presenting peri-implantitis were included. Guided bone regeneration was applied by means of autogenous bone/deproteinized bovine bone mineral grafting mixture and collagen membrane. Patients were assessed at baseline (T0) and at 6 (T1) and 12 months (T2). Clinical and radiographic variables defined the composite success criteria (probing pocket depth [PPD] ≤ 5 mm, no bleeding on probing/suppuration (SUP), no further radiographic bone loss). Patient site-specific comfort was scored using a visual analog scale (VAS). Descriptive statistics was carried out to assess the changes along the study period. Outcomes are reported in terms of mean values (5%-95% percentile values).All the clinical variables substantially changed from T0 through T2. In particular, PPD decreased 3.7 mm (0.7-5.9) from T0 to T2. Likewise, the scores for the modified plaque index (mPI) and modified sulcular bleeding index (mBI) were reduced by 0.5 (-0.5-1.1) and 1.6 (0.4-2.4), respectively. SUP did not display at any implant site at T2 (59.2% implants in 29.2% patients suppurated at T0). Keratinized mucosa decreased 0.6 mm (-0.2-4.4) and while mucosal recession increased 2.5 mm (1.0-4.3). Alike, the radiographic parameters varied significantly from T0 through T2. Infrabony defects were filled by 2.2 mm (0.0-8.6) at T2 and marginal bone loss was reduced by 2.3 mm (-1.1-8.1). The mean VAS score significantly increased from T0 (56.7) through T1 to T2, reaching a score of 96 at T2. At this timepoint, 85.2% of the peri-implantitis lesions were resolved.The proposed surgical approach followed by submerged healing to reconstruct peri-implant bone defects may offer one therapeutic option for failing dental implants. Given the nature of the present study, its effectiveness in comparison to less invasive treatments needs investigation in randomized controlled trials.

Ravidà A., Saleh I., Siqueira R., Garaicoa‐Pazmiño C., Saleh M.H., Monje A., Wang H.

Aim To assess the impact of keratinized mucosa (KM) width around dental implants on surgical therapeutic outcomes when treating peri-implantitis. Material and methods Surgically treated peri-implantitis implants were divided into two groups (KM width Results A total of 40 patients (68 implants) (average follow-up: 52.4 ± 30.5 months) were included in this study. From T0 to T1, no differences were found between KM groups in terms of peri-implant probing depths (PPD) and bleeding on probing (BOP). However, sites with .01). Between T1 and T2, no major differences were noted on PPD reduction, BOP and MBL changes between the two groups. GEE modelling demonstrated that MBL severity prior to surgical therapy was a better predictor for implant survival than KM width. Conclusion Surgical outcome in treating peri-implantitis was influenced by the severity of bone loss present at the time of treatment and not by the presence of KM at the time of treatment.

Lasserre J., Brecx M., Toma S.

Carcuac O., Abrahamsson I., Derks J., Petzold M., Berglundh T.

To examine the progression of experimental peri-implantitis around different implants placed in augmented and pristine sites.Six labrador dogs were used. Three months after tooth extraction, four implants with different surface modifications were installed on each side of the mandible. A standard osteotomy was applied on one side, while on the contralateral side the osteotomy was modified, resulting in a gap between the implant and the bone wall. The gap was filled with a bone substitute and covered by a resorbable membrane. Three months after implant installation, implants were exposed and healing abutments were connected. Two months later, oral hygiene procedures were abandoned and a cotton ligature was placed in a submarginal position around the neck of all implants and kept in place for 4 weeks. Following ligature removal, plaque formation continued for 6 months (spontaneous progression period). Radiographs were obtained throughout the experiment, and biopsies were collected and prepared for histological evaluation at the end of the spontaneous progression period.Differences in bone loss during the spontaneous progression period between pristine and augmented sites were small. The size and vertical dimension of the peri-implantitis lesion were larger at augmented than at pristine sites. Implants with non-modified surfaces exhibited smaller amounts of bone loss and smaller dimensions of peri-implantitis lesions than implants with modified surfaces.Small differences in spontaneous progression of peri-implantitis were detected between pristine and augmented sites. Implants with modified surfaces exhibited more bone loss and larger lesions than implants with non-modified surfaces, irrespective of the type of surrounding bone.

Ramanauskaite A., Borges T., Almeida B.L., Correia A.

Stavropoulos A., Bertl K., Eren S., Gotfredsen K.

Implantoplasty, that is, the mechanical modification of the implant, including thread removal and surface smoothening, has been proposed during surgical peri-implantitis treatment. Currently, there is no information about any potential mechanical and/or biological complications after this approach. The aim of the current review was to systematically assess the literature to answer the focused question "Are there any mechanical and/or biological complications due to implantoplasty?".A systematic literature search was performed in three databases until 23/09/2018 to assess potential mechanical and/or biological complications after implantoplasty. All laboratory, preclinical in vivo, and clinical studies involving implantoplasty were included, and any complication potentially related to implantoplasty was recorded and summarized.Out of 386 titles, 26 publications were included in the present review (six laboratory, two preclinical in vivo, and 18 clinical studies). Laboratory studies have shown that implantoplasty does not result in temperature increase, provided proper cooling is used, but leads in reduced implant strength in "standard" dimension implants; further, preclinical studies have shown titanium particle deposition in the surrounding tissues. Nevertheless, no clinical study has reported any remarkable complication due to implantoplasty; among 217-291 implants subjected to implantoplasty, no implant fracture was reported during a follow-up of 3-126 months, while only a single case of mucosal discoloration, likely due to titanium particle deposition, has been reported.Based on all currently available, yet limited, preclinical in vivo and clinical evidence, implantoplasty seems not associated with any remarkable mechanical or biological complications on the short- to medium-term.

Tomasi C., Regidor E., Ortiz-Vigón A., Derks J.

The present systematic review aimed at evaluating the efficacy of reconstructive surgical therapy at peri-implantitis-related bone defects.Studies reporting on outcomes of reconstructive surgery at peri-implantitis-related bone defects at 12 months were identified through an electronic search. Following data extraction, two different sets of meta-analyses were performed. Primarily, controlled studies were used to evaluate the potential benefit of reconstructive surgical therapy over controls. Secondly, overall outcome of reconstructive surgical therapy was assessed by comparing baseline values with outcomes at 12 months. Results were expressed as weighted mean differences (WMD) or risk ratios (RR). Heterogeneity was described by I2 and prediction intervals.The potential benefit of reconstructive techniques over control procedures was evaluated in three studies, representing a total of 116 implants. Altogether, 16 studies reported on the outcome of reconstructive measures at 12 months after surgery. The meta-analyses identified a larger improvement in marginal bone levels (MBL, WMD = 1.7 mm) and in defect fill (WMD = 57%) for test procedures, but found no differences for clinical measures (reduction of probing depth (PD) and bleeding on probing (BOP). Changes of clinical attachment and soft tissue levels were not considered. In terms of overall outcome, therapy resulted in improved MBL (WMD = 2.0 mm) and CAL (WMD = 1.8 mm), in recession (WMD = 0.7 mm), in reduced PD (WMD = 2.8 mm) and in reduced BOP (Implants: RR = 0.4/Sites: RR = 0.2). None of the included studies addressed patient-reported outcome measures.The available evidence on reconstructive therapy at peri-implantitis-related defects is limited by (a) the low number of controlled studies, (b) the lack of controlled studies for commonly used procedures, (c) the heterogeneity between studies and (d) the choice of outcome measures. A high variability for predicted outcomes at 12 months was noted. The interpretation of the demonstrated larger MBL gain for test procedures is difficult as graft material may not be distinguishable from newly formed bone. Potential aesthetic and patient-reported advantages remain to be demonstrated.

Bianchini M.A., Galarraga‐Vinueza M.E., Apaza‐Bedoya K., De Souza J.M., Magini R., Schwarz F.

Different nonsurgical, antibacterial, surgical, and regenerative approaches to treat peri-implantitis have been proposed, but there is no an actual "gold" standard treatment showing the most favorable results to counteract peri-implantitis effects.To evaluate radiographically and clinically the disease resolution and peri-implant marginal bone stability rates of peri-implantitis cases treated through a combined resective-implantoplasty therapy in a moderate to long-term period.Records of patients diagnosed with peri-implantitis and treated through the same protocol applying a combined resective-implantoplasty therapy with minimum 2-year follow-up were screened. Eligible patients were contacted and asked to undergo clinical and radiologic examination. Progressive marginal bone loss, bleeding on probing, suppuration, implant mobility, and implant fracture were considered to establish the disease resolution rate and peri-implant bone stability of the treated implants.Twenty-three patients with 32 treated implants fulfilled the inclusion criteria. Over the 2 to 6-year follow-up, (mean time: 3.4 ± 1.5 years), the disease resolution rate was 83% (patient level) and 87% (implant level). Four implants (13%) were lost or removed due to continuous MBL and osseointegration failure. At follow-up, peri-implant marginal bone remained stable with no further bone loss in 87% of the treated implants. BOP was absent in 89.3% (implant level), suppuration was resolved in all cases, and no pain or implant fracture was reported.Implantoplasty treated cases showed high disease resolution rate and peri-implant marginal bone stability. This surgical antibiofilm strategy can counteract peri-implantitis progression providing an adequate environment for implant function and longevity over a moderate to long-term period.

Monje A., Blasi G.

Given the fact that most patients are not regular compliers in supportive peri-implant maintenance programs, it is of interest to examine the significance of the peri-implant soft tissue characteristics in relationship to the onset of peri-implant diseases.Based on an a priori statistical power calculation, a cross-sectional study was conducted on erratic peri-implant maintenance compliers (

Roccuzzo M., Layton D.M., Roccuzzo A., Heitz‐Mayfield L.J.

To report the clinical outcomes for patients with implants treated for peri-implantitis who subsequently received supportive care (supportive peri-implant/periodontal therapy) for at least 3 years.A systematic search of multiple electronic databases, grey literature and hand searching, without language restriction, to identify studies including ≥10 patients was constructed. Data and risk of bias were explored qualitatively. Estimated cumulative survival at the implant- and patient-level was pooled with random-effects meta-analysis and explored for publication bias (funnel plot) at different time intervals.The search identified 5,761 studies. Of 83 records selected during screening, 65 were excluded through independent review (kappa = 0.94), with 18 retained for qualitative and 13 of those for quantitative assessments. On average, studies included 26 patients (median, IQR 21-32), with 36 implants (median, IQR 26-45). Study designs (case definitions of peri-implantitis, peri-implantitis treatment, supportive care) and population characteristics (patient, implant and prosthesis characteristics) varied markedly. Data extraction was affected by reduced reporting quality, but over 75% of studies had low risk of bias. Implant survival was 81.73%-100% at 3 years (seven studies), 74.09%-100% at 4 years (three studies), 76.03%-100% at 5 years (four studies) and 69.63%-98.72% at 7 years (two studies). Success and recurrence definitions were reported in five and two studies respectively, were heterogeneous, and those outcomes were unable to be explored quantitatively.Therapy of peri-implantitis followed by regular supportive care resulted in high patient- and implant-level survival in the medium to long term. Favourable results were reported, with clinical improvements and stable peri-implant bone levels in the majority of patients.

Becher S.

Gao X., Ha Y.

Abdillah R.A., Budhy T.I., Narmada I.B., Ardani I.G., Ramadhani N.F., Sitalaksmi R.M., Luthfi M., Ulfa N.M., Nugraha A.P., Tengku Ahmad Noor T.N., Nugraha A.P.

Slade A., Aps J., Cascarini L.

With advances in dental technology, even severe edentulism can now be managed effectively with groundbreaking solutions like AMSJI®, redefining treatment options.

Cheng Y., Liu G., Huang X., Xiong Y., Song N., An Z., Hong W., Leethanakul C., Samruajbenjakun B., Liao J.

ABSTRACTIntroductionInflammatory factors leading to bone loss significantly increase the risk of tooth loosening or implantation failure. Zoledronic acid (ZOL) is a widely used medication for effectively inhibiting excessive bone destruction, but its effect on alleviating inflammatory bone loss remains to be elucidated. In this study, we investigated whether ZOL alleviates inflammatory bone resorption through immunomodulatory effect.MethodsThe viability of the cells was evaluated by Cell Counting Kit 8 (CCK8) assay. Osteoclast (OC) differentiation and function were determined by tartrate‐resistant acid phosphatase (TRAP) staining and bone resorption pits assays, respectively. Autophagosomes and actin ring structures of OC were observed using transmission electron microscopy (TEM) and F‐actin ring staining, respectively. The microstructure in mice maxillary alveolar bone model was observed by micro computed tomography (Miro‐CT). Reverse transcription‐quantitative PCR (RT‐qPCR) to detect the mRNA expression of osteoclast‐related genes and Western blot (WB) analysis to evaluate the protein expression levels of autophagy‐related proteins and the NOD‐like receptor family pyrin domain‐containing protein 3 (NLRP3)‐related proteins in pre‐OCs.ResultsThe findings indicated that ZOL hindered lipopolysaccharide (LPS)‐mediated OC differentiation, formation, bone resorption activity and autophagosome levels. Furthermore, ZOL diminished the expression of genes associated with OC. And the expression of proteins ATG7, LC3II, Beclin1, NLRP3‐related proteins and tumor necrosis factor‐α (TNF‐α) protein were markedly decreased while P62 was increased, especially in the 1 μM ZOL group or MCC950 + ZOL group.ConclusionsZOL has a certain immunomodulatory effect that exhibits anti‐inflammatory properties at lower concentrations, which can weaken LPS‐induced OCs differentiation and function, and NLRP3‐mediated autophagy pathway may participate in this process.

Lucrezia P.H., Chiara M., Marla C.

Naguib G.H., Abougazia A.O., Al-Turki L.E., Mously H.A., Hashem A.B., Mira A.I., Qutub O.A., Binmahfooz A.M., Almabadi A.A., Hamed M.T.

This study investigates the impact of tightening torque (preload) and the friction coefficient on stress generation and fatigue resistance of a Ti-6Al-4V abutment screw with an internal hexagonal connection under dynamic multi-axial masticatory loads in high-cycle fatigue (HCF) conditions. A three-dimensional model of the implant–abutment assembly was simulated using ANSYS Workbench 16.2 computer aided engineering software with chewing forces ranging from 300 N to 1000 N, evaluated over 1.35 × 107 cycles, simulating 15 years of service. Results indicate that the healthy range of normal to maximal mastication forces (300–550 N) preserved the screw’s structural integrity, while higher loads (≥800 N) exceeded the Ti-6Al-4V alloy’s yield strength, indicating a risk of plastic deformation under extreme conditions. Stress peaked near the end of the occluding phase (206.5 ms), marking a critical temporal point for fatigue accumulation. Optimizing the friction coefficient (0.5 µ) and preload management improved stress distribution, minimized fatigue damage, and ensured joint stability. Masticatory forces up to 550 N were well within the abutment screw’s capacity to sustain extended service life and maintain its elastic behavior.

Gkioka M., Rausch-Fan X.

Introduction: Peri-implantitis poses a significant challenge for implant dentistry due to its association with bacterial colonization on implant surfaces and the complexity of its management. This systematic review aims to assess evidence from in vivo studies regarding the antimicrobial efficacy of titanium (Ti) dental implant surfaces following physical/chemical modifications or the application of various metal element coatings in preventing bacterial growth associated with peri-implantitis. Materials and Methods: A literature review was conducted across four scientific databases (PubMed, Embase, Scopus, Web of Science), encompassing in vivo studies published between 2013 and 2024, and 18 reports were included in the systematic review. Results: The findings suggest that titanium dental implant surfaces, following physical/chemical modifications and metal element coatings, exhibit antimicrobial effects against bacteria associated with peri-implantitis in humans and various animal models. Conclusions: The reviewed studies indicated a reduction in bacterial colonization, diminished biofilm formation, and decreased signs of inflammation in the peri-implant tissues, which provides evidence that physical/chemical alterations on titanium dental implant surfaces or metal element coatings, like silver (Ag), zinc (Zn), magnesium (Mg), and copper (Cu), demonstrate antimicrobial properties in in vivo studies. However, caution is warranted when translating findings to clinical practice due to methodological disparities and high bias risks. Further larger-scale clinical trials are imperative to assess their long-term efficacy and validate their clinical applicability.

Bischof F.M., Mathey A.A., Stähli A., Salvi G.E., Brägger U.

AbstractBackgroundTooth‐ and implant‐supported fixed dental prostheses are well‐documented and aesthetic treatment alternatives, and after a comprehensive periodontal treatment, a protocol with a good long‐term prognosis if the maintenance program is strictly followed.AimTo reexamine a pre‐existing patient cohort in order to obtain estimated long‐term survival and complication outcomes of fixed dental prostheses.Materials and MethodsFor this study, patients treated with fixed dental prostheses between 1978 and 2002 were reexamined between 2019 and 2020. The restorations were divided in single crowns and fixed dental prostheses supported by teeth (TSC, FPTDP) and implants (ISC, FPIDP). Survival and complication rates were obtained. Kaplan–Meier functions were used to model complication probabilities, and average hazard ratios of different strata were compared using weighted Cox regression.ResultsThe mean observation time of 40 patients and 223 reconstructions was 20.3 (±9.7, 1.2–36.2) years. The estimated survival rates were 84% (CI: 77%–92%) for TSC, 63% (CI: 51%–79%) for FPTDP, 87% (CI: 71%–100%) for ISC, and 64% (CI: 34%–100%) for FPIDP after 25 years. Biological complications included carious lesions (10.6%), periodontitis (7.9%), and peri‐implantitis (6.8%). Technical complications included chipping (20.2%) and loss of retention (10.8%).ConclusionBiological complications lead to abutment loss in more than two‐thirds of cases, regardless of the type of abutment (tooth or implant). Technical complications are less associated with abutment loss than biological complications.

Erduran N.E., Guncu G.N., Akman A.C., Acar B., Pinar A., Karabulut E., Nohutcu R.M.

Abstract Objectives To assess both the clinical and immunological effectiveness of diode laser therapy when used as an adjunct to non-surgical mechanical therapy in managing peri-implantitis. Materials and methods A cohort of 27 participants, comprising 21 females and 6 males, agreed to take part in this investigation. 37 dental implants with peri-implantitis diagnosis were randomly allocated to either the laser group (n = 19) or the control group (n = 18). Evaluation of peri-implant clinical parameters and collection peri-implant crevicular fluid (PICF) samples occurred at baseline, as well as at 3 and 6-month follow-up intervals. The level of various biomarkers (TWEAK, IL-1β, sclerostin, IL-17, RANKL, OPG and IL-10) within the PICF were quantified using enzyme-linked immunosorbent assay. Results Significant time-dependent decreases in clinical and biochemical parameters were detected in both groups compared to the baseline. There were marked differences between the groups in terms of periodontal parameters, except probing depth, and IL-1β, IL-17, sclerostin levels in PICF at 3rd month follow-up. However, no statistically significant difference was detected at 6th month. Conclusions Diode laser seems to be a reliable tool as an adjunct for supporting the nonsurgical mechanical treatment during the early stages of peri-implantitis. Furthermore, the findings suggest that IL-17, sclerostin and IL-1β may serve as promising biomarkers for assessing efficacy of peri-implantitis treatment. Clinical relevance Based on these outcomes, clinicians may consider the application of adjunctive use of diode laser to non-surgical peri-implantitis treatment to achieve better clinical and immunological improvements than nonsurgical peri-implantitis therapy alone in just early healing period. However, it should be noted that there was no difference between the two methods in the long term.

Konishi D., Hirata E., Takano Y., Maeda Y., Ushijima N., Yudasaka M., Yokoyama A.

A near-infrared responsive composite material (MC/HA/CNH) was developed for the treatment of peri-implantitis. The MC/HA/CNH showed enhanced antimicrobial effect by near-infrared light irradiation, which lasted for 48 hours.

Bellon B., Pippenger B., Stähli A., Degen M., Parisi L.

AbstractAimsTo test whether titanium surface roughness disparity might be used to specifically guide the behavior of gingiva fibroblasts and keratinocytes, thereby improving the quality of soft tissue (ST) integration around abutments.MethodsTitanium discs resembling the roughness of enamel (M) or cementum (MA) were created with normal or increased hydrophilicity and used as substrates for human fibroblasts and keratinocytes. Adhesion and proliferation assays were performed to assess cell‐type specific responses upon encountering the different surfaces. Additionally, immunofluorescence and qPCR analyses were performed to study more in depth the behavior of fibroblasts and keratinocytes on MA and M surfaces, respectively.ResultsWhile enamel‐like M surfaces supported adhesion, growth and a normal differentiation potential of keratinocytes, cementum‐emulating MA surfaces specifically impaired the growth of keratinocytes. Vice versa, MA surfaces sustained regular adhesion and proliferation of fibroblasts. Yet, a more intimate adhesion between fibroblasts and titanium was achieved by an increased hydrophilicity of MA surfaces, which was associated with an increased expression of elastin.ConclusionThe optimal titanium implant abutment might be achieved by a bimodal roughness design, mimicking the roughness of enamel (M) and cementum with increased hydrophilicity (hMA), respectively. These surfaces can selectively elicit cell responses favoring proper ST barrier by impairing epithelial downgrowth and promoting firm adhesion of fibroblasts.

Öztürk A., Tosun E., Meral S.E., Baştan F.E., Üstel F., Kan B., Avcu E.

Laser application for the treatment of peri-implantitis provides a variety of advantages; however, depending on the laser type and parameters, it may also have adverse effects on the implant surface qualities. This study's objective is to assess the effects of laser type and parameters on the surface properties of two different titanium-based implant materials: titanium Grade 4 (Ti-Grade 4) and titanium zirconium (Ti-Zr) discs with sand-blasted and acid-etched (SLA) surfaces under in vitro conditions. Sand-blasted and acid-etched discs made of titanium grade 4 (Ti-Grade 4) and titanium zirconium (Ti-Zr) were treated using 808nm AlGaAs (diode) and 2940nm Er:YAG lasers with varying parameters (i.e., diode laser in continuous wave mode, Er:YAG in short pulse mode, and Er:YAG in variable square pulse mode with four different doses). Then, the surface morphology and topography of treated discs were characterized using scanning electron microscopy and optical profilometry. The 3D surface topographies of discs treated with a high power Er:YAG laser displayed irregular peaks and deep valleys, indicating surface deterioration. The average surface roughness values (Sa) of both discs varied with laser type and parameters (3.55-4.80 µm for Ti-Grade 4 versus 3.25-4.5 µm for Ti-Zr). With diode laser applications, the topography features of the discs were preserved despite a small number of irregular valleys and peaks. However, the surface morphologies of the discs were dramatically altered by erosion and local melting because of the Er:YAG laser treatment. Diode laser application appears to be the most reliable method for treating peri-implantitis, as diode laser-treated implants retained their overall surface quality despite a small number of irregular peaks and valleys.

Eliyas S.

This chapter gives an introduction to the periodontic-endodontic (perio-endo) interface. It describes the importance of saving teeth and compares the alternative replacement options. The learning objectives of this book are set out at the end of this first chapter.

Roccuzzo M., Mirra D., Roccuzzo A.

AbstractAs utilisation of dental implants continues to rise, so does the incidence of biological complications. When peri-implantitis has already caused extensive bone resorption, the dentist faces the dilemma of which therapy is the most appropriate to maintain the implant. Since non-surgical approaches of peri-implantitis have shown limited effectiveness, the present paper describes different surgical treatment modalities, underlining their indications and limitations. The primary goal in the management of peri-implantitis is to decontaminate the surface of the infected implant and to eliminate deep peri-implant pockets. For this purpose, access flap debridement, with or without resective procedures, has shown to be effective in a large number of cases. These surgical treatments, however, may be linked to post-operative recession of the mucosal margin. In addition to disease resolution, reconstructive approaches also seek to regenerate the bone defect and to achieve re-osseointegration.