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Surface decontamination in the reconstructive therapy of peri-implantitis is of paramount importance to achieve favorable outcomes. The objective of this single-center study derived from a large multicenter clinical trial was to compare the electrolytic method (EM) used as an adjunct to mechanical decontamination, to hydrogen peroxide (HP) also used as an adjunct to mechanical decontamination, in the reconstructive therapy of peri-implantitis. At 12-month (T2) follow-up, 19 patients (Nimplants= 23) completed the study. None of the tested modalities demonstrated superiority in terms of the assessed clinical parameters. Only mucosal recession showed higher stability in the EM group. Alike, radiographic marginal bone level gain and defect angle changes at T2 did not differ between the evaluated strategies. Notably, disease resolution was ∼16% higher in the EM; however, differences did not reach statistical significance. Additionally, it was demonstrated that pocket depth and intra-bony component depth at baseline were predictors of disease resolution. In conclusion, the EM combined with mechanical instrumentation results in a safe and effective surface decontamination modality in the reconstructive therapy of peri-implantitis. This strategy resulted in ∼91% disease resolution rate.

The aim of this PRISMA-compliant systematic review was to analyze the evidence pertaining to disease resolution after treatment of peri-implant diseases (PROSPERO: CRD42022306999) with the following PICO question: what is the rate of disease resolution following non-surgical and surgical therapy for peri-implant diseases in adult human subjects? A literature search to identify studies that fulfilled a pre-established eligibility criteria was conducted. Data on primary therapeutic outcomes, including treatment success, rate of disease resolution and/or recurrence, as well as a variety of secondary outcomes was extracted and categorized. Fifty-five articles were included. Few studies investigated the efficacy of different non-surgical and surgical therapies to treat peri-implant diseases using a set of pre-defined criteria and with follow-up periods of at least one year. The definition of treatment success and outcomes of disease resolution differed considerably among the included studies. Treatment of peri-implant mucositis was most commonly reported to be successful in arresting disease progression for ≤60% of the cases, whereas most studies on peri-implantitis treatment reported disease resolution occurring in <50% of the fixtures. In conclusion, disease resolution is generally unpredictable and infrequently achieved after the treatment of peri-implant diseases. A great variety of definitions have been used to define treatment success. Notably, percentages of treatment success and disease resolution were generally underreported. The use of standardized parameters to evaluate disease resolution should be considered an integral component in future clinical studies. Keywords: Peri-implantitis, dental implant, diagnosis, peri-implant endosseous healing, tooth loss, outcome assessment.

A clinical observation usually encountered after vestibuloplasty or interventions aiming at deepening the vestibule with or without simultaneous free epithelialized grafts in the posterior ridges is that they are subjected to major dimensional changes attributed to the buccinator fibers attachment. Hence, this study aimed at assessing the attachment of the buccinator muscles in relation to other anatomical landmarks. An ex-vivo study was performed in cadaver heads to explore the association of fibers attachment in relation to the distance from the crestal aspect of edentulous alveolar process (CAP) and the vestibular depth (VD), crestal band of keratinized mucosa (KM), and ridge height (RH). Interestingly, VD and KM were found to be strongly correlated. Likewise, VD/KM and CAP-BUC were further noted being correlated. CAP-BUC was negatively correlated with RH. Accordingly, the more atrophic the alveolar ridge (being more noticeable in the mandible) is, the shallower the vestibule, the lesser the crestal band of KM and the more crestal attachment of the buccinator muscular fibers. That might be the reason why whenever performing free epithelized graft in the posterior ridges to enhance the peri-implant soft tissue phenotype and deepening the vestibule, the graft is subjected to major dimensional changes. 

This PRISMA-compliant systematic review aimed to investigate the effect of supportive peri- implant care (SPIC) on peri-implant tissue health and disease recurrence following the non surgical and surgical treatment of peri-implant diseases. The protocol of this review was registered in PROSPERO (CRD42023468656). A literature search was conducted to identify investigations that fulfilled a set of pre-defined eligibility criteria based on the PICO question: what is the effect of SPIC upon peri-implant tissue stability following non-surgical and surgical interventions for the treatment of peri-implant diseases in adult human subjects? Data on SPIC (protocol, frequency, and compliance), clinical and radiographic outcomes, and other variables of interest were extracted and subsequently categorized and analyzed. A total of 8 studies, with 288 patients and 512 implants previously diagnosed with peri-implantitis were included. No studies including peri-implant mucositis fit the eligibility criteria. Clinical and radiographic outcomes were similar independently of specific SPIC features. Nevertheless, a 3-month recall interval was generally associated with a slightly lower percentage of disease recurrence. The absence of disease recurrence at the final follow-up period (mean of 58.7±25.7 months) ranged between 23.3% and 90.3%. However, when the most favorable definition of disease recurrence reported in the selected studies was used, mean disease recurrence was 28.5% at baseline, considered 1 year after treatment for this investigation, and increased to 47.2% after 2 years of follow-up. In conclusion, regardless of the SPIC interval and protocol, disease recurrence tends to increase over time after the treatment of peri-implantitis, occasionally requiring additional interventions. Keywords: dental implants; peri-implantitis; peri-implant mucositis; disease progression; risk factors

Purpose: To assess site-related features of peri-implantitis occurring adjacent to teeth and its association with the proximal periodontal bone level. Materials and Methods: Periapical radiographs were collected from partially edentulous patients exhibiting peri-implantitis adjacent to teeth. The following variables were quantified: intrabony defect width (DW), implant marginal bone loss (MBLi), tooth marginal bone loss (MBLt), implant-tooth distance (ITd), intrabony defect angulation (DA), adjacent periodontal bone peak height (ABPh), and implant-tooth angulation (ITa). A correlation matrix using the Spearman correlation coefficient was created to explore the dependence of these variables. Univariate linear regression analysis was carried out by means of generalized estimating equations (GEE), using MBLt as dependent variable. Results: Overall, 61 patients and 84 implants were included in this study, consisting of a total of 105 implant sites facing adjacent teeth. This resulted in 515 linear and 194 angular measurements. A total of 11 different statistically significant associations were demonstrated between the different variables analyzed. Moreover, the univariate regression analysis revealed significant positive associations between MBLt and MBLi (P = .013) and between MBLt and periodontitis (PD) (P = .014). These associations were confirmed in the multivariate model. Conclusions: Teeth adjacent to untreated peri-implantitis lesions are associated with proximal loss of periodontal support. This finding is more remarkable in scenarios that display short implant-tooth distance. Keywords: peri-implantitis, peri-implant diseases, dental implant, periodontal disease, periodontitis

The goal of this section ist o bring our readers eye-catching and high quality images related to novel techniques, clinical challenges and emerging trends relevant to esthetic dentistry. The section portrays the clinical image, the photographer, the camera and a short caption of the story behind the photograph.

Peri-implantitis is an infectious disease that leads to progressive bone loss. Surgical therapy has been advocated as a way of halting its progression and re-establishing peri-implant health. One of the most challenging but crucial tasks in the management of peri-implantitis is biofilm removal to achieve reosseointegration and promote the reduction of peri-implant pockets. A wide variety of strategies have been used for implant surface decontamination. Mechanical means have been demonstrated to be effective in eliminating calculus deposits and residual debris; however, the presence of undercuts and the grooves and porosities along the roughened implant surface make it difficult to achieve an aseptic surface. In conjunction with mechanical measures, use of chemical adjuncts has been advocated to dilute bacterial concentrations, destroy the bacteria’s organic components and eliminate endotoxins. Pharmacological adjuncts have also been recommended to diminish the bacterial load. Other strategies, such as use of lasers, implantoplasty and electrolysis, have been suggested for implant surface decontamination to promote predictable clinical and radiographic outcomes. Keywords: dental implant, dental implantation, peri-implant endosseous healing, peri-implantitis Conflict-of-interest statement: The authors declare that they have no direct conflicts of interest. Dr Monje owns royalties to a peri-implantitis kit that includes burs for mechanical detoxi

Purpose: The scarce standard therapeutic protocols for the management of peri-implant diseases results in the empirical application of therapeutic modalities. The objective of this study was to carry out a survey to analyze the therapeutic trends of professionals with different academic backgrounds and levels of expertise. Materials and methods: An exploratory cross-sectional internet-based study survey of board-certified members of the American Academy of Periodontology (AAP) and the European Federation of Periodontology (EFP) was conducted. To assess the therapeutic trends, four clinical vignettes representing different scenarios of peri-implant biologic complications were provided to the participants. Differences in practice patterns were determined using chi-square test and Student t test or analysis of variance (ANOVA) test for qualitative variables. Results: A total of 268 members of the AAP and EFP completed the survey. A significant difference in preferred treatment plan was found between EFP and AAP periodontists, resective therapy being the treatment of choice by the majority of the former (41.2%) and regenerative therapy by the latter (48.9%; P < .001). Overall, 48.1% of experts did not consider any intervention for the management of mucositis. Antibiotic prescriptions differed among groups, with statistical significance in each clinical case, and the explantation criteria were inconsistent and differed significantly among groups. Conclusion: Substantial variations exist concerning the decision-making to manage peri-implant diseases and conditions. Keywords: diagnostic procedure, peri-implantitis, periodontist, periodontology, surgical procedure