International Journal of Oral Implantology, 01/2025

Purpose: To conduct a comprehensive umbrella review to synthesise existing evidence and critically evaluate the significance of keratinised mucosa width in peri-implant health and assess the consistency and heterogeneity among previous systematic reviews on this topic. Materials and methods: A comprehensive search strategy was implemented across multiple databases. Eligible studies were screened and data were extracted. Methodological quality was assessed using A MeaSurement Tool to Assess systematic Reviews version 2, and strength of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation criteria. A meta-meta-analysis using Hedges’ g as the effect size measure was performed to investigate the outcomes of implant therapy in patients with (control) and without adequate keratinised mucosa width (case). Results: Ten systematic reviews, published between 2012 and 2023, were included. Significant effect sizes were found for mucosal recession, Gingival Index/modified Gingival Index, modified Plaque Index and marginal bone loss. Specifically, narrow keratinised mucosa width ( 2 mm) was associated with increased mucosal recession (equivalent odds ratio 4.05, P = 0.03), higher Gingival Index/modified Gingival Index scores (equivalent odds ratio 3.131, P = 0.001), elevated modified Plaque Index scores (equivalent odds ratio 5.34, P = 0.005) and greater marginal bone loss (equivalent odds ratio 1.852, P = 0.0007). No significant associations were observed for bleeding on probing, pocket depth changes or pocket depth values. Follow-up time did not have a significant effect on these outcomes. Conclusions: Inadequate keratinised mucosa width ( 2 mm) correlated with increased mucosal recession, higher Gingival Index/modified Gingival Index, Plaque Index/modified Plaque Index scores and greater marginal bone loss. However, there is still a lack of sufficient evidence indicating the impact on bleeding on probing, pocket depth, implant survival and disease prevalence (no significant association or insufficient evidence). Keywords: keratinised mucosa, keratinised tissue, peri-implant health, peri-implant mucositis, peri-implantitis The authors declare there are no conflicts of interest relating to this study.

Purpose: This systematic review and meta-analysis aimed to compare the primary stability of immediate implants placed in fresh sockets to implants placed in healed sites. Materials and methods: A systematic search was conducted of the PubMed, Scopus, Web of Science, Embase, Clinicaltrials.gov and Cochrane databases, and the grey literature. The risk of bias was assessed using the Risk of Bias 2 and Risk of Bias In Non-randomized Studies of Interventions tools (both Cochrane Collaboration, London, UK). Primary stability was assessed through resonance frequency analysis (implant stability quotient) and insertion torque. Subgroup analyses were performed to investigate factors that impact the outcome. Meta-analyses of mean difference were conducted using random-effects models. The certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach. The study was registered in the International Prospective Register of Systematic Reviews (no. CRD42022304379). Results: Out of 2,317 studies published up to and including January 2024, 4 randomised and 5 non-randomised studies were included, representing 438 individuals with a total of 515 implants (265 in healed sites and 250 placed immediately). Seven studies were included in the meta-analysis of implant stability quotient and showed an overall mean difference of 5.66 (95% confidence interval 1.52 to 9.79), favouring the healed sites group. Implant torque meta-analysis did not present statistical differences (mean difference 4.22; 95% confidence interval −1.04 to 9.51). Concerning the subgroup analyses, higher stability was seen in the immediate implant placement group for wider implants. In conventional implants, the difference in implant stability quotient was 8.09 (95% confidence interval 3.43 to 12.75). The certainty of evidence was very low for both analyses. Conclusion: Higher primary stability was achieved in the healed sites group, with statistical significance but unclear clinical relevance; however, wider implants appeared to counter the lower stability of implants placed immediately. Due to the very low certainty of evidence, the results should be interpreted with caution. Keywords: dental implants, fresh sockets, immediate implants, primary stability, resonance frequency analysis, torque The authors declare there are no conflicts of interest relating to this study.

Background: The treatment of advanced peri-implantitis–related bone defects is often associated with ineffective efforts to halt disease progression. The objective of this case series was to evaluate the performance of reconstructive therapy for the management of advanced peri-implantitis using recombinant human platelet-derived growth factor-BB as an adjunctive biological agent. Materials and methods: A prospective case series study on advanced intrabony peri-implantitis bone defects (≥ 50% bone loss) was performed. Clinical and radiographic variables were collected at baseline (after non-surgical therapy) and 12 months after surgical treatment. Implant surface decontamination of the intrabony component was carried out using titanium brushes and the electrolytic method. Before grafting, recombinant human platelet-derived growth factor-BB was applied on the implant surface. A mixture of mineralised allograft and xenograft hydrated with recombinant human platelet-derived growth factor-BB and covered by a collagen barrier membrane was used for reconstructive therapy. Disease resolution was defined as an absence of bleeding on probing, pocket depth 6 mm and no radiographic evidence of progressive bone loss. Descriptive statistics were performed to assess the effect of treatment on the clinical and radiographic variables. Results: A total of 10 patients exhibiting 13 advanced peri-implantitis-related bone defects were included. Implant survival at the 1-year follow-up was 100%. No major complications occurred during the early healing phase. All the clinical parameters, with the exception of keratinised mucosa, and radiographic parameters yielded statistical significance. In particular, mean pocket depth decreased by 4.5 mm and the mean Sulcus Bleeding Index was reduced by 1.8. Radiographic intrabony defects displayed a significantly narrower, shallower and less angled configuration at the 1-year follow-up. The disease resolution rate at implant level was 61.5%. Conclusion: The surgical reconstructive strategy involving the use of recombinant human platelet-derived growth factor-BB proved to be safe and effective for treating advanced peri-implantitis–related bone defects. Keywords: growth factors, guided bone regeneration, peri-implantitis AM receives fees for lecturing and participating in other education-related events from Straumann (Basel, Switzerland) and SigmaGraft (Fullerton, CA, USA). MHAS was a scientific consultant for Lynch Biologics (Franklin, TN, USA) at the time of inception of this study. The other authors declare no conflicts of interest relating to this study.

Purpose: Dislocation of implants into the maxillary sinus typically occurs during surgery or in the early postoperative period. This case study presents an instance of implant dislocation that occurred after 30 years under functional loading due to peri-implantitis. Materials and methods: An 87-year-old woman presented with a loosened fixed partial denture, revealing a missing implant in the maxillary left second molar site upon clinical examination. The patient showed no symptoms of sinusitis. Imaging confirmed the dislocation of the implant, along with a pathological radiodensity filling the sinus. Maxillary sinus revision was performed via a bone lid under conscious sedation. The implant was removed along with a polypous mass, and the latter was sent for pathological examination. Following debridement, disinfection (3% hydrogen peroxide, photodynamic decontamination) was performed. The oroantral fistula was closed through double-layer closure with a pedicled connective tissue flap and a mucoperiosteal flap. Two months after surgery, sinus floor elevation using the layering technique and implant placement were performed. After 3 months, the implants were exposed, and the restoration was placed 6 weeks later. Results: Histopathological examination confirmed chronic sinusitis with the presence of polyps. A 2-month follow-up CBCT scan revealed a healthy sinus with an open ostium. Subsequent procedures went uneventfully. Conclusions: Progressive peri-implantitis in the posterior maxilla can lead to the dislocation of dental implants into the sinus and subsequent chronic sinusitis. Removing the implant through a bone lid from the lateral sinus wall with simultaneous sinus revision is an effective way to treat this condition and allows for later bone grafting and implant placement. Keywords: bone lid, chronic sinusitis, dental implant dislocation, maxillary sinus, peri-implantitis The authors declare there are no conflicts of interest relating to this study.

This manuscript introduces a concept that aims to optimise peri-implant health and ensure stability of peri-implant tissues in dental implant therapy. It encompasses the principles of platform switching, restorative abutment design, optimal (internal conical) connection and subcrestal implant placement, and is thus referred to as the PROS concept. Platform switching involves strategic repositioning of the implant–abutment junction to contain inflammatory infiltrate, whereas restorative abutment design emphasises the importance of abutment height and contour in peri-implant tissue stability. Optimal (internal conical) connection focuses on minimising micromovements to reduce microgaps and enhancing stability, and subcrestal placement explores the benefits of implant placement depth on peri-implant tissue health. By integrating these principles, clinicians can enhance the predictability of peri-implant bone stability, leading to successful outcomes in dental implant therapy. This clinical guideline has been developed in accordance with the Appraisal of Guidelines for Research and Evaluation, ensuring methodological rigour and transparency, and enhancing its credibility and usability in clinical practice. Keywords: dental implant-abutment design, dental implants, osseointegration, peri-implantitis, prosthesis design The authors declare there are no conflicts of interest relating to this study.