Influence of keratinized mucosa on the surgical therapeutical outcomes of peri‐implantitis

Ravidà, Andrea; Saleh, Islam; Siqueira, Rafael; Garaicoa-Pazmiño, Carlos; Saleh, Muhammad H A; Monje, Alberto; Wang, Hom Lay

doi:10.1111/jcpe.13250

Cited by 31 publications

(35 citation statements)

References 60 publications

(93 reference statements)

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“…Recently, Ravidà et al. showed that in patients with peri‐implantitis, SUP was present in 84.6% of the implants with <2 mm of KM, versus in 59.5% of the implants with >2 mm of KM 25 . Findings from our study are consistent with those of the aforementioned article, since the prevalence of SUP in our patients with peri‐implantitis was 54.3%.…”

Section: Discussionsupporting

confidence: 92%

Suppuration as diagnostic criterium of peri‐implantitis

Monje

Vera

Muñoz-Sanz

et al. 2020

Journal of Periodontology

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Background Suppuration (SUP) as a diagnostic parameter for monitoring dental implants is not yet well understood. The retrospective clinical and radiographic study was therefore performed to investigate the patient, implant, and site characteristics among individuals exhibiting SUP. Methods Demographic characteristics and clinical parameters were recorded. Radiographic features were analyzed using cone‐beam computed tomography. Peri‐implantitis was defined based on the consensus report of Workgroup 4 of the 2017 World Workshop on the Classification of Periodontal and Peri‐Implant Diseases and Conditions: probing depth (PD) ≥6 mm, presence of bleeding and/or SUP on gentle probing, and radiographic marginal bone loss (MBL) ≥3 mm. SUP was graded according to profuseness (dot versus line/drop) and time after probing (≥15 seconds versus <15 seconds after probing versus spontaneous). Simple binary logistic regression models were estimated using generalized estimation equations to explain the probability of SUP based on demographic, clinical, and radiographic variables. Results A total of 111 eligible patients (nimplants = 501) were assessed. Of them, 57 (nimplants = 334) were diagnosed with peri‐implantitis according to the established case definition, and of these individuals, 31 (nimplants = 96) presented SUP. Therefore, the prevalence of SUP was 27.92% in the total sample size and 54.38% in peri‐implantitis patients. Overall, 28.74% implants displayed SUP within patients with peri‐implantitis. SUP was more frequently found at buccal sites (51%) and proved less prevalent at mesio‐lingual sites (16.7%). Defect morphology (OR = 6.59; P = 0.004), PD (OR = 1.63; P = 0.024), and MBL (OR = 1.35; P = 0.010) were significantly associated with the presence of SUP. Likewise, defect morphology (P = 0.02), PD (P = 0.003), and MBL (P = 0.01) were significantly correlated with the grade of SUP. Conclusion The presence and grade of SUP are associated with peri‐implant bone loss, probing depth, and defect morphology in patients with peri‐implantitis.

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Section: Discussionsupporting

confidence: 92%

Suppuration as diagnostic criterium of peri‐implantitis

Monje

Vera

Muñoz-Sanz

et al. 2020

Journal of Periodontology

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“…Multilevel regression analysis showed that implant failure was influenced by the amount of MBL at the time of treatment, as opposed to the type of treatment itself. Although hardly reported, the severity of MBL is a commonsensical risk for implant survival following peri-implantitis therapy, and there seems to be an agreement in the literature regarding its significance (Froum et al 2015; Sinjab et al 2018; Ravida et al 2020).…”

Section: Discussionmentioning

confidence: 98%

Lack of Clinical Benefit of Implantoplasty to Improve Implant Survival Rate

et al. 2020

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The objective of this study was to compare postsurgical outcomes of resective treatment for peri-implantitis with and without implant surface modification (implantoplasty [IP]). This was accomplished by a retrospective analysis with data from patients with ≥1 implant who were surgically treated for peri-implantitis by resective therapy. Patients were divided into 2 groups regarding treatment approach: IP (test) and no IP (control). Retrospective data were obtained after implant placement (T0) and the day of peri-implantitis surgical treatment (T1). Patients were then recalled (≥1 y after T1) for clinical and radiographic examination (T2). The findings were conclusive. A total of 41 patients (68 implants; mean ± SD follow-up, 41.6 ± 24.4 mo) were included in this study. The survival rate at the implant level was 90% in the test group and 81.6% in the control group ( P > 0.05). Multilevel regression analysis showed that the probability of implant failure was influenced by marginal bone loss (MBL) at T1 and not surgical modality. For example, peri-implantitis defects ≥50% and 25% to 50% MBL were 18.6 and 8.86 times more likely to lose the implant, respectively, when compared with <25% MBL. Nonetheless, MBL changes were similar in the test and control groups ( P = 0.592). Similarly, changes in bleeding on probing, probing pocket depth, and suppuration at T2 did not differ between groups ( P > 0.05). Multilevel regression analysis indicated that clinical improvement of these parameters was influenced by the number of supportive peri-implant therapy visits ( P < 0.01). The results demonstrate little difference between the procedures. Regardless of the implant surface modification (IP) being performed or not, the survival rate of implants treated for peri-implantitis was primarily influenced by the amount of bone loss at the time of treatment. Other clinical parameters (MBL, probing pocket depth, bleeding on probing, suppuration) were influenced by the frequency of supportive peri-implant therapy visits and not by the IP procedure (ClinicalTrials.gov NCT04259840).

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“…Clinicians should be aware of the limited diagnostic value of this secondary case definition, given the importance of early diagnosis of peri‐implantitis. Cases with incipient peri‐implantitis are the ones amenable of less invasive (i.e., non‐surgical) treatment (Figuero et al, 2014) and demonstrate most favorable long‐term outcomes following therapy (Ravidà, Saleh, et al, 2020; Ravidà, Siqueira, et al, 2020).…”

Section: Discussionmentioning

confidence: 99%

Diagnosis of peri‐implantitis in the absence of baseline data: A diagnostic accuracy study

Romandini

Berglundh

Derks

et al. 2021

Clinical Oral Implants Res

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Objectives The aim of the present study was to evaluate the diagnostic accuracy of clinical and radiographic evaluations made at a single time point during follow‐up in identifying (a) a history of peri‐implant bone loss and (b) the presence of peri‐implantitis. Material & Methods 427 patients provided with implant‐supported reconstructions 9 years earlier were evaluated clinically by Probing Pocket Depth, Bleeding or Suppuration on Probing (PPD, BoP & SoP) and radiographically. Bone levels were assessed relative to the most coronal point of the intra‐osseous part of the implant. A history of bone loss and diagnosis of peri‐implantitis was confirmed through baseline documentation (direct evidence). Diagnostic accuracy of radiographic bone levels at 9 years and clinical findings (indirect evidence/secondary case definition) in identifying a history of bone loss and peri‐implantitis were evaluated through correlation and multilevel regression analyses as well as receiver operating characteristic curves. Results were expressed as sensitivity/specificity and area under the curve (AUC). Results Bone levels observed at 9 years were highly accurate in identifying pronounced bone loss (>2 mm; AUC = 0.96; 95% CI 0.95–0.98). In the absence of baseline documentation, a secondary case definition based on the presence of BoP/SoP & bone level ≥ 1 mm (indirect evidence) provided the overall best diagnostic accuracy (AUC = 0.80; 95% CI 0.77–0.82) in identifying peri‐implantitis cases (direct evidence: BoP/SoP & bone loss > 0.5 mm). Moderate/severe peri‐implantitis (BoP/SoP & bone loss > 2 mm) was most accurately identified by the combination of BoP/SoP & bone level ≥ 2 mm (AUC = 0.93; 95% CI 0.91–0.96). Sensitivity of the secondary case definition suggested by the 2017 World Workshop of Periodontology (WWP) (BoP/SoP ≥ 1 site & bone level ≥ 3 mm & PPD ≥ 6 mm) was low. Conclusions The present results underline the importance of baseline documentation for the correct diagnosis of peri‐implantitis, especially in its early/incipient forms. The secondary case definition of peri‐implantitis suggested at the 2017 WWP demonstrated a high level of specificity but low sensitivity. Moderate/severe peri‐implantitis was most accurately identified by the combination of BoP/SoP & bone level ≥ 2 mm.

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Influence of keratinized mucosa on the surgical therapeutical outcomes of peri‐implantitis

Cited by 31 publications

References 60 publications

Suppuration as diagnostic criterium of peri‐implantitis

Suppuration as diagnostic criterium of peri‐implantitis

Lack of Clinical Benefit of Implantoplasty to Improve Implant Survival Rate

Diagnosis of peri‐implantitis in the absence of baseline data: A diagnostic accuracy study

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