Federico Berton

Risk Factors for Peri-Implantitis: Effect of History of Periodontal Disease and Smoking Habits. A Systematic Review and Meta-Analysis

ABSTRACT Objectives The purpose of this review was to evaluate whether history of periodontitis and smoking habits could represent a risk factor for peri-implantitis and implant loss. Material and Methods This systematic review followed PRISMA guidelines and was registered at the PROSPERO database [registration numbers CRD42016034160 (effect of history of periodontitis) and CRD42016033676 (effect of smoking)]. Broad electronic (MEDLINE) and manual searches were conducted among articles published from January 1st 1990 up to December 31st 2015, resulting in 49332 records for history of periodontitis and 3199 for smoking habits. Selection criteria included prospective studies comparing two cohorts of patients, with and without the investigated risk factor, with a minimum follow-up period of three years, and reporting data on peri-implantitis and implant loss occurrence. Considering that only prospective studies were included, dichotomous data were expressed as risk ratios and 95% confidence intervals. Results Three studies evaluating history of periodontitis (on which quantitative analysis was performed) and one study on smoking effect were included. Both implant and patient-based meta-analyses revealed a significantly higher risk of developing peri-implantitis in patients with a history of periodontitis compared with periodontally healthy subjects, but not a statistically significant increased risk for implant loss. Conclusions The outcomes of this systematic review indicate history of periodontitis as a possible risk factor for peri-implantitis, while insufficient data are present in literature to evaluate the role of smoking. However, available evidence is still weak and immature, and sound epidemiological studies are needed to analyse the specific contribution of these potential risk factors.

Laurell-Gottlow suture modified by Sentineri for tight closure of a wound with a single line of sutures.

Primary wound healing requires precise approximation of he edges of the wound and their firm stabilisation during he early phases of healing.1 A line of horizontal mattress utures followed by interrupted sutures is considered reliable or the closure of flaps.2 Horizontal mattress sutures maxmise eversion of the wound, which encourages close contact etween the inner portions of the flap and keeps epithelium way from underlying structures, reduces dead space and inimises tension across the wound. However, the use of dditional interrupted sutures is necessary to approximate he edges of the wound and obtain primary healing. The Laurell and Gottlow suture3 is a modified horizontal attress suture used to avoid interrupted sutures, even if its version potential and tightness of closure are less than those f conventional mattress sutures. Our proposal is to modify he technique in a single line of sutures to close the edges of he incision completely with eversion comparable to that of orizontal mattress sutures. The Sentineri technique has five steps in common with the aurell and Gottlow suture. First, the needle is inserted from he outside of the buccal flap 3–4 mm from its margin. The nternal side of the lingual flap is then pierced 3–4 mm from he margin of the lingual flap. The outside of the lingual flap is then pierced 5 mm lateral o the second piercing, and the needle passed through the nside of the buccal flap (point A). The needle is then brought own lingually over the coronal aspect of the flap and passed hrough the loop. In the Laurell and Gottlow technique the suture is now tied o the free end. However, the Sentineri technique proceeds Fig. 1) by leaving the suture with the needle over the loop. he thread that exits from point A is pulled and tied to the free nd with a surgical knot (Fig. 2). The needle is then pulled o tighten the suture, and tied to the free end with a surgical not (Figs. 3 and 4).

Intraoperative Complications During Sinus Floor Elevation with Lateral Approach: A Systematic Review

PURPOSE To analyze the occurrence of intraoperative complications during sinus floor elevation with a lateral approach and their correlations with the technique adopted by surgeons. MATERIALS AND METHODS Electronic and manual searches resulted in 4,417 records on sinus floor elevation. Twenty-one randomized clinical trials (RCTs) and 11 prospective controlled clinical trials (CCTs) reporting occurrence of intraoperative complications were included. Risk of bias was assessed according to the Cochrane tool and a modified Downs and Black quality analysis for RCTs and CCTs, respectively. RESULTS Sinus membrane perforation and hemorrhagic events following vascular lesions were the only intraoperative complications reported by the selected studies with overall occurrences of 15.7% and 0.4%, respectively. Three different surgical devices (rotary instruments, piezoelectric osteotomes, and manual bone scrapers) were used to perform the lateral antrostomy. Ultrasonic devices and bone scrapers showed a lower incidence (10.9% and 6.0%, respectively) of membrane perforation compared with that of rotary instruments (20.1%). Among the different ultrasonic procedures, erosion of the lateral antral wall showed the lowest membrane perforations (4.7% incidence). Hemorrhagic complications seemed to be extremely infrequent with any surgical technique. CONCLUSION Sinus membrane perforation was the most frequently described intraoperative complication during sinus floor elevation with a lateral approach. Thinning the lateral wall of the sinus before performing the antrostomy (either with ultrasonic devices or manual bone scrapers) seemed to be an important factor in preventing membrane perforation during sinus surgery. Further high-quality RCTs specifically investigating intraoperative complication occurrence are needed.

Influence of Maxillary Sinus Width on New Bone Formation After Transcrestal Sinus Floor Elevation: A Proof-of-Concept Prospective Cohort Study.

Purpose: Graft maturation in the maxillary sinus requires adequate angiogenesis and osteoprogenitor cells migration from the surrounding bony walls: the aim of this study was to analyze the correlation between sinus cavity dimensions and new bone formation after transcrestal sinus floor elevation (tSFE). Methods: Patients needing maxillary sinus augmentation (residual crest height ⩽ 4 mm) were treated with tSFE using xenogeneic granules. Six months later, bone-core biopsies were retrieved for histological analysis in the implant insertion sites. Buccopalatal sinus width (SW) was evaluated on cone beam computed tomography, and correlations between histomorphometric and anatomical parameters were quantified by means of linear regression analysis. Results: Eight consecutive patients underwent tSFE procedures: at 6 months, average percentage of newly formed bone resulted 24.2% ± 7.9%. Statistical analysis showed a strong inverse correlation between SW and new bone formation (R2 = 0.88), and a strong direct correlation between the number of exposed bone walls and new bone formation (R2 = 0.82). Conclusion: Within the limitations of this proof-of-concept study, in which a restricted number of patients were analyzed, tSFE showed more predictable results in narrow than in large sinuses, in terms of new bone formation.

Reuse of Implant Healing Abutments: Comparative Evaluation of the Efficacy of Two Cleaning Procedures

PURPOSE To compare the efficacy of two systems in cleaning used healing abutments (HAs). MATERIALS AND METHODS A total of 60 used HAs were randomized into two groups: one treated with an automatic cleaning system, and the other with conventional decontamination procedures. After sterilization and staining, the HAs were microscopically analyzed and underwent a cellular adhesion in vitro assay. RESULTS Contaminated areas were observed with different frequencies in the two groups (3.6% test; 78.2% control; P < .001). In vitro assay showed a uniform cell distribution in test HAs, while areas of debris without adhering cells were a common finding in the control HAs. CONCLUSION Further studies investigating the chemical composition and clinical influence of biologic remnants are necessary before considering reusing HAs.

Bone Scrapers Versus Piezoelectric Surgery in the Lateral Antrostomy for Sinus Floor Elevation

Abstract The purpose of this investigation is to evaluate 2 different methods for reducing cortical wall thickness in sinus floor augmentation surgery. A manual bone scraper was compared in terms of efficacy, speed, and safety to an ultrasonic insert for osteoplasty, in a randomized controlled clinical trial with a split-mouth design. Twenty-five patients with severe posterior maxillary atrophy were treated with bilateral sinus floor elevation with lateral approach. Antrostomies were randomly performed by eroding the cortical wall with a manual bone scraper (test site) or with an ultrasonic insert (control site) until the membrane was visible under a thin layer of bone, before outlining the window with a piezoelectric device. Occurrence of membrane perforation, laceration of vascular branches, and surgical time were recorded. Mean surgical time of the antrostomy in the test sites was 9’18”, while in the control sites was 9’47”. No significant differences were found in terms of surgical time, incidence of membrane perforation during antrostomy (4.3% in both groups), or other intraoperative complications between the 2 techniques. Both surgical approaches represent effective options for performing lateral antrostomies during sinus floor elevation procedures in a safe and predictable way.

Conjunctival chemosis: an uncommon complication after transcrestal lifting of the sinus floor

Conjunctival chemosis is non-specific oedema, which may e caused by many systemic and local factors, including llergies; bacterial, viral, and mycotic infections; autoimune diseases; thyroid disorders; and neoplasms. The orbit s susceptible to the contiguous spread of infections from the axillary sinus as they are separated only by a thin plate of one, which could also have congenital bony dehiscences. hese infections may then cause complications, which have een categorised by Chandler et al,1 into five stages, accordng to severity. A 47-year-old woman presented with no systemic comlaints or abnormalities of the sinuses. After performing a restal access with ultrasonic instruments, We used hydroynamic pressure to raise the Schneiderian membrane. There ere no perforations or any other intraoperative compliations, so we inserted a xenogeneic graft and two dental mplants. She was given antibiotics and non-steroidal antinflammatory drugs for one week. At the follow-up visit days later, she had considerable conjunctival oedema Fig. 1), which had begun the day before. She had no clinical igns of sinusitis and the wound was healing well. We did one-beam computed tomography (CBCT), which showed

Shifts of subgingival bacterial population after nonsurgical and pharmacological therapy of localized aggressive periodontitis, followed for 1 year by Ion Torrent PGM platform

The possibility of targeting the hypervariable region V3 of the 16S rRNA gene using Ion Torrent Personal Genome Machine (PGM) could provide a complete analysis of subgingival plaque samples, potentially able to identify microbiological species missed by culture-based methods. A 16-year-old female smoker patient, affected by localized aggressive periodontitis, underwent a full-mouth disinfection protocol and was inserted in a 3-month recall program. Microbiological samples were collected at baseline and at 30, 100, 365 days follow-up and analyzed by Ion Torrent PGM. Capnocytophaga, Fusobacterium, Prevotella, and Treponema were the most represented pathogens at baseline. Nonsurgical treatment and systemic antibiotics drastically lowered the anaerobic species, and their presence remained limited after 100 days, while a consistent recolonization by anaerobic bacteria was detected at 365 days. The patient showed a general improvement of periodontal conditions. Differently from polymerase chain reaction and other microarray techniques, Ion Torrent performs a quantitative analysis of the microbiota, irrespective of the searched species. An accurate definition of the shifts of the bacterial community might help periodontal researchers for a better understanding of the impact of different treatment approaches or in intercepting nonresponsive conditions.

Toothpaste-Induced Oral Mucosal Desquamation.

Oral mucosal desquamation is a common scenario in a number of pathologic conditions, suchas chemical and electrical burns, allergic reactions, hormonal disorders, and mucocutaneous alterations. There are, to the authors’ knowledge, only a few studies describing specific oral care products as a cause of mucosal desquamative lesions.3Y5 Eleven patients presented to our observation between September 2015 and February 2016, showing mucosal alterations of the oral vestibule, consisting of whitish-grey areas with detachment of a thin epithelial layer. These lesions were asymptomatic, and the underlying tissue appeared unaltered (Fig. 1). Every examined patient reported the use of the same toothpaste, recently put on the market (AZ Pro-Expert; Procter & Gamble, Cincinnati, Ohio). Samples of desquamated mucosa were retrieved from each patient with a gentle brushing action, and histological analysis was performed. The constant histological finding was represented by an alteration in the maturation process of the epithelium. The samples harvested were composed by desquamated keratinocytes, characterized by hypodysmaturation. Parakeratosis is a well-defined condition, showing the incomplete maturation of epidermal keratinocytes and an abnormal retention of nuclei in the stratum corneum, which appears thin and ready to exfoliate. Conversely, the pattern observed here indicates a stimulus to maturation hindering the complete growing phase, bringing anisocoric shapes of voluminous cells with big irregular nuclei (Fig. 2). Unfortunately, in the histological analysis, the underlying tissue conditions could not be examined because of the harvesting technique (full-thickness biopsies were not performed because they were not indicated both from clinical and ethical point of view). Furthermore, discontinuing the use of the aforementioned toothpaste resulted in rapid healing, with restitutio ad integrum, for all the patients. During the 1990s, a ‘‘dentifrice reaction’’ was identified after the use of toothpastes containing sanguinaria3; more recently, the acronym ‘‘TIME’’ (toothpaste-induced mucosal etching) was assigned to specific lesions, characterized by strong cellular edema, comparable with a chemical/physical insult.5 Although some evidence of mucosal alterations related to the use of oral care products is detectable in the unofficial literature, to date, no works clarify the etiological mechanism or pathophysiology of the lesions. Considering our cases, it must be noted that AZ Pro-Expert has a formulation with an extremely low water content (0.5%Y1%) if compared with other toothpastes (30%Y50%), to stabilize stannous fluoride in the compound. This feature could be a key to explain the uncommon mucosal response, more than a direct action of the stannous fluoride on the tissues. Hypersensitivity reaction could be reasonably excluded both for the lack of clinical signs on the underlying tissue and for the complete absence of eosinophils in the

The 1st Baltic Osseointegration Academy and Lithuanian University of Health Sciences Consensus Conference 2016. Summary and Consensus Statements: Group I - Peri-Implantitis Aetiology, Risk Factors and Pathogenesis

ABSTRACT Introduction The task of Group 1 was to review and update the existing data concerning aetiology, risk factors and pathogenesis of peri-implantitis. Previous history of periodontitis, poor oral hygiene, smoking and presence of general diseases have been considered among the aetiological risk factors for the onset of peri-implant pathologies, while late dental implant failures are commonly associated with peri-implantitis and/or with the application of incorrect biomechanical forces. Special interest was paid to the bone cells dynamics as part of the pathogenesis of peri-implantitis. Material and Methods The main areas indagated by this group were as follows: influence of smoking, history of periodontitis and general diseases on peri-implantitis development, bio-mechanics of implant loading and its influence on peri-implant bone and cellular dynamics related to the pathogenesis of peri-implantitis. The systematic reviews and/or meta-analyses were registered in PROSPERO, an international prospective register of systematic reviews: http://www.crd.york.ac.uk/PROSPERO/. The literature in the corresponding areas of interest was screened and reported following the PRISMA (Preferred Reporting Item for Systematic Review and Meta-Analysis) Statement: http://www.prisma-statement.org/. Method of preparation of the systematic reviews, based on comprehensive search strategies, was discussed and standardized. The summary of the materials and methods employed by the authors in preparing the systematic reviews and/or meta-analyses is presented in Preface chapter. Results The results and conclusions of the review process are presented in the respective papers. One systematic review with meta-analysis, three systematic reviews and one theoretical analysis were performed. The group′s general commentaries, consensus statements, clinical recommendations and implications for research are presented in this article.