Chinese Journal of Oral Implantology

Preface for the key column on peri-implantitis

2023, 28(6): 392-393. DOI: 10.12337/zgkqzzxzz.2023.12.001

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Treatment decision-making and prognosis assessment of peri-implantitis

Xu Shulan, Zhu Yuanxi

2023, 28(6): 394-401. DOI: 10.12337/zgkqzzxzz.2023.12.002

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Peri-implantitis is a common biological complication of dental implant treatment, and it is one of the significant causes of implant failure as well. The treatment decision-making and prognosis assessment of peri-implantitis present two major problems for implantologists in clinical practice. Evidence-based treatment decision-making and accurate prognosis assessment could help doctors propose appropriate treatment approaches and guide patients to conduct oral self-care and systemic factors control according to their own conditions, aiming for more a streamlined treatment process and better clinical outcomes. This literature review provides a comprehensive overview of the treatment decision-making and prognosis assessment of peri-implantitis, discusses its research progress and clinical recommendations, and puts forth suggestions for further research.

Recent advances in the factors affecting the pathogenesis, diagnosis, and treatment of peri-implantitis

Yan Fuhua, Song Shiyuan

2023, 28(6): 402-409. DOI: 10.12337/zgkqzzxzz.2023.12.003

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Oral implant therapy is one of the most common methods for restoring defective and missing dentition. Peri-implantitis is a prevalent biological complication of implant therapy, characterized by inflammation of the peri-implant mucosa and subsequent progressive loss of supporting bone. The occurrence of peri-implantitis can impact the prognosis of implant restorations or even lead to implant failure, significantly affecting the patient's health and quality of life. Therefore, reducing the risk factors of peri-implantitis, timely diagnosis and effective treatments are of great importance to enhance the prognosis of implant therapy. This review describes the factors influencing the pathogenesis of peri-implantitis, the current diagnostic criteria, and therapeutic methods. Furthermore, it discusses emerging treatment modalities with potential clinical applications and reviews ongoing research progress.

Inhibition of Porphyromonas gingivalis by hydrophilic titanium surface modified with cinnamaldehyde

Ou Yanjing, Lu Jie, Chen Jiang

2023, 28(6): 410-416. DOI: 10.12337/zgkqzzxzz.2023.12.004

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Objective Mechanical debridement exhibits a poor prognosis in the treatment of peri-implantitis, necessitating the adjunctive use of local antimicrobial agents. Cinnamaldehyde (CA) possesses antimicrobial properties, yet its application in peri-implantitis remains unclear. This study aimed to investigate the inhibitory effects of cinnamaldehyde on the primary pathogen, Porphyromonas gingivalis (P.gingivalis), in peri-implantitis. Furthermore, the study explored the loading of cinnamaldehyde onto titanium surfaces through plasma plus alkali and heat treatment for potential in vivo applications. Methods The minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of cinnamaldehyde on P.gingivalis were determined by serial dilution. Its impact on gingipain activity of P.gingivalis was evaluated. Subsequently, titanium surfaces were subjected to alkali and heat treatment combined with or without plasma treatment to assess its hydrophilicity, drug-loading capacity, and sustained release of cinnamaldehyde. P.gingivalis cultures on differently treated titanium surfaces were examined for antimicrobial properties. Results The MIC and MBC of cinnamaldehyde on P.gingivalis were found to be 21.12 μg/mL and 42.24 μg/mL, respectively. Cinnamaldehyde at 1/2 and 1/4 MIC significantly inhibited the gingipain produced by P.gingivalis. Alkali and heat treatment with or without plasma treatment significantly enhanced the hydrophilicity of titanium surfaces and facilitated cinnamaldehyde loading, exerting inhibitory effects on the adhesion and growth of P.gingivalis. The composite treatment outperformed the alkali and heat treatment alone in terms of loading capacity and antimicrobial efficacy on P.gingivalis. Conclusion Cinnamaldehyde effectively inhibits the growth and virulence of P.gingivalis. Plasma-alkali composite treatment enables successful loading of cinnamaldehyde, augmenting the antibacterial properties of titanium surfaces and offering promise for peri-implantitis prevention and therapy.

Evaluation of the clinical effects of Er, Cr: YSGG laser in the treatment of peri-implantitis

Sun Fei, Wang Cui, Hu Wenjie

2023, 28(6): 417-423. DOI: 10.12337/zgkqzzxzz.2023.12.005

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Objective To evaluate changes in clinical parameters using Er, Cr: YSGG laser compared to submucosal debridement for the non-surgical treatment of early peri-implantitis. Methods Twenty-eight patients and 28 implants with early peri-implantitis were recruited. The patients were randomly divided into a test group and a control group. The test group (14 subjects/14 implants) was treated with Er, Cr: YSGG laser, and the control group (14 subjects/14 implants) received mechanical submucosal debridement using a titanium curettage and chlorhexidine irrigation. Clinical parameters, such as modified plaque index (mPI), peri-implant pocket probing depth (PD), and bleeding index (BI), were measured at baseline, 2 months, and 3 months after treatment. Differences in clinical parameters before and after treatment were compared. Results The mPI, PD and BI of both the test group and control group significantly reduced at 2 and 3 months after non-surgical intervention (P<0.05). Compared to the control group, the test group significantly achieved a reduction in BI value at 2 and 3 months after treatment (1.67 ± 0.45 vs. 2.40 ± 0.55, P=0.001; 1.07 ± 0.38 vs. 2.09 ± 0.83, P<0.001). Both the control and test group exhibited comparable mPI and PD reductions (P>0.05). The treatment success rates were 28.6% and 7.1% at the patient level (P=0.037) and 70.2% and 48.8% at the site level (P=0.012), respectively. Conclusion Er, Cr: YSGG laser for the treatment of early peri-implantitis may be used as an alternative to hand instrumentation to reduce soft tissue inflammation.

Application of platform technology in the treatment of peri-implantitis combined with implant infraposition in the aesthetic zone: a case report and literature review

Lin Zhihui, Wang Xi, Man Yi

2023, 28(6): 424-429. DOI: 10.12337/zgkqzzxzz.2023.12.006

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In the process of long-term functional use of implant-supported dentures, the occurrence of peri-implant biological complications is often difficult to avoid due to various factors such as the patient's overall health condition, surgical procedures, implant restorations, and prosthetic techniques. Additionally, during the long-term clinical follow-up of patients with aesthetic zone implant restorations, it is often observed that the incisal edge of implant restoration is positioned lower towards the root compared to the contralateral natural tooth, indicating implant infraposition. This article reports a case of aesthetic zone implant peri-implantitis combined with implant infraposition treated using platform techniques. In this case, non-surgical treatment was used to control inflammation in the surgical area before the surgery, and connective tissue platform techniques were employed during the surgery to increase soft tissue volume around the implant. Temporary restoration was performed after 3 months postoperatively, followed by the final restoration after 6 months. Short-term treatment results showed that for cases of aesthetic zone implant peri-implantitis combined with implant infraposition, the use of connective tissue platform techniques can effectively achieve soft tissue reconstruction in the surgical area and reduce aesthetic risks.

Follow-up maintenance compliance and related factors in implant restoration patients: current status and outlook

Song Jiaying, Chen Zhuofan, Huang Baoxin

2023, 28(6): 430-436. DOI: 10.12337/zgkqzzxzz.2023.12.007

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Regular follow-up and periodontal and peri-implant maintenance is a guarantee for the long-term success of implant restorations. However, the follow-up compliance of patients with dental implants is not optimistic. Fully understanding the importance of maintenance and the factors related to patients' compliance is helpful to enhance patients' compliance with maintenance and then improve the long-term success of dental implants. Therefore, this review describes the impact of maintenance on implant restorations and the factors related to patients’ compliance.

Surface decontamination in peri-implantitis management

Dong Xiaoxiao

2023, 28(6): 437-443. DOI: 10.12337/zgkqzzxzz.2023.12.008

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Surface decontamination of implants is much more difficult than that of natural teeth. Incomplete decontamination is the main reason causing peri-implantitis treatment failure. This article reviews the implant surface decontamination modalities: mechanical decontamination methods, chemical decontamination methods and physical methods. Mechanical decontamination methods are the treatment most well documented. It is the foundation for peri-implantitis treatment. Nowadays, there is no gold standard for management of peri-implantitis. A combination of different decontamination modalities is recommended.

Biological properties of 3D printed bionic titanium mesh and polyurethane coating on the effect of bone augmentation after titanium mesh exposure

Han Zhenjia, Wang Xinyu, Dong Meixi, Zhang Liang, Han Zekui, Su Yucheng, Zang Yixin, Duan Feng

2023, 28(6): 444-450. DOI: 10.12337/zgkqzzxzz.2023.12.009

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Objective To observe the bone augmentation effect of spiderweb-shaped customized titanium mesh after exposure, and to investigate whether polyurethane coating of titanium mesh could reduce the infection rate. Methods Six Beagle dogs were selected, and the second and third premolars on both sides of the mandibles were virtually removed to construct the bone defect models. The spiderweb-structured customized titanium meshes and osteotomy guides were designed and printed. The titanium meshes were treated with acid etching and polyurethane coating, respectively. Guided bone regeneration (GBR) was performed in the mandibles of Beagle dogs bilaterally. The titanium mesh exposure models were established by feeding bait 2 weeks after GBR. Six Beagle dogs were executed 3 months later. The effect of alveolar bone augmentation after titanium mesh exposure in each group was analyzed by gross observation, CBCT analysis and microscope observation. Results There were 3 kinds of results at 12 sites of titanium mesh exposure: ① Titanium mesh detachment with soft tissue healing;② Titanium mesh in place with persistent exposure; ③ Titanium mesh in place with soft tissue healing. Among them, 2 acid etching sites and 1 polyurethane coating site showed different degrees of infection symptoms. The results of CBCT volume ratio calculation and microscope showed that 35% ± 13% osteogenesis in the titanium mesh detachment group, and 48% ± 8% osteogenesis in the titanium mesh exposed healing group was significantly higher than the 27% ± 10% in the exposed persistence group (P<0.05). The titanium mesh exposed healing group was higher than the titanium mesh detachment group (P>0.05). Conclusion Customized titanium mesh can still form new bone after early exposure, the best osteogenesis results were achieved with post-exposure healing. The infection rate after polyurethane coating was slightly lower than that of acid etching group, and the difference between the two groups was 16.6%.

Study on the preparation and antibacterial properties of polytetrafluoroethylene film modified customized titanium mesh

Yang Bo, Han Zekui, Dai Haoran, Zhang Liang, Zang Yixin, Wang Xinyu, Su Yucheng

2023, 28(6): 451-459. DOI: 10.12337/zgkqzzxzz.2023.12.010

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Objective By preparing polytetrafluoroethylene film on the surface of customized titanium mesh, the biocompatibility and antibacterial ability of the surface of customized titanium mesh were improved. Methods The surface of the customized titanium mesh was sandblasted to roughen the surface by alumina and air-sprayed with PTFE dispersion. The polytetrafluoroethylene film modified customized titanium mesh (PMTM) was obtained by sintering and heat curing. The experimental groups were selective laser melting printing untreated group (CON), mechanical polishing group (MP), low-grit sandblasting group (SB), titanium-reinforced dense polytetrafluoroethylene film group (TRDP). The surface morphology, roughness, hydrophilicity, functional groups and phase composition of the samples were analyzed. The number and morphology of bacteria adhering to the surface of each group of samples after co-culture with Staphylococcus aureus and Escherichia coli were analyzed to evaluate the in vitro antibacterial ability of polytetrafluoroethylene film modified customized titanium mesh. Results The polytetrafluoroethylene film with stable bonding and a high purity is formed on the surface of the PMTM group, which reduced the micron-scale roughness and is highly hydrophobic. The number of bacteria on the surface of the CON group was the largest (P<0.001), and the numbers of bacteria on the surface of the MP and SB groups were lower. The PMTM and TRDP groups had the lowest bacterial adhesion, and their antibacterial adhesion effects were similar (P>0.05). Conclusion The preparation of polytetrafluoroethylene film on the surface of customized titanium mesh can improve its ability to inhibit bacterial adhesion, which is an ideal surface treatment method for customized titanium mesh.

Imaging correlation analysis of the occurrence of major complications of lateral window technique for sinus floor elevation

Han Bin, Ke Pinting, Lin Yanjun, Xu Zonghe, Xing Yifeng, Xu Qiyin, Wu Dong

2023, 28(6): 460-465. DOI: 10.12337/zgkqzzxzz.2023.12.011

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Objective The aim of this study was to analyze the imaging data and investigate the influence of the differences and correlations of local anatomical structures on the occurrence of major complications of lateral window technique for sinus floor elevation, in order to provide help for avoiding the occurrence of complications. Methods The maxillary sinus images of 380 patients (206 males and 174 females) were analyzed by cone-beam CT scanning to measure the width of the maxillary sinus, the angle formed by the lateral and the medial walls of the maxillary sinus at the floor of the maxillary sinus (LFM), the thickness of the lateral wall of the maxillary sinus, the thickness of the mucoperiosteum at the floor of the maxillary sinus, the diameter of the blood vessels of the lateral wall of the maxillary sinus, the height of the remaining alveolar bone, and to analyze correlations between the local anatomical factors that contributed to the development of the complications of lateral window technique for sinus floor elevation. Results Maxillary sinus width was positively correlated with LFM, and the correlation was statistically significant at all tooth sites(P<0.05). There was a positive correlation between remaining alveolar bone height and maxillary sinus lateral wall thickness, vessel diameter and lateral wall thickness, and vessel diameter and remaining alveolar bone height, and the correlation was statistically significant in some of the tooth sites (P<0.05). Conclusions The study and statistical analysis from the imaging point of view revealed that among the factors that may cause complications of lateral window technique for sinus floor elevation, the maxillary sinus width has a positive correlation with the LFM, the remaining alveolar bone height with the maxillary sinus lateral wall thickness, the blood vessel diameter with the maxillary sinus lateral wall thickness, and the blood vessel diameter with the remaining alveolar bone height.

Implant restoration of severely insufficient residual bone height and limited interarch distance in the maxillary posterior region: a case report

Xu Yehao, Dai Jieting, Ren Bihui, Wei Hongwu, Guo Shuigen

2023, 28(6): 466-472. DOI: 10.12337/zgkqzzxzz.2023.12.012

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This paper reports on the implant restoration of a case with severely insufficient residual bone height and limited interarch distance in the maxillary posterior region, aiming to provide reference value for the treatment of such patients. In this case, occlusal reconstruction of other teeth was performed first to raise a portion of the occlusion. However, after occlusal reconstruction, the interarch distance remained insufficient. Subsequently, transalveolar sinus floor elevation and bone augmentation surgery were performed at the implant sites to create stable conditions for the late implant placement with surrounding bone. A second transalveolar sinus floor elevation was performed 8 months later, with two taper-retained short implants placed deep under the bone level simultaneously. Follow-up examinations indicated good osseointegration. The peri-implant bone tissue was shown to be stable during the follow-up 2 years after the permanent restoration. Therefore, if the residual bone height and interarch distance in the maxillary posterior region are severely insufficient, transalveolar sinus floor elevation and bone augmentation can be performed first to create a stable condition for bone integration around the implant during late implant placement. Then transalveolar sinus floor elevation and the deep implant placement of short implants can be carried out during the second surgery to create sufficient restorative space for the final restoration.

Current status of virtual patient construction in implant dentistry

Chen Jinyan, Zhang Yun, Wu Yiqun, Wang Feng

2023, 28(6): 473-477. DOI: 10.12337/zgkqzzxzz.2023.12.013

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With the application of digital technology in dentistry, the construction of virtual patients can integrate multi-source digital information of patients to assist dentists in diagnosis and treatment planning, which has good prospects in dental implant therapy. The article discusses the acquisition of multi-source three-dimensional images and dynamic information, the construction of virtual patients as well as their application in the field of implant dentistry.

Exploration of online and offline blended learning mode in implant dentistry

Sun Xiaolin, Liu Jia, Zhou Yanmin, Wang Lin, Li Chunyan, A Lan, Fu Li

2023, 28(6): 478-482. DOI: 10.12337/zgkqzzxzz.2023.12.014

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Implant dentistry has rapidly developed due to the increasing attention to oral health. This has brought about opportunities and challenges in implant education. To address the limitations of traditional learning mode and the stratification between graduate and undergraduate education, as well as to integrate clinical and scientific research aspects, we propose a novel blended learning approach. The approach combines online and offline components and consists of four key elements: (1) online teacher-led Massive Open Online Course (MOOC) theoretical instruction, expanding students' knowledge and understanding; (2) offline Problem-Based Learning (PBL), Case-Based Learning (CBL), and Team-Based Learning (TBL) activities, consolidating students' foundational knowledge and clinical thinking; (3) offline practical implant training involving student participation, nurturing their clinical skills; (4) post-class Q&A sessions and showcasing of achievements through social media platforms, facilitating the presentation of students' learning outcomes. Preliminary results indicate that this blended learning mode contributes to students' learning and review of theoretical knowledge during their clinical trainings, fostering their independent learning and teamwork abilities while enhancing their interest and engagement in learning. The dental implant education method provides students with a flexible and personalized learning experience, promoting knowledge acquisition and practical skills development.

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