Journal of Periodontal and Implant Science最新文献

Purpose: The aim of this study was to clinically and radiographically investigate the effect of soft tissue grafting as an adjunct in the surgical treatment of ligature-induced peri-implantitis lesions in canines.

Methods: Seven Mongrel dogs received implant placements on both sides of the posterior mandible (3 fixtures per side). After inducing peri-implantitis via ligation with suture material, surgical treatment was performed on each implant according to randomly assigned groups: DI, implantoplasty only; DIB, implantoplasty followed by collagenated, deproteinized bovine bone mineral (DBBM-C) grafting; DIC, implantoplasty followed by autogenous connective tissue graft (CTG); DIV, implantoplasty followed by volume-stable collagen matrix (VCMX) grafting; DIBC, implantoplasty followed by DBBM-C grafting and CTG; and DIBV, implantoplasty followed by DBBM-C and VCMX grafting. Clinical and radiographic outcomes were evaluated. Composite treatment success was defined by the following criteria: absence of bleeding on probing at 12 weeks post-surgery; a reduction in probing depth (PD) or an increase of 1 mm or less in PD at 12 weeks post-surgery; and absence of additional bone loss ≥0.5 mm at 12 weeks post-surgery compared to radiographic baseline. Statistical significance was set at P<0.05.

Results: All groups exhibited clinical and radiographic improvement after surgery. Clinical parameters, radiographic bone levels, and mucosal thickness did not significantly differ among the groups. The DI and DIV groups demonstrated higher composite treatment success rates (71.4%) compared to the other 4 groups. Adjunctive soft tissue grafting resulted in fewer changes in peri-implant mucosa. The effect of hard tissue grafting on bone regeneration was minimal, and combining hard and soft tissue grafting did not yield better outcomes than implantoplasty alone.

Conclusions: The surgical treatment of peri-implantitis lesions remains challenging. Soft tissue grafting showed clinical benefits by reducing changes in the peri-implant mucosa. The effect of hard tissue grafting on bone regeneration was very limited.

Purpose: This study was conducted to compare the clinical efficacy and patient-reported outcomes of de-epithelialized gingival graft (DGG) alone versus DGG combined with leukocyte platelet-rich fibrin (L-PRF) for the treatment of multiple adjacent gingival recessions using a coronally advanced flap technique.

Methods: In this split-mouth randomized controlled trial, 15 patients with multiple gingival recessions affecting at least 3 adjacent teeth were treated on one side with DGG only (termed the DGG group) and on the contralateral side with DGG and L-PRF (the DGG+PRF group). Clinical parameters-recession depth, recession width, probing depth, clinical attachment level, keratinized tissue width, gingival thickness, and percentage of root coverage (RC%)-were recorded at 1 month, 3 months, and 6 months postoperatively. Patient-reported outcome measures, including Oral Health Impact Profile-14 scores, postoperative pain, bleeding, discomfort, and analgesic consumption, were also assessed.

Results: At T6, the mean RC% was 93.30%±6.97% in the DGG group and 95.28%±4.99% in the DGG+PRF group, with no statistically significant difference observed. Patients receiving DGG+PRF reported significantly lower discomfort on days 2, 3, and 5 and reduced pain on days 6 and 7 relative to the DGG group.

Conclusions: Combining L-PRF with DGG achieves root coverage outcomes comparable to DGG alone, while significantly reducing early postoperative discomfort and morbidity.

Purpose: This study aimed to evaluate and compare the responses of an artificial intelligence (AI)-powered chatbot and professional periodontists to patient queries in periodontology and implantology, using the Korean Academy of Periodontology's (KAP) online question and answer (Q&A) section.

Methods: In this comparative cross-sectional study, we analyzed 219 patient-submitted periodontal and implant knowledge questions from the KAP online Q&A section. A panel of 10 evaluators-5 periodontists and 5 laypersons-rated both the periodontist's and the AI chatbot's responses using standardized scales. We applied the t-test and Spearman correlation coefficients to compare response quality, empathy, consistency, and evaluator preferences.

Results: Ten evaluators judged the AI chatbot's responses to be significantly superior in quality and empathy compared to periodontist replies. A higher proportion of periodontist responses fell below acceptable quality ("very poor" or "poor") than chatbot responses (28.7% vs. 15.0%; P<0.001), and more chatbot replies were rated "empathetic" or "very empathetic" (62.5% vs. 42.8%; P<0.001). Overall response consistency was deemed satisfactory at 64.2%, with no significant difference in consistency or preference between periodontist and lay evaluators.

Conclusions: AI-powered chatbots can deliver more accurate and empathetic answers than human periodontists, suggesting their potential role as consultation assistants merits further investigation. The high intraclass correlation coefficient values (0.79-0.93) indicate a high level of agreement among evaluators in both the periodontist and lay evaluator groups, thus confirming the reliability and robustness of the study's assessment methodology.

Purpose: The identification of specific target molecules and their appropriate cut-off values is crucial for the successful development of in vitro diagnostics. Salivary biomarkers, such as interleukin-1β (IL-1β) and matrix metalloproteinase-8 (MMP-8), have been investigated for their potential in diagnosing periodontal disease. This study aimed to evaluate the efficacy of IL-1β and MMP-8 as diagnostic tools and to establish their cut-off values for distinguishing active types of periodontal disease from healthy conditions.

Methods: We conducted a prospective cohort study involving 47 participants, who were divided into 2 groups: the control group consisted of 24 individuals with healthy or mild periodontal conditions (stages I-II of periodontal disease), and the periodontal group comprised 23 individuals with moderate to severe periodontal disease (stages III-IV). Saliva samples were collected from all participants, followed by an oral examination, periodontal charting, and radiographic assessments. The salivary concentrations of IL-1β and MMP-8 were quantified using enzyme-linked immunosorbent assays.

Results: Significant differences in salivary levels of IL-1β and MMP-8 were observed between the control group and those with periodontal disease. However, after adjusting for age and sex, these differences were not statistically significant for IL-1β. In contrast, the differences remained significant for MMP-8 in participants classified as having an active type of periodontal disease, specifically those in the periodontal group with more than 10% bleeding on probing. By setting a cut-off value of 200 ng/mL for salivary MMP-8, the sensitivity and specificity for diagnosing active periodontal disease were determined to be 70% and 86.5%, respectively.

Conclusions: Our findings indicate that salivary MMP-8, using a cut-off value of 200 ng/mL, serves as a reliable biomarker for identifying active periodontal disease. This biomarker holds potential for further development into a diagnostic tool in in vitro settings, which could improve the early detection and management of periodontal disease.

Purpose: Implant stability testing is crucial for verifying osseointegration before prosthetic loading. Several methods have been developed to assess osseointegration. Among these, damping capacity analysis (DCA) devices offer a user-friendly and non-invasive approach. In this study, we evaluated the accuracy and reliability of newly available DCA devices in assessing dental implant stability.

Methods: This study included 58 implants from 37 patients over a 1-month period. Three measurements per implant were obtained with healing abutments in place, following the manufacturers' guidelines, using the DCA-P (Periotest M, Medizintechnik Gulden), DCA-A (Anycheck, Neobiotech), and DCA-T (The Trust, Dentium) devices. Factors such as healing abutment height, time since placement, bone grafting, fixture diameter, and fixture length were evaluated. Accuracy was assessed using DCA-P as the reference, and reproducibility was statistically analyzed using 3 measurements per implant. Statistical analyses were performed with SPSS Statistics 23.0 (IBM Corp.).

Results: All implants that passed the stability tests using DCA devices were restored with definitive prostheses and showed no signs of early failure. The DCA-A value demonstrated a very strong correlation with the DCA-P value (DCAV-P), whereas the DCA-T value exhibited only a moderate correlation with DCAV-P. DCA-P also showed the highest reliability, followed by DCA-A and then DCA-T. The reliability of DCA-A and DCA-T was not significantly affected by any of the assessed factors; in contrast, DCA-P's reliability was significantly influenced by arch location and specific quadrant position.

Conclusions: With DCA-P as the reference, DCA-A demonstrated superior accuracy compared to DCA-T. Although DCA-P exhibited the highest reliability, its performance was significantly affected by the positional factors of the target implant.

Purpose: The aim of this study was to evaluate the diagnostic and classification performance of a deep learning (DL) model for peri-implantitis-related bone defects using panoramic radiographs, focusing on defect morphology and severity.

Methods: A dataset comprising 1,075 panoramic radiographs from 426 patients with peri-implantitis was analyzed. A total of 2,250 implant sites were annotated and categorized based on defect morphology (intraosseous [class I], supracrestal/horizontal [class II], or combined [class III]) and severity (slight, moderate, or severe). The ensemble-based YOLOv8 DL model was trained on 80% of the dataset, with the remaining 20% reserved for testing. Performance was assessed using classification metrics, including accuracy, precision, recall, and F1 score. The diagnostic accuracy of the DL model was also compared with that of 2 board-certified periodontal surgeons.

Results: The DL model achieved an overall accuracy of 85.33%, significantly outperforming the periodontal surgeons, who exhibited a mean accuracy of 75.6%. The DL model performed especially well for slight class II defects, with precision and recall values of 100% and 98%, respectively. In contrast, the periodontal surgeons demonstrated higher accuracy in severe cases, particularly for class II defects.

Conclusions: DL enables reliable and accurate detection of peri-implantitis bone defects. It outperformed periodontal surgeons in overall accuracy, demonstrating its potential as a valuable second-opinion tool to support clinical decision-making. Future research should focus on expanding datasets and incorporating multimodal imaging.

Purpose: The aim of this study was to determine predictors of implant treatment failure after alveolar ridge preservation (ARP).

Methods: The study included patients who received implant treatment after ARP between 2014 and 2020. The demographic, clinical, and radiographic data of these patients were collected. Implant success was defined as the absence of pain or tenderness, no mobility, a change of <2 mm in marginal bone level, and no exudation. A Cox proportional hazards model with shared frailty was used to estimate hazard ratios (HRs) for the demographic, clinical, and radiographic factors contributing to implant failure.

Results: The study included 528 implants from 412 patients. The cumulative success rate over 3.5±1.8 years (mean ± standard deviation) was 89.0% (95% confidence interval [CI], 85.4%-92.8%), with 43 failed implants. The multiple Cox proportional hazards model with shared frailty indicated that a pristine bone engagement (PBE) of <1.1 mm was significantly associated with implant failure (HR, 2.50; 95% CI, 1.34-4.67; P=0.004).

Conclusions: PBE of at least 1.1 mm appears to decrease the probability of implant failure after ARP.

Purpose: This review was conducted to systematically assess the impact of bisphosphonates (BPs) and denosumab, used as anti-resorptive therapies, on the incidence of dental implant failure.

Methods: Electronic and manual searches were performed in accordance with the described search protocol. Only articles that met the inclusion criteria were selected. The primary outcome was implant failure, while secondary outcomes included biological complications and comorbidities. Following data extraction, a quality assessment and meta-analysis were conducted.

Results: Fourteen eligible studies were included in the analysis following a qualitative evaluation. BP administration, regardless of the timing of anti-resorptive therapy, did not significantly increase the risk of implant failure (odds ratio [OR], 1.40; 95% confidence interval, 0.83-2.34). Subgroup analysis revealed a slightly higher, although statistically insignificant, risk of failure in patients with a follow-up period of 3 years or more compared to those with a follow-up duration of less than 3 years (with ORs of 2.82 and 1.53, respectively). Due to a lack of eligible studies, a meta-analysis for denosumab could not be conducted.

Conclusions: Our findings suggest that BP treatment does not compromise the survival of dental implants. Specifically, in patients with osteoporosis, implant failure rates were not significantly influenced by the administration of BPs before the placement of dental implants, suggesting that low-dose BP therapy may not contraindicate implant placement. Nevertheless, regular check-ups and maintenance periodontal treatment must not be neglected, and concomitant biological factors should be considered to ensure the long-term success of implant rehabilitation.

Purpose: This study retrospectively investigated the long-term clinical and radiographic outcomes of a bone-level type, 2-piece, internal connection dental implant system characterized by coronal microthreads.

Methods: A total of 872 implants placed in 284 patients were selected from 1,845 implants placed in 691 patients by experienced periodontists at Yonsei University Dental Hospital. These selected implants had been followed up for over 10 years and were included in the present study. A statistical evaluation of implant survival and treatment success, based on changes in marginal bone levels, was conducted using electronic records and consecutively taken radiographs.

Results: Over a follow-up period of 12.3±2.0 years, 830 of the 872 implants remained intact, yielding a cumulative survival rate of 95.2% at the implant level and 88.4% at the patient level. The cumulative treatment success rates, characterized by marginal bone loss of less than 2 mm, stood at 87.0% for implants and 76.1% for patients. Among the 830 surviving implants, 113 fixtures were classified as ailing, with an average marginal bone loss of 4.09±1.44 mm. Cox regression analysis revealed that implants 8 mm in length or shorter were significantly more likely to fail or experience pathologic marginal bone resorption, with hazard ratios of 3.71 and 2.00, respectively (P<0.05).

Conclusions: The survival and treatment success of the investigated microthreaded, bone-level, 2-piece, internal connection implants were acceptable over a follow-up period exceeding 10 years. However, shorter dental implants exhibited a higher propensity for failure and excessive marginal bone loss.

Purpose: We examined the progression of experimental peri-implantitis in sites that underwent either alveolar ridge preservation (ARP) or spontaneous healing (SH), comparing infected teeth (IT) and non-infected teeth (NIT). This investigation is a secondary analysis of a preclinical study aimed at exploring the correlation between newly formed bone and implant stability quotient (ISQ), as well as the association between newly formed bone and the progression of experimental peri-implantitis.

Methods: The bilateral mandibular third or fourth premolars of 6 beagle dogs were randomly assigned to 4 groups: IT/SH, IT/ARP, NIT/SH, and NIT/ARP. Following implant placement, core biopsies were retrieved from each site, and the ISQ value was measured. A 3-month period was allowed for peri-implantitis induction, followed by an additional 3 months for the spontaneous progression of peri-implantitis, with radiographs taken at each time point.

Results: During the spontaneous progression of peri-implantitis, no statistically significant differences were observed among the groups in terms of mean ISQ values and radiographic marginal bone loss. Similarly, the percentages of bone substitute, newly formed bone, and fibrovascular connective tissue in core biopsies did not differ significantly among the groups. Linear regression analysis revealed no significant linear correlation between newly formed bone and ISQ in any group (P>0.05). However, a weak linear correlation between newly formed bone and marginal bone loss during the spontaneous progression of peri-implantitis was noted in the IT/SH group alone (P=0.036).

Conclusions: Within the limitations of this study, we were unable to demonstrate that ARP could improve newly formed bone or primary implant stability. Furthermore, neither ARP nor SH significantly influenced the spontaneous progression of experimental peri-implantitis.