Peri-Implantitis Clinical Trial
Official title:
Sensitivity and Specificity of Peri-Implantitis-Related Parameters: A Case-Control Study
Bleeding on probing demonstrated to have high specificity with certain level of sensitivity
to detect periodontal disease. Again, understanding the weak hemidesmosome attachment to the
implant surface is imperative to discern on the probe penetration extent and subsequent
bleeding. In the presence of inflammation, bleeding should be present indicating high
sensitivity when probing deeper sites; nevertheless the lack thereof in healthy condition
does not seem to translate high specificity. In this sense, it is noteworthy to mention that
the mucogingival shift after implant placement often decreases the presence of keratinized
mucosa, triggering a greater inflammatory condition on the peri-implant tissues. Thereupon,
bleeding on probing, although might reliably indicate presence of disease, it does not seem
to be a suitable diagnostic parameter. On the other side, suppuration characterizes the
necrosis of peri-implant tissues, being rich in polymorphonuclear cells and as such, a
sensitive indicator of bone turnover. In this sense, it must be noted that, if detected in
early stages where bone resorption has not occurred yet, it might be a consequence of a
foreign body reaction (i.e., residual cement or floss).
Therefore, in the diagnosis of peri-implantitis, radiographic examination must be always
incorporated to the clinical assessment as the 'gold standard'. Hence, the aim of this
case-control study was to assess the diagnostic accuracy of peri-implantitis-related
clinical parameters compared to otherwise healthy dental implants.
All subjects enrolled had to be consecutively evaluated in a routine peri-implant
maintenance t with dental implants for fixed prosthesis rehabilitation with a minimum period
of 12 months after final prosthesis delivery. Patients were contacted and informed to
participate in a cross-sectional assessment to identify the presence of peri-implant
diseases. Eligible implants had to be in an ideal prosthetically driven position, otherwise
they were excluded from the analysis. Moreover, implants that could not be accurately
recorded the probing depth due to inadequate prosthesis design were further excluded.
Baseline periapical x-ray at time of prosthesis delivery was retrospective assessed to
exclude implants with early peri-implant bone loss before function. A detailed description
of risk factors and indicators of peri-implant disease were explained at the same stage.
Additionally, patients were thoroughly instructed on plaque control home care strategies
including but not limited to interdental brushes with nylon-coated core wire, soft
toothbrushes (manual and power) and floss with stiffened end to clean under multiple units
fixed-prosthesis. Moreover, treated patients were encouraged to routinely enroll in a
peri-implant maintenance therapy program.
The present case-control study will be conducted in accordance with the Helsinki declaration
of human studies and received approval from the ethics committee from the University of
Extremadura (Badajoz, Spain). An informed written consent was signed from each subject
enrolled in the present study.
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