A conceptual review on reconstructive peri‐implantitis therapy: Challenges and opportunities
Abstract Objectives The current strategies to reconstruct lost peri‐implant tissues due to the disease have been largely unpredictable. The aim of this conceptual review is to discuss relevant biological and biomechanical challenges of applying reconstructive means to treat peri‐implantitis. Additio...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2023-10-01
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| Series: | Clinical and Experimental Dental Research |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/cre2.788 |
| _version_ | 1797657955228712960 |
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| author | Hsun‐Liang Chan Amanda Rodriguez Betancourt Chun Ching Liu Yi‐Chen Chiang Patrick R. Schmidlin |
| author_facet | Hsun‐Liang Chan Amanda Rodriguez Betancourt Chun Ching Liu Yi‐Chen Chiang Patrick R. Schmidlin |
| author_sort | Hsun‐Liang Chan |
| collection | DOAJ |
| description | Abstract Objectives The current strategies to reconstruct lost peri‐implant tissues due to the disease have been largely unpredictable. The aim of this conceptual review is to discuss relevant biological and biomechanical challenges of applying reconstructive means to treat peri‐implantitis. Additionally, opportunities to improve treatment predictability are presented. Material and Methods A narrative review was conducted to fulfill the aim. Results The four interrelated negative conditions hampering effective reconstruction are: inferior tissue perfusion, unfavorable bone topography, ineffective surface treatment, and unstable wound. First, peri‐implant tissues resemble scars with reduced cellularity and vascularity, coupled with the absence of the periodontal ligament plexuses and the avascular implant and biomaterials, maintaining primary closure is a challenge, which is critical for regeneration. Second, defect morphology and bone topography surrounding implants determine the reconstructive potential. Unfortunately, noncontained defects are frequently encountered, with a combination of suprabony (horizontal bone loss) and infrabony (vertical usually involving circumferential bone loss) defects. Third, current attempts for implant surface decontamination are insufficient due to inaccessible macrostructure and rough surfaces in the micro‐scale. Histologic evaluation has shown bacteria aggregation and calcified deposits around implants. Lastly, wound stability is difficult to achieve due to inherent soft tissue biomechanical quality and quantity deficiencies and mobile bone particulates. Opportunities to tackle the abovementioned challenges include the use of novel imaging technologies, such as high‐frequency dental ultrasound and laser speckle imaging to evaluate tissue perfusion, soft tissue quality/quantity, and bone topography pre‐surgically. The use of the operating microscope could allow better visualization and removal of etiologic factors. Strategies to improve soft tissue quality may include preoperative control of soft tissue inflammation and the potential use of biologics. Methods such as fixation to stabilize the biomaterials could be beneficial. Conclusions A more nuanced understanding of the current challenges and opportunities can lead to more effective preoperative and postoperative care protocols, ultimately improving the success rate of reconstructive procedures. |
| first_indexed | 2024-03-11T17:52:00Z |
| format | Article |
| id | doaj.art-7eb94902038542bb821fe7d3ed99533e |
| institution | Directory Open Access Journal |
| issn | 2057-4347 |
| language | English |
| last_indexed | 2024-03-11T17:52:00Z |
| publishDate | 2023-10-01 |
| publisher | Wiley |
| record_format | Article |
| series | Clinical and Experimental Dental Research |
| spelling | doaj.art-7eb94902038542bb821fe7d3ed99533e2023-10-18T03:37:29ZengWileyClinical and Experimental Dental Research2057-43472023-10-019573574510.1002/cre2.788A conceptual review on reconstructive peri‐implantitis therapy: Challenges and opportunitiesHsun‐Liang Chan0Amanda Rodriguez Betancourt1Chun Ching Liu2Yi‐Chen Chiang3Patrick R. Schmidlin4Department of Periodontics and Oral Medicine The University of Michigan School of Dentistry Ann Arbor Michigan USADepartment of Periodontics and Oral Medicine The University of Michigan School of Dentistry Ann Arbor Michigan USACenter of Dental Medicine, Division of Periodontology and Peri‐implant diseases, Clinic of Conservative and Preventive Dentistry University of Zurich Zurich SwitzerlandDepartment of Periodontics and Oral Medicine The University of Michigan School of Dentistry Ann Arbor Michigan USACenter of Dental Medicine, Division of Periodontology and Peri‐implant diseases, Clinic of Conservative and Preventive Dentistry University of Zurich Zurich SwitzerlandAbstract Objectives The current strategies to reconstruct lost peri‐implant tissues due to the disease have been largely unpredictable. The aim of this conceptual review is to discuss relevant biological and biomechanical challenges of applying reconstructive means to treat peri‐implantitis. Additionally, opportunities to improve treatment predictability are presented. Material and Methods A narrative review was conducted to fulfill the aim. Results The four interrelated negative conditions hampering effective reconstruction are: inferior tissue perfusion, unfavorable bone topography, ineffective surface treatment, and unstable wound. First, peri‐implant tissues resemble scars with reduced cellularity and vascularity, coupled with the absence of the periodontal ligament plexuses and the avascular implant and biomaterials, maintaining primary closure is a challenge, which is critical for regeneration. Second, defect morphology and bone topography surrounding implants determine the reconstructive potential. Unfortunately, noncontained defects are frequently encountered, with a combination of suprabony (horizontal bone loss) and infrabony (vertical usually involving circumferential bone loss) defects. Third, current attempts for implant surface decontamination are insufficient due to inaccessible macrostructure and rough surfaces in the micro‐scale. Histologic evaluation has shown bacteria aggregation and calcified deposits around implants. Lastly, wound stability is difficult to achieve due to inherent soft tissue biomechanical quality and quantity deficiencies and mobile bone particulates. Opportunities to tackle the abovementioned challenges include the use of novel imaging technologies, such as high‐frequency dental ultrasound and laser speckle imaging to evaluate tissue perfusion, soft tissue quality/quantity, and bone topography pre‐surgically. The use of the operating microscope could allow better visualization and removal of etiologic factors. Strategies to improve soft tissue quality may include preoperative control of soft tissue inflammation and the potential use of biologics. Methods such as fixation to stabilize the biomaterials could be beneficial. Conclusions A more nuanced understanding of the current challenges and opportunities can lead to more effective preoperative and postoperative care protocols, ultimately improving the success rate of reconstructive procedures.https://doi.org/10.1002/cre2.788microsurgeryperi‐implantitisultrasonographywound healing |
| spellingShingle | Hsun‐Liang Chan Amanda Rodriguez Betancourt Chun Ching Liu Yi‐Chen Chiang Patrick R. Schmidlin A conceptual review on reconstructive peri‐implantitis therapy: Challenges and opportunities Clinical and Experimental Dental Research microsurgery peri‐implantitis ultrasonography wound healing |
| title | A conceptual review on reconstructive peri‐implantitis therapy: Challenges and opportunities |
| title_full | A conceptual review on reconstructive peri‐implantitis therapy: Challenges and opportunities |
| title_fullStr | A conceptual review on reconstructive peri‐implantitis therapy: Challenges and opportunities |
| title_full_unstemmed | A conceptual review on reconstructive peri‐implantitis therapy: Challenges and opportunities |
| title_short | A conceptual review on reconstructive peri‐implantitis therapy: Challenges and opportunities |
| title_sort | conceptual review on reconstructive peri implantitis therapy challenges and opportunities |
| topic | microsurgery peri‐implantitis ultrasonography wound healing |
| url | https://doi.org/10.1002/cre2.788 |
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