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Peri-implantitis is an infectious disease that causes inflammation of the tissue surrounding an implant. The aim of this systematic review of the literature is to assess the effect of the use of lasers in the nonsurgical treatment of peri-implantitis in order to estimate its benefits compared with conventional therapies. The review's protocol has been registered on PROSPERO international prospective register. The research strategy was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The inclusion criteria were as follows: in vivo studies, written in English, measurements of clinical parameters, minimum follow-up at 6 months and with nonsurgical control group, studies about photodynamic therapy, randomized clinical trial, and clinical trial. Electronic (on PubMed, Cochrane, Latin American and Caribbean Health Sciences Literature, and Report Evidence-based Practice Centers databases) and manual searches (in articles' references) were conducted until July 2021. Risk of bias was assessed for each reference thanks to the Cochrane Collaboration's tool. A total of 12 randomized clinical trials, with a high level of evidence, were selected and investigated in this systematic review. A table summarizes data extracted from these articles. It appears that the parameters improve favorably by using lasers, but without any significant difference. In accordance with the analysis of studies, our results show that laser therapy with specific characteristics allows to obtain beneficial therapeutic effects on wound healing in the short and the medium-term concerning the clinical parameters in the nonsurgical treatment of peri-implantitis. Concerning its long-term usefulness, it has yet to be confirmed. However, its benefits remains limited since the results agree that the effects of the laser are similar to those obtained by using conventional therapy. [ABSTRACT FROM AUTHOR]

During implant maintenance, preserving a smooth surface on the machined transmucosal abutment is critical to reduce biofilm attachment and colonization. The present study compared the surface roughness and bacterial colonization of machined titanium surfaces after instrumentation with various materials. Forty-four machined grade 23 titanium discs were instrumented with a round polyether ether ketone (PEEK) tip, a plastic curette tip, or a pure titanium curette tip with piezoelectric devices. Before and after instrumentation, the surface roughness (Ra and Rz) values were analyzed with a profilometer and scanning electron microscopy (SEM). Streptococcus sanguinis was cultured and incubated for 24 hours on the instrumented discs, and colony-forming units per milliliter were obtained for each group. Samples instrumented with the metal ultrasonic tip significantly increased surface roughness compared with the other groups. This resulted in greater colonization by S. sanguinis than surfaces instrumented with PEEK tips or the negative control. Samples instrumented with PEEK and plastic tips did not exhibit any statistically significant increase in surface roughness, and SEM analysis revealed a significantly rougher surface of discs instrumented with metal compared with discs instrumented with plastic or PEEK tips despite the possibility of debris from tip dissolution. Our results suggest that instrumentation with metal ultrasonic tips with piezoelectric devices significantly increased machined titanium's surface roughness and elicited higher biofilm formation in vitro. Meanwhile, instrumentation of machined titanium with PEEK or plastic ultrasonic tips did not affect the surface roughness or bacterial adhesion. [ABSTRACT FROM AUTHOR]

The present study aims to evaluate the trends of oral implant–related research in design and topics between the range of 2016 to the end of 2022. The electronic search was conducted in MEDLINE via Pubmed. Papers published in Clinical Oral Implant Research, Clinical Implant Dentistry and Related Research, and International Journal of Oral Implantology as well as previously European Journal of Oral Implantology, International Journal of Oral and Maxillofacial Implants, and Journal of Oral Implantology between January 1, 2016, and December 30, 2022, were retrieved. Articles were classified according to their study design and major subjects. The Joinpoint regression model was used to determine changes in the trends of study designs and topics. Statistical significance was defined as a p-value <.05. A total of 3382 articles were analyzed in this study. In the specified period, in vivo, prospective cohort, retrospective case control, randomized clinical studies in the design and prosthetic complications, peri-implant hard tissue studies in the topic experienced a significant decreasing pattern in the number of published articles as well as the total number of articles. Case reports and series, retrospective cohort, nonrandomized clinical studies in the design and outcomes of implant-related treatment plans, immediate implant placement, and peri-implantitis in the topic experienced a significant decreasing pattern followed by a significant increasing pattern with a turning point between 2017 and 2020. Considering the limitations of this scientific topical trend analysis, it can be concluded that the recent pandemic affected the research path in oral implantology in many ways. [ABSTRACT FROM AUTHOR]

This report aims to present a treatment of retrograde peri-implantitis originating from apical periodontitis of an adjacent tooth in an 84-year-old male. Apical periodontitis of the maxillary left central incisor (#9) extended to the apex of the maxillary left lateral incisor implant (#10), which had been functioning for 16 years. Root canal treatment for #9 was performed, followed by root end surgery to treat the apical periodontitis, which showed a periapical radiolucency measured 1 cm in its greatest dimension. After the root end filling was placed, neither bone substitute materials nor barrier membranes were used to fill and cover the bony defect area. A 2-year postoperative radiograph confirmed the osseous healing around the apices of #9 and #10. [ABSTRACT FROM AUTHOR]

Dental implants are increasing in prevalence as desirable options for replacing missing teeth. Unfortunately, implants come with complications, and animal models are crucial to studying the pathophysiology of complications. Current murine model experiments can be lengthy, with 8 weeks of extraction socket healing before implant placement. Therefore, we aimed to investigate the efficacy of decreasing extraction healing time from 8 to 4 weeks in a dental implant mouse model. Thirty-one 3-week-old C57BL/6J male mice underwent maxillary first and second molar extractions followed by 8 (control) or 4 (test) weeks of extraction socket healing before implant placement. Mice were euthanized after 4 weeks of implant osseointegration. Samples were analyzed via microcomputerized tomography and histology. When mice received implants 4 weeks after extractions, there was no statistical difference in initial bone crest remodeling or surrounding bone volume compared to those after 8 weeks of healing. Histologically, the hard and soft tissues surrounding both groups of implants displayed similar alveolar bone levels, inflammatory infiltrate, osteoclast count, and collagen organization. A 4-week extraction healing period can be utilized without concern for osseointegration in a murine implant model and is a viable experimental alternative to the previous eight weeks of healing. While small animal implant models are less directly applicable to humans, advancements in experimental methods will ultimately benefit patients receiving dental implants through improved prevention and treatment of complications. Subsequent research could investigate occlusal effects or whether healing time affects prognosis after induction of peri-implantitis. [ABSTRACT FROM AUTHOR]

Maintaining dental implants and managing peri-implant tissues has become integral to dental practice. Owing to the larger number of implants placed, the number of peri-implant lesions is increasing. Periodontal implant maintenance therapy (PIMT) provides a conservative long-term treatment modality to monitor and maintain implants. This study aims to investigate periodontal maintenance effects on peri-implant tissue health to add to existing evidence. A retrospective analysis included implant patients with 1–7 years of follow-up, assessing peri-implantitis and early implant failure as outcome variables. The frequency of PIMT, implant characteristics, and demographics served as predictors, and associations between peri-implantitis, implant failure, and PIMT frequency were analyzed using Fisher exact tests with the significance level set at.05. Data were collected on 501 implants from 185 patients. Twenty-nine (6%) demonstrated peri-implantitis, whereas 22 (5%) experienced early implant failure. A significant association between PIMT and peri-implantitis was observed (p-value =.0169) with the rate of peri-implantitis at 9% (n = 20) for patients without PIMT and only 4% (n = 10) for those with PIMT. Whereas PIMT was not significantly associated with early implant failure (p-value =.4372), peri-implantitis was: 25% of implants with peri-implantitis experienced early failure compared with 4% without (p-value =.0062). Considering the limitations of the present study, the absence of PIMT was found to be associated with peri-implantitis, which was itself associated with early implant failure. Implant maintenance at 6-month intervals is important in maintaining peri-implant health. [ABSTRACT FROM AUTHOR]

Zirconia implants have gained popularity for their aesthetic appeal and biocompatibility, making them a preferred choice for anterior teeth replacement. This study explores the interaction between telomere length and inflammatory biomarkers in seven cases of zirconia implant placement to gain insights into postoperative cellular aging, inflammatory responses, and long-term outcomes. Zirconia implants offer advantages over titanium implants, as they do not corrode or release metal ions, leading to potential inflammation and implant failure. Monitoring immune and inflammatory biomarkers is essential to assess inflammation initiation, severity, and progression. C-reactive protein (CRP) and pro-inflammatory cytokines, like interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α), play crucial roles in host immune responses, while anti-inflammatory cytokines, including interleukin-10 (IL-10), regulate and dampen immune responses. Achieving a delicate balance between pro- and anti-inflammatory cytokines is vital for maintaining a healthy immune response and preventing chronic inflammatory conditions. Telomeres, protective structures present at chromosome ends, influence cellular aging and mitochondrial function. Shorter telomeres are associated with impaired mitochondrial function, increased oxidative stress, and cellular senescence, while longer telomeres are linked to reduced inflammation and improved immune function. Understanding these mechanisms is essential for addressing age-related conditions and promoting overall well-being. In this case series, we investigated the interaction between telomere length and inflammatory biomarkers in patients who received zirconia dental implants. The study aims to improve our understanding of postoperative cellular aging, inflammatory responses, and the biocompatibility of zirconia implants, potentially leading to improved treatment protocols and patient outcomes. This innovative assessment of telomere length and inflammatory biomarkers in the context of zirconia implants provides novel insights into the field of dental implantology. By exploring the effects of zirconia implants on cellular health and inflammation, this study contributes to advancements in implant technology and patient care. [ABSTRACT FROM AUTHOR]

Peri-implantitis is an inflammatory process initiating in the soft tissue and then progressing to the hard tissue surrounding dental implants leading to loss of osseous support and potential loss of the implant if not identified early in the process. This process initiates in the soft tissue, which become inflamed spreading to the underlying bone leading to decreases in bone density with subsequent crestal resorption and thread exposure. In the absence of treatment of the peri-implantitis, the bone loss at the osseous implant interface progresses with inflammatory mediated decrease in the bone density that moves apically, eventually leading to mobility of the implant and its failure. Low-magnitude high-frequency vibration (LMHFV) has been shown to improve bone density, stimulate osteoblastic activity, and arrest progression of peri-implantitis with improvement of the bone or graft around the affected implant with or without surgery as part of the treatment. Two cases are presented using LMHFV to augment treatment. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate temperature changes in titanium and ceramic implants after using a 445-nm diode laser under different in vitro conditions. Titanium (Ti) and ceramic (Zr) dental implants were placed into a bone analog, and an intrabony defect was created at each implant. A 445-nm diode laser was used to irradiate the defects for 30 seconds, noncontact, at 2 W in continuous wave (c.w.) and pulsed mode. The experiment was done at room temperature (21.0 ± 1°C) and in a water bath (37.0 ± 1°C). Two thermocouple probes were used to record real-time temperature changes (°C) at the coronal part of the implant (Tc) and the apex (Ta). The temperature was recorded at time 0 (To) and after 30 seconds of irradiation (Tf). The average temperature change was calculated, and a descriptive analysis was conducted (P <.05). The Ti implant resulted in the highest ΔT values coronally (29.6°C) and apically (6.7°C) using continuous wave at 21°C. The Zr implant increased to 26.4°C coronally and 5.2°C apically. In the water bath, the coronal portion of the Ti and Zr implants rose to 14.2°C and 14.01°C, respectively, using continuous waves. The ΔT values for Ti were 11.9°C coronally and 1.7°C apically when placed in a water bath using pulsed mode. The lowest ΔT occurred on the Zr implant with ΔTc and ΔTa of 4.8°C and 0.78°C, respectively. Under in vitro conditions, the 445-nm diode laser in pulsed mode seems to be safe for use on ceramic implants and should be used with caution on titanium implants. [ABSTRACT FROM AUTHOR]

This systematic review aimed to assess the clinical efficacy of the local application of minocycline hydrochloride for treating peri-implantitis. Four databases—PubMed, EMBASE, Cochrane Library, and China National Knowledge Infrastructure—were searched from their inception through December 2020. English and Chinese randomized controlled trials (RCTs) that compared minocycline hydrochloride with control regimes, including negative control, iodine solution or glycerin, and chlorhexidine, for patients with peri-implant diseases were retrieved. Three outcomes—plaque index (PLI), probing depth (PD), and sulcus bleeding index (SBI)—were assessed using meta-analysis based on the random-effects model. Fifteen RCTs were included in the present meta-analysis, and results suggested that minocycline hydrochloride significantly affected PLI, PD, or SBI reduction regardless of the type of comparator regime. However, subgroup analyses suggested that minocycline hydrochloride was not superior to chlorhexidine in terms of reduction of PLI (1 week: MD = −0.18, 95% CI = −0.55 to 0.20, P =.36; 4 weeks: MD = −0.08, 95% CI = −0.23 to 0.07, P =.28; 8 weeks: MD = −0.01, 95% CI = −0.18 to 0.16, P =.91) and PD (1 week: MD = 0.07, 95% CI = −0.27 to 0.41, P =.68; 4 weeks: MD = −0.10, 95% CI = −0.43 to 0.24, P =.58; 8 weeks: MD = −0.30, 95% CI = −0.68 to 0.08, P =.12), and minocycline hydrochloride was also not better than chlorhexidine regarding reduction of SBI at 1 week after treatment (MD = −0.10; 95% CI = −0.21 to 0.01; P =.08). This study concludes that minocycline hydrochloride as adjuvant therapy of nonsurgical treatment enhances the clinical results when compared to control regimes. However, the difference between minocycline hydrochloride and chlorhexidine should be further investigated by designing additional high-quality studies with large sample sizes. [ABSTRACT FROM AUTHOR]

The purpose of this case report is to feature an interesting case where a staged approach was used to manage a failed implant site that led to a late sinus graft infection and sinusitis with an oroantral fistula (OAF), by using functional endoscopic sinus surgery (FESS) and an intraoral press-fit block bone graft technique. Sixteen years ago, a 60-year-old female patient underwent maxillary sinus augmentation (MSA) with 3 implants placed simultaneously in the right atrophic ridge. However, No. 3 and 4 implants were removed due to advanced peri-implantitis. The patient later developed purulent discharge from the site, headache, and complained of air leakage due to an OAF. The patient was referred to an otolaryngologist for FESS to treat the sinusitis. Two months after FESS, the sinus was re-entered. Residual inflammatory tissues and necrotic graft particles in the OAF site were removed. A block bone harvested from the maxillary tuberosity was press-fitted to the OAF site and grafted. After 4 months of grafting, the grafted bone was well incorporated with the surrounding native bone. Two implants were successfully placed in the grafted site with good initial stability. The prosthesis was delivered 6 months after implant placement. After the 2 years of follow-up, patient was functioning well without sinus complications. Within limitation of this case report, the staged approach via FESS and intraoral press-fit block bone graft is an effective method that can be used to successfully manage OAF and vertical defects at the implant site. [ABSTRACT FROM AUTHOR]

Implant rehabilitation after implant removal is a major challenge, especially in mandibular posterior arches. This case report describes the reconstruction of a severe vertical bone defect using customized titanium mesh covered by collagen membrane and solid advanced platelet-rich fibrin, combined with autogenous bone, deproteinized bovine bone mineral, and injectable platelet-rich fibrin after implant removal caused by advanced peri-implantitis. This individualized titanium mesh may be a reliable technique for severe alveolar ridge reconstruction, with the additional benefits of reduced surgery time and a simplified operation. [ABSTRACT FROM AUTHOR]

The present systematic review evaluated the efficacy of adjunctive therapies in the treatment of peri-implantitis. Studies comparing the outcome of conventional surgical- or nonsurgical mechanical debridement with the addition of an adjunctive therapeutic modality were identified through an electronic and hand search of available literature. Following data extraction, meta-analyses were performed on the primary outcome measures. The effects of the adjunctive therapies on bleeding on probing (13 studies), probing pocket depth (9 studies), and radiographic bone level changes (7 studies) were analyzed to evaluate potential clinical benefit. Heterogeneity was expressed as the I2 index. Fixed and random effect models were demonstrated. The potential benefit of adjunctive therapies over control procedures was evaluated in 18 studies, representing a total of 773 implants. Quality assessment of the studies found only 3 studies to be at a low risk of bias. Meta-analysis among the different additional modalities revealed chemical therapy demonstrating significant effects in probing pocket depth reduction (0.58 mm; 0.44–0.72) and radiographic bone level gain (0.54 mm; 0.16–0.92). No significant improvements in bleeding on probing reduction were found using any adjunctive therapy. Available evidence on the benefits of adjunctive therapy to nonsurgical or surgical mechanical debridement in the treatment of peri-implantitis is limited by low numbers of standardized, controlled studies for individual therapies, heterogeneity between studies, and a variety of outcome measures. The lack of effect of any adjunctive therapy in reducing bleeding on probing questions the overall effectiveness over conventional treatment. The long-term clinical benefit potential of these therapies is not demonstrated. [ABSTRACT FROM AUTHOR]

The role of systemic diseases in the development and progression of peri-implantitis remains unclear and requires discussion from various perspectives. This retrospective cohort study aimed to evaluate whether the type of systemic disease affects the onset time of peri-implantitis. The cohort consisted of patients who underwent implant maintenance evaluations between January 1998 and June 2020. Information on age, sex, history of periodontal disease, smoking habits, body mass index, systemic diseases, implant placement sites, and diagnosis of peri-implantitis were obtained. The relationships between the time of onset of peri-implantitis and the medical history of systemic diseases were determined statistically by applying the Kaplan-Meier analysis method and log-rank test. A total of 216 implants in 89 patients (34 male and 55 female) were included in this study. The average patient age was 53.9 ± 11.8 years at the first visit, and the mean duration of maintenance was 7 years and 4 months. A total of 43 patients had medical histories and were assigned to the systemic disease group. In this group, the overall prevalence of peri-implantitis was 25.4% (29 of 114 implants). The medical history of systemic diseases (odds ratio [OR], 6.87; 95% confidence interval [CI], 2.37–19.9) and dental history of periodontitis (OR, 3.64; 95% CI, 1.25–10.6) were assessed as risk factors for peri-implantitis. A significant difference in the time of onset of peri-implantitis was confirmed between patients with systemic disease and healthy patients. Diabetes mellitus, osteoporosis, and hypertension had a significant impact on the earlier onset of peri-implantitis. [ABSTRACT FROM AUTHOR]

Metastases around dental implants are extremely rare. They usually represent a secondary localization of a multiorgan metastatic neoplasm but also are, exceptionally, recognized as the first clinical manifestation of a still unknown cancer of whatever organ. Metastases usually manifest as rapidly growing lesions of hard and soft tissues and always represent a true diagnostic/therapeutic dilemma both for clinicians in choosing the more appropriate treatment and for pathologists in recognizing the primary tumor when still undiagnosed. We report 2 distinct cases of metastasis occurring around dental implants in the maxilla and mimicking peri-implantitis at the onset; more precisely, in one case, the lesion involved exclusively the alveolar bone, where an implant were previously inserted, while in the other case, a neoplasm caused bone destruction around the fixture with an impressive and rapid exophytic growth. In both cases, maxillary lesions were the first metastatic manifestation of an unknown adenocarcinoma of the lung. [ABSTRACT FROM AUTHOR]

Dental implants may require attached tissue to prevent peri-mucositis or peri-implantitis. When there is a lack of attached tissue at the mandibular lingual aspect of dental implants, a free gingival graft may be done after careful consideration of nearby anatomical structures. An acryl stent can be used to protect the site from oral functioning. [ABSTRACT FROM AUTHOR]

This case report describes the treatment of peri-implantitis lesions through a minimally invasive surgical procedure using a peri-implant excisional procedure and access surgery (PEAS). The prosthesis was disconnected, and the peri-implant granulation tissue removed after a peri-implant circular incision. Chemical debridement with hydrogen peroxide on a cotton ball and then mechanical debridement with a rotary round titanium brush and tufted brush with titanium bristles were conducted. The surgical intervention was effective in arresting the peri-implantitis. No further radiographic bone loss was observed over the 2-year follow-up period. This technique effectively cleans the contaminated implant surface, minimizes surgical morbidity, and allows for prosthesis delivery on the day of surgery. However, further studies with a larger sample size are needed to identify the reliability and validity of this novel technique. [ABSTRACT FROM AUTHOR]

Objectives: Electronic cigarettes (e-cigarettes) are offered to consumers as a healthier option than traditional tobacco. However, the long-term effect of non-heat-burning tobacco and e-cigarettes on periodontal and peri-implantitis is unknown. The present review evaluates the impact of electronic cigarettes on peri-implantitis and compares the results with traditional cigarettes and non-smokers., Materials and Methods: Systematic/meta-analysis studies were searched in PubMed, MEDLINE, EMBASE, Cochrane Library, and Google Scholar until December 30, 2022., Results: Five systematic/meta-analysis studies were identified based on the search strategy in the selected databases. The overall quality assessment of the studies showed acceptable evidence with high quality. All systematic review studies showed that compared to traditional tobacco smoke, electronic cigarettes might reduce or not change the clinical inflammatory symptoms of periodontitis and peri-implantitis, such as bleeding on probing, probing depth, peri-implant bone loss, and response to treatments., Conclusion: Electronic cigarettes contain nicotine, which can harm periodontal and implant health. On the other hand, a wide range of oral health consequences may be associated with using e-cigarettes. E-cigarette is a potential risk factor for the healing process and the results of implant treatment.

The effect of bevacizumab-related osteonecrosis of the jaw on previously osseointegrated dental implants has not been adequately studied. Here, we report a case of osteonecrosis of the jaw detected around dental implants placed before bevacizumab therapy. A 66-year-old woman undergoing bevacizumab therapy for metastatic triple-negative breast cancer developed malocclusion after buccal gingival swelling and pain in the #18, #19, and #20 tooth region. The patient visited a local dental clinic, where existing implants in relation to #19 and #20 were removed. Subsequently, the patient visited our department, and intraoral examination revealed necrotic bone in the region corresponding to #19 and #20. Radiographic examination showed a pathologic fracture in this region that was considered to result from osteonecrosis of the jaw. Bevacizumab therapy was suspended temporarily until the acute inflammation had subsided. In addition, treatment with antibacterial agents and conservative surgery was considered. Complete soft tissue coverage was observed 14 days after surgery. In recent years, the number of patients receiving bevacizumab treatment has increased. Because bevacizumab-related osteonecrosis of the jaw could occur around previously osseointegrated dental implants as well, this case report suggests an effective treatment regimen based on a combination of antibacterial agents and conservative surgery. [ABSTRACT FROM AUTHOR]

The article presents the discussion on homeostasis between the intraoral microbial biofilm and the host response in the peri-implant tissue. Topics include risk factor being insufficient soft tissue quality as indicated by the width of the keratinized mucosa (KM), and the mucosal thickness; and followed by the application of antimicrobial agents and permanent biofilm controlling through supportive implant therapy (SIT).

The aim of this report was to document a rare case of medication-related osteonecrosis of the jaw (MRONJ) that developed around the already osseointegrated implants in the maxillary right molar region. A 73-year-old woman presented at our university dental hospital in May 2017 with a chief complaint of discomfort near a maxillary implant. Her first visit was in 2006, and the maintenance treatment began in 2007 after the periodontal treatment. During the implant maintenance period there were no complications; however, the patient began taking alendronate sodium hydrate (Fosamac tablets, 35 mg, once weekly), an oral bisphosphonate (BP) since 2013, for treatment of osteoporosis. Eight years after starting implant maintenance, in 2016, peri-implantitis occurred, for which mechanical cleaning and antimicrobial therapy were performed. Peri-implantitis symptoms disappeared, and the medical condition improved. Nonetheless, in 2017, MRONJ developed 4 years after she commenced taking the BP. The patient underwent implant removal and sequestrectomy. There was no postoperative recurrence. Since it was such a rare case, we performed a literature review but only discovered a few similar cases. Because various triggers may lead to the development of MRONJ, even if already osseointegrated implant, it is important to note that implants in patients taking BPs should be more carefully maintained. [ABSTRACT FROM AUTHOR]

The article informs about advanced peri-implantitis and implant removal as risk factors for Osteonecrosis of the jaw in patients on oral bisphosphonate therapy. Topics include cases necessitate implant removal because of severe bone destruction with various degrees of inflammation around the dental implant; and potential adverse events associated with certain systemic conditions, especially when patients are on antiresorptive drugs, such as bisphosphonates.

This preliminary study investigates the differences between experimental periodontitis and peri-implantitis in a dog model, with a focus on the histopathology, inflammatory responses, and specific immunoregulatory activities driven by Th1/Th2-positive cells. Twelve dental implants were inserted into the edentulated posterior mandibles of 6 beagle dogs and were given 12 weeks for osseointegration. Experimental peri-implantitis and periodontitis (first mandible molar) were then induced using cotton-floss ligatures. Twelve weeks later, alveolar bones were quantitated by cone beam-computer tomography. Histopathologic analysis of the inflamed gingiva and periodontal tissues was performed by light microscopy, and the Th1/Th2 cell populations were investigated by flow cytometry. Peri-implantitis and periodontitis were both found to be associated with pronounced bone resorption effects, both to a similar degree vertically, but with a differential bone resorption pattern mesio-distally, and with a significantly higher and consistent bone resorption result in peri-implantitis, although with a higher variance of bone resorption in periodontitis. The histologic appearances of the inflammatory tissues were identical. The percentages of Th1/Th2 cells in the inflamed gingival tissues of both experimental peri-implantitis and periodontitis were also found to be similar. Experimental periodontitis and peri-implantitis in the dog model show essentially the same cellular pathology of inflammation. However, bone resorption was found to be significantly higher in peri-implantitis; the histopathologic changes in the periodontal tissues were similar in both groups but showed a higher interindividual variation in periodontitis and appeared more uniform in peri-implantitis. This preliminary study indicates that more focused experimental in vivo inflammation models need to be developed to better simulate the human pathology in the 2 different diseases and to have a valuable tool to investigate more specifically how novel treatments/prevention approaches may heal the differential adverse effects on bone tissue and on periodontium in periodontitis and in periimplantitis. [ABSTRACT FROM AUTHOR]

Dental implants are a widely used treatment option for tooth replacement. However, they are susceptible to inflammatory diseases such as peri-implant mucositis and peri-implantitis, which are highly prevalent and may lead to implant loss. Unfortunately, the understanding of the pathogenesis of peri-implant mucositis and peri-implantitis is fragmented and incomplete. Therefore, the availability of a reproducible animal model to study these inflammatory diseases would facilitate the dissection of their pathogenic mechanisms. The objective of this study is to propose a murine model of experimental peri-implant mucositis and peri-implantitis. Screw-shaped titanium implants were placed in the upper healed edentulous alveolar ridges of C57BL/6J mice 8 weeks after tooth extraction. Following 4 weeks of osseointegration, Porphyromonas gingivalis -lipolysaccharide (LPS) injections were delivered to the peri-implant soft tissues for 6 weeks. No-injections and vehicle injections were utilized as controls. Peri-implant mucositis and peri-implantitis were assessed clinically, radiographically (microcomputerized tomograph [CT]), and histologically following LPS-treatment. LPS-injections resulted in a significant increase in soft tissue edema around the head of the implants as compared to the control groups. Micro-CT analysis revealed significantly greater bone loss in the LPS-treated implants. Histological analysis of the specimens demonstrated that the LPS-group had increased soft tissue vascularity, which harbored a dense mixed inflammatory cell infiltrate, and the bone exhibited noticeable osteoclast activity. The induction of peri-implant mucositis and peri-implantitis in mice via localized delivery of bacterial LPS has been demonstrated. We anticipate that this model will contribute to the development of more effective preventive and therapeutic approaches for these 2 conditions.

Pathologies in peri-implant tissues are common and may disturb long-term implant supported rehabilitation. We aimed to evaluate the occurrence of such peri-implant diseases and their associated factors in this study. Peri-implantitis and mucositis were diagnosed based on clinical and radiological findings. Statistical analysis was performed with the X2 and logistic regression. Peri-implant mucositis and peri-implantitis were observed in 43.4% and 13.8% of patients with implants evaluated, respectively. Univariate analysis found associations with systemic changes (P =.016; yes), medication use (P =.010; yes), implant location (P <.0001; upper jaw), implant region (P =.008; posterior), previous augmentation procedure (P =.023; yes), time of prostheses use (P <.0001; >2 years), keratinized mucosa (P <.0001; absence); and gingival bleeding index (P =.005; >30%). In the multiple analysis, independent predictors were: >2 years of prostheses use (P <.0001; PR = 1.720), upper jaw location (P <.0001; PR = 1.421), gingival bleeding index >30% (P =.001; PR = 1.496), and use of medication (P <.0001; PR = 1.261). The frequency of peri-implant pathologies is high (approximately 57.2%) with several aspects of the occurrence being related to the patients' prosthesis. Prostheses type and the complexity of rehabilitation are worth highlighting. Factors include the location of the dental implant, gingival bleeding index, patient's use of medication(s), and the time of prostheses use. [ABSTRACT FROM AUTHOR]

Hypothyroidism (HT) is an endocrine disorder characterized by abnormally reduced thyroid gland activity and is most commonly of autoimmune etiology. HT is associated with alterations in bone metabolism, and HT patients typically experience decreased bone resorption. The objective of this study was to use dental implants as standardized reference markers to compare the extent of alveolar bone loss in implant patients with and without HT. We examined medical and dental history records and radiographic data from 635 patients receiving 1480 implants during 2000–2017. The rate of bone loss was calculated from differences in radiographic bone levels over time, corrected for radiographic distortion. Peri-implant bone loss from patients with HT was significantly lower than for those without HT (t1252= −3.42; 95% confidence interval= 0.47–1.73; P <.001; M = 0.53 and 1.63 mm/yr, respectively). A similar relationship persisted after excluding smokers and diabetics and after additionally excluding those on systemic steroids, hormone replacement therapy, hormone medications, or autoimmune diseases other than HT. Our data suggest that patients with HT have a decreased rate of bone loss around dental implants and may not be at increased risk for dental implant failure. The decreased bone metabolic rate among patients with HT might contribute to those findings. [ABSTRACT FROM AUTHOR]

The aim of this systematic review and meta-analysis was to determine the efficacy of chlorhexidine (CHX) as an adjunctive therapy to mechanical debridement in the treatment of peri-implant diseases. Five databases (PubMed, EMBASE, Cochrane Central Register of Controlled Trails, Web of Science, and ClinicalTrials.gov) were searched. Randomized controlled trials (RCTs) comparing mechanical debridement combined with CHX to mechanical debridement alone for patients with peri-implant disease were identified. The trial investigators evaluated factors indicating inflammatory levels, including bleeding on probing (BOP), probing depth (PD), and clinical attachment level (CAL). Six RCTs with 207 patients were ultimately included in this review. Low- to moderate-quality evidence demonstrated that the adjunctive CHX therapy had no significant effect on BOP reduction within 1 month (mean difference [MD], 0.10; 95% confidence interval [CI], −0.06 to 0.25), 3–4 months (MD, 0.06; 95% CI, −0.03 to 0.15), and 6–8 months (MD, 0.06; 95% CI, −0.03 to 0.14) of follow-up. Significant differences in PD reduction and CAL gain were also not found. Although 1 subgroup analysis revealed a significant result (MD, 009; 95% CI, 0.01–0.18) for the use of CHX solution, this could be interpreted as clinically slight. Based on available evidence, adding CHX to mechanical debridement, compared with mechanical debridement alone, did not significantly enhance the clinical results. Therefore, clinicians should consider the negligible effect of adjunctive CHX. [ABSTRACT FROM AUTHOR]

The present study aims to assess the feasibility of implant rehabilitation in kidney-transplanted patients. Patients with kidney transplantation included in periodontal supportive care and at least one year of dialysis with mono- or partial edentulism were eligible for this study. Histomorphometric evaluation of the harvested bone was matched with radiological bone assessment. Implant stability was also monitored with resonance frequency analysis and insertion torque value. Fixed cemented prostheses have been delivered after conventional loading protocol. Supportive periodontal therapy has been administered. Eleven patients (9 males and 2 females) were included. The mean age was 58.1 ± 9.9 years. A total of 17 implants were inserted and analyzed. Mean ITV was 39.3 ± 23.8 Ncm. The mean primary stability (implant stability quotient) at T0 was 71.7 ± 10.5, whereas the mean secondary stability at T1 was 73.0 ± 7.3. The minimum follow-up was 62 months, with a maximum of 84 months (7 years) reached by 4 patients. Fourteen out of 15 implants were in function at a 5-year follow-up (survival rate: 93.3%). Two implants showed peri-implantitis. Seventeen bone samples were collected (13 in the mandible and 4 in the maxilla). The mean percentage of marrow spaces and lamellar bone was 41.6% and 58.4%, respectively. Class 3, according to Misch classification, was found as the mean value of radiological bone density. It can be concluded that implant-supported rehabilitation in kidney-transplanted patients is possible. Adequate periodontal maintenance allows implant rehabilitation in kidney-transplanted patients with long-term sufficient survival rates.

The article presents a case study of a 56-year-old man, came to clinic complaining of a problem with 2 crowns over implants. The article discusses that the treatment proposed was organized in different steps regarding decontamination and remodeling, and PBM was used to enhance the healing process; and photodynamic therapy (PDT), consisting of the association of a low-energy laser irradiation with proper cromophore delivery, was proposed for bacteria decontamination in peri-implantitis.

The article focuses on the regenerative treatment of Peri-Implantitis and following Implant Surface Decontamination with Titanium Brush and Antimicrobial Photodynamic Therapy. It report the reentry phase after regenerative surgical therapy of peri-implantitis following combined mechanical and laser-assisted decontamination to allow direct visualization of the actual bone gain and the residual bone defect at each treated implant.

We hypothesized that in the long term (6-month follow-up), nonsurgical mechanical debridement (NSMD) with adjunct low-level laser therapy (LLLT) is more effective for the treatment of peri-implantitis than NSMD alone. The aim of the present 6-month follow-up convenience-sample cohort study was to assess the efficacy of LLLT as an adjunct to NSMD in the treatment of peri-implantitis. A questionnaire was used to collect demographic information. Patients with peri-implantitis in the test and control groups underwent NSMD with and without adjunct LLLT, respectively. Randomization was done by tossing a coin. In the test group, the laser was applied perpendicular to the periodontal pocket for 20 seconds at a constant distance of 15 mm and with a continuous wavelength (3.41 J/cm2 delivery with a 1.76 cm2 spot and average output of 0.3 W). In both groups, peri-implant probing depth, bleeding upon probing, and crestal bone resorption were assessed at baseline and at the 3-month and 6-month follow-up. Group comparisons were performed, and P <.05 was considered statistically significant. Sixty-seven individuals with peri-implantitis were included. The mean age of participants who underwent NSMD with adjunct LLLT and NSMD alone was 46.5 ± 3.4 and 45.3 ± 1.1 years, respectively. At the 3- and 6-month follow-up, peri-implant (P <.05), bleeding upon probing (P <.05), and probing depth (P <.05) were significantly higher among patients who underwent NSMD alone compared with patients who underwent NSMD with adjunct LLLT. There was no significant difference in crestal bone resorption in all patients up to the 6-month follow-up. In the short term, NSMD with adjunct LLLT was a useful treatment protocol for the treatment of peri-implant soft-tissue inflammation. [ABSTRACT FROM AUTHOR]

The aim of this case report was to report the course of treatment for advanced paranasal sinus infection triggered by peri-implantitis, managed using functional endoscopic sinus surgery (FESS), with outcomes. A nonsmoking male patient received sinus augmentation with implant placement on his left posterior maxilla 15 years ago. Possibly due to noncompliance to maintenance, peri-implantitis developed and progressed into the augmented bone area in the maxilla. Eventually, maxillary sinusitis occurred concomitantly with a spread of the infection to the other paranasal sinuses. Implant removal and intraoral debridement of inflammatory tissue were performed, but there was no resolution. Subsequently, FESS was performed, with removal of nasal polyp and sequestrum. After FESS, the patient's sinusitis resolved. Histologically, the sequestrum was composed of bone substitute particles, necrotic bone, stromal fibrosis, and a very limited cellular component. Two implants were placed on the present site, and no adverse event occurred for up to 1 year after the insertion of the final prosthesis. Peri-implantitis in the posterior maxilla can trigger maxillary sinusitis with concomitant infection to the neighboring paranasal sinuses. FESS should be considered to treat this condition. [ABSTRACT FROM AUTHOR]

The report is presenting a case of implant placement in the postoperative maxillary cyst (POMC) with a follow-up of 13 years. The POMC is a complication associated with various surgical interventions involving maxillary sinus diseases such as Caldwell-Luc operation, orthognathic surgery, and sinus grafting procedures. The lesion of POMC is believed to develop as a result of the changes of ciliated cells or the blockage of ostia inside the maxillary sinus. Two dental implants were placed near the lesion that was later confirmed to be POMC. Of the 2 dental implants placed, one was explanted and the other was successfully managed with surface debridement followed by guided bone regeneration. The removed specimen inclusive of the implant and surrounding tissue was evaluated with clinical photographs, radiographs, and histology and the findings are described in the paper. [ABSTRACT FROM AUTHOR]

The aim of this case report was to find common treatment with the use of laser energy to treat failing implants. This article discusses definition of peri-implantitis and how-to diagnosis peri-implantitis. The article shows a case report of treatment with the use of two different lasers. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the effects of the luting methods on the amount of cement remnants in implant restorations and to determine the restoration surface with the maximum amount of residual cement. Forty abutments and crowns were divided into 4 groups as follows: TB group, luting with zinc oxide-eugenol cement; TBV group, luting with zinc oxide-eugenol cement after application of a separating agent over the transmucosal area of the abutment; PI group, luting with methacrylate cement; and PIV group, luting with methacrylate cement after application of a separating agent. After cementation, all the quadrants of the specimens were photographed, and the amount and location of the cement remnants were statistically analyzed (P ≤.05). The amount of cement remnants was significantly smaller in the groups with a separating agent. The type of luting material did not significantly affect the results. Cement remnants were more abundant on the mesial and distal sides than on the buccal and lingual sides of the restoration. [ABSTRACT FROM AUTHOR]

Implant loss is the most serious complication of dental implants. Although the problems and causes behind the implant failure are clearly defined today, determination of the underlying causes of failure varies by the case. The clusterization phenomenon of implant loss (multiple implant failures) implies the existence of genetic risk factors. Inflammation has a critical effect on osseointegration and implant success. Peri-implantitis is an inflammatory disease of tissue supporting the tooth or implant. Inflammation leads to loss of support tissue, particularly bone, resulting in failure of implants. A single nucleotide polymorphism (SNP) of pro-inflammatory mediator genes may affect their expression levels or amino acid sequence, and, consequently, the host inflammatory response. Since the end of the past century, many studies have been conducted to investigate the association of SNP with implant failure and related conditions. Involvement of several groups of genes—including interleukins, tumor necrosis factor-α, matrix metalloproteinases, and growth factors involved in immune regulation, inflammatory response, and bone metabolism—has been explored. Some have been found to be associated with implant loss and considered potential genetic risk factors for implant failure. In this review, we summarize results of recent studies of impact of genetic factors on dental implant failure. [ABSTRACT FROM AUTHOR]

The article presents a consecutive case series study of 16 healthy and nonsmoking patients with advanced peri-implant bone loss who were treated in a periodontal office by an experienced periodontist. It explores a wide range of surgical approaches for the therapy of peri-implantitis including open-flap debridement of implant surface, resective techniques and implantoplasty. The successful outcomes of implant surface decontamination with the use of titanium brushes is also explored.

The aim of this review was to determine the most common peri-implant mucositis and peri-implantitis case definitions used worldwide in the implant dentistry literature. A systematic assessment of peri-implant disease classification was conducted using all publications in MEDLINE, EMBASE, SCOPUS, and Google Scholar between 1994 and November 2017. Screening of eligible studies and data extraction were conducted in duplicate and independently by 2 reviewers. The search protocol identified 3049 unique articles, of which 2784 were excluded based on title and abstract. In total, 265 full texts were screened, 106 of which met the eligibility criteria. Of these, 41 defined peri-implant mucositis. Eight (19.6%) used bleeding on probing (BOP) only; 8 (19.6.7%) used a combination of probing depth (PD), BOP, and radiograph; and 5 (12.3%) used PD and BOP. Cases with crestal bone loss of ≤2 mm in the first year and ≤0.2 mm in each subsequent year were considered as peri-implant mucositis. Ninety-three articles defined peri-implantitis; 28 (30.1%) used a combination of PD with suppuration, BOP, and radiograph, followed by 25 (26.9%) using a combination of PD, BOP, and radiograph. The main criteria in most of the studies were considered to be BOP, PD, and radiograph. Cases of crestal bone loss of ≥2 mm and PD ≥3 mm are considered peri-implantitis. Different peri-implant disease case definitions may affect disease prevalence and treatment strategies. We need to standardize case definitions to avoid discrepancies in case diagnosis and prognosis. [ABSTRACT FROM AUTHOR]

Local delivery agents (LDAs) are widely used in peri-implantitis treatments. The aim of this study was to identify LDAs remaining on the dental implant surfaces and to analyze the components of these residues after applying various cleaning methods. Implants were prepared with a sand-blasted, large-grit, acid-etched surface. Four kinds of LDAs were applied on the implant surfaces: chlorhexidine gel (group 2), tetracycline solution (group 3), and 2 kinds of minocycline hydrochloride agents (groups 4 and 5). Group 1 received normal saline as a control. Two cleaning methods were applied for different durations as follows: (1) running distilled water for 10 seconds (subgroup A), 5 minutes (subgroup B), and 15 minutes (subgroup C); and (2) water spray of a dental-unit chair for 10 seconds (subgroup D) and 5 minutes (subgroup E). Scanning electron microscopy and energy-dispersive x-ray spectroscopy were used to analyze the surface morphology and residue components for all implants. The amount of LDA removed from the implant surfaces in groups 1, 2, 3, and 5 increased with the cleaning duration and pressure. However, Minocline remained coated on the implant surfaces in group 4 under all cleaning conditions. Minocline could not be cleaned off well by water due to its hydrophobicity. Therefore, directly using this agent on implant surfaces with peri-implantitis should be carefully considered. The presence of LDA residues without drug efficacies on implant surfaces might interfere with reosseointegration and act as a reservoir of microorganisms. [ABSTRACT FROM AUTHOR]

The objective of this systematic review was to perform a comprehensive overview of systematic reviews and meta-analyses pertaining to peri-implantitis in humans, including the prevalence and incidence, the diagnostic findings, microbial findings, effects of systemic diseases, and treatment of peri-implantitis. Electronic databases were searched for systematic reviews and meta-analyses of peri-implantitis. In view of the limitations of the included systematic reviews, the outcome of this overview suggested that (1) occurrence of peri-implantitis was higher in patients with periodontitis, in patients who smoke, and after 5 years of implant function; (2) the microbial profile of periimplantitis was different from periodontitis; (3) risk for peri-implantitis was higher in patients with uncontrolled diabetes and cardiovascular disease; (4) there was no strong evidence to suggest the most effective treatment intervention for peri-implantitis, although most peri-implantitis treatments can produce successful outcomes; and (5) postimplant maintenance may be crucial in patients with a high risk of peri-implantitis. [ABSTRACT FROM AUTHOR]

Peri-implantitis is defined as an inflammatory disease affecting the tissues around osseointegrated functioning implants. Unfortunately, detailed peri-implantitis pathogenesis is not well understood and current treatments lack predictability. Compare the healing potential of late-stage ligature-induced periodontitis and peri-implantitis after ligature removal. Four-week-old C57BL/6J male mice had their left maxillary molars extracted. After 8 weeks, implants were placed in healed sockets and allowed to osseointegrate. Mice were separated into control (no ligature) and experimental (ligature) groups. In the experimental group, ligatures were placed around the implant and the contralateral second molar. Four weeks later, the ligature group was randomly divided into ligature-retained and ligature-removed groups. Mice were sacrificed at 2 time points: 1 and 2 weeks after ligature removal. The samples were analyzed by microcomputed tomography (micro-CT) and histology. Ligature-induced significant bone loss in peri-implantitis and periodontitis were compared with respective controls. At the 2-week time point, bone formation was observed in the ligature-removed groups compared with respective controls; however, more bone was regained in periodontitis ligature-removed compared with the peri-implantitis ligature-removed group. Histologically, the peri-implantitis ligature-retained group had higher inflammatory levels and a higher number of osteoclasts compared with the periodontitis ligature-retained group. Moreover, in the peri-implantitis ligature-retained group, collagen appeared less organized compared with the periodontitis ligature-retained group at both time points; although collagen tended to reorganize following ligature removal in both conditions. Peri-implantitis does not respond to treatment as well as periodontitis. Future work includes understanding peri-implantitis pathogenesis and developing predictable treatment protocols. [ABSTRACT FROM AUTHOR]

Peri-implant diseases have received much attention since dental implants are generally used in contemporary dentistry. Several contributing factors associated with the development of peri-implant diseases have also been investigated. The prevalence of peri-implantitis has been reported but with great heterogeneity because of a lack of a universally accepted classification system that could define the extent and severity of peri-implantitis. Several parameters-including radiographic bone loss, probing depth, bleeding on probing, and suppuration-have been introduced in these reports to assist with clinical diagnosis. This article provides an objective evaluation of these parameters based on currently available evidence, offers further recommendations, and proposes a multidomain scale for diagnosis of peri-implantitis. Future investigations and modifications may be needed to develop a comprehensive, evidence-based classification system that addresses the multifactorial etiology of peri-implant diseases. [ABSTRACT FROM AUTHOR]

This study aimed to identify the preferred crown material by measuring the peri-implant clinical parameters and the concentrations of receptor activator of nuclear factor-κB ligand (RANKL), osteoprotegerin (OPG), and calcium in peri-implant crevicular fluid (PICF) with 4 different crown materials. A total of 196 patients with a single missing posterior tooth received crown restoration with cobalt-chromium (Co-Cr) porcelain-fused-to-metal (PFM; n = 50), aurum platinum (Au-Pt) PFM (n = 48), titanium (Ti) PFM (n = 52), or zirconia (Zi) all-ceramic crown (n = 46). Fifty-one natural counterpart teeth served as controls. Before and 12 months after restoration, the PICF was collected, and the concentrations of RANKL, OPG, and calcium were quantified. The peri-implant clinical parameters (plaque index, bleeding on probing, and probing depth [PD]) and gingival crevicular fluid (GCF) volumes were assessed. Twelve months after restoration, the PD and GCF volumes for the 4 experimental groups were significantly greater than those for the control group and before restoration. The Co-Cr group showed the greatest PD, GCF volume, RANKL/OPG, RANKL, and calcium ion concentration, followed by the Au-Pt group. The Ti group had the highest OPG concentration, followed by the Zi group. The RANKL and calcium ion concentrations of the Ti and Zi groups were the smallest. The Ti group had the smallest RANKL/OPG ratio, followed by the Zi group. Different crown materials differentially affected the PD, volume, RANKL/OPG ratio, OPG, RANKL, and calcium concentration. Among the 4 tested crown materials, Zi and Ti are preferred. However, some limitations of the present study should be considered. [ABSTRACT FROM AUTHOR]

The most common cause of peri-implantitis is the accumulation of plaque and the formation of a biofilm on the implant surface. Terminating the development of the disease requires the biofilm to be removed from the implant surface. This paper describes 2 cases of severe peri-implantitis lesions treated through surgical approaches. Complete mechanical debridement with a round titanium brush was mainly performed to detoxify and modify the affected implant surface. A regenerative approach was then performed. In both cases, the surgical procedure was effective in arresting the peri-implantitis, and clinical reentry revealed uneventful healing of the existing bone defect. No further radiographic bone loss was observed over the 2-year follow-up period. This technique has the advantage of effective cleaning the contaminated implant surface, producing positive clinical and radiological results. However, further studies involving more cases are necessary to verify the reliability and validity of this technique. [ABSTRACT FROM AUTHOR]

This case report presents a treatment of peri-implantitis associated with a pre-existing pathology. Peri-implantitis around implant #19 was detected from pus discharge upon probing. Guided bone regeneration was performed to treat the peri-implantitis with the administration of antibiotics. The histopathologic evaluation of soft tissue taken from the circumferential defect around the implant exhibited a cyst. The postsurgical CBCT and the follow-up radiograph confirmed the maturing bone graft and a reduced size of the defect around the implant. [ABSTRACT FROM AUTHOR]

Enterococcus faecalis appears in many tooth root infections and is not eliminated by root canal therapy. It can reside in tooth root canals and the surrounding bone. This species may vegetate in bone after extraction of an infected tooth and colonize a dental implant after placement in the healed site. A colonization may cause fixture loss or marginal bone loss. These colonizations are generally multibacterial and pathogenic properties can be shared via plasmids. However, E faecalis is not detectable with some culture techniques and thus can be missed. It is usually not a dominant species in these infections. Nonetheless, E faecalis may be a 'keystone' player in dental implant bone loss or peri-implantitis. That is, E faecalis may be the pathogenic determinant for any particular peri-implantitis infection of a multiple-species infection. [ABSTRACT FROM AUTHOR]

Bacterial leakage from the implant-abutment-interface (IAI) is suspected of contributing to the development of peri-implantitis. The aim of the study was to develop a straightforward test setup to evaluate the bacterial leakage of the IAI of 2-piece implant systems under laboratory conditions. A test suspension of Enterococcus faecium was injected into 7 implants (PerioType Rapid Implants) prior to abutment fixation. The IAI was covered by kanamycin aesculn azide agar (KAAA), which serves as an optical indicator for E. faecium. The specimens were cyclically loaded with a force of 120 N for up to 1 000 000 cycles in a universal testing machine in accordance with the ISO 14801:2007 standard. The color change of the KAAA was recorded. Three of the 7 implants showed bacterial leakage before the cyclic loading test started. The bacterial tightness of the IAIs of the 4 remaining implants lasted for 35 680 ± 22 467 cycles on average. The experimental setup at hand provides the means for a straightforward evaluation of the bacterial tightness of the IAI of 2-piece dental implants. [ABSTRACT FROM AUTHOR]