Peri-implant diseases are prevalent with a weighted mean prevalence rate of 43% across Europe and 22% across South and North America. Although the main etiologic agent is bacterial biofilm, a myriad of factors influence the initiation and progression of the disease. Unfortunately, the treatment of peri-implant diseases is at best favorable in the short term with a high rate of persistent inflammation and recurrence. Therefore, it is sensible to consider and control all potential factors that may predispose an implant to peri-implant tissue inflammation in an attempt to avoid the disease. This paper reviews recent evidence on factors that may predispose implants to peri-implantitis and measures that can be taken to prevent it.

Breaking the wave of peri-implantitis

Local and endogenous patient-related factors on implant failures

In vivo implants that are composed of titanium and titanium alloys as raw materials are widely used in the fields of biology and medicine. In the field of dental medicine, titanium is considered to be an ideal dental implant material. Good osseointegration and soft tissue closure are the foundation for the success of dental implants. Therefore, the enhancement of the osseointegration and antibacterial abilities of titanium and its alloys has been the focus of much research. With its many advantages, layer-by-layer (LbL) assembly is a self-assembly technique that is used to develop multilayer films based on complementary interactions between differently charged polyelectrolytes. The LbL approach provides new methods and applications for the surface modification of dental titanium implant. In this review, the application of the LbL technique to surface modification of titanium including promoting osteogenesis and osseointegration, promoting the formation and healing of soft tissues, improving the antibacterial properties of titanium implant, achieving local drug delivery and sustained release is summarized.

Surface Modification of Dental Titanium Implant by Layer-by-Layer Electrostatic Self-Assembly.

In healthy subjects, dental implants have evolved to be a common therapy to solve problems related to stability and retention of dentures as well as to replace failing teeth. Although dental implants are applied in medically compromised patients, it is often not well known whether this therapy is also feasible in these patients, whether the risk of implant failure and developing peri-implantitis is increased, and what specific preventive measures, if any, have to be taken when applying dental implants in these patients. Generally speaking, as was the conclusion by the leading review of Diz, Scully, and Sanz on placement of dental implants in medically compromised patients (J Dent, 41, 2013, 195), in a few disorders implant survival may be lower, and the risk of a compromised peri-implant health and its related complications be greater, but the degree of systemic disease control outweighs the nature of the disorder rather than the risk accompanying dental implant treatment. So, as dental implant treatment is accompanied by significant functional benefits and improved oral health-related quality of life, dental implant therapy is a feasible treatment in almost any medically compromised patient when the required preventive measures are taken and follow-up care is at a high level.

The medically compromised patient : Are dental implants a feasible option?

Background and Objective: Minor dental surgery is invasive and hemorrhagic. Thus, in patients treated with anticoagulants, the bleeding risk related to these invasive procedures is concerning. The aim of this meta-analysis is to evaluate this risk by comparing the postoperative bleeding rates of oral anticoagulation treatment (OAT) patients (without interrupted or altered anticoagulant intake) with non-OAT patients. Methods: PubMed, Embase and the Cochrane Library were searched for eligible studies that compared the postoperative (following minor dental surgery) bleeding rates of OAT patients without interrupted or altered therapy with those of non-OAT patients. Relative risk (RR) and 95% confidence interval (CI) were calculated. Subgroup analyses were used to identify the association between the bleeding rate and different dental surgeries or anticoagulants. Results: 32 full text articles were assessed for eligibility and 20 studies were excluded according to the selection criteria. Finally, 12 studies and a total of 2102 OAT patients and 2271 non-OAT patients were included. A pooled analysis indicated that the postoperative bleeding risk in OAT patients is higher than that of non-OAT patients (RR: 2.794, 95% CI: 1.722-4.532, P=0.000). The pooled relative risks in the dental implant surgery and dental extraction subgroups were 2.136 (95% CI: 0.825-5.531, P=0.118) and 2.003 (95% CI: 0.987-4.063, P=0.054), respectively. As for the different oral anticoagulants, the pooled RR in the subgroup of new oral anticoagulants (NOACs) was 1.603 (95% CI: 0.430-5.980, P=0.482), while the pooled RR in the vitamin K antagonists subgroup was 3.067 (95% CI: 1.838-5.118, P=0.000). Conclusions: Under current evidence, OAT patients were under a higher postoperative bleeding risk than the non-OAT patients following minor dental surgery. For the dental implant surgeries and dental extractions, our study failed to demonstrate a higher risk of bleeding in the OAT patients compared with the non-OAT patients. Besides, The NOACs might be safer than the vitamin K antagonists in dental implant surgery. However, more well-designed studies are required for future research.

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Post-operative Bleeding Risk in Dental Surgery for Patients on Oral Anticoagulant Therapy: A Meta-analysis of Observational Studies.

Background Owing to limited evidence, it is unclear whether diabetes that is not well controlled would lead to a higher rate of dental implant failure. The authors of this meta-analysis evaluated whether the failure rate for patients with diabetes that was not well controlled was higher than the failure rate for patients with well-controlled diabetes. Types of Studies Reviewed The authors searched PubMed, the Cochrane Library, and ClinicalTrials.gov without limitations for studies whose investigators compared the dental implant failure rates between patients with well-controlled diabetes and diabetes that was not well controlled. The authors pooled the relative risk (RR) and 95% confidence interval (CI) values to estimate the relative effect of the glycemic level on dental implant failures. The authors used a subgroup analysis to identify the association between the implant failure rate and the stage at which the failure occurred. Results The authors included 7 studies in this meta-analysis, including a total of 252 patients and 587 dental implants. The results of the pooled analysis did not indicate a direct association between the glycemic level in patients with diabetes and the dental implant failure rate (RR, 0.620; 95% CI, 0.225-1.705). The pooled RR in the subgroup of patients who experienced early implant failure was 0.817 (95% CI, 0.096-6.927), whereas in the subgroup of patients who experienced late implant failure, the pooled RR was 0.572 (95% CI, 0.206-1.586). Conclusions and Practical Implications On the basis of the evidence, the results of this meta-analysis failed to show a difference in the failure rates for dental implants between patients with well-controlled diabetes and patients with diabetes that was not well controlled. However, considering the limitations associated with this meta-analysis, the authors determined that future studies that are well designed and provide adequate controls for confounding factors are required.

Does a higher glycemic level lead to a higher rate of dental implant failure?: A meta-analysis.

Background and Objective: Many clinical researches have been carried out to investigate the relationship between myocardial infarction (MI) and periodontitis. Despite most of them indicated that the periodontitis may be associated with an increased risk of MI, the findings and study types of these studies have been inconsistent. The goal of this meta-analysis was to critically assess the strength of the association between MI and periodontitis in case-control studies. Methods: PubMed and the Cochrane Library were searched for eligible case-control studies reporting relevant parameters that compared periodontal status between MI and control subjects. The odds ratios (ORs) and 95% confidence intervals (CIs) from each study were pooled to estimate the strength of the association between MI and periodontitis. The mean differences and 95% CIs for periodontal-related parameters were calculated to determine their overall effects. Results: Seventeen studies including a total of 3456 MI patients and 3875 non-MI control subjects were included. The pooled OR for the association between MI and periodontitis was 2.531 (95% CI: 1.927-3.324). The mean differences (95% CIs) for clinical attachment loss, probing depth, bleeding on probing, plaque index, and the number of missing teeth were 1.000 (0.726-1.247), 1.209 (0.538-1.880), 0.342 (0.129-0.555), 0.383 (0.205-0.560), and 4.122 (2.012-6.232), respectively. Conclusion: With the current evidence, the results support the presence of a significant association between MI and periodontitis. Moreover, MI patients had worse periodontal and oral hygiene status and fewer teeth than did control subjects. More high-quality and well-designed studies focusing on the casual relationship between MI and periodontitis should be conducted in the future.

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Association between Myocardial Infarction and Periodontitis: A Meta-Analysis of Case-Control Studies.

As natural nanoparticles, exosomes are a type of extracellular vesicles that are enclosed by a lipid bilayer and contain various cargos, including miRNA, mRNA, DNA and proteins. Exosomes have rapidly gained attention as a highly promising cell-free therapy. Because the cargo of exosomes changes with the changes in parent cells and status, exosomes from different types of cells may exhibit different biological effects. Considering the particularity of oral tissue stem cells, their exosomes were isolated and used to examine their related biological functions and the possibility of replacing stem cells. A variety of exosomes of oral tissue stem cells were studied, and the results revealed many special biological characteristics of these exosomes and their parent cells, especially immunomodulation, osteogenesis, odontogenesis, neuroprotection, nerve regeneration, wound healing, skin regeneration and vascularization. The oral tissue stem cell exosomes may be loaded with drugs or genes and act as tools for tumor treatment. The relevant results showed that exosomes from oral tissue stem cells were potent therapeutic tools. The present review focuses on the biological function and application of oral tissue stem cell-derived exosomes.

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Na Huo

Papers

Does a higher glycemic level lead to a higher rate of dental implant failure?: A meta-analysis.

Association between Myocardial Infarction and Periodontitis: A Meta-Analysis of Case-Control Studies.

Exosomes from oral tissue stem cells: biological effects and applications

Association between polymorphisms in interleukins and oral lichen planus: A meta-analysis.

Is there an association between IFN-γ +874A/T polymorphism and periodontitis susceptibility?: A meta-analysis.