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Published in: International Journal of Implant Dentistry 1/2015

Open Access 01-12-2015 | Research

Soft-tissue grafting for peri-implantitis—a treatment option in case of unsuitable skeletal basic morphology of the alveolar bone and lack of keratinized mucosa: a retrospective clinical cohort study

Authors: Michael Stiller, Rainer Mengel, Sebastian Becher, Bernhard Brinkmann, Barbara Peleska, Esther Kluk

Published in: International Journal of Implant Dentistry | Issue 1/2015

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Abstract

Background

This retrospective study evaluated soft-tissue grafting as a surgical treatment option for peri-implantitis in case of unsuitable basic skeletal morphology of the alveolar bone and lack of keratinized mucosa.

Methods

Twenty-eight patients (21 females, 7 males, at a mean age 59.4 years) were included with a total of 54 implants. All implants showed peri-implantitis and attached keratinized buccal mucosa of ≤2 mm. A surgical procedure of soft-tissue grafting (STG) was made by inserting an inlay and inlay-onlay transplant. Clinical investigations were made prior to the STG (baseline) and after 9–180 months (Ø 43 months) including the following parameters: soft-tissue biotype, skeletal basic morphology of the alveolar bone, width of the peri-implant keratinized mucosa (KM), mobility of the KM, pocket probing depth (PPD), and bleeding on probing (BOP).

Results

Nearly all patients showed a thin soft-tissue biotype. The analysis of the skeletal basic morphology of the alveolar bone revealed a narrow apical base in 18 patients, middle base in 7 patients, and broad base in 3 patients. Width of the KM increased significantly (p < 0.01) from 0.4 ± 0,5 mm to 4.3 ± 1.5 mm after STG and PPD was significantly (p < 0,01) reduced from 6.3 ± 2,3 mm to 4.1 ± 1.9 mm. A significant reduction (p < 0.01) in BOP was recorded. All patients reported a clinical improvement of the inflammatory symptoms at follow-up.

Conclusions

The results of this study showed that the STG can be applied successfully as a surgical treatment of peri-implantitis. It remains unclear whether soft-tissue biotype or the skeletal basic morphology of the alveolar bone affects the outcome of this surgical treatment.
Literature
1.
go back to reference Atieh MA, Alsabeeha NH, Faggion Jr CM, Duncan WJ. The frequency of peri-implant diseases: a systematic review and meta-analysis. J Periodontol. 2013;84(11):1586–98.PubMed Atieh MA, Alsabeeha NH, Faggion Jr CM, Duncan WJ. The frequency of peri-implant diseases: a systematic review and meta-analysis. J Periodontol. 2013;84(11):1586–98.PubMed
2.
go back to reference Mombelli A, Müller N, Cionca N. The epidemiology of peri-implantitis. Clin Oral Implants Res. 2012;23(6):67–76.CrossRefPubMed Mombelli A, Müller N, Cionca N. The epidemiology of peri-implantitis. Clin Oral Implants Res. 2012;23(6):67–76.CrossRefPubMed
3.
go back to reference Swierkot K, Lottholz P, Flores-de-Jacoby L, Mengel R. Mucositis, peri-implantitis, implant success, and survival of implants in patients with treated generalized aggressive periodontitis: 3- to 16-year results of a prospective long-term cohort study. J Periodontol. 2012;83:1213–25.CrossRefPubMed Swierkot K, Lottholz P, Flores-de-Jacoby L, Mengel R. Mucositis, peri-implantitis, implant success, and survival of implants in patients with treated generalized aggressive periodontitis: 3- to 16-year results of a prospective long-term cohort study. J Periodontol. 2012;83:1213–25.CrossRefPubMed
4.
go back to reference Albrektsson T, Buser D, Chen ST, Cochran D, DeBruyn H, Jemt T, et al. Statements from the Estepona Consensus Meeting on Peri-implantitis, 2012. Clin Implant Dent Relat Res. 2012;14:781–2.CrossRefPubMed Albrektsson T, Buser D, Chen ST, Cochran D, DeBruyn H, Jemt T, et al. Statements from the Estepona Consensus Meeting on Peri-implantitis, 2012. Clin Implant Dent Relat Res. 2012;14:781–2.CrossRefPubMed
5.
go back to reference Khoshkam V, Chan HL, Lin GH, MacEachern MP, Monje A, Suarez F, et al. Reconstructive procedures for treating peri-implantitis: a systematic review. J Dent Res. 2013;92(12):131–8.CrossRef Khoshkam V, Chan HL, Lin GH, MacEachern MP, Monje A, Suarez F, et al. Reconstructive procedures for treating peri-implantitis: a systematic review. J Dent Res. 2013;92(12):131–8.CrossRef
6.
go back to reference Lang NP, Wilson TG, Corbet EF. Biological complications with dental implants: their prevention, diagnosis and treatment. Clin Oral Implants Res. 2000;11 Suppl 1:146–55.CrossRefPubMed Lang NP, Wilson TG, Corbet EF. Biological complications with dental implants: their prevention, diagnosis and treatment. Clin Oral Implants Res. 2000;11 Suppl 1:146–55.CrossRefPubMed
7.
go back to reference Greenstein G, Cavallaro J. Failed dental implants: diagnosis, removal and survival of reimplantations. J Am Dent Assoc. 2011;145(8):835–42.CrossRef Greenstein G, Cavallaro J. Failed dental implants: diagnosis, removal and survival of reimplantations. J Am Dent Assoc. 2011;145(8):835–42.CrossRef
8.
go back to reference Lin GH, Chan HL, Wang HL. The significance of keratinized mucosa on implant health: a systematic review. J Periodontol. 2013;84(12):1755–67.CrossRefPubMed Lin GH, Chan HL, Wang HL. The significance of keratinized mucosa on implant health: a systematic review. J Periodontol. 2013;84(12):1755–67.CrossRefPubMed
9.
go back to reference Boynueğri D, Nemli SK, Kasko YA. Significance of keratinized mucosa around dental implants: a prospective comparative study. Clin Oral Implants Res. 2013;24(8):928–33.CrossRefPubMed Boynueğri D, Nemli SK, Kasko YA. Significance of keratinized mucosa around dental implants: a prospective comparative study. Clin Oral Implants Res. 2013;24(8):928–33.CrossRefPubMed
10.
go back to reference Bengazi F, Botticelli D, Favero V, Perini A, Urbizo Velez J, Lang NP. Influence of presence or absence of keratinized mucosa on the alveolar bony crest level as it relates to different buccal marginal bone thicknesses. An experimental study in dogs. Clin Oral Implants Res. 2014;25(9):1065–71.CrossRefPubMed Bengazi F, Botticelli D, Favero V, Perini A, Urbizo Velez J, Lang NP. Influence of presence or absence of keratinized mucosa on the alveolar bony crest level as it relates to different buccal marginal bone thicknesses. An experimental study in dogs. Clin Oral Implants Res. 2014;25(9):1065–71.CrossRefPubMed
11.
go back to reference World Medical Association. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA. 2013;310(20):2191–4.CrossRef World Medical Association. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA. 2013;310(20):2191–4.CrossRef
12.
go back to reference Albrektsson T, Zarb G, Worthington P, Eriksson AR. The long-term efficacy of currently used dental implants: a review and proposed criteria of success. Int J Oral Maxillofac Implants. 1986;1(1):11–25.PubMed Albrektsson T, Zarb G, Worthington P, Eriksson AR. The long-term efficacy of currently used dental implants: a review and proposed criteria of success. Int J Oral Maxillofac Implants. 1986;1(1):11–25.PubMed
13.
go back to reference Naert I, Gizani S, Vuylsteke M, van Steenberghe D. A 5-year randomized clinical trial on the influence of splinted and unsplinted oral implants in the mandibular overdenture therapy. Part I: Peri-implant outcome. Clin Oral Implants Res. 1998;9(3):170–7.CrossRefPubMed Naert I, Gizani S, Vuylsteke M, van Steenberghe D. A 5-year randomized clinical trial on the influence of splinted and unsplinted oral implants in the mandibular overdenture therapy. Part I: Peri-implant outcome. Clin Oral Implants Res. 1998;9(3):170–7.CrossRefPubMed
14.
go back to reference Seibert JS, Louis JV. Soft tissue ridge augmentation utilizing a combination onlay-interpositional graft procedure: a case report. Int J Periodontics Restorative Dent. 1996;16(4):310–21.PubMed Seibert JS, Louis JV. Soft tissue ridge augmentation utilizing a combination onlay-interpositional graft procedure: a case report. Int J Periodontics Restorative Dent. 1996;16(4):310–21.PubMed
15.
go back to reference Stiller M, Eisenmann E, Fritz H, Freesmeyer WB. Der lokale Alveolarkammaufbau bei Weichgewebsdefiziten. Z Zahnärztl Implantol. 1998;14:213–8. Stiller M, Eisenmann E, Fritz H, Freesmeyer WB. Der lokale Alveolarkammaufbau bei Weichgewebsdefiziten. Z Zahnärztl Implantol. 1998;14:213–8.
16.
go back to reference Stiller M. Die Rekonstruktion des mukogingivalen Komplexes an Einzelzahnimplantaten zur Verbesserung von Funktion und Ästhetik mit Hilfe mikrochirurgischer Wundversorgungstechniken. ZWR - Das deutsche Zahnärzteblatt. 2001;110:578–84. Stiller M. Die Rekonstruktion des mukogingivalen Komplexes an Einzelzahnimplantaten zur Verbesserung von Funktion und Ästhetik mit Hilfe mikrochirurgischer Wundversorgungstechniken. ZWR - Das deutsche Zahnärzteblatt. 2001;110:578–84.
17.
go back to reference De Rouck T, Eghbali R, Collys K, De Bruyn H, Cosyn J. The gingival biotype revisited: transparency of the periodontal probe through the gingival margin as a method to discriminate thin from thick gingiva. J Clin Periodontol. 2009;36:428–33.CrossRefPubMed De Rouck T, Eghbali R, Collys K, De Bruyn H, Cosyn J. The gingival biotype revisited: transparency of the periodontal probe through the gingival margin as a method to discriminate thin from thick gingiva. J Clin Periodontol. 2009;36:428–33.CrossRefPubMed
18.
go back to reference Cawood JI, Howell RA. A classification of the edentulous jaws. Int J Oral Maxillofac Surg. 1988;17(4):232–6.CrossRefPubMed Cawood JI, Howell RA. A classification of the edentulous jaws. Int J Oral Maxillofac Surg. 1988;17(4):232–6.CrossRefPubMed
19.
go back to reference Kern G, Stadler G, Hinderfeld E. Die Schillersche Jodprobe. Archiv für Gynäkologie. 1962;197(1):36–56.CrossRefPubMed Kern G, Stadler G, Hinderfeld E. Die Schillersche Jodprobe. Archiv für Gynäkologie. 1962;197(1):36–56.CrossRefPubMed
20.
go back to reference Lange DE, Plagmann HC, Eenboom A, Promesberger A. Clinical methods for the objective evaluation of oral hygiene. Dtsch Zahnarztl T. 1977;32(1):44–7. Lange DE, Plagmann HC, Eenboom A, Promesberger A. Clinical methods for the objective evaluation of oral hygiene. Dtsch Zahnarztl T. 1977;32(1):44–7.
21.
go back to reference Heitz-Mayfield LJ, Lang NP. Comparative biology of chronic and aggressive periodontitis vs. peri-implantitis. Periodontol 2000. 2010;53:167–81.CrossRefPubMed Heitz-Mayfield LJ, Lang NP. Comparative biology of chronic and aggressive periodontitis vs. peri-implantitis. Periodontol 2000. 2010;53:167–81.CrossRefPubMed
22.
go back to reference Serino G, Turri A. Outcome of surgical treatment of peri-implantitis: results from a 2-year prospective clinical study in humans. Clin Oral Implants Res. 2011;22(11):1214–20.CrossRefPubMed Serino G, Turri A. Outcome of surgical treatment of peri-implantitis: results from a 2-year prospective clinical study in humans. Clin Oral Implants Res. 2011;22(11):1214–20.CrossRefPubMed
23.
go back to reference Charalampakis G, Rabe P, Leonhardt A, Dahlén G. A follow-up study of peri-implantitis cases after treatment. J Clin Periodontol. 2011;38(9):864–71.CrossRefPubMed Charalampakis G, Rabe P, Leonhardt A, Dahlén G. A follow-up study of peri-implantitis cases after treatment. J Clin Periodontol. 2011;38(9):864–71.CrossRefPubMed
24.
go back to reference Schwarz F, John G, Mainusch S, Sahm N, Becker J. Combined surgical therapy of peri-implantitis evaluating two methods of surface debridement and decontamination. A two-year clinical follow up report. J Clin Periodontol. 2012;39(8):789–97.CrossRefPubMed Schwarz F, John G, Mainusch S, Sahm N, Becker J. Combined surgical therapy of peri-implantitis evaluating two methods of surface debridement and decontamination. A two-year clinical follow up report. J Clin Periodontol. 2012;39(8):789–97.CrossRefPubMed
25.
go back to reference Enhos S, Uysal T, Yagci A, Veli İ, Ucar FI, Ozer T. Dehiscence and fenestration in patients with different vertical growth patterns assessed with cone-beam computed tomography. Angle Orthod. 2012;82(5):868–74.CrossRefPubMed Enhos S, Uysal T, Yagci A, Veli İ, Ucar FI, Ozer T. Dehiscence and fenestration in patients with different vertical growth patterns assessed with cone-beam computed tomography. Angle Orthod. 2012;82(5):868–74.CrossRefPubMed
26.
go back to reference Evangelista K, Vasconcelos Kde F, Bumann A, Hirsch E, Nitka M, Silva MA. Dehiscence and fenestration in patients with Class I and Class II Division 1 malocclusion assessed with cone-beam computed tomography. Am J Orthod Dentofacial Orthop. 2010;138(2):133–7.CrossRefPubMed Evangelista K, Vasconcelos Kde F, Bumann A, Hirsch E, Nitka M, Silva MA. Dehiscence and fenestration in patients with Class I and Class II Division 1 malocclusion assessed with cone-beam computed tomography. Am J Orthod Dentofacial Orthop. 2010;138(2):133–7.CrossRefPubMed
27.
go back to reference Gobbato L, Avila-Ortiz G, Sohrabi K, Wang CW, Karimbux N. The effect of keratinized mucosa width on peri-implant health: a systematic review. Int J Oral Maxillofac Implants. 2013;28(6):1536–45.CrossRefPubMed Gobbato L, Avila-Ortiz G, Sohrabi K, Wang CW, Karimbux N. The effect of keratinized mucosa width on peri-implant health: a systematic review. Int J Oral Maxillofac Implants. 2013;28(6):1536–45.CrossRefPubMed
28.
go back to reference Linkevicius T, Apse P, Grybauskas S, Puisys A. The influence of soft tissue thickness on crestal bone changes around implants: a 1-year prospective controlled clinical trial. Int J Oral Maxillofac Implants. 2009;24(4):712–9.PubMed Linkevicius T, Apse P, Grybauskas S, Puisys A. The influence of soft tissue thickness on crestal bone changes around implants: a 1-year prospective controlled clinical trial. Int J Oral Maxillofac Implants. 2009;24(4):712–9.PubMed
29.
go back to reference Linkevicius T, Puisys A, Linkeviciene L, Peciuliene V, Schlee M. Crestal bone stability around implants with horizontally matching connection after soft tissue thickening: a prospective clinical trial. Clin Implant Dent Relat Res. 2013;17. doi:10.1111/cid.12155. [Epub ahead of print]. Linkevicius T, Puisys A, Linkeviciene L, Peciuliene V, Schlee M. Crestal bone stability around implants with horizontally matching connection after soft tissue thickening: a prospective clinical trial. Clin Implant Dent Relat Res. 2013;17. doi:10.​1111/​cid.​12155. [Epub ahead of print].
30.
go back to reference Brito C, Tenenbaum HC, Wong BK, Schmitt C, Nogueira-Filho G. Is keratinized mucosa indispensable to maintain peri-implant health? A systematic review of the literature. J Biomed Mater Res B Appl Biomater. 2014;102(3):643–50.CrossRefPubMed Brito C, Tenenbaum HC, Wong BK, Schmitt C, Nogueira-Filho G. Is keratinized mucosa indispensable to maintain peri-implant health? A systematic review of the literature. J Biomed Mater Res B Appl Biomater. 2014;102(3):643–50.CrossRefPubMed
31.
go back to reference Patil R, van Brakel R, Mahesh K, de Putter C, Cune MS. An exploratory study on assessment of gingival biotype and crown dimensions as predictors for implant esthetics comparing caucasian and Indian subjects. J Oral Implantol. 2013;39(3):308–13.CrossRefPubMed Patil R, van Brakel R, Mahesh K, de Putter C, Cune MS. An exploratory study on assessment of gingival biotype and crown dimensions as predictors for implant esthetics comparing caucasian and Indian subjects. J Oral Implantol. 2013;39(3):308–13.CrossRefPubMed
Metadata
Title
Soft-tissue grafting for peri-implantitis—a treatment option in case of unsuitable skeletal basic morphology of the alveolar bone and lack of keratinized mucosa: a retrospective clinical cohort study
Authors
Michael Stiller
Rainer Mengel
Sebastian Becher
Bernhard Brinkmann
Barbara Peleska
Esther Kluk
Publication date
01-12-2015
Publisher
Springer Berlin Heidelberg
Published in
International Journal of Implant Dentistry / Issue 1/2015
Electronic ISSN: 2198-4034
DOI
https://doi.org/10.1186/s40729-015-0029-8

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