Editor-in-Chief's note: We asked the authors if they wished to respond to R. Adam's letter, ‘Unscientific statements'. They do so below, pointing out that the context of their article was not a compendium of the evidence, but now including comprehensive references to back their case, which we publish in full in this particular circumstance.
Sir, thank you for the opportunity to respond to the feedback from R. Adams. Unfortunately, R. Adams has completely missed the point of this series of very short articles which are experiential tips, rather than a compendium of the evidence. The authors are fully cognisant of basing opinion on evidence and interestingly R. Adams uses one of the author's systematic reviews in his own self-citation, highlighting the importance of utilising quality evidence in clinical decision making.1
It is stated that ARP has been developed to promote retention of the bone and soft tissue topographical contour, not preservation of the original bone.
ARP includes a range of different techniques, including different surgical approaches, guided bone regeneration (GBR) and socket seal (SS) techniques with various membrane or bone grafting materials. Histologically, socket healing is influenced by the procedural risks and the healing times of examination.2,3,4,5,6,7 Both GBR and SS encourage the induction of new bone formation8 promoting the availability and cellular activity of osteogenic cells,9,10 with different ARP materials having a unique effect on healing.11,12,13,14,15
There are limitations in the evidence base, regarding the direct causality of occlusal overload and implant marginal bone loss, but researchers acknowledge an association.16,17,18,19,20,21 The articles raising an objection to this statement do not present a conflicting view. The review by Naert et al.22was inconclusive, with Afrashtefar23 and Bertolini24only reporting on animal studies and Afrashtefar indicating bias and heterogeneity. The EFP World Workshop25 summarises that the effects of occlusal overloading on stable implants are limited and conflicting.
Whilst intrusion of dental implants into the sinus cavity during maxillary implant placement is common, researchers agree that the survival rate of these implants is high (95.6%). Clinical and radiological complications are reported at 3.4% and 14.8%, respectively.26 To compensate for the lack of maxillary bone height, several bone augmentation or sinus lift techniques have been proposed. Membrane perforations represent the most common complication among these procedures,27,28,29 with sinus infection a known risk outcome. The authors were highlighting this as something general dentists should have some awareness of as a cautionary measure.
Peri-implantitis is a plaque-associated disease characterised by inflammation in the peri-implant mucosa and progressive loss of supporting bone, following initial implant healing.
The definition of peri-implant disease is taken directly from the EFP peri-implantitis classification25,30 and case example. The statement agrees with the definition outlined by the respondent.
The EFP S3 clinical treatment priorities for peri-implantitis patients31 indicate: ‘peri-implantitis therapy starts with a non-surgical step, followed by re-evaluation and, depending on the outcomes, progress to the surgical step or to SPIC'.
Successful treatment of the site requires concurrent plaque control and biofilm disruption, with the BSP and EFP suggesting that both non-surgical and surgical techniques can be beneficial.32
References
MacBeth N, Trullenque-Eriksson A, Donos N, Mardas N. Hard and soft tissue changes following alveolar ridge preservation: a systematic review. Clin Oral Implants Res 2017; 28: 982-1004.
Sculean A, Stavropoulos A, Bosshardt D D. Self-regenerative capacity of intra-oral bone defects. J Clin Periodontol 2019; 46: 70-81.
Retzepi M, Donos N. Guided Bone Regeneration: biological principle and therapeutic applications. Clin Oral Implants Res 2010; 21: 567-576.
Tal H, Kozlovsky A, Artzi Z, Nemcovsky C E, Moses O. Long-term bio-degradation of cross-linked and non-cross-linked collagen barriers in human guided bone regeneration. Clin Oral Implants Res 2008; 19: 295-302.
Calciolari E, Ravanetti F, Strange A et al. Degradation pattern of a porcine collagen membrane in an in vivo model of guided bone regeneration. J Periodontal Res 2018; 53: 430-439.
Elgali I, Igawa K, Palmquist A et al. Molecular and structural patterns of bone regeneration in surgically created defects containing bone substitutes. Biomaterials 2014; 35: 3229-3242.
Turri A, Elgali I, Vazirisani F et al. Guided bone regeneration is promoted by the molecular events in the membrane compartment. Biomaterials 2016; 84: 167-183.
Kumar P, Vinitha B, Fathima G. Bone grafts in dentistry. J Pharm Bioallied Sci 2013; doi: doi: 10.4103/0975-7406.113312.
Omar O, Elgali I, Dahlin C, Thomsen P. Barrier membranes: More than the barrier effect? J Clin Periodontol 2019; 46: 103-123.
Dahlin C, Gottlow J, Linde A, Nyman S. Healing of maxillary and mandibular bone defects using a membrane technique. An experimental study in monkeys. Scand J Plast Reconstr Surg Hand Surg 1990; 24: 13-19.
Hammerle C H F, Araujo M G, Simion M, Araujo M G. Evidence-based knowledge on the biology and treatment of extraction sockets. Clin Oral Implants Res 2012; 23: 80-82.
Jambhekar S, Kernen F, Bidra A S. Clinical and histologic outcomes of socket grafting after flapless tooth extraction: a systematic review of randomized controlled clinical trials. J Prosthet Dent 2015; 113: 371-382.
Hanser T, Khoury F. Extraction site management in the esthetic zone using autogenous hard and soft tissue grafts: a 5-year consecutive clinical study. Int J Periodontics Restorative Dent 2014; 34: 305-312.
Pelegrine A A, da Costa C E S, Correa M E P, Marques J F C. Clinical and histomorphometric evaluation of extraction sockets treated with an autologous bone marrow graft. Clin Oral Implants Res 2010; 21: 535-542.
Eskow A J, Mealey B L. Evaluation of healing following tooth extraction with ridge preservation using cortical versus cancellous freeze-dried bone allograft. J Periodontol 2014; 85: 514-524.
Chrcanovic B R, Albrektsson T, Wennerberg A. Bruxism and dental implants: a meta-analysis. Implant Dent 2015; 24: 505-516.
Chrcanovic B R, Kisch J, Albrektsson T, Wennerberg A. Bruxism and dental implant failures: a multilevel mixed effects parametric survival analysis approach. J Oral Rehabil 2016; 43: 813-823.
Yadav K, Nagpal A, Agarwal S K, Kochhar A. Intricate assessment and evaluation of effect of bruxism on long-term survival and failure of dental implants: a comparative study. J Contemp Dent Pract 2016; 17: 670-674.
Do T A, Le H S, Shen Y W, Huang H L, Fuh L J. Risk factors related to late failure of dental implant - a systematic review of recent studies. Int J Environ Res Public Health 2020; doi: 10.3390/ijerph17113931.
Di Fiore A, Montagner M, Sivolella S, Stellini E, Yilmaz B, Brunello G. Peri-implant bone loss and overload: a systematic review focusing on occlusal analysis through digital and analogic methods. J Clin Med 2022; doi: 10.3390/jcm11164812.
Kozlovsky A, Tal H, Laufer B-Z et al. Impact of implant overloading on the peri-implant bone in inflamed and non-inflamed per-implant mucosa. Clin Oral Implants Res 2007; 18: 601-610.
Naert I, Duyck J, Vandamme K. Occlusal overload and bone/implant loss. Clin Oral Implants Res 2012; doi: 10.1111/j.1600-0501.2012.02550.x.
Afrashtehfar K I, Afrashtehfar C D. Lack of association between overload and peri-implant tissue loss in healthy conditions. Evid Based Dent 2016; 17: 92-93.
Bertolini M M, Del Bel Cury, A. A., Pizzoloto L, Acapa I R H, Shibli J A, Bordin D.. Does traumatic occlusal forces lead to peri-implant bone loss? A systematic review. Braz Oral Res 2019; doi: 10.1590/1807-3107bor-2019.vol33.0069.
Berglundh T, Armitage G, Araujo M G et al. Peri-implant diseases and conditions: Consensus report of workgroup 4 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. J Clin Periodontol 2018; doi: 10.1111/jcpe.12957.
Ragucci G M, Elnayef B, Suárez-López Del Amo F, Wang H-L, Hernández-Alfaro F, Gargallo-Albiol J. Influence of exposing dental implants into the sinus cavity on survival and complications rate: a systematic review. Int J Implant Dent 2019; doi: 10.1186/s40729-019-0157-7.
Testori T, Tavelli L, Scaini R et al. How to avoid intraoperative and postoperative complications in maxillary sinus elevation. Periodontol 2000 2023; 92: 299-328.
Zijderveld S A, van den Bergh J P, Schulten E A, ten Bruggenkate C M. Anatomical and surgical findings and complications in 100 consecutive maxillary sinus floor elevation procedures. J Oral Maxillofac Surg 2008; 66: 1426-1438.
Schlund M, Meeus J, Politis C, Ferri J. Management of sinus graft infection - a systematic review. Int J Oral Maxillofac Surg 2022; 51: 690-698.
European Federation of Periodontology. New classification of periodontal and peri-implant diseases and conditions. March 2019. Available at: www.efp.org/fileadmin/uploads/efp/Documents/Campaigns/New_Classification/Guidance_Notes/report-04.pdf (accessed November 2023).
Herrera D, Berglundh T, Schwarz F et al. Prevention and treatment of peri-implant diseases - The EFP S3 level clinical practice guideline. J Clin Periodontol 2023; doi: 10.1111/jcpe.13823.
Cosgarea R, Roccuzzo A, Jepsen K, Sculean A, Jepsen S, Salvi G E. Efficacy of mechanical/physical approaches for implant surface decontamination in non-surgical submarginal instrumentation of peri-implantitis. A systematic review. J Clin Periodontol 2023; 50: 188-211.
Schwarz F, Jepsen S, Obreja K, Galarraga-Vinueza M E, Ramanauskaite A. Surgical therapy of peri-implantitis. Periodontol 2000 2022; 88: 145-181.
Donos N, Calciolari E, Ghuman M, Baccini M, Sousa V, Nibali L. 2023. The efficacy of bone reconstructive therapies in the management of peri-implantitis. A systematic review and meta-analysis. J Clin Periodontol 2023; 50: 285-316.
Karlsson K, Derks J, Wennström J L, Petzold M, Berglundh T. Health economic aspects of implant-supported restorative therapy. Clin Oral Implants Res 2022; 33: 221-230.
Heitz-Mayfield L, Heitz F, Lang N. Implant Disease Risk Assessment IDRA - a tool for preventing peri-implant disease. Clin Oral Implants Res 2020; 31: 397-403.
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McColl, E., Macbeth, N. Missing the point. Br Dent J 235, 841–843 (2023). https://doi.org/10.1038/s41415-023-6618-7
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DOI: https://doi.org/10.1038/s41415-023-6618-7