Sensitivity and Specificity of Peri-Implantitis-Related Parameters
Condition: Sensitivity; Peri-implant Mucositis; Peri-Implantational Loss; Peri-Implantitis
MeSH terms: Mucositis; Peri-Implantitis; Hypersensitivity
Study type: Observational

Summary: 
      Bleeding on probing demonstrated to have high specificity with certain level of sensitivity
      to detect periodontal disease. Again, understanding the weak hemidesmosome attachment to the
      implant surface is imperative to discern on the probe penetration extent and subsequent
      bleeding. In the presence of inflammation, bleeding should be present indicating high
      sensitivity when probing deeper sites; nevertheless the lack thereof in healthy condition
      does not seem to translate high specificity. In this sense, it is noteworthy to mention that
      the mucogingival shift after implant placement often decreases the presence of keratinized
      mucosa, triggering a greater inflammatory condition on the peri-implant tissues. Thereupon,
      bleeding on probing, although might reliably indicate presence of disease, it does not seem
      to be a suitable diagnostic parameter. On the other side, suppuration characterizes the
      necrosis of peri-implant tissues, being rich in polymorphonuclear cells and as such, a
      sensitive indicator of bone turnover. In this sense, it must be noted that, if detected in
      early stages where bone resorption has not occurred yet, it might be a consequence of a
      foreign body reaction (i.e., residual cement or floss).

      Therefore, in the diagnosis of peri-implantitis, radiographic examination must be always
      incorporated to the clinical assessment as the 'gold standard'. Hence, the aim of this
      case-control study was to assess the diagnostic accuracy of peri-implantitis-related clinical
      parameters compared to otherwise healthy dental implants.
    

Detailed description: 
      All subjects enrolled had to be consecutively evaluated in a routine peri-implant maintenance
      t with dental implants for fixed prosthesis rehabilitation with a minimum period of 12 months
      after final prosthesis delivery. Patients were contacted and informed to participate in a
      cross-sectional assessment to identify the presence of peri-implant diseases. Eligible
      implants had to be in an ideal prosthetically driven position, otherwise they were excluded
      from the analysis. Moreover, implants that could not be accurately recorded the probing depth
      due to inadequate prosthesis design were further excluded. Baseline periapical x-ray at time
      of prosthesis delivery was retrospective assessed to exclude implants with early peri-implant
      bone loss before function. A detailed description of risk factors and indicators of
      peri-implant disease were explained at the same stage. Additionally, patients were thoroughly
      instructed on plaque control home care strategies including but not limited to interdental
      brushes with nylon-coated core wire, soft toothbrushes (manual and power) and floss with
      stiffened end to clean under multiple units fixed-prosthesis. Moreover, treated patients were
      encouraged to routinely enroll in a peri-implant maintenance therapy program.

      The present case-control study will be conducted in accordance with the Helsinki declaration
      of human studies and received approval from the ethics committee from the University of
      Extremadura (Badajoz, Spain). An informed written consent was signed from each subject
      enrolled in the present study.
    

Intervention name(s): Sensitivity test
Intervention type(s): Diagnostic Test
Intervention description(s): Routine clinical and radiographic examination
Observational model: Case-Control
Time perspective: Cross-Sectional
Sampling method: Probability Sample
Study population: 
        Patients will be either approached during their biannual peri-implant maintenance recall
        appointment or contacted and asked to participate in a free clinical and radiographic
        examination to identify the possible presence of peri-implant pathology.