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Implant Tribune Italian Edition No.1, 2017

Implant Tribune Italian Edition - Marzo 2017 Revisione della Letteratura 19 A systematic review on the defi nition of periimplantitis Limits related to the various diagnoses proposed Marco Tallarico a, Alberto Monje b, Hom-Lay Wang b, Pablo Galindo Moreno c, Erta Xhanari d & Luigi Canullo e a Private practice, Rome, Italy; Dentistry Unit, University Hospital of Sassari, Sassari, Italy & Research Project Manager of Osstem AIC Italy b Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, Mich., U.S. c Department of Oral Surgery and Implant Dentistry, University of Granada, Granada, Spain d Independent researcher, Tirana, Albania e Independent researcher, Rome, Italy L’articolo è stato pubblicato su Journal of Oral Science & Rehabilitation No. 4, 2016 < pagina 1 Despite this very clear and com- prehensive disease definition, inconsistencies and confusion emerge in applying the terminol- ogy clinically. All of these factors together have led to diferent interpretations and definitions of this common emerging disease. Besides, re- cently, for- reaction hypothesis eign-body has further complicated the un- derstanding of this issue.22 The aim of the present systematic review was to present the difer- ent definitions of periimplantitis proposed in the literature. the noninfectious Materials and methods The present paper was prepared in partial fulfillment of a consen- sus statement held in Rome, Italy, in January 2016. This systematic review was writ- ten according to the PRISMA (Pre- ferred Reporting Items for System- atic Reviews and Meta-Analyses) guidelines (http://www.prismas- tatement. org/PRISMAStatement/ PRISMAStatement.aspx). The fo- cused question was: Is there an unanimous definition of periim- plantitis, including clinical diag- nosis. The research question was adapted to the PICO format: • P = population: human pa- tients derived from clinical studies, systematic reviews, narrative reviews, consensu- ses statements, commentaries or editorials, who presented with at least one dental im- plant in function for a mini- mum of one year, afected by periimplantitis; I = intervention: clinical data collected with the aim of esta- blishing the severity of the pe- riimplant disease and of defi- ning novel criteria by which to classify periimplant diseases; • C = comparator/control: clini- cal outcomes of periimplanti- tis compared with clinical si- gns of periodontitis, as well as with healthy patients; • • O = outcomes: clinical parame- ters and radiographic asses- sment of periimplantitis: BOP, PPD, bleeding index, presence of SUP and marginal bone loss (MBL). Search strategy An initial search strategy encom- Table 1 - Search strategy for the selected databases. passing the English literature from 1967 up to October 2015 was performed online to identify rel- evant studies that met the inclu- sion criteria. The following electronic databas- es were consulted: PubMed data- base of the U.S. National Library of Medicine, Embase (Excerpta Medica dataBASE) and the Co- chrane Library. According to the AMSTAR (A Measurement Tool to Assess Systematic Reviews) check- list, the Grey Literature Database was screened in the New York Academy of Medicine Grey Litera- ture Report in order to find possi- ble unpublished works. Screening was performed inde- pendently and simultaneously by two examiners (MT and AM). A third reviewer (LC) reassessed the included and excluded stud- ies. The electron ic databases were searched using a combination of boolean keywords, including MeSH and several free-text terms (Table 1). Eligibility criteria The following inclusion criteria were defined for the selection of articles: – written in English; – entailing clinical examination of human patients; – randomized controlled clini- cal trials of implants of ≥ 1 year in function; – prospective and retrospective cohort studies of implants of ≥ 1 year in function; – cross-sectional studies of ≥ 1 year in function; and – systematic reviews, narrati- ve reviews, consensus state- ments, commentaries or edito- rials. Articles were excluded if they were: – animal studies; – in vitro studies; – reports of locally or systemi- cally compromised sites and/ or conditions; – reports with < 15 cases; – reports involving mini-im- plants, one-piece implants or blade implants; or – reports on implants < 1 year in function. Papers without abstracts, but with titles related to the objectives of this review were selected so that the full text could be screened for eligibility. Full-text papers were obtained for all abstracts and ti- tles that appeared to meet the in- clusion criteria and were assessed for inclusion by the same two ex- aminers. The reference lists of the selected studies was screened for addition- al papers that may have met the eligibility criteria of the study. Additionally, manual searches of the reference lists of selected sys- tematic reviews were conducted, limited to the following journals: Clinical Implant Dentistry and Related Research, Clinical Oral Implants Research, International Journal of Oral and Maxillofacial Implants, Journal of Clinical Peri- odontology and Journal of Peri- odontology. Any disagreement between the two reviewers was resolved after an additional discussion. Furthermore, inter-investigator agreement was calculated in the second stage. A final reviewer (LC) evaluated possible inconsisten- cies between the two reviewers. All of the full texts of the select- ed papers were stored in shared folders accessible to all of the re- viewers. Qualitative assessment of parame- ters to define periimplantitis A descriptive evaluation was per- formed to analyze qualitatively the range of parameters consid- ered to define periimplantitis as an irreversible inflammatory condition that results in hardtis- sue breakdown. Accordingly, following common parameters were ap- praised: PPD, BOP, SUP and ra- diographic MBL. Such param- eters from the various articles were pooled to analyze the variance or uniformity among the reported case definitions of periimplantitis. Graphs for pre- senting the variance were gen- erated. While PPD was classified into three diferent groups (< 3 mm, 3–5 mm and > 5 mm), ra- diographic MBL was categorized into four main ranges, depen ding on the main reference tak- ing prosthesis delivery as the baseline: ≤ 1 mm, > 1–2 mm, > 3–4 mm and ≥ 5 mm. the Results Screening process The combinations of search terms and a manual search of references in selected articles resulted in a list of 1,061 titles. Of these, 976 articles were exclud- ed on the basis of the evaluation of the title and abstract, leaving 85 articles eligible for inclusion (k = 0.84). After application of the eligibility criteria, a total of 49 ar- ticles were considered for review. After full-text article selection and reading, the relevant infor- mation from each article was ex- tracted. A diagram of the search strategy is shown in Figure 1. Definitions of “periimplantitis” Eighteen manuscripts, including narrative and systematic reviews, consensus statements and origi- nal papers, were selected and data were extracted. In 1965, Levignac reported a inflam- periimplant soft-tissue mation with subsequent de- struction of bone and labeled it “periimplantitis.”1 In the 1987, Mombelli et al. described periim- plantitis as an infectious disease that shares features with chronic periodontitis.13 The same author emphasized the infectious nature of this patho logical condition, focusing on the bacterial load of the implant surface and subsequent appearance of a soft-tissue in- flammatory reaction adjacent to dental implants that sometimes resulted in loss of supporting bone.11,24,25 the > pagina 20

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