Frailty is a highly prevalent condition in the elderly that has been increasingly considered as a crucial public health issue, due to the strict correlation with a higher risk of fragility fractures, hospitalization, and mortality. Among the age-related diseases, sarcopenia and dysphagia are two common pathological conditions in frail older people and could coexist leading to dehydration and malnutrition in these subjects. “Sarcopenic dysphagia” is a complex condition characterized by deglutition impairment due to the loss of mass and strength of swallowing muscles and might be also related to poor oral health status. Moreover, the aging process is strictly related to poor oral health status due to direct impairment of the immune system and wound healing and physical and cognitive impairment might indirectly influence older people’s ability to carry out adequate oral hygiene. Therefore, poor oral health might affect nutrient intake, leading to malnutrition and, consequently, to frailty. In this scenario, sarcopenia, dysphagia, and oral health are closely linked sharing common pathophysiological pathways, disabling sequelae, and frailty. Thus, the aim of the present comprehensive review is to describe the correlation among sarcopenic dysphagia, malnutrition, and oral frailty, characterizing their phenotypically overlapping features, to propose a comprehensive and effective management of elderly frail subjects.

Objectives: To report the clinical outcomes for patients with implants treated for peri‐implantitis who subsequently received supportive care (supportive peri‐implant/periodontal therapy) for at least 3 years.Material and methods: A systematic search of multiple electronic databases, grey literature and hand searching, without language restriction, to identify studies including ≥10 patients was constructed. Data and risk of bias were explored qualitatively. Estimated cumulative survival at the implant‐ and patient‐level was pooled with random‐effects meta‐analysis and explored for publication bias (funnel plot) at different time intervals.Results: The search identified 5,761 studies. Of 83 records selected during screening, 65 were excluded through independent review (kappa = 0.94), with 18 retained for qualitative and 13 of those for quantitative assessments. On average, studies included 26 patients (median, IQR 21–32), with 36 implants (median, IQR 26–45). Study designs (case definitions of peri‐implantitis, peri‐implantitis treatment, supportive care) and population characteristics (patient, implant and prosthesis characteristics) varied markedly. Data extraction was affected by reduced reporting quality, but over 75% of studies had low risk of bias. Implant survival was 81.73%–100% at 3 years (seven studies), 74.09%–100% at 4 years (three studies), 76.03%–100% at 5 years (four studies) and 69.63%–98.72% at 7 years (two studies). Success and recurrence definitions were reported in five and two studies respectively, were heterogeneous, and those outcomes were unable to be explored quantitatively.Conclusion: Therapy of peri‐implantitis followed by regular supportive care resulted in high patient‐ and implant‐level survival in the medium to long term. Favourable results were reported, with clinical improvements and stable peri‐implant bone levels in the majority of patients.

Aim: To present the 20‐year clinical outcomes of tissue‐level implants in partially edentulous patients previously treated for periodontitis and in periodontally healthy patients (PHP).Material and Methods: The original population consisted of 149 partially edentulous patients consecutively enrolled in a private specialist practice and divided into three groups: PHP, moderately periodontally compromised patients (mPCP) and severely PCP (sPCP). After successful completion of periodontal/implant therapy, patients were enrolled in an individualized supportive periodontal care (SPC) programme.Results: Eighty‐four patients rehabilitated with 172 implants reached the 20‐year examination. During the observation time, 12 implants were removed (i.e., 11 due to biological complications and 1 due to implant fracture), leading to an overall implant survival rate of 93% (i.e., 94.9% for PHP, 91.8% for mPCP and 93.1% for sPCP [p = .29]). At 20 years, PCP compliant with SPC did not present with significantly higher odds of implant loss compared with PHP compliant with SPC (p > .05). Conversely, PCP not compliant with SPC experienced implant loss with odds ratio of 14.59 (1.30–164.29, p = .03).Conclusions: Tissue‐level implants, placed after comprehensive periodontal therapy and SPC, yield favourable long‐term results. However, patients with a history of periodontitis and non‐compliant with SPC are at higher risk of biological complications and implant loss.

Background: The significance on the association between the peri‐implant bucco‐lingual dimension (BLD) at the stage of implant placement and the occurrence of biological and esthetic complications is yet unknown.Material and methods: Systematic screening of electronic sources was carried out to identify clinical and preclinical studies reporting on the baseline BLD and/or buccal bone thickness (BBT) values. A secondary objective was to assess the effect of simultaneous grafting at sites with deficient or no buccal bone wall (BBW) at baseline. The primary outcome variables were BBT, BLD, and buccal vertical bone loss (VBL) at re‐evaluation. Moreover, radiographic, clinical, and patient‐reported outcome measures (PROMs) were evaluated.Results: Overall, 12 clinical and four preclinical studies met the inclusion criteria. Inconsistencies were found in defining the critical BBT across the clinical and preclinical data evaluated. The clinical evidence demonstrated that during healing, dimensional changes occur in the alveolar bone and in the BBW that may compromise the integrity of the peri‐implant bone, leading to VBL and mucosal recession (MR), particularly in scenarios exhibiting a thin BBW. The preclinical evidence validated the fact that implants placed in the presence of a thin BBW, are more prone to exhibit major dimensional changes and VBL. Moreover, the clinical data supported that, in scenarios where dehiscence‐type defects occur and are left for spontaneous healing, greater VBL and MR together with the occurrence of biologic complications are expected. Furthermore, the augmentation of dehiscence‐type defects is associated with hard and soft tissue stability. PROMs were not reported.Conclusions: Dimensional changes occur as result of implant placement in healed ridges that may lead to instability of the peri‐implant hard and soft tissues. Sites presenting a thin BBW are more prone to exhibit major changes that may compromise the integrity of the buccal bone and may lead to biologic and esthetic complications.