Background: smoking is considered the most modifiable risk factor for periodontal disease. Objective: the aim of this narrative review is to emphasize the effect of smoking on periodontal and implant therapy. Methods: The authors reviewed the literature reporting the clinical outcomes of smoking on periodontal surgical and nonsurgical treatment. The impact of smoking on implant therapy and sinus lifting procedures were also reviewed. Results: Periodontal and implant therapy outcomes are adversely affected by smoking. Smokers respond less favorably to periodontal therapy and periodontal flap procedures as compared to nonsmokers. Clinical outcomes for smokers are 50–75% worse than for nonsmokers. Studies reveal that smokers experience a significantly lower reduction in pocket depth compared to nonsmokers as well as less bone growth after treating infra-bony defects with guided tissue regeneration. The relative risk of implant failure is significantly higher in patients who smoke 20 cigarettes or more per day compared to nonsmokers. Additionally, smoking has also been shown to increase postoperative wound dehiscence and infection rates following sinus floor elevation. Longitudinal studies on smoke cessation have shown a reduction in bone loss and probing depths for periodontitis patients after cessation compared to those who smoke. Conclusion: Smoking cessation can reduce probing depths and improve clinical attachment after nonsurgical periodontal therapy. There is insufficient evidence regarding the effect of smoking on peri-implantitis, as well as the loss of implants in the long-term.

This review considers possible surgical treatment modalities for induced periimplantitis to regain re-osseointegration as reported in the recent literature. Electronic searches in MEDLINE/PubMed and Google Scholar databases were performed on experimental studies considering induced periimplantitis and attempts to achieve re-osseointegration from 2003 up to December 2016. Conflicts about articles were solved by authors' discussion. A total of 15 studies of 159 were finally included in the review. Various implant surface decontamination techniques chemical and/or mechanical have been used either alone or simultaneously with/without guided bone regeneration. Despite the access-flap surgery, it was observed that application of single decontamination measure either chemical or mechanical was not adequate to provide a better treatment outcome. Laser application such as CO2, diode, and Er: YAG has been a new treatment approach used for periimplantitis treatment. Er: YAG laser had showed no implant surface alteration and provided favorable environment for re-osseointegration. Promising results were observed in the studies that used combination of bone substitutes together with guided bone regeneration for the regenerative therapy. Regarding implant surfaces, better re-osseointegration was observed with rough implant surfaces rather than smooth ones.

Background: Although oral rehabilitation with dental implants is a very promising and effective procedure, peri‐implantitis is an emerging concern. Surgical and non‐surgical methods have been applied to treat peri‐implantitis together with various implant surface decontamination methods. However, there is no consensus concerning the most effective treatment for peri‐implantitis. The aim of the present study is to evaluate the effects of erbium‐doped:yttrium, aluminum, and garnet (Er:YAG) laser, photodynamic therapy (PDT), and titanium bur with and without citric acid on ligature‐induced peri‐implantitis around an anodized implant surface.Methods: Thirty dental implants with anodized surface (3.3 × 10 mm) were installed in the mandibles of five beagle dogs. After 3 months, peri‐implantitis was induced by applying cotton ligatures subgingivally. After ligature removal (baseline), the implants were divided into the following treatment groups: 1) Er:YAG laser, 2) PDT, 3) titanium bur alone, and 4) titanium bur with citric acid. Animals were sacrificed after 3 months, and clinical, radiologic, histologic, and histomorphometric evaluations were conducted for all treatment modalities. The data were analyzed using one‐way analysis of variance and Tukey test. A value of P <0.05 was considered statistically significant.Results: The titanium bur with citric acid group exhibited statistically significantly greater improvement in vertical bone height than the Er:YAG laser group and significantly better bone‐to‐implant contact than the PDT group and the bur‐alone group.Conclusion: Within the limits of the study, the combination of mechanical and chemical treatment proved to be the most effective treatment for disinfection of the anodized implant surface.

Marwa Madi, BDS, MDS, PhD/Osama Zakaria, BDS, MDS, PhD/Kanako Noritake, DDS, PhD/Masaki Fuji, DDS, PhD/Shohei Kasugai, DDS, PhD: Purpose: Soft and hard tissue responses to experimental peri-implantitis around thin sputter hydroxyapatite (HA)?coated implants were evaluated and compared to the responses to implants with other surface treatments. Materials and Methods: Forty-eight dental implants with four different surfaces?machined (M), sandblasted/acid-etched (SA), 1-μm thin sputter HA-coated (S), and plasma-sprayed HA-coated (P)?were inserted into the mandibles of six beagle dogs. Three months later, experimental peri-implantitis was induced with ligatures to allow plaque accumulation. After a 4-month period of active breakdown, the ligatures were removed, and plaque accumulation continued for 5 additional months (progression period). Radiographic marginal bone levels, probing depths, clinical attachment levels, and modified Gingival Index were evaluated at baseline, after the active breakdown period, and after the progression period. Results: Significant increases in mean probing depths and clinical attachment levels were seen around all implants after active breakdown, but no significant differences were found during the progression period. Radiographic analysis revealed marginal bone loss of 1 to 1.7 mm during the active breakdown period. Additional bone loss occurred during the progression period (M 0.2 mm, SA 0.3 mm, S 0.2 mm, P 0.4 mm). Conclusion: Comparable tissue behavior was demonstrated around dental implants with all four surfaces under peri-implantitis conditions. Thin sputter HA-coated implants possess the favorable osteoconductive properties of calcium phosphate coatings without exacerbating further peri-implant tissue breakdown during the progression of peri-implantitis. Int J Oral Maxillofac Implants 2013;28:701?709. doi: 10.11607/jomi.2891