Objectives: Biofilms contamination of implant surfaces are part of the aetiology of peri-implantitis, and different surface decontamination techniques have been proposed as anti-infective therapy. However, no single intervention has been found to be superior. The focus of the present study was to explore the microbial ecology of the peri-implantitis microcosm, and to develop novel surface decontamination methods. Methods: Microcosm biofilms were grown for 30 days in a constant depth film fermenter (CDFF) on SLA andmTi discs, under standardised parameters associated with peri-implantitis. The discs were randomly allocated to three test groups (T1, T2, T3), and two control groups, one consisting of discs with undisturbed peri-implantitis microcosm biofilms (MC) and one with sterile discs (SC). The test group T1 underwent mechanical cleaning with a TiBrushTM (TiB); T2 underwent a combination of TiB and photodynamic therapy (PDT); and T3 underwent a combination of TiB and 0.2% chlorhexidine gluconate/1% sodium hypochlorate (CA). The biofilms were visualised under confocal laser scanning microscopy and surface chemistry was evaluated by scanning electron microscopy with energy dispersive x-ray analysis (SEM/EDX) and X-ray photoelectron spectroscopy (XPS). The bacterial composition of the biofilms was studied before and after disinfection by next-generation sequencing (NGS) of 16S rRNA gene amplicons (MiSeq). Cytocompatibility testing was carried out using AdB Serotech and endotoxin testing bacterial by Kinetic-QCL. Image J and CasaXPS were used for image analysis. Results: The CDFF peri-implantitis model presented here favoured the growth of higher proportions of Klebsiella, Prevotella, Parvimonas, Porphyromonadaceae (family), Actinomyces, Fusobacterium, Enterobacteriaceae (family), Lachno anaerobaculum and Corynebacterium in in vitro peri-implantitis conditions. ISO-surface-volume rendering and analysis of the confocal biofilm stacks revealed the complex microstructure of the undisturbed MC. The physicochemical composition of titanium surfaces before and after decontamination was also investigated, as well as the biocompatibility effect when cultured with MG-63 cells. Elemental analysis disclosed surface alterations of the discs undergoing different treatments. Endotoxin was found in MC and all test groups. The highest levels were found in M surfaces (MC: 12,000 UI/mL). The core microbiome differed between M and SLA surfaces. Bacteria were observed in all groups after disinfection. Streptococcus were present in all SLA- and M-treated samples. Overall, M surfaces were contaminated by Prevotella, Parvimonas, Klebsiella and Neisseria in the highest proportions. Conclusion: The CDFF is useful for modelling microbial shifts associated with peri-implantitis pathogen communities. It seems that the titanium substrata plays only a minor role in the development of mature biofilms. Our data suggest that no treatment modality hindered biocompatibility of the titanium surface. The bacteria were mainly composed of gram-negative species and Streptococcus, which prevailed after chemical and mechanical therapy and LPS was found in all experimental groups. Collectively, these results suggest that a successful treatment for peri-implantitis should be holistic, eliminating live bacteria and bacterial virulence factors, and take account of alterations in the titanium surface. The state of the titanium oxide layer following disinfection and host interactions biofilms warrant further investigation.

Animals with defects of the gum can be used to investigate the effectiveness and safety of scaffold materials, devices and biologics for bone and soft tissue repair, before they are tested in people. Living models are essential for observing changes in structure and function over time, sometimes long periods, during the remodeling and healing phases. This chapter recommends which animals are best suited for studying agents such as growth factors and barrier membranes. They include both small and large animals, such as rats, dogs and primates, with both natural defects and surgically or ligature-induced defects. The design of the studies is addressed specifically, with instructions on the creation of various standardized defects, and how to care for the animals before and after surgery, including management of biohazardous materials such as viral vectors. The roles of institutional guidelines and the requirements of regulatory bodies and animal housing authorities are also covered. Investigators who are studying the healing process sometimes need guidance on selecting suitable endpoints that can be adapted to humans in clinical settings; several measurable outcomes are specified here, based on histologic, morphometric and imaging findings, which aim to provide relevant and reproducible data on molecular and cellular responses, and entire gum tissue reactions to the intervention. 

Objectives: The aim of this study was to evaluate maxillary sinus health in patients who underwent sinus floor augmentation for implant placement after endoscopic sinus surgery (ESS) for the treatment of chronic maxillary sinusitis. Methods: In this series, ESS was performed on four patients with chronic maxillary sinusitis before sinus floor augmentation. A two-stage sinus floor augmentation was performed using deproteinised bovine bone graft and non-cross-linked collagen membrane, 3 months later. Root-form dental implants were placed after 5 months of healing. Cone-beam CT (CBCT) images were taken before ESS, before and after sinus augmentation, and 3 years postoperatively. Sinus membrane thickness and ostium patency were evaluated during the observation period. Marginal bone loss for each dental implant was analysed by CBCT scanning and implant success was evaluated. All patients were rehabilitated with implant-supported fixed restorations. Results: All dental implants were placed in the grafted sinuses and the success rate was 100%. Sinusitis did not recur during the 3-year follow-up period. The ostiomeatal complex was not stenosed after ESS throughout the observation period, however the sinus membranes of two patients were thick and almost filled the sinus cavity before sinus floor augmentation. Corticosteroids were administered for 3 weeks to decrease the membrane thickness. Additive CBCT images confirmed membrane changes in these patients. On completion of medical therapy, sinus floor augmentations could be performed. Conclusion: ESS therapy before sinus augmentation is a reliable and predictable technique for achieving and maintaining the normal physiological environment of the maxillary sinus, after which dental implants can be safely placed in augmented sinus floor sites. CBCT scanning at regular intervals is recommended after ESS treatment for monitoring sinus membrane inflammation and ostium patency.