(1) My Dental Clinic, Al Thanya Street, Umm Suqeim 2, Dubai, UAE
(1) ConfiDent Dental Surgery Clinic, Golden Mile Galleria 2, Dubai Palm Jumeirah, Dubai, UAE
(1) Duval Clinic, 252 Jumeirah St - Jumeirah - Jumeirah 2, Dubai, UAE
(2) Dpt of Periodontology, Sahlgrenska Academy, University of Gothenburg, Sweden
Dr Olivier Carcuac
Dr Olivier Carcuac is a certified specialist in Periodontics since 2008. He is currently a part-time private practitioner at My Dental Clinic, at ConfiDent Dubai Surgery Clinic and Duval Clinic in Dubai, UAE.
Dr Carcuac is also an active senior researcher at the Department of Periodontology at the Institue of Odontology, University of Gothenburg, Sweden. His research is focused on the pathogenesis and treatment of periodontal and peri-implant diseases.
MY LATEST RESEARCH
Long-term outcomes and prognostic factors of surgical treatment of peri-implantitis - A retrospective study
Clinical Oral Implants Research 2023
Romandini M, Bougas K, Alibegovic L, Hosseini S, Carcuac O, Berglundh T, Derks J..
Aim: To evaluate long-term outcomes and prognostic factors of non-reconstructive surgical treatment of peri-implantitis.
Materials and methods: One hundred forty-nine patients (267 implants) were surgically treated for peri-implantitis and followed for an average of 7.0 (SD: 3.6) years. The primary outcome was implant loss. Additional bone loss and surgical retreatment were secondary outcomes. Patient/implant characteristics, as well as clinical and radiographic parameters collected prior to initial surgery, were evaluated as potential predictors of implant loss. Flexible parametric survival models using restricted cubic spline functions were used; 5- and 10-year predicted rates of implant loss were calculated according to different scenarios.
Results: Fifty-three implants (19.9%) in 35 patients (23.5%) were lost during the observation period. Implant loss occurred after a mean period of 4.4 (SD: 3.0) years and was predicted by implant surface characteristics (modified surface; HR 4.5), implant length (HR 0.8 by mm), suppuration at baseline (HR 2.7) and disease severity (baseline bone loss: HR 1.2 by mm). Estimates of 5- and 10-year implant loss ranged from 1% (best prognostic scenario; initial bone loss <40% of implant length, turned implant surface and absence of suppuration on probing (SoP)) to 63% (worst prognostic scenario; initial bone loss ≥60% of implant length, modified implant surface and SoP) and from 3% to 89%, respectively. Surgical retreatment was performed at 65 implants (24.3%) in 36 patients (24.2%) after a mean time period of 4.5 (3.1) years. In all, 59.5% of implants showed additional bone loss, were surgically retreated or lost.
Conclusions: Recurrence of disease is common following surgical treatment of peri-implantitis. The strongest predictor for implant loss was implant surface characteristics. Implant length as well as suppuration and disease severity at baseline were also relevant factors.
The expanded mesh free gingival graft: A novel approach to increase the width of keratinized mucosa
Clin Adv Periodontics 2023
De Greef A., Carcuac O., De Mars G., Stankov V., Cortasse B, Giordani G., Van Dooren E.
Background: The importance of an adequate amount of peri-implant keratinized tissue and attached mucosa has recently been emphasized. This manuscript presents preliminary findings of a novel approach for increasing the width of keratinized mucosa (KM) around dental implants using a mesh free gingival graft (mesh-FGG).
Methods: Two healthy adults were treated as part of this study. After implant placement, a large edentulous alveolar ridge with shallow vestibule and minimal amount of KM was treated in both subjects (one in the posterior mandible and the other in the anterior mandible) with the combination of an apically positioned flap and a mesh-FGG. Clinical, esthetic and patient-reported outcomes were observed at approximately 4-month time points.
Results: All sites healed uneventfully after the treatments. In both cases, increased vestibule depth, soft-tissue thickness, and width of peri-implant KM were obtained. The patients did not report any accessory discomfort. Four months following the grafting procedure, good overall esthetic outcome was observed with minimal color disparity and graft demarcation.
Conclusions: Width of KM around dental implants can be increased using a mesh-FGG. Randomized controlled clinical studies comparing mesh-FGG to conventional FGG and other commonly applied techniques are required to assess the long-term efficacy of this novel technique in terms of soft-tissue thickness, width of peri-implant KM, and patient-reported outcomes.
Modified-free gingival graft technique for treatment of gingival recession defects at mandibular incisors: A randomized clinical trial
J Periodontol 2023
Carcuac O., Trullenque-Eriksson A, Derks J.
The aim of this study was to evaluate clinical and patient-reported outcomes following surgical root coverage at RT1 gingival recession defects at mandibular incisors, using either a conventional free gingival graft (FGG) or a modified FGG (ModFGG).
Total of 30 patients with RT1 gingival recessions at mandibular incisors were enrolled and randomly allocated to either a control (FGG) or test group (ModFGG). Evaluations of clinical changes (recession depth, height of keratinized tissue) and patient satisfaction were performed over a follow-up period of 12 months. Post-surgical changes of keratinized tissue height (shrinkage) were assessed from 1 month and onward.
ModFGG resulted in more pronounced root coverage at 1 year compared to FGG (91.8% vs. 60.7%, p < 0.001). Height of keratinized tissue was improved by 4.2 and 2.2 mm (p < 0.001), respectively, with significantly less shrinkage in ModFGG. Post-surgical morbidity was significantly lower for ModFGG at 2 weeks and patient satisfaction was significantly higher 12 months after treatment (9.1 vs. 5.4; p < 0.001).
ModFGG represents a valid approach for the management of RT1 recession defects at mandibular incisors. The technique is superior to traditional FGG in terms of root coverage, the gain of keratinized tissue height, and patient satisfaction.
Modified Free Gingival Graft Technique for Root Coverage at Mandibular Incisors: A Case Series
Int J Periodontics Restorative Dent 2021
Carcuac O. & Derks J.
Numerous surgical techniques for root coverage have been suggested with different degrees of success, as assessed by the proportion of complete root coverage.
Mandibular incisors, teeth with a high frequency of gingival recession defects (GRDs), were associated with the least favorable outcomes due to unfavorable anatomical conditions.
In the present series of three cases, a modified version of the free gingival graft technique for the purpose of root coverage at mandibular incisors is illustrated. The purpose of the modification of the original technique was to achieve improved blood supply from the recipient site to the graft, with the ultimate aim of enhancing predictability and outcomes of the procedure.
In all included cases, complete or almost complete root coverage was achieved at challenging GRDs in the mandibular incisor area.
Cellular expression of DNA damage/repair and reactive oxygen/nitrogen species in human periodontitis and peri-implantitis lesions
Journal of Clinical Periodontology 2020
Dionigi C., Larsson L., Carcuac O. & Berglundh T.
The aim of the study was to evaluate differences in the cellular expression of DNA damage/repair and reactive oxygen/nitrogen species between human periodontitis and peri-implantitis lesions..
40 patients presenting with generalized severe periodontitis and 40 patients with severe peri-implantitis were included. Soft tissue biopsies were collected from diseased sites in conjunction with surgical therapy and prepared for histological analysis. Four regions of interest were identified: the pocket epithelium (PE), the infiltrated connective tissue (ICT), which was divided into one inner area facing the PE (ICT-1) and one outer area (ICT-2). A non-infiltrated connective tissue area (NCT) lateral of the ICT was also selected.
It was demonstrated that the ICT of peri-implantitis specimens was considerably larger and contained significantly larger area proportions and densities of CD68-, MPO- and iNOS-positive cells than that of periodontitis samples. Cellular densities were overall higher in the inner ICT zone lateral of the PE (ICT-1) than in the outer ICT compartment (ICT-2). While the NCT area lateral of the ICT comprised significantly larger proportions and densities of y-H2AX-, iNOS-, NOX2-, MPO- and PAD4/MPO-positive cells in peri-implantitis than in periodontitis sites, a reverse difference was noted for the area proportion and density of 8-OHdG-positive cells in the PE.
It is suggested that peri-implantitis lesions are associated with an enhanced and upregulated host response and contain larger numbers of neutrophils, macrophages and iNOS-positive cells than periodontitis lesions.
Risk for recurrence of disease following surgical therapy of peri-implantitis - a prospective longitudinal study
Clinical Oral Implants Research 2020
Carcuac O. et al.
The aim of the present prospective study was to assess the risk for disease recurrence following surgical therapy of peri-implantitis.
73 patients (130 implants) treated surgically for peri-implantitis were examined at 1 and 5 years after therapy. The primary outcome was recurrence/progression of disease defined as any of the following events: (i) bone loss >1.0 mm, (ii) surgical retreatment, (iii) implant removal/loss after year 1. Patient- and implant-related parameters as well as 1-year outcomes were evaluated as potential predictors through multiple logistic regression analysis.
57 implants (44%) displayed recurrence/progression of peri-implantitis during follow-up. Among these, 27 implants were removed. Residual deep probing pocket depth (≥6 mm; odds ratio 7.4; 95% confidence interval 2.8-19.3) and reduced marginal bone level (OR 1.4; 95%CI 1.1-1.7) at 1 year after surgery constituted risk factors for recurrence/progression of disease. Furthermore, implants with modified surfaces were at higher risk than implants with non-modified surfaces (OR 5.1; 95%CI 1.6-16.5).
IImplants with (i) residual deep probing pocket depth, (ii) reduced marginal bone level or (iii) modified surfaces following surgical therapy of peri-implantitis present with increased risk for recurrence/progression.
(ClinicalTrials.gov NCT01857804)
Surgical treatment of peri-implantitis. 3-year results from a randomized controlled clinical trial
Journal of Clinical Periodontology 2017
Carcuac O. et al.
This study reports on the 3-year follow-up of patients enrolled in a randomized controlled clinical trial on surgical treatment of advanced peri-implantitis.
100 patients with advanced peri-implantitis were randomly assigned to one of four treatment groups. Surgical therapy aiming at pocket elimination was performed and, in three test groups, supplemented by either systemic antibiotics, use of an antiseptic agent for implant surface decontamination or both. Outcomes were evaluated after 1 and 3 years by means of clinical
and radiological examinations. Differences between groups were explored by regression analysis.
Clinical examinations at 3 years after treatment revealed (i) improved peri-implant soft tissue health with a mean reduction in probing depth of 2.7 mm and a reduction in bleeding/suppuration on probing of 40% and (ii) stable peri-implant marginal bone levels (mean bone loss during follow-up: 0.04 mm). Implant surface characteristics had a significant impact on 3-year outcomes, in favor of implants with non-modified surfaces. Benefits of systemic antibiotics were limited to implants with modified surfaces and to the first year of follow-up.
It is suggested that surgical treatment of peri-implantitis is effective and that outcomes of therapy are affected by implant surface characteristics. Potential benefits of systemic antibiotics are not sustained over 3 years.
(ClinicalTrials.gov NCT01857804)
Adjunctive systemic and local antimicrobial therapy in surgical treatment of peri-implantitis. A randomized controlled clinical trial.
Journal of Dental Research 2016
Carcuac O. et al.
The aim of the present randomized controlled clinical trial was to investigate the adjunctive effect of systemic antibiotics and the local use of chlorhexidine for implant surface decontamination in the surgical treatment of peri-implantitis.
One hundred patients with severe peri-implantitis were recruited. Surgical therapy was performed with or without adjunctive systemic antibiotics or the local use of chlorhexidine for implant surface decontamination. Treatment outcomes were evaluated at 1 y. A binary logistic regression analysis was used to identify factors influencing the probability of treatment success, that is, probing pocket depth ≤5 mm, absence of bleeding/suppuration on probing, and no additional bone loss.
Treatment success was obtained in 45% of all implants but was higher in implants with a nonmodified surface (79%) than those with a modified surface (34%).
The local use of chlorhexidine had no overall effect on treatment outcomes. While adjunctive systemic antibiotics had no impact on treatment success at implants with a nonmodified surface, a positive effect on treatment success was observed at implants with a modified surface. The likelihood for treatment success using adjunctive systemic antibiotics in patients with implants with a modified surface, however, was low. As the effect of adjunctive systemic antibiotics depended on implant surface characteristics, recommendations for their use in the surgical treatment of peri-implantitis should be based on careful assessments of the targeted implant.
(ClinicalTrials.gov NCT01857804)
Composition of human peri-implantitis and periodontitis lesions.
Journal of Dental Research 2014
Carcuac O. et Berglundh T.
The aim of the present study was to examine differences in cellular characteristics of human peri-implantitis and periodontitis lesions.
Two groups of patients were included: 40 patients with generalized severe chronic periodontitis and 40 patients presenting with severe peri-implantitis. Soft tissue biopsies were obtained from diseased sites (probing pocket depth ≥ 7 mm with bleeding on probing) and prepared for histologic and immunohistochemical analysis.
In contrast to periodontitis samples, peri-implantitis lesions were more than twice as large and contained significantly larger area proportions, numbers, and densities of CD138-, CD68-, and MPO-positive cells than periodontitis lesions. Peri-implantitis lesions also extended to a position that was apical of the pocket epithelium and not surrounded by noninfiltrated connective tissue. They further presented with significantly larger densities of vascular structures in the connective tissue area lateral to the infiltrated connective tissue than within the infiltrate.
This study suggests that peri-implantitis and periodontitis lesions exhibit critical histopathologic differences, which contribute to the understanding of dissimilarities in onset and progression between the 2 diseases.
