Saudi Cultural Missions Theses & Dissertations
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Item Restricted Estimating the Impact of Co-localized Risk Variables on Peri-implant Diseases(University of Michigan, 2025) Albaqawi, Hoda; Purnima, KumarThis study hypothesizes that peri-implant diseases, including peri-implant mucositis and peri- implantitis, result from the combined influence of site-level anatomical factors and patient-level behavioral or systemic characteristics. Specifically, features such as inadequate gingival attachment, shallow vestibular depth, and poor interproximal hygiene access significantly increase the risk of disease onset and progression. Peri-implant diseased states are associated with distinct shifts in the peri-implant microbiome, marked by a transition from health-associated commensals to pathogenic, dysbiotic microbial communities. The aim of this study is to quantify the contribution of site-level and patient-level variables to peri-implant disease risk using multivariate modeling and machine learning techniques. Materials & Methods: In this cross-sectional analysis, 240 participants with single, non-splinted implants in function for at least one year were enrolled. Clinical and radiographic assessments categorized implants as healthy (n = 72), peri-implant mucositis (n = 135), or peri-implantitis (n = 33). Site-level factors (gingival attachment, keratinized mucosa, vestibular depth, plaque and inflammation indices, implant position) and patient-level variables (age, hygiene behavior) were analyzed using multinomial logistic regression and Random Forest classification. Linear Discriminant Analysis (LDA) of Bray-Curtis distances was applied to examine clustering based on combined variables. Results: Of the 240 implants analyzed, 47.1% were healthy, 40.4% had mucositis, and 12.5% had peri- implantitis. Multinomial logistic regression identified gingival attachment (GA <1 mm) and vestibular depth (VD <11 mm) as the strongest predictors of disease, with odds ratios of 4.2 and 7.8. The covaiate risk of the Interaction effects between shallow VD and inadequate keratinized mucosa (KM) significantly elevated mucositis risk. Implant adjacency without tooth support, shorter implant length, and posterior positioning were associated with peri-implantitis. The Modified Plaque Index (mPI) consistently predicted both disease states, with its impact intensified in sites with reduced GA, shallow VD, or limited KM. Random Forest models further highlighted age, interproximal hygiene access, and anatomical constraints as key features, achieving over 95% accuracy in disease classification. Conclusions: In conclusion, this study reinforces the multifactorial and interdependent nature of peri-implant disease risk. By integrating site-level and patient-level variables into a unified framework, we provide novel insights into how co-localized factors synergize to influence disease onset and progression. These findings advocate for early identification of site-level disease predictors, and preventive approach in implant therapy, highlighting the importance of individualized treatment planning and maintenance strategies for optimal long-term outcomes.8 0Item Restricted An in vitro study for the management of peri-implantitis using air abrasion with a bactericidal zinc and strontium containing glass (Bioactive glass)(Queen Mary University of London, 2024-06) Alsaqer, Jaber; Gillam, David; Hill, RobertObjective: The primary objective of the study is to develop a bioactive glass (BAG) incorporating strontium and zinc to manage peri-implantitis. It focuses on exploring BAG formulas with zinc and strontium for air abrasive surface treatments. The primary objective is to embed the new BAG powder into the titanium surface. The secondary goal involves inspecting titanium abrasion under a Scanning Electron Microscope (SEM) and identifying the presence of zinc and strontium within the titanium surface. The study also assesses the release of BAG, which contains strontium and zinc, on the abraded titanium in three distinct solutions (acetic acid, TRIS, and Simulated Body Fluid) over various periods up to seven days. Methods: The in vitro study conducted involved the creation and application of two bioactive glasses on titanium discs. The process of synthesizing the glasses involved mixing specific reagents, heating, and rapid cooling. The resulting glasses were then ground into a powder of specific particle size. The titanium discs were prepared through laser cutting, polishing, and coating with the glass powder using a grit blasting technique. To analyze the effectiveness of the glass coating, various techniques such as X-Ray Diffraction, White Light Profilometry, and Scanning Electron Microscopy were used. Additionally, Tris buffer and Simulated Body Fluid solutions were utilized to examine the dissolution properties and bioactivity of the glasses. Results: The study results show the effects of embedding zinc and strontium glass into titanium discs and the outcomes of immersing these abraded discs in various solutions over different durations. Analysis techniques, including backscatter analysis and Energy-Dispersive X-ray Spectroscopy (EDX), confirmed the successful embedding of glasses into the abraded discs, as indicated by irregular surface textures and the presence of zinc and strontium. In contrast, non-abraded discs remained unaltered. The findings provide insights into the impact of strontium and zinc bioactive glass on titanium discs and the potential for embedding various bioactive glass materials into titanium discs. Conclusion: This study's findings on zinc- and strontium-containing BAG formulas provide promising insights into their potential for managing peri-implantitis. The results have shown a significant increase in the concentration of zinc and strontium in the abraded discs over time, indicating the effective release of these elements from the bioactive glass. This suggests that these new BAG formulas have promising potential in the field of implantology. Further research and testing may lead to the development of more effective treatments for peri-implantitis using these BAG formulas.8 0