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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Microflora around teeth and dental implants</title><author><name sortKey="Shahabouee, Mohammad" sort="Shahabouee, Mohammad" uniqKey="Shahabouee M" first="Mohammad" last="Shahabouee">Mohammad Shahabouee</name><affiliation><nlm:aff id="aff1">Dental Research Center and Department of Periodontology, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran</nlm:aff></affiliation></author><author><name sortKey="Rismanchian, Mansour" sort="Rismanchian, Mansour" uniqKey="Rismanchian M" first="Mansour" last="Rismanchian">Mansour Rismanchian</name><affiliation><nlm:aff id="aff2">Dental Implants Research Center and Department of Prosthodontics, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran</nlm:aff></affiliation></author><author><name sortKey="Yaghini, Jaber" sort="Yaghini, Jaber" uniqKey="Yaghini J" first="Jaber" last="Yaghini">Jaber Yaghini</name><affiliation><nlm:aff id="aff1">Dental Research Center and Department of Periodontology, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran</nlm:aff></affiliation></author><author><name sortKey="Babashahi, Akram" sort="Babashahi, Akram" uniqKey="Babashahi A" first="Akram" last="Babashahi">Akram Babashahi</name><affiliation><nlm:aff id="aff3">School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran</nlm:aff></affiliation></author><author><name sortKey="Badrian, Hamid" sort="Badrian, Hamid" uniqKey="Badrian H" first="Hamid" last="Badrian">Hamid Badrian</name><affiliation><nlm:aff id="aff3">School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran</nlm:aff></affiliation></author><author><name sortKey="Goroohi, Hossein" sort="Goroohi, Hossein" uniqKey="Goroohi H" first="Hossein" last="Goroohi">Hossein Goroohi</name><affiliation><nlm:aff id="aff3">School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">22623941</idno><idno type="pmc">3353701</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3353701</idno><idno type="RBID">PMC:3353701</idno><date when="2012">2012</date><idno type="wicri:Area/Pmc/Corpus">002B59</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">002B59</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Microflora around teeth and dental implants</title><author><name sortKey="Shahabouee, Mohammad" sort="Shahabouee, Mohammad" uniqKey="Shahabouee M" first="Mohammad" last="Shahabouee">Mohammad Shahabouee</name><affiliation><nlm:aff id="aff1">Dental Research Center and Department of Periodontology, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran</nlm:aff></affiliation></author><author><name sortKey="Rismanchian, Mansour" sort="Rismanchian, Mansour" uniqKey="Rismanchian M" first="Mansour" last="Rismanchian">Mansour Rismanchian</name><affiliation><nlm:aff id="aff2">Dental Implants Research Center and Department of Prosthodontics, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran</nlm:aff></affiliation></author><author><name sortKey="Yaghini, Jaber" sort="Yaghini, Jaber" uniqKey="Yaghini J" first="Jaber" last="Yaghini">Jaber Yaghini</name><affiliation><nlm:aff id="aff1">Dental Research Center and Department of Periodontology, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran</nlm:aff></affiliation></author><author><name sortKey="Babashahi, Akram" sort="Babashahi, Akram" uniqKey="Babashahi A" first="Akram" last="Babashahi">Akram Babashahi</name><affiliation><nlm:aff id="aff3">School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran</nlm:aff></affiliation></author><author><name sortKey="Badrian, Hamid" sort="Badrian, Hamid" uniqKey="Badrian H" first="Hamid" last="Badrian">Hamid Badrian</name><affiliation><nlm:aff id="aff3">School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran</nlm:aff></affiliation></author><author><name sortKey="Goroohi, Hossein" sort="Goroohi, Hossein" uniqKey="Goroohi H" first="Hossein" last="Goroohi">Hossein Goroohi</name><affiliation><nlm:aff id="aff3">School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran</nlm:aff></affiliation></author></analytic><series><title level="j">Dental Research Journal</title><idno type="ISSN">1735-3327</idno><idno type="eISSN">2008-0255</idno><imprint><date when="2012">2012</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec id="st1"><title>Background:</title><p>When an implant is exposed to oral cavity, its surface gets colonized by micro-organisms. The aim of this study is to comparatively assess the microbiological parameters in sulci around the teeth and the crowns supported by dental implants.</p></sec><sec id="st2"><title>Materials and Methods:</title><p>In this prospective, cross-sectional study, 34 partially edentulous patients aged between 40 and 50 years with total 50 anterior maxillary single implants with cemented crowns (depth of sulci <4 mm) and 34 similar teeth in the same jaw of the same patients were included. Excluded were the patients with compromised systemic and periodontal health and smoking habits. None of the patients had used any antimicrobial mouthwashes during at least two weeks before the study. All of the implants (ITI) were at least 6 months in place covered by definitive prostheses. Samples of gingival sulci were taken around teeth with paper cone and transported to Stuart transport medium. Samples were cultured and examined by a dark field microscope and eight laboratory tests were performed to determine the micro-organisms The data were evaluated statistically using Chi-square test (α=0.05).</p></sec><sec id="st3"><title>Results:</title><p>Six anerobic bacteria found in teeth and implants sulci were Gram-positive cocci, Gram-negative cocci, Prevotella, <italic>Porphyromonas gingivalis, Bacteroid Fragilis</italic> and <italic>Fusobacterium</italic>. Gram-positive cocci and Gram-negative cocci had maximum and minimum percentage frequency in the two groups, respectively. There were no significant differences between the two groups (<italic>P</italic> value >0.05).</p></sec><sec id="st4"><title>Conclusion:</title><p>The present study indicated that microflora in implant sulci is similar to the tooth sulci, when the depth of sulci is normal (<4 mm). 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<front><journal-meta><journal-id journal-id-type="nlm-ta">Dent Res J (Isfahan)</journal-id><journal-id journal-id-type="iso-abbrev">Dent Res J (Isfahan)</journal-id><journal-id journal-id-type="publisher-id">DRJ</journal-id><journal-title-group><journal-title>Dental Research Journal</journal-title></journal-title-group><issn pub-type="ppub">1735-3327</issn><issn pub-type="epub">2008-0255</issn><publisher><publisher-name>Medknow Publications & Media Pvt Ltd</publisher-name><publisher-loc>India</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">22623941</article-id><article-id pub-id-type="pmc">3353701</article-id><article-id pub-id-type="publisher-id">DRJ-9-215</article-id><article-categories><subj-group subj-group-type="heading"><subject>Original Article</subject></subj-group></article-categories><title-group><article-title>Microflora around teeth and dental implants</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Shahabouee</surname><given-names>Mohammad</given-names></name><xref ref-type="aff" rid="aff1">1</xref></contrib><contrib contrib-type="author"><name><surname>Rismanchian</surname><given-names>Mansour</given-names></name><xref ref-type="aff" rid="aff2">2</xref><xref ref-type="corresp" rid="cor1"></xref></contrib><contrib contrib-type="author"><name><surname>Yaghini</surname><given-names>Jaber</given-names></name><xref ref-type="aff" rid="aff1">1</xref></contrib><contrib contrib-type="author"><name><surname>Babashahi</surname><given-names>Akram</given-names></name><xref ref-type="aff" rid="aff3">3</xref></contrib><contrib contrib-type="author"><name><surname>Badrian</surname><given-names>Hamid</given-names></name><xref ref-type="aff" rid="aff3">3</xref></contrib><contrib contrib-type="author"><name><surname>Goroohi</surname><given-names>Hossein</given-names></name><xref ref-type="aff" rid="aff3">3</xref></contrib></contrib-group><aff id="aff1"><label>1</label>Dental Research Center and Department of Periodontology, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran</aff><aff id="aff2"><label>2</label>Dental Implants Research Center and Department of Prosthodontics, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran</aff><aff id="aff3"><label>3</label>School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran</aff><author-notes><corresp id="cor1"><bold>Address for correspondence:</bold> Dr. Mansour Rismanchian, Dental Implant Research Center and Department of Prosthodontics, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran. E-mail: <email xlink:href="rismanchian@dnt.mui.ac.ir">rismanchian@dnt.mui.ac.ir</email></corresp></author-notes><pub-date pub-type="ppub"><season>Mar-Apr</season><year>2012</year></pub-date><volume>9</volume><issue>2</issue><fpage>215</fpage><lpage>220</lpage><history><date date-type="received"><month>6</month><year>2011</year></date><date date-type="accepted"><month>11</month><year>2011</year></date></history><permissions><copyright-statement>Copyright: © Dental Research Journal</copyright-statement><copyright-year>2012</copyright-year><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc-sa/3.0"><license-p>This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p></license></permissions><abstract><sec id="st1"><title>Background:</title><p>When an implant is exposed to oral cavity, its surface gets colonized by micro-organisms. The aim of this study is to comparatively assess the microbiological parameters in sulci around the teeth and the crowns supported by dental implants.</p></sec><sec id="st2"><title>Materials and Methods:</title><p>In this prospective, cross-sectional study, 34 partially edentulous patients aged between 40 and 50 years with total 50 anterior maxillary single implants with cemented crowns (depth of sulci <4 mm) and 34 similar teeth in the same jaw of the same patients were included. Excluded were the patients with compromised systemic and periodontal health and smoking habits. None of the patients had used any antimicrobial mouthwashes during at least two weeks before the study. All of the implants (ITI) were at least 6 months in place covered by definitive prostheses. Samples of gingival sulci were taken around teeth with paper cone and transported to Stuart transport medium. Samples were cultured and examined by a dark field microscope and eight laboratory tests were performed to determine the micro-organisms The data were evaluated statistically using Chi-square test (α=0.05).</p></sec><sec id="st3"><title>Results:</title><p>Six anerobic bacteria found in teeth and implants sulci were Gram-positive cocci, Gram-negative cocci, Prevotella, <italic>Porphyromonas gingivalis, Bacteroid Fragilis</italic> and <italic>Fusobacterium</italic>. Gram-positive cocci and Gram-negative cocci had maximum and minimum percentage frequency in the two groups, respectively. There were no significant differences between the two groups (<italic>P</italic> value >0.05).</p></sec><sec id="st4"><title>Conclusion:</title><p>The present study indicated that microflora in implant sulci is similar to the tooth sulci, when the depth of sulci is normal (<4 mm). As a result, implants’ susceptibility to inflammation is the same as teeth.</p></sec></abstract><kwd-group><kwd>Dental implants</kwd><kwd>microflora</kwd><kwd>tooth</kwd></kwd-group></article-meta></front><body><sec id="sec1-1"><title>INTRODUCTION</title><p>Use of dental implants is a widespread treatment modality to restore missing teeth and edentulous cases;[<xref ref-type="bibr" rid="ref1">1</xref>–<xref ref-type="bibr" rid="ref3">3</xref>] however, a successful implant treatment depends on the lack of inflammation in peri-implant tissues.[<xref ref-type="bibr" rid="ref4">4</xref>–<xref ref-type="bibr" rid="ref6">6</xref>] Being exposed to the oral cavity, implant's surface gets colonized by micro-organisms.[<xref ref-type="bibr" rid="ref7">7</xref>] A recent <italic>in vivo</italic> study indicated that bacterial colonization occurred within 30 min after implant placement.[<xref ref-type="bibr" rid="ref8">8</xref>] Another research showed that, following exposure of dental implants to the oral cavity, streptococci were predominant after 4 h and anerobic bacteria increase after 48 h.[<xref ref-type="bibr" rid="ref9">9</xref>]</p><p>We should point out that some characteristics of dental implant – for example roughness – play an important role in bacterial biofilm formation, and biofilms on dental implant surface are the main source of pathogens for peri-implantitis.[<xref ref-type="bibr" rid="ref10">10</xref>] Moreover, subsequent to the accumulation of plaque on implant surface, dense inflammatory infiltration occurs in connective tissue, which weakens the attachment of overlying epithelium.[<xref ref-type="bibr" rid="ref11">11</xref>]</p><p>Apical progression of the plaque is associated with clinical and radiographic manifestations of tissue injury. The soft tissue density of inflammatory infiltration and bone resorption is higher around implants compared to teeth. Also, peri-implant lesions involve the supra-crestal connective tissue and damage to bone marrow.[<xref ref-type="bibr" rid="ref11">11</xref>]</p><p>Opportunistic periodontal pathogens like <italic>Actinobacillus, Actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Peptostreptococcus microbes</italic> and <italic>Fusobacterium nucleatum</italic> are responsible for peri-implantitis in partially edentulous patients.</p><p>These micro-organisms are also common among peri-implantitis and periodontal diseases.[<xref ref-type="bibr" rid="ref12">12</xref>]</p><p>Meijndert <italic>et al</italic>. assessed the prevalence of seven periodontal marker pathogens, before implant placement and 1 year after loading. They concluded that in almost half of periodontal healthy individuals, the subgingival biofilm harbors periodontal pathogens above threshold values. Keller <italic>et al</italic>. compared clinical and microbiological features in the peri-implant area of implants carrying either screw retained or cemented suprastructures and investigated the relationship between the peri-implant microflora, the microbiota on the inner surface of removable suprastructures, and the periodontal microflora within the same subject. They found that the microbial leakage through the gap between the suprastructure and the abutment plays an important role in the bacterial colonization of the internal part of screw retained crowns and bridges. The study furthermore confirmed the impact of the dental microflora on the microbial colonization of implants.</p><p>Since oral cavity is a main source of bacteria responsible for oral biofilm-related diseases such as periodontal and peri-implant diseases[<xref ref-type="bibr" rid="ref13">13</xref>] and bacterial infection is an important cause of peri-implant bone loss, the aim of this study was to comparatively assess the microflora in periodontal and peri-implant tissues to put a small step forward in understanding the etiology of complications encountered following implant surgeries.</p></sec><sec sec-type="materials|methods" id="sec1-2"><title>MATERIALS AND METHODS</title><sec id="sec2-1"><title>Design and overview</title><p>This cross-sectional study intended to comparatively assess the microbiologic content of the gingival sulci of teeth and implant-supported crowns with shallow (<4 mm) pockets. This study was conducted during a 16-month period from January 2007 to May 2008 in Dental Implants Research Clinic. Sulcular samples were cultured and examined at Isfahan Medical School microbiology laboratory and examined microscopically to determine the microflora.</p><p>ITI implants 6 months after placement were included. A periodontist examined all implants and confirmed absence of any acute or chronic clinical signs of exudates, inflammation, swelling, gingival recession or periodontal diseases for the included implants. None of the patients had used any antimicrobial mouthwashes during at least two weeks before the study. Prosthetic reconstruction was already incorporated for all patients at the time of the study. Selected patients were partially edentulous and their pocket depths were assessed by the same periodontist.</p><p>Patients with only implants or only natural dentition, systemically compromised patients, smokers and also patients with poor oral hygiene or improper cooperation were excluded from the study.</p><sec id="sec3-1"><title>Experimental set</title><p>Thirty-four partially edentulous patients aged between 40 and 50 years with total 50 anterior maxillary single implants with cemented crowns (depth of sulci <4 mm) and 34 same teeth in the same jaw of the same patients were included. Sulci were first examined by a periodontal probe and gingival bleeding and other clinical signs were recorded. The gingiva around the teeth and the implants were then air dried and isolated. Sulcular samples were taken using a paper cone placed into the sulcus for 15 s [<xref ref-type="fig" rid="F1">Figure 1</xref>]. Samples were kept in Stuart transport medium (STM) and transferred to the microbiology laboratory within 3 h.</p><fig id="F1" position="float"><label>Figure 1</label><caption><p>Sampling by paper cone</p></caption><graphic xlink:href="DRJ-9-215-g001"></graphic></fig></sec><sec id="sec3-2"><title>Laboratory procedures</title><p>Paper cones were taken out of the transport tubes using sterile forcipes and immediately transferred to anerobic culture mediums (42 plates; each containing two samples). Two types of culture media were used in this study; non-specific and specific. All anerobic micro-organisms grow in non-specific cultures including a base of Columbia agar, Brucella agar or BHI (Brain Heart Infusion) agar; however, only certain anerobic micro-organisms can grow in specific culture [Figures <xref ref-type="fig" rid="F2">2</xref> and <xref ref-type="fig" rid="F3">3</xref>] which includes a base of Columbia, Brucella and BHI with Vancomycin and Kanamycin added next.</p><fig id="F2" position="float"><label>Figure 2</label><caption><p><italic>Prevotella intermedia</italic> in specific culture</p></caption><graphic xlink:href="DRJ-9-215-g002"></graphic></fig><fig id="F3" position="float"><label>Figure 3</label><caption><p><italic>Porphyromana Gingivalis</italic> in specific culture</p></caption><graphic xlink:href="DRJ-9-215-g003"></graphic></fig></sec><sec id="sec3-3"><title>Laboratory tests</title><p>After bacterial culturing, the following nine laboratory tests were performed: (a) Gram test; for bacterial morphological assessment [Figures <xref ref-type="fig" rid="F4">4</xref>–<xref ref-type="fig" rid="F6">6</xref>]. (b) Catalase test; to detect anerobes which can not synthesize catalase enzyme. (c) DNAase test; to find DNAase producing bacteria. (d) Triple sugar iron (TSI) test; to detect enterobacteriaceae species. (e) Urease test; for detection of bacteria which are capable of urea-breakdown. (f) (Sulfide-Indole-Motility) medium motility test; to determine the capability of H2S production, and bacterial motility. (g) Gelatinase test. (h) Bile-esculin test to detect streptococcus; and (i) Lipase and Lesetinase. The data was evaluated statistically using Chi-square test (α=0.05).</p><fig id="F4" position="float"><label>Figure 4</label><caption><p>Gram staining: <italic>Fusobacterium</italic></p></caption><graphic xlink:href="DRJ-9-215-g004"></graphic></fig><fig id="F5" position="float"><label>Figure 5</label><caption><p>Gram staining: Gr‾ Cocci</p></caption><graphic xlink:href="DRJ-9-215-g005"></graphic></fig><fig id="F6" position="float"><label>Figure 6</label><caption><p>Gram staining: Gr<sup>+</sup> Cocci</p></caption><graphic xlink:href="DRJ-9-215-g006"></graphic></fig></sec></sec></sec><sec sec-type="results" id="sec1-3"><title>RESULTS</title><p>Six groups of bacteria were found around the implants and the teeth, all of which were anerobic. Percentage frequency of these bacteria in the teeth sulci and the implants sulci is illustrated in <xref ref-type="table" rid="T1">Table 1</xref> and Figures <xref ref-type="fig" rid="F7">7</xref> and <xref ref-type="fig" rid="F8">8</xref>.</p><table-wrap id="T1" position="float"><label>Table 1</label><caption><p>Relative frequency of species according to the study groups</p></caption><graphic xlink:href="DRJ-9-215-g007"></graphic></table-wrap><fig id="F7" position="float"><label>Figure 7</label><caption><p>Frequency of different micro-organisms among teeth and sulci</p></caption><graphic xlink:href="DRJ-9-215-g008"></graphic></fig><fig id="F8" position="float"><label>Figure 8</label><caption><p>Frequency of different micro-organisms among teeth and implants</p></caption><graphic xlink:href="DRJ-9-215-g009"></graphic></fig><p>Gram-positive anerobic micro-organisms including <italic>Fusobacterium</italic> and <italic>Bacteroid Fragilis</italic> were found in the sulci of teeth and implants, as well as prevotella (a black-pigmented organism) and <italic>Porphyromonas gingivalis</italic> which are also Gram-negative anerobes. Gram-positive cocci form bacteria were also observed in many samples.</p><p>The last cultured bacteria were Gram-negative cocci which were seen only in three samples, two in peri-implant sulci and one in tooth sulcus. Overall, no significant differences were observed between these two groups.</p></sec><sec sec-type="discussion" id="sec1-4"><title>DISCUSSION</title><p>Shape, type and design of the implants are the determining factors in the development of peri-implantitis.[<xref ref-type="bibr" rid="ref14">14</xref>] Sardin assessed the adherence effect of streptococcus on the alloy used in the fabrication of implants. He concluded that the alloy used might be a contributing factor in the attachment of micro-organisms and the development of infection around the implants.[<xref ref-type="bibr" rid="ref15">15</xref>] The present study included ITI implants. The alloy used in the fabrication of these implants might have served as a contributing factor in the attachment of Gram-positive anerobes.</p><p>Comparing one-stage and two-stage implants, Adell <italic>et al</italic>.,[<xref ref-type="bibr" rid="ref16">16</xref>] did not find any Aa micro-organisms in the studied groups. PG bacteria was found in one stage implants. low levels of Prevotella Intermadia (PI) and high levels of <italic>F. nucleatum</italic> were found in the sulci of both implant groups.[<xref ref-type="bibr" rid="ref16">16</xref>] All implants in the present study were one-stage. No Aa micro-organisms, B Forsythus and <italic>F. nucleatum</italic> were found in the study groups of our study while PG and PI were detected.</p><p>Koing[<xref ref-type="bibr" rid="ref17">17</xref>] concluded that staphylococcus is one of the primary culprits for peri-implant bacterial infections. This micro-organism was not found in the present study which may confirm the periodontal and peri-implant soft-tissue health of the included cases.</p><p>Also in Mengel's[<xref ref-type="bibr" rid="ref18">18</xref>] study, Aa was associated with acute periodontal diseases. Again, the absence of this species in the present study may confirm that none of the included cases had acute periodontal problems. Moreover, Puchades-Roman[<xref ref-type="bibr" rid="ref19">19</xref>] claimed that spirochetes are the dominant bacteria of the Astra and Branmark implants; however, in the present study they were not found. This could be attributed to the effect of surface conditions of the fixture to the microflora of the sulci.</p><p>In the study of Leonhardt <italic>et al</italic>.,[<xref ref-type="bibr" rid="ref20">20</xref>] PG and Prevotella were among the bacteria detected in teeth and implants sulci, where PG was significantly of higher amounts in teeth sulci compared to implants’ while Prevotella did not show a significant difference. However, in the present study, neither PG nor Prevotella were significantly different between the two groups. Nakazato <italic>et al</italic>.,[<xref ref-type="bibr" rid="ref21">21</xref>] reported that anerobic Gram-positive cocci were the most prevalent bacteria in implant sulci. They did not isolate PG and spirochetes. In our study, also, Gram-positive cocci were the most obtained micro-organisms and no spirochetes were found, while PG was isolated in contrast to Nakazato study.</p><p>Rams <italic>et al</italic>,[<xref ref-type="bibr" rid="ref22">22</xref>] Takanashi <italic>et al</italic>.,[<xref ref-type="bibr" rid="ref23">23</xref>] Mengel <italic>et al</italic>.,[<xref ref-type="bibr" rid="ref18">18</xref>] Rabel <italic>et al</italic>.,[<xref ref-type="bibr" rid="ref24">24</xref>] the students and the professors of Geneva University, and Leonhardt <italic>et al</italic>.,[<xref ref-type="bibr" rid="ref25">25</xref>] consistently isolated PG, Aa and PI from implant sulci. In the present study, the same micro-flora was detected except for Aa.</p><p>Leonhardt <italic>et al</italic>.,[<xref ref-type="bibr" rid="ref25">25</xref>] did not find any difference between tooth and implant sulci with 4 mm pocket depth in terms of microflora. Similarly, no statistically significant differences were found between teeth and shallow implant sulci in terms of microflora in the present study.</p><p>In the study of Renvert <italic>et al</italic>.,[<xref ref-type="bibr" rid="ref26">26</xref>] partial edentulousness was found to be related to presence of PG which seems to be in accordance to the findings of the present study since we found high counts of PG especially around implants.</p><p>Rams <italic>et al</italic>.[<xref ref-type="bibr" rid="ref27">27</xref>] stated that cocci were the most observed micro-organisms where implant sulci were of less than 5 mm. In the present study, however, anerobic Gram-positive cocci were the most obtained micro-organisms. Also, the amount of these micro-organisms in implant sulci was quite similar to tooth sulci in the present study, which supports the findings of Rams <italic>et al</italic>. Again, it should be noted that no statistically significant differences were found between study groups in terms of relative Gram-positive cocci counts.</p><p>Borgarello <italic>et al</italic>.,[<xref ref-type="bibr" rid="ref28">28</xref>] reported the dominant micro-organisms around implants to be stomatococcus, <italic>Prevotella intermedia</italic>, peptostreptococcus, <italic>Fusobacterium nucleatum</italic> and a.a. <italic>Prevotella intermedia</italic> was only found in one case and stomatococcus was found only in three cases. Due to the lack of sufficient laboratory equipment, it was not possible to determine Prevotella and <italic>Fusobacterium</italic> in the present study; thus, we recommend to determine these two in the future studies. As all of the tests used in this study are not the newest methods to detect oral microflora, it is recommended to adopt the most recent methods for the determination of bacteria. Also, it is recommended to repeat the same study with different age ranges, different implant systems and designs and in different areas of the oral cavity to be able to distinguish the influence that each type of these criteria might have on the sulcular microflora, as adequate information about sulcular microflora may help in determining the prognosis of an implant treatment.</p></sec><sec sec-type="conclusion" id="sec1-5"><title>CONCLUSION</title><p>The results of this study show that as long as peri-implant pocket depth is in the normal range, the implant is not at stake in terms of periimplantitis; and clinicians must caution their patients to pay attention to their oral hygiene.</p><p>(This article is written based on the findings of the thesis: Evaluation of Microflora in Teeth and Implants; Project number: 386332).</p></sec></body><back><fn-group><fn fn-type="supported-by"><p><bold>Source of Support:</bold> This report is based on a thesis which was submitted to the School of Dentistry, Isfahan University of Medical Sciences, in partial fulfillment of the requirements for the Doctoral degree in Dentistry (#386332). 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