Surgical or non-surgical treatment of peri-implantitis — what is the verdict?,

Efficacy of non-surgical mechanical debridement with and without adjunct antimicrobial photodynamic therapy in the treatment of peri-implantitis among patients undergoing chemotherapy

OBJECTIVE

Studies have shown that a single session of antimicrobial photodynamic therapy (aPDT) as an adjunct to mechanical debridement (MD) is effective for treating peri-implant diseases. The objective was to assess the efficacy of MD with and without adjunct aPDT in treating peri-implantitis among patients undergoing chemotherapy.

METHODS

Patients with peri-implantitis were included. These individuals were divided into two groups (a) patients with peri-implantitis undergoing chemotherapy; (b) systemically healthy patients with peri-implantitis. These individuals were further subclassified into two subgroups: (a) individuals that received NSMD alone and (b) individuals that underwent NSMD with adjunct aPDT. Non-surgical MD was performed using plastic curettes. The aPDT was performed using a 680 nm diode laser at a power and power density of 150 mW and 1.1 mW/cm2, respectively. The photosensitizer was placed in the peri-implant pocket and left in place for 60 seconds following which the laser was applied using a using an optical fiber with a diameter of 600 μm. Peri-implant modified plaque and gingival indices (mPI and mGI), probing depth (PD) and crestal bone loss (CBL) were measured at baseline and after three months. Group comparisons were performed using one way analysis of variance and Bonferroni post-hoc adjustment tests. P-values less than 0.05 were considered statistically significant.

RESULTS

At baseline, there was no statistically significant difference in peri-implant mPI, mGI, PD and CBL among patients undergoing chemotherapy and systemically healthy individuals with peri-implantitis. At three months' follow up, there was no statistically significant difference in peri-implant mPI, mGI, PD and CBL among patients undergoing chemotherapy and systemically healthy individuals with peri-implantitis compared to their respective baseline scores.

CONCLUSION

Among patients undergoing chemotherapy and systemically healthy individuals, a single session of aPDT and NSMD is ineffective in the treatment of peri-implantitis. Nevertheless, poor oral hygiene of the participants and the short-term follow-up may have influenced the results. Hence further long-term follow-up clinical trials involving multiple sessions of aPDT after MD are needed.

Role of antimicrobial photodynamic therapy for the management of peri‑implant diseases among habitual nicotinic product users: A systematic review

OBJECTIVE

The objective was to systematically review original studies that assessed the influence of antimicrobial photodynamic therapy (aPDT) for managing peri‑implant diseases among habitual nicotinic product (NP) users.

METHODS

The research question was "Is aPDT effective for managing peri‑implant diseases among NP users?" Indexed databases (PubMed/Medline, EMBASE, Scopus, and ISI Web of Knowledge) and Google Scholar were searched up to and including December 2024 without time and language barriers. Using Boolean operators, the following keywords were searched in different combinations: antimicrobial photodynamic therapy; crestal bone loss; peri‑implant diseases; probing depth; nicotine; and smoking. Original clinical studies were included. Letters to the Editor, Case-reports, case-series, commentaries, reviews and perspectives/expert opinions were excluded. The literature search was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses. The risk of bias (RoB) was assessed using the Cochrane RoB 2 tool.

RESULTS

Seven RCTs performed on adult males were included and processed for data extraction. The mean ages of participants ranged between 31 and 57 years. The wavelength of the diode laser ranged between 660 and 670 nm in all studies. Results from all RCTs showed that aPDT, when performed as an adjunct to MD, is more effective in reducing peri‑implant plaque index, bleeding scores, and peri‑implant PD in contrast to when mechanical debridement (MD) was performed alone. None of the studies reported a statistically significant difference in crestal bone height, irrespective of whether MD was done with or without adjunct aPDT. In all studies, the follow-up duration ranged between 3 and 12 months. The aPDT was performed once (after MD) in all studies. All studies had a low RoB and their results were based on power-adjusted data.

CONCLUSION

In the short term, a single session of aPDT as an adjunct to MD effectively reduces peri‑implant soft-tissue inflammation among NP users with peri‑implant diseases. However, this treatment does not influence CBL in these patients.

Comparison of local minocycline hydrochloride delivery and antimicrobial photodynamic therapy as adjuncts to mechanical debridement for the treatment of peri‑implant mucositis: A randomized controlled trial

OBJECTIVE

The aim was to compare the efficacy of local minocycline hydrochloride delivery (LMHD) and antimicrobial photodynamic therapy (aPDT) as adjuncts to mechanical debridement (MD) for the treatment of peri‑implant mucositis (PM).

METHODS

Patients with PM were included. The following information was retrieved from patients' digital dental records: (a) age, (b) gender, (c) duration of implants in function, (d) number of implants, (e) depth of implant placement, and (f) mode of prosthesis retention. Information related to daily toothbrushing and flossing of interproximal spaces and the most recent visit to an oral healthcare provider was also recorded. Participants were randomly divided into three groups as follows: (a) MD + LMHD; (b) MD + aPDT, and (c) MD alone. Peri-implant modified plaque index (mPI), modified gingival index (mGI) and probing depth (PD) were measured at baseline and at 45 days follow-up. Peri-implant crestal bone levels were measured at baseline. Group comparisons were done using One-way analysis of variance and Bonferroni post-hoc adjustment tests. The correlation between peri‑implant clinical parameters and age, gender, and duration of implants in function was assessed using linear regression analysis. Level of significance was set at P < 0.05.

RESULTS

Twenty-two and 22 patients underwent MD with adjunct LMDH and aPDT, respectively. Twenty-two participants underwent MD alone. There was no difference in the mean ages of all individuals. At baseline, there was no difference in mPI, mGI and PD in all groups. At follow-up, mPI (P < 0.05), mGI (P < 0.05) and PD (P < 0.05) were higher among patients who underwent MD alone than individuals who received LMHD or aPDT as adjuncts to MD. There was no difference in mPI, mGI, and PD among individuals who underwent LMHD and aPDT as adjuvants to MD.

CONCLUSION

In the short term, MD with adjunct LMHD or aPDT is effective for managing PM.

Biomaterials science and surface engineering strategies for dental peri-implantitis management

Peri-implantitis is a bacterial infection that causes soft tissue inflammatory lesions and alveolar bone resorption, ultimately resulting in implant failure. Dental implants for clinical use barely have antibacterial properties, and bacterial colonization and biofilm formation on the dental implants are major causes of peri-implantitis. Treatment strategies such as mechanical debridement and antibiotic therapy have been used to remove dental plaque. However, it is particularly important to prevent the occurrence of peri-implantitis rather than treatment. Therefore, the current research spot has focused on improving the antibacterial properties of dental implants, such as the construction of specific micro-nano surface texture, the introduction of diverse functional coatings, or the application of materials with intrinsic antibacterial properties. The aforementioned antibacterial surfaces can be incorporated with bioactive molecules, metallic nanoparticles, or other functional components to further enhance the osteogenic properties and accelerate the healing process. In this review, we summarize the recent developments in biomaterial science and the modification strategies applied to dental implants to inhibit biofilm formation and facilitate bone-implant integration. Furthermore, we summarized the obstacles existing in the process of laboratory research to reach the clinic products, and propose corresponding directions for future developments and research perspectives, so that to provide insights into the rational design and construction of dental implants with the aim to balance antibacterial efficacy, biological safety, and osteogenic property.

Rhamnolipid 89 Biosurfactant Is Effective against Streptococcus oralis Biofilm and Preserves Osteoblast Behavior: Perspectives in Dental Implantology

Biofilm-related peri-implant diseases represent the major complication for osteointegrated dental implants, requiring complex treatments or implant removal. Microbial biosurfactants emerged as new antibiofilm coating agents for implantable devices thanks to their high biocompatibility. This study aimed to assess the efficacy of the rhamnolipid 89 biosurfactant (R89BS) in limiting Streptococcus oralis biofilm formation and dislodging sessile cells from medical grade titanium, but preserving adhesion and proliferation of human osteoblasts. The inhibitory activity of a R89BS coating on S. oralis biofilm formation was assayed by quantifying biofilm biomass and microbial cells on titanium discs incubated up to 72 h. R89BS dispersal activity was addressed by measuring residual biomass of pre-formed biofilms after rhamnolipid treatment up to 24 h. Adhesion and proliferation of human primary osteoblasts on R89BS-coated titanium were evaluated by cell count and adenosine-triphosphate quantification, while cell differentiation was studied by measuring alkaline phosphatase activity and observing mineral deposition. Results showed that R89BS coating inhibited S. oralis biofilm formation by 80% at 72 h and dislodged 63-86% of pre-formed biofilms in 24 h according to concentration. No change in the adhesion of human osteoblasts was observed, whereas proliferation was reduced accompanied by an increase in cell differentiation. R89BS effectively counteracts S. oralis biofilm formation on titanium and preserves overall osteoblasts behavior representing a promising preventive strategy against biofilm-related peri-implant diseases.

Effect of non-surgical periodontal therapy with adjunct photodynamic therapy on periodontal and glycemic statuses in prediabetic patients with periodontal disease

OBJECTIVE

Studies have shown that non-surgical periodontal therapy (NSPT) helps reduce periodontal inflammation and glycemic levels in patients with type-2 diabetes mellitus; however, the role of NSPT with adjunct photodynamic therapy on glycemic status and periodontal parameters in prediabetic patients remains unclear. The aim of the present study was to assess the effect of NSPT with and without adjunct PDT on periodontal and glycemic statuses in prediabetic patients with periodontal disease.

METHODS

Prediabetic (Group-1) and non-diabetic (Group-2) patients diagnosed with periodontal inflammation were included. In both groups, patients were randomly assigned to test and control-groups. In the test- and control groups, patients underwent NSPT with and without adjunct PDT, respectively. The following parameters were assessed at baseline and at four weeks' follow-up: plaque index (PI); gingival index (GI), probing depth (PD), clinical attachment loss (CAL) and hemoglobin A1c (HbA1c). Collection of demographic data and assessment of full mouth marginal bone loss was performed at baseline. Level of significance was set at P < 0.05.

RESULTS

At baseline, there was no difference in PI, GI and PD among patients with and without prediabetes. At 3-weeks' follow up there was no difference in PI, GI and PD among patients without prediabetes. PI (P < 0.01), GI (P < 0.01) and PD (P < 0.01) were significantly higher in the control-group compared with the test-group at 3-weeks' follow-up in patients without prediabetes. The HbA1c levels were significantly higher in patients with prediabetes throughout the study duration compared with individuals without prediabetes.

CONCLUSION

One session of NSPT with or without PDT reduce periodontal inflammation but do not influence glycemic levels in prediabetic patients.

Short-term influence of antimicrobial photodynamic therapy as an adjuvant to mechanical debridement in reducing soft-tissue inflammation and subgingival yeasts colonization in patients with peri-implant mucositis

OBJECTIVE

The objective of this short-term follow-up study was to evaluate the influence of antimicrobial photodynamic therapy (aPDT) as an adjuvant to mechanical debridement (MD) in reducing soft-tissue inflammation and subgingival yeasts colonization (SYC) in patients with peri‑implant mucositis (PiM).

METHODS

Individuals diagnosed with PiM were included. Demographic data was collected using a questionnaire. Peri-implant plaque index (PI), bleeding index (BI), probing depth (PD), crestal bone levels and SYC were measured at baseline. Therapeutically, these individuals were divided into test and control groups. In the control-group patients underwent MD and in the test-group patients underwent MD with adjunct single session of aPDT. Clinical peri‑implant parameters and SYC were reassessed after 12-weeks. Correlation between age, gender and duration of implants with SYC and clinical peri‑implant status was assessed using logistic regression models. P < 0.05 was selected as an indicator of statistical significance.

RESULTS

The test and control-groups comprised of 24 and 23 individuals, respectively. In the test and control groups, toothbrushing twice daily was reported by 7 (29.2%) and 5 (21.7%) individuals, respectively. None of the individuals had ever used a dental floss. At baseline, there was no difference in peri‑implant PI, BI, PD and CBL in the test and control groups. At follow-up, peri‑implant PI (P < 0.01), BI (P < 0.01) and PD (P < 0.01) were significantly higher in the control compared with the test-group. At baseline, SYC in the test and control groups were 1865.3 ± 403.4 CFU/ml and 1963.7 ± 512.4 CFU/ml, respectively. At 90 days' follow-up, SYC in the test and control groups were 1472 ± 202.7 and 1538.4 ± 331.7 CFU/ml, respectively. There was no significant difference in SYC in both groups when baseline values were compared with 90 days' follow-up.

CONCLUSION

One session of aPDT after MC with adjunct aPDT is effective in reducing soft tissue inflammation but not SYC in patients with PiM.

Postoperative anti-inflammatory efficacy of 2% saline rinses and a herbal- mouthwash after non-surgical periodontal therapy for the management of periodontal inflammation in young adults with chlorhexidine allergy: A randomized controlled trial

AIM

The present randomized controlled trial assessed the postoperative anti-inflammatory efficacy of 2% saline rinses (SR) and a herbal- mouthwash (HMW) after non-surgical periodontal therapy (NSPT) for the management of periodontal inflammation in patients with chlorhexidine (CHX) allergy.

MATERIALS AND METHODS

Patients with periodontal inflammation with and without self-reported CHX-allergy were included. All patients underwent non-surgical periodontal therapy (NSPT). Patients were randomly divided into three groups. In the SR and HMW groups, 2% SR, and a HMW, respectively were prescribed. In Group-3 (CHX-group), patients without CHX allergy were included and were prescribed 0.12% CHX. In all groups, plaque index (PI), gingival index (GI), probing depth (PD), clinical attachment loss (AL) and marginal bone loss were measured at baseline. Clinical periodontal parameters were re-assessed at 6-weeks' follow-up. P<0.01 were considered statistically significant.

RESULTS

Thirteen, 12 and 12 patients were included in the SR, HMW and CHX groups, respectively. At baseline clinical and radiographic periodontal parameters were comparable in all groups. In all groups, PI (P<0.01), GI (P<0.01) and PD (P<0.01) were significantly higher at baseline compared with their respective values at 6-weeks of follow-up. There was no significant difference in clinical AL at all time intervals in all groups. There was no significant correlation between periodontal parameters and age, gender and daily toothbrushing/flossing in all groups.

CONCLUSION

In young adults with self-reported CHX-allergy, herbal-mouthwashes and/or 2% SR are suitable postoperative prescriptions after NSPT.

Effect of photobiomodulation after non-surgical mechanical debridement on cortisol levels in the peri-implant sulcular fluid among patients with peri-implant mucositis

OBJECTIVE

The aim of this was to compare the efficacy of photobiomodulation after non-surgical mechanical debridement (MD) on cortisol levels (CL) in peri-implant sulcular fluid (PISF) among patients with peri-implant mucositis.

METHODS

Patients with peri-implant mucositis were encompassed. All patients underwent non-surgical MD with (test group) and without (control group) a single application of photobiomodulation. Demographic data were collected and PISF was collected. Peri-implant modified plaque index (mPI), modified gingival index (mGI), probing depth and crestal bone loss were measured, and CL in PISF were recorded. All clinical parameters and PISF CL were re-assessed at 4 months of follow-up. p < .05 showed statistical significance.

RESULTS

Seventeen (14 males and 3 females) and 17 (15 males and 2 females) patients with peri-implant mucositis were recruited in test and control groups. The mean age of patients in the test and control groups was 46.1 ± 6.5 and 50.2 ± 2.7 years respectively. At baseline, mPI, mGI, PD and PISF volume and CL in control and test groups were similar. At follow-up, there was a significant reduction in mPI (p < .001), mGI (p < .001), PD (p < .001) and PISF volume (p < .001) and CL (p < .001) in both groups compared with baseline. There was no difference in mPI, mGI, PD and PISF volume and CL in test and control groups at follow-up.

CONCLUSION

In short term, non-surgical MD with photobiomodulation does not offer additional benefits in terms of reducing soft-tissue inflammatory parameters and PISF CL in patients with peri-implant mucositis.