Successful Surgical Protocols in the Treatment of Peri-Implantitis: A Narrative Review of the Literature

Clinical and Radiographic Outcomes of Adjunctive Photodynamic Therapy for Treating Peri-Implant Mucositis Among Cigarette Smokers and Diabetics: A Systematic Review and Meta-Analysis

Objective: This systematic review aimed to assess the influence of antimicrobial photodynamic therapy (aPDT) as an adjunct to mechanical debridement (MD) on peri-implant clinical and radiographic outcomes among cigarette smokers and diabetics with peri-implant mucositis (piM). Methods: Randomized controlled trials, assessing the clinical and radiographic parameters of aPDT versus MD alone among smokers and diabetics with piM, were included in the study. Meta-analyses were conducted to calculate the standard mean difference with a 95% confidence interval. The methodological quality of the included studies was assessed utilizing the modified Jadad quality scale. Results: The meta-analyses found statistically significant differences between the impact of adjunct aPDT and MD alone on the peri-implant plaque index (PI), probing depth (PD), and bleeding on probing among smokers and diabetics with piM at the final follow-up visit. However, no significant differences were found between the impact of adjunct aPDT and MD alone on the peri-implant crestal bone loss among smokers and diabetics with piM at the final follow-up. Conclusions: The application of aPDT as an adjunctive to MD demonstrated improved scores of the peri-implant clinical parameters among smokers and diabetics with piM in comparison with MD alone.

Peri-implantitis and systemic inflammation: A critical update

Peri-implantitis is an inflammatory condition induced by bacterial biofilm that affects the soft and hard tissues surrounding dental implants, compromising the success of implant therapy. Recent studies have highlighted the potential links between peri-implant health and systemic inflammation, including uncontrolled diabetes mellitus, psychological stress, cardiovascular disease, obesity, and infectious diseases such as COVID-19. As an inflammatory disease, peri-implantitis may trigger systemic inflammation by elevating circulating levels of pro-inflammatory cytokines, which could have unknown impacts on overall health. While the relationship between periodontal health and systemic conditions is better understood, the association between peri-implant disease and systemic inflammation remains unclear. Therefore, this comprehensive review aims to summarize the most recent evidence on the relationship between peri-implantitis and systemic inflammation, focusing on biological complications, microbiology, and biomarkers. This review aims to enhance our understanding of the links between peri-implantitis and systemic inflammation and promote further research in this field by discussing the latest insights and clinical implications.

Strength of titanium-zirconium alloy implants with a conical connection after implantoplasty

STATEMENT OF PROBLEM

Peri-implantitis occurs around dental implants, and implantoplasty has been used to address this ongoing disease; however, the changes to the physical properties of an implant after implantoplasty have not been well documented.

PURPOSE

The purpose of this in vitro study was to determine the effect of implantoplasty on fracture strength and the load required for plastic deformation after cyclic fatigue on dental implants.

MATERIAL AND METHODS

Twenty-six titanium/zirconium (TiZr) alloy implants (Roxolid Bone Level Implant; 4.1×10 mm) were embedded with 50% thread exposure and divided into 4 groups based on whether they had implantoplasty treatment by using different diamond rotary instruments and/or cyclic loading at 250 N for 2 million cycles: C0 (control, no cyclic loading), T0 (test, no cyclic loading), CM (control, cyclic loading), and TM (test, cyclic loading). After implantoplasty and/or cyclic loading, all implants underwent a load-to-failure test. The maximum fracture strength (FS) and load required for the onset of plastic deformation (PD) were recorded in Newtons. One-way ANOVA and nonparametric comparisons with control by using the Dunn and Wilcoxon method for joint ranking were used for statistical analysis.

RESULTS

The mean ±standard deviation FS for C0, CM, T0, and TM was 1465.2 ±86.4 N, 1480.7 ±64.1 N, 1299.3 ±123.8 N, and 1252.1 ±85.7 N, respectively. The mean ±standard deviation load for onset of PD for C0, CM, T0, and TM was 860.2 ±88.1 N, 797.0 ±130.5 N, 776.5 ±181.8 N, and 631.3 ±84.5 N, respectively. The TM group had a significantly lower FS and PD than the C0, CM, and T0 groups (P<.05) CONCLUSIONS: Both fracture strength (FS) and the onset of plastic deformation (PD) were significantly reduced after a TiZr alloy implant received implantoplasty and cyclic loading.

The benefit of antimicrobial photodynamic therapy to mechanical debridement in the treatment of smokers with peri-implant diseases: a systematic review and meta-analysis

Antimicrobial photodynamic therapy (aPDT) has been proposed as an adjunctive treatment strategy for peri-implant diseases. This systematic review aimed to determine whether aPDT as an adjunct to mechanical debridement has an additional benefit for smokers with peri-implant diseases. Randomized controlled trials (RCTs), which evaluated the clinical outcomes of mechanical debridement alone versus mechanical debridement + aPDT among smokers, were considered eligible to be included. The primary outcome was bleeding on probing (BOP) and secondary outcomes included probing depth (PD), plaque index (PI), and crestal bone loss (CBL). Meta-analyses using a random-effects model were conducted to calculate the mean difference (MD) with a 95% confidence interval (CI). The quality of evidence was assessed according to Grading of Recommendations Assessment, Development and Evaluation (GRADE). A total of four RCTs (188 participants) were included. The aPDT group showed significantly improved PD (MD =  - 1.26, 95% CI =  - 2.19 to - 0.32, p = 0.008) and PI (MD =  - 10.6%, 95% CI =  - 14.46 to - 6.74%, p = 0.0001) compared with mechanical debridement group at 3-month follow-up. No significant difference in bleeding on probing (BOP) was observed at 3-month follow-up (MD =  - 0.60%, 95% CI =  - 2.36 to 1.16%, p = 0.50). The subgroup analyses on photosensitizers demonstrated significant differences between the two groups on PD (MD =  - 1.23, 95% CI =  - 2.41 to - 0.05, p = 0.04) and PI (MD =  - 12.33, 95% CI =  - 14.74 to - 9.92, p < 0.00001) by the use of methylene blue (MB). Within the limitation of this study, compared with mechanical debridement alone, combined use of aPDT was more effective in reducing PD and PI in smokers at 3-month follow-up. MB was a predictable photosensitizer for aPDT. However, the findings should be interpreted with caution due to the limited number of included studies, methodological deficiencies, and heterogeneity between studies.

An Umbrella Review on Low-Abrasive Air Powder Water Jet Technology in Periodontitis and Peri-Implantitis Patients

This umbrella review was conducted to assess the existing literature and scientific evidence on air powder water jet technology (APWJT) in periodontal and peri-implantitis therapy. A systematic literature search for systematic reviews and meta-analyses of the last decade on the use of APWJT in periodontitis and implant patients was performed in the databases of MEDLINE/Ovid, Embase, Cochrane library and Scopus. An additional hand search on PubMed and Google Scholar was conducted. Ten articles that fit the inclusion criteria were selected after the full-text screening. Two systematic reviews, including one with a meta-analysis, investigated the use of APWJT in active periodontal therapy. The use of APWJT as an adjunct to conventional scaling and root planing (SRP) in active periodontal treatment showed improved results in the test group. Six articles, including two with a meta-analysis, reported on the use of APWJT as a stand-alone therapy or as an adjunct in supportive periodontal therapy. Similarly significant improved results were reported for the use of APWJT. Regarding the active treatment of peri-implant mucositis and peri-implantitis, four systematic reviews could not show an improved clinical outcome when APWJT was used as an adjunct to conventional treatment measures. Furthermore, one article investigated APWJT as a stand-alone therapy or as an adjunct in supportive peri-implant mucositis and peri-implantitis therapy. In systematic reviews that also investigated patient perception, APWJT was generally well-tolerated by the patient. Within the limitations of this umbrella review, it can be concluded that the use of APWJT with low-abrasive powders such as glycine, erythritol or trehalose as an adjunct in active periodontitis therapy shows similar clinical results compared to conventional SRP alone. In surgical peri-implantitis treatment, APWJT can be used adjunctively. It could be considered that the use of APWJT in supportive periodontal treatment results in a comparable clinical outcome and an enhanced patient perception, as well as a shorter clinical time.

Effect of sterile tetracycline ophthalmic ointment as an adjuvant to mechanical debridement on the treatment of peri-implantitis: A randomized controlled clinical trial

Background

Peri-implantitis is an infectious disease that affects the tissues around dental implants, with clinical signs of inflammation and irreversible loss of supporting bone. This study aimed to compare the effect of sterile topical tetracycline ophthalmic ointment as an adjuvant to mechanical debridement with mechanical debridement alone in the treatment of peri-implantitis.

Methods

In this single-blind randomized clinical trial, 32 patients (16 patients in each group) with peri-implantitis were treated topically using sterile tetracycline ophthalmic ointment. Four clinical parameters, including modified bleeding index (mBI), modified plaque index (mPI), probing depth (PD), and clinical attachment level (CAL), were measured at baseline and at 3- and 6-month follow-up intervals.

Results

PD reduction was statistically significant after 3 and 6 months in the test and control groups (P=0.001). Also, mPI and mBI reduction rates were significant in the test and control groups (P=0.001) after 3 and 6 months. However, in all the samples in the two groups, the mean of CAL before and after treatment was constant, with no significant difference (P>0.05).

Conclusion

Using sterile ocular tetracycline ointment could be an adjunctive treatment in improving and enhancing the therapeutic effects of mechanical debridement in the treatment of peri-implantitis. (IRCT20210909052418N1)

Microbiota in Gingival Crevicular Fluid Before and After Mechanical Debridement With Antimicrobial Photodynamic Therapy in Peri-Implantitis

Objectives

This study aims to compare the microbiota of gingival crevicular fluid (GCF) before and after mechanical debridement (MD) with antimicrobial photodynamic therapy (aPDT) and determine the core efficient microbiota in peri-implantitis after treatment.

Methods

We recruited 9 patients (14 implants) treated with MD+aPDT for peri-implantitis at our center from February 1, 2018, to February 1, 2019. GCF was collected using filter paper strip before and after the treatment. The bacterial 16S rRNA was amplified and sequenced using an Illumina MiSeq platform to characterize the GCF. Bioinformatics and statistical analyses were performed using QIIME2 and R.

Results

A total of 4,110,861 high-quality sequences were obtained from GCF samples. Based on the reference database, 1,120 amplicon sequence variants (ASVs) were finally harvested. Principal coordinates analysis indicated significant differences in the bacterial community structure between the 180 days after-treatment group and pre-treatment group. Difference analysis and least discriminant analysis showed that the differences were mainly reflected in non-dominant bacteria between these two groups. The non-dominant genera with significantly different distribution between the 180 days after-treatment group and the pre-treatment group included Lactobacillus, Pedobacter, Bulleidia, Centipeda, Desulfovibrio, Ochrobactrum, Staphylococcus, Microbacterium, Brevundimonas, Desulfobulbus, and Parvimonas. Moreover, a total of 29 predictive functional categories at KEGG level 2 were identified. The significant difference pathways at KEGG level 2 between after-treatment and pre-treatment were concentrated in infectious disease-related pathways.

Conclusions

Patients with peri-implantitis have significant changes in the low-abundance bacteria of the GCF before and after MD+aPDT. MD+aPDT may change the composition of GCF microbiota by increasing the abundance of cluster 1 (beneficial) and decreasing that of cluster 4 (harmful), which may decrease metabolic response to infection and thus improve peri-implantitis.

Effects of implant surface mechanical instrumentation methods on peri-implantitis: An in vitro study using a circumferential bone defect model

Background/purpose

Although several mechanical and chemical debridement techniques have been reported for the management of peri-implantitis, there is no consensus on the most effective method at present. This in vitro study aimed to examine the effects of different mechanical instrumentation techniques on the debridement of hard calcified materials, which are present on the implant surface, as well as the effect of the defect morphology.

Materials and methods

From a total of 15 implants, five each were assigned to one of three decontamination groups (Rotary titanium brush [Ti], tricalcium phosphate air powder abrasive treatment [Air], and titanium ultrasonic scaler [US] groups); the exposed hydroxyapatite (HA)-coated portion was divided into three 1-mm sections (coronal, middle, and apical). The residual-HA of each portion was measured using a digital microscope.

Results

The overall percentage of residual HA coating was significantly lower in the US group than in the Ti or Air groups (p < 0.01). The percentage of residual HA in the coronal portion was significantly lower in the Ti and US groups than in the Air group (p < 0.05 and p < 0.01, respectively). The percentage of residual HA in the middle portion was significantly lower in the US group than in the Air group (p < 0.01). The percentage of residual HA in the apical portion was significantly lower in the Ti group than in the Air or US groups (p < 0.01).

Conclusion

Ti and US were more effective for shallow defects, whereas US was more effective for deeper defects.

Reduced fracture load of dental implants after implantoplasty with different instrumentation sequences. An in vitro study

OBJECTIVES

To assess the mechanical stability of implants after implantoplasty and thermocyclic loading, the residual thickness of the instrumented areas and neighbouring tooth injury due to implantoplasty.

MATERIALS AND METHODS

Using a phantom head simulator and maxillary model implants were subjected to an implantoplasty procedure. Thirty implants were randomly assigned to receive one of three instrumentation sequences. After instrumentation, injury on neighbouring teeth was assessed. Instrumented implants and non-instrumented controls were subjected to 1.2 million cycles of thermo-mechanical loading in a chewing machine. Afterwards, maximum fracture load for all implants and an additional five pristine control implants was tested.

RESULTS

Generally, damage of neighbour teeth was a frequent finding (33 ± 56% of all cases) with considerable inter-group differences. No considerable inter-group difference for the residual implant thickness was found for different areas assessed. No implant fractured during cyclic loading. Fracture load was reduced after cyclic loading of uninstrumented implants from 2,724 ± 70 N to 2,299 ± 127 N, and after implantoplasty to 1,737 ± 165 N, while no effect by the instrumentation sequence could be observed.

CONCLUSIONS

Both implantoplasty and cyclic loading were shown to reduce the implants' maximum bending strength. Cyclic loading in a laboratory masticator, simulating a five-year equivalent of chewing, did not result in fractured implants. Since neighbouring tooth injury was assessed often, care should be taken with the selection of suitable instruments.

Photoacoustic removal of Enterococcus faecalis biofilms from titanium surface with an Er:YAG laser using super short pulses

Biofilms that grow on implant surfaces pose a great risk and challenge for the dental implant survival. In this work, we have applied Er:YAG photoacoustic irrigation using super short pulses (Er:YAG-SSP) to remove biofilms from the titanium surfaces in the non-contact mode. Mature Enterococcus faecalis biofilms were treated with saline solution, chlorhexidine, and hydrogen peroxide, or photoacoustically with Er:YAG-SSP for 10 or 60 s. The number of total and viable bacteria as well as biofilm surface coverage was determined prior and after different treatments. Er:YAG-SSP photoacoustic treatment significantly increases the biofilm removal rate compared to saline or chemically treated biofilms. Up to 92% of biofilm-covered surface can be cleaned in non-contact mode during 10 s without the use of abrasives or chemicals. In addition, Er:YAG-SSP photoacoustic irrigation significantly decreases the number of viable bacteria that remained on the titanium surface. Within the limitations of the present in vitro model, the ER:YAG-SSP seems to constitute an efficient therapeutic option for quick debridement and decontamination of titanium implants without using abrasives or chemicals.

Efficacy of Probiotics as Adjunctive Therapy to Nonsurgical Treatment of Peri-Implant Mucositis: A Systematic Review and Meta-Analysis

Background: Peri-implant mucositis (PiM) is an inflammation of the soft tissues surrounding the dental implant and is the precursor of the destructive inflammatory peri-implantitis. PiM is usually reversible, but difficult to eradicate. Mechanical debridement (MD) is the conventional procedure to treat PiM although not enough to reach a complete resolution. Recently, probiotics have been considered in the treatment of peri-implant disease. Therefore, the aim of this systematic review and meta-analysis was to investigate the efficacy of the probiotic therapy combined with MD compared with MD alone or MD + placebo in patients with PiM.

Methods: A search using electronic databases (MEDLINE, Science Direct databases, and Cochrane Central Register of Controlled Trials) and a manual search were performed up to November 2019 by two reviewers independently of each other. Eligible randomized controlled trials (RCTs) comparing MD + probiotic vs. MD were included. The quality assessment for all the selected RCTs was conducted according to the Cochrane Handbook for Systematic Reviews of Interventions. Probing depth reduction was selected as the primary outcome. Weighted mean difference (WMD) and 95% confidence interval (CI) were calculated for continuous outcomes, and odds ratio (OR) and 95% CI were calculated for dichotomous outcomes, using random effect models. This review was registered on the PROSPERO database (CRD42020213625).

Results: Five eligible publications were included in this systematic review and four in the meta-analysis. As regards the implant, the WMD in the probing depth reduction between the test and control group was −0.12 mm [95% CI (−0.38, 0.14), p = 0.38], meaning that the adjunctive probiotic therapy was not improving PiM compared with MD alone or MD + placebo. The meta-analysis also showed no statistically significant results in the secondary outcomes (reduction of full mouth plaque index and full mouth bleeding on probing, absence of bleeding on probing at implant level, and changes in microorganism load and species).

Conclusion: The findings of this systematic review and meta-analysis suggested that the additional use of probiotics did not improve the efficacy of MD in PiM treatment regarding clinical and microbial outcomes, at least in a short-term.

Surgical treatment of peri-implantitis defects with two different xenograft granules: A randomized clinical pilot study

Objectives

To investigate whether xenograft EB (EndoBon) is non‐inferior to xenograft BO (Bio‐Oss) when used in reconstructive surgery of peri‐implant osseous defects.

Materials and methods

Dental patients with one implant each demonstrating peri‐implantitis were randomized to receive surgical debridement and defect fill with either BO or EB. Changes in bone level (BL) and intrabony defect depth (IDD) evaluated radiographically were the primary outcomes. The secondary outcomes included changes in probing pocket depth (PPD), bleeding on probing (BoP), and suppuration on probing (SoP). All outcomes were recorded before treatment and at 6 and 12 months post‐treatment.

Results

Twenty‐four patients (n = 11 BO, n = 13 EB) completed the study. Both groups demonstrated significant within‐group improvements in all clinical and radiographic parameters at 6 and 12 months (p ≤ .001). At 12 months, both groups presented with IDD reductions of 2.5–3.0 mm on average. The inter‐group differences were not statistically significant at all time points and for all the examined parameters (p > .05). While the radiographic defect fill in both groups exceeded > 1 mm and can be considered treatment success, successful treatment outcomes as defined by Consensus Reporting (no further bone loss, PPD ≤ 5 mm, no BOP, and no SoP) were identified in 2/11 (18%) BO and 0/13 (0%) EB individuals (Fisher's exact test, p = .199).

Conclusions

Within the limitations of this pilot study, the application of xenograft EB showed to be non‐inferior to xenograft BO when used in reconstructive surgery of peri‐implant osseous defects.

Reosseointegration after the surgical treatment of induced peri-implantitis: systematic review on current evidence and translation from the animal to the human model

INTRODUCTION

The aim of this study was to review the histologic evidence of reosseointegration and related influencing factors in experimental induced peri-implantitis.

EVIDENCE ACQUISITION

An electronic search was performed on Medline for animal studies that included a histometric evaluation of the amount of regenerated bone in contact with an implant surface. Questions raised in the study focused on the role of implant surfaces, bone regeneration and decontamination treatments in achieving reosseointegration. A detailed electronic search was then conducted on MEDLINE (PubMed) up to July 2017.

EVIDENCE SYNTHESIS

One hundred and one articles were selected as abstract, thirty-seven articles assessed as full-text and sixteen finally included in the study. Reported measurements of reosseointegration varied significantly in the study, from 0 to 3.37 mm. There is histological evidence that reosseointegration can occur after treatment of ligature-induced peri-implantitis. However regenerated bone in contact with bone is generally restricted to the most apical portion of the peri-implant defect.

CONCLUSIONS

Animal studies of induced peri-implantitis seem to indicate that rough surfaces can enhance reosseointegration as compared to smooth surfaces. With regard to bone regeneration techniques and materials, submerged healing and barrier membranes have shown a positive effect on reosseointegration. No evidence exists, however, about the specific role of different bone substitutes and their ability to improve bone formation. Growth factors have been shown to improve reosseointegration in animal models, though additional study is required to confirm the data. Several decontamination treatments have been shown to promote reosseointegration compared to control; however no specific procedure has proven superior to others in achieving reosseointegration.

Management of peri-implantitis - A contemporary synopsis

Prevalence of peri-implant complication is expected to be on the rise with the increased number of implants being placed. Depending on the degree of osseous involvement, the clinician needs to decide if the treatment goal is to arrest the disease progression, regeneration or explantation and replacement. Host's medical status, defect configuration, aesthetic outcome, ability to access for plaque control post-treatment, and the patient's wishes are key factors to consider. The purpose of this review is to provide a contemporary synopsis on the management of peri-implantitis with emphasis on explantation. Guidance on the identification of factors/situations where salvaging an implant may be less favourable is discussed and the various techniques to remove a fractured, or peri-implantitis-affected non-mobile implant are described.

Surgical Therapy of Peri-Implantitis with Local Minocycline: A 6-Month Randomized Controlled Clinical Trial

The purpose of this study was to determine the clinical, microbial, and radiographic effects of local minocycline combined with surgical treatment of peri-implantitis. Fifty patients with peri-implantitis were recruited, and surgical treatment with the local application of either minocycline or placebo ointment was performed. The application of minocycline was repeated with supragingival debridement at 1, 3, and 6 mo postoperatively. Plaque index, gingival index (GI), probing pocket depth (PPD), and bleeding/suppuration on probing were measured at baseline and 1-, 3-, and 6-mo evaluations. The change in supporting bone level (SBL) measured with cone beam computed tomography was analyzed between baseline and 6 mo. Microbial analysis was performed with real-time polymerase chain reaction. Both groups exhibited improvements in clinical and radiographic measurements after surgical treatment. There was a significant difference in the changes of mean PPD between the test and control groups (2.68 ± 1.73 and 1.55 ± 1.86 mm, respectively, P = 0.039). The changes of mean GI and SBL differed significantly between the groups (ΔGI: 0.83 ± 0.60 and 0.40 ± 0.68; ΔSBL: 0.72 ± 0.56 and 0.31 ± 0.49 mm, respectively, P = 0.026 and 0.014). Treatment success rates (defined as PPD <5 mm, absence of bleeding/suppuration on probing, and no further bone loss) were 66.7% and 36.3% in the test and control groups, respectively. The count of red complex bacteria tended to decrease in both groups until 6 mo; however, no significant intergroup difference was found. None of the patients in the test group carried Porphyromonas gingivalis or Tannerella forsythia at 6 mo. These findings indicate that the repeated local delivery of minocycline combined with surgical treatment provides significant benefits in terms of clinical parameters and radiographic bone fill, with a higher treatment success rate in the short healing period (cris.nih.go.kr KCT0002844).

LOX-1 is involved in IL-1β production and extracellular matrix breakdown in dental peri-implantitis

PURPOSE

To explore whether lectin-type oxidized LDL receptor 1 (LOX-1), interleukin 1 beta (IL-1β), matrix metalloproteinase 2 (MMP2) and matrix metalloproteinase 9 (MMP9) are involved in the nosogenesis of human dental peri-implantitis and determine the role of LOX-1 in IL-1β, MMP2 and MMP9 production in response to Porphyromonas gingivalis.

METHODS

Peri-implant crevicular fluid (PICF) was collected from ten patients with healthy implants and ten patients with peri-implantitis. The LOX-1 protein in PICF was detected by Western-blot, and the expression of LOX-1 in superficial gingiva of peri-implantitis patients was detected by immunofluorescence staining. The IL-1β, MMP2 and MMP9 proteins in PICF were detected by enzyme-linked immunosorbent assay (ELISA). THP-1 macrophages were pretreated with neutralizing antibody (LOX-1) and inhibitors (LOX-1 and c-Jun N-terminal kinase, JNK) to evaluate the role of LOX-1 and JNK in IL-1β production, as well as the role of LOX-1 in MMP2 and MMP9 production in response to P. gingivalis by quantitative polymerase chain reaction (RT-PCR) and Western-blot.

RESULTS

LOX-1, IL-1β, MMP2 and MMP9 increased in PICF of peri-implantitis patients and in THP-1 macrophages on P. gingivalis stimulation. IL-1β, MMP2 and MMP9 production in response to P. gingivalis in THP-1 macrophages was dependent on LOX-1. JNK was responsible for LOX-1 induced IL-1β production as a result of P. gingivalis infection.

CONCLUSION

LOX-1 is involved in IL-1β production and extracellular matrix breakdown is a novel inflammatory pathway trigger and potential drug target in human dental peri-implantitis.

Mesenchymal stromal cell and osteoblast responses to oxidized titanium surfaces pre-treated with λ = 808 nm GaAlAs diode laser or chlorhexidine: in vitro study

Preservation of implant biocompatibility following peri-implantitis treatments is a crucial issue in odontostomatological practice, being closely linked to implant re-osseointegration. Our aim was to assess the responses of osteoblast-like Saos2 cells and adult human bone marrow-mesenchymal stromal cells (MSCs) to oxidized titanium surfaces (TiUnite^®, TiU) pre-treated with a 808 ± 10 nm GaAlAs diode laser operating in non-contact mode, in continuous (2 W, 400 J/cm²; CW) or pulsed (20 kHz, 7 μs, 0.44 W, 88 J/cm²; PW) wave, previously demonstrated to have a strong bactericidal effect and proposed as optional treatment for peri-implantitis. The biocompatibility of TiU surfaces pre-treated with chlorhexidine digluconate (CHX) was also evaluated. In particular, in order to mimic the in vivo approach, TiU surfaces were pre-treated with CHX (0.2%, 5 min); CHX and rinse; and CHX, rinse and air drying. In some experiments, the cells were cultured on untreated TiU before being exposed to CHX. Cell viability (MTS assay), proliferation (EdU incorporation assay; Ki67 confocal immunofluorescence analysis), adhesion (morphological analysis of actin cytoskeleton organization), and osteogenic differentiation (osteopontin confocal immunofluorescence analysis; mineralized bone-like nodule formation) analyses were performed. CHX resulted cytotoxic in all experimental conditions. Diode laser irradiation preserved TiU surface biocompatibility. Notably, laser treatment appeared even to improve the known osteoconductive properties of TiU surfaces. Within the limitations of an in vitro experimentation, this study contributes to provide additional experimental basis to support the potential use of 808 ± 10 nm GaAlAs diode laser at the indicated irradiation setting, in the treatment of peri-implantitis and to discourage the use of CHX.

Efficacy of periimplant mechanical curettage with and without adjunct antimicrobial photodynamic therapy in smokeless-tobacco product users

OBJECTIVE

The aim was to investigate the effectiveness of antimicrobial photodynamic therapy (aPDT) as an adjuvant to mechanical curettage (MC) in the treatment of periimplant mucositis in smokeless tobacco (ST) product users.

METHODS

Forty-eight ST product users with periimplant mucositis were randomly divided into 2 groups. In the test-group, participants underwent periimplant MC with adjunct aPDT; and in the control-group, the patients underwent MC alone. Periimplant plaque index (PI), bleeding on probing (BOP), and probing depth (PD) were measured at baseline and after 3-months of follow-up. Statistical analysis was performed using the Kruskal-Wallis test. Level of significance was set at P<0.05.

RESULTS

At baseline, periimplant PI, BOP and PD were comparable among individuals in the test- and control groups. At 3-months follow-up, scores of periimplant PI (P<0.05), BOP (P<0.05) and PD (P<0.05) were statistically significantly higher among patients in the control-group compared with the test-group. At 3-months follow-up, the percentages of sites of PI, BOP and PD were statistically significantly higher in the control-sites as compared to the test-sites.

CONCLUSION

Among patients with periimplant mucositis, MC with adjunct aPDT is more effective in reducing periimplant inflammation in ST product users as compared to MC alone; however, the present result should be interpreted with caution as they were based on a short-term follow-up. Further long-term studies are needed in this regard.

Adjunctive efficacy of probiotics in the treatment of experimental peri-implant mucositis with mechanical and photodynamic therapy: a randomized, cross-over clinical trial

AIM

To evaluate the adjunctive clinical efficacy of probiotics in the treatment of peri-implant mucositis (p-iM) with professionally administered plaque removal (PAPR) and photodynamic therapy (PDT).

MATERIALS AND METHODS

Following p-iM induction, patients underwent PAPR + PDT and were randomly assigned to receive the professional and home-based administration of probiotics (Lactobacillus plantarum and Lactobacillus brevis) (test treatment) or placebo preparation (control treatment) according to a cross-over design. Clinical parameters were assessed at six sites for each implant before as well as at 2 and 6 weeks after professional treatment administration.

RESULTS

Twenty patients contributing one dental implant each were included. Immediately before treatment and at 6 weeks, the median number of sites with bleeding on probing (BoP+) sites per implant unit was 4 (3-6) and 2 (0-2) (p < 0.001), respectively, for test treatment, and 3.5 (2-4) and 2 (0-3) (p = 0.03), respectively, for control treatment. No significant difference in clinical outcomes was observed between treatment groups.

CONCLUSION

The combination of PAPR and PDT either alone or associated with probiotics determined a significant reduction in the number of BoP+ sites at 2 and 6 weeks around implants with p-iM. The adjunctive use of probiotics did not significantly enhance the clinical outcomes of PAPR + PDT.

Efficacy of periimplant mechanical debridement with and without adjunct antimicrobial photodynamic therapy in the treatment of periimplant diseases among cigarette smokers and non-smokers

OBJECTIVE

The aim was to assess the efficacy of mechanical debridement (MD) with and without adjunct antimicrobial photodynamic therapy (aPDT) in reducing periimplant inflammation among cigarette-smokers and non-smokers.

METHODS

Cigarette-smokers and non-smokers were randomly divided into 2 groups. In the test-group, participants underwent full mouth scaling and periimplant MD with adjunct aPDT; and in the control-group, the participants underwent full mouth scaling and periimplant MD alone. Periimplant bleeding on probing (BOP), probing depth (PD) and crestal bone loss (CBL) were measured at baseline and at 6- and 12-months follow-up. Statistical analysis was performed using the Kruskal-Wallis test. P-values<0.05 were considered statistically significant.

RESULTS

Eighty-four smokers (41 patients in the test group and 43 in the control group) and 82 non-smokers (40 patients in the test group and 42 in the control group) were included. Among smokers and non-smokers, periimplant PD was significantly higher in the control-group compared with the test-group (P<0.05) at 6-months of follow-up. There was no statistically significant difference in BOP, PD and CBL among smokers and non-smokers in the test- and control-groups at 12-months of follow-up. BOP was comparable among smokers at all time intervals.

CONCLUSION

In the short-term, MD with adjunct aPDT is more effective in reducing periimplant probing depth than MD alone in smokers and non-smokers. However, in the long-term outcomes of MD either with or without aPDT among smokers and non-smokers are comparable.