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Hakkers J, Vangsted TE, van Winkelhoff AJ, de Waal YCM. Do systemic amoxicillin and metronidazole during the non-surgical peri-implantitis treatment phase prevent the need for future surgical treatment? A retrospective long-term cohort study. J Clin Periodontol 2024. [PMID: 38837305 DOI: 10.1111/jcpe.14024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 05/16/2024] [Accepted: 05/19/2024] [Indexed: 06/07/2024]
Abstract
AIM The aim of this retrospective long-term follow-up of a 3-month RCT was to assess whether non-surgical peri-implantitis treatment with adjunctive systemic antibiotics influenced the need for additional surgical treatment. MATERIALS AND METHODS Patients enrolled in an aftercare programme following non-surgical peri-implantitis treatment, with or without systemic amoxicillin and metronidazole, were analysed. Data had previously been collected pre-treatment (T0) and 3 months after treatment (T1) and were additionally collected during subsequent aftercare visits, until the final assessment (T2). Primary outcome was the need for additional surgical peri-implantitis therapy during the aftercare programme, analysed via Kaplan-Meier analysis and Cox regression. Secondary outcomes involved clinical parameters, assessed using parametric and non-parametric tests. RESULTS Forty-five patients (22 AB- group, 23 AB+ group) were included. The mean follow-up time between T1 and T2 was 35.9 months (SD = 21.0). 73.9% of the AB+ group and 50.0% of the AB- group did not receive additional surgical therapy (log-rank test, p = .110). The adjusted Cox regression model did not provide a significant result for antibiotics (β = .441, 95% CI = 0.159-1.220, p = .115). Univariable regression analysis highlighted the influence of baseline peri-implant pocket depth on the need for surgical treatment (β = 1.446, 95% CI = 1.035-2.020, p = .031). CONCLUSIONS Systemic amoxicillin and metronidazole administered during non-surgical peri-implantitis treatment do not seem to prevent the need for additional surgical therapy in the long term, during a structured aftercare programme.
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Affiliation(s)
- Jarno Hakkers
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands
| | - Tine E Vangsted
- Parodontologische Kliniek Den Haag, The Hague, The Netherlands
| | - Arie Jan van Winkelhoff
- Center for Dentistry and Oral Hygiene, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands
| | - Yvonne C M de Waal
- Center for Dentistry and Oral Hygiene, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands
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2
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Becker K, Gurzawska-Comis K, Klinge B, Lund B, Brunello G. Patterns of antibiotic prescription in implant dentistry and antibiotic resistance awareness among European dentists: A questionnaire-based study. Clin Oral Implants Res 2024. [PMID: 38785175 DOI: 10.1111/clr.14285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 05/01/2024] [Accepted: 05/06/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVES Antimicrobial resistance is an alarming global public health concern, threatening the effective treatment of common infections. This phenomenon is driven by the improper prescription of antibiotics. This study aimed to elucidate the patterns of antibiotic prescription in implant dentistry among European dentists and their awareness of antibiotic resistance. MATERIALS AND METHODS An anonymous online validated questionnaire was distributed via e-mail to 6431 recipients through the European Association for Osseointegration. It comprised of 17 structured questions investigating demographic variables, working environment, clinical experience, attitude towards antibiotic prescription in particular in relation to implant dentistry and COVID-19 pandemic, and awareness of antibiotic resistance. Data were collected from April to May 2023. RESULTS 281 dentists from 33 European countries completed the survey. Almost 80% affirmed to routinely prescribe antibiotics as prophylaxis as well as after dental implant placement, especially in medically compromised patients or in cases of bone grafting. Amoxicillin, alone (61%) or in combination with clavulanic acid (56%), was the most common antibiotic of choice. Awareness of penicillin resistance among respondents was high. For peri-implantitis treatment, more than half reported the use of systemic antibiotics. The large majority (95%) did not prescribe more antibiotics since the beginning of COVID-19 pandemic. Less than 40% declared to follow national guidelines for antibiotic prescription. CONCLUSION This survey revealed a high prescription rate of antibiotics in implant dentistry, despite the awareness about antibiotic resistance among the respondents. The development and adherence to European guidelines has been identified as a potential strategy for improving antimicrobial stewardship.
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Affiliation(s)
- Kathrin Becker
- Department of Orthodontics and Dentofacial Orthopedics, Charité - University Medicine Berlin, Berlin, Germany
| | | | - Björn Klinge
- Department of Dental Medicine, Division of Oral Health and Periodontology, Karolinska Institutet, Huddinge, Sweden
- Faculty of Odontology, Malmo University, Malmo, Sweden
| | - Bodil Lund
- Medical Unit of Plastic Surgery and Oral and Maxillofacial Surgery, Karolinska University Hospital, Stockholm, Sweden
- Department of Dental Medicine, Division of Oral Diagnostics and Surgery, Karolinska Institutet, Huddinge, Sweden
| | - Giulia Brunello
- Department of Orthodontics and Dentofacial Orthopedics, Charité - University Medicine Berlin, Berlin, Germany
- Department of Oral Surgery, University Hospital Düsseldorf, Düsseldorf, Germany
- Department of Neurosciences, Dentistry Section, University of Padova, Padova, Italy
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3
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Riben Grundström C, Lund B, Kämpe J, Belibasakis GN, Hultin M. Systemic antibiotics in the surgical treatment of peri-implantitis: A randomized placebo-controlled trial. J Clin Periodontol 2024. [PMID: 38699828 DOI: 10.1111/jcpe.13994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 03/22/2024] [Accepted: 04/16/2024] [Indexed: 05/05/2024]
Abstract
AIM To study the clinical, radiographic and microbiological outcomes after surgical treatment of peri-implantitis, with or without adjunctive systemic antibiotics. MATERIALS AND METHODS Eighty-four patients (113 implants) with peri-implantitis were randomized into three groups (A, amoxicillin and metronidazole; B, phenoxymethylpenicillin and metronidazole; or C, placebo). Treatment included resective surgery and implant surface decontamination with adjunctive antibiotics or placebo. Primary outcomes were probing pocket depth (PPD) reduction and marginal bone level (MBL) stability. Secondary outcomes were treatment success (defined as PPD ≤ 5 mm, bleeding on probing [BOP] ≤ 1site, absence of suppuration on probing [SOP] and absence of progressive bone loss of >0.5 mm), changes in BOP/SOP, mucosal recession (REC), clinical attachment level (CAL), bacterial levels and adverse events. Outcomes were evaluated for up to 12 months. The impact of potential prognostic indicators on treatment success was evaluated using multilevel logistic regression analysis. RESULTS A total of 76 patients (104 implants) completed the study. All groups showed clinical and radiological improvements over time. Statistically significant differences were observed between groups for MBL stability (A = 97%, B = 89%, C = 76%), treatment success (A = 68%, B = 66%, C = 28%) and bacterial levels of Aggregatibacter actinomycetemcomitans and Tannerella forsythia, favouring antibiotics compared to placebo. Multiple regression identified antibiotic use as potential prognostic indicator for treatment success. Gastrointestinal disorders were the most reported adverse events in the antibiotic groups. CONCLUSIONS Adjunctive systemic antibiotics resulted in additional improvements in MBL stability. However, the potential clinical benefits of antibiotics need to be carefully balanced against the risk of adverse events and possible antibiotic resistance.
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Affiliation(s)
- Caroline Riben Grundström
- Department of Periodontology, Specialist Clinic Kaniken, Public Dental Health Service, Uppsala, Sweden
- Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden
| | - Bodil Lund
- Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden
- Medical Unit of Plastic Surgery and Oral and Maxillofacial Surgery, Department for Oral and Maxillofacial Surgery and Jaw Orthopedics, Karolinska University Hospital, Stockholm, Sweden
| | - Johan Kämpe
- Department of Plastic and Oral and Maxillofacial Surgery, Uppsala University Hospital, Uppsala, Sweden
| | | | - Margareta Hultin
- Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden
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4
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Giok KC, Veettil SK, Menon RK. Comparative effectiveness of interventions for the treatment of peri-implantitis: A systematic review with network meta-analysis. J Prosthet Dent 2024:S0022-3913(24)00219-1. [PMID: 38632026 DOI: 10.1016/j.prosdent.2024.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 03/15/2024] [Accepted: 03/18/2024] [Indexed: 04/19/2024]
Abstract
STATEMENT OF PROBLEM Extensive research has been carried out on the various aspects of diagnosing and treating peri-implantitis. However, clinical guidelines for the management of peri-implantitis based on high quality evidence are lacking. PURPOSE The purpose of this systematic review with network meta-analysis was to analyze the current evidence on nonsurgical and surgical interventions for the treatment of peri-implantitis and synthesize clinical guidelines based on high quality evidence. MATERIAL AND METHODS A search was conducted for trials published in Medline, Scopus, PubMed, and Cochrane Central Register of Controlled Trials from inception until July 2023. The study was registered with the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42023451056). A network meta-analysis was performed on data from randomized controlled trials that assessed nonsurgical and surgical interventions for the treatment of peri-implantitis. The interventions were ranked according to their efficacy using surface under the cumulative ranking (SUCRA) system. The grading of recommendations, assessment, development, and evaluations (GRADE) approach was used to assess the level of certainty of evidence. RESULTS A total of 45 articles were included in the quantitative analysis. The GRADE approach determined a moderate to high level of certainty of evidence. Among the nonsurgical interventions, mechanical debridement with adjunctive systemic antibiotics was significant in improving probing depth at 3 months and beyond 6 months, clinical attachment loss at 3 months, and clinical attachment loss beyond 6 months. Mechanical debridement with adjunctive topical antibiotics was significant in improving probing depth beyond 6 months, clinical attachment loss at 3 months, clinical attachment loss beyond 6 months, and radiographic bone loss beyond 6 months. Mechanical debridement with adjunctive photodynamic therapy was significant in improving probing depth beyond 6 months, clinical attachment loss at 3 months, clinical attachment loss beyond 6 months, and radiographic bone loss beyond 6 months. Mechanical debridement with adjunctive systemic antibiotics and photodynamic therapy was significant in improving probing depth beyond 6 months. Among surgical interventions, open flap debridement with implant surface decontamination and open flap debridement with decontamination and adjunctive photodynamic therapy were significant in improving probing depth at 3 months. CONCLUSIONS Mechanical debridement with adjunctive systemic antibiotics or photodynamic therapy results in improved clinical outcomes.
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Affiliation(s)
- Koay Chun Giok
- Predoctoral student, School of Dentistry, International Medical University, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Sajesh K Veettil
- Associate Professor, Department of Pharmacy Practice, School of Pharmacy, College of Pharmacy, International Medical University, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Rohit Kunnath Menon
- Assistant Professor, Prosthodontics, College of Dentistry, Ajman University, Ajman, United Arab Emirates.
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Berglundh T, Mombelli A, Schwarz F, Derks J. Etiology, pathogenesis and treatment of peri-implantitis: A European perspective. Periodontol 2000 2024. [PMID: 38305506 DOI: 10.1111/prd.12549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 12/19/2023] [Accepted: 12/22/2023] [Indexed: 02/03/2024]
Abstract
Peri-implantitis is a plaque-associated pathological condition occurring in tissues around dental implants. It is characterized by inflammation in the peri-implant mucosa and progressive loss of supporting bone. Over the last 30 years, peri-implantitis has become a major disease burden in dentistry. An understanding of the diagnosis, etiology and pathogenesis, epidemiology, and treatment of peri-implantitis must be a central component in undergraduate and postgraduate training programs in dentistry. In view of the strong role of European research in periodontology and implant dentistry, the focus of this review was to address peri-implantitis from a European perspective. One component of the work was to summarize new and reliable data on patients with dental implants to underpin the relevance of peri-implantitis from a population perspective. The nature of the peri-implantitis lesion was evaluated through results presented in preclinical models and evaluations of human biopsy material together with an appraisal of the microbiological characteristics. An overview of strategies and outcomes presented in clinical studies on nonsurgical and surgical treatment of peri-implantitis is discussed with a particular focus on end points of therapy and recommendations presented in the S3 level Clinical Practice Guideline for the prevention and treatment of peri-implant diseases.
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Affiliation(s)
- Tord Berglundh
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Andrea Mombelli
- Division of Regenerative Dental Medicine and Periodontology, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Frank Schwarz
- Department of Oral Surgery and Implantology, Goethe University, Carolinum, Frankfurt, Germany
| | - Jan Derks
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Peng X, Guo X, Zhou Y. The Efficacy of Ten Different Adjunctive Measures in Patients with Nonsurgically Treated Peri-Implant Disease: A Network Meta-Analysis of Randomized Controlled Trials. Photobiomodul Photomed Laser Surg 2024; 42:99-124. [PMID: 38294889 DOI: 10.1089/photob.2023.0109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024] Open
Abstract
Objective: This study aimed to evaluate the impact of 10 adjunctive measures on non-surgical therapy outcomes for peri-implant disease. Methods: We formulated the study question and keywords following the Population, Intervention, Comparator, Outcome framework. Randomized controlled trials were identified through searches in PubMed, Embase, the Cochrane Library, and the Web of Science. Two researchers assessed the quality of included literature according to the Cochrane Risk of Bias Assessment Tool. Data analysis and ranking were performed using Stata 15.0 software. Results: This study, involving 51 pieces of literature and 2660 samples, conducted a network meta-analysis (NMA), which revealed that photodynamic therapy (PDT) significantly reduced probing pocket depth values in patients with peri-implant mucositis (SUCRA = 96.3%) and peri-implantitis (SUCRA = 96.7%). In addition, it showed an improvement in bleeding on probing (BOP) values for peri-implantitis (SUCRA = 91.6%). Furthermore, diode lasers improved BOP values for peri-implant mucositis (SUCRA = 76.5%). Conclusions: According to the NMA results and the surface under the cumulative ranking curve (SUCRA), PDT and diode laser outperform other adjuncts in peri-implant disease.
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Affiliation(s)
- Xuepei Peng
- School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xingtong Guo
- School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yuwen Zhou
- Department of Stomatology, Jiaxing Maternal and Child Health Hospital, Jiaxing, China
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Shiba T, Komatsu K, Takeuchi Y, Koyanagi T, Taniguchi Y, Takagi T, Maekawa S, Nagai T, Kobayashi R, Matsumura S, Katagiri S, Izumi Y, Aoki A, Iwata T. Novel Flowchart Guiding the Non-Surgical and Surgical Management of Peri-Implant Complications: A Narrative Review. Bioengineering (Basel) 2024; 11:118. [PMID: 38391604 PMCID: PMC10885994 DOI: 10.3390/bioengineering11020118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 01/04/2024] [Accepted: 01/22/2024] [Indexed: 02/24/2024] Open
Abstract
Peri-implant diseases, such as peri-implant mucositis and peri-implantitis, are induced by dysbiotic microbiota resulting in the inflammatory destruction of peri-implant tissue. Nonetheless, there has yet to be an established protocol for the treatment of these diseases in a predictable manner, although many clinicians and researchers have proposed various treatment modalities for their management. With the increase in the number of reports evaluating the efficacy of various treatment modalities and new materials, the use of multiple decontamination methods to clean infected implant surfaces is recommended; moreover, the use of hard tissue laser and/or air abrasion techniques may prove advantageous in the future. Limited evidence supports additional effects on clinical improvement in antimicrobial administration for treating peri-implantitis. Implantoplasty may be justified for decontaminating the implant surfaces in the supracrestal area. Surgical treatment is employed for advanced peri-implantitis, and appropriate surgical methods, such as resection therapy or combination therapy, should be selected based on bone defect configuration. This review presents recent clinical advances in debridement methods for contaminated implant surfaces and regenerative materials for treating peri-implant bone defects. It also proposes a new flowchart to guide the treatment decisions for peri-implant disease.
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Affiliation(s)
- Takahiko Shiba
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8549, Japan
- Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, MA 02115, USA
| | - Keiji Komatsu
- Department of Lifetime Oral Health Care Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8549, Japan
- Weintraub Center for Reconstructive Biotechnology, UCLA School of Dentistry, Los Angeles, CA 90095, USA
| | - Yasuo Takeuchi
- Department of Lifetime Oral Health Care Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8549, Japan
| | - Tatsuro Koyanagi
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8549, Japan
| | - Yoichi Taniguchi
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8549, Japan
| | - Toru Takagi
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8549, Japan
| | - Shogo Maekawa
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8549, Japan
| | - Takahiko Nagai
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8549, Japan
| | - Ryota Kobayashi
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8549, Japan
| | - Shunsuke Matsumura
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8549, Japan
| | - Sayaka Katagiri
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8549, Japan
| | - Yuichi Izumi
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8549, Japan
- Oral Care Periodontics Center, Southern TOHOKU Research Institute for Neuroscience, Southern TOHOKU General Hospital, Koriyama 963-8052, Japan
| | - Akira Aoki
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8549, Japan
| | - Takanori Iwata
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8549, Japan
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Barbato L, Cavalcanti R, Rupe C, Scartabelli D, Serni L, Chambrone L, Cairo F. Clinical efficacy of adjunctive methods for the non-surgical treatment of peri-implantitis: a systematic review and meta-analysis. BMC Oral Health 2023; 23:375. [PMID: 37296382 PMCID: PMC10251565 DOI: 10.1186/s12903-023-03058-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 05/18/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND The aim of this systematic review (SR) was to evaluate the clinical efficacy of different adjunctive methods/therapies to the non-surgical treatment (NST) of peri-implantitis. MATERIALS AND METHODS The protocol of the review was registered in PROSPERO database (CRD42022339709) and was designed according to PRISMA statement. Electronic and hand searches were performed to identify randomized clinical trials (RCTs) comparing non-surgical treatment of peri-implantitis alone versus NST plus any adjunctive method/treatment. The primary outcome was probing pocket depth (PPD) reduction. RESULTS Sixteen RCTs were included. Only 2 out of 1189 implants were lost and follow-up ranged from 3 to 12 months. PPD reduction across the studies varied from 0.17 to 3.1 mm, while defect resolution from 5.3% to 57.1%. Systemic antimicrobials were associated to higher PPD reduction (1.56 mm; [95% CI 0.24 to 2.89]; p = 0.02) with high heterogeneity, and treatment success (OR = 3.23; [95% CI 1.17 to 8.94]; p = 0.02), compared to NST alone. No differences were found with adjunctive local antimicrobials and lasers for PPD and bleeding on probing (BoP) reduction. CONCLUSIONS Non-surgical treatment with or without adjunctive methods may reduce PPD and BoP even if complete resolution of the pocket is unpredictable. Among possible adjunctive methods, only systemic antibiotics seems to provide further benefits, but their usage should be considered with caution.
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Affiliation(s)
- Luigi Barbato
- Department of Clinical and Experimental Medicine, Research Unit in Periodontology and Periodontal Medicine, University of Florence (Italy), Via Casentino, 29, Florence, Italy.
| | - Raffaele Cavalcanti
- Department of General Surgery and Surgical-Medical Specialties, University of Catania (Italy), Catania, Italy
| | - Cosimo Rupe
- Department of Clinical and Experimental Medicine, Research Unit in Periodontology and Periodontal Medicine, University of Florence (Italy), Via Casentino, 29, Florence, Italy
| | - Daniele Scartabelli
- Department of Clinical and Experimental Medicine, Research Unit in Periodontology and Periodontal Medicine, University of Florence (Italy), Via Casentino, 29, Florence, Italy
| | - Lapo Serni
- Department of Clinical and Experimental Medicine, Research Unit in Periodontology and Periodontal Medicine, University of Florence (Italy), Via Casentino, 29, Florence, Italy
| | - Leandro Chambrone
- Evidence-Based Hub, Egas Moniz Center for Interdisciplinary Research, Egas Moniz School of Health & Science, Almada, Portugal
- Unit of Basic Oral Investigation (UIBO), Universidad El Bosque, Bogotá, Colombia
- Department of Periodontics, School of Dental Medicine, The University of Pennsylvania, Philadelphia, PA, USA
| | - Francesco Cairo
- Department of Clinical and Experimental Medicine, Research Unit in Periodontology and Periodontal Medicine, University of Florence (Italy), Via Casentino, 29, Florence, Italy
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López-Valverde N, López-Valverde A, Blanco-Rueda JA. Efficacy of adjuvant metronidazole therapy on peri-implantitis: a systematic review and meta-analysis of randomized clinical studies. Front Cell Infect Microbiol 2023; 13:1149055. [PMID: 37287463 PMCID: PMC10242105 DOI: 10.3389/fcimb.2023.1149055] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 05/02/2023] [Indexed: 06/09/2023] Open
Abstract
Peri-implant diseases are pathological conditions that affect the survival of dental implants. Etiological studies are limited, accepting a prevalence of 20% at the implant level and 24% at the patient level. The benefits of adjuvant metronidazole are controversial. A systematic review and meta-analysis of RCTs according to PRISMA and PICOS was performed with an electronic search over the last 10 years in MEDLINE (PubMed), WOS, Embase, and Cochrane Library. The risk of bias was measured using the Cochrane Risk of Bias tool and the methodological quality using the Jadad scale. Meta-analysis was performed with RevMan version 5.4.1, based on mean difference and standard deviation, with 95% confidence intervals; the random-effects model was selected, and the threshold for statistical significance was defined as p < 0.05. A total of 38 studies were collected and five were selected. Finally, one of the studies was eliminated because of unanalyzable results. All studies reached a high methodological quality. A total of 289 patients were studied with follow-up periods from 2 weeks to 1 year. Statistical significance was only found, with respect to the use of adjunctive metronidazole, in the pooled analysis of the studies (p = 0.02) and in the analysis of the radiographic values reported on peri-implant marginal bone levels, in the studies with a 3-month follow-up (p = 0.03). Discrepancies in the use of systemic metronidazole require long-term randomized clinical trials (RCTs) to determine the role of antibiotics in the treatment of peri-implantitis.
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Affiliation(s)
- Nansi López-Valverde
- Department of Medicine and Medical Specialties, Faculty of Health Sciences, Universidad Alcalá de Henares, Madrid, Spain
| | - Antonio López-Valverde
- Department of Surgery, Instituto de Investigación Biomédica de Salamanca (IBSAL), University of Salamanca, Salamanca, Spain
| | - José Antonio Blanco-Rueda
- Department of Surgery, Instituto de Investigación Biomédica de Salamanca (IBSAL), University of Salamanca, Salamanca, Spain
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10
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Non-Surgical Therapy and Oral Microbiota Features in Peri-Implant Complications: A Brief Narrative Review. Healthcare (Basel) 2023; 11:healthcare11050652. [PMID: 36900657 PMCID: PMC10000417 DOI: 10.3390/healthcare11050652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/18/2023] [Accepted: 02/21/2023] [Indexed: 02/25/2023] Open
Abstract
The therapeutic discretion in cases of peri-implantitis should take into account the limits and advantages of specific therapeutic itineraries tailored according to each clinical case and each individual patient. This type of oral pathology emphasizes the complex classification and diagnostic issues coupled with the need for targeted treatments, in light of the oral peri-implant microbiota changes. This review highlights the current indications for the non-surgical treatment of peri-implantitis, describing the specific therapeutic efficacy of different approaches and discussing the more appropriate application of single non-invasive therapies The non-surgical treatment choice with antiseptics or antibiotics (single or combined, local, or systemic) for short courses should be considered on a case-by-case basis to minimize the incidence of side effects and concomitantly avoid disease progression.
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11
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Vilarrasa J, Soldini MC, Pons R, Valles C, Blasi G, Monje A, Nart J. Outcome indicators of non-surgical therapy of peri-implantitis: a prospective case series analysis. Clin Oral Investig 2023:10.1007/s00784-023-04918-2. [PMID: 36786958 DOI: 10.1007/s00784-023-04918-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 02/05/2023] [Indexed: 02/15/2023]
Abstract
OBJECTIVES This study aims to identify patient and implant indicators influencing the non-surgical therapeutic outcomes of peri-implantitis at 6 months of follow-up. METHODS This case series involved patients with at least one implant diagnosed with peri-implantitis according to the 2017 World Workshop criteria. Non-surgical therapy consisted of mechanical debridement of the peri-implant pockets combined with metronidazole 500 mg 3 times a day for 7 days. At baseline and at 6 months, clinical and radiographic variables were collected to calculate treatment success (probing pocket depth reduction to 5 mm without bleeding on probing or < 5 mm irrespective of bleeding on probing at all implant sites, and lack of bone loss progression). The primary outcome was treatment success (%) at 6 months. The influence of the patient and implant/prosthetic variables upon disease resolution was assessed through simple and multiple logistic regression analyses at patient and implant level, using generalized estimation equations models. RESULTS A total of 74 patients and 107 implants were analyzed at 6 months. Disease resolution was established in 25.7% of the patients and 24.1% of the implants. Patients with stage IV and grade C periodontitis, inadequate oral hygiene at baseline, and wide diameter (≥ 4.5 mm) presented significantly greater treatment failure, whereas smokers and former smokers demonstrated a tendency toward failure. At 6 months, there was a significant decrease in probing pocket depth and bleeding on probing of 1.08 ± 1.06 mm and 14%, respectively. Radiographically, a significant gain in marginal bone level of 0.43 ± 0.56 mm was observed. CONCLUSION Disease resolution after non-surgical treatment of peri-implantitis is negatively influenced by the loss of support of the adjacent periodontium, poor baseline oral hygiene, and wide diameter implants (≥ 4.5 mm). CLINICAL RELEVANCE This study helps to discriminate the clinical situations in which non-surgical treatment is less likely to achieve treatment success at short term.
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Affiliation(s)
- Javi Vilarrasa
- Department of Periodontology, Universitat Internacional de Catalunya, C/ Josep Trueta s/n, Sant Cugat del Vallés, 08195, Barcelona, Spain
| | - Maria Costanza Soldini
- Department of Periodontology, Universitat Internacional de Catalunya, C/ Josep Trueta s/n, Sant Cugat del Vallés, 08195, Barcelona, Spain
| | - Ramón Pons
- Department of Periodontology, Universitat Internacional de Catalunya, C/ Josep Trueta s/n, Sant Cugat del Vallés, 08195, Barcelona, Spain.
| | - Cristina Valles
- Department of Periodontology, Universitat Internacional de Catalunya, C/ Josep Trueta s/n, Sant Cugat del Vallés, 08195, Barcelona, Spain
| | - Gonzalo Blasi
- Department of Periodontology, Universitat Internacional de Catalunya, C/ Josep Trueta s/n, Sant Cugat del Vallés, 08195, Barcelona, Spain
| | - Alberto Monje
- Department of Periodontology, Universitat Internacional de Catalunya, C/ Josep Trueta s/n, Sant Cugat del Vallés, 08195, Barcelona, Spain.,Department of Periodontology and Oral Medicine, University of Michigan, Ann Arbor, MI, USA.,Department of Periodontology, University of Bern, Bern, Switzerland
| | - José Nart
- Department of Periodontology, Universitat Internacional de Catalunya, C/ Josep Trueta s/n, Sant Cugat del Vallés, 08195, Barcelona, Spain
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12
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Metabolic Conditions and Peri-Implantitis. Antibiotics (Basel) 2022; 12:antibiotics12010065. [PMID: 36671266 PMCID: PMC9854649 DOI: 10.3390/antibiotics12010065] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 12/24/2022] [Accepted: 12/28/2022] [Indexed: 01/01/2023] Open
Abstract
Dental implants to replace lost teeth are a common dentistry practice nowadays. Titanium dental implants display a high success rate and improved safety profile. Nevertheless, there is an increasing peri-implantitis (PI), an inflammatory disease associated with polymicrobial infection that adversely affects the hard and soft tissues around the implant. The present review highlights the contribution of different metabolic conditions to PI. The considerations of both local and systemic metabolic conditions are crucial for planning successful dental implant procedures and during the treatment course of PI. Un- or undertreated PI can lead to permanent jaw bone suffering and dental implant losses. The common mediators of PI are inflammation and oxidative stress, which are also the key mediators of most systemic metabolic disorders. Chronic periodontitis, low-grade tissue inflammation, and increased oxidative stress raise the incidence of PI and the underlying systemic metabolic conditions, such as obesity, diabetes mellitus, or harmful lifestyle factors (cigarette smoking, etc.). Using dental biomaterials with antimicrobial effects could partly solve the problem of pathogenic microbial contamination and local inflammation. With local dentistry considering factors, including oral microbiota and implant quality control, the inclusion of the underlying systemic metabolic conditions into the pre-procedure planning and during the treatment course should improve the chances of successful outcomes.
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13
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Grusovin MG, Pispero A, Del Fabbro M, Sangiorgi M, Simion M, Stefanini M, Varoni EM. Antibiotics as Adjunctive Therapy in the Non-Surgical Treatment of Peri-Implantitis: A Systematic Review and Meta-Analysis. Antibiotics (Basel) 2022; 11:1766. [PMID: 36551424 PMCID: PMC9774402 DOI: 10.3390/antibiotics11121766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 11/21/2022] [Accepted: 11/24/2022] [Indexed: 12/12/2022] Open
Abstract
The role of antibiotics as adjunctive therapy in the non-surgical treatment of peri-implantitis is uncertain. The aim of this systematic review of randomized controlled trials was to assess the efficacy of antibiotic therapy, local or systemic, as an adjunctive to the non-surgical therapy of peri-implantitis. Primary outcomes were: implant success rate and complications, changes in radiographic bone level, probing pocket depth (PPD), probing attachment level (PAL), bleeding on probing (BOP) and peri-implantitis resolution. Six studies were included: two using topical and four systemic antibiotics. Adjunctive local antibiotics improved PPD (mean difference (MD) = 0.6 mm; 95% CI 0.42-0.78), BOP (MD = 0.15% (95% CI 0.10, 0.19)) and the success rate (risk ratio = 9.89; 95% CI 2.39-40.84). No significant difference in bone level and success rate were found with the use of systemic antibiotics, although they appeared to improve PPD (MD = 1.15 mm; 95% CI 0.31-1.99) and PAL (MD = 1.10 mm; 95% CI 0.13-2.08). Within the limitations of this review, the adjunctive local antibiotics showed improved outcomes in terms of success rate, PPD and BOP, while adjunctive systemic antibiotics improved PPD and PAL only. Peri-implantitis resolution was about 20-30% using adjunctive local antibiotics, whilst it ranged from 2% to 65% with adjunctive systemic antibiotics. Findings are still controversial, since they are based on few studies with high heterogeneity, at the uncertain or high risk of bias and involve few patients. Non-surgical debridement and maintenance periodontal support therapy remain pivotal and the adjunctive use of antibiotics for peri-implantitis cannot be routinely recommended, even considering the increasing concern on antibiotic resistance.
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Affiliation(s)
- Maria Gabriella Grusovin
- Dipartimento Odontoiatria, Università Vita Salute “S. Raffaele”, 20132 Milan, Italy
- Libera Professionista in Gorizia (Dental Private Practice), 34170 Gorizia, Italy
| | - Alberto Pispero
- Dipartimento di Scienze Biomediche, Chirurgiche ed Odontoiatriche, Università Degli Studi di Milano, 20122 Milan, Italy
| | - Massimo Del Fabbro
- Dipartimento di Scienze Biomediche, Chirurgiche ed Odontoiatriche, Università Degli Studi di Milano, 20122 Milan, Italy
- IRCCS Fondazione Ca’Granda Ospedale Maggiore Policlinico, 20122 Milano, Italy
| | - Matteo Sangiorgi
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna,40123 Bologna, Italy
| | - Massimo Simion
- Dipartimento di Scienze Biomediche, Chirurgiche ed Odontoiatriche, Università Degli Studi di Milano, 20122 Milan, Italy
| | - Martina Stefanini
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna,40123 Bologna, Italy
| | - Elena Maria Varoni
- Dipartimento di Scienze Biomediche, Chirurgiche ed Odontoiatriche, Università Degli Studi di Milano, 20122 Milan, Italy
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14
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Luengo F, Solonko M, Sanz-Esporrín J, Sanz-Sánchez I, Herrera D, Sanz M. Clinical, Microbiological, and Biochemical Impact of the Surgical Treatment of Peri-Implantitis-A Prospective Case Series. J Clin Med 2022; 11:jcm11164699. [PMID: 36012939 PMCID: PMC9410201 DOI: 10.3390/jcm11164699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/01/2022] [Accepted: 08/09/2022] [Indexed: 11/24/2022] Open
Abstract
Background: The aim of this study, a prospective case series, was to evaluate the clinical, microbiological, and biochemical impact of the surgical treatment of peri-implantitis. Methods: Thirty subjects with diagnosis of peri-implantitis were treated following a surgical protocol including access flaps, surface decontamination with ultrasonics and glycine powder air-polishing, and systemic antibiotics. Disease resolution was defined by the composite outcome including presence of probing depths (PD) ≤5 mm, absence of bleeding on probing (BoP)/suppuration, and no additional radiographic bone loss (>1 mm). Regression analysis was used to evaluate the patient-, implant-, and prosthetic-related factors possibly influencing treatment outcomes. Results: Patients were evaluated at 6 months post treatment, demonstrating statistically significant reductions in PD (2.14 ± 1.07 mm) and increase in mucosal recession (1.0 ± 0.77 mm). Plaque, BoP, and suppuration were also reduced by 40.56%, 62.22%, and 7.78%, respectively. Disease resolution was achieved in 56.67% of patients. No significant changes were detected in microbiological parameters except for a significant reduction in proportions of Parvimonas micra. Similarly, the levels of the biomarker interleukin-8 in crevicular fluid were significantly lower at 6 months. Conclusions: The proposed surgical treatment of peri-implantitis demonstrated statistically significant clinical improvements although the impact on microbiological and biochemical parameters was scarce.
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Affiliation(s)
- Fernando Luengo
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, University Complutense, 28040 Madrid, Spain
| | - Myroslav Solonko
- Section of Periodontology, Faculty of Odontology, University Complutense, 28040 Madrid, Spain
| | - Javier Sanz-Esporrín
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, University Complutense, 28040 Madrid, Spain
| | - Ignacio Sanz-Sánchez
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, University Complutense, 28040 Madrid, Spain
- Correspondence:
| | - David Herrera
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, University Complutense, 28040 Madrid, Spain
| | - Mariano Sanz
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, University Complutense, 28040 Madrid, Spain
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