Non-surgical treatment of peri-implant pathology

Evaluation of the Photoactivation Effect of 3% Hydrogen Peroxide in the Disinfection of Dental Implants: In Vitro Study

Photoactivation of 3% hydrogen peroxide with a 445 nm diode laser represents a relatively new, insufficiently researched antimicrobial method in the treatment of peri-implantitis. The purpose of this work is to evaluate the effect of photoactivation of 3% hydrogen peroxide with a 445 nm diode laser, and to compare the obtained results with 0.2% chlorhexidine treatment and 3% hydrogen peroxide treatment without photoactivation, in vitro, on the surface of dental implants contaminated with S. aureus and C. albicans biofilms. Previously, 80 infected titanium implants with S. aureus and C. albicans cultures were divided into four groups: G1-negative control (no treatment), G2-positive control (0.2% chlorhexidine), G3 (3% hydrogen peroxide), and G4 (photoactivated 3% hydrogen peroxide). The number of viable microbes in each sample was determined by the colony forming unit (CFU) count. The results were statistically processed and analyzed, showing a statistically significant difference across all groups compared to the negative control (G1), and the absence of a statistically significant difference between groups G1-G3. The new antimicrobial treatment, according to the results, could be worthy of further analysis and research.

Early osseointegration of micro-arc oxidation coated titanium alloy implants containing Ag: a histomorphometric study

BACKGROUND

This study aimed to evaluate bone response to micro-arc oxidation coated titanium alloy implants containing Ag.

METHODS

144 titanium alloy implants were prepared by machine grinding and divided into three treatment groups as following, SLA group: sand-blasting and acid-etched coating; MAO group: micro-arc oxidation without Ag coating; MAO + Ag group: micro-arc oxidation containing Ag coating. Surface characterization of three kind of implants were observed by X-ray diffraction, energy dispersive X-ray spectrometer, scanning electron microscopy, High Resolution Transmission Electron Microscope and roughness analysis. The implants were inserted into dog femurs. 4, 8 and 12 weeks after operation, the bone response to the implant to the bone was evaluated by push-out experiment, histological and fluorescent labeling analysis.

RESULTS

MAO + Ag group consisted of a mixture of anatase and rutile. Ag was found in the form of Ag₂O on the surface. The surface morphology of MAO + Ag group seemed more like a circular crater with upheaved edges and holes than the other two groups. The surface roughness of MAO and MAO + Ag groups were higher than SLA group, but no statistical difference between MAO and MAO + Ag groups. The contact angles in MAO + Ag group was smallest and the surface free energy was the highest among three groups. The maximum push-out strength of MAO and MAO + Ag groups were higher than SLA group at all time point, the value of MAO + Ag group was higher than MAO group at 4 and 8 weeks. Scanning electron microscopy examination for the surface and cross-section of the bone segments and fluorescent labeling analysis showed that the ability of bone formation and osseointegration in MAO + Ag group was higher than that of the other two groups.

CONCLUSION

The micro-arc oxidation combination with Ag coating is an excellent surface modification technique to posse porous surface structure and hydrophilicity on the titanium alloy implants surface and exhibits desirable ability of osseointegration.

Ozonized Water Administration in Peri-Implant Mucositis Sites: A Randomized Clinical Trial

Peri-implant mucositis represents an inflammatory lesion of the mucosa surrounding an endosseous implant, without the loss of the supporting peri-implant bone. Considering its reversible nature, every effort should be made to contrast it, thus avoiding the eventual progression towards peri-implantitis. The aim of the present randomized clinical trial is to evaluate the efficacy of the ozonized water against peri-implant mucositis. A total of 26 patients diagnosed for this latter clinical condition were randomly divided according to the professional oral hygiene protocol performed on the pathological sites at baseline, at T1 (1 month), and T2 (2 months). Group 1 underwent an ozonized water administration (experimental treatment), whereas Group 2 underwent a pure water one (control treatment). Both administrations were performed with the same professional irrigator (Aquolab® professional water jet, Aquolab s.r.l. EB2C S.r.l., Milano, Italy) with no differences in color or taste between the two substances delivered. At each appointment, the following indexes were assessed: the Probing Pocket Depth (PPD), Plaque Index (PI), Bleeding on Probing (BoP), and Bleeding Score (BS). As regards intragroup differences, in Group 1 ozonized water significantly and progressively reduced all the clinical indexes tested, except for PI in the period T1–T2, whereas no significant differences occurred within the control group. Despite this, no significant intergroup differences were generally detected between the two treatments. Accordingly, the role of ozone for the management of peri-implant mucositis deserves to be further investigated.

Therapy for peri-implantitis: Significant radiographic bone fill after keratinized mucosa augmentation surgery with supportive implant therapy (SIT): A novel approach

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Does Probiotic Lactobacillus Have an Adjunctive Effect in the Nonsurgical Treatment of Peri-Implant Diseases? A Systematic Review and Meta-analysis

OBJECTIVE

To evaluate the additional effect of probiotic Lactobacillus in the nonsurgical management of peri-implant diseases (peri-implant mucositis and peri-implantitis).

METHODS

Six databases were searched up to May 2019 without time and language restrictions. Study selection and data extraction were conducted independently by 2 reviewers. The inclusion criteria for this systematic review were defined based on the participants, intervention, comparison, outcomes, and study design (PICOS) format. Randomized controlled trials comparing nonsurgical treatment combined with probiotic Lactobacillus or placebo agent in patients with peri-implant diseases were included. The methodological quality of retrieved studies was assessed according to the Cochrane Collaboration's Risk of Bias tool, and the quality of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool. Odds ratio and 95% confidence interval (CI) were used to describe dichotomous data, while mean difference and standardized mean difference with 95% CI were used to describe continuous variables.

RESULTS

Seven randomized controlled trials with 296 implants were included in this meta-analysis. The mean difference of probing pocket depth (PPD) was -0.05 (95% CI: -0.28 to 0.18; P = .67) immediately after treatment termination and -0.17 (95% CI: -1.01 to 0.67, P = .69) at least 2 months after treatment termination. There was a slight reduction of PPD after treatment termination. Compared with placebo, Lactobacillus provided limited benefits in peri-implant mucositis. There were no significant differences in the secondary outcomes of bleeding on probing or plaque index (P > .05). In a narrative synthesis of peri-implantitis, the effect of Lactobacillus on PPD and bleeding on probing remained controversial.

CONCLUSIONS

This systematic review and meta-analysis showed that probiotic Lactobacillus provide limited benefits to the nonsurgical treatment of peri-implant mucositis or peri-implantitis.

Bone Remineralization around Dental Implants following Conservative Treatment after Peri-Implantitis

The aim of this case report is to show that bone remineralization around dental implants with a history of peri-implantitis is possible after irritant factors are removed and only conservative treatment is performed. Patient came to the clinic after three years of dental implant placement complaining about swelling, sensitivity and gingiva color changes at the posterior part of the maxilla. During radiographic and intraoral examinations peri-implantitis of the #24 implant site was diagnosed. The surgical treatment method was rejected and performed conservative treatment instead. The outcome is promising; periapical radiographs three months later showed bone remineralization as well as stable bone after 10 years. A key clinical message: Bone remineralization around dental implants with a history of peri-implantitis is possible after irritant factors are removed and conservative treatment performed.

Roles of a new drug-delivery healing abutment in the prevention and treatment of peri-implant infections: a preliminary study

In this study we modified the common healing abutment into a specifically designed drug-delivery abutment (DDA), which is a hollow columnar system with drug-distribution holes in peripheral wall. The objective of this study was to investigate the possibility of the prevention and treatment of peri-implant diseases with this drug-delivery system. Minocycline hydrochloride was added to DDAs with different hole diameters, and then subjected to bacteria-inhibition tests in vitro with three oral bacterial strains, namely, Streptococcus mutans, Streptococcus sanguinis, and Porphyromonas gingivalis. The implants were placed into the mandible of beagle dogs. DDAs with or without minocycline and normal healing abutments were installed. One week after surgery, the plaques on all the abutments were analyzed by plaque stain. Following this, both abutments and adjacent teeth received oral hygiene to maintain a healing environment. Eleven weeks later, the ligature-induced experimental peri-implantitis model was set up for eight weeks. Periapical radiographs and clinical measurements were performed during the process. We found that inhibition zones were observed surrounding all the tested drug-delivery abutments in all three bacterial strains. One week after implant installation, oral plaque formed on the DDAs with minocycline was significantly less than that on normal abutments and DDAs without drugs. DDA with the minocycline group showed a relatively slower rate of deterioration of the mucosal inflammation and probing depth in the experimental peri-implant lesions. We suggest that this drug-delivery abutment could effectively deliver medications into peri-implant tissues to minimize plaque formation and relieve peri-implant inflammation in the experimental peri-implantitis model.

A Prognosis System for Periimplant Diseases

INTRODUCTION

Periimplant diseases have slowly become a common complication in implant patients. Here, we present a prognosis system to aid clinicians and researchers in the evaluation and treatment of periimplant diseases. This prognosis system divides periimplant disease into favorable, questionable, unfavorable, and hopeless cases based on the level of bone loss, pocket depth, mobility, bleeding on probing, and suppuration.

MATERIALS AND METHODS

To test the accuracy of our prognostic scale, the authors designed and conducted a database search to compile articles allowing for testing of the proposed prognostic scale.

DISCUSSION

The literature search returned 101 articles, of which two reported all relevant values for the prognostic system and were used to evaluate its reliability and accuracy. The prognostic system correctly predicted the likely outcome of periimplant disease up to 1 year posttreatment for all examined implants.

CONCLUSIONS

The proposed prognostic system can be used as a tool for clinicians as they develop a treatment plan for all stages of periimplant disease.

Associations of clinical characteristics and interval between maintenance visits with peri-implant pathology

We investigated the effects of clinical characteristics and the interval between maintenance visits on incidence of peri-implant pathology in a sample of 1,350 patients treated with dental implants (270 cases of peri-implant pathology and 1,080 healthy controls). The chi-square test was used to evaluate differences between cases and controls in the presence of dental plaque, bleeding, peri-implant pockets >4 mm, bone level, and interval between maintenance visits (significance level, 5%). Crude odds ratios (ORs) and attributable fractions were calculated for variables that significantly differed between cases and controls. The variables identified as risk indicators were dental plaque (P < 0.001; OR = 5.2), bleeding (P < 0.001; OR = 5.0), peri-implant pockets >4 mm (P < 0.001; OR = 17.2), bone level (P < 0.001; middle third, OR = 8.4; apical third, OR = 8.6), and interval between maintenance visits (P < 0.001; 1-3 months, OR = 2.9; 3-5 months, OR = 2.1). Attributable fractions revealed a potential reduction in peri-implant pathology of 53-94% after removing exposures to dental plaque (81%), bleeding (80%), peri-implant pockets >4 mm (94%), bone level (88%), and interval between maintenance visits (53-66%). Selected clinical characteristics and the interval between maintenance visits were significantly associated with the incidence of peri-implant pathology.

Topical application of 1% chlorhexidine gel versus 0.2% mouthwash in the treatment of peri-implant mucositis. An observational study

OBJECTIVE

The aim of this study was to compare the use of two chlorhexidine-based antimicrobial agents as an adjunct to mechanical therapy for the treatment of peri-implant mucositis.

MATERIALS AND METHODS

Thirty patients with peri-implant mucositis were included in the study and randomized in two groups. In addition to mechanical therapy, group A was treated with chlorhexidine 0.2% mouthwash, while group B was treated with chlorhexidine 1% gel. Probing depth, plaque index and bleeding index were recorded at each scheduled follow-up visit: ten days, 1 month and 3 months after giving the patients the assigned formulation. Patients had to fill in a questionnaire investigating their satisfaction and ease of use of the product.

RESULTS

A total of 23 patients (13 in group A and 10 in group B) attended all the follow-up visits. Chlorhexidine 0.2% mouthwash and chlorhexidine 1% gel were equally useful in the treatment of peri-implant mucositis leading to the reduction in inflammatory parameters. Probing depth decreased over time in both groups. Patients showed preference for gel formulation even if they found it more difficult to use.

CONCLUSIONS

Adjunctive treatment with different chlorhexidine formulations was beneficial to the treatment of peri-implant mucositis. Besides, no differences could be found between 0.2% mouthwash and 1% gel.

Comparison of the effects of treatment of peri-implant infection in animal and human studies: systematic review and meta-analysis

OBJECTIVE

The main objective of this systematic review is to compare the effects of treatment of peri-implant infection between animal and human studies.

MATERIAL AND METHODS

A literature search was conducted using the Medline, Cochrane Central Register of Controlled Trials, and Latin American and Caribbean Health Sciences Literature databases up to and including May 2008. In addition, bibliographies of systematic reviews on peri-implant diseases were searched manually. Non-surgical and surgical treatments of peri-implantitis/mucositis in animal models or human studies were compared. Meta-analysis was conducted to investigate the difference between the reported treatment effects in animal and human studies. Changes in probing pocket depth (PPD) and probing attachment level (PAL) from baseline measurements were used as measures of outcome. Single-level and multilevel meta-regression analysis was performed by taking into account the different follow-up times of the studies included.

RESULTS

The single-level and multilevel random-effects meta-analysis showed that the difference in PPD reduction [0.31 mm, 95% confidence interval (CI): -0.27, 0.88] and in PAL gain (0.21 mm, 95% CI: -0.47, 0.88) between animal and human studies was not statistically significant. The random-effects meta-regression suggested that studies with longer follow-up times revealed greater PPD reduction (0.25 mm per month, 95% CI: 0.14, 0.35). However, when the different follow-up times were taken into account, these differences became greater. Substantial heterogeneity between studies was found in the meta-analyses (I(2)=97.6% for animal studies and 99.9% for human studies).

CONCLUSION

There was great heterogeneity between human and animal studies in terms of study designs and treatment procedures. Therefore, the results from this meta-analysis should be interpreted with caution. Heterogeneity between studies and its causes merit further investigations.

Non-surgical treatment of peri-implant mucositis and peri-implantitis: a literature review

OBJECTIVES

To review the literature on non-surgical treatment of peri-implant mucositis and peri-implantitis.

MATERIAL AND METHODS

A search of PubMed and The Cochrane Library of the Cochrane Collaboration (CENTRAL) as well as a hand search of articles were conducted. Publications and articles accepted for publication up to November 2007 were included.

RESULTS

Out of 437 studies retrieved a total of 24 studies were selected for the review. Thus the available evidence for non-surgical treatment of peri-implant mucositis and peri-implantitis is scarce.

CONCLUSIONS

It was observed that mechanical non-surgical therapy could be effective in the treatment of peri-implant mucositis lesions. Furthermore, the adjunctive use of antimicrobial mouth rinses enhanced the outcome of mechanical therapy of such mucositis lesions. In peri-implantitis lesions non-surgical therapy was not found to be effective. Adjunctive chlorhexidine application had only limited effects on clinical and microbiological parameters. However, adjunctive local or systemic antibiotics were shown to reduce bleeding on probing and probing depths. Minor beneficial effects of laser therapy on peri-implantitis have been shown; this approach needs to be further evaluated. There is a need for randomized-controlled studies evaluating treatment models of non-surgical therapy of peri-implant mucositis and peri-implantitis.