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Seoane-Viaño I, Seoane-Gigirey M, Bendicho-Lavilla C, Gigirey LM, Otero-Espinar FJ, Seoane-Trigo S. The Integration of Advanced Drug Delivery Systems into Conventional Adjuvant Therapies for Peri-Implantitis Treatment. Pharmaceutics 2024; 16:769. [PMID: 38931890 PMCID: PMC11207621 DOI: 10.3390/pharmaceutics16060769] [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: 04/07/2024] [Revised: 05/31/2024] [Accepted: 06/03/2024] [Indexed: 06/28/2024] Open
Abstract
Despite the high success rates of dental implants, peri-implantitis is currently the most common complication in dental implantology. Peri-implantitis has an inflammatory nature, it is associated with the accumulation of plaque in the peri-implant tissues, and its evolution can be progressive depending on various factors, comorbidities, and poor oral health. Prophylaxis and different treatment methods have been widely discussed in recent decades, and surgical and non-surgical techniques present both advantages and disadvantages. In this work, a literature review of different studies on the application of adjuvant treatments, such as local and systemic antibiotics and antiseptic treatments, was conducted. Positive outcomes have been found in the short (up to one year after treatment) and long term (up to ten years after treatment) with combined therapies. However, there is still a need to explore new therapies based on the use of advanced drug delivery systems for the effective treatment of peri-implantitis in the long term and without relapses. Hence, micro- and nanoparticles, implants, and injectable hydrogels, among others, should be considered in future peri-implantitis treatment with the aim of enhancing overall therapy outcomes.
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Affiliation(s)
- Iria Seoane-Viaño
- Department of Pharmacology, Pharmacy and Pharmaceutical Technology, Faculty of Pharmacy, and Institute of Materials (iMATUS), University of Santiago de Compostela (USC), 15782 Santiago de Compostela, Spain; (M.S.-G.); (C.B.-L.); (F.J.O.-E.)
- Paraquasil Group (GI-2109), Health Research Institute of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain
| | - Mariola Seoane-Gigirey
- Department of Pharmacology, Pharmacy and Pharmaceutical Technology, Faculty of Pharmacy, and Institute of Materials (iMATUS), University of Santiago de Compostela (USC), 15782 Santiago de Compostela, Spain; (M.S.-G.); (C.B.-L.); (F.J.O.-E.)
| | - Carlos Bendicho-Lavilla
- Department of Pharmacology, Pharmacy and Pharmaceutical Technology, Faculty of Pharmacy, and Institute of Materials (iMATUS), University of Santiago de Compostela (USC), 15782 Santiago de Compostela, Spain; (M.S.-G.); (C.B.-L.); (F.J.O.-E.)
- Paraquasil Group (GI-2109), Health Research Institute of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain
| | - Luz M. Gigirey
- Department of Applied Physics, Faculty of Optics and Optometry, University of Santiago de Compostela (USC), 15782 Santiago de Compostela, Spain;
| | - Francisco J. Otero-Espinar
- Department of Pharmacology, Pharmacy and Pharmaceutical Technology, Faculty of Pharmacy, and Institute of Materials (iMATUS), University of Santiago de Compostela (USC), 15782 Santiago de Compostela, Spain; (M.S.-G.); (C.B.-L.); (F.J.O.-E.)
- Paraquasil Group (GI-2109), Health Research Institute of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain
| | - Santiago Seoane-Trigo
- Ph. Dr. Adult Comprehensive Dentistry, University of Santiago de Compostela (USC), 15782 Santiago de Compostela, Spain
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West N, Chapple I, Culshaw S, Donos N, Needleman I, Suvan J, Nibali L, Patel A, Preshaw PM, Kebschull M. BSP Implementation of Prevention and Treatment of Peri-implant Diseases - The EFP S3 Level Clinical Practice Guideline. J Dent 2024:104980. [PMID: 38697506 DOI: 10.1016/j.jdent.2024.104980] [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: 03/11/2024] [Accepted: 03/28/2024] [Indexed: 05/05/2024] Open
Abstract
OBJECTIVES to adapt the supranational European Federation of Periodontology (EFP) Prevention and Treatment of Peri-implant Diseases - The EFP S3 Level Clinical Practice Guideline for UK healthcare environment, taking into account a broad range of views from stakeholders and patients. SOURCES This UK version, based on the supranational EFP guideline [1] published in the Journal of Clinical Periodontology, was developed using S3-level methodology, combining assessment of formal evidence from 13 systematic reviews with a moderated consensus process of a representative group of stakeholders, and accounts for health equality, environmental factors and clinical effectiveness. It encompasses 55 clinical recommendations for the Prevention and Treatment of Peri-implant Diseases, based on the classification for periodontal and peri-implant diseases and conditions [2]. METHODOLOGY The UK version was developed from the source guideline using a formal process called the GRADE ADOLOPMENT framework. This framework allows for adoption (unmodified acceptance), adaptation (acceptance with modifications) and the de novo development of clinical recommendations. Using this framework, following the S3-process, the underlying evidence was updated and a representative guideline group of 111 delegates from 26 stakeholder organisations was assembled into four working groups. Following the formal S3-process, all clinical recommendations were formally assessed for their applicability to the UK and adoloped accordingly. RESULTS AND CONCLUSION Using the ADOLOPMENT protocol, a UK version of the EFP S3-level clinical practice guideline for the Prevention and Treatment of Peri-implant Diseases was developed. This guideline delivers evidence- and consensus-based clinical recommendations of direct relevance to the UK healthcare community including the public. CLINICAL SIGNIFICANCE The S3-level-guidelines combine evaluation of formal evidence, grading of recommendations and synthesis with clinical expertise of a broad range of stakeholders. The international S3-level-guideline was implemented for direct clinical applicability in the UK healthcare system, facilitating a consistent, interdisciplinary, evidence-based approach with public involvement for the prevention and treatment of peri-implant diseases.
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Affiliation(s)
- Nicola West
- Restorative Dentistry, Bristol Dental School, University of Bristol, Bristol BS1 2LY, UK; Restorative Dentistry, Bristol Dental Hospital, University Hospitals Bristol and Weston NHS Foundation Trust, Marlborough Street, Bristol, BS1 3NU, Secretary General of the European Federation of Periodontology.
| | - Iain Chapple
- Birmingham NIHR Biomedical Research Centre in Inflammation. The University of Birmingham, Birmingham, United Kingdom; Birmingham Community Healthcare NHS Foundation Trust, Birmingham, United Kingdom
| | - Shauna Culshaw
- University of Glasgow Dental School, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Nikos Donos
- Centre for Oral Clinical Research, Institute of Dentistry, Faculty of Medicine and Dentistry, Queen Mary University of London (AMUL), Turner Street, London, E1 2AD
| | - Ian Needleman
- Unit of Periodontology, UCL Eastman Dental Institute, Bloomsbury Campus, Rockefeller Building, 21 University Street, London, WC1E 6DE
| | - Jeanie Suvan
- Unit of Periodontology, UCL Eastman Dental Institute, Bloomsbury Campus, Rockefeller Building, 21 University Street, London, WC1E 6DE
| | - Luigi Nibali
- Periodontology Unit, Centre for Host-Microbiome Interactions, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, Guys Hospital, Great Maze Pond, London, SE1 9RT
| | - Amit Patel
- Birmingham Dental Specialists, Associate Professor, University of Birmingham, Birmingham, UK, President of the Association of Dental Implantology
| | - Philip M Preshaw
- School of Dentistry, University of Dundee, Dundee UK; School of Dental Sciences, University of Newcastle, Newcastle upon Tyne, UK
| | - Moritz Kebschull
- Birmingham NIHR Biomedical Research Centre in Inflammation. The University of Birmingham, Birmingham, United Kingdom; Birmingham Community Healthcare NHS Foundation Trust, Birmingham, United Kingdom; Division of Periodontics, Section of Oral, Diagnostic and Rehabilitation Sciences, College of Dental Medicine, Columbia University, New York, NY, USA; School of Dentistry, University of Birmingham, Birmingham B5 7EG, UK, President-Elect of the European Federation of Periodontology.
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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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Mayer Y, Khoury J, Horwitz J, Ginesin O, Canullo L, Gabay E, Giladi HZ. A novel nonsurgical therapy for peri-implantitis using focused pulsed electromagnetic field: A pilot randomized double-blind controlled clinical trial. Bioelectromagnetics 2023; 44:144-155. [PMID: 37655846 DOI: 10.1002/bem.22481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 05/06/2023] [Accepted: 07/18/2023] [Indexed: 09/02/2023]
Abstract
Pulsed electromagnetic field (PEMF) therapy modulates the immune response and is successfully used in orthopedics to treat osteoarthritis and improve bone regeneration. This may suggest that this treatment may consequently reduce peri-implant soft tissue inflammation and marginal bone loss. To compare clinical, radiographic, and immunological results following nonsurgical treatment for peri-implantitis with or without PEMF therapy. Patients with peri-implantitis were included: pocket probing depth (PPD) between 6 and 8 mm with bleeding on probing (BOP); crestal bone loss between 3 and 5 mm. A novel healing abutment that contained active (test) or inactive (control) PEMF was connected. PEMF was administered via the abutment at exposure ratio of 1/500-1/5000, intensity: 0.05-0.5 mT, frequency: 10-50 kHz for 30 days. Nonsurgical mechanical implant surface debridement was performed. Patients were examined at baseline, 1 and 3 months. Clinical assessment included: plaque index, BOP, PPD, recession, and bone crest level which was radiography measured. Samples of peri-implant crevicular fluid were taken to analyze interleukin-1β (IL-1β). Twenty-three patients (34 implants; 19 control, 15 test) were included. At the follow-up, mean crestal bone loss was lower in the test group at 1 and 3 months (2.48 mm vs. 3.73 mm, p < 0.05 and 2.39 vs. 3.37, p < 0.01). IL-1β levels were also lower in the test group at 2 weeks (72.86 pg/mL vs. 111.7, p < 0.05). Within all the limitation of this preliminary study, the test group improved clinical parameters after a short-term period compared to the control group.
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Affiliation(s)
- Yaniv Mayer
- Department of Periodontology, School of Graduate Dentistry, Rambam Health Care Campus (RHCC), Haifa, Israel
- Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Juan Khoury
- Department of Periodontology, School of Graduate Dentistry, Rambam Health Care Campus (RHCC), Haifa, Israel
| | - Jacob Horwitz
- Department of Periodontology, School of Graduate Dentistry, Rambam Health Care Campus (RHCC), Haifa, Israel
- Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Ofir Ginesin
- Department of Periodontology, School of Graduate Dentistry, Rambam Health Care Campus (RHCC), Haifa, Israel
- Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Luigi Canullo
- Department of Surgical Sciences (DISC), Division of Prosthodontics and Implant Prosthodontics, University of Genoa, Genova, Italy
| | - Eran Gabay
- Department of Periodontology, School of Graduate Dentistry, Rambam Health Care Campus (RHCC), Haifa, Israel
- Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Hadar Z Giladi
- Department of Periodontology, School of Graduate Dentistry, Rambam Health Care Campus (RHCC), Haifa, Israel
- Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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Dumitriu AS, Păunică S, Nicolae XA, Bodnar DC, Albu ȘD, Suciu I, Ciongaru DN, Giurgiu MC. The Effectiveness of the Association of Chlorhexidine with Mechanical Treatment of Peri-Implant Mucositis. Healthcare (Basel) 2023; 11:1918. [PMID: 37444752 DOI: 10.3390/healthcare11131918] [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: 05/22/2023] [Revised: 06/21/2023] [Accepted: 06/30/2023] [Indexed: 07/15/2023] Open
Abstract
(1) Background: The aim of the study was to evaluate the benefit of combining chlorhexidine with the mechanical treatment of peri-implant mucositis. (2) Methods: Articles from 2016 to 2021 included in the PubMed and Scopus databases were analyzed, following the PICOS criteria and the randomized controlled study model that used chlorhexidine in various forms in the treatment of peri-mucositis. According to the established criteria, a limited number of studies were selected. These studies had as their criteria of evaluation for the effectiveness of chlorhexidine, plaque indices, bleeding indices and depth probing indices. Chlorhexidine has been used after mechanical debridement as a solution, with different concentrations of 0.06%/0.12%/0.2% alone or in a concentration of 0.03%, in combination with 0.05% cetylpyridinium chloride, as well as in the form of a gel with a concentration of 0.2%. (3) Results: The results were assessed to a placebo or other substances, and showed a significant reduction in the indices with a follow-up period ranging from 3 months to 1 year. (4) Conclusions: The association of chlorhexidine with the mechanical treatment of peri-implant mucositis has a role in reducing inflammation, although a complete remission was not obtained in all cases, and the results were not statistically significantly different from the use of other antiseptics.
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Affiliation(s)
- Anca Silvia Dumitriu
- Department of Periodontology, Faculty of Dental Medicine, University of Medicine and Pharmacy "Carol Davila", 37 Dionisie Lupu Street, 020021 Bucharest, Romania
| | - Stana Păunică
- Department of Periodontology, Faculty of Dental Medicine, University of Medicine and Pharmacy "Carol Davila", 37 Dionisie Lupu Street, 020021 Bucharest, Romania
| | - Ximena Anca Nicolae
- Doctoral School, Faculty of Dental Medicine, University of Medicine and Pharmacy "Carol Davila", 37 Dionisie Lupu Street, 020021 Bucharest, Romania
| | - Dana Cristina Bodnar
- Department of Restorative Odontotherapy, Faculty of Dental Medicine, University of Medicine and Pharmacy "Carol Davila", 37 Dionisie Lupu Street, 020021 Bucharest, Romania
| | - Ștefan Dimitrie Albu
- Department of Periodontology, Faculty of Dental Medicine, University of Medicine and Pharmacy "Carol Davila", 37 Dionisie Lupu Street, 020021 Bucharest, Romania
| | - Ioana Suciu
- Department of Endodontics, Faculty of Dental Medicine, University of Medicine and Pharmacy "Carol Davila", 37 Dionisie Lupu Street, 020021 Bucharest, Romania
| | - Dragoș Nicolae Ciongaru
- Department of Periodontology, Faculty of Dental Medicine, University of Medicine and Pharmacy "Carol Davila", 37 Dionisie Lupu Street, 020021 Bucharest, Romania
| | - Marina Cristina Giurgiu
- Department of Periodontology, Faculty of Dental Medicine, University of Medicine and Pharmacy "Carol Davila", 37 Dionisie Lupu Street, 020021 Bucharest, Romania
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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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Zakir M, Thomas D, Adams R, Farnell D, Claydon N. A Systematic Review and Meta-Analysis of the Clinical Outcomes for Adjunctive Physical, Chemical, and Biological Treatment of Dental Implants With Peri-Implantitis. J ORAL IMPLANTOL 2023; 49:168-178. [PMID: 37071563 DOI: 10.1563/aaid-joi-d-21-00204] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
The present systematic review evaluated the efficacy of adjunctive therapies in the treatment of peri-implantitis. Studies comparing the outcome of conventional surgical- or nonsurgical mechanical debridement with the addition of an adjunctive therapeutic modality were identified through an electronic and hand search of available literature. Following data extraction, meta-analyses were performed on the primary outcome measures. The effects of the adjunctive therapies on bleeding on probing (13 studies), probing pocket depth (9 studies), and radiographic bone level changes (7 studies) were analyzed to evaluate potential clinical benefit. Heterogeneity was expressed as the I2 index. Fixed and random effect models were demonstrated. The potential benefit of adjunctive therapies over control procedures was evaluated in 18 studies, representing a total of 773 implants. Quality assessment of the studies found only 3 studies to be at a low risk of bias. Meta-analysis among the different additional modalities revealed chemical therapy demonstrating significant effects in probing pocket depth reduction (0.58 mm; 0.44-0.72) and radiographic bone level gain (0.54 mm; 0.16-0.92). No significant improvements in bleeding on probing reduction were found using any adjunctive therapy. Available evidence on the benefits of adjunctive therapy to nonsurgical or surgical mechanical debridement in the treatment of peri-implantitis is limited by low numbers of standardized, controlled studies for individual therapies, heterogeneity between studies, and a variety of outcome measures. The lack of effect of any adjunctive therapy in reducing bleeding on probing questions the overall effectiveness over conventional treatment. The long-term clinical benefit potential of these therapies is not demonstrated.
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Affiliation(s)
- Mehreen Zakir
- School of Dentistry, Cardiff University, Heath Park, Cardiff, CF14 4XY, United Kingdom
| | - David Thomas
- School of Dentistry, Cardiff University, Heath Park, Cardiff, CF14 4XY, United Kingdom
| | - Robert Adams
- School of Dentistry, Cardiff University, Heath Park, Cardiff, CF14 4XY, United Kingdom
| | - Damian Farnell
- School of Dentistry, Cardiff University, Heath Park, Cardiff, CF14 4XY, United Kingdom
| | - Nicholas Claydon
- School of Dentistry, Cardiff University, Heath Park, Cardiff, CF14 4XY, United Kingdom
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The Antimicrobial Activity of Curcumin and Xanthohumol on Bacterial Biofilms Developed over Dental Implant Surfaces. Int J Mol Sci 2023; 24:ijms24032335. [PMID: 36768657 PMCID: PMC9917338 DOI: 10.3390/ijms24032335] [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: 01/06/2023] [Revised: 01/21/2023] [Accepted: 01/22/2023] [Indexed: 01/26/2023] Open
Abstract
In search for natural products with antimicrobial properties for use in the prevention and treatment of peri-implantitis, the purpose of this investigation was to evaluate the antimicrobial activity of curcumin and xanthohumol, using an in vitro multi-species dynamic biofilm model including Streptococcus oralis, Actinomyces naeslundii, Veillonella parvula, Fusobacterium nucleatum, Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans. The antimicrobial activities of curcumin (5 mM) and xanthohumol (100 μM) extracts, and the respective controls, were evaluated with 72-h biofilms formed over dental implants by their submersion for 60 seconds. The evaluation was assessed by quantitative polymerase chain reaction (qPCR), confocal laser scanning microscopy (CLSM) and scanning electron microscopy (SEM). For the data analysis, comparisons were tested applying ANOVA tests with post-hoc Bonferroni corrections to evaluate the antimicrobial activity of both extracts. With qPCR, statistically significant reductions in bacterial counts were observed for curcumin and xanthohumol, when compared to the negative control. The results with CLSM and SEM were consistent with those reported with qPCR. It was concluded that both curcumin and xanthohumol have demonstrated antimicrobial activity against the six bacterial species included in the dynamic in vitro biofilm model used.
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Teughels W, Seyssens L, Christiaens V, Temmerman A, Castro AB, Cosyn J. Adjunctive locally and systemically delivered antimicrobials during surgical treatment of peri-implantitis: A systematic review. J Clin Periodontol 2023. [PMID: 36644805 DOI: 10.1111/jcpe.13773] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 12/23/2022] [Accepted: 01/09/2023] [Indexed: 01/17/2023]
Abstract
AIM To answer the following PICOS question: "In patients with peri-implantitis, what is the efficacy of surgical therapy with adjunctive systemic or local antimicrobials, in comparison with surgical therapy alone, in terms of pocket probing depth reduction, as assessed in randomized controlled trials (RCTs) with at least 6 months of follow-up?" MATERIALS AND METHODS A systematic literature search was conducted. Reduction in mean probing pocket depth (PPD) was the primary outcome. Secondary clinical outcomes were changes in suppuration (%), changes in bleeding on probing (BOP) (%), marginal bone level changes (mm), disease resolution (%), and implant/prosthesis loss (%). Patient-reported outcome measures, possible adverse effects, and oral-health-related quality of life were also extracted if such data were available. RESULTS Four RCTs assessing the use of locally (two RCTs) and systemically (two RCTs) administered antimicrobial adjuncts to surgical treatment of peri-implantitis, with 6-36-month follow-up, were included. Because of the substantial heterogeneity of interventions between the studies, meta-analysis could not be performed. A reduction in the mean PPD was observed following all the involved surgical treatments, irrespective of the addition of antimicrobials. Except for the effect of systemic antimicrobials on marginal bone level changes and local antimicrobials on BOP, the effect of systemic and local antimicrobials was equivocal for all secondary outcome measures. CONCLUSIONS Based on the limited available evidence, the adjunctive use of the currently tested systemic or local antimicrobials during surgical therapy, in comparison with surgical therapy alone, in patients with peri-implantitis does not seem to improve the clinical efficacy. With regard the use of systemic antimicrobials, only 50% of the cases showed disease resolution after 1 year. There is a lack of studies that consider the sole use of local antimicrobials. Therefore, their true effect remains unclear.
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Affiliation(s)
- Wim Teughels
- Department of Oral Health Sciences, Periodontology and Oral Microbiology, KU Leuven and Dentistry, University Hospitals Leuven, Leuven, Belgium
| | - Lorenz Seyssens
- Faculty of Medicine and Health Sciences, Oral Health Sciences, Department of Periodontology and Oral Implantology, Ghent University, Ghent, Belgium
| | - Véronique Christiaens
- Faculty of Medicine and Health Sciences, Oral Health Sciences, Department of Periodontology and Oral Implantology, Ghent University, Ghent, Belgium
| | - Andy Temmerman
- Department of Oral Health Sciences, Periodontology and Oral Microbiology, KU Leuven and Dentistry, University Hospitals Leuven, Leuven, Belgium
| | - Ana B Castro
- Department of Oral Health Sciences, Periodontology and Oral Microbiology, KU Leuven and Dentistry, University Hospitals Leuven, Leuven, Belgium
| | - Jan Cosyn
- Faculty of Medicine and Health Sciences, Oral Health Sciences, Department of Periodontology and Oral Implantology, Ghent University, Ghent, Belgium
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11
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Poppolo Deus F, Ouanounou A. Chlorhexidine in Dentistry: Pharmacology, Uses, and Adverse Effects. Int Dent J 2022; 72:269-277. [PMID: 35287956 PMCID: PMC9275362 DOI: 10.1016/j.identj.2022.01.005] [Citation(s) in RCA: 57] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 12/14/2021] [Accepted: 01/29/2022] [Indexed: 01/15/2023] Open
Abstract
Objectives The aim of this work was to review the current uses of chlorhexidine (CHX) in dentistry based on its mechanism of action, whilst highlighting the most effective protocols that render the highest clinical efficacy whilst limiting adverse drug reactions. Methods A literature search was conducted using the key words chlorhexidine, mechanism of action, adverse effects, and dentistry using databases in the University of Toronto library system. The titles and abstracts were read, and relevant articles were selected. Results A total of 1100 publications were identified, 100 were investigated, and 67 of them were used. Out of the 67 selected articles, 12 were reviews on CHX; 5 articles focussed on CHX gels; 13 focussed on CHX mouthwashes; 8 focussed on CHX products; 13 discussed adverse effects associated with CHX; 13 focussed on periodontal pathology and treatment; 6 focussed on implant periodontal and dental surgeries; 7 evaluated effects on caries; 6 looked at the mechanisms of action; and 12 focussed on the antibacterial and antimicrobial impact on the oral biome. There were multiple areas of overlap amongst the articles, and results showed that CHX provides different uses, but mainly as an adjunct to various treatments. Mouthwash was the most superior medium when used in short time spans when mechanical prophylaxis was not possible for the prevention of gingivitis and maintenance of oral hygiene. CHX products are often used in periodontics, post–oral surgical procedures, and as a prophylaxis for multiple invasive procedures with minimal adverse effects. Tooth staining was the most negative adverse effect reported by patients. Conclusions CHX's antimicrobial properties make it an ideal prophylactic when mechanical debridement is not possible. CHX mouthwash appears to be more effective compared to gels. Concentrations of 0.12% to 0.2% are recommended; any mouthwash with concentrations above 0.2% will unnecessarily increase the unwanted side effects. CHX is useful amongst various areas of dentistry including oral surgery, periodontics, and even general dentistry. For long-term treatments, especially in periodontitis patients (stage I-III) undergoing nonsurgical treatments, CHX chips are recommended. CHX chips are also recommended as an adjunct to implant debridement in patients with peri-implant mucositis and peri-implantitis over CHX mouthwash and gels.
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12
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Ramanauskaite A, Fretwurst T, Schwarz F. Efficacy of alternative or adjunctive measures to conventional non-surgical and surgical treatment of peri-implant mucositis and peri-implantitis: a systematic review and meta-analysis. Int J Implant Dent 2021; 7:112. [PMID: 34779939 PMCID: PMC8593130 DOI: 10.1186/s40729-021-00388-x] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 10/06/2021] [Indexed: 12/26/2022] Open
Abstract
Purpose To evaluate the efficacy of alternative or adjunctive measures to conventional non-surgical or surgical treatment of peri-implant mucositis and peri-implantitis. Material and methods Prospective randomized and nonrandomized controlled studies comparing alternative or adjunctive measures, and reporting on changes in bleeding scores (i.e., bleed0ing index (BI) or bleeding on probing (BOP)), probing depth (PD) values or suppuration (SUPP) were searched. Results Peri-implant mucositis: adjunctive use of local antiseptics lead to greater PD reduction (weighted mean difference (WMD) = − 0.23 mm; p = 0.03, respectively), whereas changes in BOP were comparable (WMD = − 5.30%; p = 0.29). Non-surgical treatment of peri-implantitis: alternative measures for biofilm removal and systemic antibiotics yielded higher BOP reduction (WMD = − 28.09%; p = 0.01 and WMD = − 17.35%; p = 0.01, respectively). Surgical non-reconstructive peri-implantitis treatment: WMD in PD amounted to − 1.11 mm favoring adjunctive implantoplasty (p = 0.02). Adjunctive reconstructive measures lead to significantly higher radiographic bone defect fill/reduction (WMD = 56.46%; p = 0.01 and WMD = − 1.47 mm; p = 0.01), PD (− 0.51 mm; p = 0.01) and lower soft-tissue recession (WMD = − 0.63 mm; p = 0.01), while changes in BOP were not significant (WMD = − 11.11%; p = 0.11). Conclusions Alternative and adjunctive measures provided no beneficial effect in resolving peri-implant mucositis, while alternative measures were superior in reducing BOP values following non-surgical treatment of peri-implantitis. Adjunctive reconstructive measures were beneficial regarding radiographic bone-defect fill/reduction, PD reduction and lower soft-tissue recession, although they did not improve the resolution of mucosal inflammation. Supplementary Information The online version contains supplementary material available at 10.1186/s40729-021-00388-x.
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Affiliation(s)
- Ausra Ramanauskaite
- Department of Oral Surgery and Implantology, Johann Wolfgang Goethe-University Frankfurt, Carolinum, 60596, Frankfurt am Main, Germany
| | - Tobias Fretwurst
- Department of Oral- and Maxillofacial Surgery, Medical Center, Faculty of Medicine, University of Freiburg, University of Freiburg, Frankfurt, Germany
| | - Frank Schwarz
- Department of Oral Surgery and Implantology, Goethe University, Carolinum, Frankfurt, Germany.
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13
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Wagner TP, Pires PR, Rios FS, de Oliveira JAP, Costa RDSA, Cunha KF, Silveira HLD, Pimentel S, Casati MZ, Rosing CK, Haas AN. Surgical and non-surgical debridement for the treatment of peri-implantitis: a two-center 12-month randomized trial. Clin Oral Investig 2021; 25:5723-5733. [PMID: 33725166 DOI: 10.1007/s00784-021-03874-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 03/03/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To compare surgical (ST) and non-surgical (NST) debridement for the treatment of peri-implantitis in a two-center randomized trial. MATERIALS AND METHODS Forty-five individuals with 63 implants with probing depth (PPD) ≥5mm, bleeding on probing (BOP), and radiographic bone loss ≥2mm were included. In the NST (30 implants), submucosal debridement was performed. In the ST (33 implants), a mucoperiosteal flap was raised and surfaces were decontaminated only by debridement as performed in NST. Clinical parameters and radiographs were compared at baseline and after 12 months. Means and standard errors were reported. RESULTS PPD considering all implant sites reduced significantly in NST from 4.14±0.25 to 3.25±0.18mm. In ST, PPD also significantly changed (3.74±0.22 to 3.00±0.29mm). No significant differences were observed between the two groups. For deep sites (≥7mm), PPD was 7.82±0.20mm at baseline and reduced to 5.10±0.30mm in NST, while in ST group, it was 7.11±0.11mm and changed to 5.22±0.91mm (between-groups p value=0.51). BOP significantly reduced from ~60 to 35% of all sites in both groups, without significant differences between them. When sites with radiographic bone level ≥3mm at baseline were analyzed, there was a significant difference between groups in bone gain after 12 months in favor of ST (ST=0.78±0.30mm compared to NST=0.25mm±0.13; p=0.03). CONCLUSIONS Surgical and non-surgical debridement for the treatment of peri-implantitis present similar clinical outcomes. Bone levels were better improved in ST than NST for sites with higher initial bone loss. CLINICAL RELEVANCE The treatment of peri-implantitis is still a challenge in clinical practice, since less than half of affected implants achieve health after surgical or non-surgical debridement. Considering the lack of clinically relevant differences between these two treatments, non-surgical debridement should be considered the first therapeutic choice for peri-implantitis, mainly mild to moderate cases.
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Affiliation(s)
- Tassiane Panta Wagner
- Periodontology, Faculty of Dentistry, Federal University of Rio Grande do Sul, Rua Ramiro Barcelos, 2492, Porto Alegre, RS, 90030-035, Brazil
| | | | - Fernando Silva Rios
- Periodontology, Faculty of Dentistry, Federal University of Rio Grande do Sul, Rua Ramiro Barcelos, 2492, Porto Alegre, RS, 90030-035, Brazil
| | - Joao Augusto Peixoto de Oliveira
- Periodontology, Faculty of Dentistry, Federal University of Rio Grande do Sul, Rua Ramiro Barcelos, 2492, Porto Alegre, RS, 90030-035, Brazil
| | - Ricardo Dos Santos Araujo Costa
- Periodontology, Faculty of Dentistry, Federal University of Rio Grande do Sul, Rua Ramiro Barcelos, 2492, Porto Alegre, RS, 90030-035, Brazil
| | - Kelly F Cunha
- Periodontology, Faculty of Dentistry, Federal University of Rio Grande do Sul, Rua Ramiro Barcelos, 2492, Porto Alegre, RS, 90030-035, Brazil
| | | | - Suzana Pimentel
- Periodontology, Faculty of Dentistry, Paulista University, São Paulo, Brazil
| | - Marcio Zaffalon Casati
- Periodontology, Faculty of Dentistry, Paulista University, São Paulo, Brazil.,Periodontology, Faculty of Dentistry, University of Campinas, Piracicaba, Brazil
| | - Cassiano Kuchenbecker Rosing
- Periodontology, Faculty of Dentistry, Federal University of Rio Grande do Sul, Rua Ramiro Barcelos, 2492, Porto Alegre, RS, 90030-035, Brazil
| | - Alex Nogueira Haas
- Periodontology, Faculty of Dentistry, Federal University of Rio Grande do Sul, Rua Ramiro Barcelos, 2492, Porto Alegre, RS, 90030-035, Brazil.
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14
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Zhao P, Wang Q, Zhang P, Zhou X, Nie L, Liang X, Ding Y, Wang Q. Clinical Efficacy of Chlorhexidine as an Adjunct to Mechanical Therapy of Peri-Implant Disease: A Systematic Review and Meta-Analysis. J ORAL IMPLANTOL 2021; 47:78-87. [PMID: 32663270 DOI: 10.1563/aaid-joi-d-19-00213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The aim of this systematic review and meta-analysis was to determine the efficacy of chlorhexidine (CHX) as an adjunctive therapy to mechanical debridement in the treatment of peri-implant diseases. Five databases (PubMed, EMBASE, Cochrane Central Register of Controlled Trails, Web of Science, and ClinicalTrials.gov) were searched. Randomized controlled trials (RCTs) comparing mechanical debridement combined with CHX to mechanical debridement alone for patients with peri-implant disease were identified. The trial investigators evaluated factors indicating inflammatory levels, including bleeding on probing (BOP), probing depth (PD), and clinical attachment level (CAL). Six RCTs with 207 patients were ultimately included in this review. Low- to moderate-quality evidence demonstrated that the adjunctive CHX therapy had no significant effect on BOP reduction within 1 month (mean difference [MD], 0.10; 95% confidence interval [CI], -0.06 to 0.25), 3-4 months (MD, 0.06; 95% CI, -0.03 to 0.15), and 6-8 months (MD, 0.06; 95% CI, -0.03 to 0.14) of follow-up. Significant differences in PD reduction and CAL gain were also not found. Although 1 subgroup analysis revealed a significant result (MD, 009; 95% CI, 0.01-0.18) for the use of CHX solution, this could be interpreted as clinically slight. Based on available evidence, adding CHX to mechanical debridement, compared with mechanical debridement alone, did not significantly enhance the clinical results. Therefore, clinicians should consider the negligible effect of adjunctive CHX.
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Affiliation(s)
- Pengfei Zhao
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China.,Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Qian Wang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China.,Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Peng Zhang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China.,Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Xinyi Zhou
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China.,Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Lulingxiao Nie
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China.,Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Xing Liang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China.,Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yi Ding
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China.,Department of Periodontology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Qi Wang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China.,Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
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15
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Abd-Ul-Salam H. Peri-implantitis. INNOVATIVE PERSPECTIVES IN ORAL AND MAXILLOFACIAL SURGERY 2021:47-59. [DOI: 10.1007/978-3-030-75750-2_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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16
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Machtei EE, Romanos G, Kang P, Travan S, Schmidt S, Papathanasiou E, Tatarakis N, Tandlich M, Liberman LH, Horwitz J, Bassir SH, Myneni S, Shiau HJ, Shapira L, Donos N, Papas A, Meyle J, Giannobile WV, Papapanou PN, Kim DM. Repeated delivery of chlorhexidine chips for the treatment of peri-implantitis: A multicenter, randomized, comparative clinical trial. J Periodontol 2020; 92:11-20. [PMID: 33111988 DOI: 10.1002/jper.20-0353] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 09/15/2020] [Accepted: 09/20/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND Peri-implantitis is a challenging condition to manage and is frequently treated using non-surgical debridement. The local delivery of antimicrobial agents has demonstrated benefit in mild to moderate cases of peri-implantitis. This study compared the safety and efficacy of chlorhexidine gluconate 2.5 mg chip (CHX chips) as an adjunctive treatment to subgingival debridement in patients afflicted with peri-implantitis. METHODS A multicenter, randomized, single-blind, two-arm, parallel Phase-3 study was conducted. Peri-implantitis patients with implant pocket depths (IPD) of 5-8 mm underwent subgingival implant surface debridement followed by repeated bi-weekly supragingival plaque removal and chlorhexidine chips application (ChxC group) for 12 weeks, or similar therapy but without application of ChxC (control group). All patients were followed for 24 weeks. Plaque and gingival indices were measured at every visit whereas IPD, recession, and bleeding on probing were assessed at 8, 12, 16, 24 week. RESULTS A total of 290 patients were included: 146 in the ChxC group and 144 in the control. At 24 weeks, a significant reduction in IPD (P = 0.01) was measured in the ChxC group (1.76 ± 1.13 mm) compared with the control group (1.54 ± 1.13 mm). IPD reduction of ≥2 mm was found in 59% and 47.2% of the implants in the ChxC and control groups, respectively (P = 0.03). Changes in gingival recession (0.29 ± 0.68 mm versus 0.15 ± 0.55 mm, P = 0.015) and relative attachment gain (1.47 ± 1.32 mm and 1.39 ± 1.27 mm, P = 0.0017) were significantly larger in the ChxC group. Patients in the ChxC group that were < 65 years exhibited significantly better responses (P < 0.02); likewise, non-smokers had similarly better response (P < 0.02). Both protocols were well tolerated, and no severe treatment-related adverse events were recorded throughout the study. CONCLUSIONS Patients with peri-implantitis that were treated with an intensive treatment protocol of bi-weekly supragingival plaque removal and local application of chlorhexidine chips had greater mean IPD reduction and greater percentile of sites with IPD reduction of ≥2 mm as compared with bi-weekly supra-gingival plaque removal.
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Affiliation(s)
- Eli E Machtei
- Department of Periodontology, School of Graduate Dentistry, Faculty of Medicine, Technion (I.I.T.), Rambam health care campus, Haifa, Israel.,Division of Periodontology, Department of Oral Medicine Infection and Immunity, Harvard School of Dental Medicine, Harvard University, Boston, Massachusetts, USA
| | - Georgios Romanos
- Department of Periodontology, School of Dental Medicine, Stony Brook, New York, USA
| | - Philip Kang
- Division of Periodontics, Section of Oral, Diagnostic and Rehabilitation Sciences, College of Dental Medicine, Columbia University, New York, USA
| | - Suncica Travan
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Stephan Schmidt
- Department of Periodontics, Justus-Liebig University, Giessen & Avadent, Bad Homburg, Germany
| | - Evangelos Papathanasiou
- Department of Periodontology, Tufts University School of Dental Medicine, Boston, Massachusetts, USA
| | - Nikolaos Tatarakis
- Center for Oral Clinical Research, Barts & The Royal London School of Medicine and Dentistry, Institute of Dentistry, Queen Mary University of London (QMUL), London, UK
| | - Moshik Tandlich
- Department of Periodontology, the Hebrew University-Hadassah Faculty of Dental Medicine, Jerusalem, Israel
| | | | - Jacob Horwitz
- Department of Periodontology, School of Graduate Dentistry, Faculty of Medicine, Technion (I.I.T.), Rambam health care campus, Haifa, Israel
| | - Seyed Hossein Bassir
- Department of Periodontology, School of Dental Medicine, Stony Brook, New York, USA
| | - Srinivas Myneni
- Department of Periodontology, School of Dental Medicine, Stony Brook, New York, USA
| | - Harlan J Shiau
- Department of Advanced Oral Sciences and Therapeutics, School of Dentistry, University of Maryland, Maryland, USA
| | - Lior Shapira
- Department of Periodontology, the Hebrew University-Hadassah Faculty of Dental Medicine, Jerusalem, Israel
| | - Nikos Donos
- Center for Oral Clinical Research, Barts & The Royal London School of Medicine and Dentistry, Institute of Dentistry, Queen Mary University of London (QMUL), London, UK
| | - Athena Papas
- Division of Oral Medicine, Tufts University School of Dental Medicine, Boston, Massachusetts, USA
| | - Joerg Meyle
- Department of Periodontics, Justus-Liebig University, Giessen & Avadent, Bad Homburg, Germany
| | - William V Giannobile
- Division of Periodontology, Department of Oral Medicine Infection and Immunity, Harvard School of Dental Medicine, Harvard University, Boston, Massachusetts, USA.,Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Panos N Papapanou
- Division of Periodontics, Section of Oral, Diagnostic and Rehabilitation Sciences, College of Dental Medicine, Columbia University, New York, USA
| | - David M Kim
- Division of Periodontology, Department of Oral Medicine Infection and Immunity, Harvard School of Dental Medicine, Harvard University, Boston, Massachusetts, USA
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17
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Current uses of chlorhexidine for management of oral disease: a narrative review. J Dent 2020; 103:103497. [PMID: 33075450 PMCID: PMC7567658 DOI: 10.1016/j.jdent.2020.103497] [Citation(s) in RCA: 118] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 10/04/2020] [Accepted: 10/10/2020] [Indexed: 12/18/2022] Open
Abstract
Objectives Chlorhexidine (CHX) is a commonly used antiseptic mouthwash, used by dental practitioners and the public, due to its antimicrobial effects. The aim of this article was to provide a narrative review of current antimicrobial uses of CHX relevant to dentistry in the context of oral diseases, highlighting need for further studies to support its safe and appropriate use. Study selection, data and sources Randomised controlled trials, systematic reviews and national (UK and US) guidelines were consulted where available, with search terms for each subject category entered into MEDLINE, PubMed, Google Scholar and the Cochrane database. Results Some evidence existed to support adjunctive short-term use of CHX to manage dental plaque, and reduce clinical symptoms of gingivitis, dry socket, as well as reduce aerosolisation of bacteria. However, use must be weighed alongside the less desirable effects of CHX, including extrinsic staining of teeth, antimicrobial resistance to antiseptic agents and the rare, but fatal, allergic reactions to CHX. Conversely, evidence for the effectiveness of chlorhexidine to manage or prevent periodontitis, dental caries, necrotising periodontal diseases, peri-implantitis, and infections associated with extraction and aerosolised viruses remains less certain. Conclusions The use of CHX in dentistry and oral healthcare continues to be widespread and thus it is important that dental practitioners understand that, based on its differential mechanisms of action on different microbes, appropriate clinical and dental use of CHX should be oral disease specific. However, further scientific and clinical research is required before full recommendations can be made.
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18
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Khan A, Goyal A, Currell SD, Sharma D. Management of Peri-Implantitis Lesions without the Use of Systemic Antibiotics: A Systematic Review. Dent J (Basel) 2020; 8:E106. [PMID: 32937892 PMCID: PMC7576475 DOI: 10.3390/dj8030106] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 08/31/2020] [Accepted: 09/08/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND This systematic review aims to assess the current evidence on the efficacy of surgical and non-surgical debridement techniques in the treatment of peri-implantitis lesions without the use of any antimicrobials. METHOD Five electronic databases (MEDLINE, Pubmed, Scopus, CINAHL and Cochrane) were used, alongside hand searches, to find relevant articles. Full-text articles that were randomised controlled trials, published in the English language from 2011 onwards without pre-operative, peri-operative and post-operative antibiotic usage were included. The study was conducted according to the latest Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-P protocols, the latest Cochrane Risk of Bias tool and each investigated intervention was evaluated using the grading of recommendation, assessment, development and evaluation (GRADE) system. RESULTS The search yielded 2718 results. After initial screening, 38 full-text articles were assessed for eligibility. From these, 11 studies satisfied all inclusion criteria. These 11 articles described six non-surgical and five surgical debridement therapies. Most articles were classified as having either a high risk of bias or presenting with some concerns. Small sample sizes, in combination with this risk of bias, meant that all interventions were adjudged to be of either low or very low quality of evidence. CONCLUSION While all investigated modalities displayed some sort of efficacy, this review suggests that a surgical approach may be best suited to treating peri-implantitis lesions in the absence of antibiotic therapy. Despite this weak indication, further research is required in this field.
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Affiliation(s)
- Ahsen Khan
- College of Medicine and Dentistry, James Cook University, 14-88 McGregor Road, Smithfield, QLD 4878, Australia; (A.K.); (A.G.); (S.D.C.)
| | - Ankit Goyal
- College of Medicine and Dentistry, James Cook University, 14-88 McGregor Road, Smithfield, QLD 4878, Australia; (A.K.); (A.G.); (S.D.C.)
| | - Scott D. Currell
- College of Medicine and Dentistry, James Cook University, 14-88 McGregor Road, Smithfield, QLD 4878, Australia; (A.K.); (A.G.); (S.D.C.)
| | - Dileep Sharma
- College of Medicine and Dentistry, James Cook University, 14-88 McGregor Road, Smithfield, QLD 4878, Australia; (A.K.); (A.G.); (S.D.C.)
- Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, QLD 4878, Australia
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19
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Liu S, Li M, Yu J. Does chlorhexidine improve outcomes in non-surgical management of peri-implant mucositis or peri-implantitis?: a systematic review and meta-analysis. Med Oral Patol Oral Cir Bucal 2020; 25:e608-e615. [PMID: 32683389 PMCID: PMC7473444 DOI: 10.4317/medoral.23633] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 05/03/2020] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND With greater number of implants being placed in clinical practice, incidence of peri-implant diseases are on the rise. It is not known whether chlorhexidine (CHX) improves outcomes in the management of peri-implant diseases. The aim of this systematic review and meta-analysis was to evaluate the role of CHX in improving outcomes with non-surgical management of peri-implant mucositis and peri-implantitis. MATERIAL AND METHODS An electronic search of PubMed, Scopus, Embase, and CENTRAL (Cochrane Central Register of Controlled Trials) databases up to 1st August 2019 was carried out to search for studies evaluating the efficacy of CHX for non-surgical management of peri-implant diseases. RESULTS Seven studies were included. Four studies evaluated the role of CHX in peri-implant mucositis and three in peri-implantitis. Oral prophylaxis with mechanical cleansing of implant surface prior to CHX use was carried out in all seven studies. Meta-analysis indicated that use of CHX did not improve probing depths in peri-implant mucositis (SMD= 0.11; 95% CI: -0.16 to 0.38; p=0.42, I2= 0%). Similarly, CHX did not significantly reduce probing depths in patients with peri-implantitis (MD= 1.57; 95% CI: -0.88 to 4.0; p=0.21, I2= 98%). Results on the efficacy of CHX in reducing BOP in peri-implantitis are conflicting. CONCLUSIONS Results of our study indicate that adjunctive therapy with CHX may not improve outcomes with non-surgical management of peri-implant mucositis. Conclusions with regards to its role in non-surgical management of peri-implantitis cannot be drawn. There is a need for more homogenous RCTs with large sample size to define the role of CHX in non-surgical management of peri-implant mucositis and peri-implantitis.
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Affiliation(s)
- S Liu
- Department of Stomatology affiliated Hospital of Shaoxing University 999 Zhongxing South Road, Shaoxing Zhejiang 312000, P.R. China
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Martorano-Fernandes L, Cavalcanti YW, de Almeida LDFD. "Inhibitory effect of Brazilian red propolis on Candida biofilms developed on titanium surfaces". BMC Complement Med Ther 2020; 20:104. [PMID: 32245474 PMCID: PMC7118980 DOI: 10.1186/s12906-020-02893-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 03/11/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Peri-implant inflammation resulting from the presence of Candida biofilms may compromise the longevity of implant-supported dentures. This study evaluated the inhibitory effect of Brazilian red propolis on mono-species biofilms of C. albicans (ATCC 90028) and co-culture biofilms of C. albicans (ATCC 90028) and C. glabrata (ATCC 2001), developed on titanium surfaces. METHODS Titanium specimens were pre-conditioned with artificial saliva and submitted to biofilm formation (1 × 106 CFU/mL). After 24 h (under microaerophilic conditions at 37 °C) biofilms were submitted to treatment for 10 min, according to the groups: sterile saline solution (growth control), 0.12% chlorhexidine and 3% red propolis extract. Treatments were performed every 24 h for 3 days and analyses were conducted 96 h after initial adhesion. After that, the metabolic activity (MTT assay) (n = 12/group), cell viability (CFU counts) (n = 12/group) and surface roughness (optical profilometry) (n = 6/group) were evaluated. Data from viability and metabolic activity assays were evaluated by ANOVA and Tukey tests. Surface roughness analysis was determined by Kruskal Wallis e Mann Whitney tests. RESULTS Regarding the mono-species biofilm, the cell viability and the metabolic activity showed that both chlorhexidine and red propolis had inhibitory effects and reduced the metabolism of biofilms, differing statistically from the growth control (p < 0.05). With regards the co-culture biofilms, chlorhexidine had the highest inhibitory effect (p < 0.05). The metabolic activity was reduced by the exposure to chlorhexidine and to red propolis, different from the growth control group (p < 0.05). The surface roughness (Sa parameter) within the mono-species and the co-culture biofilms statistically differed among groups (p < 0.05). CONCLUSIONS Brazilian red propolis demonstrated potential antifungal activity against Candida biofilms, suggesting it is a feasible alternative for the treatment of peri-implantitis.
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Affiliation(s)
- Loyse Martorano-Fernandes
- Postgraduate Program in Dentistry, Federal University of Paraíba, Cidade Universitária, João Pessoa, Paraiba Brazil
| | - Yuri Wanderley Cavalcanti
- Department of Clinic and Social Dentistry, Federal University of Paraíba, Cidade Universitária, João Pessoa, Paraiba Brazil
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Liang J, Peng X, Zhou X, Zou J, Cheng L. Emerging Applications of Drug Delivery Systems in Oral Infectious Diseases Prevention and Treatment. Molecules 2020; 25:E516. [PMID: 31991678 PMCID: PMC7038021 DOI: 10.3390/molecules25030516] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 01/17/2020] [Accepted: 01/20/2020] [Indexed: 12/27/2022] Open
Abstract
The oral cavity is a unique complex ecosystem colonized with huge numbers of microorganism species. Oral cavities are closely associated with oral health and sequentially with systemic health. Many factors might cause the shift of composition of oral microbiota, thus leading to the dysbiosis of oral micro-environment and oral infectious diseases. Local therapies and dental hygiene procedures are the main kinds of treatment. Currently, oral drug delivery systems (DDS) have drawn great attention, and are considered as important adjuvant therapy for oral infectious diseases. DDS are devices that could transport and release the therapeutic drugs or bioactive agents to a certain site and a certain rate in vivo. They could significantly increase the therapeutic effect and reduce the side effect compared with traditional medicine. In the review, emerging recent applications of DDS in the treatment for oral infectious diseases have been summarized, including dental caries, periodontitis, peri-implantitis and oral candidiasis. Furthermore, oral stimuli-responsive DDS, also known as "smart" DDS, have been reported recently, which could react to oral environment and provide more accurate drug delivery or release. In this article, oral smart DDS have also been reviewed. The limits have been discussed, and the research potential demonstrates good prospects.
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Affiliation(s)
| | | | | | - Jing Zou
- State Key Laboratory of Oral Diseases& West China School of Stomatology& National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu 610041, China; (J.L.); (X.P.); (X.Z.)
| | - Lei Cheng
- State Key Laboratory of Oral Diseases& West China School of Stomatology& National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu 610041, China; (J.L.); (X.P.); (X.Z.)
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Treatment of Peri-Implant Mucositis with Repeated Application of Chlorhexidine Chips or Gel during Supportive Therapy - A Randomized Clinical Trial. Dent J (Basel) 2019; 7:dj7040115. [PMID: 31835899 PMCID: PMC6961024 DOI: 10.3390/dj7040115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 11/17/2019] [Accepted: 12/03/2019] [Indexed: 12/16/2022] Open
Abstract
Running head Peri-implant maintenance with CHX Abstract Background: To assess the effect of chlorhexidine (CHX) chip application in patients with peri-implant mucositis as compared to CHX gel application. Methods: In peri-implant sites with mucositis, CHX gel was applied in the control group (GC) and CHX chips in the test group (CC) at baseline and after three months. At baseline and after six months, peri-implant pocket depths (PPD), bleeding-on-probing (BOP) and activated matrix metalloproteinase-8 (aMMP8) were assessed. Longitudinal changes were tested for inter-group differences. Results: Thirty-two patients were treated. BOP was more reduced (p = 0.006) in CC than in GC, with means and standard deviations of 46 ± 28% and 17 ± 27%, respectively. PPD was more reduced (p = 0.002) in CC than in GC with 0.65 ± 0.40 mm and 0.18 ± 0.32 mm, respectively. Regarding BOP, the percentages of improved, unchanged and worsened sites accounted for 32%, 61% and 7% in GC and 46%, 53% and 1% in CC, respectively. For probing pocket depth, the according values were 26%, 66% and 8% (GC) versus 57%, 38% and 5% (CC). Conclusions: During supportive therapy, repeated CHX chip application might resolve marginal peri-implant inflammation in terms of bleeding better than CHX gel.
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Abstract
PURPOSE Periimplantitis has become an emerging challenge faced by practicing dentists worldwide. When treating periimplantitis, we should attempt to manage this problem via nonsurgical therapies that include addressing all modifiable systemic risk factors and local contributing factors. Hence, the aim of this narrative review was to examine published studies on nonsurgical treatment of periimplantitis and evaluate their effectiveness and limitations. MATERIALS AND METHODS A literature search was performed in MEDLINE via PubMed database up to December 31, 2017. Current published clinical approaches focused on mechanical debridement, adjunctive antiseptic therapy, adjunctive antibiotic therapy, laser-assisted therapy, and combination approaches were included in this analysis. RESULTS Nonsurgical therapy of periimplantitis may result in complete healing of the disease and the patient is then placed on a supportive maintenance program. If the disease is not resolved and surgical intervention is not an option, active nonsurgical retreatment may be considered. In many cases where disease is not resolved, surgical therapy or implant removal could be considered. CONCLUSIONS Nonsurgical treatment of periimplantitis usually provides clinical improvements in reducing bleeding tendency and in some cases pocket reduction. Early diagnosis, detection, and intervention remain the key for managing periimplantitis.
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Bone Remineralization around Dental Implants following Conservative Treatment after Peri-Implantitis. Case Rep Dent 2019; 2019:7210837. [PMID: 31583138 PMCID: PMC6748190 DOI: 10.1155/2019/7210837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 07/08/2019] [Indexed: 11/17/2022] Open
Abstract
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.
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Abstract
Peri-implant mucositis and peri-implantitis are clinically associated with inflammation of soft tissue around implants; however, peri-implantitis is associated with radiographic bone loss. Recently a new classification scheme-peri-implant health, peri-implant mucositis, peri-implantitis, and peri-implant soft-tissue and hard-tissue deficiencies-was introduced. Although various clinical interventions to treat peri-implant diseases have been suggested, early diagnosis and treatment is the key to successful outcomes. Clinicians can select nonsurgical or surgical techniques according to the clinical parameters present, although surgical intervention seems to be more effective in treating peri-implantitis. The best approach to treat peri-implantitis remains controversial.
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Affiliation(s)
- Mohanad Al-Sabbagh
- Division of Periodontology, Department of Oral Health Practice, University of Kentucky College of Dentistry, D-438 Chandler Medical Center, 800 Rose Street, Lexington, KY 40536-0927, USA
| | - Luciana M Shaddox
- Division of Periodontology, Department of Oral Health Practice, College of Dentistry, University of Kentucky, 800 Rose Street, Lexington, KY 40536, USA.
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Estefanía‐Fresco R, García‐de‐la‐Fuente AM, Egaña‐Fernández‐Valderrama A, Bravo M, Aguirre‐Zorzano LA. One‐year results of a nonsurgical treatment protocol for peri‐implantitis. A retrospective case series. Clin Oral Implants Res 2019; 30:702-712. [DOI: 10.1111/clr.13456] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 04/16/2019] [Accepted: 05/05/2019] [Indexed: 12/28/2022]
Affiliation(s)
| | | | | | - Manuel Bravo
- School of Dentistry University of Granada Granada Spain
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Dawood A, Marti BM, Tanner S. Peri-implantitis and the prosthodontist. Br Dent J 2018; 223:325-332. [PMID: 28883590 DOI: 10.1038/sj.bdj.2017.755] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2017] [Indexed: 11/09/2022]
Abstract
Peri-implantitis has been described as progressive crestal bone loss around a dental implant. The condition is poorly understood, and is challenging to manage; it is commonly and widely attributed to issues with the implant, the implant surface, surgical technique and oral hygiene. The effect of prosthodontic stages of treatment on the postoperatively established state has not been adequately investigated. It is the authors' contention that the manner in which the implant is restored contributes significantly to prognosis and peri-implant disease experience, and that the role of prosthodontic aspects of treatment in the causation of peri-implantitis may be seriously underestimated. The prosthodontist has a clear role and responsibility in the avoidance of future peri-implant problems by ensuring that implants are restored in an entirely biologically and biomechanically sound manner. The number of implant treatments carried out year-on-year is rising apace, with more and more implants being restored in general dental practice. With the rapid emergence of lower cost dental implant systems and a broadening range of generic restorative options and components for well-established systems, there is an increasing need to consider and understand how the implant restorative process may have a negative impact upon the peri-implant tissues, and how this effect may be minimised and peri-implant health promoted and maintained by paying attention to detail throughout the entire process.
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Affiliation(s)
- A Dawood
- Dawood and Tanner Dental Practice, 45 Wimpole St, London, W1G 8SB, UK
| | - B Marti Marti
- Dawood and Tanner Dental Practice, 45 Wimpole St, London, W1G 8SB, UK
| | - S Tanner
- Dawood and Tanner Dental Practice, 45 Wimpole St, London, W1G 8SB, UK
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Zhang S, Wang M, Jiang T, Zhou Y, Wang Y. Roles of a new drug-delivery healing abutment in the prevention and treatment of peri-implant infections: a preliminary study. RSC Adv 2018; 8:38836-38843. [PMID: 35558280 PMCID: PMC9090660 DOI: 10.1039/c8ra07676f] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Accepted: 11/05/2018] [Indexed: 11/21/2022] Open
Abstract
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. We modified a normal abutment into a drug delivery abutment and discussed its possible application in the prevention and treatment of peri-implant infections.![]()
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Affiliation(s)
- Shuang Zhang
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST)
- Key Laboratory of Oral Biomedicine Ministry of Education
- School and Hospital of Stomatology
- Wuhan University
- Wuhan 430079
| | - Min Wang
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST)
- Key Laboratory of Oral Biomedicine Ministry of Education
- School and Hospital of Stomatology
- Wuhan University
- Wuhan 430079
| | - Tao Jiang
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST)
- Key Laboratory of Oral Biomedicine Ministry of Education
- School and Hospital of Stomatology
- Wuhan University
- Wuhan 430079
| | - Yi Zhou
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST)
- Key Laboratory of Oral Biomedicine Ministry of Education
- School and Hospital of Stomatology
- Wuhan University
- Wuhan 430079
| | - Yining Wang
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST)
- Key Laboratory of Oral Biomedicine Ministry of Education
- School and Hospital of Stomatology
- Wuhan University
- Wuhan 430079
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Stein JM, Hammächer C, Michael SSY. Combination of ultrasonic decontamination, soft tissue curettage, and submucosal air polishing with povidone-iodine application for non-surgical therapy of peri-implantitis: 12 Month clinical outcomes. J Periodontol 2017; 89:139-147. [PMID: 29381189 DOI: 10.1902/jop.2017.170362] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 07/27/2017] [Indexed: 12/30/2022]
Abstract
BACKGROUND The aim of this study is to evaluate clinical outcomes of a concept for non-surgical peri-implantitis combining stepwise mechanical debridement measures with adjuvant povidone-iodine application with and without systemic antibiotics. METHODS Forty-five patients with chronic periodontitis and a total of 164 screw-typed implants with peri-implantitis were included. Peri-implantitis was defined as radiographic bone loss of > 2 mm, probing depth (PD) ≥5 mm with bleeding on probing (BOP). Stepwise treatment of implants was performed with ultrasonic debridement, soft tissue curettage (STC), glycine powder air polishing (GPAP), and a repeated submucosal application of povidone-iodine. Teeth with PD > 4 mm were treated simultaneously according to the same concept except STC. In cases with severe periodontitis (n = 24), amoxicillin and metronidazole (AM) were prescribed for 7 days. RESULTS After 12 months, implants treated without AM showed significant reductions (P < 0.05) of mean PD (1.4 ± 0.7 mm), clinical attachment level (CAL) (1.3 ± 0.8 mm), and BOP (33.4% ± 17.2%). In deep pockets (PD > 6 mm) changes of mean PD (2.3 ± 1.3 mm), CAL (2.0 ± 1.6 mm), and BOP (44.0% ± 41.7%) were more pronounced. Intake of AM did not significantly influence the changes in these parameters. However, the reduction of implant sites with PD > 4 mm and BOP was significantly higher in patients with AM than in those without AM (31.8% ± 12.6% versus 20.8% ± 14.7%; P < 0.05). CONCLUSIONS The combination of ultrasonic debridement, STC, and GPAP with adjuvant povidone-iodine led to significant clinical improvements at implants. Systemic antibiotics had limited effects on the reduction of persisting implant sites with treatment need.
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Affiliation(s)
- Jamal M Stein
- Department of Operative Dentistry, Periodontology and Preventive Dentistry, University Hospital Aachen (RWTH), Aachen, Germany
- Private practice, Aachen, Germany
| | | | - Sareh Said-Yekta Michael
- Department of Operative Dentistry, Periodontology and Preventive Dentistry, University Hospital Aachen (RWTH), Aachen, Germany
- Interdisciplinary Center for Clinical Research, University Hospital Aachen (RWTH)
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Effectiveness of Mechanical Debridement Combined With Adjunctive Therapies for Nonsurgical Treatment of Periimplantitis: A Systematic Review. IMPLANT DENT 2017; 26:137-144. [PMID: 27548110 DOI: 10.1097/id.0000000000000469] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aimed to perform a systematic review of the effectiveness of nonsurgical treatment associated with different adjuvant therapies on periimplantitis. MATERIALS AND METHODS Different individuals, following a research process, performed a network research of controlled and randomized controlled clinical trials on PubMed, Embase/MEDLINE, with 20 years' time constraint and the last search in January 2016. RESULTS From 108 articles found by the first search, they analyzed 10 full texts, and in none did they find a standard control group. When compared, mechanical therapies combined with adjuvant therapy decreased prevalence of periimplant ratios; however, some groups showed unsatisfactory results, mainly related to the probing depth and bleeding index. When comparing debridement with other nonsurgical therapies (Er:YAG, Vector, air abrasive with amino acid glycine powder), increased periimplant levels were noticed in the test and control groups, although in different periods. CONCLUSION Despite the improvement in the periimplant indices, there is no sufficient evidence to score the best results or even to choose the best association for nonsurgical treatment of periimplantitis; hence, more trials are necessary to answer this question.
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Suárez-López Del Amo F, Yu SH, Wang HL. Non-Surgical Therapy for Peri-Implant Diseases: a Systematic Review. EJOURNAL OF ORAL MAXILLOFACIAL RESEARCH 2016; 7:e13. [PMID: 27833738 PMCID: PMC5100638 DOI: 10.5037/jomr.2016.7313] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 09/07/2016] [Indexed: 01/11/2023]
Abstract
Objectives The purpose of this paper was to systematically evaluate the effectiveness of non-surgical therapy for the treatment of peri-implant diseases including both, mucositis and peri-implantitis lesions. Material and Methods An electronic search in two different databases was performed including MEDLINE (PubMed) and EMBASE from 2011 to 2016. Human studies reporting non-surgical treatment of peri-implant mucositis and peri-implantitis with more than 10 implants and at least 6 months follow up published in English language were evaluated. A systematic review was performed to evaluate the effectiveness of the different methods of decontamination employed in the included investigations. Risk of bias assessment was elaborated for included investigations. Results Twenty-five articles were identified of which 14 were further evaluated and included in the analysis. Due to significant heterogeneity in between included studies, a meta-analysis could not be performed. Instead, a systematic descriptive review was performed. Included investigations reported the used of different methods for implant decontamination, including self-performed cleaning techniques, and professionally delivered treatment such as laser, photodynamic therapy, supra-/sub-mucosal mechanical debridement, and air-abrasive devices. Follow-up periods ranged from 6 to 60 months. Conclusions Non-surgical treatment for peri-implant mucositis seems to be effective while modest and not-predictable outcomes are expected for peri-implantitis lesions. Limitations include different peri-implant diseases definitions, treatment approaches, as well as different implant designs/surfaces and defect characteristics.
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Affiliation(s)
| | - Shan-Huey Yu
- Department of Periodontics and Oral Medicine, University of Michigan, Ann Arbor Michigan USA
| | - Hom-Lay Wang
- Department of Periodontics and Oral Medicine, University of Michigan, Ann Arbor Michigan USA
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Mahato N, Wu X, Wang L. Management of peri-implantitis: a systematic review, 2010-2015. SPRINGERPLUS 2016; 5:105. [PMID: 26877903 PMCID: PMC4735040 DOI: 10.1186/s40064-016-1735-2] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 01/18/2016] [Indexed: 11/23/2022]
Abstract
Peri-implantitis or Periimplantitis is characterized as an inflammatory reaction that affects the hard and soft tissue, which results in loss of supporting bone and pocket formation surrounding the functioning osseointegrated implant. This review aimed to evaluate the effectiveness of surgical and non-surgical treatment of peri-implantitis. The data sources used was PubMed. Searches of this database were restricted to English language publications from January 2010 to June 2015. All Randomized Controlled Trials describing the treatments of peri-implantitis of human studies with a follow up of at least 6 months were included. Eligibility and quality were assessed and two reviewers extracted the data. Data extraction comprised of type, intensity provider, and location of the intervention. A total of 20 publications were included (10 involving surgical and 10 involving non-surgical mechanical procedure). The non-surgical approach involves the mechanical surface debridement using carbon or titanium currettes, laser light, and antibiotics whereas, surgical approach involves implantoplasty, elevation of mucoperiosteal flap and removal of peri-inflammatory granulation tissue followed by surface decontamination and bone grafting. This study reveals that non-surgical therapy tends to remove only the local irritant from the peri-implantitis surface with or without some additional adjunctive therapies agents or device. Hence, non-surgical therapy is not helpful in osseous defect. Surgical therapy in combination with osseous resective or regenerative approach removes the residual sub-gingival deposits additionally reducing the peri-implantitis pocket. Although there is no specific recommendation for the treatment of peri-implantitis, surgical therapy in combination with osseous resective or regenerative approach showed the positive outcome.
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Affiliation(s)
- Nisha Mahato
- Department of Prosthodontics, Stomatological Hospital of Chongqing Medical University, No. 426 Songshi Bei Road, Yubei District Chongqing, 401147 People's Republic of China
| | - Xiaohong Wu
- Department of Prosthodontics, Stomatological Hospital of Chongqing Medical University, No. 426 Songshi Bei Road, Yubei District Chongqing, 401147 People's Republic of China ; Chongqing Key Laboratory for Oral Diseases and Biomedical Sciences, No. 426 Songshi Bei Road, Yubei District Chongqing, 401147 People's Republic of China ; Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, No. 426 Songshi Bei Road, Yubei District Chongqing, 401147 People's Republic of China
| | - Lu Wang
- Department of Prosthodontics, Stomatological Hospital of Chongqing Medical University, No. 426 Songshi Bei Road, Yubei District Chongqing, 401147 People's Republic of China ; Chongqing Key Laboratory for Oral Diseases and Biomedical Sciences, No. 426 Songshi Bei Road, Yubei District Chongqing, 401147 People's Republic of China ; Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, No. 426 Songshi Bei Road, Yubei District Chongqing, 401147 People's Republic of China
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Schwarz F, Schmucker A, Becker J. Efficacy of alternative or adjunctive measures to conventional treatment of peri-implant mucositis and peri-implantitis: a systematic review and meta-analysis. Int J Implant Dent 2015; 1:22. [PMID: 27747644 PMCID: PMC5005629 DOI: 10.1186/s40729-015-0023-1] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 07/28/2015] [Indexed: 01/06/2023] Open
Abstract
In patients with peri-implant mucositis and peri-implantitis, what is the efficacy of nonsurgical (i.e. referring to peri-implant mucositis and peri-implantitis) and surgical (i.e. referring to peri-implantitis) treatments with alternative or adjunctive measures on changing signs of inflammation compared with conventional nonsurgical (i.e. mechanical/ultrasonic debridement) and surgical (i.e. open flap debridement) treatments alone? After electronic database and hand search, a total of 40 publications (reporting on 32 studies) were finally considered for the qualitative and quantitative assessment. The weighted mean changes (WM)/ and WM differences (WMD) were estimated for bleeding on probing scores (BOP) and probing pocket depths (PD) (random effect model). Peri-implant mucositis: WMD in BOP and PD reductions amounted to -8.16 % [SE = 4.61] and -0.15 mm [SE = 0.13], not favouring adjunctive antiseptics/antibiotics (local and systemic) over control measures (p > 0.05). Peri-implantitis (nonsurgical): WMD in BOP scores amounted to -23.12 % [SE = 4.81] and -16.53 % [SE = 4.41], favouring alternative measures (glycine powder air polishing, Er:YAG laser) for plaque removal and adjunctive local antibiotics over control measures (p < 0.001), respectively. Peri-implantitis (surgical): WMD in BOP and PD reductions did not favour alternative over control measures for surface decontamination. WM reductions following open flap surgery (±resective therapy) and adjunctive augmentative therapy amounted to 34.81 and 50.73 % for BOP and 1.75 and 2.20 mm for PD, respectively. While mechanical debridement alone was found to be effective for the management of peri-implant mucositis, alternative/adjunctive measures may improve the efficacy over/of conventional nonsurgical treatments at peri-implantitis sites. Adjunctive resective and/or augmentative measures are promising; however, their beneficial effect on the clinical outcome of surgical treatments needs to be further investigated.
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Affiliation(s)
- Frank Schwarz
- Department of Oral Surgery, Westdeutsche Kieferklinik, Universitätsklinikum Düsseldorf, D-40225, Düsseldorf, Germany.
| | - Andrea Schmucker
- Department of Oral Surgery, Westdeutsche Kieferklinik, Universitätsklinikum Düsseldorf, D-40225, Düsseldorf, Germany
| | - Jürgen Becker
- Department of Oral Surgery, Westdeutsche Kieferklinik, Universitätsklinikum Düsseldorf, D-40225, Düsseldorf, Germany
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Abstract
Over the past few decades, dental implants have been found to have high predictability and survival rates because of improvements in knowledge, clinical expertise, and implant designs. As such, dental implants are frequently integrated in the clinical management of fully or partially edentulous patients. It is prudent to realize that despite the high early survival rates, dental implants do have their fair share of long-term esthetic, biological, and mechanical complications. Therefore, this paper aims to review the current evidence on the management of peri-implant diseases in an attempt to answer the following question: Can periimplantitis be treated?
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Affiliation(s)
- Jia-Hui Fu
- Discipline of Periodontics, Faculty of Dentistry, National University of Singapore, 11 Lower Kent Ridge Road, Singapore 119083, Singapore
| | - Hom-Lay Wang
- Department of Periodontics and Oral Medicine, University of Michigan, School of Dentistry, 1011 North University Avenue, Ann Arbor, MI 48109-1078, USA.
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Wood NJ, Jenkinson HF, Davis SA, Mann S, O’Sullivan DJ, Barbour ME. Chlorhexidine hexametaphosphate nanoparticles as a novel antimicrobial coating for dental implants. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2015; 26:201. [PMID: 26123234 PMCID: PMC4486094 DOI: 10.1007/s10856-015-5532-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 06/20/2015] [Indexed: 06/04/2023]
Abstract
Dental implants are an increasingly popular solution to missing teeth. Implants are prone to colonisation by pathogenic oral bacteria which can lead to inflammation, destruction of bone and ultimately implant failure. The aim of this study was to investigate the use of chlorhexidine (CHX) hexametaphosphate (HMP) nanoparticles (NPs) with a total CHX concentration equivalent to 5 mM as a coating for dental implants. The CHX HMP NPs had mean diameter 49 nm and composition was confirmed showing presence of both chlorine and phosphorus. The NPs formed micrometer-sized aggregated surface deposits on commercially pure grade II titanium substrates following immersion-coating for 30 s. When CHX HMP NP-coated titanium specimens were immersed in deionised water, sustained release of soluble CHX was observed, both in the absence and presence of a salivary pellicle, for the duration of the study (99 days) without reaching a plateau. Control specimens exposed to a solution of aqueous 25 µM CHX (equivalent to the residual aqueous CHX present with the NPs) did not exhibit CHX release. CHX HMP NP-coated surfaces exhibited antimicrobial efficacy against oral primary colonising bacterium Streptococcus gordonii within 8 h. The antimicrobial efficacy was greater in the presence of an acquired pellicle which is postulated to be due to retention of soluble CHX by the pellicle.
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Affiliation(s)
- Natalie J. Wood
- />Oral Nanoscience, School of Oral & Dental Sciences, University of Bristol, Bristol, UK
- />Centre for Organized Matter Chemistry, School of Chemistry, University of Bristol, Bristol, UK
- />Bristol Centre for Functional Nanomaterials, University of Bristol, Bristol, UK
| | - Howard F. Jenkinson
- />Oral Microbiology, School of Oral & Dental Sciences, University of Bristol, Bristol, UK
| | - Sean A. Davis
- />Centre for Organized Matter Chemistry, School of Chemistry, University of Bristol, Bristol, UK
| | - Stephen Mann
- />Centre for Organized Matter Chemistry, School of Chemistry, University of Bristol, Bristol, UK
| | - Dominic J. O’Sullivan
- />Oral Nanoscience, School of Oral & Dental Sciences, University of Bristol, Bristol, UK
| | - Michele E. Barbour
- />Oral Nanoscience, School of Oral & Dental Sciences, University of Bristol, Bristol, UK
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Renvert S, Polyzois IN. Clinical approaches to treat peri-implant mucositis and peri-implantitis. Periodontol 2000 2015; 68:369-404. [DOI: 10.1111/prd.12069] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2014] [Indexed: 12/21/2022]
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Smeets R, Henningsen A, Jung O, Heiland M, Hammächer C, Stein JM. Definition, etiology, prevention and treatment of peri-implantitis--a review. Head Face Med 2014; 10:34. [PMID: 25185675 PMCID: PMC4164121 DOI: 10.1186/1746-160x-10-34] [Citation(s) in RCA: 192] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 08/15/2014] [Indexed: 11/10/2022] Open
Abstract
Peri-implant inflammations represent serious diseases after dental implant treatment, which affect both the surrounding hard and soft tissue. Due to prevalence rates up to 56%, peri-implantitis can lead to the loss of the implant without multilateral prevention and therapy concepts. Specific continuous check-ups with evaluation and elimination of risk factors (e.g. smoking, systemic diseases and periodontitis) are effective precautions. In addition to aspects of osseointegration, type and structure of the implant surface are of importance. For the treatment of peri-implant disease various conservative and surgical approaches are available. Mucositis and moderate forms of peri-implantitis can obviously be treated effectively using conservative methods. These include the utilization of different manual ablations, laser-supported systems as well as photodynamic therapy, which may be extended by local or systemic antibiotics. It is possible to regain osseointegration. In cases with advanced peri-implantitis surgical therapies are more effective than conservative approaches. Depending on the configuration of the defects, resective surgery can be carried out for elimination of peri-implant lesions, whereas regenerative therapies may be applicable for defect filling. The cumulative interceptive supportive therapy (CIST) protocol serves as guidance for the treatment of the peri-implantitis. The aim of this review is to provide an overview about current data and to give advices regarding diagnosis, prevention and treatment of peri-implant disease for practitioners.
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Affiliation(s)
- Ralf Smeets
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Martinistr, 52, 20246 Hamburg, Germany.
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Faggion CM, Listl S, Frühauf N, Chang HJ, Tu YK. A systematic review and Bayesian network meta-analysis of randomized clinical trials on non-surgical treatments for peri-implantitis. J Clin Periodontol 2014; 41:1015-25. [DOI: 10.1111/jcpe.12292] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2014] [Indexed: 01/08/2023]
Affiliation(s)
- Clovis M. Faggion
- Department of Periodontology; Faculty of Dentistry; University of Münster; Münster Germany
| | - Stefan Listl
- Department of Conservative Dentistry; Dental School Ruprecht-Karls-University of Heidelberg; Heidelberg Germany
- Max Planck Institute for Social Law and Social Policy; Munich Center for the Economics of Aging; Munich Germany
| | - Nadine Frühauf
- Department of Conservative Dentistry; Dental School Ruprecht-Karls-University of Heidelberg; Heidelberg Germany
| | - Huei-Ju Chang
- Institute of Epidemiology and Preventive Medicine; College of Public Health; National Taiwan University; Taipei Taiwan
| | - Yu-Kang Tu
- Institute of Epidemiology and Preventive Medicine; College of Public Health; National Taiwan University; Taipei Taiwan
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40
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Treatment Alternatives to Negotiate Peri-Implantitis. Adv Med 2014; 2014:487903. [PMID: 26556414 PMCID: PMC4590969 DOI: 10.1155/2014/487903] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Revised: 04/26/2014] [Accepted: 04/28/2014] [Indexed: 12/15/2022] Open
Abstract
Peri-implant diseases are becoming a major health issue in dentistry. Despite the magnitude of this problem and the potential grave consequences, commonly acceptable treatment protocols are missing. Hence, the present paper reviews the literature treatment of peri-implantitis in order to explore their benefits and limitations. Treatment of peri-implantitis may include surgical and nonsurgical approaches, either individually or combined. Nonsurgical therapy is aimed at removing local irritants from the implants' surface with or without surface decontamination and possibly some additional adjunctive therapies agents or devices. Systemic antibiotics may also be incorporated. Surgical therapy is aimed at removing any residual subgingival deposits and additionally reducing the peri-implant pockets depth. This can be done alone or in conjunction with either osseous respective approach or regenerative approach. Finally, if all fails, explantation might be the best alternative in order to arrest the destruction of the osseous structure around the implant, thus preserving whatever is left in this site for future reconstruction. The available literature is still lacking with large heterogeneity in the clinical response thus suggesting possible underlying predisposing conditions that are not all clear to us. Therefore, at present time treatment of peri-implantitis should be considered possible but not necessarily predictable.
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Campoccia D, Montanaro L, Arciola CR. A review of the clinical implications of anti-infective biomaterials and infection-resistant surfaces. Biomaterials 2013; 34:8018-29. [PMID: 23932292 DOI: 10.1016/j.biomaterials.2013.07.048] [Citation(s) in RCA: 215] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2013] [Accepted: 07/15/2013] [Indexed: 12/28/2022]
Abstract
Infection is currently regarded as the most severe and devastating complication associated to the use of biomaterials. The important social, clinical and economic impacts of implant-related infections are promoting the efforts to obviate these severe diseases. In this context, the development of anti-infective biomaterials and of infection-resistant surfaces is being regarded as the main strategy to prevent the establishment of implant colonisation and biofilm formation by bacteria. In this review, the attention is focused on the biomaterial-associated infections, from which the need for anti-infective biomaterials originates. Biomaterial-associated infections differ markedly for epidemiology, aetiology and severity, depending mainly on the anatomic site, on the time of biomaterial application, and on the depth of the tissues harbouring the prosthesis. Here, the diversity and complexity of the different scenarios where medical devices are currently utilised are explored, providing an overview of the emblematic applicative fields and of the requirements for anti-infective biomaterials.
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Affiliation(s)
- Davide Campoccia
- Research Unit on Implant Infections, Rizzoli Orthopaedic Institute, Bologna, Via di Barbiano 1/10, 40136 Bologna, Italy
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